By virtue of their pre-care and care experiences, Care Leavers are deemed to be a disadvantaged group. National and local research provides evidence that outcomes for this group of young people are consistently poor on a number of fronts including; employment, educational attainment, homelessness, young parenthood, poverty, crime and mental health (DHSSPS 2007; DHSSPS 2004; DHSSPS 2006). In addressing these poor outcomes, the agency in which I am employed applies a model which is based upon trauma informed responsive reflective practice and resilience. The essay will explore the outcomes, challenges and ethical issues (with reference to two complex practice examples) involved in promoting choice, independence and empowerment.
The literature aims to:
• Examine relative literature in relation to Care Leavers
• Critically reflect on and evaluate the Social Work Process for the service user and practitioner
• Examine the outcomes, challenges and ethical issues involved in promoting choice, independence and empowerment of service users
To structure my reflections, I will use a framework put forward by Schon [1992). By reflecting both on practice, i.e. after the event, and in practice, i.e. during the event Schon believes practitioners gain an in-depth understanding of the situation which aids critical reflection. Fook (2002) expands on this concept by describing reflection as ‘reflectivity’ (reflecting on practice) and reflexivity (reflecting in practice). The overall benefit of reflective practice is to learn from a given situation and to inform your future practice with the view of becoming a ‘critical practitioner’ (Adams et. al, 2002).
As a Social Worker within the Voluntary sector, I do hold a legal mandate for intervention as enshrined in legislation. However, I do have a duty to ensure my work is governed by the legal framework to ensure the young people I work with are aware of their rights, their needs are met and they are safeguarded from harm. It is also important I have an understanding of the legislation to ensure the young people I support are receiving the best level of care/support and advocate on their behalf if there is a discrepancy.
Whilst having a knowledge of legislation it is important it is also key to examine the wider political context. As a consequence of ‘Troubles’, Northern Ireland is an area of high social need and deprivation (Kenway et al, 2006). As a result, Duffy (2008) suggests, people of Northern Ireland live in a ‘socially deprived and ‘divided society’. As a consequence, there is a greater demand on and for services. Due to lack of resources and the quality of existing services, needs are not being met. In this environment it is therefore essential to have a legal framework which protects the rights and needs of vulnerable Care Leavers. Whilst there is legislation and policy in place in relation to Care Leavers, recent messages from research highlights that more can be done to tackled the disadvantage faced by this vulnerable group
The Children (NI) Order 1995 established the overriding principle of the paramountcy
of the child which must direct the work of each HSC Trust in its general duty to
“Safeguard and promote the welfare of children within its area who are in need”. The
Children (Leaving Care) Act 2002 reinforced this duty and extended the HSC Trusts responsibilities to Young people leaving care, to include a continued obligation to provide support until aged 21 years and in certain circumstances until aged 24. While both Miss X and Miss Y are no longer ‘Looked After’, under the Children Leaving Care Act they would be categorised as ‘Former Relative’ Young People. The implication of this is the local Trust has a duty to provide support to meet their needs whilst ensuring they are safeguarded from harm, this therefore is the mandate for commissioning the services my agency offer. However, under the provisions of the Leaving Care Act there is no formal mechanisms for the option to ‘staying put’ rather than making the accelerated transition to independent living {Munro 2010} Miss X was in a very settled foster placement and her ultimate choice would have been to remain in this placement for as long as possible however despite arrangement’s being in place for her to continue living in her placement under the GEM scheme, her foster carers decided this was not an option and Miss X had to move out the night before her 18th birthday. This had a detrimental effect on Miss X’s emotional wellbeing and compounded her feelings of rejection. If there was an inbuilt mechanism within the legislation with clear financial benefit’s outlined this may have change her foster carers’ decision.
