Values and Planning in Social Care

Instructions:-

Learning outcomes

On completion of this unit a learner should:

1 Understand principles and values which underpin the planning of support for individuals

2 Know processes involved in planning support for individuals

3 Understand legislation, policies and codes of practice related to the planning of support for individuals

4 Understand ethical principles in relation to providing support for individuals.

Solution

Values and Planning in Social Care

Task 1:  The principles and values which underpin the planning of support for Individuals

What is empowering individuals?

This is when individuals are given the opportunity to make their own choices and decisions regarding their care and life. This enables professionals to provide holistic support by giving the individuals the right to make their own choices regarding all aspects of their care. Therefore, the individual will be able to tell members of staff if they are unhappy about any part of the support they are receiving. This will then be investigated and an appropriate measure will be taken to make sure that the individual will be happy and cared for appropriately. The individual will be able to voice when they are happy and when they are not happy, they will also be able to voice their own opinions and preferences which will be taken into account when their care is being performed. The individual’s care, wellbeing and preferences will always come first.  For example, in a care home, an individual is included in the making of their care plan which means that they will be able to voice their opinions, questions and concerns.

What is promotion of choice?

This is when health and social care workers make sure that all service users are able to make their own choices.This enables professionals to provide holistic support by making sure that all individuals are able to make their own choices about their care. This means that the individual will be happy and cared for appropriately.  For example, an individual in a care home is able to make the choice regarding their diet as they are a vegetarian. This means that they will feel safe and comfortable in the care of the staff.

What is the promotion of rights?

This is when health and social care workers make sure that individuals are given their human rights and the ability to perform these rights.This enables professionals to provide holistic support by making sure that every person in their care is given their human rights and that these are not infringed. The individuals must be informed of their own and other individual’s rights in order to make sure that no rights are being abused or ignored. This will make the individuals feel comfortable, safe and happy within the care of the staff.

For example, all residents in a care home must be informed of their own rights and the rights of the people around them to make sure that the rights are not abused, ignored, broken or forgotten. This means that their stay in the care home will be much happier and safer.

What is recognition of preferences?

Recognition of preferences is when members of staff in a health and social care setting understand that all individuals have their own personal preferences that should be respected. This enables professionals to provide holistic support by making sure that all individuals in their care are able to voice their own preferences and that these preferences are not ignored or forgotten. This means that all individuals are given the correct care for all aspects of their needs. For example, if a new resident arrives at a care home, they will be asked about their preferences and the members of staff will make sure that these preferences are noted down and enforced.

What is involvement of individuals in planning their support?

This is when Health and Social care workers make sure that they involve the service users when they are planning their support. For example, in a care home, when an individual’s care plan is being made and their support is being organised, the individual will be involved with this in order to make sure that they are able to receive the appropriate amount of care and support. The involvement of individuals in planning their support will enable professionals to provide holistic support as the individual will be able to voice their opinions and feelings on all different aspects of holistic support,for example, physical, intellectual, emotional and social. Therefore, all aspects will be met and the individuals will be supported appropriately.

What is respect for religious beliefs, moral beliefs and values and culture?

This is when a health and social care professional ensures that all individual’s personal religious beliefs, moral beliefs, values and culture are respected, not disregarded and that the individuals are not discriminated against due to these things. For example, in a care home all members of staff will ensure that all individuals will receive respect and give respect for each other’s beliefs, values and culture. This will enable professionals to provide holistic support as all individual’s beliefs and values will be respected by all members of staff, therefore applying to all aspects of holistic support. The individual’s personal moral beliefs, religious beliefs, values and culture all have physical, intellectual, emotional and social beliefs.

What is anti-discriminatory practice?

This is when services make sure that they are able to meet the needs of all of their users. They will also make sure that no one service user receives a better standard of care than another. For example, if a man in a care home is being discriminated against due to his age, staff member will make sure that it will be stopped and prevented from happening again.  This will enable professionals to provide holistic support as, all aspects of the individual, such as physical, emotional, intellectual and social, will be protected from discrimination. This is because in order to practice anti-discrimination, an individual must remove all types of discrimination and not just some.

What is the Holistic approach?

This is an approach which addressed an individual’s intellectual, physical, social and emotional health in order to care and support the ‘whole’ or ‘entire’ person.

For example, in a health and social care setting, a carer will make sure that they provide care and support for all aspects of an individual’s health and not just one of those aspects. This is in order to make sure that the full person is cared for and supported. This will enable professionals to provide holistic support as it sets out all of the aspects that should be covered in order to give full care and support to individuals.

This is when health and social care professionals work with an individual and a whole array of other professionals in order to provide the best possible care for the individual. This helps to maintain a close relationship with the individual and gather information and opinions based on their requirements, care and needs. For example, if an individual suffers from dementia and requires full time care, a whole team of professionals from different jobs, services and companies will be involved with deciding with what care and overall outcome will be best for that individual. This will enable professionals to provide holistic support as in multi-agency working, all individuals will have their own job role in which they will be allocated a job that will provide support for a specific aspect of the individual’s health. The will be a professional allocated to every aspect of the person’s health; physical, intellectual, emotional and social. Therefore, no aspect will be missed and the support and care will be holistic.

What is confidentiality?

Confidentiality is when a person ensures that information and personal details of another individual are kept private, safe and secure. For example, in a care home, all of the resident’s personal information will be kept, either, in a locked cupboard or on a password protected computer and only those on a need-to-know basis should have access to these documents. This will enable professionals to provide holistic support as the professionals will ensure that all types of documents are kept confidential. Such as, medical information, addresses, family member’s information and care plans. All of these documents provide information about all aspects of an individual’s health, therefore in keeping them secure and safe, the professional is providing support in all of those aspects.

What is fulfilling responsibilities?

