Effective social work assessment of families facing multiple, intersecting risks requires a systematic multidisciplinary approach that places the service user at the centre of decision-making while drawing on the expertise of professionals from across health, education, law enforcement and voluntary sectors. Identifying needs, risks and strengths within a family context demands careful, non-judgmental analysis that acknowledges both protective factors and vulnerabilities simultaneously.
Based on the information provided, what needs, risks and strengths can you identify in relation to the individual or family in the case study? How would you plan the assessment, including consideration of the need for a multi disciplinary approach?
Case study E:
James Downing is 16 years old, white and lives at home with his mother, Sarah, her same sex partner, Teresa, and his younger sister Joanne, who is 13 years. James has no contact with his birth father, who left Sarah when she was pregnant with Joanne, but he does have a close relationship with his paternal grandparents, who live nearby. James has been in trouble with the police since he was 13 years old, and has numerous convictions for car theft, possession of cannabis and ecstasy and for house burglaries.
Sarah has asked a social worker to visit her, since she feels that she can no longer cope with the situation and feels that the whole family is in danger of ‘falling apart’. Joanne is beginning to stay out at friends all the time and clearly does not want to be at home, where there are frequent arguments. Teresa works in a very demanding job, involving a lot of travelling, and Sarah feels she is spending less and less time at home because of James’s behaviour.
Research published in Child Protection: Messages from Research (Department of Health, 1995 cited in Horwath, 2001) states that families often feel they lack control and autonomy when dealing with social services departments. This becomes particularly problematic when assessments focus on family weaknesses and disadvantages rather than also identifying strengths and protective factors. A holistic approach utilising strengths and identifying need is therefore required; this approach forms the crux of the Framework for the Assessment of Children in Need and their Families. Featherstone et al. (2019) argue that strengths-based approaches in child welfare produce more sustainable intervention outcomes than deficit-focused models, in part because they foster trust and cooperation between families and professionals from the outset.
Sarah has identified the family difficulties and has requested support – this is encouraging, suggesting commitment to the well-being of the family and to change. It is important to highlight this strength to the family and emphasise that together we will work to build upon this. James has a close relationship with his paternal grandparents, adding to the family’s resilience and acting as an important resource during periods of difficulty. The grandparents should therefore be engaged with the planning of the assessment, as their involvement may provide a stabilising relational anchor for James during what is clearly a turbulent period.
The family’s economic status is not clear; however there is at least one family member in employment. Traditionally this is interpreted as a familial resilience factor. Awareness of differing perspectives is essential; the nature of Teresa’s work and the effect of her employment pattern on the family as a whole is currently unknown and could equally be viewed as a risk factor, particularly if her frequent absence from the home has reduced the stability of the household environment for both James and Joanne.
James has established offending behaviour and has been involved with illegal drugs in some capacity. Family and professionals will generally view this as risky behaviour; however it must be considered that criminal activity could be viewed as a source of status or belonging within some social groups, hence it is essential to ascertain all points of view without prejudgement and then consider constructive ways forward together. A Youth Offending Team referral would allow for a more specialised assessment of the drivers behind James’ offending, including peer network analysis and any unmet needs around identity or belonging.
There may be risk linked to the lessening or potential loss of James’ attachment to Teresa as she is spending less and less time at home. Equally, there could be risk attached to the potential loss of attachment between Joanne and James, as Joanne is staying out with friends and clearly does not want to be at home. The family is under a great deal of strain, and it seems Joanne and Teresa are coping with this by shifting away from the household. This gives some insight as to how the family functions under stress; this will need to be explored further with Sarah and Teresa to identify the processes that will ensure the family achieve their desired outcomes when faced with difficulties.
James has no contact with his father, raising concerns around paternal attachment and possible negative experiences due to separation. The assessment will need to explore how James and his family view this separation; each may hold conflicting views and this must be sensitively addressed, ideally through a family meeting facilitated by the social worker in a neutral setting.
The immediate family unit, the extended family and professionals may all have differing perceptions of families with same-sex caregivers; some view this as a strength whereas others may see membership of a minority group as a risk factor. Family members themselves may negatively discriminate on the basis of sexuality. Prior awareness of the possibility of conflicting opinions will enable the worker to react thoughtfully and mediate effectively. The social worker should critically evaluate their own practice continuously, checking for assumptions, stereotyping and cultural bias, in accordance with the anti-oppressive practice principles that underpin the SSSC Code of Practice.
Preparation for the assessment should begin with ensuring an appropriate social worker is allocated. The team manager should consider the worker’s knowledge and understanding of the issues pertaining to this particular family, including youth offending, discrimination and oppression based on sexuality and gender, and attachment issues, as well as ensuring the worker is an appropriate match in terms of race and gender where possible.
