Prot ect ing People Unit Workbook

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Below is a list of outcomes you can expect to work towards in this unit. ..... now turn to consider some of the ways the new social care practitioner can play his or ...... (1986) Elder Abuse: Conflict in the family, Auburn House, Dover, ... 5th International Family Violence Research Conference, Durham, New Hampshire, Family.
ACCOUNTABLE SOCIAL WORK

Protecting People Unit Workbook

Jonathan Parker and Bridget Penhale

ACKNOWLEDGEMENTS Protecting People Written by:

Jonathan Parker and Bridget Penhale

Edited by:

Dr Raymond Jack

Open learning editing by:

Tim Burton

Reviewer:

Dr Patricia Higham

© Open Learning Foundation Enterprises Ltd 1998 The views expressed are those of the team members and do not necessarily reflect those of the Open Learning Foundation. All rights reserved. No parts of this work may be reproduced in any form, by photocopying or by any other means, without permission from the Open Learning Foundation.

Ordering If you would like to receive further details about the DipSW series, please contact the Open Learning Foundation for a copy of our catalogue. All DipSW materials are available on licence to OLF members. Enquiries and orders for licences should be made to: The Programmes Assistant Open Learning Foundation 3 Devonshire Street London W1N 2BA Tel: 0171 636 4186 Fax: 0171 631 0132 All other enquiries should be made to the Publishing Manager.

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CONTENTS Unit Objectives

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Introduction

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Learning Profile

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Session One: The Concept of Protection Session Objectives Introduction What is protection? Taking action to protect Care and control Legislation, policies and procedures for protection Prevention in social work and social care Training and management for protection Summary

Session Two: Ethics, Tensions, Care and Control Session Objectives Introduction Why are values important in protection? CCETSW value requirements BASW Code of Ethics, 1997 Protection or self-determination? Protective responsibility Accepting and rejecting help Personal, professional, social ethics Summary

Session Three: Protecting Children and Young People Session Objectives Introduction Legislation in child protection Theories used in child abuse Assessing and balancing risks The symptoms of child abuse Making effective interventions Protecting children in care Direct work with abused children Evaluating change Summary

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9 9 9 10 12 13 15 17 18 20 23 23 23 24 24 26 28 29 29 30 31 33 33 33 34 36 37 38 38 40 42 44 46

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Session Four: Protection for Vulnerable Adults Session Objectives Introduction Social work and social care with vulnerable adults Understanding domestic violence Intervening to protect vulnerable adults Legislation and domestic violence Reviewing and evaluating protection Summary

47 47 47 48 48 54 58 59 61

Unit Summary

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Learning Review

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References

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Further Study

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UNIT OBJECTIVES By the end of this unit you will be able to: describe the main features of protection and its place in contemporary social work

analyse the ethical tensions involved in social work’s dual role of care and control

place the role of social work in protecting people in the contexts of other professional roles and the wider expectations of society

identify protection needs when working with children and young people and relate these to social work practice

identify vulnerability in adults and design a practice framework for protection

describe how social work can be protective in situations of domestic violence and apply your knowledge to practice.

INTRODUCTION This unit contributes to the module Accountable Social Work. The titles of the six units which make up the module are: Assuring quality Creating and sustaining quality social work environments Working in partnership with people Protecting people Supporting people Working across disciplinary, professional and organisational boundaries. Some of the activities in this unit ask you to visit a library or in other ways search out information. You will need to be prepared to take time out to do this. We also need to stress that the material to which you will be introduced in this unit is not sufficient in itself to prepare you for all forms of practice in the areas of protection. It is introductory only and will provide an overview of some of the many complex issues involved. It would be useful if you were to read Preventing Family Violence by Browne and Herbert (1997) alongside this unit. It contains many valuable insights into prevention and protection from harm and danger and does so from the perspective of many helping professionals.

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LEARNING PROFILE Below is a list of outcomes you can expect to work towards in this unit. You can use it to identify your current knowledge and to help you decide how the unit can develop your learning. The profile is for your general guidance only. It does not involve formal assessment by anyone else. For each of the outcomes listed below, please tick the box which most closely describes your current knowledge. This will give you a profile of your own learning needs, and will also introduce you to the areas covered by each session. Not at all

Partly

Very well







Session One I can: ● define protection in social work and social care settings ●

describe the differences and similarities between care and control









explain the importance of legislation in protecting people









explain the importance of good management systems for effective risk assessment









evaluate the need for and implementation of protection in social work and social care practice.







I can: ● explain the importance of social work and social care values ❏ in relation to protection





Session Two



apply a knowledge of social work and social care values to my professional practice in matters of protection









determine when risks outweigh rights









analyse a wide range of values, their sources and their impact ❏ on social work and social care practice







place social work and social care values in the context of other professional roles and values.













Session Three I can: ● identify the legal and statutory requirements for child protection ●

describe and critically analyse the main theories of child protection









assess the degree of risk, the need for protection and the need for support







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Learning Profile

Not at all

Partly

Very well

Session Three continued ●

design effective intervention to protect children and young people









evaluate social work and social care practice in child protection.







I can: ● describe the role of social work and social care when working with vulnerable adults









decide where rights are surpassed by risks









explain the importance of risk assessment in working with vulnerable adults









design and implement social work and social care interventions to protect vulnerable adults









review and evaluate protection practice with vulnerable adults.







Session Four

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SESSION ONE

The Concept of Protection SESSION OBJECTIVES By the end of this session you should be able to: define protection in social work and social care settings

describe the differences and similarities between care and control

explain the importance of legislation in protecting people

explain the importance of good management systems for effective risk assessment

evaluate the need for and implementation of protection in social work and social care practice.

INTRODUCTION In this session we introduce the concept of protection and consider its implications for social work and social care practice. We discuss the dual role of social work and social care in promoting change and self-determination while also being responsible for controlling and regulating some aspects of social life. We suggest that these roles are not contradictory but are complementary in practice which protects rights and reduces risks. The rest of this session deals with training issues and the need for good management systems. This is important because the roles and tasks of social work and social care demand an informed response that protects individuals, groups and communities while promoting rights. There is a need for social work and social care practitioners to learn about, use and evaluate risk assessment techniques. Towards the end of the session we will therefore look at evaluating the protective function of social work and social care and briefly review the legislation designed to protect people.

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WHAT IS PROTECTION? We all have some idea of what ‘protection’ means. It may be that the immediate image that comes to mind is of a vulnerable person, a child perhaps, who is in some kind of danger of harm or injury. The term carries with it a sense that the protector has the right, responsibility or power to protect and that the individual is in need of this protection. The concept of protection is therefore bound up with the rules by which society operates and through which individuals interact with one another.

ACTIVITY 1 Spend a few minutes thinking about the term protection. Write down two or three examples of the ways you have used or have heard the term being used both at work and more generally in daily life. If you have a colleague you can share your ideas with please do so. Do not worry, however, if you are working on your own.

Comment You may have written down examples from your knowledge of work in social work or social care, whether this is direct work experience or thoughts you have had about such work. This perhaps demonstrates that protection is considered a priority in these areas, and your awareness shows this. You may have chosen examples from a wider perspective, such as protecting society from violent offenders by imprisonment. Equally, you may have chosen an example from daily life – for example, speed limits and traffic wardens.

If we take a sample of the ways in which protection is used in social work and social care it becomes clear that it has two main meanings: ●

actions by individuals, families, communities and society to ensure that members are not harmed in the first place – which may be termed prevention



actions that ensure no further harm takes place after an initial act warranting protection.

Protection may therefore be both preventive and reactive (Bennett, Kingston and Penhale, 1997). Let’s look at each of these senses in turn.

Preventive protection Preventive actions may include:

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formulating rules and laws to protect from injury and harm



promoting policies and procedures aimed at increasing health and safety in the workplace

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The Concept of Protection: Session One



action by community groups designed to protect themselves from identified and perceived risks



the way families and individuals behave towards one another and for themselves.

ACTIVITY 2 Spend ten minutes on this activity. Think about the different laws and rules designed to protect people and write down a list of five that you feel are particularly important. Add a note explaining why you think they are important.

Comment Our own list would have included: ●

the Children Act 1989



the Mental Health Act 1983



the National Health Service and Community Care Act 1990



the Disabled Persons Act 1986



the Criminal Justice and Public Order Act 1993



the Family Law Act 1996.

These are all important and reflect different aspects of social life, although each concerns the protection of certain groups of people. The laws and rules you noted will have reflected your work experience and interests. It is important, however, to be clear in your own mind about what you see as protective and why you believe this to be the case. This will help when you come to practise as a social work or social care worker with people who have different values and differing needs for protection to your own. Refer back to this activity after completing Session Two.

Reactive protection Protection may also relate to taking actions to remove dangers and, at times, removing people from situations perceived to be a danger to them. One of us (Parker) remembers being asked to see a man in his early sixties who had dropped a cigarette on to his bedding. This had caused a small fire. Fortunately, he had not been badly injured. However, he also had severe memory impairment which was diagnosed as resulting from heavy alcohol use throughout his life. After a full assessment by an approved social worker in consultation with his GP and psychiatrist, it was decided that he was in considerable danger if he remained at home. A short period in hospital was arranged as the best possible way of assessing the risks and determining his future needs.

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Actions which are reactive and preventive Sometimes actions which are reactive may also be preventive through reducing the risks of future harm, as the following situation study illustrates. Situation study Minnie Bell has rheumatoid arthritis which particularly affects her hands and feet. She has been finding it increasingly difficult to use cooking equipment, such as the cooker and the tin-opener and to lift pots, pans and the kettle. Recently, she dropped a kettle of boiling water on to the floor, just missing her feet. Minnie was so shocked by this that she asked her GP for advice about it. The GP referred Minnie to the local social services team for adults who assessed her needs for support and assistance with daily living tasks. In order to protect Minnie from the risk of injury and harm, the social worker and occupational therapist provided a range of equipment such as a kettle-tipper, special tin-opener, and jar and pan grips. As Minnie was also beginning to have difficulty in turning on her gas cooker, special adaptations were made to the cooker. These actions helped to protect Minnie. They enabled her to use her kitchen safely and to remain in her own chosen environment without outside help from others who might take over these tasks and not allow Minnie to be independent. Loss of independence is one of the risks involved in protecting people.

TAKING ACTION TO PROTECT Social work and social care workers frequently act to protect people from harm or danger to themselves. The following activity will help you to consider what this action may involve.

ACTIVITY 3 Allow five minutes for this activity. Try to recall a situation which you know about from your experience or reading where social work and social care workers have acted to protect people. Write down the protective features and the reactive features of this action.

Comment You may have written about people who have been protected from other people, whether relatives, friends or strangers. Alternatively, you may have focused on measures taken to make situations safe and manageable for the future.

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The Concept of Protection: Session One

One person considering this activity looked at the way people could be protected from actions through which they placed themselves at risk. This included the removal of someone with a severe mental illness from a situation of extreme physical danger, in which the person was unaware of the risks because of illness. In this case the worker was reacting to a situation, but as result began to plan a longer-term, preventive strategy. This activity has highlighted another dilemma in protecting people – that of care and control. In the next section we will discuss the kinds of people who need protecting and then look at the types of situation in which protection may be required.

CARE AND CONTROL In social work and social care, protection is generally associated with children and families, but it is also used in connection with: ●

adults who are vulnerable because of a physical disability, mental health problem or a learning disability



older people who may be subject to maltreatment and neglect



people who may, by their own actions or neglect of themselves, put themselves at some degree of risk of harm or injury.