This is when a health and social care professional ensures that they take care of and respects their responsibilities. For example, in a multi-disciplinary team one professional has the responsibility of finding out the person at the centre’s personal preferences of care. This professional must then make sure that they fulfil their responsibility by making sure that they complete the task that has been set for them, properly and thoroughly. 

This enables professionals to provide holistic support as if every individual will fulfil their responsibilities, all aspects of an individual’s health will be cared for. For example, one carer in a nursing home is given the responsibility of helping the residents socialise and go to local groups (social), another carer is given the responsibility of making sure that the residents are engaging in games, activities and projects (intellectual) another, the responsibility of helping and caring for those who are unwell (physical) and another carer to provide a shoulder to cry on and offer support for those in need (emotional). In this situation, if all carers fulfil their responsibilities, then holistic support will be achieved as all aspects of the individual’s health are cared for.

the benefits to individuals and professional staff, of taking a holistic approach

How the individual benefits from a holistic approach?

Jim benefits from a holistic approach in the following ways:

All of Jim’s health aspects are cared for appropriately. For example, due to his emotional changes caused by his bipolar illness, Jim was referred to a community psychiatric team for a needs assessment so the professionals could decide on what would be best to help Jim. due to Jim’s intellectual health, in the fact that he is a child in the relationship between his parents, although he is in this 50s, and that he does not cook, clean or do his laundry, the decision that has been made that he shall move into a supported tenancy. He will also work with a support worker, who will be his key worker, in order to make sure that Jim is safe and able to care for himself.

How the professional benefits from a holistic approach?

The professional in this situation benefits from a holistic approach as each individual professional has their own responsibilities and jobs to do. For example, Jim’s GP will monitor his condition and review this mental and physical conditions. Jims approved social worker will assess his capacity to make well informed judgments and decisions. The professional will benefit from the holistic approach as it will make things easier for them to keep track of and deal with as each professional will have their own aspects of Jim’s health and to work with and support.

reasons for working with professionals from more than one agency when planning support for individuals

• A multi agency approach would be used to ensure that Jim’s emotional health will be cared for appropriately and professional. This means that there will be a specific professional for each health aspect and therefore the job will be done more thoroughly as the professional will have extensive knowledge on the subject. For example; in Jim’s situation, this GP will monitor his condition and review his bipolar disorder.

• A multi agency approach would be used to ensure that Jim is supported during the transition between living at his parent house and supported tenancy. This will make sure that Jim feels comfortable and safe and his physical, and emotional health is supported. The professional involved will be specialised in the situation and therefore will be able to provide the individual with the best support possible. For example in Jim’s case, he will work with his key worker in order for him to be provided with support whilst moving into a supported tenancy.

• A multi agency approach would make sure that individuals are supported whilst joining in with activities in the communities. This will make the individual feel more confident and safe when in the community. The professional will be fully aware of their job roles and they will make sure that the individual is safe, and comfortable in all situations. As this will be the professionals specific job, they will have knowledge on the situation and how to deal with them.

Case study

Jim was diagnosed with bipolar illness during his first year at university. Now in his mid- fifties, he has stayed with his parents in the same house his whole life. Jim’s parents have not had access to any support and they are increasingly worried about their ability to cope with Jim when he is at his most withdrawn and what will happen to him when they are no longer able to look after him. While they have tried to treat Jim as an adult, the reality is that he is the “child “in the relationship. Jim’s GP is well aware of this and is concerned that Jim’s are becoming frail and have difficulty in coping with Jim’s mood changes and meeting his needs. Jim doesn’t cook, clean or do his own laundry and his parents’ friends and also his friend. After discussing with Jim and his parents, Jim’s GP decides to refer him to the community psychiatric team for needs assessment. It is decides that Jim will move into supported tendency and work with a support worker who will be his key worker. There are several key people involved in supporting both Jim and his family. The first point of contact is the family’s GP. A GP has extensive knowledge of medical conditions and has skills to assess a problem and decide on a course of action, which can be a combination of treatment, prevention and education. In Jim’s case his GP will monitor his condition and review his medication. Jim also has access to an approved social worker (ASW) who has completed additional specialised training regarding mental health issues/legislation. Jim’s (ASW) will be able assess whether Jim has the capability to make his own decisions. If Jim is unable to make independent choices the social worker could act as his advocate or refer Jim to advocacy service. 

                                                                                                                                                                                                                                                                                                                              Questions

• What is Bipolar illness?

Bipolar disorder (pronounced “bipolar one” and also known as manic-depressive disorder or manic depression) is a form of mental illness. A person affected by bipolar I disorder has had at least one manic episode in his or her life. A manic episode is a period of abnormally elevated mood and high energy, accompanied by abnormal behaviour that disrupts life. Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. Where the term “manic depression” comes from. In between episodes of manic and depression, many people with bipolar I disorder can live normal lives.

• Identify the professionals who would be part of the multi-disciplinary and inter-agency team working with both Jim and his parents

There are many professionals who can work together to support Jim and his family. These include: The Community Mental Health Team and a Family Focused Therapy

• Community Mental Health teams are made of professionals who work with adults with medium to long term psychological and psychiatric problems of significant complexity and seriousness, under these circumstances they would work alongside Jim and his family. The health team would be working with Jim and his family to make sure that his mental state is being taken into consideration and cared for.  http://www.hpft.nhs.uk/help-for-adults/adult-services/cmht/

• Family focused therapy is a form of treatment which is used to encourage family members to come up with ways  to  deal with the disease and manage its symptoms, with the goal of preventing the disorder from recurring in the future. http://www.scielo.br/scielo.phppid=S151644462004000700012&script=sci_arttext&tlng=en

Devise a support plan that would support Jim in his transition.

