Comprehensive Needs Assessment

Answer

• • 1. Comprehensive Needs Assignment

       Simply put, a need is a gap between what already exists in the present state and what should exist. In any particular system, a need is focused on a target group in order to determine their needs. For any particular problem, a needs assessment – the process of gathering information – is eminent in addressing such needs and gaps. My literature search, for instance, drives my needs assessment towards an effective education program that will address a gap for my chosen target audience. Through this assessment, I seek to achieve the best practice for nurses by seeking and improving evidence based practice among the nurses within my hospital. For that reason, the nurses need to improve their practice in regards to care will be addressed, making them competent and able to take care of patients based on proven methods.

                   Nursing care practice is very dynamic and requires consistent and continuous update to its practice (Douglas et al., 2013). For this reason, it is eminent to ensure that the technology as well as the practice at hand is based on current evidence and is not outdated. For this reason, the gap that exists between the nurses for who this assessment is done is the guidelines for evidence-based practice that is up to date. Therefore, the nurses need to achieve evidence-based practice from their current practice, which could be outdated. For the nurses, I feel it is eminent – as a specific need – for them to espouse scientific evidence in their assessing practice and ensuring that every practice is approved before implementation to the patient. Therefore, since several evidence-based information already exists, the nurses need to apply these scientific skills into their daily practice.

        

       References

       Douglas, M. K., Pierce, J. U., Rosenkoetter, M., Pacquiao, D., Callister, L. C., Hattar-Pollara, M., ... & Purnell, L. (2013). Standards of practice for culturally competent nursing care: 2011 update. SALUTE E SOCIETÀ.

        

       33.QUESTION

        Study questions    

       Module 1: Study Questions GSC 506

        

       1. According to McCormick, what large global forces have been at work reducing the significance of national boundaries?

        

        

       1. What are the three broad categories McCormick uses to categorize domestic influences on foreign policy?

        

        

       1. According to McCormick, why have the bureaucratic battles within the US government increased over the last two decades?

        

        

       1. McCormick suggests that focusing on the individual decision maker and their policy positions points the student to not only how individuals can imprint policy with their views, but also on what?

        

       1. Mack wants to explain the outcome of conflicts between parties of vastly differing military strength - asymmetric conflicts. What aspect of asymmetry is he most concerned with?

        

        

       1. Why does Mack argue that the metropolitan power is unlikely to be able to mobilize the totality of its resources to fight an asymmetric war?

        

       1. Mack accepts that the weaker power cannot defeat the more powerful actor militarily. How, then, does the weaker power win?

        

        

       1. Putnam seeks to advance theory regarding the entanglement of domestic and international interactions. He suggests the metaphor of a two-level game can help clarify. What are the game and who are the players in each game?

        

       1. In Putnam’s two-level game metaphor, what is a win-set and how is it determined?

        

        

       1. In a two-level game, what role does the relationship between the win-sets of the two Level I actors play in determining the outcome of the Level I negotiation?

        

       1. How does Putnam’s two-level game metaphor challenge the idea of rationality in foreign policy decision making?

        

        

       1. According to Mead, how has the United States' reliance on foreign investment changed over time?

        

       1. How does Mead argue American leaders' focus on foreign policy changed over time?

        

       ANSWER

       Study Questions:

       1. According to McCormick, changes in technology, culture, economics, education, and the environment have led to a reduction in the significance of national boundaries.
       2. McCormick argues that the rational actor model, the organizational process model, and bureaucratic politics models are domestic influences to foreign policy.
       3. Due to the failures of the state governments, bureaucracies have increased with the bureaucrats demanding more from the government.
       4. Individuals can as well imprint their policy positions on their values and beliefs.
       5. Mack is concerned with aspects of political asymmetry, economic asymmetry, and social asymmetry.
       6. Metropolitan states do not have internal sovereignty in foreign relations, therefore will not engage in the asymmetrical wars, but will direct its resources towards the economic and social aspect of its citizens. 
       7. Through strategy, the weaker nations will use the strategy effectively to offset deficiencies in the quantity and quality of their forces and equipment.
       8. The two-level game involves forces shaping outcomes simultaneously in international negotiations. These two players are international level and national level.
       9. A "win-set" is the universe of possible outcomes that will be acceptable to both sides in a given negotiation and cause an agreement to "win".
       10. Larger win-sets make Level 1 agreements more likely to win the negotiation.
       11. Close links between domestic negotiations and international negotiations amongst states become pronounced between economic and trade-related issues, members of international organizations, or environmental policies fostering growth and further talks.
       12. Increased foreign investment by the US has led to an increase in the demand for currency while raising its exchange rate. Ultimately, due to the US currency's growth, the terms of trade have also improved.
       13.   Mead believes that American leaders' focus on foreign policies should include bipartisanship as a way of finding common ground and fostering implementation policies.