So people need protection for a wide range of complex reasons and we must beware of falling into the trap of labelling people as vulnerable and in need of protection solely because of their physical or mental characteristics. It is important to see the whole person – not just their ‘disability’ – and to take into account their perceptions and understanding of the situation.

Care versus control Social work and social care workers offer protection in ways which can be seen as both caring and controlling. For example, they may seek to provide services and help to people which allows them to make choices in a safe and enabling way and to maintain a life style of their choosing. But they may also be responsible for controlling actions which at times prevent people living in the way they would choose. An example of these ambiguities is contained in the following situation study. When reading this and other situation studies you will probably find it helpful to write brief notes of the relevant points. Situation study James, aged 14, lived with his father since his parents separated two years previously. It was noticed that he was becoming increasingly withdrawn at school. His teachers tried to talk to him but received either no reply or a torrent of verbal abuse. The school contacted his father who told the school that he was finding it difficult to manage James’s behaviour and believed he could no longer look after him.

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James then reported that his father had begun to hit him with a belt on a regular basis. The school informed social services who investigated these concerns. James did not wish to leave his father but it was decided at a multi-disciplinary case conference that he was in need of a more structured and less violent environment. In this case, it transpired that James’s wishes were not followed because of the concerns for his physical and emotional safety.

ACTIVITY 4 Spend five minutes completing this activity. Think carefully about the situation study you have just read. Make a brief note of aspects of this situation which involve: ●

care



control.

Comment Under ‘care’ you may have written about the school’s concern for James’s health and behaviour. They cared enough to inform social services about his situation and need for protection. Under ‘control’ you may have noted the investigation and subsequent safety planning carried out on James’s behalf.

Let’s think a little more about the tension between care and control. Social work and social care practitioners are authorised by legislation to take action to ensure that people do not put others at risk and to protect people from danger, injury and harm. We have found that many people enter social work qualifying training because they want to ‘help’ people learn or recover the skills to live independently but do not feel comfortable with actions which might limit choice and freedom. On the other hand, social workers and social care workers may talk about empowerment and enabling people to function and participate in society but may act in a way which restricts freedom. These conflicts and dilemmas are found within all the varied fields of social work and social care practice and are not easy to resolve. In fact, care and control are intrinsic to social work and social care and are two sides of the same coin. We may enter a career in the helping professions because of a deep commitment to the care of vulnerable, disadvantaged and excluded people. This may demand a protective role in working to prevent exploitation at an individual, group or social level. However, it can also involve a degree of control in using the law to ensure that people are granted their rights, are protected from abuse and harm, and receive the care to which they are entitled. Let’s look at the role of legislation in more detail.

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The Concept of Protection: Session One

LEGISLATION, POLICIES AND PROCEDURES FOR PROTECTION Social work and social care workers are bound to work to legislation designed to protect individuals and society. All practitioners starting out in professional life need to have a basic knowledge of this legislation.

ACTIVITY 5 Allow ten minutes for this activity. See if you can compile a list of what you consider to be the three main pieces of legislation affecting the duties of social workers. This could include any legislation designed to regulate social life.

Comment You could have mentioned: ●

the Children Act 1989



the National Health Service and Community Care Act 1990



the Education Act 1993.

You could also have mentioned legislation concerning criminal justice. There are many other forms of legislation affecting the role and function of social care work. Let’s now review some of the more important of these.

Legislation to protect children ●

The Children Act 1989 outlines the duty to investigate and protect (sections 31, 47) and to offer services for children in need (section 17).



The Department for Education (1994) circular concerns a school’s ‘duty of care’ to its pupils, including setting a behaviour policy and a code of policy on bullying.



The Criminal Justice Act 1993 includes elements of protection. It is essential that risk factors and dangers are included in any pre-sentence report (PSR) written for the court. The recommendations made in the PSR will help to protect the individual and others from future criminal activity.

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Legislation to protect adults Adults may be vulnerable and at risk of abuse from others, and may put others at risk of harm by their actions. ●

The Mental Health Act 1983 and the more recent Mental Health (Patients in the Community) Act 1995 are designed to protect people with mental illness from harm or from harming others.



The National Health Service and Community Care Act 1990 provides protection for adults in need by entitlement to an assessment and services to meet identified needs.



The Sexual Offences Act 1957 offers protection to people from unwanted sexual advances.



The Protection from Harassment Act 1997 may offer protection from bullying and stalking.



The Matrimonial and Domestic Proceedings Act 1973 and Family Law Act 1996 offer some protection from domestic violence.

Adults who have been abused There is no single piece of legislation comparable to the Children Act 1989 which concerns the abuse of adults.

ACTIVITY 6 Spend five minutes thinking about why the legislation is different for adults and children and write down two main points.

Comment You may believe that ageism and discriminatory attitudes to people with physical and mental health problems prevent governments from passing legislation that adequately protects or meets people’s needs (Bytheway, 1994; Oliver, 1986). On the other hand, you may think that adults can make choices for themselves and that passing legislation may promote a more rigid and less enabling social work and social care response. These two views are not necessarily contradictory and, in fact, there is a range of legal measures available for work with adults, as we now note.

Legal remedies for the abuse and harm of an adult include:

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the National Assistance Act 1948, Section 47 allows for the removal of a person in need of protection



general measures concerning criminal assault or theft.

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The Concept of Protection: Session One

However, these tend to be remedies after the event, rather than preventive measures. Let’s therefore turn now to the issue of prevention.

PREVENTION IN SOCIAL WORK AND SOCIAL CARE Prevention is much talked about in social work, social care and allied professions as a way of working with people deemed to be in need of protection. Browne and Herbert (1997) identify three levels of prevention: ●

primary



secondary



tertiary.

Primary prevention This refers to policy and actions taken before harm and danger is apparent. An example would be the development of a community group for young parents at which participants can share and learn ways of parenting with each other and benefit from social support. This may reduce risks associated with isolation and may provide support before a protection issue is raised.

Secondary prevention This relates to people who might be identified as in potential need of protection. For instance, a man caring for a wife with a severe, long-term mental health problem who is unemployed, is socially isolated, under increasing stress and reliant on his wife’s disability living allowance, may well be thought to be in need of protection or at some degree of risk. A practitioner offering secondary preventive measures might suggest certain services and assistance to reduce need and stress before an abusive act demands further action.

Tertiary protection This involves providing services and intervention after an actual protection issue has been identified, for example, after an act of physical violence or emotional abuse has occurred. The objectives of acting at this stage are to reduce the risk of harm or danger in the future, for example, by removing a child or adult.

ACTIVITY 7 You will need to set a time in the future when you can carry out this activity, which involves a trip to you local library. In the meantime, you can continue with the section following the comment. Visit your local library and search through recent copies of your local newspaper. Find and note down reports about social care situations and decide what level of work is being reported in each case. Is it: ●

primary



secondary



tertiary?

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Comment While newspaper reports offer a particular slant on a story, you should be able to identify: ●

policy and development initiatives in local communities (primary preventive work)



examples of identified need that are reacted to before reaching crisis point (secondary prevention)



circumstances demanding a significant response to change a dangerous or risky situation (tertiary prevention).

TRAINING AND MANAGEMENT FOR PROTECTION Social care is not simply about the provision of direct care and protection to individuals. The delivery of quality care depends on clear policies and procedures designed to ensure that the services and care provided are the most appropriate, use resources effectively and represent good value for money. As a social care practitioner you will therefore need to be trained in the policies and procedures of your agency and the legislation which underpins them. These policies should lay down clear lines of responsibility and accountability, so that decisions are checked and authorised by staff with the training and experience necessary to make them.

Policies in practice An effective social care agency will not only develop policy and procedure directives. It will put these into practice by ensuring that practitioners: ●

comply with these directives



complete case records on time



share information with a line manager regularly and consistently.

ACTIVITY 8 Allow up to 30 minutes for this activity, depending on how easily you can access the information you need. 1

Compile a list of the policies and procedures of your agency which relate to issues of protection.

2

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For each policy or procedure, try to identify the legislation on which it is based.

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The Concept of Protection: Session One

Comment Your findings will depend on the organisation for which you work. It may be that you have mentioned policies such as the annual community care plan or a policy relating to ‘looked after’ children. You might have listed procedures on filing, case recording, responding to vulnerable adults, or the procedure for dealing with a request for a Zimmer frame. The Children Act 1989, the Mental Health Act 1983 and the National Health Service and Community Care Act 1990, will underpin many of the policies and procedures you have described. Others might have been taken from criminal justice legislation, adoption and fostering legislation or laws governing education.

Having reviewed some of the necessary management systems required to provide care, we must now turn to consider some of the ways the new social care practitioner can play his or her part in ensuring quality and safety for those people served.

Ensuring quality The provision of social work and social care is governed by legislation. They are commissioned by the State to help regulate and make better social lives for its citizens. The State passes laws and publishes guidelines to mark out the ways in which social work and social care operate. The policies and procedures set by individual agencies reflect their particular mission and field of operations. You will need to be fully aware of these in order to work as an accountable and effective employee. Social care practitioners cannot simply work according to their own preferred methods towards their own desired ends. Their responsibility is to carry out ethically the requirements of State and agency.

Evaluation procedures It is important for each practitioner to ensure that the plans they agree with service users are realistic. Working to clear, negotiated agreements, setting targets and goals and recording progress will help with this. It will also enable work to be evaluated at a later date, and demonstrates the individual practitioner’s commitment to accountability.

Supervision One essential way of ensuring quality and accountability in social care is through supervision. This helps the practitioner to: ●

share responsibility and information



develop new ways of proceeding



feel valued and supported.

Supervision also enables managers to gather information, identify learning needs and assess actions performed on behalf of the agency (Brown and Bourne, 1996).

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REVIEW ACTIVITY Spend 10 to 15 minutes completing this activity. 1

As a reminder to yourself, note down the three levels of protection, and make a note of what each involves.

2

With your list in mind, see if you can identify at least three dilemmas or tensions that arise in protection social work and social care.

3

Note three or four aspects of procedure and practice which can support you as you work to resolve these dilemmas.

Comment 1

2

3

The three levels of protection you have come across in this session are: ●

the primary level, before harm has occurred



the secondary level, where risks and dangers are recognised



the tertiary level, where harm has already occurred.

There may be tensions involving: ●

preventive and reactive approaches



care and control



the use of legislation



taking away independence by protecting.

Policies, procedures, training and good management systems – including effective supervision – are necessary to protect the social work and social care practitioner who is in turn working to protect other people.

SUMMARY In this session we have introduced the concept of protection, which has been described as being both reactive and preventive. Protection relates to reducing the risk of harm and danger, a risk which may be posed directly by other individuals, or indirectly through social disadvantage and exclusion. When social workers and social care workers act to protect they may act in both caring and controlling ways. While there may be some differences between care and control, we have suggested that they are similar in many ways; in fact, both are integral parts of the social work and social care task. We have seen that the social work and social care role and task in protection is determined by the State in its legislation on social issues and by the agency worked for and its mission. In order to function appropriately and effectively social work and social care practitioners need to be supported by clear policies and procedures and by systems of management that are supportive and

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The Concept of Protection: Session One

which encourage communication and accountability. Social work and social care practitioners gain much of this support and potential for future development through the supervisory relationship. In the next session we will look in more detail at the ethical dilemmas facing those who work to protect other people.

