This was my third contact with Mrs G however my first contact with Mrs G on her own without Ps presence. The purpose of the visit was to carry out a carer’s assessment which focused on Mrs G’s needs separate from P’s needs. It was important that I tuned into the visit in order to work with Mrs G effectively. The process of tuning in helped me consider the legal mandate for the intervention, it helped me prepare myself for areas Mrs G may have wanted to discuss, I was able to consider relevant theories, Mrs G’s feelings, my feelings as a worker and how I would address these feelings through the use of good knowledge, skills and values.
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Before meeting with the family I had read through the existing case file which allowed me to gain an insight into the social work involvement of MS the transition co-ordinator to date, other professionals involved and an insight into the family background. I had previously carried out a UNOCINI assessment on P, had been on a few visits to P and Mrs G and liaised with several other professionals involved with P such as the Renal Team at the Royal Belfast Hospital for Sick Children (RBHSC), the school, P’s G.P, Clinical psychologist etc. I had already gathered relevant information and thus obtained a good insight into the family situation, particularly through liaising with the Clinical Psychologist who had done some brief family work with the family. From liaising with him, I was able to determine that there were strained relationships within the home. As my role in this instance involved assessing the needs of a carer, I read around carers in Northern Ireland, their needs and what they often experience etc. This allowed me to tune into what Mrs G’s life may involve with regards to caring for P and consider some of the challenges carers experience on a regular basis.
As I had already been involved with the family and completed a UNOCINI assessment, I gained a great insight into the family’s circumstances, history/background. During this contact I wanted to obtain a greater insight into how P’s disability impacted is currently impacting on Mrs G, the primary carer of P. I prepared myself for the contact by familiarising myself with the carers assessment form however I had already decided to approach the situation by allowing Mrs G to take control and explain openly how she was coping etc. My practice teacher also discussed her expectations with me during supervision.
My primary purpose in this piece of work was:
The purpose of the work was to meet with Mrs G in her home. Carry out an assessment of Mrs G’s needs as a carer separate from P’s needs by allowing Mrs G to talk openly about her situation, how she was coping as a carer etc, express any concerns she had and ask her how she feels we could best support her at this time. This allowed Mrs G to take control of the discussion and identify areas to discuss.
My main aims and were they achieved
I contacted Mrs G prior to the visit to explain the observation so that she was aware of the situation before we arrived at the house. On arrival, I discovered that Mrs G had forgotten about the visit and planned to go into town. I asked Mrs G if she would like to reschedule but she said she would prefer to go ahead with the visit. I did not have to introduce myself at the beginning of this contact as I had clarified my role and function within the agency during the first visit with the family. I firstly introduced my practice teacher, reassuring Mrs G that she was there to assess me and my practice and that anything she would be writing would be about myself and not her. I further reassured Mrs G that anything discussed within the visit would not be discussed outside of the visit. At this stage I feel I could have explained the boundaries of confidentiality. I explained to Mrs G she was entitled to a carers assessment under the Carers and Direct Payments Act and that this would focus on her needs as a carer as apposed to P’s needs. On reflection I do feel I could have explained to Mrs G at this stage what the assessment involved and I could have summarised what I intended to cover during the visit. Instead I just explained her entitlement to a carer’s assessment and that it focused on her needs.
I acknowledged how difficult life has been for Mrs G and her family up until this point and asked Mrs g what it was like caring for P. Mrs G gave a very detailed account of P’s medical history and how his condition affected him. Issues arising were P’s restricted diet intake, P’s noncompliance to take medication and his personal care. On reflection, although I did attempt to probe further on these issues as an attempt to determine if and what triggers may have been contributing, looking back I do feel I could have used more effective questioning as an attempt to determine the impact this has had for Mrs G as a carer. Other issues arising were P’s lack of self-esteem and body issues which clearly contributed to his low mood. Looking back I feel I could have explored into this area more through probing more however I recall the carer at this stage having given me allot of in-depth information. I had reacted by probing further on another topic and had forgotten to go back and explore this area. On reflection I feel it would have been important to have explored this area further to gain a greater insight into how Mrs G coped with knowing that her son was insecure and body issues. Does she attempt to talk to P? Does this worry her, make her feel stressed etc, how does she cope seeing how P’s disability impacts upon him?
