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Introduction Beginnings Making sense of the information Deciding what to do Reviewing the plan
 
     
     

Stage 4 - Reviewing the plan

Case Information

  • The final stage of the task centred work is terminating the work and evaluating what had been achieved.
  • The practitioners involved with each family member are aware of the risks that the needs of one or more family members may become swamped by the complexity of the situation and the needs of other family members. The social worker is concerned that the work with Marta, Jan and Kristina as individuals and as a family, is evaluated.
  • The assessment of Marta's, Jan's and Kristina's circumstances was not a one-off event. Now, it has to be reviewed regularly to identify and respond to any changes in their circumstances.
  • The social worker has taken charge of organising and coordinating the review. It is necessary to decide several aspects: Where should the review take place? Who should attend? Should the review be a meeting with all members sat round together or informal? Should the review be conducted formally with decisions and areas of discussion and agreement communicated through the chair, or should the proceedings be discussed with Kristina, Jan and Marta informally, by the social worker, for instance?
  • The implementation of the plan is evaluated. The plan has worked better in some areas than others.

Kristina

  • Kristina's vulnerability and areas of risk, including her sexual vulnerability, need reviewing. The social worker has attempted to put Kristina in touch with the self help group to improve Kristina's sexual knowledge and behaviour with members of the opposite sex. . The aim was to decrease her vulnerability and the question now is how effective has the work been. To the social worker's surprise, Kristina has continued to attend the self-help group and appears to have gained a good deal of support, made some positive friendships and learned some useful social skills.
  • The social worker listens to Kristina listing her achievements. She has felt valued. There are negative aspects as well. Kristina expresses the view that the written agreement has made her uncomfortable. She is aware of her limitations in reading and writing and feels the worker is in charge and she can't challenge her.
  • The worker judges using a task centred approach has increased Kristina's opportunities to retain control and stay in charge of her situation. Whilst the social worker has retained an understanding of Kristina's responses to her situation, in terms of the impact of losses on her, she has worked with Kristina on her feelings and coping strategies in the present.
  • The worker realises she should have asked Kristina at the outset if she wants an advocate. This would have taken up the aspect of the power relations between the worker and the person receiving services. The worker said it was hard negotiating with Kristina rather than simply arriving at the list of prioritised tasks. Time was spent which could have been saved, if Kristina's full participation hadn't been the goal. The worker took Kristina to three hotels for interviews. These were hotels Kristina chose. Kristina was not identified as the problem. It was her lack of a job they were trying to solve.
  • The social worker has come to suspect Kristina is intermittently hard of hearing. The social worker realises this should have been part of Kristina's health action plan under the Valuing People initiative. Arrangements are made for her to be examined by an audiologist at the audiology clinic of the local hospital.
  • The questions about Kristina's hearing difficulties raise further questions. She could be suffering the early onset of dementia. Her symptoms of hearing impairment could be ambiguous.
  • The situation illustrated the imbalance of power between Kristina and the worker. It showed how powerless and vulnerable Kristina would be in other circumstances, when in work, at college, in any situation where she had to negotiate with people and assert herself.

Kristina and Marta

  • The task centred approach clarified the relative situations of Kristina and Marta. It enabled Marta to perceive her own needs. It also enabled her to see how Kristina needed to be empowered to identify, seek and achieve her own goals. This was important. The approach adopted by the social worker did not exclude Marta. It included her, but did not allow her to encroach on Kristina's space to act. Marta was not excluded from being a carer.

Marta

  • Marta has benefited from support as carer. The approach has enabled Marta to contribute to empowering Kristina to challenge and overcome discrimination embedded in situations she encountered. Kristina needed to be equipped with knowledge, skills and confidence to do this. As mentioned above, the shortcoming has been the lack of advocacy for Kristina. This perhaps imposed limitations on her achieving more full participation as citizen. Awareness of this weakness in the work has enabled Kristina to ask for an advocate to be brought in, at this stage.

Jan

  • Attention has been paid to Jan, Marta's husband and Kristina's father. He needs not to be excluded. He has work to do, to shift and change. He also has needs and wants to be taken into account.
  • He has needed adaptations to enable him to use the toilet and bathroom without undue discomfort and the risk of becoming stuck. His worker has provided a hoist, bath seat, perching stool and rails under Section 2 of the Chronically Sick and Disabled Persons Act (1970).
  • Jan has benefited through the improved support he receives. His worker noticed the stick Jan was using was not adjusted to his height. She persuaded him to try a purpose-measured stick. He feels steadier on his feet with this and is confident enough to take a regular walk out of the house.

