Today I had my trial placement day, in preparation for my start in January. I'm not going to discuss my opinions on the placement or details today because I quite want to wait until I start, however one thing that was v interesting was the 4 hour meeting conducted every Friday afternoon.
Alongside admin issues, staff have a group one hour therapy session facilitated by an outside moderator, and group supervision and training where each week someone discusses a designated article or clinical case. I really enjoyed this session and some really big questions came out of it:
- at what point is one the therapist vs a member of the community? If you have a finite 1 hour therapy session with a client which is stuctured, should you behave in a consistently controlled manner the ret of the time or react more "normally" to client's behaviour?
- if you don't give enough feedback to their behaviour, does the residential setting reflect the real world enough and aid rehabilitation?
- age. If you've just turned 18 you're technically an adult, but if you've been used to being treated as a child for so long, it doesn't change in a day and yet the way the services work do. How can that transition be smoothed?
- was also quite intersting to see how different clients bring out such different emotions in staff. While one enjoys working with one client, another can find it near impossible. Its a lot about your own personal issues, being particularly in tune with a client or them bringing up something in your past.
- lots of questions about boundaries, the process of detaching, and the role of the professional vs the human.
The less enjoyable part of the day was hearing a story about recent self harm with a needle, repeated to many staff members. I have the worst needle phobia of anyone i know. Not fainting was an achievement.
That's all folks.
Am rather ready for the weekend!
Friday, 30 September 2011
Wednesday, 28 September 2011
Week One
This week has been the first of the MA programme and I’ve found it incredibly interesting and at times overwhelming, particularly being one of the few students without a psychology or sociology degree, a question asked by the lecturers of every module. Despite this, as I had done a fair amount of reading before university, I was glad to feel a little acquainted with some of the topics presented and discussed.
I have found a few topics and elements from this week’s lectures particularly engaging. The first is learning and discussing issues that are so topical, issues that crop up on the news each day – not something I’m familiar with from my Classics degree (!)
Our first Social Policy lecture was about the welfare state and our practice essay looks at whether it is tenable during a recession. On the news this morning David Miliband was discussing the same issue at the annual Labour party conference. We discussed it from three angles; the economic, political and structural/institutional and all of these seemed to come together when listening to his broad policies on welfare reform during this financial period. Similarly, we held a debate about the recent riots in our Critical Introductions module which helped me to reflect and refresh myself as to the many viewpoints I’d read about at the time. It did, however, remind me that the political opinions of most people in our class are fairly similar and not reflective of the debates I have had on this topic with some of my more right wing friends. I believe this is something quite important to keep in mind through this module and more broadly the MA programme.
The other element I particularly enjoyed was part of our Foundations for Social Work practice module where we learnt about different methods of communication and the different parts of ourselves we use when communicating; the critical adult or the free child for example. It gave me a good framework from which to reflect on much of my past communication, and helped me, unfortunately perhaps, to see my recent response to a friend’s revelation as coming far too much from the viewpoint of a “critical adult”.
It’s been a great first week and an opportunity not only to learn in lectures but from other students who have a wealth of knowledge between them. I have really enjoyed being in a setting where everyone is so vocal and willing to contribute to the many issues up for discussion.
I have found a few topics and elements from this week’s lectures particularly engaging. The first is learning and discussing issues that are so topical, issues that crop up on the news each day – not something I’m familiar with from my Classics degree (!)
Our first Social Policy lecture was about the welfare state and our practice essay looks at whether it is tenable during a recession. On the news this morning David Miliband was discussing the same issue at the annual Labour party conference. We discussed it from three angles; the economic, political and structural/institutional and all of these seemed to come together when listening to his broad policies on welfare reform during this financial period. Similarly, we held a debate about the recent riots in our Critical Introductions module which helped me to reflect and refresh myself as to the many viewpoints I’d read about at the time. It did, however, remind me that the political opinions of most people in our class are fairly similar and not reflective of the debates I have had on this topic with some of my more right wing friends. I believe this is something quite important to keep in mind through this module and more broadly the MA programme.
