Department of social work

Master of Social Work- Year 2
Ethics Assignment
Matriculation Number: 0235286
Exam Number: 3528633
Submission Date: 12th of December
No of Words: 2713
All names have been made anonymous to protect the identity of individuals.


Scenario
David aged 11 was in residential care along with his 7 siblings. He had a
severe history of abuse (sexual, physical and emotional) from a female
relative. His stay in this residential setting was one of assessment no
work at this stage was being carried out to address these issues.This
child was restrained whilst shouting at his brother.This had been an
extremely distressing day as three of his younger siblings had been placed
with foster carers and these two boys were unsure where they would be
going. They had quite a volatile relationship and it had been agreed by all
staff that there would be a cool-off time enforced, to calm the children.

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On this occasion an argument occurred between my colleague and the young
person, who we will call David. Unfortunately my colleague did not wait
until she has changeover to be informed of the day’s events and immersed
herself in this situation.


In residential care theC.A.L.M(Crisis;AggressionLimitation
Management.) technique is used to support agencies in the management of
aggressive and challenging behaviour. This is a very successful and highly
regarded model of treatment and is accredited and registered.1On this
occasion my colleague did not have this level of training and used holding
techniques, which were unsuitable for residential work. The restraint did
not follow the C.A.L.M. physical restraint model. It also lasted for over
an hour, which resulted in injury to staff.There was also no trained
member of staff on shift and no one that was willing to assist in physical
holding.


At the beginning of this project, it was made clear who had the adequate
training for restraints and those that did not. We were strongly advised
not to intervene unless there was no alternative and/or immediate harm
would have been caused to a young person or those around them. David became
very emotional and his anxiety level increased as he thrashed around and
screamed for the member of staff to get off him.He was heard shouting;
“this is what bad people did to me” Even at this stage the restraint did
not stop and was clearly upsetting him. I believe the upset was directly
related to the holding measures as they were not appropriate or safe holds.


Ethical Issues ; problems
The ethical issues around in this scenario include the individual rights of
David who should have been given the same rights as he would have at home,
also the responsibility that my colleague had to adhere to agency policy
and procedures. Ethical Issues around inequality i.e. the power balance
between service provider and service user were huge and particularly
threatening for David as most of the staff were woman with whom he had a
tenuous relationship.


In this case; mainly agency personnel staffed the unit. This in itself can
have its own drawbacks. Having researched the recruitment practices for
this particular agency for the purpose of this essay, and indeed having
been recruited by them myself; the level of qualifications and skills
required is high. However, on entering a residential unit it is rare that
a member of staff will ask you if you are C.A.L.M trained. Ethically, some
people due, to their own value base, will not restrain, as they believe it
to be damaging to a child.A recurring problem for the social work
department will be the staff shortages within the department requiring bank
and agency staff to fill the gaps Even when staff have been trained, the
training course for C.A.L.M is not considered an essential skill to have
for the job within residential work with young people.


Children Scotland Act 1995
The Children (Scotland) Act 1995, incorporates provisions from the UN
convention on the Right’s of the child and also takes accountof
obligations under the European Convention on human Right’s. The Children
Scotland Act states that each child has the right to:
. be treated as an individual.

. Form and express views on matters affecting him or her; and
. be protected from all forms of abuse, neglect or exploitation.


Parents and local authorities have rights and responsibilities in achieving
the balance of care. When considering David, we must look at the scenario
in terms of the big picture and look not only at the code of ethics that
applies to social service employees but also the statutory duties and
obligations that we must work within also. The United Nation Rights of the
child states that all children have the rights to all principles laid down
in the convention without discrimination (article 2) When adults or
organisations make decisions for the child they must act in a child’s best
interests (article 3) and that Children have a right to express views on
anything that affects them (article 12)
In David’s case I do not believe my colleague acted in his best interests
nor was his view that he should not have been held valued when he asked to
make a complaint. However, my colleague did consistently work in an anti-
discriminatory manor and largely her practice I believe was for the
children’s best interest.


Care commission
The main principles of the care commission for children and young people in
residential care are dignity, privacy, choice, safety, realising potential
and equality and diversity. The standards are categorised into 19 headings
from entering care to moving on from care (see appendix 1). These standards
are written for young people who receive a service described in Section
2(3) of the Regulation of Care (Scotland) Act 2001, the service ‘provides
accommodation, together with nursing, personal care or personal support,
for persons by reason of their vulnerability or need’.


