Multi Disciplinary Approach Case Study

Based on the information provided, what needs, risks and strengths is it possible to identify with regards to the individual or family in the event study? How would you intend the assessment, including consideration of theneed for a multi disciplinary approach?

Case study E:

James Downing is 16 years old, white andlives aware of his mother, Sarah, her same sexpartner, Teresa, and his younger sister Joanne, who is 13 years. Jameshas no connection with his birth father, who left Sarah when she was pregnant withJoanne, but he does have a close relationship along with his paternal grandparents, who live nearby. James has been around trouble with the police since he was 13years old, and has numerous convictions for care theft, possession of cannabisand ecstasy and then for house burglaries.

Sarah has asked a social worker to visither, since she feels that she can't cope with the situation and feelsthat the whole family is in danger of `fallingapart'. Joanne is beginning to stay out at friends constantly and clearlydoes not need to be at home, where there are frequent arguments. Teresa worksin a very demanding job, involving a lot of travelling, and Sarah feels she isspending less and less time at home because of James's behaviour.

Research published in Child Protection:Messages from Research (Department of Health, 1995 cited in Horwath, 2001)states that families often feel they lack control and autonomy when dealingwith social services departments. This becomes particularly problematic whenassessments concentrate on family weaknesses and disadvantages. Hence a holisticapproach utilising strengths and identifying need is necessary. This approachforms the crux of the Framework for the Assessment of Children in Need andtheir Families.

Sarah has discovered the family difficultiesand has requested support - this is encouraging, suggesting commitment to thewell being of the family, and change. It's important to highlight thisstrength to the family and emphasise that together we will work to construct uponthis. James has a detailed relationship with hispaternal grandparents, adding to the family resilience and acting as animportant resource during periods of difficultly. Hence grandparents should beengaged with the look of the assessment.

The family's economic status is not clear;however there reaches least one relative in employment. Traditionally thisis interpreted as a familial resilience factor. Knowing of differingperspectives is vital - the nature of Teresa's work and the effect of theemployment on the family as a whole is currently unknown and hence couldequally be viewed as a risk factor by the family.

James has established offending behaviourand has been associated with illegal drugs in a few capacity. Family and professionals will generally treat this as risky behaviour; however it must beconsidered that criminal activity could be looked at as a strength within somesocial groups, hence it is vital to ascertain all points of view, withoutprejudgement and then consider ways forward together.

There maybe risk linked to the lessening orloss of James' attachment to Teresa as she is spending less and less time athome. Equally, there may be risk attached to the actual loss ofattachment between Joanne and James, as Joanne is stay(ing) out withfriends. and plainly does not desire to be at home. The family is under a greatdeal of strain, and it appears Joanne and Teresa are coping with this by shiftingaway from family members. Thus giving some insight as to the way the family functionsunder stress; this should be explored further with Sarah and Teresa to recognize the processes that will ensure the family achieve theirdesired outcomes when confronted with difficulties.

James has no connection with his father, raising concerns around paternal attachment and possible negative life events/experiences due to separation. The assessment should explore how James and his family treat this separation; again each may hold conflictingviews which must be sensitively addressed.

One must consider that the immediate family unit, the extended family and professionals may all have differing perceptions of families with same-sex caregivers; some view this as strength whereas others will dsicover membership of an minority group as a risk. Family themselves may negatively discriminate based on sexuality. Prior awareness of the opportunity of conflicting opinions will allow the worker to react thoughtfully and mediate effectively. The social worker should critically evaluate their own practice continuously, checking for assumptions, stereotyping and cultural bias.

Preparation for the assessment should commence with ensuring a proper social worker is allocated. The team manager should think about the field employees knowledge and understanding of the issues pertaining to this particular family (for example youth offending, discrimination/oppression predicated on sexuality/gender, attachment issues etc), as well as ensuring the worker can be an appropriate match in conditions of race and gender.

Once the right worker is allocated thecase, he/she will need to refer to all information gathered previously. This will likely avoid the family repeating sensitive information again, and can enable the social worker to recognize gaps in information that need to be filled during the assessment.