The other element I particularly enjoyed was part of our Foundations for Social Work practice module where we learnt about different methods of communication and the different parts of ourselves we use when communicating; the critical adult or the free child for example. It gave me a good framework from which to reflect on much of my past communication, and helped me, unfortunately perhaps, to see my recent response to a friend’s revelation as coming far too much from the viewpoint of a “critical adult”.
It’s been a great first week and an opportunity not only to learn in lectures but from other students who have a wealth of knowledge between them. I have really enjoyed being in a setting where everyone is so vocal and willing to contribute to the many issues up for discussion.
Friday, 23 September 2011
Induction week of MA
This week was my induction week for my Social Work MA.
After a few logistical nightmares i am finally registered!!
It's been quite a fun, if perhaps slightly pointless few days but a great opportunity to meet the others on the course. There's about 30 of us and everyone seems really lovely. There's also a huge mix of backgrounds and although as expected, i'm one of the few without much relevant experience, there are at least a few others - one who worked in the DOH and one as a physio - there's also someone who is using the course to help her family law career, and an ex met policeman who spent 30 odd years in the force! Some pretty great experience across the mix.
We had one lecture with the Youth and Community degree programme about the importance of integrated working, looking at a case study in groups. And today and yesterday we spent some time looking at our research methods module - discussing the importance of research within social work, and experience we had in this field, and today designing a practice research project looking into people's perceptions of social work. It was a fairly laid back day designing a questioniarre and going out on campus to fill it in before presenting back results later.
I've been really impressed with how friendly the tutors have been. The course tutor put on a lunch for us all to bond with the tutors mingling with us all, discussing the course etc and it was also interesting hearing people's experiences with other universities.
Inevitably there is already a fair amount of placement comparison. There are others who are probably going to residential homes, and then one "student unit" off to the local authority - they were called out infront of everyone as the people being put forward for the statutory placement - but there's lots of politics - i.e those wanting to end up in C+F, don't want a children's placement this year so are trying to move to adults etc! WE've also heard from a LA who presented to us about their bursary scheme we can apply to in March - you get a position with them for your second placement and then a job for 2 years after...obviously will be hugely competitive!
Oh and we've been given our first assignment already - a reflective diary, that involves us writing every week of the term, and also some extra reflection on key areas of social work such as values, communication etc - it;s a pass or fail assignment apparently.
Anyway...lectures begin on Monday and i have a 9-5pm trial day at my potential placement on Friday. Having spent time with my coursemates and already started to become submersed in the SW world, i'm really looking forward to next week.
After a few logistical nightmares i am finally registered!!
It's been quite a fun, if perhaps slightly pointless few days but a great opportunity to meet the others on the course. There's about 30 of us and everyone seems really lovely. There's also a huge mix of backgrounds and although as expected, i'm one of the few without much relevant experience, there are at least a few others - one who worked in the DOH and one as a physio - there's also someone who is using the course to help her family law career, and an ex met policeman who spent 30 odd years in the force! Some pretty great experience across the mix.
We had one lecture with the Youth and Community degree programme about the importance of integrated working, looking at a case study in groups. And today and yesterday we spent some time looking at our research methods module - discussing the importance of research within social work, and experience we had in this field, and today designing a practice research project looking into people's perceptions of social work. It was a fairly laid back day designing a questioniarre and going out on campus to fill it in before presenting back results later.
I've been really impressed with how friendly the tutors have been. The course tutor put on a lunch for us all to bond with the tutors mingling with us all, discussing the course etc and it was also interesting hearing people's experiences with other universities.
Inevitably there is already a fair amount of placement comparison. There are others who are probably going to residential homes, and then one "student unit" off to the local authority - they were called out infront of everyone as the people being put forward for the statutory placement - but there's lots of politics - i.e those wanting to end up in C+F, don't want a children's placement this year so are trying to move to adults etc! WE've also heard from a LA who presented to us about their bursary scheme we can apply to in March - you get a position with them for your second placement and then a job for 2 years after...obviously will be hugely competitive!
