Social_Theory

SCW 205 – The Theory and Practice of Social Work Problems Module Leader: Andrea Collins Due Date: 5th May 2006 Assessment 1: With reference to one of the social problems discussed in the module, in no more than 500 words, outline the extent to which you think people bring the social problem upon themselves. Assessment 2: In no more than 750 words each, answer two of the set questions analysing data from Social Trends. Assessment 3: Choose any of the social problems discussed and in no more than 1000 words each, answer the following two questions:- i) identify the main obstacles that practitioners face when working with (insert name of social problem); ii) explain how, in practice, using a case study of your own design involving an individual person, you would begin to overcome the problems identified Assessment 1: Ill Health There is powerful evidence that social disadvantage is associated with increased chances of profound ill health, reflected in the incidence of illness and reduced life expectancy (Graham, 2000a). Relative poverty is deeply implicated in people’s susceptibility to ill health. In the UK, a child from social class IV or V has a 40 per cent higher chance of dying during the first year of life than a child from social class I or II (Independent Inquiry, 1998). Socio-economic differences in the risk of ill health persist throughout the life course. Poverty interacts with other dimensions of structural inequalities, such as racism and sexism. Nazroo (1997) found that members of the Pakistani and Bangladeshi populations in the United Kingdom, four-fifths of whom live in relative poverty, were on average 50 per cent more likely to report ill health than either the majority white population, or Indian and Chinese respondents. Similarly, the complex interaction of gender and poverty with physical well-being is reflected in damage to health through accidents, violence and suicide, as well as illness. For example, men in social class V are four times more likely to commit suicide than men in class I, with men three times more likely to commit suicide than women (Independent Inquiry, 1998). In addition, almost a third of women will experience domestic violence at some point in their lives (Mullender, 1996). Service users are particularly vulnerable to such socially created inequalities in health chances, primarily because relative poverty is the most common problem confronting them (Davies, 2002). Individuals’ efforts to obtain basic resources for warding off ill health – adequate nourishment, shelter, warmth and social support, together with access to secondary resources such as screening – are circumscribed by relative poverty and discrimination (Graham, 2000b). Being unable to afford to heat their homes adequately remains a significant threat to older people, increasing both the risk of ill health and current suffering (Independent Inquiry, 1998). Discriminatory attitudes and behaviour also undermine the supportive social relations which are essential to maintaining health. Institutionalised discrimination means that the experience of people who are lesbian, gay or bisexual remains a marginalised issue in social work discourse and practice, but there is disturbing evidence of the impact of homophobia on their physical well-being (Mason & Palmer, 1996). Health screening programmes could be an important element in reducing service users’ chances of ill health, but social disadvantage is associated with lower rates of screening. This is reflected in the experience of people with learning disabilities. Even though it is known that they are more likely to have concurrent illnesses and lower life expectancy, they are screened significantly less for serious conditions such as hypertension and cervical cancer (Whitfield et al., 1996). The physical state of being ill, involving pain, malaise and debility, is marked by social inequality, exacerbating the suffering involved. Physical ill health as a site of social inequality needs to be a major issue in social work. Threats to health and the experience of ill health characterise the lives of service users because of disadvantaged social conditions and interlocking dimensions to discrimination. The ultimate reason for this aspect of social injustice being a focus of practice is that social work can contribute to tackling service users’ unequal chances and experience of ill health (Blackburn, 1992). Word Count: 520 Assignment 2 (i): Outline what conclusions can be drawn about domestic violence from the data presented in Table 9.10 |Table 9.10 | | | | | | |Victims of violent crime:1 by sex and age, 2003/04 | | | | |England & Wales | | | | |Percentages | | |Domestic |Mugging |Stranger |Acquaintance2 |All violence | |Males | | | | | | |16–24 |0.8 |3.6 |7.1 |6.1 |15.6 | |25–44 |0.6 |0.8 |3.1 |2.0 |6.0 | |45–64 |0.2 |0.4 |1.3 |0.8 |2.5 | |65–74 |- |0.1 |0.4 |0.1 |0.6 | |75 and over |- |0.2 |- |0.1 |0.3 | |All aged 16 and over |0.4 |1.0 |2.7 |1.9 |5.4 | | | | | | | | |Females | | | | | | |16–24 |1.9 |2.1 |2.1 |2.1 |7.6 | |25–44 |1.1 |0.5 |0.9 |1.1 |3.4 | |45–64 |0.3 |0.6 |0.4 |0.4 |1.7 | |65–74 |0.1 |0.3 |0.2 |0.1 |0.7 | |75 and over |- |0.5 |- |- |0.5 | |All aged 16 and over |0.7 |0.7 |0.8 |0.8 |2.9 | |1 Percentage victimised once or more in the previous 12 months. | | | |2 Assaults in which the victim knew one or more of the offenders at least by sight. | | | |Source: British Crime Survey, Home Office | | | | |Social Trends (2005: table 9:10) | | | | The above table seems to suggest that recorded levels of violent crime are highest amongst young males. Domestic violence was the only category of violent crime where the risk for women was higher than that for men. This corresponds with several relevant pieces of research, which suggest that male-perpetrated violence against women is particularly widespread and gender related (Kurz, 1997; Dobash, Dobash, Wilson & Daly, 1992; Kimmel, 2002). Gender related domestic violence is not focused on violence committed by persons of one sex against those of the other. Rather, it is in reference to the gendered underpinnings of such violence. That domestic violence is symptomatic of gender-based power of men over women is evident from the extent to which women and men are socialised into accepting such power, almost without question (Kishor, 2005). However, domestic violence occurs among all ethnic, cultural, socio-economic, geographical and racial groups. It can lead to depression, negative self-esteem and general psychological distress (Shavers et al., 2005). Table 9:10 (Social Trends, 2005) shows that very few actual incidents of domestic violence seem to be reported officially. Changes in the family structure have entailed problems in families, which may manifest themselves in violent behavioural changes (Frost, 1999). The inadequacy of support systems, the stereotypical attitudes, and the lack of skills and negative feelings of helpers may prevent violence from being revealed (Campbell, 1994; Cohen, 1996; Frost, 1999; Johnson & Ferraro, 2000; Waalen et al., 2000). Without doubt, the extent of domestic violence is difficult to quantify due to the sensitive nature of the topic. Violence is universally under reported. It has been estimated that some 2 – 3 American women are sexually abused annually (Fontaine, 1995). The British Crime Survey (1992) reported that 11% of women experienced some degree of physical violence in their partnerships (Frost, 1999). In South Africa, the lifetime prevalence of experiencing physical violence from a current or ex-husband or boyfriend was 24.6% (Jewkes et al., 2002). Spouse abusers are not a homogeneous group and no one factor can predict the likelihood of spouse violence. The characteristics that research has associated with domestically violent men include low assertiveness, low self-esteem, poor social skills and alcohol or drug abuse (Murphy et al., 1994; Danielson et al., 1998; Dutton, 1999; Russel & Wells, 2000; Arseneault et al., 2002; Dixon & Browne, 2003). Similarly, women who experience domestic violence do not belong to one specific grouping. Domestic abuse crosses all spheres, i.e. class, gender, race, disability, age, religious affiliation and sexual orientation (Evans, 2005) and is not limited to physical violence. It encompasses emotional, financial and psychological abuse also. However, the World Report on Violence and Health (WHO, 2002) states that poverty is the greatest risk factor for all forms of relationship violence, including intimate partner violence. Contributions to research surrounding the link between poverty and domestic violence include studies by Gilligan (1996; 2001) and Garbarino (1999). Gilligan, after working with violent men for 25 years, discovered that the effects of economic and social inequalities are the main cause of behavioural violence (Gilligan, 2001). He proposes that people who are relatively poor in a society are not essentially more violent, but are more likely to be disrespected and treated as less than human and the feelings (shame and worthlessness) evoked from such treatment make violence more of an option for these people. Garbarino’s (1999) research with boys who have violent behaviours has led him to believe that there exists a strong correlation between growing up in a ‘toxic social environment’, with economic impoverishment being a main feature of this environment, and the use of violence. Garbarino is not claiming that poverty causes violence, but brings attention to how the effects of poverty and other social inequalities shape boys developing an ‘impaired inner world’ that enables a perception that violence is acceptable or even necessary behaviour. Sadly, many incidents of domestic violence remain unreported, not recorded or not prosecuted. The Table 9:10 (Social Trends, 2005) seems to support this view. It is often described as a ‘hidden crime’, purely in relation to its nature and the implications for victims, such as shame, lack of support, lack of protection and the economic implications of life as a single parent. The impact of domestic violence will vary from person to person, but consideration must be given to the wider consequences beyond the individual involved and could relate to children and other relatives. Effective intervention, from a multi-disciplinary approach, and support early on is crucial, particularly