Essay Examples - Social Work Essays
Report: Organizing to Encourage Effective Direct Support.
The following report is based upon the experiences and perceptions of direct support (and of the 'social model' of disability provision) of a particular person with : Mark.
The experiences and perceptions in this case study are taken from interviews and discussions with Mark himself, with members of his family, and with his social workers and managers. The purpose of the report is to describe Mark's experiences of social care under direct support and to compare these with the types of social work that he experienced before the introduction of direct support. The report focuses upon Mark's growing sense of 'empowerment', 'ability to help himself', and 'individuality' that emerge from his experiences of direct support. Thus a major theme of this report is to examine how direct support assists people with to gain recognition as contributing members of the community.
The report has the following structure:
A. (i) An analysis of the government's seminal white paper Valuing People: A New Strategy for Learning Disability for the 21st Century (DOH, 2001). This white paper was a momentous recognition by government of the 'social model' of social provision, and it thrust direct support to the front of the government's strategy for learning disability. A discussion of this white paper allows an analysis of Mark's own experiences of direct support: how successful it has been for him, how he perceives the changed attitudes of the social workers he works with - how they now perceive their work differently now.
(ii) This section also examines the notion of 'empowerment' and the idea that people with must be recognized as contributing members of society also, rather than 'medical problems'.
(iii) The module Organizing to Encourage Effective Direct Support stresses the need to examine direct support from the perspectives of all involved: the person with , his carers and also the government and managers who make decisions that effect him. This white paper then is a highly useful document for understanding the government's perspective and attitude to the needs of people with learning disabilities.
B. An analysis of the biographical material furnished by Mark's case study. Does his experience of direct support match that set out by the government in Valuing People? Which direct support schemes in this white paper has Mark benefited from? What are does he perceive the benefits of direct support to be in contrast to previous types of social care that he has experienced? How do those people who live and work with Mark perceive these changes?
C. An analysis of three theoretical and practical existing models of disability provision - moral, medical, social - and Mark's various experiences of these models. How does Mark experience the theory of social provision when it is put into practice?
D. Conclusion. The report concludes with an examination of Mark's future prospects working with direct support, and the future prospects of direct support itself.
A: Valuing People: A New Strategy for Learning Disability in the 21st Century
'A person-centred approach to planning means that planning should start with the individual (not with services), and take account of their wishes and aspirations. Person-centred-planning is a mechanism for reflecting the needs and preferences of a person with a learning disability.'
(Valuing People, 2001, p49)
This quotation from the government's seminal white paper Valuing People: A New Strategy for Learning Disability for the 21st Century encapsulates the radically new ideas and ideals established by this document for the provision and practice of social work for people with learning disabilities. This white paper represented both an important official recognition of the validity of the 'social model' of disability provision, and also a promise to implement its ideas and philosophy of learning difficulties, as had been advocated by social work practitioners and academics for some time. Thus this white paper was a significant move away from the 'medical model' of disability provision that had held supremacy for most of recent healthcare history. As the above quotation suggests, this new approach to disability gives the individual far greater freedom to make decisions about his own future - the philosophy is 'person-centred' and 'individualized' - and, more than this, recognizes that people with learning difficulty have exactly the same rights and should have exactly the same opportunities as non-disabled people. The white paper acknowledges the new phenomenon of the 'empowerment' of people with learning difficulties and suggests how empowerment can be extended amongst those with such difficulties.
An analysis of this white paper is vital for any learning difficulties student who seeks to analyze how direct support works in practice. Valuing People established guidelines and proposed schemes that have to be met in practice, in the lives of people with . In the next section, this report looks at how this government model has been experienced by one particular person with learning difficulties: Mark.