       34.QUESTION

       Taking a case or a piece of practical work from your placement or experience, analyse critically the use of legislation, guidance and policy in practice.    

       ANSWER

       Part 1: Case Summary

       Introduction

       Statement of Confidentiality

       The identity of service users will remain anonymous within this assignment to remain within the terms of confidentiality agreements. The service user names have therefore been changed and agency details been rendered unidentifiable.

       Author and Agency Details   

       The author is a second-year social work student with a statutory learning disability team. This agency is a team of multidisciplinary nature, and the work of helping the children with learning disabilities involves working together with psychiatrists, psychologists, occupational therapists and learning disability community nurses. The author’s role is to work with an identified case, identifying the unique attributes and getting at the perceived causes of her anxieties so as to suggest remedies, including if possible, counselling services both to her and her family.

       Service User Details      

       Ellen Udo is a 23 year old young lady. She is a British born Nigerian who has a mild learning disability. Udo lives with her mother, step-father, and a younger brother.

       Udo has recently managed to finish college where she completed a course in catering. In addition, she acquired some Basic English and Math skills. In this regard, Udo is a literate young lady. She likes going out to meet new friends, an activity that has reduced in frequency following her completion of college and having less time and less money. Udo would love to work in the catering industry; however, she cannot find work now. Since she does not get along well with her step-father, she wants to move out from her home and become more independent.

       Sources of Information

       The foundation for this report is based on:

       • Conversations with the user at home and at the agency
       • Information from the children’s social worker
       • A careful study of agency-held user records
       • Information from the multidisciplinary team members who are aware of her case

       Background History and Presenting Issue

       The issues of anxiety and low academic achievement have been part and parcel of Udo’s life for a long time now, which has severely affected her self-confidence and social progress. Her low academic achievement has been a consequence of her mild learning disability. Udo’s problems of anxiety and depression began shortly after she finished college. Udo says that it is the right time for her to move out and be independent. She cites her step-father’s persistent rants as the chief reason.

       Despite her well-known interests in the catering industry and the qualification that she already possesses, the step-father does not show a keen interest in helping her secure a job. Instead, she has disclosed that Amos shouts at her a lot and calls her lazy because she is at home most of the time. Consequently, Udo has in the last couple of weeks gone to see her GP due to the feelings of depression, anxiety and restlessness, which she believes are directly tied to her home life as well as to the fact that she neither is at college nor work presently. Due to her litany of challenges, and the fact that the problems she goes through have recently exacerbated, I am going to visit Udo at the recommendation of the agency to talk both to her and her mum.

        

        

       Summary of Risks

       • Udo has consistently attributed her low achievement to her home challenges, and not her mild learning disability
       • The relationship with her step-father has affected Udo’s participation in the past
       • The agency records that Udo displays negative and challenging behaviour following her learning disability and anxiety, a fact that makes it harder for her to form and maintain relationships. The instances she has displayed it while at the agency suggest limited self-control.
       • Udo seems unaware of how her mild learning disability affects her academic achievement in school.
       • With strained step-father relations, Udo has a smaller support system chiefly made up of her mother.

       Identified strengths

       • Udo is proud of her catering background and is confident that she will do well in her job once she gets one
       • Udo is less anxious especially after her GP appointment
       • Her mother is supportive and understanding and has committed to ensuring the agency helps her daughter
       • Despite her mild learning disability, Udo has demonstrated that she can grasp basic competencies and apply them usefully.

        

       Current intervention and Future Planning

       In line with empowering her, the agency suggests helping her get into her catering dream job. In addition, the agency has to ensure that Udo is safe and protected. The agency will work with the mother to detect abuse cases (if any) and make recommendations as appropriate.