in light of evidence that the severity of violence has been found to escalate over time (Dobash & Dobash, 1992). Word Count: 762 Assignment 2 (ii): Explain why life expectancy has risen since 1961. See Table 7.1 |Table 7.1 | | | | | | |Life expectancy and healthy life expectancy1 at birth: by sex | | | |United Kingdom | |Source: Government Actuary's Department; Office for National Statistics | | | Social Trends (2005) Table7:1 Social and environmental conditions affect health. This is obvious where the environment is one of material deprivation; lack of clean water and sewage facilities, inadequate shelter and overcrowding can all contribute to an enhanced propensity to contract disease. Another example of the connections between environment and health can be seen in research on inequalities in health. For example, a study by Phillimore et al. (1994) of mortality rates in northern England showed an increase in death rates in the poorest communities. Europe has a unique position in the world, for, as has been noted, it is the first region in which the demographic transformation in ageing was manifested and has the highest proportion of old people in the world (Ferring et al., 2004). Late life ageing is shaped by the accumulation of life events. The expectations of older people for improved material and health status may have as much impact on late life as the proportionate increase in the number of older people in the population (Davies, 2002). Societies are also becoming more heterogeneous, with widening differences (sometimes referred to as inequalities) in health and income, which persist into later life. The overall impact of recent health and social care systems on late life ageing is debated. Some have argued that the net effect has been the ‘survival of the unfittest’ (Issacs, 1972), whereby people who would otherwise have died are saved for a life of disability. Others argue that the net effect has been to extend healthy active life, which could lead to the compression of the period of disability into the last few years of life, prior to natural death from old age (Fries, 1980). The balance of epidemiological evidence suggests that modern health and social care systems are helping to extend both healthy active life and disability-associated life prior to death (Pennix, 1996; WHO, 2000; Kinsella & Velkoff, 2001; WHO, 2002; Leichsenring & Alaszewski, 2004). Average human life expectancy has increased throughout the 20th century because of reductions in infant mortality and advances in the treatment of chronic diseases in older age (Lucke & Hall, 2006). Social policies on public health and sanitation, housing and the working environment, and the regulation of food storage and hygiene have all reduced the opportunities for infectious diseases to spread. As McKeown (1979) has demonstrated, much if not all the improvement in death rates in the twentieth century came before the introduction of effective medical treatments, such as immunization. Although people of extreme old age (centenarians) constitute a tiny proportion of the world’s total population, the numbers are of growing importance. Improvements in nutrition, health and health care have created the opportunity for a significant numeric growth of the population aged 100 years and older (Kinsella, 2005). According to researchers in Europe, the number of centenarians has doubled each decade since 1950 in industrialised countries (Vaupel & Jeune, 1995). There can be little doubt in Britain that the rising levels of life expectancy, as shown in Table 7:1 (Social Trends, 2005) are related to improved health care, education of the population on adverse life-style choices, such as smoking, excessive drinking or unprotected sex and increased economic success. There is also powerful evidence that social disadvantage is associated with increased chances of profound ill-health, reflected in the incidence of illness and reduced life expectancy (Graham, 2000). Health improvement programmes, local strategic partnerships and other existing arrangements are the vehicles for change locally. There will also need to be Government-wide action to tackle the wider determinants of health, such as on child poverty, improving the educational attainment of disadvantaged groups, targeted welfare benefits, regeneration of deprived areas and tackling social exclusion. Furthermore, advances in research surrounding chronic conditions, such as cardio-pulmonary disease, cancer and the resulting health screen programmes, designed to provide preventative interventions are progressing, with advanced technology being the primary root cause. Advances in community care are also instrumental in providing wrap-around services for older people. Older people are maintained in their own homes for increasing lengths of time, with visits from district nurses, occupational health therapists and domiciliary care providers, amongst others, providing less need for people to enter residential care homes (Adams et al., 2002). Providing services to maintain people in their own homes has an effect on longevity. Entering residential care can have the effect on older people of life drawing