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SESSION TWO

Ethics, Tensions, Care and Control SESSION OBJECTIVES By the end of this session you should be able to: explain the importance of social work and social care values in relation to protection

apply a knowledge of social work and social care values to your professional practice in matters of protection

determine when risks outweigh rights

analyse a wide range of values, their sources and their impact on social work and social care practice

place social work and social care values in the context of other professional roles and values.

INTRODUCTION In this session we look at the importance of values in social work and social care where protection is an issue, and apply this in practical ways to the social work and social care task. We explore the difficulties arising in complex situations where there are high levels of risk yet where individuals express a wish to choose and determine their own course of action. Finally, we consider where values and standards come from and how your own values and attitudes may affect your work. It would be useful if you were to read Ethics and Values in Social Work, (Banks, 1995) in conjunction with this session. This excellent book provides a useful introduction to some of the ethical dilemmas in social work and social care and is written in a very readable way.

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WHY ARE VALUES IMPORTANT IN PROTECTION ? In the previous session we began to consider the way social work may be defined, in part, by its role and function to protect. Another definitive characteristic, as Reamer (1993) suggests, is that social work can be defined by the emphasis it places, throughout the world, on values and ethics for practice. The social work task implies that social workers have a responsibility to take action to protect people from harm and injury, whether this is from themselves, others or the way society itself conducts its affairs. It also suggests that individuals within that society have a right to be protected. This raises a number of ethical questions, including: ●

the rights people have not to be protected



the right to take risks



the right to privacy and self-determination



questions concerning the rights of professionals to limit the rights of others and to control their actions.

As we saw in Session One, social work and social care practitioners are bound by legislation to act in certain ways. However, as professionals, they are also bound by codes of standards and ethics. These are designed to ensure that basic principles concerning values are adhered to and that control, when necessary, is legitimate and warranted. Such values and principles include a need for commitment to the dignity of individuals and the ‘right to respect, privacy and confidentiality’ (CCETSW, 1995). Let’s look at these values in more detail.

CCETSW VALUE REQUIREMENTS CCETSW has identified six value requirements for social work and social care practitioners.

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Identify and question their own values and prejudices, and their implications for practice.



Respect and value uniqueness and diversity, and recognise and build on strengths.



Promote people’s rights to choice, privacy, confidentiality and protection, while recognising and addressing the complexities of competing rights and demands.



Assist people to increase control of and improve the quality of their lives, while recognising that control of behaviour will be required at times in order to protect children and adults from harm.



Identify, analyse and take action to counter discrimination, racism, disadvantage, inequality and injustice, using strategies appropriate to role and context.



Practice in a manner that does not stigmatise or disadvantage either individuals or groups. (CCETSW, 1995, p. 18)

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Ethics, Tensions, Care and Control: Session Two

These requirements recognise that an element of control may be necessary for professional practice, however they emphasise that respect for the person is paramount whether they need protection from others or from their own actions (O’Hagan, 1996; Horne, 1987).

ACTIVITY 9 Spend ten minutes completing this activity. Read the following situation study. Then summarise what you feel are the ethical tensions raised and explain what you might do in this situation.

Situation study Francine DuPont had been depressed since her husband committed suicide two years ago. She has expressed the feeling that she would probably be better off if she joined him. Having visited Francine, you believe that she is a strong-willed woman, acutely feeling her loss and looking actively for some way of filling ‘the gap’ left by this bereavement. She did not appear to be at risk of suicide. She has no plan and few means to actually kill herself and explained her statement by expressing how much she missed her husband and continued to feel a close bond with him. She requested that you do not visit again and that you do not share the content of your discussion with anyone else. Her daughter, a local councillor, has asked that you offer help immediately.

Comment Some of the ethical tensions might be as follows. ●

You may believe that everyone has a right to determine the course of their own life but there may be situations where this is not possible.



Your particular agency’s role and function may be at odds with your value base.



You may wish to respect Francine’s choices but your agency may demand certain actions.

What you might do in this situation is to: ●

explain the limits of confidentiality within your agency



use your lines of accountability and supervision



be familiar with the remit of the agency and explain this to others.

Whatever action you take you must carry it out sensitively and with respect for Francine’s wishes, as far as this is possible within statutory and departmental requirements.

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Having considered the values promoted by CCETSW and how these have a bearing on the practice of social work and social care, we will now turn to the ethical code of the British Association of Social Workers (BASW).

BASW CODE OF ETHICS, 1997 BASW has developed a code of ethics which members of the association should uphold. The code contains the values that are considered to be fundamental to social work. These are as follows. ●

Knowledge, skills and experience used positively for the benefit of all sections of the community and individuals.



Respect for clients as individuals and safeguarding their dignity and rights.



No discrimination exercised, nor tolerated in others, on grounds of origin, race, status, sex, sexual orientation, age, disability, beliefs or contribution to society.



Empowerment of clients and their participation in decisions and defining services.



Sustained concern for clients even when unable to help them or where self-protection is necessary.



Professional responsibility takes precedence over personal interest.



Responsibility for standards of service and for continuing education and training.



Collaboration with others in the interest of clients.



Clarity in public as to whether acting in a personal or organisational capacity.



Promotion of appropriate ethnic and cultural diversity of services.



Confidentiality of information and divulgence only by consent or exceptionally where there is evidence of serious danger.



Pursuit of conditions of employment which enable these obligations to be respected.

These values are important to the context of social work and social care in Britain, which concerns care, choice, protection and control. We will now consider the dilemmas for social workers and social care workers when balancing values and the need for protection.

Rights versus risks Although social work and social care is about caring for individuals it may, as we have seen, be necessary for professionals to exercise elements of control over individuals. Protection concerns the reduction of the risks and dangers of harm and injury to self or others. In order to protect an individual, some control over their actions may be required. However, respect for the person is fundamental, whether they need protection from others or from their own actions (Timms, 1983; Banks, 1995). It is possible to maintain respect for the individual even when some control over their actions is needed.

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We must also not forget that people may receive protection as a right. The next activity asks you to think about some of the dilemmas posed by BASW’s values statement.

ACTIVITY 10 Spend about five minutes making brief notes on: ●

two situations in which a person may receive protection as a right



how these situations might involve aspects of BASW's code of ethics



what personal values of your own are important in these situations.

Comment You could have noted that people may receive protection: ●

when it is determined that they are not in a position to care adequately for themselves



when they are in need of health care



when they pose a danger to other people.

BASW is clear about the need to encourage, enable and empower in its code of ethics. This does not mean, however, that people are not offered protection when the need outweighs the right to refuse services. The present activity asks you to look at your own values and attitudes also. You may feel that people have an absolute right to decide for themselves. However, you may believe that under certain circumstances, such as severe mental illness or chronic self-neglect, people, should be protected from themselves and their own actions. Perhaps this is because you would like to be treated in such a way yourself or because you believe the greater good of society is more important than an individual’s rights.

We have seen, therefore that there are dilemmas in assessing the need to take action to protect and the injunction to respect the wishes of the individual. In the next section we will look in greater depth at issues of protection, and individual choice or ‘self-determination’.

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PROTECTION OR SELF-DETERMINATION? One of the crucial difficulties for professionals is how to achieve and maintain a balance between the protection of the individual and the right to self-determination (Banks, 1995). Adults have the right in most instances to be autonomous. It is quite possible for professionals to work hard with the individual to determine both their needs and appropriate treatment options and for the person to then refuse such offers. For example, Fulmer and O’Malley (1987) found that older people preferred independence over safety and protection whenever possible. Risk-taking was seen very much as part of daily life for elders and the ability to take risks was viewed as an essential and necessary part of growing older. Preserving independence and autonomy is critical for a significant number of people as they grow older, and – despite the dilemmas it raises – social workers and social care workers must try to ‘stand in the service user’s shoes’. There is some evidence that people are aware of the difficulties which social work and social care practitioners face in these areas. People know that social workers have to act to protect individuals on occasion and expect them to do so (Harding and Beresford, 1996). Researchers have found, however, that sometimes social workers and social care workers are seen as over-protective and unwilling to allow risk-taking. This is considered to be disempowering for the service user. The opposite view, that at times social workers and social care workers do not act soon enough to protect children, in particular, and take too many risks, has also been taken by certain groups (Harding and Beresford, 1996). The following activity asks you to reflect on the dilemmas resulting from the need to protect and the need to respect people’s wishes.

ACTIVITY 11 Spend ten minutes completing this activity. 1

Think of a situation in which social workers might act to protect people and be accused of acting too hastily or not soon enough.

2

Write down your thoughts and feelings about the ethical questions raised for you.

Comment You may have chosen situations similar to the following.

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A child of seven who was left for up to three hours on her own at night while her parents went drinking.



A woman of 76 with dementia who was locked in her bedroom during the day while her daughter, who cared for her, went to work.



A scenario in which a person has spoken of his desire to ‘end it all’ and is reported as hoarding sleeping tablets.

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Your thoughts and feelings about the ethical questions will be specific to you and your own value base. However, it is important to remember the values underpinning social work and social care and to be aware of how these may influence your decisions. It is also important to remember that social workers and social care workers often have legal obligations to fulfil and that these will necessarily determine the speed and type of response made. For example, a call relating to the seven-year-old would lead to an investigation by social workers and police and would be likely to be treated with some urgency. It may be that a less rapid response would be made to the older woman and her daughter. Also, if the people involved refused to cooperate with an investigation or assessment, legal measures would be possible in the first scenario, whereas in the second this would be much more difficult.

Practitioners do, however, need to know when it is necessary for them to act in terms of ‘protective responsibility’ towards a vulnerable adult or their carer (Stevenson and Parsloe, 1993). The next section will introduce this concept.

PROTECTIVE RESPONSIBILITY There are a number of distinct aspects to the concept of protective responsibility. These are as follows. ●

The practitioner must act, on occasion, in a way that is protective towards the person.



Such actions must be thoughtful.



They should assist and empower the person rather than demean and disempower them.



Actions should not create unnecessary dependency.



Practitioners have a moral duty to be protectively responsible towards their service users.



Vulnerable adults do sometimes refuse offers of help and express their rights to be selfdetermining.

We will now turn to issues stemming from accepting and rejecting help.

ACCEPTING AND REJECTING HELP People may sometimes refuse offers of assistance and support initially but then return at some later point for further information and assistance. It is crucial, therefore, to achieve sufficient groundwork during that first contact to enable the individual to feel they can come back in future.

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ACTIVITY 12 Allow five minutes for this activity. What kinds of information might it be useful to provide to a service user on their initial contact? Make a short list.

Comment You could have suggested: ●

an explanation of abusive situations (in general terms)



the systems for assistance and support that might be available



support networks for the person that might be called on in the future (safe people; safe houses; safety routes)



how to summon help and assistance.

PERSONAL , PROFESSIONAL , SOCIAL ETHICS It is important to remember that in social work and social care practice, your own beliefs and values often influence the approach you take, and that some may stem from social values and ethics to which not everyone would subscribe.

ACTIVITY 13 Spend five minutes or so thinking about where your own values and standards have come from. Make a brief list of the main sources of your values and standards.

Comment You may believe that your main influences come from your upbringing and family. They also come from friends at school and work. It is also likely that many of your assumptions about behaviour and ‘right and wrong’ are not questioned, but accepted from the dominant viewpoints and accepted standards in society, the media, education and religion. This does not mean that your values are in any way invalid. But it is important to be aware of their source and to be ready to question and reflect on your assumptions and to understand that others may not ‘take them for granted’ as you do because they derive their values and standards from different – but equally valid – sources.

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REVIEW ACTIVITY Spend about 10 minutes on this activity. Check back through the main points covered in this session and compile a list of the main ethical questions we have raised.

