Working with Vulnerable Adults
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Working with Vulnerable Adults

Bridget Penhale, Jonathan Parker

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eBook - ePub

Working with Vulnerable Adults

Bridget Penhale, Jonathan Parker

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About This Book

This text provides an understanding of current professional practice in social and health care, examining abuse of vulnerable adults and the ways in which social policy, welfare services and practitioners may compound or alleviate vulnerability.

Working with Vulnerable Adults develops a sound basis for understanding issues of risk, vulnerability and protection and investigates how agency policies and procedures may, often unintentionally, lead to the voice of service users being marginalised or unheard. Drawing on recent and established research about the protection of vulnerable adults, the book covers:

· Social work, social care settings and vulnerable adults

· The concept of abuse and adult protection

· Using the law in adult protection

· Professional and quality assurance issues

· Assessment in social work with vulnerable adults

· Dealing with and managing vulnerability, risk and abuse

· Adults with mental health difficulties, long-term conditions and learning disabilities

· Community abuse and asylum seekers

Much contemporary social and health care practice with adults is concerned with issues of risk and protection. Working with Vulnerable Adults provides information and knowledge for students and practitioners who are interested in finding out more about this important field.

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Information

Publisher
Routledge
Year
2007
ISBN
9781134416530

CHAPTER 1
CONTEXT AND BACKGROUND

OBJECTIVES

By the end of this chapter you should:
  • understand the role of a social care practitioner with vulnerable adults
  • be able to describe some of the key elements of social care and social work
  • be able to describe some of the particular settings in which social care takes place
  • be able to discuss the different service user groups that comprise adult social care and their possible needs for protection.

INTRODUCTION

In this chapter we consider the range of care settings and the changing world of social work and social care within them. The tasks and roles of practitioners in these settings are introduced, as are the various service user groups with whom social workers and social care workers come into contact during their practice. The dynamic but sometimes fraught question ‘what is social work?’ is addressed first in order to set the context for the chapter.

UNDERSTANDING SOCIAL WORK TODAY

ACTIVITY 1.1

Spend a few minutes thinking about what you understand as social work. Write down three or four key themes, roles or activities that you might associate with social work and bear these in mind as you read through the rest of this chapter.
It may help you to read Payne (2005) if you are particularly interested in the historical development of social work in the UK and to read the introductory book by Horner (2006) concerning what is social work.
If you ask a member of the public to tell you what social workers do or to tell you what social services can offer, you may get a range of responses largely based on media stories, which are usually negative, or anecdotes based on personal experiences. In the main, it is likely that you will hear either about alleged failings of the child protection system or scare stories relating to potentially dangerous people who are mentally ill. Indeed, if you consider the recent development of social policy it is littered with references to dangerousness and control, seeking to make individuals vulnerable whilst containing vulnerability. Alternatively, more personal good and bad experiences about relatives who have had some contact with a social worker or in residential care may be mentioned. However, for those working in social work and social care or indeed using the services, the story is much more complex. The range of settings and agencies has grown, and the roles and tasks of practitioners within them have increased in recent years. This has become much more complex as a result of the government’s modernising agenda for social care, which has been taking place over the last two decades.
Since the full implementation of the National Health Service and Community Care Act, 1990, in April 1993 in England and Wales, social care settings have widened to include providers of social care from local authorities, voluntary agencies and private organisations. Whilst there has always been a mixed economy of social care, the increased emphasis on choice and consumerism has changed the very concept of social work and social care. The tasks associated with community care assessments, the planning, implementing and reviewing process of care management, have further redefined social work and social care. Postle’s work shows how perceptions of practitioners about their role and tasks have changed more than practice, however (Postle, 2002).
Perhaps the most obvious change has been the separation, in many Councils with Social Services Responsibilities (CSSRs), which is the new name for what were known as Social Services Departments or authorities, of commissioning services, which remain legally the responsibility of the local authority, and the provision of services, which can be bought in from this expanding range of agencies and organisations. This means, for example, that whereas previously a person could obtain help at home from a Home Care service organised and run by the council, this type of help is now likely to be provided by a privately run care agency, although the CSSR may well retain responsibility for arranging this, so that the individual makes payments for or towards the cost of the care to the CSSR rather than to the agency direct.
The modernisation changes we have just discussed do not just affect social care services, however, as we have also seen changes in the world of health care in recent years. The changing role of health providers, the development of Primary Care Trusts and within them Primary Care Teams, and the increasing emphasis on community and social aspects of nursing and health professionals such as occupational therapists, has led to a blurring of social and health care provision. Whilst this may be confusing, even threatening at times, for practitioners from particular disciplines, it is perhaps the role and tasks undertaken that are of greater importance to service users than the name or indeed the qualification of the person providing the service.