1. Whose rights, wishes and needs must be paramount? How can the professionals in the multi-agency team ensure that both Jim’s and his parent’s rights are protected?

It is important that Jim’s rights, wishes and needs are being made paramount. Regardless of Jim being mentally ill, it should not affect the amount of support that Jim is going to need in the long run. If Jim’s circumstances change and he needs professional advice on how to handle his situation, it may be worth considering or appointing another family member to make informed decisions  in Jim’s  care.

Task 2:  The processes involved in planning support for individuals 

When producing a care plan cycle it is important to consider all of the individuals needs and how this cycle can help meet them. When the first assessment is taken, the needs of the person may not be so apparent, therefore it is important to set certain dates to review and update the cycle if necessary and ensure all the individuals’ needs are being met.

The care plan cycle starts with the person being referred to a new place such as a care home, people can be referred by family, a GP, they may refer themselves or support/social worker may refer them. The organisations will then do a holistic assessment this may be done by a care manager. They will then have to identify what services the person already uses such as meals on wheels or day centres. Then they will set targets for the person to achieve, record what care is required and who has what roles and responsibilities. The next stage of the care plan is recording this is to know what is to be done or what has been done to ensure the right care is given. All carers who will be involved in the care of the individual need to be informed of what actions are being taken and imply the actions and know the date of completion. Care will monitored by the manager or carers. When the set date of completion arrives the care plan will be reviewed and will be checked to see if targets have been achieved. The care plan will then be evaluated and new targets may be set.

Assessment tools are used in the care planning process to build up a holistic picture of an individual’s needs. When all the details have been recorded an assessment can be made and suitable care and support can be identified. A few of the assessment tools are information from the individual such as diaries, observations, medical histories and checklists.  If an individual keeps a diary, this can be used to see what their likes and dislikes are, what activities they may like to do and it can also be used to see what care they are already receiving such as day centres or meals on wheels. Observations are done to see what the individual is able to do themselves and what things they may struggle with, it helps see what the person’s behaviour patterns are such as when they like to go to bed or wake up.

Medical histories are looked into to see if carers should be aware of any conditions the person has, carers may also do some medical checks such as checking the person’s height, weight, temperature, pulse and blood sugar these will be monitored regularly to see if the person’s condition is getting better or worse. Checklists can be used as an assessment tool to ensure every one of the person specific needs is being met, these checklists may be reviewed by a social worker or the manager of the organisation.

Describe how three key professionals could be involved in planning support for individuals/Mr.Ali

There are three key professionals working with Mr.Ali and supporting him through his decisions. They are also working together with each other to put together a support plan for Mr.Ali. The three key professionals are; a community psychiatric nurse, support worker and dietician. Each has a different role in the planning support for Mr.Ali as they are all supporting Mr.Ali with different aspects of his health and well-being.

A Community Psychiatric Nurse is fully trained and has many years experience in a hospital setting before going out into the community. Their experience would have been on psychiatric wards in hospitals. The role of the Community Psychiatric Nurse is to visit people in the community, usually in the patient’s own home but can also be clinic based. CPN’s are normally the patient’s first point of contact as they are there to support people who are experiencing a difficult time in their lives. They also visit patients in the community who are in good health to ensure they are okay. A CPN administers medication to patients and ensure they know the reason to why they are taking then and when they should take them. A CPN does not only support the patient but also family, friends and carers. This role is valuable as it helps them to understand and cope with any illnesses the patient has. CPN’s also take referrals from GP’s, psychiatrists and inpatient wards as the CPN will support the patient and help them get back out into the community and from then on the CPN is usually the patient’s key-worker.

In regards to Mr.Ali, the community psychiatric nurse will visit him at home to ensure his emotional and psychological state is not going to be jeopardised due to him taking part in the sponsored walk. The CPN will also ensure Mr.Ali is still taking his medication correctly and support him through any tough times he is facing. The CPN’s role as a nurse and key-worker when participating in the planning of Mr.Ali’s support plan is,to review Mr.Ali’s progress and assess if all of Mr.Ali’s needs are being addressed. This involves, getting feedback from Mr.Ali about how positive or negative the help and support is that he is receiving from the mental health team. The key-worker can be anyone who is a member of the community mental health team; a psychiatrist, CPN, Occupational Therapist, Social Worker or psychologist.

A support worker is someone who supports people with different need in their everyday lives. They support them in many ways and in many situations. They focus on the needs of the service users by supporting them, giving time to the service user and promote their recovery or support them through illness. The role of a support worker is to; promote the independence of the service user, provide companionship and friendships whilst providing practical and regular support. A support worker will provide support with daily living and facilitate people living normal lives. A support worker plays a huge role in any service user’s life and helps them gain access to resources such as; day centres, support groups etc. If a service user was to deteriorate then their support worker will help identify this and then supporting the service user when they are going through treatment. Health promotion information is also provided by a support worker.

In regards to Mr.Ali, a support worker working with mental health is known as a STR; a support, time and recovery worker. The STR will work as a team who focuses directly on Mr.Ali and provide mental health services. Even though Mr.Ali lives independently, his STR will support him to keep his independence. The STR would need to have a good relationship with Mr.Ali, providing companionship and friendship, and then they will be able to provide regular and practical support. Mr.Ali attends a day centre and to gain access to this, the STR would have helped Mr.Ali. The STR will give Mr.Ali all the support he need with daily living whilst facilitating Mr.Ali to live an ordinary life. If Mr.Ali was to start having a relapse his STR would help identify the early signs and report it to other health professionals involved in Mr.Ali’s care and support. The STR would the support Mr.Ali with any treatment he is involved in. When Mr.Ali attends the day centre, his support worker may be with him at times to provide emotional support and could also act as an advocate.