       Udo will remain on the agency programme until the agency, together with Udo’s GP, determine to what extent her mild learning disability affects her ability to control her feelings, emotions and grasp of new concepts.

       Udo is to be referred for counselling services to help her reduce the anxieties that afflict her.

       Besides, Udo will remain on an adult in need plan because of what she undergoes in the hands of the step-father.

       With understanding that social work entails empowering the users by the agencies that take up their cases, the ultimate goal for Udo would be to create capacity for her ultimate getting into a job and seamlessly transitioning into a life of her own.

       Name:

       Date:

       Signature:

       Part 2:

       Introduction

       This paper looks at social work in the context of the roles that ought to be performed, and the responsibilities that social workers have in view of the case study detailed above. Social workers do not operate in a vacuum; they base their practice on the rules, regulations, laws and policies that specify what is acceptable and what is not within their field (Braye and  Preston-Shoot Wigley 2015). It is the law that specifies the full scope of practice, helping to determine what is legal or illegal, as well as guaranteeing that the only acceptable standards are those that adhere to the ethical codes of regulation. These ethical standards are set out by the British Association of Social workers (BASW 2014). Using the case summary presented, this paper assesses the key safeguarding issues, quality control, multi-agency analysis and the ethical dilemmas that confront workers in the interplay between social justice, care and upholding the law. The essay does this in light of legislations such as the Mental Capacity Act (MCA) 2005 and the Care Act (CA) 2014.

       In order to see how vital legislations are in the realm of social work, the case Re D (A Child) (No 2)) [2015] EWFC 2, which was dubbed “unconscionable” funding challenges for parents with learning difficulties, is analysed. The matter was whether child C should live with the parents, or in case the parents could not care for him, live with family members as adopted outside the family. Legal Aid Agency resolved the issues of funding, but only ten months later. Baker J in Re DE (A child) [2014] EWFC 6 paragraph 49 introduced safeguards to help parents who were facing the removal of children under their care in a care order. While making recommendations, social workers have to remember that such protections and rights exist, and despite its limitations, practice is strictly guided by law. This example, though for child care, demonstrates the overall relationship between law and the agency roles.

       There is a clear demonstration of the relationship between the law and the agency discussed within the case study. The decisions that social workers make at individual levels are what form the backbone of accountability and general good practice. The decisions, interventions and support that Udo receives is generally based upon the MCA 2005, HA 2009, and CA 2014.

       Relevant Legislation, Policy and Context

                   Social workers have a crucial part to play in improving mental health services for citizens. They bring a unique social and rights-based perspective to their mandate. Their advanced relationship-based skills can support people to make positive, self-directed change. These workers are trained to work in partnership with people using services, their families and carers, to optimise involvement and collaborative agenda. Social workers also manage some of the most challenging and complex risks for individuals and society, and take decisions with and on behalf of people within complicated legal frameworks, citing and protecting the rights of different parties. Udo has to be helped in her quest for independence so that it is not seen that through her, there is a breach of Article 5 of the HRA 1998 which if the “Right to Liberty and Security.”

       As an adult suffering from a mild learning disability, there are certain relevant legislation, policies and the context within which the social workers have to operate.  The MCA 2005 offers a statutory framework for those who do not have the necessary capacity to make decisions for themselves or who have the capacity but still want to make preparations for when they lack the capacity. The very first section, for example, highlights the fact that individuals are assumed to have the capacity until it can be proven otherwise, and even then ought not to be treated as lacking that capacity just because they choose to make unwise decisions. Udo is understood to be in favour of getting a job and furthering her career. She wants to move out and claim her independence. She must not be denied this independence simply because of her mild learning disability. In addition, one of the identified risks was her propensity towards the occasional temper tantrum; this should not take away her capability to decide for herself. What Udo decides to do or not is purely a matter of her own volition, tastes and interests. She is not bound to follow what her step-father or mother dictate, as she is an adult now.