CASE STUDY 1.1: MANDY

Mandy worked as an unqualified co-ordinator of adult care before taking her DipSW (the Diploma in Social Work qualification) in the mid-1990s. After qualifying in 1996, she returned to her area team as a care manager with responsibility for undertaking community care assessments for adults and developing Care Plans to meet identified and agreed needs. The role was familiar to her but the team had undergone a number of changes that were at first disconcerting. Her team manager was now Jane, an occupational therapist from a hospital background, with whom she had collaborated previously when co-ordinating care for people being discharged form hospital. There were two other qualified care managers in the team: one was a social worker like herself and the other was a nurse by profession. Some of the service users that Mandy had worked with prior to training still received assistance and a service from the team. Mandy was reassured to note that the service users were concerned not with the professional background of the practitioners but whether services that were provided following the assessments were appropriate or adequate to meet their individual needs.
It is important to note that whilst blurring professional roles and boundaries can be somewhat disturbing for practitioners, especially initially, service users remain the central focus of social care, and the impact of such organisational changes may not be as great as practitioners fear at the beginning. It is quite likely that the service user may not mind what the professional background of the practitioner is as long as they are effective and efficient and professional in both their practice and their manner. As such it is the values that underpin social work and social care that must be referred to when suspicions or uncertainties for practitioners may work to confound good practice.
At present, the ways in which services are delivered and organised are again undergoing changes. This has pretty much been the case since the change of government in 1997. The modernising agenda in social care effectively began with the publication of the government White Paper in 1998 (see further in Chapter 4). This paper emphasised the importance of promoting independence for vulnerable people, of working together across professions and of closer links between social and health care for adults who need services. The need for greater consumer choice and accountability as well as a clear emphasis on improving effective protection of service users who are at risk was highlighted. These principles were enshrined in the Health Act, 1999, and have been further strengthened by legislation such as the Care Standards Act, 2000, as we will see later, in Chapter 3.
The National Care Standards Commission was set up under the Care Standards Act, 2000, to ensure that services were regulated and that clear and consistent standards were established. It has been taken forward by the creation of an integrated service comprising the Commission and the Social Services Inspectorate (formerly part of the Department of Health), and is now known as the Commission for Social Care Inspection (CSCI). Further changes are anticipated in 2008 when CSCI will merge with the Commission for Health Improvement and the Mental Health Act Commission. The National Service Frameworks for mental health, older people and the White Paper, Valuing People (Department of Health, 2001a), concerning learning disability, are adding to the development of services that operate more closely with health care professionals and health systems. These changes are driving the need to reconceptualise social work and social care and once again to promote these areas as distinctive and important agencies in making a difference in people’s lives.
At the same time that these developments are transforming the landscape of social work and social care, however, comparable changes are taking place in respect of expectations of qualified social workers. Social work has traditionally been notoriously difficult to define and has laboured under many misconceptions, public and otherwise. Latterly, there has been growing acceptance and adoption of the following definition of social work agreed by the International Association of Schools of Social Work and International Federation of Social Workers in 2001:
The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.
This definition provides a much more positive view of social work and reclaims its aim to effect change, to empower and enable individuals whilst also focusing on social, structural and political factors affecting people. It advances the more common individually focused definitions (see Thomas and Pierson, 2006). The definition also promotes the use of knowledge, theories and models to enhance effective practice and roots itself in the values of social justice and human rights.
This definition has been taken up within the National Occupational Standards for Social Work and is seen as something to which social workers can and should subscribe. The Standards bring with them a set of core values for social work and social workers that concern the need for good interpersonal skills and information sharing, being service-user-led, able to advocate on behalf of others and to work openly with other professionals from different disciplines. These key values concern respect for individuals, families, carers, groups and communities, honesty about role and resources, commitment to empowerment and ability to challenge discrimination. These are associated with the General Social Care Council’s (GSCC) Codes of Practice for Social Care practitioners and agencies, which have been produced. There is an opportunity for social work to assert its position in working to protect vulnerable people at an individual, policy or agency and social structural level. Social work’s location at the intersection between society and those excluded from it in some way is confirmed within this.
We must acknowledge here that not everyone working within social care settings is a social worker. However, the Codes of Practice which have been developed by the GSCC set forth certain expectations and standards, which are common to all involved in social care, including employers (GSCC, 2002). Social care practitioners must safeguard the rights of individuals as far as possible, maintaining public trust and working to increase choice whilst balancing rights and risks. The emphasis in the GSCC Code of Practice for Social Care Workers is on probity and on protecting service users who are in some way vulnerable: some examples are shown in Box 1.1.