to a close, with the eventual ‘giving up’ on life, whereas life vitality is maintained if people can be supported in their own environments for longer (D.o.H., 1998). Word Count: 751 Assignment 3 (i): Identify the main obstacles that practitioners face when working with domestic violence. Throughout history, societal perceptions of weak females and dominant males, interactions and power struggles between the two genders and the underlying theme of collective community ignorance have fostered opposition and misconceptions which invade contemporary thinking. The post-modern rise of feminist theorists and the emancipation of women have assisted in bringing to the surface this difficult issue, with the struggle for elimination top of the political agenda (D.o.H.2004). This assignment will focus on male perpetrated violence on their intimate female partners. The problem of obtaining information from men who are violent to their intimate female partners has been noted by commentators for many years (Davidson, 1978; Coleman, 1980; Hyden, 1994) and much of what we know about them has been acquired through the study of the women they abuse. From studies of women partners, we know that men erect complex justificatory stories and strategies to which women must respond (Dobash & Dobash, 1979; Hoff, 1990; Dutton, 1996). Men apologise, they promise to ‘change’ and never use violence again (Bowker, 1983; Mills, 1985). Commentators, activists and professionals generally agree that the majority of violent men attempt to rationalise their violence and use a range of tactics to minimise, deny and blame others, particularly their partner, in order to mitigate their own culpability (Dobash & Dobash, 1979, 1984; Gondolf, 1985; Dutton, 1986; Bograd, 1988; Pence & Paymar, 1990). In recognising that abuse takes many forms (physical, sexual, emotional, financial and psychological for example), Mullender (1996) is clear that it is physical abuse, or the anticipation of it, which keeps all other forms of abuse in place, and that the aim of such physical abuse is power and control of men over women. Since the early 1970’s, when Erin Pizzey set up the first refuge for battered wives in London, a wider understanding of why and how the phenomenon is found throughout society has developed (Pizzey, 1974). The complex nature of power relationships and intimate partner violence (IPV) continues to be explored (See, for example, Flinck, et al., 2005; Evans, 2005; Jackson, Witte & Petretic-Jackson, 2001; Moffett, 2006). As much as domestic violence is predominantly perpetrated by men against women (across all ethnic, cultural and socio-economic groupings), it also occurs in same-sex relationships, whose victims may find it even more difficult to obtain help owing to homophobic attitudes and heterosexist assumptions. Disabled women may be particularly vulnerable to abuse, for example when their abuser is also their carer. Women with learning difficulties have been found to be highly vulnerable to domestic violence, and research on the abuse of older people suggests that a proportion of this abuse is the continuation of domestic violence into old age (McGibbon et al., 1989). Although domestic violence is now on the social-political agenda as never before, women still report that assistance is patchy, and often accompanied by judgemental and woman-blaming attitudes (Mullender & Hague, 2000). Women’s difficulties in accessing appropriate help, combined with the losses she would incur if she were to separate and the ease with which she could be isolated increase the power and control of the abuser and compound the impact of abuse. The dynamics of relationships, whether considered from psychodynamic or sociological perspectives, are complex and the responses to disturbances in them need to reflect these complexities. Dependence and interdependence take many forms and people have their needs met in different ways by their partners; it is not always an all-or-nothing, all-good or all-bad relationship (Part, 2006). As well as abuse developing over time, people in abusive relationships may be socialised into ‘learned helplessness’ as described by Seligman (in Dobash & Dobash, 1992). They may have low self-esteem, little energy to make and follow through decisions. They may find it difficult to consider the implications of alerting people outside the house, to ask for help or to make a move. A non-supportive environment can make it much more difficult for an abused woman to leave the family home (Campbell Ulrich in Campbell 1998). Campbell Ulrich argues that leaving is a process and the victim’s concept of self changes over time (ibid). The abused partner’s wish to protect any children in the home is a strong reason for making a change or asking for help, coupled with the fear that the children, as well as being unsettled by changes that would follow an admission of abuse, might be removed from them (Mullender & Hague, 2000). Furthermore, women tend to turn to professionals only when the violence has become frequent and severe and they have exhausted all the resources of self, family and friends (Dobash et al., 1985). Encountering a lack of effective help