Stage 4 - Reviewing the plan
- 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'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 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.
- 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
- 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.
- 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
- Does the work done with the family members meet Fair Access to
- 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
- 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?
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
- 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 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
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
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
- 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).
The main features of this case have been:
- practitioners engaging with family members in self-critical,
- engaging with family members in an empowering person-centred
- working with family members to assess their needs as clients
- 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.
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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.