Oh and we've been given our first assignment already - a reflective diary, that involves us writing every week of the term, and also some extra reflection on key areas of social work such as values, communication etc - it;s a pass or fail assignment apparently.
Anyway...lectures begin on Monday and i have a 9-5pm trial day at my potential placement on Friday. Having spent time with my coursemates and already started to become submersed in the SW world, i'm really looking forward to next week.
Thursday, 15 September 2011
Last week of shadowing in Fostering and Adoption
I’ve just come back from my trip across the country to shadow a supervising social worker in fostering and adoption. Before I get into the details, this week I also spent a day in a duty and assessment team. I’d shadowed there before and have posted about it in detail (it seems to be my most read post!) but this day was a bit different as I sat on the duty desk just seeing the different referrals that get made and which ones go through to social workers. It was really interesting as they get all the police reports through as a matter of course, many of which aren’t relevant to social services but if someone under 18 has been involved, they have to know about it. And then a huge variety of cases come in – from kids who went missing and have since come back but seem to be depressed (possible referral to children and adolescent mental health services) to possible domestic violence cases – some of which don’t need SS intervention because court proceedings are already in place for contact and the police are involved. It was just interesting seeing the behind the scenes work and the invaluable work of the social work assistants who input all these referalls onto the systems so if any case comes up more than once, it’s carefully noted – these are some of the people losing their jobs in the cuts.
Anyway, back to fostering and adoption!
A supervising social worker (SSW), supervises foster carers – supervising visits to check all is going well, helping to prepare reports for reviews, assess and recruit carers, help with life story books – and this social worker did a huge amount of other tasks too – working in adoption, (recruiting and assessing families to adopt), getting involved in life appreciation days, where all the professionals involved in a child’s life, get together with the family that is about to adopt them to tell them more about the child, and she does post adoption work – helping those who have been adopted, who want to know more and perhaps reunite with birth families. Among other things. That’s a pretty vague description of her job, having only spent 2 days with her.
The first day we had a meeting at the primary school of a child who is in foster care. We met with the foster carer, a teacher from the school, as well as a representative from another school where the child’s sibling goes, the child’s social worker and a few others. The meeting was to check how the children were doing in school, both educationally and from a social point of view – and as one had just started secondary school, it was a good opportunity to discuss in more detail the kind of support it was felt she needed and some of the things the foster carer might want to discuss with her – for example – did she like the idea of starting a clean slate and no-one knowing about her past, or did she want to feel a or several specific teachers knew about it and therefore she could turn to them when she wanted? Also, how to prepare the child for questions that would come up about her past. In biology, you tend to cover genetics and eye colour – in English they were going to be asked to write about their life so far etc.. things I’d always taken for granted.
There was also some additional things to consider about contact. These siblings had a younger sibling who was about to be adopted and whose family don’t want them to have any further contact. This issue has always been one I find difficult. I wrote a post much earlier about cutting off sibling contact – I find it a hard one to get my head around if the siblings don’t cause any risk to the child – and I could only imagine how hard it was to tell these kids that they could no longer see their younger sibling – or at least for many many years until they get to 18. It also brings up the role of social media – once they’re all on Facebook, who says how long it will take for them to reunite of their own accord, without support systems in place?
We then had lunch with the social worker I was shadowing’s old manager – where I heard more about many of the issues local authorities are facing at the moment – staff off sick, less managers about, overworked people – and much of the work getting privatized to more dynamic organisations.
