Vulnerable_Adults

Assessment Guidance Apply your knowledge of vulnerability. Apply your knowledge of anti-oppressive and anti-discriminatory practice. Consider the theories and research that will help inform your discussion. Apply your knowledge of the legislation. Assessment Criteria 1. The selection of appropriate theory in relation to an understanding of vulnerability. 2. Demonstration of the application of anti-oppressive and anti-discriminatory practice. 3. Demonstration of an understanding of abuse. 4. Demonstration of an understanding of the legislation in relation to vulnerable adults. 5. Demonstrating an understanding of partnership and empowerment. 6. Meet acceptable standards of presentation including adequate organisation of the material and use of Harvard referencing system. You would very much like to make this a home for the residents whereby the residents are able to make decisions about how the home is run and organised. In your capacity as social worker/manager, what do you think you can do to enable the residents to maximise their opportunities' What difficulties and issues do you think they will encounter' What right’s do they have' Deal with each service user individually. RESIDENTS: Mr D is a 54 yr old English man who spent the first 30 years of his life in a large institution in Kent Mr J is a 24 yr old Afro-Caribbean man who has just moved away from his family, as his older parents are not able to cope with his care needs. Ms M is a 72 yr old English woman. Like Mr D, Ms M has spent most of her life in an institution. This is her 3rd residential placement. Previous placements have broken down due to Ms M’s challenging behaviour. Ms J is a 32yr old English woman with Downs Syndrome. She has recently moved into the home to be nearer to her family. ‘Fairlawns’ is a residential home for vulnerable adults. It is authorised and regulated by the Care Quality Commission. Four residents currently occupy the home; each one has a different level of vulnerability and therefore requires an individual approach to assessing needs. My goal is to make this a home for the residents whereby each of them is able to make decisions – and agree collectively - about how the home is run and organized. Key principles would be to promote safe and healthy living by encouraging choice and variety at every given and appropriate opportunity. The main stumbling block in working with vulnerable adults is finding the appropriate balance between individual choice and civil liberties (Human Rights Act 1989) on the one hand and the paramount regard for their health and safety at all times (social care), on the other. Furthermore, it is essential to recognise their rights as individuals and not group them collectively with a ‘one type fits all’ attitude. (Dismore, A 2008) In order to achieve the goal of personalising the home so that it becomes a comfortable environment for the residents, we must find the balance between allowing for individual expression (empowerment) and requiring collective responsibility (sense of community). However, we should be aware that the very notion of empowerment may, paradoxically, be oppressive. If we think in particular about Ms M and Mr D - when historically all they are likely to have had is decisions made for them and no voice to be heard - the idea of now being given choice and opinion and thereby freedom of expression, may be overwhelming. All four residents can be considered to be vulnerable adults. The broad definition of a ‘vulnerable adult’ is given in the consultation paper ‘Who decides'’ 1997 as : “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” (www.hmso.gov.uk) Although all four can be classified under this ‘label’, the omission is that it does not recognise them as individual people with individual abilities and needs (Thomas, D and Woods, H 2003) Labels discriminate against people in all walks of life: gender, race, ethnicity, religion, sexual orientation, physical and mental disability. Each resident at this home is likely to have been discriminated against in some way. We need to be clear that we are here to safeguard these adults in the best way possible. This can be done by acknowledging the difficulties and promoting change through teaching and training. The best way to help people not to discriminate and be aware of issues such as abuse is to acknowledge it and talk about it. Sadly, it is fact of life that some individuals in society will take advantage of others less able than themselves and exploit their vulnerability to gain advantage. This can take the form of both intentional and unintentional abuse. Abuse is a violation of an individual’s human and civil rights by any other person or persons. Abuse can be physical, psychological, financial, sexual, discrimination or neglect. Abuse can also arise from acts of neglect or omission and can be physical as well as emotional (Pritchard, J 2007). Consideration must also be given to the safeguarding of the residents in the home from each other. Having discussed the broad scope that covers the different types of abuse, we cannot assume that their own vulnerability precludes them from being potential