Make a note of any issues you would like to discuss further with colleagues or with your tutor, and if possible commit yourself to a time when you will do this.

Comment We will not comment directly on the activity, since you can double check your notes against the material in this session. Instead we offer some further thoughts about the significance of the questions you have identified. Social care practitioners need to perform a balancing act between the rights of individuals to live in their chosen manner and the need to protect people according to the laws of the country and values of social work and social care. This raises potential hazards. Practitioners may be seen as rigidly prescriptive, in ordering and regulating people’s lives and may be seen by some as denying the rights of different cultures. Social workers and social care workers must be sensitive to and accepting of difference. The profession’s code of ethics is therefore important. The value base of social work and social care reflects professional thinking and it is important for all practitioners to subscribe to it. Decisions about intervention are based not only on what we think as individuals or what society at large suggests is a right and proper course to take. In social work and social care, it is essential that actions are taken that respect the rights of individuals as far as possible while recognising that some risks cannot be taken and that control is necessary. There is a delicate balance and tension between rights and risks in all situations encountered by social care workers.

SUMMARY This session has considered some of the fraught ethical dilemmas facing individual practitioners in social work and social care. We have introduced the importance of values within social work and in particular to issues of protection and begun to explore the difficulties arising in complex situations where there are high levels of risk and where individuals express a wish to choose and determine their own course of action. We have also looked at where values and standards come from and how our own values and attitudes may affect our work.

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SESSION THREE

Protecting Children and Young People SESSION OBJECTIVES By the end of this session you should be able to: identify the legal and statutory requirements for child protection

describe and critically analyse the main theories of child protection

assess the degree of risk, the need for protection and the need for support

design effective intervention to protect children and young people

evaluate social work and social care practice in child protection.

INTRODUCTION This session begins by looking at the importance of legislation in child protection work. Following this, we take a critical look at theories used in child protection, stressing the importance of assessing risks and examining the need for protection in context. We also look at ways in which you, as a social worker, might intervene to protect children and young people. Do bear in mind that everything we will be recommending in this session is in the context of an overriding need for effective management systems. Practitioners working in residential settings often find themselves at the sharp end of child care need. If they are to intervene effectively in the lives of children and young people who have experienced abuse it is vital for them to aim for clarity, good record-keeping and inter-professional collaboration. Remember also that this unit is intended to be an introduction to the issues involved in protecting people, not a comprehensive guide to practice in this context.

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LEGISLATION IN CHILD PROTECTION Social workers are required to practise according to the provisions of the Children Act 1989. Since they adhere to local child protection committee guidelines they are obliged to follow the legislation from which these procedures derive. The act makes it clear that: ●

social workers should work in partnership with children and families



no order will be made unless it is considered to be absolutely necessary



support will be made available to children in need.

However, it also recognises that children may need protection when they experience ‘significant harm’.

ACTIVITY 14 This activity should take you no more than five minutes. Think about the term ‘significant harm’. Make a brief note of what you think it means before continuing.

Comment ‘Significant harm’ is an imprecise term. This imprecision is to some extent deliberate, since in using it social workers are expected to take into account the child’s and family’s context and expectations. The closest we can come to an exact definition is: ●

harm which is of such a nature and severity as to warrant action



harm that would not normally be expected by the child.

Definitions of child abuse Included in our understanding of significant harm would be incidents of child abuse. The Home Office indicates four categories of child abuse under which a child or young person may be placed on the child protection register kept by local authorities in order to alert professionals to cases where risk has been identified. 1 Physical injury Actual or likely physical injury to a child, or failure to prevent physical injury (or suffering) to a child. 2 Neglect The persistent or severe neglect of a child, or the failure to protect a child from exposure to any kind of danger.

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3 Sexual abuse Actual or likely sexual exploitation of the child or adolescent. 4 Emotional abuse Actual or likely severe adverse effect on the emotional and behavioural development of the child caused by persistent or severe emotional ill-treatment or rejection. (Home Office, 1991, p. 48) These forms of abuse tend to overlap. For example, sexual abuse and physical abuse are always accompanied by emotional abuse and within each type of abuse there is a continuum of severity (Browne, 1995).

The Children Act 1989 Social work and social care practitioners not only need to gain knowledge about abuse and harm, they also need to be aware of the legislation designed to protect children and young people. Whilst there are many acts governing the welfare of children and young people, the most significant of recent years, which draws together many aspects of previous legslation, is the 1989 Children Act. The Children Act 1989 makes it clear that the child’s welfare is paramount and sets out the local authority’s duties to cater for children in need. The Act aimed to strike a balance between the rights of children to express their views about decisions affecting their lives, the rights of parents to exercise their responsibilities to parent children, and the need for the State to intervene when the child’s welfare demands it. Let’s look at these points in a little more depth.

Duties towards children Schedule 2 of the Act, relating to ss. 17, 23, 29 in particular, sets out the local authority’s duties to take preventive child care measures. These include providing services to prevent children suffering ill-treatment or neglect. This approach, termed primary prevention, tries to ensure that services are provided before the need for protection from actual or potential harm arises.

Duty to investigate Section 47 of the Act sets out the circumstances in which a local authority is bound to investigate, prior to deciding whether any further action should be taken. An investigation must determine the circumstances, needs, and wishes of the child and others involved and whether or not there has been or is likely to be significant harm. Then a decision as to future action may be taken which, in the terms we discussed in Session One, would involve secondary and tertiary protection. Having briefly looked at the legislation, let’s now turn to consider the nature of child abuse itself, starting with the theoretical background to current work in this area.

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THEORIES USED IN CHILD ABUSE In the 1960s and 1970s, attention focused primarily on the medical and physical aspects of abuse (Kempe et al., 1962). This established some degree of credibility and professional legitimacy for the idea that parents and other carers could and did injure or deliberately harm children and had important implications for policy responses to the problem (Parton, 1985). In the 1980s concerns centred on child sexual abuse. Feminist analyses took issue with the medical model of child abuse in terms of its focus on symptoms and psychological causes and instead drew attention to the influence of power imbalance in family systems and social structures (Dominelli and McLeod, 1989). Adult abusers were generally seen to be male, and their victims were young people who were generally girls and young women. These analyses highlighted the process of male socialisation, which was believed to encourage predatory and exploitative male attitudes and behaviours.

Models and causes of child abuse Browne (1995) presents four distinct models for describing the causes of child abuse. ●

Social and environmental focused models. These models relate to social exchanges between individuals and groups and suggest that power is used in the family to ensure the maintenance of male influence and control.



Individually focused models. These include the psychopathological perspective, which attributes the cause of abuse to individuals and their mental disorder, and the social learning perspective in which actions – which may well be harmful to others – are repeated for the positive gains received by the perpetrator, for example receiving more attention, or feeling more powerful in relationships.



Interaction focused models. These explain abuse in terms of the complex interactions between people and their environments.



Integrated models. These attempt to draw together a wide range of theories and perspectives.

These models can be useful when working with people who have suffered from or perpetrated abuse. If the abuse takes place in the context of certain ways of communicating – for example, violence as a way of communicating anxiety about the relationship – or is the result of a range of stresses and ill-health, then action can be taken to change these circumstances.

ACTIVITY 15 This activity should take you about ten minutes. Read the following situation study. Then answer the question that follows it.

Situation study The parents of Padraig, aged ten, had a long history of violence between themselves and towards neighbours. They stated that they had been victimised by people in their

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area and that their neighbours had been influenced by the comments of their previous neighbours who for no good reason harboured a grudge against them. They complained that this process was happening again when Padraig was taken into care after being beaten by his father with a belt for stealing a packet of cigarettes. His father said that he wanted to teach his son some discipline and respect in the same way that his own father had done and that he could not afford to pay out for his son’s cigarettes as well as his own. Which (one or more) models of child abuse do you think would be most helpful in working with this situation? Make a note of your response.

Comment There is no single correct answer to this question. What is important in a situation of this kind is to carefully consider the contribution that each perspective can make. For example, you might consider that the father's referrence to his own upbringing would suggest that social learning theory could be helpful in understanding his abusive behaviour (the individually focused model). Alternatively, the social and environmental model could be relevant in view of the importance the family seem to attach to their relationships with their neighbours and possibly the wider community. Depending on your point of view you may then wish to emphasise in your assessment and eventual intervention plan social and environmental factors, stress factors or individual factors. However, given the complexity of this kind of situation, it is probably best to consider the relevant impact of each factor and look towards an integrated model for explanations and to guide interventions.

ASSESSING AND BALANCING RISKS A recent report, ‘Child Protection: Messages from research’, attempts to draw together the main messages from research in a way that is accessible to practitioners and policy makers (DoH, 1995). The report describes what normally happens in families and assesses the long-term effects of different parenting styles. Research findings indicate that most parents have hit their children at some point. In the study carried out by the Department of Health, 81 per cent of parents reported having hit their children but half of these believed they should not do so. This research demonstrates the common occurrence of physical punishment and the – apparently contradictory – social attitudes towards it held even by those who perpetrate it. This may suggest that physical chastisement does not lead, in the majority of cases, to long-term damaging effects and that, as a corollary of this, the context must be taken into account alongside factors such as severity and duration.

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Studies of sexual behaviour in families also indicate that the presence of sexualised behaviour appears to be fairly common and accepted within degrees and is not necessarily an indicator of abuse. Again, it is the context that is important (DoH, 1995). Evidence points to duration and severity as possible indicators of poor outcomes for children and indicates that within warm and supportive environments, occasional physical punishments are unlikely to lead to long-term negative effects. Research evidence used in the Department of Health study indicates that it is not only in highly controlling situations that children experience abuse but also in situations of low control and discipline when a parent ‘snaps’ and reacts to the child’s behaviour. The main indicators are that low warmth and high criticism families lead to emotional harm over time. Let’s now look at what the specific symptoms of this harm may be.

THE SYMPTOMS OF CHILD ABUSE ACTIVITY 16 Allow between 10 and 15 minutes for this activity. From your knowledge and experience of children and young people you have worked with or read about, list the ways in which experience of abuse – whatever that abuse may be – can affect people. Aim to note down up to six symptoms.

Comment You may have listed a range of different effects depending on the type of abuse. The effects seen are often fairly similar and include: ●

stress



alertness and arousal



intrusive thoughts



aggression



flinching



avoiding the subject of abuse



dreams and nightmares about the abuse



developmental delay



fine or gross motor skill delay.

In the older child, effects include:

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anger



depression



anxiety

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dissociation



repression.

It’s unlikely that you will have included all these points – we only asked you for six. We suggest you think carefully about those you have omitted however, perhaps asking yourself whether this points to a gap in your understanding of some aspects of abuse stemming from either a shortfall in professional knowledge or perhaps – and this is not uncommon – an emotional reluctance to confront some aspect of abuse. If you do feel there is a gap, then you should discuss this with your tutor or in your supervision sessions with your manager. He or she may be able to suggest ways of building up your knowledge or help you to reflect in a safe environment on some of your feelings about abuse.

MAKING EFFECTIVE INTERVENTIONS While it is clearly important to be aware of the symptoms of abuse, this is in itself no guarantee of an effective intervention. Lloyd (1995) reports two cases which demonstrate the clear need for social workers not only to understand abuse but to develop effective strategies for tackling it when it occurs. ●

Toni Dales aged three years died in 1992 at the hands of a man with a long history of violence towards women. Social services did not contact the family after receiving information from police and probation. Nursery staff noticed disturbed behaviour.



