Models, Methods and Theories in Social Work - Assignment Example

MODELS, METHODS AND THEORIES IN SOCIAL WORK Introduction There is increased demand for health and social servicesfor older citizens both in developed and developing countries. This is changing the prospects for the social services. As studies emphasize the continued activeness contributes to longevity and health of elderly, there has been significant initiatives to increase their activeness on a personal and community level (Caring for the Elderly, 2006). The motivation is for the elderly to be able to enjoy the longevity that is afforded them by new developments in medical science to the fullest. This reflects the shift from many previous standards in the practice of social care that have been widely accepted before (Weilet al, 1985) This has been one for the primary focus of the Northern Ireland Social Care Council (NISCC) in the creation of The National Occupational Standards for Social Work in 2003. In their evaluation, for programs to serve their purpose, they have to be able to follow closely the people they are designed fro considering their needs and backgrounds (Lothian, 2001). These programs are not just part of social care and development but also are an important indication of how society values its citizens. Case Introduction The Elders Team received a phone call from M requesting Time Out services for her mother so that M can herself go out because someone can be with mother Mrs. Z. In response to the request, a background history obtained from daughter on the phone. A schedule for a home visitation was scheduled to complete assessment and determine service plan for Mrs. Z. Mrs Z was born in 1919 in a village in Poland, the youngest of a family of seven, most of who would eventually perish during the World War II. In 1940 she was taken to a labour camp in Germany where she had a pretty bad time. After the war, she came to England in 1945 and found work packing in a factory. A year later, in 1946, she married her husband who was a Polish ex-officer. They had three children and M was the oldest. M is a teacher and is living with Mrs. Z. At the time of the initial interview, it was found out that the husband died recently, about eighteen months ago. Prior to the time of M's call to the Elders Team, she said that her mother was always competent and hard working person with no particular problems. However, her mother's behaviour has become her concern recently because of some changes in behaviour that she found puzzling and disturbing. For example, Mrs Z used to speak English very well, but now insists on speaking Polish in the house. Also, Mrs. Z used to go out about two to three times a week to visit the Catholic Church but now refuses to go out unless daughter is with her. M thinks initially attributed her mother's condition is due to loneliness following death of her father, but now thinks something is wrong with her mother. Mrs. Z has become increasingly dependent on M and often stands by the window to watch for her to return. She often makes a fuss when M wants to go out in the evening. She also has begun to express negative opinions regarding the neighbours and their neighbourhood. As recent as six months ago, she has never complained about the neighbours and generally kept opinions, if any, to herself. However, she ahs repeatedly complained about the building work being done next door, which did cause noise and mess but no more than one would expected. Mrs Z in addition has complained that neighbours are harassing her and wants her to get out of the house. Mrs Z even gets worried about any post or leaflets that come to the letterbox. Mrs Z also suffers from high blood pressure and arthritis in both legs .She has poor mobility but manages to cook meals. Because of the reasons, she said she does not want to go out anymore. She thinks neighbours are making a hole in her bedroom wall which is why she has been sleeping downstairs instead. M does not know what is wrong with her mother, but thinks perhaps neighbours may have somehow upset her. Her mother often reminisced and talked about how nice the area was. She feels that it had changed so much mentioning that there are too many different races in the neighbourhood. M is contemplating that her mother needs proper looking after and needs to go into a more sheltered or perhaps residential home. Context of Social Work Practice The UK Centre for the Measurement of Government Activity (2006) has initiated the evaluation that social services should be able to address not only known conditions but also those that are yet recognized. Another key issue is the increasing economic challenges in today's society. Blank (2002) has prompted him to call for the evaluation of perspectives in welfare and social care not only as a service but also with regard to the factors that drive needs. Post World War II, health services have begun to realize the need to revolutionize the treatment of mental illness which entailed redefining disciplines, approaches and standards of performance (Sheppard, 1995). Concurrent researches in the fields of psychology and sociology have revealed the importance of social