perpetrators too. If we now examine the situations of our residents, in particular Ms M and Mr D, we need to be sure that by encouraging them to have a voice does not compound years of institutional oppression. If they have been programmed to have all decisions made for them in all significant aspects of their life, it may be overwhelming and even potentially abusive to expect them to be informed about the choices they can make. A principle role of the social worker is to protect vulnerable individuals against abuse and oppression. The terms "oppression" and "discrimination" are often used interchangeably. Thompson (1997) defines discrimination as ‘unfair or unequal treatment of individuals or groups based on an actual or perceived difference’. Discrimination is about social organisation as well as individual or group behaviour (Hine, J and Wood, J 2009). Thompson’s PCS model helps us to understand how oppression and discrimination operate in society. In this model, oppression acts as the constructer of Personal, Cultural and Societal and is reinforced by them as they interact with each other (Thompson, N 2006). In his studies on mental patients and mental institutions, Erving Goffman was especially interested in finding out how individual identity is shaped in abnormal places and situations. When we revisit Goffman’s notion of institutionalisation and how the management- to-staff-to-clients dynamics relate to each other, it is easy to see how quickly and subconsciously these difficulties not only arise but also compound and perpetuate the situation. He decided that the ‘self’ is not simply a matter of rules and regulations placed upon a single person, but rather takes form in the gaps and voids where institutions cannot lay total claim to the individual’s life (Goffman, E 1991). If we consider the differences between the younger residents and the older residents, we may well have a lot of experiences to learn from. By the very fact that the two younger residents were born into a time period where by having a learning difficulty or special need would not automatically mean that you were removed from family life and raised within an institutional setting, their experience of life will hopefully be more typical than that of Ms M. Conversely, Ms M’s experience of life may have been so structured and organised that she may fear or even not recognise any choice put before her. We have seen already that she has in the past displayed challenging behaviour, and whilst we cannot make any assumptions about why this may be, it could simply be an inability to communicate effectively due to years of oppression and control. As part of the personalisation agenda set out by Social Care Institute for Excellence, the person-centred planning approach, formally introduced in the 2001, promotes individuals to live as independently as possible and to have choice and control over the resources such as public and community services, access to education and jobs. One of the key objectives of personalisation is independent living. This does not mean living on your own or being autonomous but rather "having choice and control over the assistance and/or equipment needed to go about your daily life having equal access to housing, transport and mobility, health, employment and education and training opportunities" (officefordisability.gov.uk) Opportunity to train and to work is a huge area which all individuals should be given a right to do. Most adults given the opportunity find contributing to society through work a valuable and privileged experience and not only does it benefit them individually, but it benefits society in general; financially and in terms of changing people’s values and beliefs about people with additional needs. Deinstitutionalisation will have had a very positive influence on the lives of Mr J and Ms J. Looking at the very small piece of information about them, we can see a stark difference in the ways that they have spent their early years. As part of our duty of care towards the residents in Fairlawns, we would want opportunity to train and work to be a fundamental choice for them. This could mean taking Mr J, Mr D and Ms J to the local job centre and finding out what opportunities there are for the or seeing which local employers support employing people with additional needs. For Ms M there are likely to be clubs and courses locally run which may fit around her interests and hobbies and this would be a productive way of spending her time and meeting new people; something which all our residents will need to do and may be a source of anxiety. Individually, they will all have different ideas of what they want their home to be. Initially, the best way to find out what a person’s values and beliefs are is simply to ask them. However, one needs to be clear that they are able to put sensible parameters around the answers given. For example, Mr J is only a young man in his mid-twenties. There is possibility that he may have a new found freedom now he is out of the confines of his family home and balance needs to be sought around enabling him to live his life freely but taking into account that he