As Mr.Ali’s STR, they will be there to support Mr.Ali through anything he finds difficult in his daily life and support him with tasks when needed. The STR will put their views across to other professionals and Mr.Ali when in the process of creating a support plan. He will be able to pass on his concerns about Mr.Ali and also what he thinks Mr.Ali’s strengths are. The STR will put a lot of information into a support plan as they would know Mr.Ali best due to building a strong compassionate friendship and due to being more involved in Mr.Ali’s personal life than other professionals. Whilst being involved in the support plan the STR will promote Mr.Ali’s rights, maintain confidentiality and promote equal opportunities, ensuring Mr.Ali is being treated with respect and dignity, which is part of ethical practice.

A dietician is a trained professional who enables and empowers people to make informed and practical choices about the food they eat and lifestyle choices. They are trained in hospital and community settings and usually employed by the NHS. They can also work in the food industry research and education, and also on a freelance basis. Dieticians must be registered before working with anyone who is referred to them. Their role includes going through a practical application of nutrition with individuals, promoting the wellbeing of both individuals and the community; this will help to prevent nutrition related problems. Dieticians can also diagnose individuals with nutrition related problems and disease, and are also involved with dietary treatment of disease. Their main responsibilities include; working with individuals with special dietary needs, evaluating and improving treatments. They also use a social marketing approach to inform the public about nutrition and offer unbiased advice. They are there to also educate patients, clients, other health professionals and groups in the community. The use of mass media is used a lot by dieticians; leaflets, adverts, posters, billboards, radio advertisements, television adverts and many more forms of media are used and this is how dieticians promote well-being, inform the public, educate and give advice.

In regards to Mr.Ali, he wants to become healthier as he wants to help raise money for the day centre he attends. He will be helping raise the money by participating in a 20 mile sponsored walk. He has taken this very seriously and wants to do his absolute best in achieving his goal. The event is taking place in three months time and within this time Mr.Ali wants to gradually improve his walking distance. The main support he wants is with his diet. He wants support and advice on healthy eating; this will be part of his preparations. He wants to know what meals, drinks and snacks are best for him to keep his energy levels up but not empty calories which will make him gain weight. To help Mr.Ali with this, the dietician will advise him on what is a good way to maintain his weight and raise his energy levels. Dieticians sometimes do this by working with the service user to create a healthy eating plan.

This will consist of what Mr.Ali will eat each day, Mr.Ali will be involved in the whole process. Mr.Ali will be given leaflets full of nutritional advice and the dietician will also talk to Mr.Ali about any bad habits he has, what foods he eats more of, what his food weaknesses are and if he does any physical exercise. The dietician would have to take into consideration that Mr.Ali cannot be pushed too hard or become distressed due to his mental health illness. The dietitian needs to respect Mr.Ali’s choice and treat him with dignity. Mr.Ali’s rights should not be infringed and the dietician should not use and abuse their power; just because Mr.Ali has come to the dietician for support and advice, it does not mean the dietician can control what Mr.Ali eats or controls what he does in his personal life.

All the dietician should do is give advice and support Mr.Ali with his preparations. The dietician can review Mr.Ali’s progress before the event begins. They can do this when they feel Mr.Ali will need more advice and support. It may start off as every two weeks then move to once a month depending on his progress and health. The role of the dietician when participating in the process of creating Mr.Ali’s support plan is, to put forward his thoughts on how he thinks the healthy eating and preparation for the 20 mile sponsored walk will affect his health.

He can put forward whether they think it would be too much pressure on Mr.Ali or if it will be for his mental and emotional state. Together all three professionals can determine, with Mr.Ali present, what the best option is for Mr.Ali and how he can participate in the event without it affecting his health and well-being. When working together all professionals must consider Mr.Ali’s individuals rights and treat him as an individual. If he is not treated with respect and dignity, or not treated as an individual then he will feel his personal identity has been stripped from him. Taking a holistic approach will ensure that all Mr.Ali receiving a person centred care.

 potential issues which could arise from working in partnership/  multidisciplinary/inter-

agency approach

In a health and social care settings there could be issues that could arise when many health care professionals work together on a patient, these could be on, the professionals could have miscommunication with sending and receiving information from a professional, for example the professionals handwriting can be difficult to understand. Also, from my unit 1 miscommunication include a use of special terminology such as jargon, informal, rushed and careless interaction during had-off or transfer, including at hospital discharge, and a lack of coordination of care. This is due to the form of communication they use checklists. This provides a predictable structure regarding patient circumstances. This means that the professional understands the patient’s needs that the professional would need to be inform of. For example in a health and social care setting a service user was referred and admitted by a care professional for evaluation.

During the time in hospital the patient was found to have type 2 diabetes, which was already in his family therefore biological. The patient was referred to a dietician and put on a strict diet. Two days after admission the patient got discharge. The patient was instructed to call her primary care physician for follow-up of the diabetes. No direct communication was made with the primary care physician about the evaluation occurred, and the patient later indicated she did not understand what was required by the professional. Therefore, this shows that there was a lack of communication with both the professionals and service users. This could affect the service user as the service user would find it hard to understand what is happening to her health. Most professionals don’t give enough details that the patients need to know about their symptoms.

This is due to a lack of miscommunication within two health professionals. This could be due to one professional thinking that they are better than the other professional so they would not communicate well towards the other professional. Some professionals feel more intelligent than other professionals, this suggest that the hierarchy is shown in a professional settings. For example, conflict of information of the care professionals such as nurses and doctors could pass on different information to the patients and most likely the doctor would not agree with the information the nurses would want to pass on to the patient which could make the patients feel disempowered as they have no say about their health. This could cause them to want to disengage from the professionals.