After visting the foster carer from the school meeting again to get documents ready for updating CRB checks, and discussing risk assessments around the home, we went on to visit another foster carer. A kinda super nanny figure who has adopted many children and is now fostering many more. In many ways it was incredibly inspiring seeing how many lives she had changed. She was dealing with a whole spectrum of issues from disabled babies born from drug addicted parents, to teenagers dropping out of jobs, sleeping with their partners too young and everything in between. There were lots of interesting things for me:
- no one could sleep over at the house without being CRB’d – ie the kids’ friends
- she talked about going shopping with some of the kids in care and when random people came over saying “aahh cute, whats their names?” she has to change the names because of the situation
She was also having interesting challenges regarding contact. It seems that some of the children in the past had changed their behaviour drastically the moment contact with their birth parents stopped – they calmed down, they immediately stopped bed-wetting etc. I found this really interesting.
One thing that did concern me a bit, and something that came up in my mind the next day too, was that taking on all these children, could and it seemed sometimes did, have quite an impact on the birth children, or even older adopted children. Can you always give enough time to your own/older kids, when you have so many younger kids/kids who are quite demanding to focus on too?
The next day we visited a family looking to adopt their first child – we had a general chat with them and then did some exercises about children’s behaviour . Some of it was quite interesting, ie a discussion about hitting your child. The exercise was clearly trying to make sure the couple thought it was wrong to hit a child – but, I just wondered whether it was quite as black and white as this. I’m not saying I think it’s right – but equally I doubt everyone thinks that a light hit is the same as child abuse. I know it’s a topic that comes and goes in different generations and that we have to be particularly careful about people who are about to adopt and their attitude but I still thought it was quite a tricky issue.
We also had an interesting chat about contact and options such as keeping contact with birth parents but without sharing photos. Also, what happens if the birth parents go on to have other children after you’ve adopted this one – would you allow them contact with their siblings? Contact is clearly an incredibly challenging and interesting part of adoption and I found it particularly so as I’m pro adoption for myself at some point so was often wondering what I would do in a given situation.
This couple were going to pre-approval training where they met others in the same position – I imagine this can form a pretty great support network, and certainly many of the foster carers we visited, seemed to know others they’d met at various training groups.
Finally we visited one more foster carer who had a number of her own children as well as those on placement. She seemed to be doing a remarkable job and I very much enjoyed sitting with a baby on my lap! One of their children is soon to be adopted so there was much discussion about that process and how to make the transfer smooth, in terms of letting them come into the house and start to look after the child as much as possible. The carer seemed to be incredibly thoughtful making suggestions such as texting the adoptive parents photos of the child when they wake up saying “morning mummy and daddy” – and she’d created a gift, a printed book of photos for them, as well as the life story book they’d worked on.
We discussed a template for an ideal life story book – something the social worker could create for all her carers if they wanted to use it. A life story book is a book that gives the child a sense of history and identity as they grow older, as well as some continuity for the next carers – it includes photos of them growing up, people important in their life – and anything from what subjects they liked in school, food or toys they like, to medical history.
What also struck me over this trip was how much time and money you needed to have to make fostering or adoption work. Fostering itself pays but as it doesn’t pay much, it certainly prevents people with less money from doing it. Although I know this is a contentious issue in itself – you’d never want people to foster for the money so it’s a hard balance to get right. But also having the time – if you work, and you’re adopting, how do you take time off for regular social worker visits – many of the people we met were stay at home mums or housewives which made meeting social workers more flexible – or people who worked shifts.
The broadest point though was that in every case, the change in the children being fostered was said to be remarkable - such an incredibly rewarding thing both to do and to observe.
Another great experience, and thank you to the fantastic social worker who not only allowed me to shadow, but to stay in their home for a few nights!
So that brings my shadowing to an end. I’ve done a mental health day centre, a social worker in community mental health and in fostering and adoption and some time with a charity who work with kids in care. It’s been a fantastic five weeks.
Next week is my induction week at uni and lectures begin the week after…I’m excited and nervous too – just the idea of being a student again after this time makes me slightly anxious…but I’ve been waiting for it long enough!
Anyway, back to fostering and adoption!