may not have much experience of being out late at night and may not be used to drinking alcohol. He may well choose to go out every week and enjoy going to the local pubs and clubs. Indeed, all four of our residents may wish to go out regularly throughout the week and there needs to be careful planning (risk assessments) around how this can be implemented in the best way for them. Brown (2006) states that the impact of discrimination itself may increase the view of vulnerability of an individual and decrease the likelihood of risk taking; meaning that the possibility of day-to-day life taking place with certain ‘normality’ may be decreased because of the possible risks incurred. A day out to the shops, or even the local pub, may happen less frequently or not at all because of the assumptions made about the needs of the clients, or more so, the risks on the part of the workers. This increases the institutionalisation and acts as a contributor to the divide between areas of society. By promoting choice and offering supportive staffing we enable our residents to have freedom of movement. There will need to be sufficient staff at the home at any given time and this will encourage individual choice. Part of the measuring tool appropriate for finding out how our residents are finding their living space will be to ask them. This could be done for example, by collating a simple questionnaire and asking the members of the home to complete these every few months. These can be completed as either a group activity or individually, at the home or at the local café. This way we could also highlight any difficulties amongst the residents including any potential difficulties with staff. It may be appropriate to get a neutral person to support the completion of the evaluation sheets so that there is no bias and the residents feel comfortable answering openly and honestly. Another key measuring tool would be regular supervision of the staff. This again could be group or individual but would ensure that the residents of the home are having their needs prioritised and met over and above the needs of the staff; any issues raised by staff can of course be addressed on an individual basis and this would follow normal employee procedures. Staff surveys could be used in conjunction with motivational days out including fun days team building with both staff and residents and the notion of changing the dynamics from an ‘institutional’ residents home to a home which is made up of a household of people who care for each other’s wellbeing has better connotations for all. When Erving Goffman completed his work on asylums he considered amongst other things the power dynamics between those involved in residential homes, institutions, and prisons and examined the power balances between management/staff and service users. He concluded that because the two groups do not and cannot know each other as individuals, they set up stereotypes of one another, thus compounding the differences (Allott, M and Robb M 2003). Staff tends to feel superior and righteous and patients are often left feeling inferior and weak. By breaking down these divisions and encouraging a healthy attitude where by all members of the household are valued, appreciated and respected, I would hope that Fairlawn’s becomes a home in which everyone can take pride. Bibliography Texts Allott, M and Robb M (2003) 6th edition, Understanding Health and Social Care, London, SAGE publications Cooper, A, Lymbery, M, Ruch, G and Wilson, K (2008) Social Work: An Introduction to Contemporary Practice, Essex, Pearson Education Dismore, A (2008) A life like any other' : Human rights of adults with learning disabilities, London, House of Lords papers: The Stationery Office Elliot, A (2007) 2nd edition, Concepts of the Self, Cambridge, Polity Grant, G, Goward, P, Ramcharan, P, Richardson, M (2005), Learning disability: a life cycle approach to valuing people, Berkshire, McGraw-Hill International Goffman, E (1991) Asylums: Essays on the Social Situation of Mental patients and other inmates, London, Penguin Hine, J and Wood, J (2009) Work with Young People: Theory and Policy for Practice, California, SAGE Publications Mandelstam, M (2005) 3rd edition, Community Care Practice and the Law, London, Jessica Kingsley Publishers Penhale, B and Parker, J (2007) Working with Vulnerable Adults, Abingdon, Routledge Pritchard, J (2001) Good practice with vulnerable adults, London, Jessica Kingsley Publishers Pritchard, J (2008) Good Practice in Safeguarding Adults: Working Effectively in Adult Protection London, Jessica Kingsley Publishers Pritchard, J (2007) Working with Adult Abuse: A Training Manual for People Working with Vulnerable Adults, London, Jessica Kingsley Publishers Thomas, D and Woods, H (2003) Working with people with learning disabilities: theory and practice, London, Jessica Kingsley Publishers Thompson, N (2006) 4th edition, Anti-discriminatory practice: Practical social work, Hampshire, Palgrave Macmillan Who decides' 1997 (HMSO The Lord Chancellor’s Department) URLs www.hmso.gov.uk, Human Rights Act, 1989 www.officefordisability.gov.uk www.scie-socialcareonline.org.uk