Task 3:  The importance of legislation when planning support for individuals

Legislation are laws that the parliament makes, it ensures that everyone is clear about their rights and responsibilities within the care environment. All social care settings should understand the importance of following legal guidance because this can protect against poor practice.

One piece of legislation that could be used when planning support for an individual is the data protection act 1998. This is act can be used when planning support for an individual because it ensures that each individual has their choices considered and that organisations have a duty to protect them from harm which includes self-harm. It also ensures that confidential information is only passed on to the relevant people and only if there is a risk of harm. Also, it ensures that the person files and information wouldn’t be left around for people see. This would make planning support easier as the individual would like anything told to the care workers would be kept safe and confidential.

Health and social care organisations will have set policies which promote equal opportunities, these policies will help organisations value the individuals who are receiving care. One policy used when planning support for an individual is a risk assessment, risk assessments are looking at activities and considering problems which may arise can things that may go wrong. Healthy Working Lives (2012) states that “Then care workers would be able to decide what measures to take to prevent injury or damage and reduce or eliminate all risks”. For example if a service user in a care home becomes violent against service users when they are loud this may be a risk to the other service users therefore this would need to be put in their care plan to see if he can avoid loud activities.

Codes of practice are put in place to inform practitioners of their rights and their responsibilities. All care workers are expected to go through an induction period, this will include the right training leading to relevant qualifications which enables them to perform their roles professionally. The vetting and barring scheme can be used to when planning support for an individual as it ensures that the carer is registered with the independent safeguarding authority before being allowed to work with any vulnerable person. This would help ensure that any care given or any activities outside the specific organisation with unfamiliar people is safe.

Task 4:  Ethical principles in relation to providing support for individuals

Stretch and Whitehouse (2010) “Ethical principles are based on morality, which means it is important for care workers to have a clear understanding of morality and the meaning of moral decisions and how they are linked to health and social practice”. Although these principles are not set rules, they can help health care workers to make decisions when reflecting on moral issues that arise at work. A few key ethical principles are duty, empowerment, beneficence, safeguarding individuals. All ethical principles are faced with ethical dilemmas which may include choosing which option will benefit individuals more. All care workers have a duty of care to protect the service user’s rights. If something could be harmful for the individual such as treatment, the advantages and disadvantages have to be assessed. For example “cancer patients are quite often advised to undergo a course of chemotherapy or radiotherapy. Both treatments involve some harmful side effects, but the benefits should outweigh the harm caused by the treatment”. Doctors and nurses will have to decide whether the treatment would be too harmful for the patient or if there is a chance of survival.

Empowerment helps individuals to have control over their own lives. Vulnerable people who receive health and social care services may rely on professional carers to ensure their independence. It is important that care workers empower individuals and don’t make decisions for the individuals in their care. Staff may think they are acting in the best interest of individuals but they could actually be denying a person’s right to act as an independent individual and control their own life. An ethical dilemma involving empowerment could be not allowing a person with learning difficulties to have alcohol whilst on a trip to the pub or controlling the amount they are allowed to have. The carer may say that the individual is only allowed to have one drink instead of the amount they want.  Beneficence are actions which are taken to promote the wellbeing of other individuals, this may also mean taking actions that serve the best interests of patients. Care workers have a duty to act in an individual’s best interest at all times. An example for beneficence could be not allowing an individual with learning difficulties who goes to a care home to have a relationship with another individual. Some organisations have strict policies against service users having relationships.

Healthcare organisations need to make sure they safeguard vulnerable individuals, this means ensuring all staff have passed the CRB checks and are registered with the independent safeguarding authority and providing new resources to ensure the person’s needs are met. Organisations also have to ensure that risk of harm to service users by another service user is minimised. A service user with schizophrenia may become aggressive with other services users if something happens that they don’t like. Carers should be trained on how to deal with these situations.

how an ethical approach to providing support can benefit individuals

In this essay I shall begin to justify In this essay I shall begin to justify how an ethical approach to providing support can benefit individuals and use examples to evaluate two potential dilemmas which could be faced by staff involved with the delivery of care in day to day working. When working in a health and social care environment, there are various professionals that are often faced in day to day working of situations to which involve moral dilemmas which means that it is crucially important for each professional to have a clear understanding of morality and what moral decisions are and how they are linked to the practice of health and social care. Not only this, but health and social care professionals also need to have a good understanding of their legal position and the morals and ethics that are a foundation of their professional code of practice which is extremely important in terms of occasions where by a service user may refuse medical treatment or decides on a course of treatment which may not be beneficial for them in terms of their best interests.

When these situations arise, legislation and professional codes of practice must be implemented and used as valuable guidance for the professional to follow as well as numerous other ethical point she ethical principles however such as independence and rights, empowerment, beneficence, safeguarding, autonomy, dignity, duty, morals and independence all have to be looked at when this decision is being made and all individuals should be fully aware of their rights and should also have equal access to medical treatment. Empowering the individual means that they are ensured that they know enough information to make an informed choice about certain decisions that can affect their quality of life and helps the individual to have control in their lives. Vulnerable people in health and social care services can sometimes rely on professionals to ensure their independence and it is important that these professionals empower the individuals to influence their independence and don’t use benevolent oppression to make decisions for individuals in their care.

Examples of benevolent oppression include not allowing the individual to have relationships, limiting their alcohol intake, not allowing the individual to have privacy, preventing the individual with disabilities to go out on their own, choosing activities which are acceptable for them and not giving them any choice and not providing resources which will promote independence and autonomy. Examples of a potential ethical dilemmas which could be faced by an individual includes an individual in a care facility disclosing that they are being abused by one of the care workers and pleads to another care worker to not tell anybody else. This is an example of benevolent oppression and it is evident that the support worker and the professionals working with should be more aware of ethical principles. In this case I believe that the two learning disability individuals should have been spoken to and the matter should have been discussed with them first before any action was implemented. Keeping the individuals out of the loop prevented them from having a say in their care and they were not allowed the independence to choose how they spend their life and who they spend their life with.