A supervising social worker (SSW), supervises foster carers – supervising visits to check all is going well, helping to prepare reports for reviews, assess and recruit carers, help with life story books – and this social worker did a huge amount of other tasks too – working in adoption, (recruiting and assessing families to adopt), getting involved in life appreciation days, where all the professionals involved in a child’s life, get together with the family that is about to adopt them to tell them more about the child, and she does post adoption work – helping those who have been adopted, who want to know more and perhaps reunite with birth families. Among other things. That’s a pretty vague description of her job, having only spent 2 days with her.
The first day we had a meeting at the primary school of a child who is in foster care. We met with the foster carer, a teacher from the school, as well as a representative from another school where the child’s sibling goes, the child’s social worker and a few others. The meeting was to check how the children were doing in school, both educationally and from a social point of view – and as one had just started secondary school, it was a good opportunity to discuss in more detail the kind of support it was felt she needed and some of the things the foster carer might want to discuss with her – for example – did she like the idea of starting a clean slate and no-one knowing about her past, or did she want to feel a or several specific teachers knew about it and therefore she could turn to them when she wanted? Also, how to prepare the child for questions that would come up about her past. In biology, you tend to cover genetics and eye colour – in English they were going to be asked to write about their life so far etc.. things I’d always taken for granted.
There was also some additional things to consider about contact. These siblings had a younger sibling who was about to be adopted and whose family don’t want them to have any further contact. This issue has always been one I find difficult. I wrote a post much earlier about cutting off sibling contact – I find it a hard one to get my head around if the siblings don’t cause any risk to the child – and I could only imagine how hard it was to tell these kids that they could no longer see their younger sibling – or at least for many many years until they get to 18. It also brings up the role of social media – once they’re all on Facebook, who says how long it will take for them to reunite of their own accord, without support systems in place?
We then had lunch with the social worker I was shadowing’s old manager – where I heard more about many of the issues local authorities are facing at the moment – staff off sick, less managers about, overworked people – and much of the work getting privatized to more dynamic organisations.
After visting the foster carer from the school meeting again to get documents ready for updating CRB checks, and discussing risk assessments around the home, we went on to visit another foster carer. A kinda super nanny figure who has adopted many children and is now fostering many more. In many ways it was incredibly inspiring seeing how many lives she had changed. She was dealing with a whole spectrum of issues from disabled babies born from drug addicted parents, to teenagers dropping out of jobs, sleeping with their partners too young and everything in between. There were lots of interesting things for me:
- no one could sleep over at the house without being CRB’d – ie the kids’ friends
- she talked about going shopping with some of the kids in care and when random people came over saying “aahh cute, whats their names?” she has to change the names because of the situation
She was also having interesting challenges regarding contact. It seems that some of the children in the past had changed their behaviour drastically the moment contact with their birth parents stopped – they calmed down, they immediately stopped bed-wetting etc. I found this really interesting.
One thing that did concern me a bit, and something that came up in my mind the next day too, was that taking on all these children, could and it seemed sometimes did, have quite an impact on the birth children, or even older adopted children. Can you always give enough time to your own/older kids, when you have so many younger kids/kids who are quite demanding to focus on too?
The next day we visited a family looking to adopt their first child – we had a general chat with them and then did some exercises about children’s behaviour . Some of it was quite interesting, ie a discussion about hitting your child. The exercise was clearly trying to make sure the couple thought it was wrong to hit a child – but, I just wondered whether it was quite as black and white as this. I’m not saying I think it’s right – but equally I doubt everyone thinks that a light hit is the same as child abuse. I know it’s a topic that comes and goes in different generations and that we have to be particularly careful about people who are about to adopt and their attitude but I still thought it was quite a tricky issue.
We also had an interesting chat about contact and options such as keeping contact with birth parents but without sharing photos. Also, what happens if the birth parents go on to have other children after you’ve adopted this one – would you allow them contact with their siblings? Contact is clearly an incredibly challenging and interesting part of adoption and I found it particularly so as I’m pro adoption for myself at some point so was often wondering what I would do in a given situation.