work and the programs that promote and support welfare (Perraud et al, 2006). These developments have considered more the state of human condition and the realities that change constantly. According to the NISCC (2003), social workers are challenged to take roles that are more active so that programs can truly translate to better conditions. Increasing Diversity Multiculturalism is not just about culture, its core objective is to be able to incorporate different heritages to create a society that celebrates all the richness of humanity. It is the foundation of a just and broadminded society. The development of a multicultural society is a reflection of true social progress. Most of the conflicts in human history were initiated by forms of cultural intolerance. Continuing research in to the nature of human psychology and social work is now providing health care professional more insights to develop treatment, therapy and rehabilitation in the context of social diversity. This makers methods and systems more sensitive to the needs of clients but also considers more the reality of clients' lives. Developments in technology and health social services are changing the field of social work nursing (Morris, Bloom and Kang, 2006). Shulman (1996) says that there should be realization that economic, social and demographical pressures have highlighted the need for individual and support groups to provide emotional and psychological support for those that are most challenged. The reaction has been not just in health and social service reforms but also in the involvement of the community. In the UK, in an effort to improve channels of services, the government has established community based programs to deliver or provide for social services (Lalor et al, 2005). Marginalization Though the issue of social exclusion or effective marginalization has only come into prominence in recent years, there is no denying its significance in today's society. Though there has been significant accomplishment in addressing the factors that contribute to social exclusion, there is still an urgent to address the issue Most of the advancements that have been made in the situation have required significant resources form the government as well as private sector. Though this is a commendable avenue of action, there is the reality that high maintenance efforts are difficult to manage or sustain. At the same time, efforts have had yet to be able to effect a cohesive change in the social exclusion as a whole. Identifying primary care needs of clients like Mrs. Z who are at an age when mortality and independence increasing becomes an issue, many have suffered form these personal developments. One of the ways that have been identified as important is in helping them deal with the experience and to develop healthy perspectives. The behavioural problems that have been observed in Mrs. Z are most likely developed as his coping mechanism against the issues she may be struggling with internally (Cox & Ephross, 1998). Geriatric Care The quality of life of the elderly depends greatly on their access to the services that allow them the greatest potential for maintaining and enhancing their quality of life. Programs have to be able to follow closely the people they are designed fro considering their needs and backgrounds (Lothian, 2001). At the same time, programs should be exhaustive of the factors to it considers so that all viable approaches can be explored. The social workers have to be able to determine if there are any deficiencies in the subjects state that include the following: Physical Care and Development Physical activeness can significantly enhance everyday physical activities since muscle tone and related body functions are maintained (Caring for the Elderly, 2006). Physical conditions that are to be enhanced or maintained include dexterity, agility, endurance and coordination (McGuire-Sniecku, 2006). Physical activities or therapies serve as the host for other programs designed for the age groups that also aim to enhance their life and the effectiveness of their medications and treatments. Considerations have to be given to individuals who have existing conditions that impair their judgment as well as for cardio vascular or immunological conditions (Garland, 2002). The United Kingdom's National Health Service has sponsored community exercise programs that include Tai Chi and dance that have been successful. Emotional Health Healthy emotional states afford greater chance to cope with the stresses and challenges of growing old. Though emotional health is difficult to address, it can be enhanced by other more direct therapy methods. Emotional states can be improved by improving physical conditions and improving levels of socialization can enhance emotional health through relationships (Williams & Garland 384). Researches have indicated that severities of mental conditions are closely correlated with the state of emotional health. Since the age group becomes increasingly vulnerable to dementia, disassociation and depression, emotional health also increases in importance for health care providers. Methods of Approach through (Williams & Garland, 