       The CA 2014, on the other hand, demands that every decision made concerning the planning of care has to take into account every contributing circumstance. Section 9 of the CA 2014 states LA’s have a duty to carry out a needs assessment to establish an individual’s eligibility for services. Udo is evidently affected by the mild learning disability as much as she is by the step-father’s lack of understanding. Even though it is clear that she has a learning disability, it is only mild. In fact, she has finished college and has some competencies in English and Maths. This puts her on a different level since she can think and do things for herself. The care then has to take into consideration the other factors that make it difficult for Udo achieve the care goals that the social workers set for her. Understanding how all these factors contribute to the designed care makes it easier to respond to the emerging needs in an adequate manner. For instance, section 1 of the CA 2014, underscores a requirement to promote an individual’s wellbeing when making decisions about their care.

        

       Key Safeguarding Issues

       The area of adult safeguarding in social work has been identified as a vital part overall. It has to be acknowledged that the changes that have come with the adult safeguarding remit and even the social workers themselves demand a faster reaction by the law. This has seldom occurred. In fact, there is no legislation that can be used as reference in this regard.

       Adult social care law is complex in its implementation, and the Law Commission (2011) admits this fact. The social workers then have to navigate the legal and occupational hurdles by citing numerous legislation and laws like the MCA 2005, the Safeguarding Vulnerable Groups Act 2006 and the CA 2014. Even when the latter has assumed greater role in adult social care agencies, the rest are not null. They have to be understood just as well. The basic understanding of the CA 2014 is that it advocates for investigations whenever there are reasons to believe that an adult is getting abused or neglected.

       According to the Human Rights, Equality Act and anti-discrimination law, all forms of discrimination and abuse are not allowed. Discrimination is when one gets treated differently and unfairly so because of whom they naturally are. The legislation above gives adult social care agencies the role of shielding adults like Udo from possible abuse and discrimination. The law exists to ensure that all are treated equally and that provided one has the capacity to make decisions for themselves, they are allowed to do so.

       Key to understanding the concept of safeguarding adult issues in social work is the Safeguarding Vulnerable Groups Act of 2006 which, indeed, paved the way for the CA 2014. This Act gives the mandate to adult social care agencies protect adults who can be collectively classified as being vulnerable. In addition, the Act specifies the conditions necessary for an act to be classified as being abusive. A number of times, Udo has claimed that she was assaulted by her step-father, and this is seen in the way he is overtly hostile towards her. The Social worker would need to talk to Udo and establish the truth about this form of abuse, making it possible for them to be charged with either abuse or neglect. The Care Act 2014 (Section 42) makes it an obligation for local authorities to inquire, or cause others to inquire in case they suspect an adult is getting abused or is neglected. This section details whether any action is to be taken to mitigate the situation and if so, by whom. The agency tasked with this role would be the “Safeguarding adults” team. In case it is established that either abuse or neglect has been occurring, then a decision is made on whether the adult at risk needs a protection plan.

        Central in Safeguarding issues is whether or not Udo needs a the help of a carer. The needs that she has have to be addressed by a carer who has to ensure that she settles in and finds out that she I no longer abused before further decision can be made. Her decision-making, problem solving and the capability to utilize her autonomy efficiently have to be assessed. It has been established in the pat that Udo can perform some tasks on her own. One of the social services provided to her would then be risk reduction so she can finally be independent

       It is also important to determine whether Udo needs accommodation or not. According to the Care Act 2014, there is a National Minimum Eligibility Criteria (NMEC) where care and support needs are “eligible” if they have a significant impact on the adult’s well-being. The assessment entails considering both mental and social factors surrounding the adult in need. Udo whose social situation within their home does not support a safe place for her growth and development certainly meets the conditions for accommodation. Her care and support needs render her eligible. Based on her needs and interests though, Udo qualifies for independent living. There are basic and even high order things she can do on her own as she has managed since she was young. I would recommend accommodation as we assess her strengths and all that she would need to live independently

       One of the weaknesses presented by Udo is that she displays negative and challenging behaviour, and the instances she has displayed it while at the agency suggest poor self-control. It can be seen how Udo craves for a degree of control over her life. Following the six principles of the Care Act 2014 of empowerment, protection, prevention, proportionality, partnership and accountability, it would mean that the adult in need is assisted to increase autonomy and improve commitment. In this case, Udo would be helped to get into her career choice so that she can stand on her own. Being able to control one’s emotions and feeling is one of the hallmarks that the person has a degree of control over his/her life, and that they can be entrusted to make decisions. It can be seen how much Udo craves for a degree of control over her life and affairs. This would be constructed to mean that her temper is something borne either out of her interaction with her family or frustration at the effects of her learning disability.