In conclusion ethical principles are a key part in the delivery of patient care and each service needs to have the appropriate policies and procedures for guidelines on how the professionals should act when ethical dilemmas arise. There are numerous benefits of delivering care in an ethical approach for reasons such as the individual’s independence and rights are respected and taken into account, the individual is empowered and therefore feels confident in the fact that they have the power to say what happens in their care and how they live their life. Other reasons include factors such as the individual’s dignity will be respected which will raise their self-concept and they won’t feel like a waste of space who isn’t able to care for themselves and instead will feel respected and cared for. and use examples to evaluate two potential dilemmas which could be faced by staff involved with the delivery of care in day to day working. When working in a health and social care environment, there are various professionals that are often faced in day to day working of situations to which involve moral dilemmas which means that it is crucially important for each professional to have a clear understanding of morality and what moral decisions are and how they are linked to the practice of health and social care.

Not only this, but health and social care professionals also need to have a good understanding of their legal position and the morals and ethics that are a foundation of their professional code of practice which is extremely important in terms of occasions where by a service user may refuse medical treatment or decides on a course of treatment which may not be beneficial for them in terms of their best interests. When these situations arise, legislation and professional codes of practice must be implemented and used as valuable guidance for the professional to follow as well as numerous other ethical point she ethical principles however such as independence and rights, empowerment, beneficence, safeguarding, autonomy, dignity, duty, morals and independence all have to be looked at when this decision is being made and all individuals should be fully aware of their rights and should also have equal access to medical treatment.

Empowering the individual means that they are ensured that they know enough information to make an informed choice about certain decisions that can affect their quality of life and helps the individual to have control in their lives. Vulnerable people in health and social care services can sometimes rely on professionals to ensure their independence and it is important that these professionals empower the individuals to influence their independence and don’t use benevolent oppression to make decisions for individuals in their care.

Examples of benevolent oppression include not allowing the individual to have relationships, limiting their alcohol intake, not allowing the individual to have privacy, preventing the individual with disabilities to go out on their own, choosing activities which are acceptable for them and not giving them any choice and not providing resources which will promote independence and autonomy. Examples of a potential ethical dilemmas which could be faced by an individual includes an individual in a care facility disclosing that they are being abused by one of the care workers and pleads to another care worker to not tell anybody else. This is an example of benevolent oppression and it is evident that the support worker and the professionals working with should be more aware of ethical principles. In this case I believe that the two learning disability individuals should have been spoken to and the matter should have been discussed with them first before any action was implemented. Keeping the individuals out of the loop prevented them from having a say in their care and they were not allowed the independence to choose how they spend their life and who they spend their life with.

In conclusion ethical principles are a key part in the delivery of patient care and each service needs to have the appropriate policies and procedures for guidelines on how the professionals should act when ethical dilemmas arise. There are numerous benefits of delivering care in an ethical approach for reasons such as the individual’s independence and rights are respected and taken into account, the individual is empowered and therefore feels confident in the fact that they have the power to say what happens in their care and how they live their life. Other reasons include factors such as the individual’s dignity will be respected which will raise their self-concept and they won’t feel like a waste of space who isn’t able to care for themselves and instead will feel respected and cared for.

Benefits

It has often proved difficult to establish the exact impact of multi-agency working, mainly because of the difficulty of isolating why and how a particular outcome has been achieved. This is changing as major programmes are evaluated. This section summarises some of the key findings from recent research about the benefits of multi-agency working. It is divided into three main sections:

• Improving outcomes for children and families
• Benefits for staff and services
• Providing what children, young people and families say they want 

Improving outcomes for children and families

School staff working with child and adolescent mental health services identified that the joint work had led to an increase in children’s happiness and well-being. They identified a measurable improvement in children’s behaviour in two of the services reviewed, and better peer relationships were identified by workers. Although rarely measured, workers identified links to improved academic attainment, as children were able to learn and were developing learning skills. In work with disabled children, families with key workers to coordinate services report improved quality of life, better relationships with services, better and quicker access to services and reduced levels of stress. Even at a relatively early stage of development, the multi-agency On Track programme was identified as having a positive impact on children and families, with outcomes reported in the following areas:

• Improved behaviour
• Enhanced relationships with service providers, parents and other adults (such as police officers)
• Improved access to education
• Enhanced emotional and social well-being, especially relating to confidence and self-esteem

In healthcare, multi-agency working has been associated with better patient outcomes and lower levels of stress for staff. Numerous projects report positive outcome measures which are specific to the type of teams and range of work studied:

• Innovative multi-agency projects targeting children’s mental health showed a reduction in the proportion of those with clinically significant problems in many cases, as well as better engagement with school.
• One primary school with access to a behaviour and education support team reports that its drastic reduction in exclusions and behaviour problems. Their impact had been “tremendous – the best we’ve had. They’ve been superb in the support given to children, the family and the school. There has been a change in self-esteem, worth and children’s expectations for the future.
• In its first two years of operation the Darnall and Tinsley On Track service reported a 50% reduction in levels of crime among 10-12-year-olds and a 50% reduction in the number of referrals to social services of children and young people aged 0 to 17, against a city-wide backdrop of just over 25% .

Extended schools offering a range of services have identified a positive impact on children’s attainment, on their general well-being and on their overall life chances. Some of the key benefits are higher levels of achievement; increased motivation and self-esteem; more opportunity to participate in sports, arts and cultural activities; and specialist support to meet additional needs. Families report seeing improvements in their children’s behaviour; being more involved in their children’s learning and finding it easier to take up employment due to the provision of affordable childcare. The multi-agency composition of BESTs was found to be advantageous in terms of working practices and ultimately the impacts achieved. Referral systems were said to be more streamlined, while schools, families and children benefited from more immediate access to support when required.