2002): Socialization programs - individuals are given the chance to share concerns and commiserate with others in their age group. Physical therapies - it can serve as effective stress or emotional release for frustrations and aggravations. Spiritual Clients become contemplative and try to make sense of their lives more in terms of religious background or experience. Coordination with some religious groups sponsor who recreation centres and support groups for their denomination is necessary to coordinate care All mediums can be incorporated particularly to consider clients that may have ambulatory impediments or negative reaction to going out of the house Community Integration Based on the provision of the Community Care Act, programs for social interventions will include the development of channels for socialization and community building (NISCC, 2003). Interaction during the activities plays an important role for the individuals participating in the programs (McGuire-Snieckus, 2006). Community activities can address elderly issues that involve their marginalization and diminished access to social institutions and activities that can contribute to their decline. Socialization is a critical factor to consider in increasing the commitment of clients to rehabilitation and care. The motivation for clients is extended from himself to include associations and thus increasing the stakeholders for the recovery of the client (Lothian, 2001). Theories, Models and Methods Social theories are used to are used to understand and explain the tendencies, patterns or movement of both individuals and society based on the context of the social order they occur in. (Hebding and Glick, 1992, p. 12). Socials only are able to explain aspects of behaviour and may be difficult to apply in a universally. A person's psychological development may follow psychological models or social behaviour models but will vary greatly based on the history, anthropology, economics, politics, theology and biology of the person (Adams, Bert and Sydie, 2001). Intervention Process The intervention process followed for the case of Mrs. Z will involve an assessment of her current state and her state before the death for her husband since M attributed her mother's change in behaviour due to the said event. Focus will be given to her age and cultural history to afford an individual perspective to her case. The main objective is to deliver care and social services to Mrs. Z not only for her interest but also to afford M greater flexibility. The intervention will follow this guide: Assessment of Mrs. Z Documentation of History Assessment of change in behaviour Identification of concerns and needs Assessment of Relationships Assessment of relationship with her children Determination of her social bonds applicable Perception about her community, particularly her neighbourhood Identification of relationship components Development of Intervention Consultation with Mrs. Z Consultation with Mrs. M Assessment of available programs for the needs expressed by M and Mrs. Z Implementation of Intervention Presentation of intervention program to M and Mrs. Z for their approvals Coordination of schedules and requirements Consultation with service or care providers Evaluation of effectivity of services Redevelopment of intervention program as needed Models for Analysis of Conditions The National Occupational Standards prescribes that approached must follow not only standard practices but also derive from established assessment programs to help support the identification of critical needs (NISCC, 2003, pp. 34 -38) The common factor of all theories regarding psycho-sociological development is that the person is central figure. The key elements that are prevalent along all the theories are the importance of cognitive development and perceptions and behavioural orientation (Atkinson et al, 1993, pp. 75-76). Psychological states of a person encompass the whole aspect of the individual: his biology, orientation and perception; and the world she moves in: the social structure, norms, traditions, perceptions and environments. Biomedical Model The biomedical model was developed in the 1800's and has been the standard for medical diagnoses. The model is focuses on standard performance or characteristics of the different physical process of the body, for example its chemistry and pathology, to determine deviations (Mino and Lert, 2005). In the context of social work diagnoses, it utilizes elevation or deficiencies in the nervous system that contribute to aberrant behaviour. For example, if the biomedical model were to be used to in understanding epileptic episodes, the focus would be on the synaptic storms in the brain that characterizes epileptic episodes. The biomedical model has been tested means of identifying disorders became it utilizes a very ordered standard of reference. The biomedical model is popular in psychiatry and has been utilized particularly in the standards of medication prescriptions. Since the biomedical model considers the human body chemistry significantly, it is considered as effective model to utilize in developing drugs or treatments (McGuire-Snieckus et al, 2006). There