Sukina Hammond, aged six years, was killed by her father, who attacked her mother previously by tying her to a chair and beating her for hours. (The case conference minutes described this as ‘a domestic incident’.)

ACTIVITY 17 Allow about five minutes for this activity. There may well have been a lack of understanding of symptoms of abuse here. But what other factors do you think might have been responsible for the absence of an effective statutory response in these situations?

Comment You could have suggested: ●

a lack of communication and information sharing



a reluctance to intervene.

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The second of the two factors raises issues which we discussed earlier about the dilemma social workers face about over or under reaction to such situations and reluctance to intervene needs to be understood within this context. Early intervention is vital, but this intervention should be in the best interests of the child. There should not simply be a rush to remove the child from the situation. Farmer and Owen (1995) state that one of the most important questions in child protection and child care is to ask whether or not it is necessary to separate the alleged abuser and the child or young person. In their study of child protection practice: ●

seven alleged abusers left the family home



in four cases the children were removed into care



in two cases both the alleged abuser and the child left the home situation



in two cases the alleged abuser and child or young person remained together.

Of the six children who left, two were still in care twenty months after the initial allegation was made, while the other four had returned to the non-abusing parent. The experience of care was not well-received by these children. This study has important implications for training, policy and practice for working with children who have been abused. It underlines the need for effective and constructive intervention and help in resolving some of the issues associated with abuse, and cautions against simply removing the child as a matter of course (see Frotheringham et al., 1993, and Sharland et al., 1993).

The role of assessment In 1988 the Department of Health published its guide to undertaking and compiling a comprehensive assessment of the needs of and risk factors in child care and child protection work. This is popularly known as ‘the orange book’ (DoH, 1988). The guide proposes a systematic approach to assessing both child and family. At the end of the assessment there should be clear understanding of child and family, and this should be evaluated and used as the basis for an action plan. Both the assessment and the plan must be shared openly and honestly with the family.

PROTECTING CHILDREN IN CARE One aspect of any decision about whether to remove a child or young person from his or her family is the recognition that abuse can occur in situations outside the family of origin. Practitioners need to be aware of the possibility of abuse by other children, visitors and members of staff in residential care, and, indeed, foster care. The Home Office, Department of Health, Department for Education and the Welsh Office (1991) have produced guidelines concerning protection from abuse in care. These guidelines insist that: ●

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there must be clear policies and procedures that openly recognise the possibilities for abuse in residential settings

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these policies and procedures must be open to consultation and scrutiny



since the reporting of concerns by children and staff is important in the prevention of abuse, procedural documents need to be clear.

ACTIVITY 18 Allow about ten minutes for this activity. 1

It could be argued that the above guidelines have a down-side. Can you suggest what this might be?

2

What do you think might be done to encourage openness while minimising this down-side?

Make a note of your ideas before continuing.

Comment 1

You may have noted that children and young people could take advantage of such a system to ‘get at’ a member of staff they do not like. This is certainly possible and you may know of cases in which this has happened. You may also have suggested that a wider ‘culture of complaint’ could develop which may fuel antagonism and confrontation. There is, however, a tendency to label children and young people in residential settings as trouble-makers rather than children and young people in need (Harris and Timms, 1993). If this understanding leads to a culture in which abuse is tolerated or ignored because of a concern for staff, these children and young people are further abused. The transparency and fairness of policies and procedures suggested by the Home Office et al., (1991) will help prevent this.

2

Good practice could be promoted by: ●

encouraging outside contacts



providing access to telephone helplines and approved visitors



reassuring residents and staff about the positive contribution these procedures can make.

These will all help in creating openness and minimising the potential for abuse to take place. Another helpful corollary is that they will allow a child or young person to make a complaint without fear of being exposed, prevented or intimidated. Also, reassurance needs to be given to staff and residents about the importance of such reports.

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Let’s now turn to consider ways of working with children who have been abused.

DIRECT WORK WITH ABUSED CHILDREN When working with abused children, the role of the social worker and social care worker is partly to allow the child or young person to understand what has happened to him or her. The practitioner needs to value the child or young person and needs to listen to him or her. For example, he or she needs to: ●

keep promises



stick to arranged appointments



call the child by his or her preferred name.

Where the child or young person finds it difficult to communicate directly, the practitioner may use play or stories to encourage communication. Moore (1985) reminds us that it is important to allow the child or young person to relate his or her story in his or her own particular way. The practitioner’s role is to prompt, to repeat, and to echo or ‘reflect back’. It is not to interpret.

Groupwork Groupwork can reduce isolation and help to develop therapeutic peer relationships. However, Salter (1988) adds the caveat that group treatment and therapy may not always be feasible because of the limited number of children involved at any one time.

ACTIVITY 19 Allow yourself 15 minutes to complete this activity. 1

What do you think are the benefits of using groups as a medium to explore painful issues?

2

What possible drawbacks may there be?

Make a note of your responses before continuing.

Comment 1

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You could have suggested that groups: ●

enable children and young people to see they are not alone in having experienced abuse



model new and more adaptive ways of coping



are a cost-effective way of providing a therapeutic intervention.

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2

The possible drawbacks are that: ●

● ●

a child or young person may not wish to disclose painful memories in front of others an individual may feel inadequate if others appear to be coping better. a group may evolve in which the needs of members in relation to their abuse are overtaken by other matters – such as the struggle for dominance in the group which can occur between members.

It is important to offer support and encouragement to staff undertaking groupwork. Where problems arise this does not necessarily mean that the group is being ineffective – it may simply indicate the need for a change in direction, composition or style.

Individual work Severely distressed and hurt children may need individual work to give them sufficient self-esteem to deal with and to join in groupwork. Salter (1988) presents seven important issues that need to be addressed when working therapeutically with children who have experienced sexual abuse. These are: ●

perceptions of safety



empowerment



expression and ventilation of feelings



education about sexual offences



sex education



assertiveness and communication skills



guilt, trust and ambivalence.

While the order in which these seven issues are tackled may vary, Salter does stress that a child’s perception of safety must be one of the first concerns facing the therapist – hence its position at the top of the list. For any work with children, play can be used to good effect, especially in developing a trusting relationship (see Ryan, 1995; Rasmussen and Cunningham, 1995; Grubb, 1994). Since play binds together a child’s actual and symbolic experience of the world, the practitioner must be open to the meanings of the symbols as they are used by the child. Practitioners need to be well trained and effectively supervised to work with children directly on these issues. This session is intended to help you to increase your awareness of the issues and interventions available and to encourage you to seek opportunities to further your professional development. It is not offered as a guide to practice in this complex and often contentious area.

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EVALUATING CHANGE Let’s conclude this session by looking briefly at how the success of child protection work can be evaluated.

Assessment If you carry out a comprehensive assessment of risk and factors causing concern at the outset, it is easier to determine whether or not change has taken place throughout your work with that child or family. However, it is also important to bear in mind that assessment is a continuous process as much as it is a product, for example, in the form of a report for a case conference or the courts (Coulshed, 1991; Middleton, 1997).

ACTIVITY 20 Spend about ten minutes on this activity. What do you think are the main factors you need to assess in your first encounter with a situation of child protection? Write down your thoughts in one or two short paragraphs.

Comment You have perhaps pointed out the need to consider significant harm and what this means for the particular child or young person in question. However, your assessment will also depend upon your agency’s role and function. A local authority social worker with investigation duties will look for initial signs of abuse and consider the need for protection. On the other hand, a family centre worker may focus on acceptance of responsibility in the parents, the relationships between family members and interactions between parents and child. The orange book serves as a useful guide to assessment. However, do bear in mind that each situation is unique and that individual family characteristics need to be understood.

Setting goals and targets One of the clearest ways of being able to evaluate whether change and progress occurs is to negotiate goals and targets with a family concerning the safety of the child in question. If this is done at the outset it can act as a baseline from which to measure any subsequent change. For instance, it may be that problems with interaction and stimulation are thought to be contributing to a child’s temper outbursts and emotional deprivation. You might negotiate with the parents to spend an unconditional 30 minutes each day playing with the child. The interactions

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during this period can be monitored and a note made of any changes that occur during, or following, the play.

ACTIVITY 21 Spend five minutes completing this activity. There are problems with this negotiated way of monitoring change, however. See if you can list two of these.

Comment You could have noted problems such as the following. If the process of monitoring the achievement of targets and goals is left to the social worker, it can be costly and time-consuming. If the process is left to the service user, records may be given a positive spin to get the social worker ‘off their backs’.

Meeting agency targets It may be that your agency has its own organisational targets. These might include, for example, a reduction in the numbers of children placed on the child protection register or receiving social work or social care support. A count of numbers over time can be taken to show whether or not these agency targets have been achieved. However, there are dangers in attempting to measure outcomes in this way. For example: ●

economic decisions may adversely influence the need for continuing protection or contact with a social worker or social care worker



work may be completed too hastily



referrals may be made to supportive agencies before protection issues have been resolved and before safety plans have been fully developed.

REVIEW ACTIVITY Allow up to 30 minutes for this activity. As a way of reviewing your learning for this session, read the following situation study and then answer the question that follows it.

Situation study Geeta, aged six, was returned home by the police after being found wandering around the local shopping centre at 11 pm one night. She had not been reported as missing. When she returned home her father slapped her for the worry she had caused and

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shouted ‘Get to bed you little bastard.’ The police officer returning the child was surprised at the reaction and admonished the father to be less severe. However, he did not take matters further but put the event down to a display of ‘relief’. What child protection issues are raised by this case? Note down your response before continuing.

Comment Taking into account the need for protection and safety, you may have written that the main issue concerns the fact that Geeta was out so late at night. This might have caused you to question why and how this occurred. You might also, however, have seen the reception back at home in a different light to the police officer. Perhaps it raises questions of discipline, control and treatment that need addressing. Following on from this, you may feel that there is an agency issue concerning child protection. To be sure that safety and protection issues are taken fully into account, there needs to be closer co-operation between the services and a sharing of worrying information.

SUMMARY In this session we have looked at some possible definitions of abuse, the problems associated with these, and the possible effects of abuse. It is important to tackle these issues because such knowledge will:

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contribute to your understanding of children and young people who have experienced abuse



guard against applying stereotypes of victims of abuse to all young people who have experienced it



help you in negotiating, creating and implementing care plans and packages of intervention.

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SESSION FOUR

Protection for Vulnerable Adults SESSION OBJECTIVES By the end of this session you should be able to: describe the role of social work and social care when working with vulnerable adults

decide where rights are surpassed by risks

explain the importance of risk assessment in working with vulnerable adults

design and implement social work and social care interventions to protect vulnerable adults

review and evaluate protection practice with vulnerable adults.

INTRODUCTION In recent years there has been a gradual increase in concern about domestic violence and the abuse and neglect of vulnerable people. One particular focus has been on abuse of elders by their carers in the domestic setting. There is also an increasing focus on abuse within institutional settings (Clough, 1996), and among people with learning disabilities in institutional care and in the family setting (Brown, 1994). Recognition has also grown that people with mental health problems may be in need of protection and support. This session will help you to apply your knowledge of protection to service users from these groups. In the first section we introduce you to the general concept of domestic violence, to one particular form – elder abuse – and to the idea that people with mental health problems may need social work and social care protection. We emphasise the importance of risk assessment and management techniques and various forms of intervention, including the use of relevant statutory powers to protect vulnerable adults. We end the session and the unit by emphasising the importance of regular review and evaluation of protective interventions.