The pool of skills within the team meant that BESTs could offer holistic support to those referred, and by addressing the health, domestic and social welfare concerns of children and families, steps were made towards improving attendance, behaviour and attainment. BEST intervention was also seen to have impacted positively on parents in a number of ways.  Most frequently mentioned was improved access to services being facilitated through contact with the BEST, both in terms of services within the BEST and through signposting on to other agencies.

Also mentioned were: identification of adult’s needs, access to grants or practical resources for families, and improved parent-child relationships through parenting skills and strategies acquired through BEST interventions. Other commonly identified outcomes of multi-agency work are:

• Access to services not previously available, and a wider range of services
• Easier or quicker access to services or expertise
• Improved educational attainment and better engagement in education
• Early identification and intervention
• Better support for parents
• Children’s needs addressed more appropriately
• Better quality services
• Reduced need for more specialist services

Benefits for staff and services

Practitioners with backgrounds in single, traditional agencies report high levels of satisfaction with multi-agency working. In particular, they feel liberated from the narrow bureaucratic and cultural constraints of their parent organisation. Where the initial bedding down phase is well-managed, they find the potential for cross-fertilisation between the different agencies stimulating; and many value the opportunity to take a more holistic approach to the needs of children. Schools delivering extended services have identified opportunities for staff to work flexibly and for support staff to access more career development opportunities. Where there are swift referral systems to multi-agency support, extended schools have seen improvements in staff recruitment, retention and workload. They also provide opportunities for enhanced partnership working with the community and better school security. Working within a BEST was described as having been a rewarding experience for the majority of the practitioners interviewed. Many of the positive impacts reflected those cited more generally as benefits of multi-agency working. Most commonly mentioned was professional development:

opportunities to share expertise and learn from colleagues through discussion of casework and joint delivery of interventions. The On Track evaluation identified positive impacts for staff. These were primarily associated with new ways of working within multi-agency teams, in particular:

• Less replication between different service providers
• Better links between service providers, including a greater understanding of their practices
• Professional development and career progression opportunities
• More involvement in community development
• Improved awareness of different services and changed public perceptions of service providers

Providing what children, young people and families say they want

Families of children with additional needs are likely to be in contact with many different agencies and professionals – for example health, education, social services, housing and benefits. For example, families with disabled children see on average ten different professionals and have more than 20 clinic visits a year. Often families don’t understand the roles and responsibilities of different agencies and professionals; they don’t know who to go to for what; they may get conflicting information; they may be passed from one agency to another. This can produce rather than alleviate stress for parents and carers, which in turn impacts on relationships with their children. Families say they want a single point of contact with services and a trusted, named person to coordinate assessments, information sharing and care pathways to help ensure quicker access to the right kind of support. As well as this outcomes-based evidence, research has also identified a significant amount of information about the success factors associated with effective multi-agency working. http://webarchive.nationalarchives.gov.uk/20100210151716/dcsf.gov.uk/everychildmatters/strategy/deliveringservices1/multiagencyworking/faqs/benefitsofmultiagencyworking/

challenges

Research suggests that to help collaborative working aims,allocated time and shared ownership are required, which combined with a shared vision, goals, and resources; are the ‘building blocks’ of success.  Effectiveness can be achieved through concern for quality, but shared objectives had the biggest impact,similarly if individuals have worked together previously or have a history of team ethos effectiveness can be increased. This subscription to common values can result in individuals creating their own collaborative culture or way of doing things. These previous contact or networks are found to form ‘cultural capital’ a resource that contributes to partnership success and taken forward from previous experiences. This suggests that clear and shared aims are important and effectiveness can be increased if individuals have previously worked together. The degree of collaboration the partnership can sustain before loss of commitment is called collaborative capacity; seen in the form of skills and attributes which enable individuals to work across boundaries; however, this is not easy. Barriers are deeply rooted in organisational culture and practice; within formal behaviour patterns, dress code and language, serving as obstacles. These identity issues highlight the complexity of multi-agency working.

The need to recognise each agency’s contribution and learn from each other is important and marginalisation is reduced if individuals identify an acceptable teamplace. However, lack of clarity over role demarcation is a concern, with status issues resulting in tensions and low morale from blurred boundaries. Insecurities are felt when agencies do not appreciate each other’s abilities, resulting in crossing domains, which can threaten partners. This highlights the identity barriers to multi-agency working, which can inhibit success. Working relationship issues are at the core of multi-agency activity, with the need for understanding, communication and mutual respect.Furthermore the importance of personal views, feelings and attitudes  are more significant, than systems and structures. Differences may arise which need to be actioned; otherwise tensions arise that inhibit integration. To build and maintain collaborative relationships individuals will need specific capabilities.

This new ‘hybrid’ professional type has certain knowledge and experience that is essential for successful collaboration.Achievement could relate to having the right person, in the right place at the right time and highlights the destructiveness of having the wrong person there. Selecting the right person can be through careful selection but equally it can be down to ‘luck’. This indicates the importance of having the right individuals involved in the IYSS.Building relationships upon trust, mutual respect and understanding are important to effective working relationships; engendered through sharing skills, best practice, resources; and a common language to facilitate decision making.  Trust appears to be ‘by-product of personal connections and friendships’ and although partnerships can exist without trust, its presence forms the basis for the close stand enduring relationships. Sharing priorities, goals and working together can overcome inter-professional issues and past mistrust.Furthermore  lack of trust results in less effective collaborations; overcome if organisations agree parameters which aim to promote fairness, account for behaviour and are important in building trust.