This present analysis focuses upon Chapter 4 of the white paper: More Choice and Control for People with . The introductory statement of this chapter sets the tone for the entire document. It states:
'Government objective: To enable people with to have as much choice as possible over their lives through advocacy and a person-centred approach to planning the services and support they need.'(Valuing People, p44)
Thus from the very beginning of this chapter the paper makes it clear that people with learning difficulties must have 'as much choice as possible' and be helped by a 'person-centred approach' to take control of their own lives. A second key promise emerges soon afterwards: 'Services should respond to the wider aspirations of people with learning disabilities and give them more choice and control' (Valuing People, 2001). This phrase reveals that people with are no longer thought of only in terms of those disabilities, but that their 'aspirations' and 'personalities' are taken into account also. The paper contends that social workers must seek to reverse the many problems halting direct support at the time: for instance, services were too lethargic, advocacy was limited, and people with learning difficulties had far too little say and involvement in the management of their own care. The paper suggests methods as to how these faults in the system might be changed. For instance: advocacy services must be extended considerably, more people must receive direct payments, and a person-centred approach must be developed by social workers and managers. Managers have the vital responsibility of 'personalizing' people with and getting to know those difficulties intimately. Managers and organizations cannot help unless they take such an approach.
Valuing People made several proposals to effect such reform: the Disability Rights Commission, 1.3 million per annum to expand advocacy services, The Learning Disability Development Fund are all examples of proposals made in the white paper. Let us look at several of these methods of direct support in more detail.
Disability Rights Commission: The role of the DRC is to assist people to guarantee their rights as secured by the Disability Discrimination Act (1995). The Commission's work involves getting disabled people into consultations about major policy initiatives that concern them; ensuring that decision-making material is available in user-friendly formats; and educating businesses and institutions about how to work with people with .
Advocacy: Advocacy is absolutely crucial for successful transfer of responsibility and decision-making to people with themselves. Advocacy can be of two types: self advocacy or advocacy through organizations. The government gives 1.3 per year to further advocacy programmes.
Direct Payments: Direct Payments are a further means of giving people with more control over their own lives. Direct Payments enable Local Councils to allow people to pay for support they are entitled to before that support has been given. This was extended by the Carers and Disabled Children Act (2000) which facilitated immediate payments to carers and to 16 and 17 year olds with learning difficulties. (The Health and Social Care Act (2001) widened the availability of Direct Payments still further.) Once these payments are received disabled people have far greater freedom to choose what type of support they require for themselves. The Implementation Support Team was set-up to improve application rates for this critical scheme.
Person-Centred Planning: This initiative is intended, as its name suggests, to ensure that the planning of care for a person with is organized as much as possible by working with individuals themselves. The paper suggested that Learning Disability Partnership Boards begin to implement this approach throughout care management and practice as soon as possible.
Care management: According to the white paper care management is the 'formal mechanism for linking individuals with public services' (Valuing People, 2001). In other words, care management is the vital instrument of direct support. Therefore it must be 'responsive to person centred planning, and have the capacity to deliver the kinds of individualized services likely to emerge fro the process'. Connexions Gateway was set-up to establish vocational plans, as well as health, housing and communication plans for people with .
Fair Access to Care: Free Access to Care was aimed to establish the basis by which eligibility for social care for adults should be determined.
In conclusion, Valuing People was a sea-change in the policy of the British government and its care agencies towards the care of those with learning difficulties. Its emphasis upon direct support through person-centred care and individuality gave people with learning difficulties rights and confidence to exercise those rights that they would never have previously thought possible. It empowered disabled people to help themselves. Managers and social workers too were seen as vital instruments for changing the prejudices and attitudes of the public, and creating awareness that people with are valuable members of the community.
In the next section of this report we examine how these various measures of direct support have been experienced and perceived by a person with : Mark.
B. Case Study: Mark Biographical Information
The purpose of this section of the report is to furnish biographical material from Mark's case study of his experience of direct support as set out in Valuing People. In the next section of this report 'Service Provision Models' Mark's experiences of direct support recounted here will be compared with three models of service provision. The material is this section is based upon interviews with Mark himself, with members of his family, and with friends and helpers.