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SOCIAL WORK AND SOCIAL CARE WITH VULNERABLE ADULTS

What is domestic violence ? We all have some ideas about domestic violence and what it is. It will be useful for you to identify your current knowledge and to put your thoughts into context before going further.

ACTIVITY 22 1

Spend about ten minutes noting down what you understand by the term ‘domestic violence’.

2

When you have written down your ideas, spend a further few minutes noting where you think they have come from.

Comment 1

You could have written something like the following. Domestic violence is when a man beats up the woman he is living with or treats her roughly. It is something that happens because men are brought up to be aggressive, and often happens when they are drunk. It is likely that you have concentrated on male against female acts and acts of a physically violent nature. This is likely because these constitute the highest number of incidents and the most widely known. It is not, however, the whole story – as we shall see.

2

Your ideas may have come from a variety of sources. Perhaps you have read about it in the newspapers, talked with people, known people or worked with people who have experienced violence from a partner.

UNDERSTANDING DOMESTIC VIOLENCE Traditionally, domestic violence has been viewed as a ‘family problem’ – the family being seen as a private and almost untouchable unit. Although severe forms of violence are commonly perpetrated by men against women partners and ex-partners (Mullender, 1996), it occurs in lesbian and gay relationships (Renzetti, 1992), and there is evidence of women hitting and throwing things at male partners (Straus, 1980; Straus and Gelles, 1986; Browne and Herbert, 1997). There is a lack of an agreed definition of domestic violence (McGee, 1997; Mullender, 1996). However, we have chosen the term ‘domestic violence’ here to place the issue in the context of events and relationships which occur within households, rather than in more public spaces.

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Generally, it is assumed that domestic violence occurs between peers or partners. However, if domestic violence is construed as violence between members of a household, living group or family, we may suggest that it relates to relationships between generations also. That is to say, violence between parents and children or children and older parents may also be viewed as domestic violence. Such violence may also include wider relations and reflect: ●

a wide and diverse range of family forms



a variety of cultural values and practices.

It is important to be aware of this diversity when assessing and intervening in situations of domestic violence. One particular form of domestic violence is that of elder abuse. Let’s now turn to look at this and its implications for social work practitioners.

What is known about elder abuse? Elder abuse and neglect is a complex and sensitive area. In an early publication, Cloke (1983) characterised the problems as relating to: ●

definition



research



establishing the incidence of abuse and neglect



determining the causes of abuse



clarifying the links with other forms of family violence



acceptance by professionals of the need for procedures to deal with the problem.

Elder abuse and neglect were identified by English doctors in the mid-1970s (Baker, 1975; Burston, 1977) as ‘granny bashing’, but it was not until the mid-1980s that the issue was really picked up on in Britain. In the United States, however, the issue was identified from the mid-1970s and began to be researched from that time in attempts to explain the problem and to provide solutions to it. There are many possible reasons why abuse happens. However, some of the factors responsible may be: ●

a history of long-standing poor relationships within the family (Fulmer and O’Malley, 1987; Homer and Gilleard, 1990)



the dependence of the abuser on the victim for finance (Hwalek et al, 1986), accommodation and transport (Pillemer, 1986) or for emotional support



the abuser having a history of mental health problems or a substance misuse problem (Pillemer and Wolf, 1986)

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a pre-existing pattern of family violence (inter-generational transmission of violence) (Pillemer and Suitor, 1988)



the social isolation of the victim and the abuser (Pillemer and Wolf, 1986).

A role is also likely to be played by gender, race and class, but insufficient research has so far been carried out in relation to these factors to make any definitive statements.

Types of domestic violence Domestic violence can take a number of different forms. These can be classified as follows. ●

Physical violence. This is by far the most commonly reported form of domestic violence. It usually persists over a long period of time and often rises in intensity and severity. Physical violence is potentially lethal and should always be taken seriously.



Sexual violence and abuse. Often physical violence and sexual assault occur together in abusive relationships. Men may threaten violence to gain sexual gratification. They may force a woman to take part in acts the woman finds degrading or does not wish to do or they may commit acts of physical violence before, during or after sex.



Emotional abuse. Psychological control is often an important factor in domestic violence. Partners may be threatened by the manner of the abuser. They may be belittled, put down or intimidated.

The following activity asks you to apply this classification to a situation study.

ACTIVITY 23 Allow about ten minutes for this activity. Read the following situation study and note down the types of abuse you think might be occurring.

Situation study Martha and Benjamin had been together for seven years. They had three children. Benjamin often worked late and was often away on business. When he returned he was tired and wanted to relax. He would drink, often to excess, and was always ready for sex. When Martha did not want sex he told her how hard he had been working and how unfair and ungrateful she was when he did this all for her and the children. This usually ended in an argument. Martha said he was never violent towards her; he only gave her the odd slap. She excused this saying that there was a lot to what he said and he was ‘under the influence’ when he did it. She was not worried by this behaviour but wished he would ‘lighten up a little.’ Martha was more worried that Benjamin was unfaithful when away on business. She had no evidence of this but was upset when he talked about the women he met on business. She felt he was taunting her.

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Comment It seems to us that there are instances of physical, sexual and emotional abuse in this situation. ●

The occasional ‘slaps’ Benjamin gives may not be of concern to Martha but are worrying as violence often tends to escalate.



Benjamin is certainly pressuring Martha and not allowing her a say in their sexual relationship.



You may also have noted that Martha is feeling emotionally drained and under pressure.

Reflecting on what we have discussed so far it is not difficult to conclude that power, or its abuse, is an essential component of domestic violence. We’ll therefore pause to consider the issue of power in slightly more depth.

Power and abuse In an abusive relationship the partner with greater power dominates the other. The relationship is unequal, damaging and potentially lethal. Social attitudes that men should be able to ‘handle themselves’ and are aggressive and stronger than women tend to collude with this abuse of power and help maintain a culture which accepts domestic violence.

ACTIVITY 24 You will need to arrange to carry out this activity at a time and place convenient to you. However, if at all possible, pause at this point to make your plans for it. Spend some time in your local library looking through past newspapers. Look in particular at stories in which a well-known man is described as having been violent towards his partner. List some of the ways in which the newspaper reports portray the man and the acts.

Comment Read this comment once you have carried out the activity. You may have found that the reports tend to portray men in this position as ‘Jack-the-lad’, or excuse the behaviour because of heavy drinking and a riotous lifestyle. They may even take his side against the partner and apportion blame to her for a lack of support. These kinds of media report create a situation which maintains a culture in which violence is, if not condoned, made more acceptable. It is even possible that well-known men are portrayed as anti-heroes and potential role models: ‘If he does it, it must be OK.’

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The causes of domestic violence The reasons for domestic violence are varied and complex. For many years the idea held sway that perpetrators of domestic violence must be sick or mentally ill. However, as Mullender (1996) points out, no consistent pattern is found in all abusers and such an explanation may allow practitioners and policy makers to ignore the role of structural factors. Over-simplified theories may even weaken calls for social education and social justice.

ACTIVITY 25 Allow about ten minutes for this activity. From what you have learnt so far in this unit and this session, and allowing for the cautions we have already voiced, what do you think are likely to be the main causes of domestic violence? Make notes of your ideas.

Comment In this comment we address what we feel are three key causes, with a few additional notes on each. We identify further, contributing factors, in the text that follows the comment. You could have suggested direct causes such as the following. ●

Alcohol and substance abuse. This is certainly an indirect cause. Its role is to prevent the usual internal controls against violence from working.



Poor anger control. When assessing risks and planning interventions, practitioners naturally consider how well individuals cope with their anger. However, to simply explain violence as an inability to cope enables perpetrators to see themselves as ‘having a problem’ for which they may or may not be responsible.



Power relations and gender inequality. Mullender (1996) importantly asserts the importance of considering these factors in order to gain a complete understanding of domestic violence. This feminist approach sets domestic violence within the structures of a male-dominated society which condones and uses violence to retain its supremacy.

In fact, it is best to see domestic violence as resulting from a wide range of contributing factors rather than any one cause. Understanding this range may help us to respond more effectively at a variety of levels to protect individuals and groups. It is also important to identify circumstances which are likely to increase the risk of violence occurring. By identifying these contributing factors we can take steps to protect those who seem to be most vulnerable.

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Contributing factors Although each case is unique in its own right, research evidence suggests certain characteristics that need to be taken into account when assessing either the need for protection or the possible risks of future harm. General contributing factors include: ●

the effectiveness or otherwise of coping strategies



unequal power relations between partners or carer and cared for



structural factors linked to: – age – housing – occupation and finance – social support and isolation



the use and abuse of alcohol and other substances



violence having happened before.

We can also assess risk in terms of the characteristics of individuals, while acknowledging that none of these is a direct cause of abuse. These more specific factors include: ●

a history of severe mental health problems



being brought up in a home where violence appeared to be the preferred way of dealing with conflict



having previously witnessed family violence



having been abused.

At an even more specific level, it is often the case that the woman is pregnant when the abuse begins (The Guardian, 1997), and even more frequent to find children under five years old in the home (Pahl, 1985). Barnett et al., (1997) report that research indicates that males aged between 18 and 30, living in socially disadvantaged situations, are most likely to be violent. Care has to be taken with all criteria, however, since many violent partners share none of these and many who have experienced such things do not become abusers themselves.

The importance of identifying contributing factors Identifying the main factors may help practitioners to target their interventions. For example, if the abuse is principally due to the stress of caregiving, then providing services within the community may alleviate the situation. If, however, the abuse results from a mental health problem in the abuser, then a better approach would be to provide treatment for the abuser together with any necessary protection for the person being abused.

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Also important is the willingness of the parties to engage with interventions. If an individual is willing to undertake treatment for a problem (which will move the problem from the private to the public sphere) then the outcome is more likely to be successful.

INTERVENING TO PROTECT VULNERABLE ADULTS The first step in any protective intervention is to make a valid and comprehensive assessment, taking the lead from the individual at the centre of concern (Middleton, 1997).

ACTIVITY 26 Spend about ten minutes on this activity. Consider and write down a list of points you would want to cover when assessing this type of situation.

Comment Points you might wish to cover in your assessment could include: ●

an overview of the situation causing worry and concern



a note of the people involved and their particular contribution to the situation (to resolve or maintain the problem)



the risks involved, whether real or potential



strategies already attempted to resolve and cope with the situation



needs and expectations



other relevant factors.

These points are all important within many different types of assessment, not just those relating to protection. The development of assessment protocols which guide the assessment process closely – in particular the risk assessment – is also a necessary component of responding to adult abuse and neglect. An appropriate level of risk management needs to be instigated once the risk assessment has identified the degree of risk present, and this will lead to the development of a care plan which details ways of meeting individual protection needs.

Managing abusive situations Interventions within abusive situations have recently begun to be developed in Britain. Many strategies have focused on providing practical support and assistance (DoH, 1993). These include providing:

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respite care services



alternative accommodation – either temporary or permanent



counselling for individuals or the family as a whole



legal remedies to resolve situations.

Separating individuals has been considered as a last resort (DoH 1992), and where this does occur it may sometimes mean that the person enters some form of institutional care (Bennett et al., 1997). There may also be a need for temporary separation to allow individuals sufficient time to make future plans without risk of continuing abuse. Direct work with the person responsible for the abuse may also be needed. This may include treatment for substance abuse, or techniques to enhance anger management (Penhale, 1993; Parker, 1998). One way of working uses congnitive-behavioural approaches, which help the person to revise his or her view of a situation and to improve his or her reactions to stress (Parker and Randall, 1997).