may then escalate the danger (Hanmer, 1996), especially as many professionals continue to believe that, if the woman leaves, she will be safe, ignoring the dangers of post-separation violence for women and children (Hester & Radford, 1996). Some statutory agencies fail even to convey information about local women’s organisations, and neglect language and cultural needs (James-Hanman, 1995). While sociologists studying domestic violence generally view it as an Individual expression of learned behaviour (Straus & Gelles, 1990) or individual pathology (Dutton, 1998), some radical feminist scholars consider domestic violence to be a socially sanctioned exertion of power and control by a male over “his woman” (Bograd, 1990; Yilo, 1993). From this perspective, while the abuser may have witnessed domestic violence as a child and may report feeling “out of control,” the behaviour is actually instrumental; it makes the victim think, feel, or behave in ways which augment the power and control of the abuser (Adams, 1988) whilst limiting her power, autonomy, and sense of self-efficacy. To address these issues, there seems to be a need for further investigation of how men’s and women’s accounts, definitions and responses to violence are interactionally connected through men’s attempts to define the violence in exculpatory and expiatory terms and in women’s resistance to such definitions and their implications. Social and healthcare professionals need competence in early intervention and skills to discuss moral principles, sexuality and violence in a way that is free of prejudice and condemning attitudes. Spiritual approaches, in the context of interventions should also be taken into consideration (Flinck et al., 2005). Word Count: 1027 Assignment 3 (ii): Explain how, in practice, using a case study of your own design involving an individual person, you would begin to overcome the problems identified. Case Study Wilma, a white British woman, aged 61 lives with her recently retired husband Fred, aged 66. Their two children have grown and moved away. Wilma and Fred both identify themselves as middle-class and are proud they own their own home. Wilma has little in the way of a social support network and has spent most of her adult life concentrating on being a good mother and wife. Since Fred’s retirement, he has grown increasingly depressed, has no focus in life and has taken to visiting his local pub frequently at lunchtimes. He often returns in a foul mood, initiates arguments with Wilma, constantly criticises her and is becoming increasingly aggressive. On several occasions, Fred has physically attacked Wilma, although when challenged by Wilma during calmer episodes, he claims no memory of these incidents. There is no history of violence in the family background. Wilma is feeling increasingly isolated and is becoming depressed herself. She fears for her future and, although she wants to remain married to Fred, she also feels she can no longer tolerate his behaviour. She eventually visits her GP to seek support. The GP suspects Fred may be showing signs of a Dementia-type illness. After discussions with Wilma, the GP feels a referral to the adult mental health team, to assess Fred and support Wilma is the best course of action, with Wilma’s agreement. On receiving this referral, my initial response would be to gather further information through a face-to-face interview with Wilma. The gathering of information is an essential part of preparing for effective intervention (Parker & Bradley, 2003). Employing skills of active listening (Shulman, 1999) during the interview will allow Wilma to feel valued, whilst encouraging the beginnings of an equal working relationship (Coulshed & Orme, 1998). As Wilma is presenting as a vulnerable adult, I would seek to ensure any further risk of harm to her is as limited as possible. As described in the No Secrets (D.o.H., 2000) document: ‘A vulnerable adult is a person “who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.”’ (D.o.H., 2000). From this description, it is clear that both Fred and Wilma are eligible for community care services. As much as Fred may benefit from a Mental Health assessment, Wilma requires more direct interventions, designed to empower and safeguard her. As Wilma has stated her wishes to remain married to Fred, the work I would hope to achieve would focus on an intervention which has the best outcome, remaining mindful of stated wishes, for both service users. Fred may benefit from medical interventions which address his memory loss, depression and change in usual behaviour, such as appropriate medications. With Wilma stating her preferred wishes to remain married to Fred, a place of safety in a women’s refuge would seem inappropriate at this point. Refuges are the only agencies that women consistently believe can offer them safety and which they entrust with full details of their experiences (Hague et al., 2001). Women’s organisations specialise in offering survivors of violence respect (Sissons, 1999), with emergency, outreach and advocacy projects all playing a key role. Consequently, women evaluate such services positively (Mullender & Hague, 2000). In