1) IntroductionMy 80-day placement gave me another experience in not only developing my skills of working with young people with disabilities but also in transferring my skills that I had previously used in my previous job as an assessor of children with life threatening illnesses and special needs.2) The Reason for the InterventionZ had been previously prescribed Epilim medication by his GP; this medication has since been proven to controlling his epilepsy.
When Z does not have his medication he is unable to concentrate for long periods. The fitting also affects his safety, as when he is having a fit he has an increased tendency to fall. It was therefore agreed by the GP it was imperative that Z takes his medication to enable him to have as high a quality of life as possible. This work was carried out to improve Z’s ability to take his prescribed medication more effectively whilst at the unit.
The work was carried out with unit staff members, as there were no issues at the school or within the home regarding this matter.3) The Legal frameworkAs previously mentioned the unit provides home-from-home respite care for young people between the ages of 5-16 who had been identified as having a severe learning difficulty the residents were all accommodated under section 20 of the children Act 1989. Therefore the care that the young people received was continued whilst they were at the unit, a large part of this carry over included the administering of medication.Section one of the Children Act 1989 focuses upon the welfare of the child and states that in any dealings the welfare of the child is to be considered the most important factor when dealing with children.
This section of the act also refers to the possible harm that the child would be at risk of suffering. Section 22 of the same act outlines duty of the Local Authority to safeguard and promote the well being of children in their care. As the GP had instructed the agency that the medication was necessary to stabilise Z’s health as well as reduce the possibility of injury as he has the tendency to fall during a fit, I sought to find the most effective way for this to happen that caused the minimum level of distress to Z as possible. Upon reflection I decided that anti-oppressive practice would be the best theory to combine with group work, please see section 4.
3 for more details.4) Reflective PracticeBoud, Keogh and Walker developed their own model of reflection in 1985, the model is similar to that of Kolb’s learning model but takes into account the possible effects of feelings and values upon the learning experience. Their model has three stages: -1. Returning to the experience by recalling the past event2.
Understanding and acknowledging ones own and others feelings that were felt during the experience3. Re-evaluating the experience by adding new knowledge that has been derived from this reflective process.During my sessions at the unit, I found that my values played a large part in my reflective learning when working with this service user group than when working with young people on my 50-day placement. Due to this, I found that I utilised Boud, Keogh and Walker’s model more at this time than Kolb’s learning model as outlined in the same stages below: -4.
1. During one of my sessions at the unit, I was able to observe Z being administered his medication. The young person in question has severe learning difficulties, no verbal communication but his comprehension was at a higher developmental level.The medication (Epilim) that is used to control his epilepsy is usually administered by Mom and Dad, in his drinks.
At the unit, the staff attempts to carry on with the same routine as at home. However, Z dislikes taking it in this manner when he is there.4.2.
Z became very distressed when the cup was presented. Due to Z’s limited ability to express his needs he then began to run away from staff members, the medication was eventually syringed into his mouth after ten minutes.Shortly after this Z’s behaviour was less emotional, however I noticed that during the whole evening Z refused to have any drinks that were offered to him. The unit has to be kept quite warm at times due to the mix of children in the unit at any given time; Z’s refusal to have a drink also posed issues relating to him getting dehydrated especially as he is unable to control his dribbling and looses a lot of fluid anyway.
The fact that Z tolerated having his medication via syringe I felt was a strength and this formed the basis of my intervention.After reflection on this experience during supervision with my practice teacher and placement supervisor, I explained that I understood the importance of Z having his medication and that I was aware that if he did not have his medication that would increase fitting. However, that I was not happy with the method that had been adopted to administer the medication. My supervisor was more than happy for me to suggest a new approach.
After reflection during supervision, I discussed anti-oppressive practice issues and ways in which staff could decrease some of the power and authority that was placed over Z at medication time. By making drink times more social and fun instead of a battle for example.In my experience, increased fitting would pose barriers to Z’s ability to learn in school, as the increased brain activity would be too high. Not only that but in my experience the fitting would also restrict Z’s ability to participate as fully as he could in his environment, therefore on this basis his medication was important for him to take.
RISKDue to safety reasons I felt that simply leaving the cup near to Z and allowing him to drink it at his leisure would have compromised the safety of the other young people on the unit as unattended medication may be mistakenly taken by them. I also felt it was important that staff were present when the medication was taken as they had to observe that the full dosage had been taken and not spilled elsewhere.4.3 When this had taken place, I was able to discuss with staff and advocate on his behalf and discuss ways in which we could incorporate drink time as a group social activity.