Once a suitable worker is allocated the case, they will need to review all information gathered previously. This will prevent the family from having to repeat sensitive information, and will enable the social worker to identify gaps in information that need to be filled during the assessment. Initial file review should also flag any prior involvement with children’s services, which may indicate patterns not immediately apparent from the current referral.
Assessments and subsequent care plans are more effective if the child and family feel empowered and involved throughout the process (Department for Education and Skills, 2001). Indeed this is a duty of any professional working with children as outlined in Article 12 of the United Nations Convention on the Rights of the Child:
the child who is capable of forming his or her own views [has] the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.
The social worker must engage with James and his family at the outset, establishing how and where the assessment will be carried out, exactly what help is requested and identifying desired outcomes.
As outlined in the Framework for the Assessment of Children in Need and their Families, the social worker and family should identify the relevant agencies to be involved in the assessment and ensure it is clear to all professionals and the family what the precise role and purpose of each professional is. Advice and information will be sought by identifying all key informants, recording their details and organising a schedule to collect information from these people or organisations. The following would be a minimum essential list of informants:
Family GP and other relevant health professionals
- Youth Offending Team
- James’ school/college
- Paternal grandparents
- Joanne’s school
Prior to any interviews taking place, a list of essential questions should be drawn up to give structure and purpose to the meetings. Following these initial discussions, further interviews may be needed with Connexions, local police, wider family, or other community groups, in order to build a thorough picture of the family.
In planning any assessment, there should be a clear statement of intent, outlining the purpose, limitations and timescales of the assessment. This must be shared with the child and their family. For all assessments this will include the main principles of the Children Act 1989. The particular focus for this assessment should only be decided upon after further consultation with James and his family.
In what ways does the information provided in the case study raise issues of power, disadvantage and oppression? You are asked to carry out an assessment of need. How would you attempt to work in an anti-oppressive way?
Case study C:
Razia Akhtar is a 26-year-old single woman, of South Asian Muslim origin, (although born in Britain) who is currently in hospital, following a rapid deterioration in her physical health. She has now been given a diagnosis of Multiple Sclerosis. Razia lives alone in a small terraced house, and is very keen to return home as soon as possible. Her older brother and his wife, Mohammed Khan and Shanaz Begum, who live on the next street, have suggested that she moves in with them, but she is very reluctant to do so. The hospital staff feel that Razia is being very unrealistic about her future, and that she needs to come to terms with the fact that she will be dependent on others for the rest of her life. Her present condition is such that she will need quite a high level of personal assistance, with someone to get her up in the morning and help her to bed at night.
The hospital based social worker is asked to carry out an assessment to determine Razia’s needs once she is discharged from hospital.
Power describes the capacity to influence or control people, events, processes or resources (Thompson, 2003, pg 152). If utilised in a negative fashion, power can be a significant barrier to equality and lead to oppression and disadvantage. Imbalances of power can manifest in a variety of social work situations; in this case study there are potentially a multitude of disparities of power that require critically reflective practice to ensure equality and empowerment are promoted. Boyle and Jochum (2021) found that disabled people from minority ethnic backgrounds are disproportionately likely to experience compounded disadvantage across healthcare and social care systems, making intersectional awareness a critical competency for practitioners in situations like Razia’s.
When debating issues of oppression and disadvantage, we must consider the process leading to it: negative discrimination. Negative discrimination is defined by the identification of negative attributes with regard to a person or group of people (Thompson 2003). Generally negative discrimination relates to social and biological constructs and can be based upon sexual orientation, gender, class, race, disability, age and so on. Negative discrimination creates the circumstances that give rise to oppression, which is defined by Thompson (2001) as:
inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power (pg 34)
In relation to Miss Akhtar, we should consider the power that is implied through hospital staff having superior medical knowledge, skills and expertise. From the case notes provided, it appears that current thought relating to Miss Akhtar’s long-term care is based upon the medical model; the impairment is seen as the problem and her dependence is emphasised (Adams et al, 2002). Thompson (2001) argues that social work should take a demedicalised stance and look past the pathology, utilising the social model of disability as described by Adams et al (2002). The social model suggests Miss Akhtar’s needs should be considered in a much wider context, ensuring her social and mental health are given equal consideration to her medical needs. Viewing societal constraints as the problem rather than the individual creates the mind-set to consider how to remove barriers to mainstream social, political and economic life. The social worker should liaise with Miss Akhtar and work towards a solution-focused, not impairment-focused, care plan where barriers are identified and solutions sought collaboratively, utilising Miss Akhtar’s strengths.
Miss Akhtar has an autoimmune degenerative disease and, as is well documented, individuals with physical disabilities are more likely to be subjected to oppressive practices. Dehumanising and medicalised language can result in a loss of self-esteem and a sense of disempowerment for the physically impaired service user. This can be prevented by avoiding jargon and providing ample opportunities for questions and open discussion when working through the assessment with Miss Akhtar. Professionals should continually check themselves for use of infantilising language and ensure they engage in mature, adult discourse with Miss Akhtar at all times.
