Case Reflections in Social Work Practice

Introduction

Social work is recognized as a practice-based profession that is concerned with the promotion of social change, cohesion, development and empowerment of people and larger communities. The practice of social work involves developing an understanding of human behavior, development, and the different cultural, social, economic interactions and institutions. This paper reflects on three different cases, identifying, what was done right, what was done wrong, and what could possibly have been done differently.

Assessment

Farai and Harry

Historically, research has overlooked the different ways through which the LGBTQ community experiences domestic and sexual violence. Notably, however, recent literature on violence involving the LGBTQ community has been increasingly complete and inclusive. Research by Townsend & Bailey (2021), established that those individuals who either identified as gay or lesbian reported rates of domestic violence that were equal to or higher than those individuals who identified as heterosexual. Anyone is at risk of being a victim of domestic abuse, and this is regardless of their age, gender, socio-economic status, ethnicity, background and sexuality. Albright & Alcantara-Thompson (2011), point out that there are varying types of abuse that can possibly happen in different contexts, with the most prevalent form of domestic abuse being observed in relationships. It is worth noting that the definition of domestic violence covers gas lighting to threatening to out others, abuse between family members, including adolescent to parent abuse and violence (Jenkins, 2021).

When Beatrice was allocated Farai`s case, I was worried that it would outweigh her as she had other cases on her backlog. However, she proved me wrong over time. She requested me to be her partner as she worked on rescuing Farai from Harry, in addition to helping him come out to his family members as gay in a way that they would embrace him. One thing that I observed from this case is that Beatrice always made time for Farai. Beatrice pinpointed to me that the best times to reach out to Farai was during his moments of calm. Involving ourselves with him when tempers were flaring between him and harry would possibly put us in danger. I have to admit that we set aside plenty of time to listen to Farai whenever he opened up. It was also made clear to Farai that anything that he confided in us would remain discreet. At no point did we force him to open up against his will, and we always allowed conversations to unfold at comfortable paces. From time to time, we would ask clarifying questions, but largely, we just let Farai to vent his frustrations, feelings and fears. I learned that had previously been able to access a men`s refuge but had not gotten any help and ended up leaving as no one could communicate with him in sign language. The refuge had declined to book interpreters, arguing that they were a small charity, and interpreters would be too expensive for them. Therefore, we were the first people that Farai ever confided.

There is a common argument advanced that domestic violence more about control and less about anger, with the victim being the one who often sees the perpetrators dark side (Barrett, 2015). From time to time, outsiders even get shocked when they learn that the perpetrator, whom they always thought they know too well, commits violence. Consequently, there are innate feelings among victims that no one would believe them if they opened up about the violence they face. Beatrice made it clear to Farai that we believed in his story and said the same to him. We also were keen to validate Farai`s feelings by informing him that the feelings of fear that he had of Harry were quite normal and were okay of him. We did this to validate his feelings. We made it clear to him that the violence that was meted on him by his lover was not okay, and that living in fear of being physically attacked was quite normal. This was achieved by highlighting that abuse and violence were not part of healthy situations, and without judging Farai, we informed him, that his situation was dangerous and that we were concerned about his safety.

Sarah Smith

In the case of Ms. Sarah Smith, a community care assessment comes in handy in planning for and delivering effective care to her. In addition, the assessment facilitates collaborative work with the community, other agencies and professionals for purposes of determining the health issues that bring about the greatest concerns and subsequently planning suitable interventions to effectively address the issues. Ms. Smith suffers from Parkinson disease, a neurodegenerative condition that has relatively complex subtleties, and this often makes it hard for physicians to fully inform patients with the condition (Wilms et al. 2007). Community care would offer support to Ms. Smith in a number of ways, including personal care at home, daily living aids to help her with different daily tasks, like dressing, and even residential care, in the event her needs advance (Strandas & Bondas, 2018). There are several ways through which community care can be administered and these include the use of agencies, loved ones and care providers.

Parkinson`s disease has a fluctuating nature, and that often makes assessment of the needs of an individual with the condition rather hard (Coskuner-Weber & Uversky, 2018). This offers support to the need for an approach to care that is person centered. The implication of this is that there should be a focus on the needs of people with Parkinson`s as individuals and that the condition does not define their lives which is a fact. It is always important that all those who are involved in caring for patients with Parkinson`s accord their focus to what they can do and not what they are not able to do. It is also always important to be aware that how the condition would affect patients could possibly change from one hour to the other, and there is need that the patients are spoken to, such that they open up about their individual needs. Owing to the nature of the condition, it is necessary that Ms. Smith has access to a multidisciplinary healthcare team. A multidisciplinary team will remain important as her condition progresses and her needs also increase. Ideally, the multidisciplinary team would consist of a specialist, a physiotherapist, speech and language therapist, Parkinson`s nurse and occupational therapist. A close family member of Ms. Smith should also be a member of this team so that he or she can monitor her condition regularly, and raise any relevant issues with healthcare team. Every member of this team should be in a position to offer advice on different care points, including posture, swallowing techniques, and the appropriate diet options, and suitable equipment to help Ms. Smith with her mobility issues (McNicholas et al. 2017). The nurse’s role would involve ensuring that Ms. Smith is accorded the necessary care and support that she needs. The nurse informs and educates the patient and her carers on the correct procedures of care. The carer will spend most of the time with Ms. Smith and should be able to help her with managing her symptoms.