The role of the practitioner According to Mullender (1996) social workers have tended to underestimate the seriousness and prevalence of domestic violence. While social care workers are making more referrals to Women’s Aid and are valued in providing practical help, they have been seen as: ●

failing to identify abuse



ignoring the woman



being solely interested in the children



blaming the woman



not confronting the man



failing to provide adequate help



making women feel worse.

Social work and social care practitioners therefore have a considerable amount of ground to make up (Mullender, 1997). In fact, their role should be wide-ranging. It may include: ●

making practical arrangements to ensure safety



identifying the legal position, the availability of social support and taking into account cultural factors



assessing the risk to children and other vulnerable parties, if any, in the relationship



providing advice and information



working with individuals to deal with the effects of violence and abuse



working with families to maintain safety



working with abusers to control anger.

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In particular, it is essential that practitioners are aware of the ways in which children experience violence against their mothers and what this might mean for their future development and psychosocial health (Lloyd, 1995). One way of ensuring that children’s needs are heeded in situations where violence has occurred is to involve them in planning a suitable response – perhaps through the use of play techniques as mentioned earlier.

Ways of intervening Social workers intervene to protect, using the laws which we detailed earlier to enforce certain decisions. Alongside such statutory action social workers also: ●

offer advice and support to enable the woman to consider alternative actions and coping strategies



provide practical help and support in finding alternative accommodation, and assistance with welfare benefits



provide counselling support to those who have caught up in violence and the breakdown of a relationship. This will include children displaying a range of difficulties as a result of witnessing domestic violence, or those who recognise their problems with anger control.

The effects of domestic violence demonstrate very clearly the need for intervention on the three levels of prevention mentioned in Session One. Let’s revisit these.

Applying the three levels of prevention Primary prevention This may involve setting up telephone help lines and public awareness campaigns, especially the zero-tolerance campaign in the UK (Lloyd, 1995). These measures attempt to educate the public about the issues and reduce the potential for risk. Linked to these measures is the need to develop inter-agency policies and guidelines to increase effective knowledge, clear communication and effective responses. However, these measures can only work if: ●

there are good systems in place to document and track numbers of referrals made



there is funding and training to co-ordinate and provide specialist staff.

At this point, primary prevention merges with secondary prevention, which seeks to reduce risk as it is identified.

Secondary prevention Mullender (1996) sees a clear role for social workers in providing a point of first contact to provide advice and information, to assess issues such as physical safety, assistance with child care and practical problems, and to develop a plan to ensure the safety of the vulnerable people. This would demand clear recording and systems of management.

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ACTIVITY 27 Allow about ten minutes for this activity. The measures we have looked at so far address risks before violence occurs. In other words, they are proactive rather than reactive. What other measures can you identify to prevent risks becoming issues of reactive protection?

Comment You might have identified measures such as: ●

counselling for alcohol and drug use



providing social outlets, community groups and parent groups



relationship counselling.

Tertiary prevention When domestic violence has occurred it is the worker’s responsibility to: ●

reduce future risks



improve the present situation



help the person develop strategies for protection in the future



work with perpetrators of domestic violence to teach coping strategies, anger control and address those aspects of gender relations which may be contributing to the situation.

As in counselling, the most important factor in bringing about change is the quality of the relationship between practitioner and service user (Browne, 1995). However, the theoretical model used by the practitioner is still significant. For example, the cognitive-behavioural model can assist in developing anger control, restructuring distorted thinking and talking oneself through situations to achieve a more constructive outcome (Barnett et al., 1997). Similarly, Browne and Herbert (1997) report from a review of the research literature that groupwork and couple work appears more successful than individual work.

ACTIVITY 28 Allow up to 15 minutes for this activity. Some practitioners express reservations about groupwork or conjoint couple work. What do you think these could be? Make notes of your ideas. If you share these reservations, try to justify them. If you disagree, try to explain why. If you have a colleague with whom you can carry out this activity you may stimulate useful discussion.

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Comment It may be that you believe couple work removes the blame from the perpetrator and favours the relationship above the safety of the abused partner. Equally, you may feel that groupwork carries the danger of minimising the violence, justifying it or encouraging a camaraderie between abusers. There is probably some truth in all of these points. However, the following section demonstrates some of the benefits of these approaches.

Mullender (1996) acknowledges the problems of blaming poor impulse control and anger management for domestic violence. However, she also reports that pro-feminist groups who take a challenging stance against male-dominated social attitudes and structures often use cognitivebehavioural and group approaches to dispute, re-educate and challenge. Let’s look briefly at what this may involve in practice, focusing on the cognitive-behavioural technique of anger management.

Anger management In anger management, anger is seen as a combination of physiological arousal, thoughts and beliefs about that arousal (cognitive labelling) which are in turn influenced by external factors and behavioural responses to a given situation. This approach seeks to educate perpetrators to recognise the origins of their violence and to replace their feelings and knee-jerk responses with calm reflection and deliberate, non-aggressive reactions. This process is modelled (or ‘demonstrated’ by and rehearsed with the worker until the perpetrator feels confident in real situations which would normally result in abusive reactions. Anger management is all the more effective in a group context where self-observation, skills training and rehearsal can be assisted by the feedback and encouragement of others. Having identified a wide range of interventive techniques, it is still important to acknowledge the role of legislation in intervention, which we turn to next.

LEGISLATION AND DOMESTIC VIOLENCE There are several legal options which can be explored. The Family Law Act 1996 provides a range of legal options which may be pursued in situations of domestic violence. This covers areas such as the right to occupy the marital home (s.30), the possible effects on children (s.33), nonmolestation orders which prevent the molestation of an adult or child (s.42). Orders may be made ex parte if there is the risk of ‘significant harm’ to the applicant or child (s.45). As well as this specific legislation, there may be grounds to take action under section 1 of the Protection from Harassment Act 1997, which prevents a person from ‘stalking’ another person, and under legislation proscribing common assault.

Social work and the Mental Health Act 1983 People with mental health problems may be in need of protection from others in society, from what they may do to others and from themselves (Mental Health Act Code of Practice, 1983). The Mental Health Act 1983 created the approved social worker (ASW) whose role is to:

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protect civil liberties



advocate for the potential patient



seek less restrictive alternatives to hospital where these are practicable and available



make an application for compulsory admission to hospital when necessary



ensure there is legal compliance with the Act.

The ASW’s protective function is increased by their having to seek the views of the person’s nearest relative (Section 11(3)). In the case of guardianship (Section 7) and treatment applications (Section 3) the application cannot go ahead if the nearest relative objects (Section 11 (4)).

Assessing risk under the Mental Health Act 1983 The ASW needs to ensure that hospital is the most appropriate place for treatment and care, and whether or not the person will enter voluntarily, or at least informally. Risks must be accurately assessed, taking into account: ●

the reliability of the evidence of risk



relevant past medical history and past behaviour



the degree of likely risk and its nature



the willingness and ability to cope on the part of those with whom the individual lives



any misunderstandings that may arise from assumptions based on gender, social and cultural background, ethnic origin and other medical or health conditions – including deafness. (HMSO, 1994; Pritchard and Kemshall, 1996).

This concludes our overview of types of vulnerable adult and the interventions which can be used in protective work with them. As we have stressed before, all such interventions must be continually reviewed and evaluated to ensure that they are as effective in achieving the desired outcomes as possible, and we will finish by considering how this can be done.

REVIEWING AND EVALUATING PROTECTION It is necessary to have regular reviews when working with any vulnerable person, whether an adult or a child. The review process: ●

helps practitioners to manage cases



ensures that information is shared among those who need to know it



keeps all the relevant practitioners aware of risky situations



enables goals and plans to be negotiated with those who will be most involved in carrying these out.

It is also important that an element of safety planning is incorporated into each review meeting. This plan provides a checklist against which change can be monitored and assessed.

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Despite the indispensible role of review meetings, there are some attendant dangers in them of which you should be aware.

ACTIVITY 29 Spend ten minutes completing this activity. Think of and note down one or two ways in which review meetings might not fulfil an effective role in evaluating and reviewing risk.

Comment You may have written something like this. While the review meeting is useful for getting people round the table, it might prevent people talking openly because of a fear of being challenged or upsetting people. In this way practitioners might collude with situations of risk or even prevent a person from taking risks by agreeing with a majority view.

Evaluating change and the continuing need for protection The most useful outcome measure is whether the violence has stopped and the person being abused is protected from it. However, while this can be monitored and evaluated fairly easily there are other outcome measures that are based on the specific agreements reached with service users on goals and how far they are achieved. Review meetings should directly address these agreements and evaluate outcomes against them – even if there has been limited success. Defensiveness on the part of workers should not prevent failure to achieve outcomes being acknowledged and new approaches to intervention being identified, planned and implemented. Only in this transparent way of working can continuing risk be monitored, protection provided effectively and the legal and procedural obligations of the agency be fulfilled.

REVIEW ACTIVITY Work back through the unit and review your own understanding of domestic violence. Think about your own values and attitudes in relation to domestic violence and the particular remit of the agency for which you work. Then note down: ●

how you see your role as a social worker or social care worker



the ways in which you might work to protect vulnerable adults, using the three levels of prevention we have discussed throughout the unit.

Spend about 25 minutes completing this activity.

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Comment Lloyd (1995) suggests that agency guidelines should reflect the importance of the issues but also that social work and social care practitioners must be able to reflect on and own their personal experiences and values in this complex area (see also DoH, 1996). Perhaps you see the social work or social care role as one of protection after harm has taken place and therefore consider the social work and social care role to be reactive, or secondary and tertiary. In this case you may see a need to make referrals to shelters, to assist in developing legal protection and safety plans, or to provide direct counselling support. On the other hand, you may believe that social work and social care have a primary preventive role in publicising and raising awareness of issues. This may lead you to a community work approach or to offer telephone helpline support. There are many varied, legitimate ways of intervening to protect people experiencing or at risk of domestic violence. If we intervene with an individual we must not lose sight of his or her context. If we intervene at a community level we must remember the individuals involved and work as far as possible to the benefit of all.

SUMMARY In this session we have introduced you to a range of ideas concerning vulnerable adults. We have examined and explored domestic violence and the social work and social care role and seen that domestic violence has many effects on people and that the implications for social work and social care are many. We have seen that domestic violence is not simply something which occurs between married and heterosexual partners. It seems to be bound up with the way people are brought up or ‘socialised’ and is, to some extent, tacitly accepted in society even so far as blaming the victim. We have noted that social workers and social care workers have not, in the past, taken seriously the matter of domestic violence. As a profession, however, they are not alone in this and perhaps this suggests a continuing tension between what can remain private and ‘behind closed doors’ and what is necessarily part of the public domain. Finally, we have discussed intervention and related this to the three levels of prevention set out at the beginning of this unit. The protection of vulnerable adults is a complex matter and cannot be seen in isolation from a range of contributing factors. There are usually other people involved and their needs must be taken into account. There are short and long-term consequences for any action taken and the social worker or social care worker must attempt to plan for all eventualities, while consulting as widely as possible. Social workers and social care workers must try to ensure that respect for choice is maintained, while balancing potential rights and risks in each individual situation.

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UNIT SUMMARY We began this unit by describing the main features of protection – both preventive and reactive – and its place in contemporary social work. This led us to consider the three levels of prevention – primary, secondary and tertiary – and the ethical tensions involved in social work’s dual, and apparently contradictory, role of care and control. We concluded that these are both intrinsic aspects of social work, being ‘two sides of the same coin’. We then moved from this exploration of the general issues of protecting people to the specific concerns involved in protecting children and young people, including risk assessment and methods of intervention. We then considered issues involved in the protection of vulnerable adults, focusing particularly on domestic violence and the need for a broader perspective which recognises all its forms. We discussed some of the issues of protection involved in work with people with mental health problems and concluded the unit by considering methods of intervention in domestic violence, including using relevant law, and emphasised the need for regular review and evaluation of intervention.