Mark is forty-fives years old and lives in Stockport, where he works as a Project Officer at a Voluntary Agency two days per week. There his responsibilities involve handing out information about learning disabilities and giving assistance training to social services staff and to college and university students. Mark frequently attends the User Forum Day, and belongs to other user groups as well as being on the Disability Partnership Board. Mark has taken much valuable information from speaking with numerous other people from these groups as well as the many information leaflets that are available there. On one occasion Mark spoke with a fireman and enjoyed watching a video made by other people with learning difficulties who live in Adult Placement. Mark has even been to France to give lectures on 'His Life Story'. Mark enjoys this work enormously and he has made many new friends though it as well as seeing many new places.
Mark's experiences of social care were not always so positive however. Mark has lived in several places in Stockport, and when he was 20 he left his mother's house to go and live in a supported house run by social services - and later he lived in a flat by himself for a short while. Unfortunately Mark received little assistance from the social services in these locations and these placements did not work-out well for him. Mark often felt that people did not understand him and that little effort was made to understand him. Mark felt physically imprisoned in the support house because he was unable to leave the premises and support staff were not willing to take him anywhere. Moreover, he was made unwelcome by a bully who he had to share the flat with, his windows were smashed and he even had to enter the house by the back-door to avoid being seen by the bully. Mark also felt emotionally trapped in the house. His carers treated him as a child, he was beaten by his teacher at school for being too slow, and these events of course led Mark to think that he was 'different' and 'a problem' compared with 'normal' people. These events proved too much for Mark and he moved back into his parents' house.
It was at this point that Mark's experiences began to change - when he encountered direct support. Soon Mark entered a faster adult programme run by a local voluntary agency. Under this plan Mark has enjoyed a holiday to Spain, has met the Manchester United team and has attended Wimbledon four times. Mark now lives in a very pleasant house with Janet (the owner) and another person called Mark. Mark has his own room where he feels safe. He often goes to the pub with friends or watches television in his room. Janet helps Mark when he needs to manage money or to go to the doctor or hospital; but this help is limited to what Mark asks to be helped with. Mark is subsequently learning to be far more independent than he was, than he could be before. Mark has learnt to hover, iron, use the dishwasher, and go by himself with the bus to the bank. Every year Janet and his other carers meet with Mark to discuss how his development is progressing. When Mark was beaten by his teacher at his previous school his parents changed his school immediately and relocated him at a new school. Mark loved this new school and has even attended several courses at Stockport College. Mark also now enjoys several fixed routines: he goes every Friday to the pub for lunch and every Thursday he goes with his friend Mark to the cinema. Mark also has a season football ticket for Stockport United, and spends time with his friend Stephen every Tuesday.
Asked to suggest how the lives of people with learning difficulties might be improved, Mark said that people with learning disabilities must be allowed to live their own lives and to make decisions for themselves. Mark felt that under the previous system he was treated like a child and as incapable of making his own decisions: he was forced to attend swimming every Monday or horse-riding every Friday, for instance. Mark thought however that his association with the Disability Partnership Board, his use of Direct Payments and his attendance at User Forums had given him far greater freedom. Mark says that his experience of direct support working with Janet has changed his life: enabling and empowering him to make decisions that he would never previously been able to make.
C. Three Service Models and Their Perceptions
Mark has undoubtedly benefited enormously from direct support and the schemes introduced in Valuing People. There are however still three theoretical and practical models for the provision of disability. These are analyzed now to show Mark's various experiences of each of these models. Two are major contesting services models; the third model - the moral model - is included for purposes of accuracy and for discrediting it.