The national care standards Scottish Ministers set up the National Care
Standards Committee (NCSC) to develop national standards. The NCSC carried
out this work with the help of a number of working groups. These groups
included people who use services, and their families and carers, along with
staff, professional associations, regulators from health and social care,
local authorities, health boards and independent providers. The standards
have been developed from the point of view of children or young people who
use the services. They describe what each individual child or young person
can expect from the service provider. They focus on the quality of life
that the child or young person using the service actually experience, for
example: the right to privacy in a residential unit.


Standard 6 is the obligation for a young person to feel safe and secure.

The care commission states, “You feel safe and secure in all aspects of
your stay in the care home. At any time, there is enough staff available to
help you when needed.”
David did not feel safe after this incident, he became very withdrawn and
obviously having expressed his upset at the time and nothing was being done
did not feel secure and was left in my opinion to be very vulnerable.


Gravity of Deficiencies
The Scottish Social Services Code of Ethics
Codes of ethics have an important role to play in that theyare
specifically laid out for the use of everyone involved in the social work
process. Clark (2000) states that a code of ethics is a service, which is
there to keep all concerned, satisfied that the social work role is being
properly undertaken
The Scottish social services council provides a code of practice for social
service workers. The 6 over reaching principles of this are:
. Promote the rights & promote the interest of service users and carers.

. Strive to establish & maintain the trust & confidence of service users
& carers
. Promote the independence of service users while protecting them as far
as possible from danger and harm.

. Respect the rights of service users while seeking to ensure that their
behaviour does not harm themselves or other people.

. Uphold public trust and confidence in social services.

. Be accountable for maintaining and improving their knowledge and
skills
The analysis of the first principle highlights that social service workers
must respect and maintain the dignity and privacy of service users (1.4); I
do not feel that this young person was handled with any dignity. He became
even more distraught at being held and did not calm down, His privacy was
not respected either as he was being held in a communal area in front of
his siblings
Secondly, as a social service worker we must strive to establish and
maintain trust and confidence of service users and cares. This experience
must have felt very oppressive, David was unable to freely express his
frustrations and the over reaction of a colleague would havefelt
intimidating. Maintaining trust takes time and a level of consistency in
terms of treatment and fairness, as a staff steam we had built a degree of
trust with David, which was damaged after this incident (2.1) My colleague
was not communicating in an open manor she immediately communicated on the
attack and did not attempt any de-escalation according to the calm model
(2.2).There is also the requirement to be honest, not only with the
service user but also with ourselves. For example, did my colleague ask
herself if the intervention was really necessary?
Promoting the independence of services users while protecting them as far
as possible from danger or harm, draws attention to the ethical problem
arose because the staff could not do nothing. The two boys could have
attempted a physical attack on one another if left alone so an intervention
was necessary. However, two members of staff would have been involved to
move the boys away from each other to allow them to calm down.3.3
specifically highlights the need to follow practice procedures to keep you
and other people safe from violent and abusive behaviour at work; this is
where C.A.L.M trained staff can use physical restraint appropriately,
unlike in this case. The “holding ” techniques were unsafe; my colleague
injured her back whilst doing this. Also there was no follow up for the
young person to make a complaint (3.7). Although he asked to there was
nothing seriously done about it.In terms of promotion of a client’s
rights and empowerment of the service user this should have been easily
accessible for the young person (3.8).


The forth principle states that we “Respect the rights of service users
while seeking to ensure that their behaviour does not harm themselves or
others.” In this instance it was necessary to intervene with these two
boys and also to separate them. I do not believe physical intervention was
necessary. Here, there was no time to assess risk in terms of both boys
and the other siblings (4.2). My concern was also for the safety of the
other young people; the restraint took place on a corridor accessing the
bedrooms where the young people should have been settling to bed. This was
too difficult to manage with a restraint going on right outside their
bedroom. I also felt that the bedroom within a residential setting should
be an area of privacy and safety and this incident was disturbing that area
(4.3) however, on a positive note a pink incident form was completed which
was required by Edinburgh city council (4.4).


To uphold public trust and confidence there are 8 areas in which implicitly
states what you must do, whilst public trust was not broken in this
situation. I feel that confidence in social services was, 5.7 states that
we must not put ourselves or other people at risk, which was the outcome
here. As previously mentioned there was not another staff member who was
prepared to assist in the hold, as they felt unqualified.


To maintain and improve knowledge, skills and training was not an option in
this project. Because we were agency staff and the funding would not be
made available by either the agency or the council. As a staff team it had
been identified that half of the staff team were C.A.L.M trained and of the
remainder a quarter would be willing to assist in holding if they were
provided with the proper guidance and the remainder would not get involved
at all.