Looking back another issue which Mrs G explained was the fact that P had fell out with their local Church over his diet. This was a clear issue/concern for Mrs G, however looking back, I did not probe further on this issue as once again, I recall Mrs G explaining a number of issues at once. I explored further on one issue and again I forgot to go back and explore this concern. At this point I feel I should have listed back to Mrs G the concerns that were arising and explored each of them one by one. Instead I feel I became overwhelmed by all of the information she was giving me, I consequently responded by exploring into one issue, which then led into another issue and I forgot to cover the other issues arising a the beginning. This has been a big learning curve for me as a worker. From this in particular I have learnt that I need to be more assertive and take more control of the conversation, particularly if you are with a service user who is quite talkative. In future I plan to say, ‘ok, mrs G, you’ve given me quite a lot of information there. You have raised concerns about this, this and this’. I would then cover each of the issues separately to ensure I have explored all areas fully that the service user has identified as being problem areas. I will also ensure to take more control of the conversation by stopping the service user if I feel she has overwhelmed me with information and pace the flow of the interaction to ensure each area is being fully explored.
I recall Mrs G explaining that P had been abiding by his restricted fluid and diet intake recently as apposed to what he had done in the past. Mrs G did however express that P would still sometimes ‘push the boundaries’. I recall just reassuring Mrs G that this was very positive, however on reflection, I feel that I could have picked up on the fact that she had expressed he still pushes the boundaries at times and explored more into how they managed this, how he reacts when she reminds him the importance of his restricted diet and how P’s reactions impacted on Mrs G and other family members within the home.
Mrs G went on to explain that the clinical psychologist P had been to see recently had diagnosed P as being biologically depressed and not clinically depressed. I recall probing further as an attempt to determine how Mrs G felt about this diagnosis, and asked whether P would continue to see the psychologist. However on reflection I do feel I could have explored further with regard to the possible risks this presented for P, how P was behaving, had she noticed any significant changes in his mood, behaviour etc. Looking back I feel this would have been very important and usually I feel a very obvious area to cover however I recall reminding myself of my role within that visit and that was to focus on Mrs G as a carer and how she was coping as a carer. Looking back however I do feel it was important to have explored further on this issue as there evidently could have been risks involved which could have led me to determining how Mrs G felt and coped with these.
I recall Mrs G explaining about P’s argumentative nature. I did attempt to explore this area further however again at this stage I recall Mrs G giving a lot of detailed information and again I do feel it would have been beneficial to have redirected the information she had given back to how Mrs G was affected and how she was coping.
I summarised by explaining to Mrs. G the main issues which we had discussed during the visit and what Mrs G was currently dealing with. I then reminded Mrs G of the main reason for the contact which was an assessment of Mrs G’s needs as a carer, how things have impacted on her and how she was coping as a carer. I summarised by asking Mrs G to once again eplain what the main concerns were for her in coping and caring for P at the minute. Mrs G once again clearly highlighted that the main concern for her as a mother was the fact that P had no opportunities at the minute to meet, socialise and interact others his own age group. She further explained that she felt this would undoubtly help to promote P’s independence while giving her and her husband a little respite. I paraphrased this back to Mrs G to have her clarify what I understood in relation to P’s needs and how this would ultimately benefit them as carers. I summarised by acknowledging and explaining to Mrs G that I understood the level of P’s care needs, what the family have come through in their lives to date and the impact of caring for P and other family members. At this stage I recall advising Mrs G of some support groups which may be of support to Mrs and Mrs G. Mrs G however clarified that she felt it was not them as parents who needed the support but their son, P who would benefit from some sort of social outlet. Furthermore, she did highlight she felt this would additionally benefit her and her husband as P relied quite a lot on her and her husband to take him out.