Model 1: The Moral Model
The moral modal of disability is the oldest but also the most prejudiced and superstitious. The moral model maintains that people with learning difficulties have somehow come under the influence of the devil and that their disability is a punishment that they or their family has committed. This model argues that people with learning difficulties, for instance, somehow have less spiritual worth than others, and that they are to be withheld from God's grace and forgiveness. In the past, authorities who subscribed to the moral model used to abandon disabled people to the outskirts of a community and offered them no help whatsoever. The only 'cure' for such disabilities was Divine forgiveness for their 'sins'.
Mark, of course, did not encounter people trying to help him through the moral model. There is also no connection between direct support and the moral model. It is interesting however to note that the superstitious and prejudiced attitude of the bully in Mark's story preserves vestiges of the moral modal.
Model 2: The Medical Model
The Medical model arose in the 18th century when growing scientific confidence about the aetiology of diseases led scientists to reject the moral model and to look to cure the 'problems' of the disabled. Put very succinctly, the medical model treats disabled people - such as those with learning difficulties as sick. Disabled people were seen to have 'impairments' that needed to be cured or rehabilitated. Disabled people were 'problems' and problems only: the psychology and personality of the disabled person was hardly ever taken into account. Those people with learning difficulties that the medical model could not help were banished to live separate existences from normal society in specialist institutions especially set up for them. There was a tendency in the medical model to seek to 'normalize' disabled people by making them more like non-disabled people: there was no emphasis on the emotional and special needs of disabled people. Moreover, disabled people such as those with learning difficulties were assumed to be incapable of making decisions about their own welfare: therefore these decisions were made wholly by healthcare professionals without any consultation with the patient. This non-involvement of the actual disabled person meant that questions such as where they should live, what benefits they were due, where they might be employed - and even whether they are entitled to be born or to give birth! -- were all decided by professionals who thought that they were dealing with somebody who was no longer normal. Disabled people are urged to seek 'rehabilitation' so as to gain access to the facilities that 'normal' people are entitled to - such as recreational facilities, public arenas or sporting venues. In addition, the medical model is so consolidated in the media (in films, television and radio) that people who are not disabled think that disabled people are entirely dependent upon the handouts of the state for their existence.
Various aspects of Mark's case show that he was subjected to the prejudices of the medical model. Remember that when Mark was originally with the support services he was treated 'as a child', he wasn't allowed or helped to leave the house unaccompanied and his learning difficulty was perceived as an 'impairment'. So too remember when Mark was beaten by his teacher for being too slow. In this case Mark's teacher viewed Mark's slowness as a 'problem' rather than something that should be moulded into the framework of the class. His teacher had none of the empathy or 'person-centred care' that is advocated by Valuing People.
Model 3: The Social Model
Consistent campaigning by groups such as the Disabled People's Movement has in recent years brought about a major revision and replacement of the medical model - something acknowledged and developed by the government in Valuing People: A New Strategy for Learning Disability in the Twentieth Century. The revolutionary concept at the base of the social model is the idea that a person's so-called disabilities are not 'problems' to be overcome but instead aspects that society must learn to accommodate as part of their understanding of 'normal'. The social model makes a sharp distinction between 'impairment' and 'disability'.
As the authors of Disabled People's International noted:
'Impairment is the loss or limitation of physical, mental or sensory function on a long-term or permanent basis'
'Disablement is the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers'
(Disabled Peoples International (1981)
This distinction then is crucial. Impairment is a permanent physical restriction that means a person cannot perform a certain task; disablement means that a person is prevented from realizing his opportunities by the prejudices of a 'normal' society. The social model throws off the assertion of normal people that somehow disabled peoples' disabilities are their own fault, or, that they have created them. So too the old models made people with learning difficulties feel that they were essentially different from members of society who are without disabilities. The social model of disability sets-out to refute these ideas and to show that disabled people are no different to 'ordinary' people and that their disabilities are a healthy part of a varied society. This model suggests disabled people suffer from the same institutional discriminations as people who complain of sexual, racist or heterosexual discrimination. Thus the social model suggests that what is required is the transformation of society to accept a broader definition of 'normality' rather than disabled people having to change to meet the narrow existing model of normality. The old service models placed too much emphasis upon medical solutions of disabilities; what these models failed to see is that the vast majority of problems are with society itself rather than the disabled person.