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LEARNING REVIEW Use this checklist to review your achievements in this unit. You will see it is an exact repeat of the learning profile you completed at the start. Put a tick in the box which most nearly corresponds with your achievements at the end of this unit. Not at all

Partly

Very well







Session One I can: ● define protection in social work and social care settings ●

describe the differences and similarities between care and control









explain the importance of legislation in protecting people









explain the importance of good management systems for effective risk assessment









evaluate the need for and implementation of protection in social work and social care practice.







I can: ● explain the importance of social work and social care values ❏ in relation to protection





Session Two



apply a knowledge of social work and social care values to my professional practice in matters of protection









determine when risks outweigh rights









analyse a wide range of values, their sources and their impact on social work and social care practice









place social work and social care values in the context of other professional roles and values.













Session Three I can: ● identify the legal and statutory requirements for child protection ●

describe and critically analyse the main theories of child protection









assess the degree of risk, the need for protection and the need for support









design effective intervention to protect children and young people









evaluate social work and social care practice in child protection.







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Not at all

Partly

Very well







Session Four I can: ● describe the role of social work and social care when working with vulnerable adults ●

decide where rights are surpassed by risks









explain the importance of risk assessment in working with vulnerable adults









design and implement social work and social care interventions to protect vulnerable adults









review and evaluate protection practice with vulnerable adults.







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REFERENCES Baker, A.A, (1975) ‘Granny Bashing,’ Modern Geriatrics, 5, (8), pp. 20–24. Banks, S, (1995) Ethics and Values in Social Work, Macmillan, Basingstoke Barnett, O.W, Miller-Perrin, C.L and Perrin, R.D, (1997) Family Violence Across the Lifespan, Sage, London BASW (1997) The Code of Ethics for Social Work, BASW, Birmingham Bennett, G.C, Kingston, P.A and Penhale, B, (1997) The Dimensions of Elder Abuse: Perspectives for practitioners, Macmillan, Basingstoke Birchall, E and Hallett, C, (1995) Working Together in Child Protection, HMSO, London Braye, S and Preston-Shoot, M, (1995) Practising Social Work Law, Macmillan, Basingstoke Brayne, H and Martin, G, (1995) Law for Social Workers, 4th edn, Blackstone Press, London Brown, A and Bourne, I, (1996) The Social Work Supervisor, Open University Press, Buckingham Brown, H, (1994) ‘Establishing the incidence of abuse in services for people with learning disabilities’ in Harris, J and Craft, A (eds) People with Learning Disabilities at Risk of Physical or Sexual Abuse, BILD Seminar Papers, no. 4, Cookley Press, Kidderminster Browne, K.D, (1995) ‘Child abuse: defining, understanding, intervening’, in Wilson, K and James, A, (eds) The Child Protection Handbook, Balliere-Tindall, London Browne, K and Herbert, M, (1997) Preventing Family Violence, John Wiley, London Burston, G.R, (1977) ‘Granny bashing,’ British Medical Journal, 3, September 6, p. 592 Bytheway, B, (1994) Ageism, Open University Press, Buckingham CCETSW (1995) Rules and Requirements for the Diploma in Social Work, CCETSW, London Cloke, C, (1983) Old Age Abuse in the Domestic Setting – A review, Age Concern, London Clough, R, (1996) (ed.) The Abuse of Care in Residential Institutions, Whiting and Birch Ltd, London Coulshed, V, (1991) 2nd edn Social Work Practice, Macmillan, Basingstoke Department of Health (1988) Protecting Children: A guide for social workers undertaking comprehensive assessment, HMSO, London Department of Health and Welsh Office (1993) Mental Health Act 1983 Code of Practice, 2nd edn, HMSO, London

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Department of Health/Social Services Inspectorate (1992) Confronting Elder Abuse, HMSO, London Department of Health/Social Services Inspectorate (1993) No Longer Afraid: The safeguard of older people in the domestic setting, HMSO, London Department of Health (1995) Child Protection. Messages from Research, HMSO, London Department of Health/Social Services Inspectorate (1996) Domestic Violence and Social Care, HMSO, London Department for Education (1994) Pupil Behaviour and Discipline, Circular 8/94, Department for Education, London Dominelli, L and McLeod, E, (1989) Feminist Social Work, Macmillan, Basingstoke Farmer, E and Owen, M, (1995) Child Protection Practice: Private risks and public remedies, HMSO, London Frotheringham, T.E, Barnett, R.A.M, Hobbs, C.J and Wynne, J.A, (1993) ‘Child abuse in Leeds before and after Cleveland’, Child Abuse Review, 2, pp. 23–34 Fulmer, T and O’ Malley, T, (1987) Inadequate Care of the Elderly: A health care perspective on abuse and neglect, Springer, New York Grubb, G.A, (1994) ‘An abused child’s use of sandplay in the healing process’, Clinical Social Work Journal, 22, 2, pp. 193–209 Guardian (1997) ‘Midwives to look for abuse of women’, The Guardian, 29 December Hallett, C, (1995) Interagency Co-ordination in Child Protection, HMSO, London Harding, T and Beresford, P, (1996) The Standards We Expect, National Institute of Social Work, London Harris, R and Timms, N, (1993) Secure Accommodation, Routledge, London Home Office, Department of Health, Department of Education and Science and Welsh Office (1991) Working Together Under the Children Act 1989, HMSO, London Homer, A and Gilleard, C, (1990) ‘Abuse of elderly people by their carers,’ British Medical Journal, 301, pp. 1359–136. Horne, M, (1987) Values in Social Work, Gower, Aldershot Hwalek, M, Sengstock, M and Lawrence, R (1986) ‘Assessing the probability of abuse of the elderly,’ Journal of Applied Gerontology, 5, pp. 153–173

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Kempe, C.H, Silverman, F.N, Steele, B.F, Droegmuller, W and Silver, H.K, (1962) ‘The battered child syndrome’, Journal of the American Medical Association, 181, pp. 17–24 Lloyd, S, (1995) ‘Social work and domestic violence’ in Kingston, P and Penhale B, (1995) (eds) Family Violence and the Caring Professions, Macmillan, Basingstoke McGee, C, (1997) ‘Children’s experiences of domestic violence’, Child and Family Social Work, 2, pp. 13–23 Middleton, L, (1997) The Art of Assessment, Venture Press, Birmingham Moore, J, (1985) The ABC of Child Abuse Work, Gower, Aldershot Mullender, A, (1996) Rethinking Domestic Violence, Routledge, London Mullender, A, (1997) ‘Domestic violence and social work: The challenge to change,’ Critical Social Policy, 50, pp. 53–78 Novaco, R.W, (1975) Anger Control: The development and evaluation of an experimental treatment, Heath, Lexington Novaco, R.W, (1979) ‘The cognitive regulation of anger and stress’, in Kendall, R and Hollon, S, (eds.) Cognitive-Behavioral Interventions: Theory, research and practice, Academic, New York Novaco, R.W, (1985) ‘Anger and its therapeutic regulation’, in Chesney, M.A and Rosenman, R.H, (eds) Anger and Hostility in Cardiovascular and Behavioral Disorders, Hemisphere, New York Novaco, R.W, (1994) ‘Anger as a risk factor for violence among the mentally disordered’, in Monahan, J and Steadman, H.J, (eds) Violence and Mental Disorder: Developments in risk assessment, University of Chicago Press, Chicago O’Hagan, K, (1996) (ed.) Competence in Social Work Practice, Jessica Kingsley, London Oliver, M, (1986) The Politics of Disablement, Macmillan, Basingstoke Pahl, J, (1985) Private Violence and Public Policy, Routledge and Kegan Paul, London Parker, J and Randall, P, (1997) Using Behavioural Theories, Open Learning Foundation, London Parker, J, (1998) ‘The prevention and management of elder abuse’, in Cigno, K and Bourn, D, (eds.) Case Studies in Cognitive-Behavioural Social Work, Ashgate, Aldershot Parton, N, (1985) The Politics of Child Abuse, Macmillan, London Penhale, B, (1993) ‘The abuse of elderly people: Considerations for practice’, British Journal of Social Work 23, 2, pp. 95–112

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Pillemer, K.A, (1986) ‘Risk factors in elder abuse: Results from a case-control study’, in Pillemer, K.A and Wolf, R.S (eds.) (1986) Elder Abuse: Conflict in the family, Auburn House, Dover, Massachusetts Pillemer, K.A and Suitor, J, (1988) ‘Elder abuse’, in Van Hasselt, V, Morrison, R, Belack, A and Hensen, M, (1988) (eds.) Handbook of Family Violence, Plenum Press, New York Pillemer, K.A and Wolf, R.S, (1986) (eds.) Elder Abuse: Conflict in the family, Auburn House, Dover, Massachusetts Pizzey, E, (1974) Scream Quietly or the Neighbours Will Hear, Penguin, Harmondsworth Pritchard, J and Kemshall, H, (1996) (eds.) Good Practice in Risk Assessment and Risk Management, Jessica Kingsley, London Ptacek, J, (1997) ‘Racial politics, class politics and research on woman battering’, paper given at 5th International Family Violence Research Conference, Durham, New Hampshire, Family Violence Research Laboratory Reamer, F.G, (1993) The Philosophical Foundations of Social Work, Columbia University Press, New York Renzetti, C.M, (1992) Violent Betrayal: Partner abuse in lesbian relationships, Sage, Newbury Park Rasmussen, L.A and Cunningham, C, (1995) ‘Focused play therapy and non-directive play therapy: can they be integrated?’, Journal of Child Sexual Abuse, 4, 1, pp. 1–20. Ritchie Report (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis, London, HMSO Ryan, V, (1995) ‘Non-directive play therapy with abused children and adolescents’, in Wilson K, and James, A, (eds) The Child Protection Handbook, pp. 354–371, Balliere-Tindall, London Salter, A.C, (1988) Treating Child Sex Offenders and Victims, Sage, London Sharland, E, Jones, D, Aldgate, J, Seal, H and Croucher, M, (1993) Professional Intervention in Child Sexual Abuse. Report to the Department of Health, Department of Applied Social Studies and Social Research, Oxford Stevenson, O and Parsloe, P, (1993) Community Care and Empowerment, Joseph Rowntree Foundation, York Straus, M, (1980) ‘Victims and aggressors in marital violence,’ American Behavioral Scientist, 23, pp. 681–704 Straus, M and Gelles, R, (1986) ‘Societal change and change in family violence from 1975–1985 as revealed by two national surveys,’ Journal of Marriage and the Family, 48, pp. 465–79

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Timms, N, (1983) Social Work Values: An enquiry, Routledge and Kegan Paul, London Yllö, K, (1997) ‘Politics and the purpose of our research’, paper given at 5th International Family Violence Research Conference, Durham, New Hampshire, Family Violence Research Laboratory

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FURTHER STUDY Banks, S, (1995) Ethics and Values in Social Work, Macmillian, Basingstoke Browne, K and Herbert, M, (1997) Preventing Family Violence, John Wiley and Sons, Chichester Kingston, P and Penhale, B, (eds.) (1995) Family Violence and the Caring Professions, Macmillan, Basingstoke

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