Mrs G expressed she felt it would be beneficial for P if someone P’s age were to come and bring P out for a few hours. I mentioned a voluntary ‘befrienders scheme’ however I was unsure as to the likeliness of getting a befriender that age within the locality thus I reassured Mrs G I would follow this up and get back to her. At this stage I recall introducing the topic of direct payments. Looking back, I feel the conversation had flowed up until this point. On reflection I had no reason to bring up the topic of direct payments as the conversation up until this stage had been centred on Mrs G, her life as a carer and how this was impacting on her. I had prepared to cover this topic solely on the basis that this was one of the topics covered within the agency’s’ Carers Assessment forms. Looking back, I feel there was no reason to introduce this topic as there was simply no purpose in this instance. I recall asking Mrs G if she was aware of direct payments and or if she received direct payments. Mrs G was not and asked if this was the same as carer’s allowance. At this stage I recall going completely blank. I knew it wasn’t however I went completely blank and I could not think and turned to my practice teacher for reassurance and ask her if they were the same. At this stage I felt quite nervous and found it hard to refocus my mind back on the topic of conversation. I then recall trying to explain the concept of direct payments to Mrs G. I was able to explain that It focused on empowering service users through allowing them to be employers and this was a payment paid to them which would allow them to effectively ’employ’ someone if for example they wanted to pay someone to come in and care for their disabled child. I recall stumbling through this explanation as I consciously knew I wasn’t communicating my understanding of direct payments effectively in a way to ensure that Mrs G understood it and furthermore I doubted what I was saying. I feel I cold have tuned in better to what direct payments were, whether Mrs G and P would have been eligible for this service, what the options were for them and been able to explain to them in a way that they understood and have given an example of their circumstances as apposed to a child. i.e. considering the fact that P was turning 18 in a few months. I feel if I had prepared better by doing this, there would have been more structure and purpose to introducing the topic in the first instance, Mrs G would have grasped a clear and concise understanding of what direct payments were, I would have come across as a more competent and knowledgeable worker and this would have lessened the likeliness of confusion or unrealistic hopes and expectations on Mrs G’s behalf on their eligibility and entitlement for the service. Straight away following the visit I acknowledged how my responses could have potentially have given Mrs g unrealistic hopes and expectations with regard to what they could get. I feel nervousness and lack of concise preparation significantly contributed to my inability to explain the service effectively and concisely, particularly after I was unable to explain the difference between carers allowance and direct payments initially.
I finally summarised what I was going to do for Mrs G such as looking into the befriending scheme, their eligibility for direct payments, as she queried if she would be able to pay someone to come and take P out for a few hours a week etc. I then explained Mrs G that I would be in touch to arrange a time and date to talk through the assessment once I had completed it and have her sign it. Mrs G agreed.
Skills
I do feel I listened to Mrs G and demonstrated respect by being empathetic towards her and her situation – past and present. I was very aware of the sensitivity around what Mrs G has come through in her life to date and used silence allot to allow Mrs. G to gather her thoughts before answering the questions. When she was talking I continued to use silence as a means of letting Mrs G tell her story and express her feelings. I ensured to maintain eye contact. My non verbal’s I hope indicated to Mrs G that I was listening to what she had to say.
Although I contently listened to Mrs G and what she had to say, I do feel she overwhelmed me with information a lot of the time. Although I managed to explore further some of these issues by probing further on certain issues, I feel I failed to probe further on all the issues/concerns expressed by Mrs G. I feel I could taken control of the interaction more by stopping Mrs G at times and sensitively saying for example, ‘ok Mrs G, you have given me quite a lot of information there. You mentioned this, this, this and this.. Can you firstly tell me a bit more about (1st issue), how does this affect you as a carer etc. I would then have gone through each issue separately and have explored each issue fully. I then would have got Mrs G to proceed. This would have ensured that I was using my probing skills more effectively and ensured I was exploring and analysing equally all areas which arose. Furthermore, I feel I did probe further on certain subjects to gain a further insight into how G felt about certain things although in doing this I do accept that I still may not have kept the topics focused on Mrs G as much as what I could have. I do feel however that in this instance, the needs of Mrs G was very dependent on that of meeting P’s needs first as she continually stated, ‘if I thought that P was getting ready and looking forward to going out and meeting with others his age, I would be able to relax and when he would be away, this would act as respite for me’. I truly feel this was the main issue for Mrs G and she clarified this towards the end of the visit. I was particularly ware of this as I had tuned into the fact that in a typical encounter involving two people, it is estimated that the actual spoken or verbal content is likely to carry only one third of the social meaning in any given event, whereas the non verbal forms convey roughly two thirds of the meaning (Birdwhistell, 1970). Communication is a two way process. It involves listening as well as speaking. Non-verbal’s used were: nodding, having an appropriate body posture, using eye contact, smiling and sitting in the SOLAR position. Allot of the time Mrs G was talking. I hope my non-verbal’s indicated to her that I was listening to what she had to say, respected the information she was sharing and demonstrated empathy and respect.
