Vulnerable_Pple

Faculty of Health & Social Care (2009-2010) BA (Hons) in Social Work The aim of this paper is to focus on how a manager can bring change to the lives of people with learning disabilities to enable them exercise their rights, make choice and gain full control over their lives. Because of the nature of the case study and for the purpose of this assignment, I have looked at the government’s Valuing People policy (2001) which set out a framework to guide practitioners that work with people with learning disabilities, followed by appropriate theory and legislations in relation to vulnerability, I have demonstrated an understanding of partnership, empowerment, anti-oppressive and anti-discriminatory practice. I have also looked at the difficulties clients will encounter during their care and practitioners responsibilities towards holistic approach. The World Health Organisation defines learning disability as: …a state of arrested or incomplete development of mind”, and somebody with a learning disability is said also to have “significant impairment of intellectual functioning” and “significant impairment of adaptive/social functioning” (World Health Organisation, 2001). | The Valuing People policy (2001) set out a vision for people with learning disabilities which was underpinned by four key principles; choice, independence, rights and inclusion. Each of these principles emphasised the importance of person-centred approach, direct payments and working in partnership with people with learning disabilities in order to deliver real change in their lives. The White Paper revealed that there are about 210,000 people with severe learning disabilities in England and about 1.2 million with a mild or moderate disability and people with learning disabilities are among the most vulnerable people in society (HMSO, 2000). The No Secrets Guidance defines a vulnerable adult as “…anyone aged 18 years or over 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 against significant harm or exploitation....” Department of Health (DoH 2000) Abuse is described by the DoH (2000) as a “…violation of an individual’s human and civil rights by any other person or persons”. There are many forms of abuse including: Physical abuse (hitting, slapping...), sexual abuse (sexual assault without consent), psychological abuse (verbal abuse, threats of harm, deprivation of privacy), financial abuse (theft, fraud, exploitation), Neglect (ignoring medical and physical care). A recent Mencap report (2002) highlights the fact that sexual abuse is four times more common amongst disabled people than amongst the non-disabled population. Social workers must protect and promote the dignity, individuality, rights, responsibilities and identity of service users. People with learning disabilities have a right to live in safety, vote, make choice and freedom of expression, so practitioners need to guard against the abuse of clients by ensuring “…the protection of service users, which may include setting appropriate limits and exercising authority, with the objective of safe-guarding them…”. (BASW, 2002). Under the NHS and Community Care Act 1990, the manager will need to carry out the needs-led assessment for each client putting into account what is best for them such as: their routines (will assist them to feel stable therefore happier), likes and dislikes, support network (includes family members and friends), promoting choice by involving and making them central to their care plan (Adams et al, 2009) , making sure the manager is providing an individual package of care because all the clients have different complex unique needs, liaising and working in partnership with different agencies that will provide them with services such as work, activities, advocacy and specialist services (Leathard, 1994). For example Ms M is likely to suffer from stroke, dementia, high dependant and hearing problems due to her age whereas there is a possibility of Ms J to suffer from Alzheimer’s which causes speech impairment (Mansell, 1992). For this reason, it is paramount to involve psychologist, speech therapist, GP, occupational therapist and physiotherapist to ensure that appropriate support is provided. The Person-Centred approach was developed by Rogers (1967). This approach recognises the innate potential of each person to resolve difficulties. It aims at supporting individuals to formulate their own solutions and free to choose their own lives. This approach is relevant to Ms M with learning disability who present with challenging behaviour. Challenging behaviour refers to any behaviour that puts an individual displaying the behaviour and others at risk (Emerson et al, 1987) . Rogers (1967) believed that “a person has the necessary skills to move on in life but may need some encouragement and support to recognise the fact and get started”). For this reason, the care manager needs to know the specific challenging behaviours of Ms M so that she is treated as an individual and factors that provoke her behaviour should be prevented. Her challenging behaviours could possibly include; violence, destructiveness, untrustworthiness, self