has also been some critique regarding the biomedical model. The model has tendency to emphasize that natural science is the most compelling knowledge approach (Mino and Lert, 2005). The main contention against the model is that it diminishes societal and non-biological psychology. Critics of the model believe that this representation isolates the person. It is essential in creating standards and helps in the formulation of nursing scenarios (McGuire-Snieckus et al, 2006). A new model, the biopsychosocial, model that has been developed based on the principles of the biomedical model. The biopsychosocial model adopts the same foundations of the biomedical model but also now includes psychological and social factors. This has allowed the biomedical model also includes factors external to the biology of the individual and has increased its application to social integrations nursing programs. Cognitive Behaviour Cognitive behaviour theory focuses on the emotions and behaviour. They are dominantly used in psychology and are used only mainly as observational tools in medical fields (Department of Health, 1999). Cognitive behaviour theories are embedded in the field of psychotherapy and are used to gain insight into the emotions psychopathology of the individual (Kipling et al, 1999). It also is widely applied in the study of learning. This developed later into the formulation of the theory. The inclusion of cognitive elements to the theory brings into the theory biological elements but to differentiate its approach in cognition to that of the biomedical model, its focus is on how the psychology or emotion of the person contributes to the learning process (Whitfield and Williams, 2003). Cognitive behaviour has been able to establish the inclusion of abstracts elements such as emotions into the diagnoses and treatment of social work illness (Adams et al, 1998). It has also been able to concretize the link between cognition and behaviour: establish that perception is not just about information but that the process of perception is also an important factor (Williams et al, 1997). However, there have been also critiques regarding the theories. One of the main contentions against the theory is that it involves arbitrary standards creating discrepancies in diagnoses and treatment. Another reservation about the cognitive behaviour is that it is now being used to provide basis for self-help books that may mead to misconceptions about the nature of psychological wellness (Mino and Lert, 2005). The value of cognitive behaviour theories cannot be diminished by its flexibility and fluidity, despite its less standardized view; it still is able to support its core theories conclusively (Adams et al, 2002). Its prevalent use in popular culture is an indication of its acceptance and understanding by the public. New developments in therapy methods using its theories have been able to address control concerns of treatment (Williams and Garland, 2002). This has raised its reliability and effectiveness in mental disorders; particularly those that cannot be treated effectively with drugs or in clients that may have other conditions that contradict other health problems (Department of Health, 2001). Approach Model for Case Considering Mrs. Z's case, the approach to her treatment will be a psychosocial approach since her major issues are psychological and sociological in nature. Through this method, the intent is to ease Mrs. Z's worries and encourage her to have activities outside the home. The preparation for the social work programs for Mrs. Z is designed to include the maximum development networks available (NISCC, 2003, pp. 51-59). Factor to be considered in the case approach are as follows (Sudbery & Winstanley, 1998): Psychodynamic models of behaviour apparent in the client Application of Biestek's Principles in Casework Relationship (Payne, 1991) Attachment theory to define the change in behaviour as evidenced by deterioration of feeling of security The role of relationships in the clients condition and its use in the therapy or measures to be taken Interaction of both internal and the external in people's difficulties that may influence psychological problems Background of the client, particularly the social context of Mrs. Z's childhood and adolescence The client's perception of who she is and her current condition The client's understanding of the work of the Elders Team and the social worker In addition, the significance of emotional experience of client must also be evaluated. According to Franz Alexander, corrective emotional experience is essential in easing conditions particularly when the source of the condition is internally motivated out of fears or insecurity (Sudbery & Winstanley, 1998). In essence, the focus is relearning the psychological and social conditions that can support against deterioration of the client. Control measures for the therapy are focused on the impact of the undesired conditions to family relationships or socialization. The loss of previous fulfilment derived from activities is to be presented as something that the client can solve (Adams & Sydie, 2001). The communication of the needed for