I feel I used my interpersonal skills throughout the visit ad this contributed to a relaxed atmosphere and interaction. I do feel however I had developed a good rapport at this stage with Mrs G as I had been on a few previous home visits through carrying out the UNOCINI assessment. I feel I had a generally good structure to the contact however I do feel I could have explained at the beginning the content of what I hoped to cover with Mrs G instead of just summarising that I would be looking at her needs as a carer. I feel I demonstrated good non verbal communication through appropriate facial expressions, a good sitting position with an open posture, good eye contact and nodding my head to reassure Mrs G I acknowledged, was listening and understood what she was saying. I feel I laughed when appropriate and showed empathy when covering sensitive issues such as P’s past medical history of cancer and chemotherapy. I did ask various open questions which I had planned as a means of applying the exchange model and allowing Mrs G to talk openly about her life as a carer. This also allowed me to gain an insight into what Mrs G’s life was like, what her caring role entailed and how she coped with her caring responsibilities. I asked closed questions to gain more information on certain issues and clarify information. I feel my tone of voice was appropriate considering we were covering issues which were sensitive to Mrs G. Generally, I feel I effectively communicated with Mrs G. ‘Effective communication is an essential component of traditional social work activities’ (Lishman, 1994, pg 1). I communicated clearly with Mrs G by explaining why I was there, introducing my practice teacher, explaining her role, reassured Mrs G my practice teacher was there to observe me and not her. I explained clearly what I hoped to cover during the contact and under ground she was entitled to a carer’s assessment. The process of engaging entails social workers being explicit about what we are doing and why (Munro 1998a: 98). I feel I engaged well with Mrs G by clearing explaining my role and purpose. I paraphrased back to Mrs G what she had said at certain stages, particularly towards the end of the contact to show Mrs G that I understood what she’d told me. This involved me paraphrasing or ‘feeding back’ to Mrs G what they’d conveyed, in a meaningful way. This was also useful in having Mrs G clarify that this is indeed what she meant. Empowerment- Empowerment is more commonly used to describe service users being given ‘meaningful choice’ and ‘valuable options’ (Clark 2000: 57). I feel I provided Mrs G with choice and valuable options by providing her with information, informing her of the services available. I do feel I actively listened to G and responded by probing further on certain issues.
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On reflection, I feel the type of questions I asked G could have been more focused on the needs of G and Ge as apposed from having her explain about P. Initially I felt this may have given R an insight into what G’s life is like and I thought it may have been a good starting point however I feel I could have covered aspects such as how she coped when P was away to college, to dialysis. In saying this I do feel that G made it very clear particularly towards the end that the main concern for her at the minute was the fact that her son had no friends his age, was unable to get out and had nothing to look forward to. And continually expressed that this was the main issue for her and that if he had an opportunity to get out and socialise with others his age, this would positively impact on her as she would be able to relax if she felt P was happy and this would also act as a few hours respite for her as relationships in the family had been strained recently.
I feel I did not communicate to Mrs G in a clear and concise manner what direct payments was and was unable to provide her with a clear distinction between that of carers allowance and direct payments. Looking back I went blank at this point and felt I could not think and panicked. As a result I looked to R for re-assurance.
