Plan an Intervention Strategy

I am writing about case Scenario 1. This is a referral made by the GP of a 72 year old Punjabi lady, Jameela, to the older person’s team. She has increasing care needs and is cared for by her Daughter-in-law, Farah, who has become increasingly depressed and unable to cope. She has two children, the younger of which has learning difficulties. The GP has spoken with Majid, the husband suggesting that his mother should go into a home and asking him to discuss this with his mother.

This is a close knit family with culturally based family values which are resulting in tensions and conflict between Jameela, Majid and Farah, his wife. It is human nature that we all form our own opinions, beliefs and values but these personal values can cause problems as a social worker. According to Banks (2006, p. 6): ‘Values are particular types of belief that people hold about what is regarded as worthy or valuable’. It is important that I am consciously aware of my own views and opinions and challenge them so that they do not interfere with my treatment of all service users.

It is my duty to not allow my individual beliefs, for instance my own religious beliefs and values may cause me to have stereotypical views about the Muslim/Sikhism religions and beliefs of my service users in this scenario. This could lead to assumptions about the service users’ family values and lead to the possibility that I may let my own beliefs influence how I act with this family and I may subconsciously discriminate against this family on this basis. It is important for me to identify and challenge my own stereotypes to achieve anti-discriminatory practice positively with my service users.

My service users will all be individuals with their own make-up, as indeed I am myself and irrespective of both my own and my service users race, ethnicity, nationality, sex, sexual orientation, marital status, mental or physical disability, political or religious beliefs I need to be non-judgemental, respectful and not allow my own values to cause discrimination and prejudice to any person. This is using the important social work value of unconditional positive regard.

‘There is recognition that personal and agency values may conflict and that the worker as a person has a moral responsibility to make decisions about these conflicts’. Banks, S. 2006,p. 150) In agencies there may also be different attitudes and values to our own and social work values and it is important for me to challenge these values so they do not affect the fairness of treatment to my service users. For example an organisation with predominantly female staff may not be aware of the views and opinions that they appear to have are creating sexism towards male members of the team and may also interfere with the fair treatment of service users leading to discrimination.

It is important for me to have a non-judgemental attitude and to not judge any members of the family or treat them as being responsible for their problems or needs. There are many concerns from this referral; Majid is the point of referral from the GP and not the main service user, Jameela. This is disrespectful and disempowering to Jameela taking away from Jameela the control over her own life and decisions of her own. This referral is not promoting good practice where we would give Jameela the right to make her own informed decision and to take part in the decision making process.

Kant’s moral principle of the categorical imperative: ‘I ought never to act except in such a way that I can also will that my maxim should become a universal law’. (Kant, 1984, p. 88) Which means that we should treat other people in the way we feel all people should treat each other. By suggesting that she be taken into a home is treating her as a means to an end or a solution to the difficult family situation. Kant’s philosophies focus on respect for persons and valuing them as human beings which influenced the social work value of respect.

BASW (2002, p2, 3) states that practice should promote human dignity and worth, giving every one individual value and respect and a right to self-fulfilment and control over their own lives. As part of the process of getting to know this family it will become apparent that the actions of each adult family member are affecting others. As a social worker I have a moral obligation and responsibility to work with the family to help improve the resulting conflicts.

Majid by showing loyalty to both his wife and mother may be contributing to the problem as he is unwilling to acknowledge the views his mother holds about his wife and this in turn will increase Farah’s depression as she can’t talk to anyone about this. A utilitarian act focuses on working for a greater good or the action which benefits the majority. In this case to promote the idea, to Majid, of taking Jameela into a care home for a temporary period initially to allow Farah to recover and to improve family relationships between Majid, the children and herself.

Farah is in the position of least power in this family and this is largely due to the cultural and social expectations within the family, therefore she is probably unable to speak for herself, feeling oppressed which may have caused her to internalise her experiences and feelings and contributed to her depression. The emancipatory movements of the 1960s and 1970s where oppressed groups such as women, rebelled and fought for social justice such as the right to study at university, to have equal rights in the workplace has helped to raise awareness and influence the emancipatory values in social work practice.

These values encourage us to promote social justice and consider the inequalities that Farah has, also that she is struggling to cope with the responsibilities of her Punjabi family traditional culture and values. It would be important to consider virtue ethics, and to demonstrate that as social workers we have good character traits of truthfulness, honesty. Integrity, knowledge and that we act justly and in a trustworthy manner with all members of this family.

There is also an element of seeking and appreciating the character traits or virtues of all members of the family and the good things about them, without judging their actions. In trying to form a professional judgement, as part of the process of undertaking an assessment, I would analyse the dilemmas in this scenario and be guided by the moral philosophies already mentioned which have in turn helped to underpin the social work values that we aspire to and the BASW and the GSCC codes of ethics which guide our professional practice.