affirmative action from the client is essential in the success of the measures Another key factor to be considered is transference and counter transference (Payne, 1991). Transference develops from the client's experience with the relationships in her life. Counter transference are unavoidable tendencies of the social worker to evaluate the client in relation to other cases because of the relationship with the current and past clients as well the worker's own personal experience as well Treatment and Therapy for Case In the initial interview done during the home visit with Mrs Z, she insisted she does not want to move anywhere. At the initial stage the focus is on building her confidence and trust, eventually it would be task centred work and person centred approach (Adams et al, 2002). She expressed her desire to stay in the house that she and her husband worked for because and it was a source of pride and joy. She believes that it is only recently that the area has become unsafe and she worries for M going out in the evening. Mrs Z talked about her children and how daughter M is hardworking and helpful at home. She also talked about son P and their estrangement because of issues regarding his wife and rarely contacts her. She feels that she has lost her son now who was her favourite. Mrs Z has few interests outside the home. She attends church with two other Polish women or with daughter M. At home, she watches television, sometimes reads newspaper and likes to do knitting. In the course of the interview, I found that her welfare benefits and attendance allowances needs a review. Psychodynamic Models of Behaviour From what I gathered Mrs Z had a difficult childhood, difficult years during the war, her years of marriage had been stormy in the last six years. Her problems with her son seem to be genuine. When she is left in peace she remains locked in her world, but the least interference from outside Mrs Z hits back and gets anxious and angry, totally misjudging the situation. This could be due to her emotional state of mind or perhaps more, I believe, to circumstances of a person who has been uprooted and thrown in the depths and found no stable base. She sometimes thinks her nearest and dearest are against her. She cannot change her Polish ancestry or beliefs, she feels trapped. This should be closely condiered since the perception of having no choice can affect receptiveness to any social care given (Skerrett, 2000, p. 66) Casework Relationship I felt that Mrs Z needed company during the day and to socialize more frequently. I offered her Day Centre facilities at Age Concern. Perhaps look into her health needs possibly Dementia, once GP confirms her condition. In addition, gentle persuasion for her to attend community 'Polish Group' could break the isolation, and allow Mrs Z to share her problems with others. Mrs Z was quite friendly by then and before I left, she clearly instructed me not to send anyone to her home until she is ready for the service. Her daughter M informed me that she would ring if services required. Three weeks after my visit, I telephoned daughter M to review the situation. I was told her mother had a fall at home and has broken her arm. She was coming home soon from hospital. On her release from hospital, I went to visit her to do a 'Home from hospital Assessment' and Risk Assessment. The assessment highlighted several issues. Internal and the External Issues After going home from the hospital, Mrs Z looked tired and frail, and was very quite. It seemed that the recent experience has highlighted the conditions that she was suffering from. As the daughter could not attend to all her personal needs, I organised personal care for the morning and nighttime by contacting Social Services. This would be provided by the social Services with permission from Mrs Z. The personal carer to help her with wash, toileting needs, doing her bed and tidying up. In the evening carer will help her change her clothes and help in getting into bed. The programs are under the Community Care Act as well as programs to support disability whether it is permanent or not (NISCC, 2003). I requested for a Polish-speaking person and a women carer as this was Mrs Z request. I contacted the nursing services to visit to access her situation and provide her with the pads. With her consent and her daughter's permission, several other measures were implemented. Coordination was also done with her GP for home deliver of prescription and spoke about my concern for her emotional needs. There was no smoke alarm in the house. The carpet was torn and the kitchen surface was uneven due to broken tiles. My immediate role was to refer to our Handy person scheme based at Elders Team to repair the tiles and uneven kitchen area. Daughter M agreed to renew the carpet. The hallway area was badly light so extra light to be fitted. By the Handyperson scheme, .Mrs Z wanted a door chain to be fitted for safety. Community alarm was also suggested for her personal safety. For this purpose, Community systems were called to send relevant details and charges. The plan was that once the plaster is off her arm and she is feeling much better, then Bereavement