Jan and Marta

  • This takes the pressure off Marta as she is able to clean the sitting room, particularly the easy chair Jan tends to sit in all the time, in front of the TV. It also provides her with some respite for a few hours.

Key Questions

  • What information have we, from practitioners, and from Marta, Jan and Kristina, to indicate whether the plan is working?
  • To what extent has the plan achieved its objectives?
  • How far is it meeting the needs of Kristina, Jan and Marta?
  • Are new needs emerging?
  • How should practitioners and agencies meet Kristina's newly discovered need for help with being hard of hearing?
  • Would it be productive for a keyworker to do some focused work with Jan, Marta and Kristina together, examining roles, power and communication between them, using a person-centred approach?
  • How should the plan be changed to meet these needs?

Research Focused Questions

  • How far has the person-centred approach been effective?
  • To what extent has the task-centred work met its goals?
  • Is the person-centred and task-centred work done with the family members cost-effective?
  • Does the work done with the family members meet Fair Access to Care requirements?
  • What evidence is there to support the view that Kristina is safer now than she would have been if the intervention had not occurred?
  • What evidence is there to justify amending the plan to meet newly identified needs?
  • To what extent have Kristina, Jan and Marta collaborated with practitioners in evaluating the practice?
  • To what extent have Kristina, Jan and Marta collaborated with practitioners in evaluating the evaluation?

Relevant Knowledge

Counselling and Care Planning

Nelson-Jones (2002) gives practical guidelines on how to develop a helping relationship, listen actively, show understanding, clarify problems, assess problems, restate them in terms of skills to be gained and plan and deliver interventions for thinking, feeling and action. Finally, he deals with evaluation of this process. In short, such a staged approach is reminiscent of the stages of assessment proposed in Government guidance a decade earlier (DoH, 1991).

Gerard Egan (2002, pp. 7-9) specifies two main goals of helping:

  • first, helping clients manage their problems in living more effectively;
  • second, helping clients better to help themselves.

This emphasis on self-help is related to the social work value of respect for persons, which link with the principles of empowerment and person-centred work. Both Egan's approach to counselling and person-centredness aim to make the client the expert by basing the effective helping relationship on Biestek's (1961) casework principles of genuineness, empathy acceptance and non-evaluation (or not being judgemental). Empathy is not the same as sympathy. Empathy is recognising and appreciating the other person's situation, thoughts and feelings without necessarily sharing them.

Supported Employment

Supported employment is a widely used method, especially in the voluntary sector, of helping people with learning disabilities enter paid work. Wilson (2003) points out it fails adequately to tackle the consequences of impairment for the disabled person. These include isolation, stigmatization and disempowerment.

People who are Deaf or Hard of Hearing

Research (Rodda and Eleweke, 2002) into the difficulties of gaining access to services by minority ethnic deaf people in Alberta shows that there is insufficient recognition of their particular needs. There is a lack of information for them on available services and resources and insensitivity to their cultural background as well as a lack of any programme specifically geared to their needs.

Even though it could be argued this research does not apply outside its locality, the general message for practitioners is relevant, namely the need to take measures to meet the particular needs of people with hearing difficulties from ethnic groups.

There is a need to take into account the relative neglect by researchers of the physical needs of clients with learning disabilities. This reinforces the need for Vulnerable People policies and practices to include GPs registering people with learning disabilities and developing Health Plans for them from the base of the community team.

Evaluating task centred work

Doel (1994, p. 33-4) states that the task centred approach empowers workers as well as people receiving services, by providing a clear framework of accountability for their actions and enabling them to receive systematic feedback.

Developing work with Kristina, intermittently hard of hearing

Research in North America (Luckner, 2001) to specify essential competences necessary to educate a heterogeneous population of deaf and hard of hearing students with additional disabilities, identified 10 competences. Among them were three of particular relevance to practitioners in the UK:

  • developing appropriate behavioural support plans for work with deaf people
  • providing opportunities for learners to explore actively day to day experiences, everyday objects and activities, such as cookery.
  • helping parents and practitioners understand the impact of hearing difficulties together with other disabilities, on learning and experience.

Sexuality of disabled people

It may be necessary for social workers to confront negative stereotypes of sexuality of disabled people. Oliver and Sapey attack the stereotyping of the sexuality of disabled people as abnormal and its expression only with other disabled people (Oliver and Sapey, 1999, p. 99).