While developing a care plan for Ms. Smith, we however, missed out on also adequately preparing her caregiver for the roles she would be undertaking. As PD progresses, caregivers have more responsibilities and face more challenges. Their daily plans end up being derailed by fatigue and excessive daytime sleepiness, and their communication frustrations also increase. Therefore, with the progression of PD, the carers strain also increases. Some of the best ways to help the caregiver cope with their new roles and responsibilities include, taking time away from caregiving activities from time to time, ensuring they maintain their social connections, and even encouraging them to open up to others.

Shirley

Shirley`s behavioral problems of being violent can be attributed to her mother, Michelle, who is said to be an alcoholic and who has to some extent failed in her parental roles. She fails in keeping her houses cleanliness in order and even delegates her roles as her parent to her oldest son Mark. Michelle is reported to work for long hours on end as a way of coping. Evidence suggests that the children of this type of parents are at a greater risk for different emotional, cognitive and behavioral problems, as compared to peers who are brought up by upright parents (Perrone et al. 2021). Shirley says that she feels that she does not care about her, and she feels neglected. Michelle appears to be suffering from depression. The common signs of depression among parents include; lack of responsiveness to children, inappropriate parenting behaviors, and untidiness of homes (Huang et al. 2017), all of which are observed in Michelle.

We present a conflict resolution model that has been used by both informal and formal nurses in different health care environments. The conflict in this case is a relationship conflict that comes about as a result of the presence of strong emotion and is created from poor communication, and perceptions. This relationship conflict fuels the disputes in Michelle`s family causing them to escalate. The theory of conflict posits that since time immemorial, there has been an acceptance of adversarial disputes and harsh conflicts as some of human nature`s by products (Richards & Lynchm 2020). It is this acceptance that has pushed people into analyzing how to go about resolving conflict, that is, the best ways through which to make it go away. For progress to be made when resolving disputes, there has to be an understanding of the different reasons why conflicts come about and the ways through which people have dealt with different conflicting situations in the past (Coskun, 2021). When it is possible to do increasingly clear analysis of the causes of disputes, it becomes way easier to determine the most suitable processes that would have to be implemented such that the most positive outcomes for the conflict are produced. In the case of Shirley, there exists a conflict between her and her mother.

Even with this, it is clear that Shirley is an aggressive and violent child, and this should not be tolerated. She uses violence to get her way, beating her siblings, threatening her mother, mostly in reaction to being told that she cannot do something that she so much wants to do. Whenever this happens, she gets frustrated and angry, and violence is her way of solving her problems. Shirley`s mother has an alcohol problem and has even delegated authority to mark, his oldest son, to take care of his other siblings. It is evident that Shirley gains power by being violent, and the first thing that should be done is to take way this power by making it clear to her that the violence is not tolerated. Among children, violence is recognized as a seductive shortcut to getting things done, which when tolerated makes it hard for the children to accept other productive ways of acquiring influence. In normal circumstances, Shirley`s mum would have worked with professionals in implementing a comprehensive behavioral program. Unfortunately, she is also battling demons of her own. Therefore, a professional needs to be assigned to Shirley, with a behavioral program. Within their home, there should be no excuse whatsoever for violence and she should always be held responsible whenever she hits anyone. Being held responsible, implies that there have to be consequences, as these would go a long way in teaching her what to do differently at any other time when she is tempted to hit someone. It is worth noting that a punishment is different from a consequence, with punishment largely involving retribution for wrongful acts. On the other hand, consequences are usually natural and logical outcomes that come about from an individual’s behavior. Punishing a child into good behavior is not possible, but through effective consequences, Shirley can be molded to behave in a better way.