This couple were going to pre-approval training where they met others in the same position – I imagine this can form a pretty great support network, and certainly many of the foster carers we visited, seemed to know others they’d met at various training groups.
Finally we visited one more foster carer who had a number of her own children as well as those on placement. She seemed to be doing a remarkable job and I very much enjoyed sitting with a baby on my lap! One of their children is soon to be adopted so there was much discussion about that process and how to make the transfer smooth, in terms of letting them come into the house and start to look after the child as much as possible. The carer seemed to be incredibly thoughtful making suggestions such as texting the adoptive parents photos of the child when they wake up saying “morning mummy and daddy” – and she’d created a gift, a printed book of photos for them, as well as the life story book they’d worked on.
We discussed a template for an ideal life story book – something the social worker could create for all her carers if they wanted to use it. A life story book is a book that gives the child a sense of history and identity as they grow older, as well as some continuity for the next carers – it includes photos of them growing up, people important in their life – and anything from what subjects they liked in school, food or toys they like, to medical history.
What also struck me over this trip was how much time and money you needed to have to make fostering or adoption work. Fostering itself pays but as it doesn’t pay much, it certainly prevents people with less money from doing it. Although I know this is a contentious issue in itself – you’d never want people to foster for the money so it’s a hard balance to get right. But also having the time – if you work, and you’re adopting, how do you take time off for regular social worker visits – many of the people we met were stay at home mums or housewives which made meeting social workers more flexible – or people who worked shifts.
The broadest point though was that in every case, the change in the children being fostered was said to be remarkable - such an incredibly rewarding thing both to do and to observe.
Another great experience, and thank you to the fantastic social worker who not only allowed me to shadow, but to stay in their home for a few nights!
So that brings my shadowing to an end. I’ve done a mental health day centre, a social worker in community mental health and in fostering and adoption and some time with a charity who work with kids in care. It’s been a fantastic five weeks.
Next week is my induction week at uni and lectures begin the week after…I’m excited and nervous too – just the idea of being a student again after this time makes me slightly anxious…but I’ve been waiting for it long enough!
Thursday, 8 September 2011
Shadowing in a Community Mental Health Team
So this week I’ve been fortunate to have 3 days shadowing in a community mental health team – very different from anything that’s come before.
The first thing that I noticed and loved was the multi-disciplinary setting – we were sitting amongst occupational therapists, psychologists, nurses and social workers, which just feels like a really broad learning experience.
My first day involved going on two visits. I found the first one quite difficult – we were visiting someone with very developed dementia, and their child has given up their life to be a full time carer. This obviously happens a lot but I just felt so bad for them – they’re really cut off from the outside world, cannot engage with their parent at all, barely leave the house..and finally through creative use of their personal budget, have been able to get a laptop and hookup to Facebook – that’s the extent of contact. It upset me to think about – and I think one of the differences working with older people vs children is the ability to distance yourself. With YP – you can say, I didn’t have this childhood, poor them – with older people – it could be you, or your parents one day – and that’s quite a big thought to face each day.
The second visit was also an eye opener and comes back to the issue of taking things at face value, one I’ve discussed before. We met someone else with dementia who discussed her active daily life, amongst other things – and I went away feeling quite positive. It turns out that none of these elements are real. I guess they were a few decades ago, but not now…
It was really interesting to note little observations and checks the Social Worker does to monitor how the service user is doing – have they bought milk recently? Is it in date? They said they’re paying their bills – but can they show me they know where their bills are? Can we do a brief financial assessment – check how much they think their weekly food shop is for example; Check the carers logbook – have the carers been coming when they say they will etc.
I was fortunate to be shadowing a social worker with endless patience for my many questions. And with a huge variety of books for me to read – from psychiatric handbooks, to guidance on the mental health act and mental capacity act.
I learnt more about the differences between neurotic and psychotic conditions, about the MMSE – mini mental state examination - often done with people with dementia as a quick assessment.