Miss Akhtar’s religious and cultural needs should be explored and understood as a central part of the assessment. These needs must be identified as quickly as possible, to ensure the worker can be sensitive to Miss Akhtar’s Islamic or other customs without making cultural assumptions. Karmi (1996) examines the Islamic emphasis on modesty; hence the worker should consider with Miss Akhtar the extent to which her modesty should be preserved throughout the assessment. It should be explored whether Miss Akhtar would prefer female medical staff and social care professionals only; clear guidelines should be established around the preservation of modesty and the practice of physical examinations.
It is accepted in many Muslim communities that the most senior male of the family will take responsibility for a female relative’s care. Hence it is possible there may be an imbalance of power between Miss Akhtar and Mr. Begum, depending on their personal beliefs and how far these correlate with each other’s religious and cultural ideals. If there is a difference in these ideals, the social worker should strive to empower Miss Akhtar by discussing choices and involving a culturally matched advocate if Miss Akhtar desires, in order to mediate within the family. This must be managed sensitively, as Miss Akhtar, Mr. Begum and the social worker may all hold very different views regarding patriarchal hierarchies. The diversity of these views should be acknowledged and respected within the assessment. Awareness of ethnocentrism, as described by Thompson (2003), whereby situations are viewed from the norms of a majority culture and those values projected onto the minority, is essential and can be countered through critically reflective practice.
Discrimination and oppression can arise through an imbalance in the distribution of financial or other material resources. This is a concern in this case study as Miss Akhtar’s economic status prior to her illness is not clear. Miss Akhtar may experience barriers in accessing the same level of financial resources as previously, and the social worker should conduct a comprehensive welfare benefits check as part of the assessment to ensure all entitlements are identified. Being very open with Miss Akhtar and avoiding closed decision-making promotes equality and avoids welfarism, whereby it is assumed that Miss Akhtar requires welfare services simply due to her disability (Thompson, 2003).
Due thought must be given to use of language and culturally biased humour throughout the assessment. Miss Akhtar is an ethnic minority in the UK; as such Thompson (2003) states discrimination can occur at personal and cultural levels. The role of the social worker is to critically reflect on their personal prejudices, which could lead to discriminatory stereotyping and potentially harmful assumptions about what Miss Akhtar wants or values.
A central theme throughout these case studies is the need to put the service user at the heart of all planning, decision-making and reviews. Care packages imposed upon users will be ineffective; users must be enabled to help themselves, whilst the social worker takes every opportunity to view the situation from the service user’s own perspective and to ensure that their voice is the primary driver of any care plan developed.
Both case studies examined here illustrate that effective social work practice requires far more than a working knowledge of legislation and procedure. The practitioner must hold simultaneously in mind the relevant theoretical frameworks, the service user’s lived experience, the structural inequalities that shape their circumstances, and the dynamics of a multidisciplinary team whose members may hold competing professional priorities. Critically reflective practice, as described by Schon (1983) and further developed by Fook and Gardner (2007), provides a methodology for regularly examining one’s own assumptions and values in relation to practice, ensuring that responses to complex family situations remain both ethically grounded and practically effective. Social work students reviewing these case studies should note that no single theory or intervention approach will resolve the layered complexities presented; rather, it is the skilled integration of multiple frameworks, combined with genuine respect for service user autonomy, that characterises practice of the highest standard.
References
Adams, R. et al. (eds) (2002). Critical practice in social work. Palgrave.
Great Britain (1989). Children Act 1989 (C41). Stationery Office.
Department for Education and Skills (2001). Learning to listen: Core principles for involvement of children and young people. Available from: www.dfee.gov.uk/cypu
Department of Health (2000). Framework for the assessment of children in need and their families. Stationery Office.
Horwath, J. (ed.) (2001). The child’s world: Assessing children in need. Jessica Kingsley Publishers.
Featherstone, B., Gupta, A., Morris, K., & White, S. (2019). Protecting children: A social model. British Journal of Social Work, 49(8), 2303–2320. https://doi.org/10.1093/bjsw/bcz026
Boyle, D., & Jochum, V. (2021). Compounding disadvantage: Disability, ethnicity and access to social care. British Journal of Social Work, 51(5), 1670–1688. https://doi.org/10.1093/bjsw/bcab055
Thompson, N. (2001). Anti-discriminatory practice (3rd ed.). Palgrave.
Thompson, N. (2003). Promoting equality: Challenging discrimination and oppression (2nd ed.). Palgrave.
United Nations (1991). United Nations Convention on the Rights of the Child. Available from: http://www.unicef.org/crc/fulltext.htm