Risk management

Dealing with difficult people is always an uphill task that social workers can possibly encounter. There are risks involved for the social workers as they could also find themselves in harm’s way. Therefore, it is always important that risk strategies are implemented to help with management of risks. The first step should involve carrying quick assessments of the possibility of disruptive behaviors to escalate to violent situations. During such an assessment, consideration should be given to the causes of any presented difficult behaviors. There is also need to have an established security protocol that has both physical and verbal triggers, which could be used for initiating law enforcement support calls (Capocchi et al. 2019). In addition, there should also be organizational policies that offer the social workers with the necessary preparation and training to deal with any situations of violence, and subsequently de-escalate aggressive behaviors. There are other strategies that can be adopted to address difficult behaviors and these include; working to facilitate clarify expectations, for example, by providing the involved individuals with brochures containing details of procedures and the expected code of conduct, use of agreements for reinforcement of expectations, and implementation of complaint processes that would manage complains from patients in effective and consistent ways.

Planning & evaluation

After several meet ups with Farai, we decided to first seek the services of an attorney to help Farai get an injunction. Injunctions are court orders that protect victims of abuse from being threatened and harmed by the people abusing them (GOV.UK, 2015). When an injunction order is in place, Harry cannot come close to Farai, and if he does so, he would be arrested. We also enrolled Farai for free counselling sessions, with the hope that this would provide him with a lifeline whenever he did not have anywhere else to go. Throughout all this, we kept in touch with Farai and made it clear to him that we were always going to be there for him, available at any time.

Looking back, I realize that we never carried out domestic violence screening, and took Farais word for the truth. We should have done extensive screening, involving even questioning Harry, who was the perpetrator in this case to try to get to the root cause of their conflict. Through this screening, it would be possible to get Harry talking about his behavior. This would have been an important intervention for efforts geared towards preventing domestic violence.

Sarah`s care should be based on the principle of co-production, which implies that patients have to contribute to the provision of health services, playing the active role of professional providers (Turakhia & Combs, 2017). It is worth noting that while community care plays an instrumental role in ensuring that the necessary support is offered to those with Parkinson`s disease, those who have the condition are often not aware of community care, and how it would benefit them. Research also reveals that there are multiple benefits to providing community care for patients with Parkinson’s disease, all of which are interrelated. For instance, improving Ms. Smith`s quality of life would translate to reduced burden on carers, or avoidance of wider costs to the state including hospital admissions or residential care.

Ms. Smith`s movement has deteriorated, and she experiences stiff and slow movements in her legs and arms. In addition, she has a tremor in her hands and jaw. Her balance and coordination have reduced and this is recognized as the cause for her multiple falls. For her stiff muscles, Ms. Smith should be encouraged to exercise regularly. This would be helpful in strengthening her muscles, would help increase her joints mobility, in addition to building up her general fitness and health. If her movement is persistently slow, walking aids should be recommended. However, if she is to use any aid, this should be advised by a physiotherapist or occupational therapist, who is in a position to do thorough assessment of their needs and come up with appropriate suggestions. In relation to the tremors that Ms. Smith experiences, there are different medication free ways that would help her feel better. These include yoga, tai-chi, massage therapy, and movement therapies. These would go a long way in improving her health and well-being, preserving her physical functioning, easing her symptoms and enhancing her quality of life. It is worth noting that coupled with these interventions, regular exercise, eating healthy diets, staying hydrated, and getting enough sleep are also helpful.

In the case of Shirley, it is important that Shirley together with her other siblings are helped to cope with their mothers depression. Providing Michelle with effective treatment for her depression as part of her children`s intervention program would be ideal. Research points to cognitive behavioral therapy (CBT) as an effective treatment for depression. CBT works by challenging thought patterns that are negative and unproductive as these are the factors that reinforce depression (Lopez-Lopez et al. 2019). CBT helps with reframing these thought patterns in increasingly productive and positive ways. CBT blends cognitive and behavioral therapy, with behavioral therapy being targeted on actions and behaviors. Michelle should be encouraged to keep a journal as part of CBT. This journal would provide her a place to record her life events and her reaction. With the help of her therapist, she would be able to break down her reactions and thought patterns into different categories of self-defeating thought (Aguilera et al. 2018). With the help of the therapist, Michelle can also be helped to replace her negative thought patterns or perceptions, with others that are more constructive. That can be achieved through several well-practiced techniques, and these include learning to control and additionally modify distorted reactions and thoughts, learning to assess external situations comprehensively and accurately, practicing accurate and balanced self-talk, and use of self-evaluation for purposes of reflecting and responding appropriately.

Review of Learning

The successful undertaking of social work is marked by establishing therapeutic relationships between the patient and the social workers, holistically assessing their social support and health needs, as well as their determinants, planning and finally delivering care (Fraga, Souza and Braga, 2006). During my simulated practice, I learnt and understood that social work is highly dependent on various values, skills and knowledge, as well as theories, concepts and ideas that underpin it. I learnt that it is essential for social workers to take up a therapeutic agent role, through which they are able to establish and maintain therapeutic relationships (Kantorski et al., 2015). It is vital also for social workers to clearly understand and follow the social work process- comprised of assessment, planning and evaluation. This will significantly contribute to the development of knowledge regarding the patients’ social and health needs, the use of effective information gathering methods, the use of collected information to develop a care plan, identification and employment of the best intervention, and the evaluation of care given (Evans, 2007).