harm and psychological disturbances (Nihira et al, 1993). In addition, practitioners should view Ms M as an expert of her life (Trevithick, 2005) rather than focusing on the label ‘challenging behaviour’ which has the potential to have a negative impact on her and the way she is perceived by service providers (Gates, 1999). Person-Centred approach entails 3 conditions that can facilitate change to Ms M’s challenging behaviour: congruence, unconditional positive regard and empathy. Empathy means to fit in clients’ “shoes” in order to understand the client’s inner world. This helps the worker not only to sense the surface meanings but also those underneath by showing an emotional understanding and sensitivity to Ms M during intervention (Rogers, 1951). Unconditional positive regard compels a professional to accept Ms M’s feelings and actions during intervention rather than being disapproving or judgmental (Payne, 1997). If this condition is present in a relationship, then Ms M eventually feels free to explore and share painful feelings without worrying about personal rejection from professionals. Congruence is another condition that obliges practitioners to be genuine, open and honest to clients. Consequently, this helps to build Ms M’s confidence and perceive the practitioner as trustworthy, dependable and consistent. However, professionals working with Ms M should have a level of personal growth which increases their self-awareness and also create an environment which makes the client feel safe. This can facilitate therapeutic success (Beckett, 2006). The Social model of disability defines disability not as the problem of an individual but in terms of social barriers that exclude people with disabilities from participating fully in society By contrast the medical model views disability as a damage to a person’s body or medical function requiring diagnosis or professional treatment (Giddens, 2008). The combination of social model and medical model is applicable to Ms J with Down’s syndrome and these two models inform practitioners on how best they can meet the needs of Ms J. “Down syndrome is a chromosomal condition that is associated with intellectual disability, a characteristic facial appearance, and poor muscle tone (hypotonia) in infancy” (http://ghr.nlm.nih.gov). People with Down syndrome are at increased risk for certain medical problems such as heart defects, intestinal, muscle, joint, vision and hearing problems. The goal of medical treatments for Ms J is to manage her medical conditions associated with Down syndrome. From the social model perspective, the practitioner has to work in partnership with the mental health services and therapists. For example, an occupational therapist can coach Ms J in handling money and social interaction (Valuing People, 2001). This ensures that appropriate support is provided and these interventions help her to live long productive life. However, Oliver (1988) argues that professionals should not rely on the assumption that they know best what disabled people need or perceive them as dependants. All people need some form of support to participate in mainstream social life. Thompson (2001) stresses that people have diverse needs where some of them are common or more individually tailored. Therefore, to see aid as something disabled people need but the majority of the population do not is itself disabling. Goffman views institutions as links in adapting the deviant nature of an individual (Haralambos and Holborn, 1995). He investigated the treatment of mental illness patients in institutions and concluded that the aims of rehabilitation were not greatly successful. His main focus was on mortification and how inmates are subjected to acts which take away their identity. All their personal belongings are removed and standardised items are issued. The patients have to familiarise themselves with the routine activities which become part of their lives. Goffman’s theory is relevant to Mr D who spent the first thirty years in a large institution. The lifestyle in institutions can have damaging impact on Mr D; he may perceive himself as hopeless and find it hard to cope in an outside world because of the routine system of institutions. Goffman stressed that many institutions rather than reducing deviance instead reinforce it. As a result, clients believe they are unworthy of normal social interaction. However, Mr D can overcome the label he has been given if professionals work in partnership with him to meet his needs and live an independent life. For example an occupational therapist can help Mr D to make every task easier such as shopping, washing, dressing and cooking or teach him new ways to do things so that he gains control over his life. Thompson (2001) defines anti-discriminatory practice as an approach to social work which aims at reducing or eliminating discrimination and oppression, mainly in terms of challenging sexism, racism, ageism and disablism. Thompson (1997) defines discrimination as “…prejudicial behaviour acting against the interests of those people who characteristically