I decided that this should be done as soon as possible. The new approach involved some singing games; bubble blowing activities and then drinks time. This approach was to be adopted by all staff with all children who were at the unit at the time. I decided that medication would be syringed in the short term at least, as Z was tolerable of this.
Therefore by all staff approaching Z in the same manner Z would receive clear and consistent messages of what was expected of him and also he would not feel at a disadvantage as he was doing the same activities as the other young people. The plan was set as a long-term plan to be reviewed on a monthly basis.By decreasing anxiety and the pressure on Z and staff for his medication to be taken, this in time would win back Z’s confidence to take a drink from staff and therefore reduce the need for syringing medication, as staff were not happy to do this due to their own values. I felt that Z would feel happier having a drink once the pressure he was noticing from staff had decreased and his medication could once again be added to his drinks.
5) Anti-Oppressive IssuesAt placement, I felt able to challenge the oppression in this instance. However, there were times where I felt unable to challenge certain oppressions. For example I felt unable to challenge the minibus pick up times, some of the children were being picked up at 8pm on the school transport to travel round the borough to pick up the other young people, which in my opinion was not necessary as the school was only five minutes away from the unit.This can be identified in Freire’s three levels of consciousness.
Magical consciousness was the level at where individuals were most oppressed and disempowered. At this level, the oppressed group had also internalised the oppressor’s feelings about them.The second level which was “naï¿½ve consciousness”, this was where individuals were at the level where they had identified the oppression but felt unable to change anything (such as myself with the afore mentioned issue). I also saw my problem as individual in that I assumed the other staff had not also shared my thoughts, but after talking to them regarding Z they all felt the same way and were willing to try a new approach.
The third level was critical consciousness this was the most empowered stage. This was where individuals were aware of the oppression but also willing to challenge the inequality and oppression. To some degree I feel Z was at this stage, it appeared he was aware he had to have the drink but the only way to regain the power placed on him was to refuse it.Freire’s level of consciousness has a great level of impact on the reflective process.
For example, how empowered I am feeling also impacts on the level of service my service users receive as this determines whether I challenge the oppression.6) Effectiveness of the Models and Theories UsedThe combination of the social model and the medical model of disability was used during this piece of work. The medical model to some degree focuses on the individual as the problem and what can be done to change them to cope better in their environment. Therefore, medication was provided and continued to be administered.
The social model however looks at how the environment itself can be either enabling or inhibiting to the individual. Therefore, by changing the way we approached Z in the short term we were able to improve his circumstances in the long term.This combination appeared to be working; the medication was being administered with no upset to Z, this also limited the risk of his fits increasing and the risk to his personal safety. Z was also taking his drinks and beginning to build up his trust with staff at the unit regarding this matter, which also helped to keep him hydrated.
The approach was very effective Z was not upset any longer due to this reason and also became more sociable with staff during this time.I also felt that Boud, Keogh and Walker’s model was useful as it acknowledged the heightened feelings of the service user and myself and how negative feelings can in turn lead to a negative outcome.7) What I Have LearntI feel that this piece of work not only highlights the importance of trained staff to be aware of how to practice anti-oppressively but also how important it is to share experiences, knowledge, values and our own personal perspective.The new Department of Health guidance “Valuing People, A New Strategy for Learning Disability for the 21st Century” suggests that 75% of employees working in the area of social care and health are unqualified.
The government’s objectives are to now ensure that these employees are adequately trained and skilled. The policy guidelines aim to ensure that people with disabilities receive a good quality of service that meets and caters for their needs. The policy guidelines state that this includes persons with severe learning disabilities as well as those suffering with epilepsy.I feel that this piece of work not on substantiates this need but also highlights the importance of anti-oppressive practice to be implemented in everything I do with my service users.
In essence, anti-oppressive practice is not subject to choice of use but a way of life, a method to be adopted and engrained in my practice.The staff at the agency itself were very open to me discussing my thoughts and new approach to working with them. I strongly feel that staff morale also has a direct impact on the quality of service that users receive. For example in my experience staff disempowerment is more likely to lead to magical or naï¿½ve consciousness rather than critical consciousness.
This in turn leads to a poor service.I feel that as a social worker I too need to strive to be at a critical level of consciousness as it is my job to ensure that the service my service users receive is as tailored to their individual needs as possible as well as being provided in an anti-oppressive manner that seeks to empower rather than disempower.I have also learnt that people with severe learning disabilities are able to feel and react to oppression as well as feel and think in the same manner. These individuals are to also to be given the same dignity, respect and treatment as we would anyone else.
8) UpdateDuring my last week at placement Z had started to consistently accept drinks from staff. This was observed by myself and I also used case notes to confirm this.