BOX 1.1 VULNERABILITY AND THE CODE OF PRACTICE FOR SOCIAL CARE WORKERS

As a social care worker you must respect the independence of service users and protect them, as far as possible, from danger or harm. This includes:

  • challenging dangerous, abusive, discriminatory or exploitative behaviour and using established processes and procedures to report it
  • taking complaints seriously and responding to them or passing them to the appropriate person
  • respecting confidential information and gaining permission from those it concerns to share it for specific reasons e.g. consultation with managers or other members of the care team
  • recognising the potential for power imbalances in working relationships with service users and carers and using authority in a responsible manner
  • following practice and procedures designed to keep you and other people safe from violent and abusive behaviour at work.

As a social care worker you must, to the best of your ability, balance the rights of service users and carers with the interests of society. This includes:

  • taking necessary steps to prevent service users from doing actual or potential harm to themselves or other people.
  • balancing the rights of service users whose behaviour represents a risk to themselves or other people with the paramount interest of public safety.
Other aspects of the Code of Practice concern the importance of maintaining a professional focus, of keeping up to date in terms of knowledge and skills and of consultation if circumstances change which may make practitioners less able to complete their role. The centrality of good practice and not abusing, harming or exploiting service users in any way is stressed. The Code promotes anti-discriminatory practice as a key element here.
However, it is not just social workers and social care staff who are subject to a Code of Practice. The second Code of Practice produced by GSCC sets out its expectations for employers. The details of this Code are also relevant to work with vulnerable adults and abusive situations. The importance of ensuring that social care practitioners are suitable to work with people in care settings is highlighted. This includes completing various checks but also refers to supporting the continuing training and development of staff in order to meet service users’ needs and also to ensure that practice is safe.

ACTIVITY 1.2

Consult the GSCC website and compare the two elements of the Code of Practice – one for employees and one for employers (www.gscc.org.uk). Identify those aspects of the Code of Practice for Employers that could have an impact on the protection of vulnerable adults and consider these in the light of the Code of Practice for Employees. What are the similarities and implications for practice?
Importantly, the Codes recognise that social care practitioners may act abusively. Unfortunately, they do not explicitly acknowledge that social care workers may themselves experience abuse or be abused by other individuals, including service users, their agency or the roles and tasks prescribed to them. This is something admirably dealt with by Jack (1994), who argues convincingly that many of the workers who are marginalised and excluded in terms of pay and conditions, and who are often women, work with the most vulnerable and excluded people within care settings. Jack argues further that the power differentials within such settings may lead to abusive situations arising.
As we will see in Chapter 3, legislation has been implemented f...

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