Prevention of recurring situation
I think one of the main practices is to encourage “time out”; this should
not lead to excessive isolation or as a punishment but time for the young
person to reflect. It should be used as a safe space for the young person
away from the situation in which he/she is having difficulty coping.The
‘time out’ ends when the person is better able to cope or the situation has
changed.


There are of course times when it is necessary to use a restraint, when a
threat to safety is imminent, C.A.L.M also states that there should be at
least two people in agreement to a restraint.As identified in the
training manual, a process of de-escalation should be used first.


I also feel a greater communication amongst staff members would help.

Although I have read the Y.P.C’s philosophy for this particular unit, it is
not clearly available for staff to read. I feel that each Y.P.C’s should
state clearly which staff are trained and who is available to undertake
this sort of intervention; and also state clearly their stance on sanctions
and time out. There should also be a period of time afterwards when staff
can reflect on these matters within supervision orindeedamongst
discussion with their colleagues.


To avoid future similar situations, the young person should have his rights
clearly explained to him when entering residential care; this would include
his rights and responsibilities whilst in care and also how to contact the
children’s rights officer who can act as an advocate on his behalf and
would work independently. If things go wrong, you can refer to standards
when you raise concerns or make a complaint. (See ‘Expressing your views’,
standards 18 and 19.) It would also be appropriate for management to
anticipate staff shortages and to attempt to keep continuity going by
employing the same agency staff when looking to cover gaps etc making sure
that there is a broad skill base on each shift.


In a meeting with my manager after this event he did ask me where I felt
this incident should go, I argued that the young person should be given
information on contacting the Children’s Right’s Officer and I also
expressed my discomfort at having to work on shifts with this member of
staff. If the “whistle blowing ” campaign made it more accessible to
report bad practice, I feel I would definitely have taken it further.I
was offered no support from my manager to do this and was very much told
that I would be on my own which is a very daunting situation to be in.


Conclusion
A code of ethics as a ‘moral resource’ in the context of social work
therefore, ought to be used as a guidance to refer to in practice, which
should influence decisions in interaction and intervention in a positive
way by taking the socially constructed values of that society into account.

The purpose of a code of ethics and the practical implementation of such a
code has been greatly contested in relevant literature. In contrast to the
opinion of Hugman and Smith (1995) that “ethically informed practice is
essential if the rights and welfare of service users/clients are to be
protected.” (P12), Banks (2001) identifies five popular criticisms of a
code of ethics today:
1) The code implies that people are given ethics, instead of bringing
their own values to their work;
2) Codes cannot “cultivate attitudes” (p107);
3) Codes tend to apply to one profession, unlike much of social work
which is multidisciplinary;
4) That the code focus on work with the individual and don’t acknowledge
the wider picture
5) That code assumes values, which may not be those, expected by society.


My own opinion lies somewhere in the middle, we need someone to take a
moral and professional guiding line, otherwise what do we adhere to.In
writing this essay, I need something, which marks out the ground rules that
every social service worker should aspire to.This does not discount
personal values but makes clear professional ones. We will never meet the
values of a whole society but we work to what we believe, naively, or not
is in the best interest of a society as a whole. To some defining social
work as a profession and introducing a code of ethics is distasteful,
however, in today’s society we need to be highly trained and regarded as
the complexities of the job become ever increasing.


NATIONAL CARE STANDARDS
Care homes for children and young people
The standards are grouped under headings that follow the child or young
Person’s journey through the service. These are as follows.


Beginning your stay (standards 1 to 7)
1 Arriving for the first time
2 First meetings
3 Keeping in touch with people who are important to you
4 Support arrangements
5 Your environment
6 Feeling safe and secure
7 Management and staffing arrangements
Leading your life (standards 8 to 16)
8 Exercising rights and responsibilities
9 Making choices
10 Eating well
11 Keeping well – lifestyle
12 Keeping well – medication
13 Learning
14 Private life.

15 Daily life.

16 Supporting communications
Moving on (standard 17)
17 Moving on
Expressing your views (standards 18 and 19)
18 Concerns, comments and complaints
19 Advocacy.

BIBLIOGRAPHY
Banks, S. (2001.) Ethics and values in Social work. Basingstoke: Palgrave.


Plumtree, A. (1997.) Child Care Law: Scotland, A summary:(BAAF)
Clark, C.L. (2000) Social Work Ethics: Politics, principles and Practice.

Basingstoke: Palgrave.


Hugman, R ; Smith, D. (Eds) (1995) Ethical Issues in Social Work. London:
Routledge.


Scottish Social Services Council: Code of Practice for social service
workers.

———————–
1 The British institute of learning Disability (BILD), physical
intervention accreditation scheme, developed on behalf of the U.K
Departments of Health, Education & Skills.

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