Banks, (2006,p8) describes : ‘Ethical dilemma- a choice between two equally unwelcome alternatives relating to human welfare’. This relates to one of the ethical dilemmas in this scenario being that Jameela’s self determination is having a negative effect on Farah and an indirect effect on the children, also Majid who is colluding with his mother. ‘Self-determination of service users’. (BASW, 2002, 4, 1, 3) States that we should help to make informed decisions and promote a person’s autonomy provide it doesn’t conflict with their safety or rights of others.

There is a conflict between the needs of Jameela as opposed to the rights of Farah and her own need for autonomy. I would help Farah to recognise her rights as a carer and explain the implications of this. (GSCC, 2002, 3. 1) says that: ‘Promoting the independence of service users and assisting them to understand and exercise their rights’. The balance needs to be addressed between Farah and Jameela’s needs by limiting Jameela’s self determination but still allowing her to give informed consent, with the intention of reaching informed decisions of a joint nature with the agreement of Majid and Farah.

However, I do feel this is going to take a lot of sensitive discussion with all family members to help achieve harmony and agreement on the best solution for all. Although it may be necessary still to collaboratively make the difficult decision or choice of action to place Jameela in a care home, which may be unwelcome to her and thus compromising her rights, a further ethical dilemma. S. Banks(2006 p48) says: Yet while the social worker may be able to focus largely on one individual service user and take on the role of advocate for the service users rights, often the social worker has to take into account the rights of significant others in a situation. In the interests of justice it may not always be morally right to promote the service users rights at the expense of those of others’. This is in accord with my own conclusions for this scenario and the moral dilemma it has created by putting the rights of Farah, Majid and their children before Jameela.

On considering all the options this would be for the greater good and benefit the majority. ‘Cultural awareness’. (BASW, 2002, 4, 1, 6) As there are many cultural expectations on family members, in particular Farah and the responsibilities and duties it places on her; it is important for me to not impose westernised values on this family but to be aware of their cultural values, beliefs and customs. I would obtain a working knowledge of this individual family beliefs and culture, paying attention also to communication barriers and use an interpreter if needed.

Radical position and praxis could be used with effect to set up a day care centre to help Jameela and other elderly Punjabi members of this community, to help social inclusion of Jameela and others. Using praxis to reflect then act we could evaluate the service we have provided , its strengths and weaknesses and improve the service and expand it further to meet the needs of Punjabi members of the community. There is a power struggle within this family with Jameela having the greater and Farah the least power. As a social worker we have the power to influence the lives of our service users.

I would use my power to give information and available choices to all the members of this family to help them participate in the overall decision making process. It would be very important to try to help them to see the individual needs of other family members in a sensitive way without apportioning blame. By valuing the difference and the cultural identity of this family this would empower them and give them acceptance and equality, creating an opportunity for them to have choices in their lives. Thompson uses a Personal, Cultural and Structural (PCS) model to help understand discrimination and oppression that can result from it.

There are three levels which interrelate; the personal area looks at the psychological aspects of discrimination and how personal experiences will become apparent in our attitudes. The cultural aspect of the model is about what are perceived as the norms in society and the shared beliefs of society about what is right and wrong. The structural section of the model is making reference to the structure of society and includes within it media, religion and government (Thompson, 2006). I should consider the inequalities and discrimination that this family may face and how these may impinge on their lives.

As a social worker it would be my role to counteract the effects of oppression by focusing on both Jameela and Farah so they could gain control of their own lives, as they may feel disempowered by their situation so by adopting an anti- oppressive approach this would aim to empower them both. My own personal learning resulting from this scenario has been a reflection of my own character, my own values, personal beliefs and the importance of not allowing them to impact on the service offered to service users.

By reflecting on my previous working experience I have realised that I do actually adhere unknowingly to many of the philosophical principles that have underpinned the value base in social work. I have always treated all persons with respect, acceptance as individuals in their own right irrespective of their make-up or heritage (Kantism). I have the belief that there is some good in everyone although it is not always apparent (Virtue ethics). I am always non- judgemental and sensitive to cultural identity and aware of the diversity of all people.

The subject of ethics and the moral dilemmas that will occur in practice will be a challenge for me and all social workers I do believe on an ongoing basis. Learning how to empower people and to increase their own strengths and coping abilities is a theory for me to learn how to apply in practice situations. The importance of this to me as a future social worker is to ensure I acknowledge the power I will have, to always be reflective and consider evidence-based practice, to be a non-biased worker and to give all service users unconditional positive regard to create a safe and trusting environment so service users can express themselves.