In Northern Ireland the organisation, Supporting People create policy and funding for homelessness. In relation to Miss X and Y my agency provides short term accommodation and is deemed by Supporting People as having ‘the intention of moving an individual on to independent living’ (ODPM, 2004:3). With both Miss X and Miss Y their housing support needs are assessed and a support plan has been formulated with their input to address these needs. My agency also incorporates Northern Ireland’s ten-year strategy, Our Children and Young People – Our Pledge (2006) which identifies six high level outcomes to be promoted and achieved for all children. Within our agency the six high level outcomes are incorporated into support planning and the review process with the view of promoting independence.
As a cross over service working with young people and young adults, we are obliged to comply with Vulnerable Adults Policy and Procedures and Cooperating to Protect Children and Safeguarding policy and procedures. As a service we have robust safeguarding and vulnerable adult policies with mechanisms for reporting disclosures of abuse and safeguarding concerns.
An integral piece of legislation which impacts on my work with all service users is the Human Rights Act 1998. Human Rights must be considered in all decision making processes. The implication of the Human Rights Act (1998) is Public authorities can only interfere with an individual’s rights providing it is lawful, proportionate and necessary in a democratic society (HSC, PSNI & RQIA 2009). In working with both Miss X and Miss Y, I am mindful of Article 8- Right too private and family life and balancing this with a duty to safeguard from harm.
As a registered Social Worker it is essential I comply with NISCC Codes of Practice for Social Workers (2015). This sets a standardise framework based on ethical practice that all Social Workers must adhere to. As a commissioned Service my agency is subject to inspection from the Regulation and Quality, Improvement Authority (RQIA). As such we must comply with departmental standards in relation to the provision and quality of care and support offered to care leavers (DHSSPS 2012).
To carry out my role effectively, I have to be mindful of Attachment Theory. This provides a framework which enables me to understand the perspective and experiences of many of the young people leaving care. They are likely to have experienced disrupted relationships, insecure attachments, loss and separation. Whilst it is important to not categorise all care leavers as a homogenous group, Attachment theory can provide answers to why Young people leaving care may find it difficult to trust the adults around them, as they have not had a secure base, and had limited experience of loving, caring relationships (Howe, 1995; Stein, 2004; Crawford and Walker, 2007). In conjunction with Attachment theory research on building resilience is key carrying out my role effectively. Many commentators argue that promoting resilience at all stages of the care continuum can lead to better outcomes for children and young people. Regardless of their difficult and poor experiences, care experience young people should be given the opportunity to grow and develop their resilience post care. This can be achieved through providing young people with stability, helping them develop a positive sense of identity, enabling a positive experience of education, by having opportunities for turning points, planning and problem solving, and more gradual and supported transitions from care.
[Stein 2012, Stein 2004, Stein and Wade 2004}
Analysis of Social Work process/intervention
Miss X
Soon after moving in to our accommodation, it became evident that Miss X was struggling with the transition from Foster Care to semi-independent living. Miss X had to adjust to several changes at the one time, accommodation placement move, change in statutory social worker and beginning a new training work placement. Miss X’s emotional wellbeing deteriorated, she found it increasing difficult to cope. Miss X could not verbalise her feelings and her stress manifested its self in childlike behaviours and self-harm.