all other contexts, they fear disbelief, revulsion, blame and possible consequences for other family members (Adams et al., 2002). In light of this, intervention should be aimed not at making decisions for Wilma, but at facilitating her ability to think through alternatives and seek an acceptable course of action. Using a strengths perspective focuses on the capacities and potentialities of service users. It concentrates on enabling individuals and communities to articulate and work towards their hopes for the future, rather than seeking to remedy the problems of the past or even the present. According to Saleebey (1997, p.4) the strengths perspective formula is simple: ‘Mobilise clients’ strengths (talent, knowledge, capacities) in the service of achieving their goals and visions and the clients will have a better quality of life on their terms.’ (Saleebey, 1997, p.4) A strong interchange of ideas and practice techniques exists between strengths perspectives and solution-focused brief therapy practice (Turner & Edwards, 1999; O’Connell, 1998). Some proponents of the strengths perspective link it with empowerment approaches (Saleebey, 1997; van Wormer, 2001). Many features of the empowerment approach (Parsons et al., 1998; Payne, 1997) are consistent with the strengths perspective. Both approaches aim to recognise and build service users’ capacity to help themselves and to promote a mutual learning partnership between workers and service users. However, advocates of empowerment perspectives focus more strongly on the social and structural origins of service users’ difficulties. According to Rappaport (cited in Saleeby, 1997, p.8), a commitment to service user empowerment requires us to create opportunities for the alienated and distressed to seize some control over their lives and the decisions that are critical to their lives. In part, this involves recognising and affirming service users’ resilience and capacities in the face of adversity. Thus we recognise that people are not only unharmed by negative life events, but may actually develop capacities from them (Healy, 2005). The strengths perspective is a valuable addition to the social work practice literature. It embodies many of the humanitarian values on which the social work profession is founded. One of its key strengths is that it provides social workers with a framework for promoting respect for client capacities and potential (Quinn, 1998). The couple relationship, based on love, is a subsystem of the family, which is marked by publicity on the one hand, and by secrecy and privacy on the other. Changes in the family structure have entailed problems in families, which may manifest themselves in violent behavioural changes (Frost, 1999). Various reasons have been suggested for why people perpetrate violent behaviour, including biological, social and cultural factors and the individual’s own traumatic experiences (Flinck et al., 2005). In some cultures, the belief system may be offered as a justification for spouse abuse by men (Janssen, 1995; Miles, 1999; Russel & Wells, 2000; Simoneti, 2000; Kim & Motsei, 2002). Whilst there are significant barriers that constrain effective intervention, the increases awareness of domestic violence has led to greater attention to the development of legislation, policy and practice. A framework of good practice for working with victims affected by violence has been developed through work with Women’s Aid, social services and four children’s charities (Humphreys et al., 2000). Interventions that are targeted directly at abused women with the aim of reducing abuse or improving the health of an abused woman need to be women-centred interventions. This includes advocacy and psychological interventions including all forms of therapy and counselling. Furthermore, interventions based on an ecosystems approach can further identify an abused woman’s relationship with her direct environment (Mattaini & Meyer, 2002). Like the general systems approach (Hearn, 1969), the ecosystems perspective guides assessments and offers general directions for interventions, but it does not propose specific intervention methods (Germain & Gitterman, 1996). This approach can give a more rounded and holistic picture of the individual in their specific social and environmental surroundings, so aiding and guiding productive and empowering intervention. However, when working with this particular service user group, empowerment and advocacy could be argued to be the most effective and long term solution to problems experienced, whilst providing a preventative framework for the future. Word Count: 1022 References Assignment 1: Blackburn, C. (1992) Improving Health and Welfare Work with Families in Poverty. Buckingham: Open University Press Davies, M. (ed) (2002) The Blackwell Companion to Social Work. Oxford: Blackwell Publishing Ltd. Graham, H. (2000a) Introduction. Health Variations, 6. Lancaster: Economic and Social Research Council Health Variations Programme, Department of Applied Social Science, University of Lancaster, pp. 2-3 Graham, H. (ed) (2000b) Understanding Health Inequalities. 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