belong to relatively powerless groups. He stresses that oppression involves “…hardship and injustice brought about by the dominance of one group over another; the negative and demeaning exercise of power.” Disablism can be linked to Thompson (1997) PCS analysis as it can be seen to operate at all three levels. P level refers to Personal prejudice or feelings against people with disabilities. The P level is embedded in the C level as social values and norms are internalised through socialisation. C level refers to cultural values which reveal various responses to disability which are primarily negative in their orientation. Thompson (2001) argues that dominant cultures are geared towards the ‘able bodied’ majority and view disabled people as either ‘misfits’ or pathetic’ victims of personal tragedy. The S represents the structural level of society and the way “disability is rarely recognised in sociology texts as a dimension of social stratification and yet it very clearly acts as a social division”. As a manager, it is crucial to be aware of the internal prejudices and endeavour to empower people with learning disabilities by respecting and treating them as individuals with unique needs. The empowerment approach can give Mr J power and the chance to make his own decisions, if professionals collaborate with him and his carers when drawing his care plan, this enables Mr J to gain full control over his life. (Dubois and Miley 1992: 42). Practitioners should have cultural awareness and ensure that assessments and interventions do not ‘hinge’ on negative assumptions such as, assuming a higher level of violence amongst ‘black’ people like Mr J (Marlow and Loveday, 2000). The Race Relations Act 1976 protects against discrimination on the basis of race, ethnic or nationality and promotes fair access to resources so that clients can feel included in society (Woolfe and Malahleka, 1990). Thompson (1997) believes that, “the further one moves from personal level, the less impact an individual can have…” This is why the manager has to challenge discrimination in order to promote the rights of people with learning disabilities. However, much as practitioners would like to enable the residents to maximise their opportunities, they will encounter challenges at some point: According to the case study, it appears that most of the clients did not have a choice but came into the residential home due to breakdown in other placements for example Ms M and Mr J, a 24 year old African-Caribbean whose parents can not cope with his care needs. The Mental Capacity Act 2005 provides a framework to empower people who may lack capacity to make some decisions for themselves and this has to be approved by the doctor. In addition, decisions made on their behalf must be done in their best interests and least restrictive of their basic rights and freedoms (http://www.publicguardian.gov.uk). Practitioners who purchase services for clients find it hard to be ‘needs-led’ when they are also having to think about costs and staying within budgets. Beckett (2006) suggests that service purchasers should be much more aware of how much things cost so that they make best use of the limited financial resources that are available in an agency. The clients will experience neglect and discrimination since most of them are likely to have communication problems that make it difficult to express themselves. For this reason, advocate skills are paramount for practitioners so that they can present views on their behalf (Dalrymple and Burke, 2001). The government believes that direct payments are effective in enabling people with learning disabilities to gain control over their lives, however this can put clients at risk of abuse for example, from their relatives or carers who can put them under pressure to hand over money and some clients may lack capacity to make decisions, therefore it is the role of the manager to guard clients against exploitation (Beckett, 2006). In conclusion, there are many things to consider when helping people with learning disabilities towards independence and inclusion. It must be acknowledged that having an opportunity to make decisions in life is a fundamental right (Thomas and Woods, 2003). The key principles: Rights, independence, choice and inclusion must be promoted so that clients live full and rewarding lives. References THOMAS, D and WOODS, H (2003) Working with People with learning Difficulties. London: Jessica Kingsley BASW (2002) “Code of Ethics for Social Work” www.basw.co.uk (accessed May 2010).   Department of Health (2000) “No Secrets” www.doh.gov.uk (accessed May 2010).    Action on elder Abuse (2002) “What is elder Abuse'” www.elderabuse.org (accessed May 2010). George, M. (2002) “Protection of Vulnerable Adults” www.careandhealth.com (accessed May 2010).   HMSO (2000) Protecting Vulnerable People” www.gov.uk (accessed May 2010). World Health Organisation, 2001, World Health Report 2001 - Mental health: New understanding, new hope, http://ghr.nlm.nih.gov/condition=downsyndrome (assessed on 5/05/10). http://www.publicguardian.gov.uk/mca/mca.htm (assessed on 7/05/10).