Given Miss X moved in just before her 18th birthday she was outside of the remit for CAMH’s. She had been referred to the Therapeutic Support Service [TSS] prior to turning 18 to give her additional support in managing the transition to independent living. This referral was expedited due to growing concerns around Miss X’s emotional wellbeing. Miss X was initially reluctant to attend these appointment’s as she felt ‘stupid’ and she was worried she could not convey her feelings. Miss X felt let down by the system and helpless as she was could not cope living on her own. At that moment all of the literature and research I had studied was staring back at me. Miss X was a vulnerable young person who due to her neglectful childhood and care history was faced with difficulties she had no tools to cope, she felt hopeless and abandoned and didn’t know how to accept help and support to develop the tools needed to progress. As she cried, I reassured her if she tried working with TSS she had nothing to lose but a lot to gain from their intervention. Discussing this in supervision I raised at the moment Miss X broke down, I automatically assumed the role as a problem solver, I had to ‘fix’ Miss X’s problems, learning from this module highlighted my reaction to problem solve can be viewed within the ‘Drama Triangle. In this scenario, I can view Service Users’ as the ‘victim’ and have myself in the role of the ‘rescuer’ (Burgess, 2005). Adopting the role as ‘rescuer’, is sometimes necessary in times of crisis however discussing this in supervision, I reflected that this can compound the power imbalance between worker and service user. To be empowering my role should be to encourage Miss X to engage with services that support her to develop her tools and resources that is if a crisis arises again she can draw on her own positive coping strategies to manage thus enabling her to achieve better outcomes for herself [Huston 2015]
Miss X began working with a Psychologist from TSS, to ensure all professionals involved were working consistently and coherently a multidisciplinary case review was convened. This was a very positive experience of multidisciplinary working an information sharing with the view of improving outcomes for Miss X. From this all professionals involved including myself gained an understanding of the effect Miss X’s attachment disorder had on her ability to communicate her thoughts, feelings and emotions. Before Miss X could focus on gaining the tools and strategies required to master independent living, she needed support to develop her emotional framework. McCreave (2004) argues that once a person becomes traumatised everything else in life becomes secondary to them, if Social Work fails to recognise the impact of trauma, it may fail to recognise the reasons why Service Users may not engage or may not accept supports or services. As a practitioner, I had to rethink my intervention, whilst Miss X was in this period of crisis with heightened anxiety, it was not only unrealistic expecting her to complete independent living skills but it was compounding her anxiety therefore a different approach had to be adapted.
I adapted person centred techniques in conjunction with elements of Motivational Interviewing and pro-social modelling. I felt using scaling questions when Miss X displayed certain behaviour worked well in helping her to make the links between identifying how she was feeling and enabling her to link this with the emotion with the behaviour she was displaying. As this work progressed, I began to change the type of questions I asked. I wanted to use questions that would enable Miss X to consider what her future looks like if she continues thinking the way she is and what it looks like if she changes her behaviour (Britt et. Al, 2004). This really worked for Miss X. After a period of time she was able to verbally communicate how she had been feeling. Teaching from this module helped me identified Narrative Theory as an important tool in Social Work. The use of Narrative theory can provide Service User’s with new meaning to their stories (Seo et. Al, 2015). The benefit of adopting this approach meant by listening to Miss X’s negative story I could support her to reconfigure this to positive interpretations (Seo et. Al, 2015).
The Ethics of narrative practice, are based on respecting individuals as experts in their own lives (Williams et.al, 2014). During the course of completing this module reflecting on action a dilemma I have encountered is sometimes trusting the Service Users are expert in their own lives when they make choices and decisions which seems to contradict the ‘expert’ title. For example, Miss X decided at 18 she wanted to have contact with her birth mum. Miss X had not seen her mum since the age of 2 and it was deemed unsafe for her to have contact growing up. As an adult Miss X had a right to contact her mum and she had several questions she needed answered. I respected Miss X’s right to do so but my initial reaction was to try and shield her from further hurt. I had been working with Miss X for several months and she was finally in a good place emotionally and I was worried meeting her birth mum would set her back. Reflecting on the work we had completed on developing her emotional language and framework, I hoped Miss X had developed the resources required to cope with such an emotionally charged meeting. In respecting her choice whilst not fully agreeing with it, I supported Miss X to prepare by helping her formulate expectations she had for the meeting and helping her see how she may feel if these expectations weren’t met. By adopting a strengths based approach, I praised Miss X for her courage and we completed role plays to enact what Miss X wanted to say to her mum. In doing this Miss X knew she had been listened to and she felt empowered to so something that was vitally important to her.
Miss Y
After moving in to our service accommodation, concerns were raised about Miss Y and suspected drug misuse. She was staying out late or overnight, and this raised other concerns in relation to Sexual Exploitation, as an indication of this is young people staying out late, not returning home and increased substance misuse (Smeaton, 2013). Research highlights for a variety of reasons – adverse childhood experiences, a high incidence of psychological and behavioural problems and feelings of loss and fragmentation following time in care – young care leavers are considered particularly vulnerable to having or developing drug problems (Ward 2003).