On my second day I went to the multi-disciplinary meeting all morning, where each case is discussed. I really enjoyed this and thought it was so useful how each profession could chip in with advice about different cases. And for me, it was just interesting seeing different debates and protocols:
- one case was perceived to be a safeguarding issue, so a strategy meeting would be arranged asap, potentially involving the police
- in another instance it was unclear what more this team could do for the s/u so a case conference was going to be called involving everyone concerned with the s/u – family, people at the day centre they attend etc – and the s/u themselves would be invited
- they discussed the need for one s/u to go to residential care and how under s7 of the MHA, a patient can go into guardianship (with agreement of the closest relative, different to next of kin), the guardian may be a social services authority or any other person if the authority agrees to it. I have been reading about this further – the guardian must visit them at least every 3 months and the duration of guardianship is usually 6 months with the possibility of further renewals.
- The guardian can send someone to residential care, or make a decision on their care regime, without s/u’s consent – but cannot prescribe treatment to them. (A community treatment order is used to ensure a patient is taking treatment while still being in the community rather than needing to be detained in hospital.)
- The use of an IMCA (independent mental capacity advocate) – they’ll be involved where serious medical treatments are proposed and no one else can be consulted about the patient’s best interests or where there is a proposal for the patient to be accommodated in a care home or hospital – they will represent and support the individual, ascertain his/her wishes and consider courses of action.
and lots of small but to me interesting debates i.e:
- different children wanting their parent to live near them in a residential care home – who decides etc? Although comes down to capacity of individual themselves
- those who are diagnosed with dementia cannot attend just any residential home – they have to be dual registered to specifically work with those with dementia
- hard to engage with one s/u but they spend all their day in church – should SW-er visit them there? Or actually is it good they have their safe space uninvaded by social workers….if it’s easy to monitor their wellbeing by calling the church
- the importance of updating risk assessments and discussing doubling up on certain visits!
I also learnt more about setting up mental health assessments – to section someone. And read a best interests assessment form to assess whether the deprivation of liberty in a particular case was the best decision made in that instance – i.e was it done to prevent harm to the person themselves or to others, and proportionate to the risk posed. (I’m not explaining this well as its actually pretty detailed – see Stuart Sorensen’s blog for lots of detail about deprivation of liberty safeguards/DoLS)
I attended a training session about the importance of reducing prescriptions of anti psychotic medicine to those with dementia – it seems its often prescribed for behavioural elements such as irritability and insomnia, rather than psychotic elements – and there are many side effects that are not always considered in the detail they should be, such as strokes – this is a national target.
My final day I spent doing lots more reading. Particularly lots of reports for mental health act assessments, observations of what goes on in a mental health ward, and interviews with people after they had been sectioned – particularly interesting. I enjoyed reading the reflective reports (part of the AMHP portfolio) discussing whether the social worker felt that the assessment had been carried out in an anti-discriminatory way and the importance of trying to match gender and race where possible between service user and those carrying out the assessment.
Anyway I’ve waffled on a lot in this post about the detail. I’ve learnt lots in a few days and its particularly interesting given that first mutterings this week about my first placement suggest it may be in a voluntary mental health setting – but will know more soon.
The first thing that I noticed and loved was the multi-disciplinary setting – we were sitting amongst occupational therapists, psychologists, nurses and social workers, which just feels like a really broad learning experience.
My first day involved going on two visits. I found the first one quite difficult – we were visiting someone with very developed dementia, and their child has given up their life to be a full time carer. This obviously happens a lot but I just felt so bad for them – they’re really cut off from the outside world, cannot engage with their parent at all, barely leave the house..and finally through creative use of their personal budget, have been able to get a laptop and hookup to Facebook – that’s the extent of contact. It upset me to think about – and I think one of the differences working with older people vs children is the ability to distance yourself. With YP – you can say, I didn’t have this childhood, poor them – with older people – it could be you, or your parents one day – and that’s quite a big thought to face each day.