Assessments and subsequent care plans are far better if the child and family feel empowered and involved throughout the procedure (Department for Education and Skills, 2001). Indeed this is a duty of any professional working with children as outlined in Article 12 of the US Convention on the Rights of the kid:

the child who is capable of forming his or her own views (has) the to express those viewsfreely in all matters affecting the kid, the views of the child being givendue weight in accordance with the age and maturity of the child

The social worker must engage with James and his family at the outset, establishing how and where theassessment will be carried out, just what help is requested and identifying desired outcomes.

As outlined in the Framework for theAssessment of Children in Need and their Families, the social worker andfamily should identify the relevant agencies to be engaged in the assessment and ensure it is clear to all professionals and the family the precise role andpurpose of every professional. Advice and information will be sought by identifying all key informants, recording their details and organising aschedule to gather information from these people or organisations. The following would be a minimum essential set of informants:

FamilyGP and other relevant health professionals

  • Youth Offending Team
  • James'school/college
  • Paternal grandparents
  • Joanne's school

Prior to any interviews taking place, a set of essential questions should be used to give structure and purpose to the meetings. Following these initial discussions, further interviews may beneeded with Connexions, local police, wider family, or other community groups, to be able to create a comprehensive picture of the family.

In planning any assessment, there should be an obvious statement of intent, outlining the reason, limitations and timescales of the assessment. This must be shared with the kid and their family. For all assessments this includes the primary principles of the kids Act 1989. This focus because of this assessment should only be decided after after further consultation with the James and his family.

In what ways does the information provided in the case study raiseissues of power, disadvantage and oppression? You are asked to handle an assessment of need? How do you try to work in an anti-oppressive way?

Case study C:

Razia Akhtar is a 26-year-old single woman, of South Asian Muslim origin, (although born is Britain) who's currently in hospital, carrying out a rapid deterioration in her physical health. She has now been given a diagnosis of Multiple Sclerosis. Razia lives alone in a little terraced house, and it is very keen to come back home at the earliest opportunity. Her older brother and his wife, Mohammed Khan and Shanaz Begum, who live on another street, have suggested that she moves along with them, but she actually is very reluctant to do so. A healthcare facility staff believe that Razia has been very unrealistic about her future, which she must come to conditions with the actual fact that she willbe dependent on others for the rest of her life. Her present condition is such that she'll need quite a higher level of personal assistance, with someone to get her up each day and help her to bed at night.

The hospital based social worker is asked to handle an assessment to find out Razia' needs once she is discharged from hospital.

Power describes the capability to influence or control people, events, processes or resources (Thompson, 2003, pg 152). If utilized in a negative fashion, power can be a significant barrier to equality and lead to oppression and disadvantage. Imbalances of power can manifest in a number of social work situations; in this case study there are potentially a variety of disparities of power, which require critically reflective practice to ensure equality and empowerment are promoted.

When debating issues of oppression and disadvantage, we should consider the process resulting in it - negative discrimination. Negative discrimination is defined by the identification of negative attributes with regard to a person or group of men and women (Thompson 2003). Generally negative discrimination pertains to social and biological constructs and can be based after sexual orientation, gender, class, race, disability, age and so on. Negative discrimination creates the circumstances that give rise to oppression, which is defined by Thompson (2001) as:

inhuman or degrading treatment of people or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power (pg 34)

In relation to Miss Akhtar, we have to consider the power that is implied through hospital staff having superior medical knowledge, skills and expertise in relation to Miss Akhtar. From the case notes provided, it appears that current thought relating to Miss Akhtar's long-term care is situated after the medical model; the impairment is seen as the condition and her dependence is emphasized (Adams et al, 2002). Thompson(2001) says social work should take a demedicalised stance and appearance past thepathology, using the social style of disability as described by Adams et al (2002). The social model suggests Miss Akhtar's needs should be considered in a much wider context, ensuring her social and mental health receive equal consideration to her medical needs. Viewing societal constraints as the challenge and not the average person creates the mindset to consider how to eliminate barriers to mainstream social, political and economic life. The social worker should liaise with Miss Akhtar and look towards an solution-focused (not impairment-focused) care plan whereby within the assessment, barriers are discovered and solutions sought collaboratively, utilizing Miss Akhtar's strengths.