I do not feel I came across as a competent worker as on reflection I turned to my practice teacher when G asked me if a carer’s assessment was the same as a direct payment. Looking back on this I feel very silly as I knew the difference but I just recall going blank as I stumbled with how to explain the difference. I feel this was down to nervousness and as a result I panicked and turned to R for advice. I will definitely try to avoid doing this in future as it is not professional and service users expect that we as workers know what we are talking about.
I feel I could have been better prepared with regard to knowledge in relation to direct payments and carers allowance etc. Although I thought I knew what they were, obviously hadn’t read enough around them or had the information prepared in a way that would enable me to effectively communicate to the service user what they were. Although prior to the contact I felt I was prepared, On reflection, I feel I could have been better prepared with regard to familiarising myself better with direct payments and carers allowance etc. I should have prepared in my head how I would explain this to G in a way that was clear and concise that she would have understood.
My main aims achieved were:
I was successful in getting Mrs G to open up about her situation and her feelings
I was successful in determining what it was she felt would best help and support her and her husband at the moment, which was providing them with respite by providing P with opportunities for social interaction.
The main knowledge used and how it impacted upon my work:
I had an understanding of Mrs G’s circumstances through previous visits with the family and carrying out a UNOCINI assessment and liaising with other professionals already involved with the family. I feel I tuned in thoroughly to Mrs G’s past history, current circumstances and her life and needs as a carer. I did not have a lot of knowledge about the appropriate way of completing the carers assessment form. From discussing the topic with my practice teacher and other work colleagues, I felt it was better to not bring the form in with me during the visit. I felt this may have put Mrs G of or have distracted her. I considered the sensitivity of some of the issues that Mrs G may be relaying to me and I wanted to give her my utmost attention, reassure that I was fully listening to her, engage fully with Mrs G and let her lead the interaction and speak openly about her situation. This then led me to apply the exchange model of assessment which looks upon service users as experts in their own lives. I tuned into the fact that no-one knew Mrs G and her life situation as well as herself and so I felt this model was ideal to apply as a method of assessment. The ‘Life needs model’ is another model which informed my knowledge base prior to the visit. This is a developmental and social-ecological model and increased my knowledge base on key transitions in children’s lives. Although this model informed my knowledge base more so with regards to P’s UNOCINI assessment, it also allowed me to consider how Mrs G as a carer may be coping with P’s transition and current life stage of adolescence, as a carer and mother. Knowledge around assessment theory increased my knowledge base on what assessment is and what it involves. Erik Erikson’s life stage theory increased my knowledge base around Mrs G’s life stage. Theories around loss increased my knowledge base as to how Mrs G had experienced loss as a consequence of P’s physical disability and his cancer. This was very significant as the focus of the work was on assessing Mrs G’s needs as a carer, considering who she cares for, how that impacts on her life and how she effectively copes with her caring responsibilities. As a carer of a child who has a physical disability and who had had cancer and been treated with chemotherapy and has had two failed kidney transplants, this theory allowed me to tune into a number of losses Mrs G may has or may have had, losses in terms of lack of socialisation, independence etc. This knowledge allowed me to consider that Mrs G may have been affected psychologically, physically, emotionally and socially. One of my objectives for the visit was to discuss direct payments. I feel that I did not carry out sufficient research to allow me to explain this service clearly and concisely in a manner that Mrs G would have understood. I recognise that direct payments is a relatively new way of receiving services and other professionals are still learning about what they are and how they are used. However, this is an area I had planned to cover with Mrs G as it is one of the questions within the carers assessment form and thus I do feel I could have researched this area more concisely to ensure I was confident in explaining it in a way that Mrs G would have understood. I also feel I had a good grasp of the current family situation through completion of the initial UNOCINI assessment and thus I could have enquired into the family’s eligibility for receiving direct payments prior to the visit. I feel I had already previously adequately researched into P’s renal condition, kidney dialysis, the effects, the importance of a restricted fluid and dietary intake and the consequences of not abiding by a restricted diet from completing P’s UNOCINI assessment. This information allowed me to further consider what life is like for Mrs G as a carer. I had already gained a great insight into the family circumstances through liaising with other professionals and completing the initial UNOCINI assessment. This knowledge was significant as it allowed me to consider the challenges Mrs G was facing as a mother and carer and thus I already had an insight into how she was coping with caring for P. I also done some research on carers of children who have disabilities which allowed to familiarise myself with what pressures and stresses carers are faced with on a daily basis.