       Quality Control

       The desire to keep the best standards of care is the ultimate goal of most Social workers. It is a desire that is controlled by the expectations in society and the proliferation of the media in many aspects of social welfare. Keeping the best standards is not only a matter of giving the social worker some credit at the end of the day but it is also about casting a positive portrayal of the role of social work in the society. One of the SWE standards calls upon social workers to act safely, respectfully and with professional integrity.   

        This quality is consistently checked by the Care Quality Commission (CQC). This body appraises and makes recommendations on a regular basis to the social workers and the fundamentals of their practice.

       Safe and ethical practice can be maintained through professional registration. This registration is required to be done with the SWE. In its first domain, the Professional Capabilities Framework (BASW, 2018) outlines the need for the social worker to remain accountable to the professional regulator and to show commitment by taking self-responsibility for their practice and conduct. This is an essential element of self-evaluation for the social worker that at all times, they remain true to the principles that guide ethical and acceptable practice.

       Furthermore, integrity, accountability and the virtues of ethical practice are always maintained by the CQC. Some scholars have identified supervision as an essential element of quality control. Others, however, feel that supervision alone is not enough. There has to be constant efforts to teach the social workers on the importance of keeping high quality standards within their professions. This is based on the premise that all that supervision does is not instilling fear and dread, rather than the innate willingness to adopt safe and acceptable standards of social practice (Braye, Marrable, Preston-Shoot, 2011).

       Multi-Agency Analysis

       From the ongoing discussion, the need to maintain a multi-disciplinary approach to social work is made clear. The social worker intends to collaborate with a team of psychiatrists, psychologists, occupational therapists and learning disability community nurses. In addition, the social worker would have to evaluate the role that Udo’s GP has on the general outcome of the care provided by the social worker.

        MCA 2005 explained the role that people who make decisions on behalf of other people who cannot make the decisions themselves play. It provides guidance to the people who ultimately make these decisions. According to the Mental Capacity Act 2005 (MCA), certain people like a mental capacity advocate have to think about this code whenever they make decisions on other people’s behalf. The Act also stressed the need to have a multi-disciplinary view – a situation in which there is a well-established channel and system of communication between the police, social workers, probation, and other agencies that serve a vital role in social work. However, even while the multi-disciplinary course of action can be said to be very important, it brings the challenge of the legality of sharing data between the various agencies. The Care Act 1990 intended to eliminate the barriers that prevented multi-agency working between NHS and social care services. Some of this data is confidential. The sharing of information between agencies has to be above board, and any information shared has to be carrying the potentiality of achieving positive outcomes (Frost, Robinson and Anning 2005). The disadvantage of having this multi-agency outlook is the financial constraints that may follow in the wake of decisions.

       The case study presented here is a case where the user demands an understanding of the case from a learning disability point of view, where challenges are viewed in light of her mild learning disability condition. The need for family intervention is exacerbated by the treatment she receives from her step-father. In addition, inputs from her GP are needed so that the cause of her anxiety and depression can be explained and remedied. A more complete and exhaustive plan can be developed when information is shared with the right people.

       Professional/ Ethical Dilemmas

       It is difficult to attain absolute objectivity in social work because the very nature of the job itself demands that social workers are responsible to their employers. Striking a balance between the need to remain objective and outside influence can create dilemmas.

       The case summary illustrates Udo’s rights, including the rights to make unwise decisions if she has the capacity to do so, and the burden of how to measure rights and risks. The dangers posed by Udo’s step-father are real, and this is evidenced by the threats he constantly gives Udo. It has to be effectively established that the benefits of sharing information in this case outweigh the potential risks and dangers that Udo puts herself in

       Conclusion

       The field of social work has a number of legislations, policies and guidelines that inform the theory and practice of social work. These laws provide blueprints for social workers as they go about their service, and offer protection to users in terms of safety and confidentiality. For quality assurance, supervision and educating social workers is key. Regulatory bodies promote accountability by promoting ethical practices. In addition, multi-agency analysis showed that collaboration leads to positive outcomes. However, this presents a problem, especially in the sharing of information.