Throughout the simulated practice, I dealt with three different cases, each of which involved people with varying ages, sex, gender, ethnic and cultural characteristics, and needs. One of the cases is that of Shirley where it is witnessed that she has inconsistent relationships and is aggressive towards her mother and brother, and threatens to harm herself. The first step we undertook in this case was seeking to understand Shirley’s history and her exposure to social care. We determined that Shirley had been exposed to social care and periods of social work interventions from as far back as 2012. This step highlighted the significance of information gathering and sharing between multi-agency or multi-disciplinary social work teams. Given that Shirley had had a number of referrals and periods of social work interventions by other social workers, it is vital to first establish her background to determine how best to handle her case. A review of her background revealed concerns regarding her poor home conditions and likely neglect, Michelle’s mental health challenges (suspected alcoholism and struggling to cope), child mental health and Shirley’s physical abuse of her siblings. Through this assessment, by way of information sharing, we were able to collect information on Shirley to determine their type and level of need, as well as the type of care to give her (Wrycraft, 2015). In this case, I learnt that it was critical to address some background conditions of individuals before it would be possible to effectively address their needs. For instance, it was essential to address concerns of Shirley’s poor home conditions and possible neglect, and her mother’s alleged alcoholism before embarking on Shirley’s challenges.

In dealing with Farai, I learnt that the delivery of effective social care was also highly influenced by an understanding of an individual’s risk factors, such as physical disability or impairment. For example, Farai, by virtue of being black, deaf and gay (against the wishes of his family) is at an increased risk of domestic abuse and violence from his white and older partner, Harry, who physically and racially abuses him. Given Farai’s background, it was important to reassure him that would receive the care and assistance he needs to enable him overcome his situation. In this case, it was critical to conduct an assessment of Farai’s human conditions and take into account the various views and perspectives of those involved (Farai and Harry) in terms of their racial, cultural, ethnic and sexual characteristics, Farai’s hearing disability, as well as the legislation and policies that underpin the provision of care. Key legislations in UK, such as the Health and Social Care Act 2012 and the Equality Act 2010, significantly guided our handling of Farai’s case. Whereas the Health and Social Care Act 2012 requires health bodies to have due regard to the reduction of inequalities in terms of access to health and social care, the Equality Act 2010 aims to advance equality in the manner in which health and social care bodies deliver services to people (England, 2021). The implication of this is that social care workers must deliver care to individuals in an ethical and equal (anti-racist, anti-discriminatory and anti-oppressive) manner. We took note of, investigated and reported Farai’s physical, verbal and racial abuse by Harry and sought care and support plans that aimed to prevent such incidents from occurring in future, and in line with legal requirements, reported to the UK Care Quality Commission (CQC) (“Care Quality Commission”, 2021). Based on the various equality legislations and policies that have put in place processes to ensure that individuals with protected characteristics are not discriminated against, we ensured that Farai received the care he needed in an anti-racist and anti-discriminatory manner.

Regarding Ms Smith’s social care needs assessment, I learnt that it is important to conduct continuous community care assessments that will help identify any additional care and support needs that individuals with various physical and mental health conditions may require to enable them safely and adequately lead their lives. This is because while people may be able to effectively manage their conditions after diagnosis, they may, over time, be unable to do so due to a deterioration of their conditions. It is also essential to take a holistic approach to the provision of health and social care support to individuals. For instance, Ms Smith who is suffering from Parkinson’s disease, is also faced with other physical health challenges such as stiff and slow leg and arm movements, and mental health issues, including mood disorders and depression. Therefore, in order to determine and address her social care needs, it is important to holistically assess her physical and mental health.

Undertaking a holistic assessment enables social care workers to identify and evaluate the health and social care needs of an individual, which will help them understand the contextual (cultural, social, or political) meanings that they attach to their conditions. This will enable the planning and delivery of care that is not limited to only one aspect of the individual’s needs. Another aspect of social work that emerged during the practice was the need to adopt a proven theory or concept. One of the key theories that we employed was the theory of interpersonal relationships by Peplau (1952). This theory emphasizes the importance of social worker and patient relationships as the basis of social work, and is dependent on the establishment of therapeutic relationships between social workers and those in need of their services (Peplau, 1952; 1997). Multi-agency and multi-disciplinary collaboration and team working also emerged as an essential area of social work. Collaborating facilitates the sharing of information among social care professionals and with those in need of social care services, resulting in the adoption of the best evidence-based care plans to address their needs. This, in turn, results in the achievement of positive health outcomes.

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