One set of parameters seen as beneficial to partnerships are the Nolan Principles and assist with building strong partnerships. This indicates how important trust would be with regard to the IYSS. Leadership is an important resource for collaboration (Sullivan and Skelcher 2002). However, effective leadership of integrated teams requires a ‘special mindset and skills’ including capacity to draw others in,motivation, passion, social skills, reflection and a commitment to own learning and of others (Sullivan and Skelcher 2002, Duffy and Marshall 2007). A reticulist (Sullivan and Skelcher 2002) may be able to lead a multi-agency team, however,the idea of a lead agency and hierarchal relationships, where agencies could exercise more power, may be challenged (Sullivan and Skelcher 2002). To work collaboratively organisations will need to surrender power and resource control (Tett 2005), as this can inhibit progress.Furthermore individual’s roles should be clarified so they understand how they can contribute utilising a clear framework of responsibility.  An ‘unequal power balance’ can exist; partner’s contributions (Sullivan and Skelcher 2002) should be valued consummately, however less powerful partners can be treated with inequity, or excluded from partnership practice including the voluntary and community sector, who despite encouragement often feel inferior.

Evaluation

 An intended gain is the ability to respond effectively to the needs of children and young people and although integrated working is ‘intimately connected’ to improving outcomes, this proposal has been challenged. The mechanisms of partnerships have rarely been scrutinised and gains are difficult to realise in practice, with impact evidence being difficult to locate. The pressure to collaborate does not appear to be based on clear evidence it can work, with a literature search finding little evidence of improved outcomes. Organisations cannot learn from partnership working unless evaluation takes place and the results are fed back, however, there is no distinctive success model against which to measure. To achieve the intended results, individuals would need to understand the required ingredients for a successful partnership in terms of the concept of success; however the majority of partnerships were concerned with the process of undertaking partnerships,highlighting the lack of clarity regarding whether to measure process or outcomes.Despite refinement of models there is a lack of links to evidence and the outcomes to service users; with any documented positive impacts referring to the professionals involved.

Agencies learn from each other and inform practice by sharing differing perspectives of services; however informs this is simple notion of learning from each other and it is questionable why multi-agency working requires national initiatives to endorse it. This highlights the importance of evaluation to the IYSS, to determine if outcomes have been achieved, however it is clear that determining success is a difficult process.To determine the effectiveness of the IYSS this literature review has highlighted the need to investigate what the locally understood rationale is for the IYSS, what are the aims, of evaluation is seen as important and the range of agencies involved. To determine the efficiency it will be necessary to identify what model of multi-agency working has been selected, whether leadership is recognised as important and whether there are any barriers or challenges which appear to be affecting the development of the service.  

Answer the case study question on Alan and Jane both have learning disabilities and live in a supported tenancy in the community with eight other people. Both have their own rooms and during the past six months have become very close. They both enjoy music, going to the local pub for a drink and going to the cinema. They have started to spend more time alone in Jane’s bedroom, listening to music. Alan has revealed to Sam, his support worker, that while listening to music they both enjoy holding hands and ‘giving each other a hug’. Even though Alan and Jane are in their mid-twenties, Sam is very concerned and discusses the situation with his supervisor Claire. Without consulting Alan and Jane, Claire decides that they are not to be left alone and their outings are to be restricted. Alan becomes very angry and Jane begins to cry. When Jane’s sister visits, Claire explains that she is protecting Jane and Alan. But Jane’s sister is concerned that Jane is not being allowed her independence, and her quality of life is being affected. Claire’s behaviour is an example of benevolent oppression, but she would argue that she has to consider the importance of Alan and Jane’s needs and balance them with their rights. It is obvious that Claire and her staff need to be aware of the ethical principles to follow when faced with such dilemmas.

Identify the ethical dilemma that Claire and her team face.

There are a number of ethical difficulty that Claire and her team are facing as a result of them thinking that they know what is best for Alan and Jane. Claire feels like she has Alan and Jane’s best interest at heart, unfortunately she is the opposite.  Regardless of Alan and Jane’s learning difficulties, this shouldn’t be a reason to take away their freedom. It is a complicated situation for everyone involved because Claire is trying to make sure that Alan and Jane are receiving a fair amount of independence and are not being discriminated against their rights but she has to take into account  their learning difficulties can have an impact on their relationship.  Having a lack of resources and information in order to provide Alan and Jane with care is the main thing Claire and her team need to consider when trying to deciding what is best for them both.

How can Claire and Sam encourage Alan and Jane to become empowered and achieve autonomy?

Claire and her team have the ability to make sure that Alan and Jane feel empowered as well as making sure they receive autonomy. Once Alan and Jane are given the opportunity to develop their own independence and make decisions for themselves, it will help to improve their quality of life and autonomy would have been achieved. Allowing Alan and Jane to go out for a drink and do the stuff that they enjoy, it will allow Alan and Jane as a couple to feel more empowered. However, it is important that everyone involved is aware of Alan and Jane’s relationship as well as the dangers that may occur in the long run.

Bibliography

http HYPERLINK “http://cturner146843.weebly.com/”://cturner146843.weebly.com/

http://c HYPERLINK “http://cturner146843.weebly.com/”turner146843.weebly.com/

http://d HYPERLINK “http://docplayer.net/1504235-Values-and-planning-in-social-care.html”ocplayer.net/1504235-Values-and-planning-in-social-care.html

http://www.healthguidance.org/entry/11858/1/The-Benefits-o HYPERLINK “http://www.healthguidance.org/entry/11858/1/The-Benefits-of-Holistic-Treatments.html”f-Holistic-Treatments.html

www.netdoctor.co.uk

www.nhs.uk

Healthy working lives (2012) Risk Assessment http://www.healthyworkinglives.com/advice/minimising-workplace-risks/risk-assessment