Summary

The main features of this case have been:

  • practitioners engaging with family members in self-critical, evidence-based practice,
  • engaging with family members in an empowering person-centred way,
  • working with family members to assess their needs as clients and carers,
  • working with Marta as carer and Marta, Jim and Kristina as clients, to empower them to manage their difficulties
  • reviewing with Marta, Jan and Kristina the work done,
  • evaluating the practice self-critically.


Bibliography

Adams, Robert, Dominelli, Lena and Payne, Malcolm (2002) Critical Practice in Social Work Basingstoke, Palgrave
Banks, Sarah (1995) Ethics and Values in Social Work, Basingstoke, Macmillan
Barnes, Colin (2003) 'What a Difference a Decade Makes: Reflections on Doing 'Emancipatory' Disability Research' Disability and Society Vol. 18 No. 1, pp. 3-17
Bewley, Catherine and Glendinning, Carol 1994 Involving Disabled People in Community Care Planning, York, Joseph Rowntree Foundation
Biestek (1961) The Casework Relationship, London, Allen and Unwin
Dalley, Gillian M. 1996 Ideologies of Caring: Rethinking Community and Collectivism, Basingstoke, Macmillan
Doel, Mark and Marsh, Peter (1992) Task-centred Social Work, Aldershot, Ashgate
Doel, Mark (1994) 'Task Centred Work' in Christopher Hanvey and Terry Philpot (ed) Practising Social Work London Routledge pp. 22-34
DoH (1989) Caring for People Community Care in the Next Decade and Beyond, White Paper, Cmnd 849, London, HMSO
DoH (1999) Caring About Carers: A National Strategy for Carers, London, DoH
DoH (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century: A White Paper Cm 5086, London, Stationery Office
DoH/Home Office (2003) No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse London, DoH
DoH/SSI (1991) Care Management and Assessment: Practitioners' Guide, London, HMSO
Egan, Gerard 2002 The Skilled Helper: A Problem-Management and Opportunity Development Approach to Helping, Pacific Grove, Calif., Brooks Cole
Fawcett, Barbara (2000) Feminist Perspectives on Disability Harlow, Pearson Education
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Haslar, Frances, Campbell, Jane and Zarb, Gerry 1999 Direct Routes to Independence: A Guide to Local Authority Implementation and Management of Direct Payments, London, Policy Studies Institute
Luckner, John L. and Carter, Kathy 'Essential Competencies for Teaching Students with Hearing Loss and Additional Disabilities' American Annals of the Deaf March 2001 Vol. 146, 1, pp. 7-15
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Oliver, M. and Barnes, C. (1998) Disabled People and Social Policy: From Exclusion to Inclusion, Harlow, Addison Wesley Longman
Oliver, M. and Sapey, B. (1999) Social Work with Disabled People, (2nd ed.), Basingstoke, Macmillan
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Payne; Malcolm (1997) Modern Social Work Theory, Second Ed., Basingstoke, Macmillan
Race, David G. (2002) Learning Disability: A Social Approach, London, Routledge
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Rodda, Michael and Eleweke, C. Jonah 'Providing Accessible Services to Minority Ethnic Deaf People: Insights from a Study in Alberta, Canada.' American Annals of the Deaf Dec 2002, Vol. 147, 5 pp. 45-55
Rogers, Carl (1961) On Becoming a Person: a Therapist's View of Psychotherapy, London, Constable
Rogers, Carl 1965 Client-Centred Therapy: Its Current Practice Implications and Theory, London, Constable
Sanderson, H., Kennedy, J. and Richie, P., with Goodwin, J. (1997) People, Plans and Possibilities: Exploring Person Centred Planning, Edinburgh, SHS Ltd
Thompson, Neil (1998) Promoting Equality: Challenging Discrimination and Oppression in the Human Services, Basingstoke, Macmillan
Ward, Linda and Flynn, Margaret (1994) 'What Matters Most: Disability, Research and Empowerment' in Marcia H. Rioux and Michael M. E. S. Bach, (eds) Disability is Not Measles: New Research Paradigms in Disability North York, Ontario, Roeher Institute
Wendell, Susan (1996) The Rejected Body London, Routledge
Wilson, Alistair (2003) 'Real Jobs, 'Learning Difficulties' and Supported Employment' Disability and Society Vol. 18, No. 2 pp. 99-115

Robert Adams
Professor of Social Work
University of Teesside

My thanks to Lindy Conway and Craig Wilson
Staff Development and Training Unit, Northumberland NHS Care Trust, for critically reviewing and commenting in detail on an earlier draft of this case study. I should also like to thank Bob Sapey for his helpful review and comments. Responsibility for any mistakes remains mine.

     
       
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