The second visit was also an eye opener and comes back to the issue of taking things at face value, one I’ve discussed before. We met someone else with dementia who discussed her active daily life, amongst other things – and I went away feeling quite positive. It turns out that none of these elements are real. I guess they were a few decades ago, but not now…
It was really interesting to note little observations and checks the Social Worker does to monitor how the service user is doing – have they bought milk recently? Is it in date? They said they’re paying their bills – but can they show me they know where their bills are? Can we do a brief financial assessment – check how much they think their weekly food shop is for example; Check the carers logbook – have the carers been coming when they say they will etc.
I was fortunate to be shadowing a social worker with endless patience for my many questions. And with a huge variety of books for me to read – from psychiatric handbooks, to guidance on the mental health act and mental capacity act.
I learnt more about the differences between neurotic and psychotic conditions, about the MMSE – mini mental state examination - often done with people with dementia as a quick assessment.
On my second day I went to the multi-disciplinary meeting all morning, where each case is discussed. I really enjoyed this and thought it was so useful how each profession could chip in with advice about different cases. And for me, it was just interesting seeing different debates and protocols:
- one case was perceived to be a safeguarding issue, so a strategy meeting would be arranged asap, potentially involving the police
- in another instance it was unclear what more this team could do for the s/u so a case conference was going to be called involving everyone concerned with the s/u – family, people at the day centre they attend etc – and the s/u themselves would be invited
- they discussed the need for one s/u to go to residential care and how under s7 of the MHA, a patient can go into guardianship (with agreement of the closest relative, different to next of kin), the guardian may be a social services authority or any other person if the authority agrees to it. I have been reading about this further – the guardian must visit them at least every 3 months and the duration of guardianship is usually 6 months with the possibility of further renewals.
- The guardian can send someone to residential care, or make a decision on their care regime, without s/u’s consent – but cannot prescribe treatment to them. (A community treatment order is used to ensure a patient is taking treatment while still being in the community rather than needing to be detained in hospital.)
- The use of an IMCA (independent mental capacity advocate) – they’ll be involved where serious medical treatments are proposed and no one else can be consulted about the patient’s best interests or where there is a proposal for the patient to be accommodated in a care home or hospital – they will represent and support the individual, ascertain his/her wishes and consider courses of action.
and lots of small but to me interesting debates i.e:
- different children wanting their parent to live near them in a residential care home – who decides etc? Although comes down to capacity of individual themselves
- those who are diagnosed with dementia cannot attend just any residential home – they have to be dual registered to specifically work with those with dementia
- hard to engage with one s/u but they spend all their day in church – should SW-er visit them there? Or actually is it good they have their safe space uninvaded by social workers….if it’s easy to monitor their wellbeing by calling the church
- the importance of updating risk assessments and discussing doubling up on certain visits!
I also learnt more about setting up mental health assessments – to section someone. And read a best interests assessment form to assess whether the deprivation of liberty in a particular case was the best decision made in that instance – i.e was it done to prevent harm to the person themselves or to others, and proportionate to the risk posed. (I’m not explaining this well as its actually pretty detailed – see Stuart Sorensen’s blog for lots of detail about deprivation of liberty safeguards/DoLS)
I attended a training session about the importance of reducing prescriptions of anti psychotic medicine to those with dementia – it seems its often prescribed for behavioural elements such as irritability and insomnia, rather than psychotic elements – and there are many side effects that are not always considered in the detail they should be, such as strokes – this is a national target.
My final day I spent doing lots more reading. Particularly lots of reports for mental health act assessments, observations of what goes on in a mental health ward, and interviews with people after they had been sectioned – particularly interesting. I enjoyed reading the reflective reports (part of the AMHP portfolio) discussing whether the social worker felt that the assessment had been carried out in an anti-discriminatory way and the importance of trying to match gender and race where possible between service user and those carrying out the assessment.
Anyway I’ve waffled on a lot in this post about the detail. I’ve learnt lots in a few days and its particularly interesting given that first mutterings this week about my first placement suggest it may be in a voluntary mental health setting – but will know more soon.
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