My assessment at this time was Miss Y was in the pre-completive stage as she denied taking any substances (Prochaska, DiClemente & Norris 1992). In fostering and developing a therapeutic based relationship which centered around conveying respect and a congregant attitude [Anglin 2002], Miss Y finally disclosed the extent on her drug taking. At this point Y would make the link between her drug misuse and deterioration in her mental health and she would express her desire to make positive changes in her life and to stop her drug misuse. However, given the chaotic nature of her life, Miss Y slipped from the completive stage to relapse at regular intervals. Reflecting on the reasons for this, I found an ethical dilemma in that the barriers to change may be too painful for Miss Y to address because of damaging experiences and her resistance to engage to address it. However, if I failed to challenge Miss Y’s risk taking behaviour, I would be colluding with her (Cherry 2005). The benefits of addressing her past and her reasons for masking her feelings through her drug misuse would empower Miss Y to begin to make positive choices.
Due to Miss Y’s vulnerability a balance had to be found in respecting her right to self-determination/autonomy and choice to take drugs with the need to safeguard her and protect her from herself (Taylor & Campbell 2011). Given the increased risks, Social Services convened a risk strategy meeting. Throughout my Social Work education and practice, findings from serious case reviews is at the forefront on my mind, which continually highlight lack of communication and information sharing as key failings which need to be improved (Lamming 2009, Tonner 2008). I work closely with Miss Y’s statutory social workers and having, as ongoing communication is a key component of risk management. In relation to multi-agency working Quinney suggests ‘closer co-operation, co-ordination and communication across and between services is required’ (2006:7).
Miss Y was reluctant to attend the risk management meeting, given the culture created in my service aims at ‘partnership’ working whilst ‘bridging the power imbalance between worker and Service User’ by recognizing they are experts of their own lives’ and should actively be involved in decision making (Thompson 2006), I encouraged Miss Y to attend. On arrival Miss Y was asked to wait outside while the ‘Professionals’ met first. When Miss Y was permitted to enter the meeting she appeared subdued and gave very little input. After the meeting, Miss Y shared how she was annoyed she had to wait outside when she knew everyone in the room was talking about her. This wasn’t standard practice as usually core group meetings of professionals are convened at a different time. When she was asked to sit outside my initial reaction was this wasn’t normal procedure, but as it was the Senior Social Worker who made the request, I didn’t challenge this. Smith {2009] argues there is a hierarchy within professionals in a multidisciplinary setting, with the medical profession holding more authority. In this scenario as a practitioner in a voluntary setting, I viewed Social Services as having the authority and I didn’t feel comfortable challenging this. The decision to exclude Miss Y from the beginning alienated her from the decision making process. I raised this in supervision and reflection on action, as a social worker in a voluntary agency I have the ‘luxury’ of time with a limited case load, in comparison statutory workers have higher caseloads therefore more pressure on time constraints. It is sometimes difficult to get all professionals involved around a table due to diary constraints, therefore I could understand why the decision was made to have a core group first, however this does not negate from the negative experience Miss Y encountered. To prevent this from happening again, I should clarify if a core group is taking place prior to the risk management meeting so I could prepare the Service User and give her the choice to wait outside or to be taken to the meeting she would be attending at the appropriate time.
As 18 Miss Y is legally viewed as an adult, as such she falls outside the remit for services such as DAMH’s. Educational work from other voluntary agencies have been offered to her but Miss Y believes she does not need this as she is aware of the risks involved in substance misuse. This is challenging as a practitioner as without her consent or engagement in services Miss Y is placing herself at significant risk and her emotional health has deteriorated. With this rationale in mind, I employed Motivational Interviewing (MI) techniques to progress Miss Y, in the cycle of change (Miller& Rollnic 2002). As its non-confrontational approach allowed Miss Y to examine her thoughts, feelings and behaviours with the aim, that she herself would gain the motivation to sustain long term change. However, while Miss Y could recognise the dangers associated with her drug misuse, her association with her peer group and their pull acted as a barrier to change.