counselling would be offered to her via the GP. Overall, we all felt she had not accepted the death of her husband to date. Role of Relationships and Attachment According to her, her husband was helpful and caring, but had become rather difficult in the last years of his life. She mentioned that he had a drinking problem but that it was not too bad. She became upset when he abused her verbally and sometimes physically. The situation became unbearable when the children grew up and refused to be ruled by a rather narrow-minded father, who enforced on them a 'Polish' way of life. Mrs Z also asked me to contact her son P and let him know about her broken arm. This was a significant indication that Mrs. Z wanted to feel her son's concern. She said she had asked daughter M to do so, but she refused saying he will not reply. M was motivated not to increase any conflict between the two or develop a situation that would further depress her mother. However, when I spoke to M and she had no objection in me contacting him. Background and Self-Concept Mrs. Z was a person who experienced stressful situations and has developed a high degree of cultural identification. Her experience with the invasion of Poland was served to reinforce this as a means of coping in the conditions she encountered. From speaking to Mrs. Z, there is no indication that her anxiety is from racism but rather the core of her anxiety is from her feelings regarding safety and security. Her using of her native tongue is an indication that she is trying to find comfort in her family and what is familiar. When her husband was still alive, she most likely was to hear a piece of comfort that some things remain the same. Her husband's death and estrangement form her son leaves only daughter M as her source of security. She has stated that without M, she feels that she has no one. Impact of the Social Worker's Role I explained to her my role with Elders Team. I also informed her about 'time out' service and explained how it works. I would locate a suitable carer and will try for a polish-speaking person if possible. The carer will stay with her for up to 4hrs in a week while daughter goes out. I explained the care workers role. The carer will give her company, helping Mrs Z doing light housework, talk to her and support her in light household duties. During the visits I listened and acknowledged the depth of her feelings, she felt relief and being understood. Once the trust is build up I would gradually introduce the light exercise session offered by the hospital physiotherapist to Mrs Z, community transport would be organised for her to attend Day centre if she wishes. In befriending, building confidence, Mrs. Z had greater acceptance of the idea of a new person within the home. She also has grown more response and agreed and gave me relevant details with help from daughter to enable me to complete the assessment form. She started communicating to me after a while, and talked about her own anxiety and the reasons behind it. Assistance was also extended to Daughter M when she requested me to look into getting any Attendance Allowance for her mother. Conclusion The UK Centre for the Measurement of Government Activity (2006) has prescribed in it evaluation that social services should be able to address not only known conditions but also those that are yet recognized. A key issue is the increasing economic challenges in today's society. According to Shulman (1996), there should be realization that economic pressures have highlighted the need for individual and support groups to provide emotional and psychological support for those that are most challenged. Simultaneously, the social work profession is seen the need to be more active in social work care (Gitterman & Shulman, 2005). The nature of social work itself is a great foundation for developing social work programs that follows closely clients' progress and being able to support their critical needs physically, emotionally, socially, and spiritually (Gorman, 2000). Today, these trends have continued to emphasize the importance of creating rehabilitative social work programs that encourage re-socialization and empowerment of social work clients. Medical innovation, social developments and changing perceptions about old age are changing what is involve in being elderly in today's society (Department of Health, 1990). References Adams, R., Bert N. and Sydie, R.A. 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Belmont, CA: Brooks/Cole Thomson Learning Skerrett, D. (2000). Social Work - a shifting paradigm. Journal of Social Work Practice, 14:1, pp. 63-73 Sudbery, J. and Winstanley, I. (1998) The Use of Psychodynamic Insights in Brief Counselling. Psychodynamic Counselling 4. p. 3 UK Centre for the Measurement of Government Activity (2006). Public Service Productivity: Health Williams, C. and Garland, A. (2002). Identifying and challenging unhelpful thinking. Advan. Psychiatr. Treat., SeptemberVolume 8 Number 5: 377 - 386. Weil, M., Karls, J. M. and Associates (1985) Case Management in Human Service Practice: a systematic approach to mobilising resources for clients, San Francisco: Jossey-Bass Read More