Throughout my work with this family I am constantly aware of overarching legislation such as the Children’s Order (NI) 1995, the Human Rights Act 1998, Disabled Persons Act (NI) 1989, and The Education (NI) Order 1996. The main piece of legislation that informed this piece of work however was the Carers and direct payments Act (NI) 1996. I must always be aware of the legal and statutory context in which I work. It is impossible to practice without coming up against the Law: it is impossible to practice effectively without an in-depth understanding of how the Law affects everyday social work practice (Johns, 2005:1). Looking back I strongly feel I could have increased my knowledge base more effectively around direct payments and familiarise myself with what the criteria is for eligibility for families. I have since spoken to other workers in the team and have read around the topic more and thus feel much more confident about the topic.
The main values I used were:
The NISCC Codes of Practice for Social care Workers underpins my professional value base and I felt this impacted when working with this family. I feel that I treated Mrs G and her home environment with respect by asking Mrs G prior to the visit if she would mind my practice teacher being present to observe my work. I feel I empathised with G by being understanding of her all that her and her family have come through in their lives to date. I felt I could easily empathise with her when she was referring to P and his medical history and his cancer. I considered prior to contact how devastating this particular time would have been in their lives and acknowledged the importance of showing empathy, particularly if this service user was willing to talk openly to me who she may have looked upon as a ‘stranger’, about such a sensitive area in her life. I empathised with her further when she talked openly about her older son also having been born with a renal condition and the ongoing everyday stresses and strains this had. I did not judge Mrs G. I listened openly to what she had to say and demonstrated empathy by being understanding of Mrs G’s circumstances at present and what she has come through to date. By being empathetic and understanding towards Mrs G, I feel she was more motivated to work in partnership with me. I feel I demonstrated respect by explaining the issue of confidentiality, explaining my student status, gaining consent and ensuring Mrs G was happy and content working with myself, a student, by reminding Mrs G of my student status and allowing her to clarify she was happy to proceed. Furthermore, I feel I respected Mrs G by pre arranging the appointment and turning up on time. I feel I demonstrated respect at all times throughout the visit by maintaining eye contact, listening to Mrs G, using silence when appropriate and allowing her to speak, gather her thoughts and express her feelings. I was genuinely interested in what Mrs G had to say, finding out more about her life and past experiences and I was honest and open which I feel contributed to an effective, positive working relationship with Mrs G. I made myself aware of any cultural/structural oppression that the service user may be experiencing, such as gender, religious issues. I also considered that Mrs G attended a Church group and that she and her family held firm religious beliefs and attended Church on a regular basis.
Future learning requirements indicated by this piece of work
What I hope to improve upon in the future:
From looking back I can see that there are significant areas I need to develop my knowledge and experience in. For example I strongly feel I could have increased my knowledge base more effectively around direct payments and have familiarised myself with what the criteria is for eligibility for families. My lack of experience delivering direct payments is obvious here. I feel that my understanding on this topic could be improved through reading further on the topic and possibly shadowing other social workers in the team when they visit service users about direct payments. Being well prepared for what it is I want to cover during contacts is another significant area I need to work on. Looking back, I feel the contact had flowed up until the point at which I introduced the topic of direct payments. I feel, I already had an insight into the family situation through completing the initial assessment ad I knew that Mrs G’s main concern was that P did not have enough opportunities for social outlets and if I had prepared to introduce this topic, I should have previously enquired into whether this was an option for Mrs G and her family. On reflection this would have made much more sense as I would have had reasoning for introducing the topic and I would have been able to inform Mrs G of information that was clear, concise and accurate, preventing informing Mrs G of information that was inaccurate, risking false hopes and possible dis
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