Miss Akhtar comes with an autoimmune degenerative disease and again, it is well documented that individuals with physical disabilities are more likely to be subjected to oppressive practices. Dehumanizing and medicalised language can result in a lack of esteem and a sense of disempowerment for the physically impaired service user. This can be avoided by avoiding jargon and providing lots of opportunities for questions and open discussion when working through the assessment with Miss Akhtar. Professionals should continually check themselves for use of infantilizing language andensure they take part in mature, adult discourse with Miss Akhtar.

Miss Akhtar's religious and cultural needs should be explored and understood as central area of the assessment. These needs must be determined as fast as possible, to ensure the worker can besensitive to Miss Akhtar's Islamic or other customs, without making cultural assumptions. Karmi (1996) examines the Islamic emphasis on modesty; hence the worker should think about with Miss Akhtar the extent to which her modesty should be preserved throughout the assessment. It ought to be explored if Miss Akhtar would prefer female medical staff and social care professionals only to be involved in the assessment and clear guidelines should be established around preservation of modesty and the practice of physical examinations.

It is accepted in many Muslim communities that the most senior male of the family will take responsibility for a female relative's care. Hence it is possible there could be an imbalance of power between Miss Akhtar and Mr. Begum, dependent on their personal beliefs and how far these correlate with each other's religious and cultural ideals. If there is a notable difference in these ideals, the social worker should make an effort to empower Miss Akhtar by discussing choices and involving a culturally matched advocate if Miss Akhtar desires, in order to mediate within the family. This must be managed sensitively, as Miss Akhtar, Mr. Begum and the social worker may all hold very different views regarding patriarchal hierarchies. The diversity of the views should be acknowledged and respected within the assessment. It is important to be aware of ethnocentrism, as described by Thompson (2003), whereby situations are viewed from the norms of a majority culture and those values projected onto the minority. This can be countered by critically reflective practice, that may promote consciousness of power and oppression, resulting in a decreased likelihood of the worker making inaccurate ideological inferences.

Discrimination and oppression can arise through an imbalance in the distribution of financial or other material resources. That is a concern in cases like this study as Miss Akhtar's financial status prior to her illness is not yet determined. Miss Akhtar may experience barriers in accessing the same degree of money as previously. Hence the social worker and potentially Mr. Begum could maintain positions of power as they are more likely to have control over the allocation of resources. This will be countered when you are very open with Miss Akhtar and avoiding closed decision-making and mystery. Again, this promotes equality as it avoids welfarism, whereby it is assumed the Miss Akhtar requires welfare services dueto her disability (Thompson, 2003).

Due thought must be given to use of language and culturally biased humour throughout the assessment. Miss Akhtaris an ethnic minority in the UK; as a result Thompson (2003) states discriminationcan occur at personal and cultural levels. It is the role of the social workerto critically think about their personal prejudices, that could lead to discriminatory stereotyping. Personal discrimination is enveloped by inequity at a cultural level, whereby ethnic minorities, and hence Miss Akhtar, maybe subjected to an over-all felling of not belonging and polarization, by the use of culturally-specific language and humour.

A central theme throughout these case studies is the need to place the service user in the centre of most planning, decision-making and reviews. Care packages imposed after users will be ineffective; users must be enabled to help themselves, whilst the social workertakes every opportunity to stand in the users shoes and discover life from thetheir perspective.

References

Adams, Robert et al (eds) 2002 CriticalPractice in Social Work. Basingstoke, Palgrave.

Great Britain (1989) Children Act 1989(C41). London, Stationery Office

Department for Education and Skills (2001) Learningto Listen: Core principles for involvement of Children and Young People. Availablefrom: www. dfee. gov. uk/cypu

Department of Health (2000) Frameworkfor the assessment of children in need and their families London, TheStationary Office.

Horwath, Jan (eds) 2001 The Child'sWorld: Assessing Children in Need. London, Jessica Kingsley Publishers.

Karmi, Ghada (1996) The EthicalHandbook: A Factfile for HEALTHCARE Professionals. Oxford, BlackwellScience LTD

Thompson, Neil (2001) Anti-discriminatoryPractice 3rd Ed. Basingstoke, Palgrave.

Thompson, Neil (2003) PromotingEquality: Challenging Discrimination and Oppression 2nd Ed. NewYork, Palgrave

United Nations (1991) United NationsConvention on the Rights of the kid (online). Available from:http://www. unicef. org/crc/fulltext. htm

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