Mark can be seen to have clearly benefited from the direct support offered by the social model in Valuing Ideas. The overriding theme of Mark's development after he left social services to live with Janet is his new-found independence and sense of personal control - what he calls 'empowerment'. Mark overcome his earlier oppressive and patronizing experiences of social care by embracing schemes such as Direct Payments and using the Disability Partnership Board. Mark is treated by Janet just as any other member of society. This trust in mark's potential by someone who truly cares for him has allowed him to venture into the world knowing that he is no longer essentially different from everyone else, but rather different in his particularity. Notice that Mark now goes to the bank by himself; he goes to the pub and to football matches with friends. He has sloughed off the sense of dependence and inferiority that was imposed upon him by the stigmas of the medical model. This new freedom has led Mark to find employment as a Project Officer and to visit France to show how his 'Life Story' is an inspiration to other disabled people who felt prejudiced against. Mark's biggest obstacle to success in the past was his sense of entrapment to the stigmas of being 'disabled' and 'different. It is a fitting triumph to his determination that Mark now thinks of himself as 'en-enabled'. So too Mark's carers perceive that direct support is beneficial for themselves as well as for the people with that they help. Janet and Mark felt that Direct Support creates a greater sense of intimacy and partnership between a disabled person and his carers. So too direct support makes managers of social care more personals interested and appreciative of the individual needs of disabled people, rather than treating them just as statistics or 'problems' as too often happened under the medical model.
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D. Conclusion
The conclusion of this report must be that Mark has benefited immeasurably from the new types of direct support envisaged for many years now and granted recognition in Valuing People: A New Strategy for Learning Disability in the 21st Century. Mark's involvement with the Disability Partnership Board has provided him with freedoms of choice and rights that were never previously conceivable for him. Schemes such as Direct Payments have allowed Mark a measure of adult responsibility. Mark no longer feels that he is an 'inferior' member of society, but that he is an active and integral member of it. Mark is not however left entirely by himself under these new schemes, but has the assistance of social workers and Janet when he meets difficulties. These benefits seem to validate overwhelmingly the superiority of the 'social model' of service provision. Mark has been able to attend educational classes at Stockport College, to take employment as a Project Officer -- and even to travel internationally to promote person-centred care as a model of excellence. It is fitting that Mark himself should be an embodiment of such excellence himself.
BIBLIOGRAPHY
-- Armstrong, D. Self Advocacy, Civil Rights and the Social Model of Disability. Economic and
Social Research Council, 2001.
-- Bradley, A. Understanding Support Services for People with , (2005).
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-- C. Barnes & G. Mercer (Editors): Implementing the Social Model of Disability, (2004).
Disability Press, Leeds.
-- David, G.R. (Editor). Learning Disability: A Social Approach, (2002). Routledge, London.
-- Department of Health, (2001). Valuing People: A New Strategy for Learning Disability in the
21st Century. The Stationery Office.
-- Gilbert, P & Scragg, T. Managing to Care: The Management of Services for People with
Learning Difficulties. Sutton: BPI, 1992.
-- Her Majesty's Government, (1995). The Disability Discrimination Act 1995.
-- Her Majesty's Government, (2000). The Carers and Disabled Children Act 2000.
-- Her Majesty's Government, (2001). Health and Social Care Act 2001.
-- Kirk, J.T. The Self-Esteem and Psychological Well-Being of Young People and Adults with
Intellectual Disabilities, (2004). University of Birmingham, Birmingham.
-- Disabilities Rights Commission. www.drc.gb.org.
-- British Institute of Learning Difficulties. www.bild.org.uk
-- Disabled Living Foundation. www.dlf.gov.uk
-- Disabled Persons International. www.dpi.org
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