In this reflective log, I will focus on the social work
PCF domain 3: Rights, Justice, Economic Well-being
PCF domain 5: Critical Reflection and Analysis
Task: First Response Team
As part of duty work, I visited the Home First Team at X.
X provides support for individuals with long-term and complex conditions to remain at home rather than going into hospital or residential care. Many people prefer to be supported in their own homes, close to friends or family carers, where it is easier to get back into familiar routines and an independent lifestyle once their medical crisis has eased.
X brings together health and social care services to deliver:
- improved access to rapid support with care from the right professional / agency care
- better communication between people using services and health and social care professionals working as part of the same team
- reduced accident and emergency attendance and unplanned hospital admission or residential care
- rapid discharge from acute hospital
The service works with a thorough multi-disciplinary team, ensuring a holistic approach is met for clients. The team comprises social workers, nurses, matrons, pharmacist, GP’s, mental health nurses, occupational therapists and physiotherapists.
The service in north Hertfordshire started at the end of July 2014 and builds on a successful pilot scheme which was run in the Lower Lea Valley area since November 2012 with excellent feedback from staff, GPs and people using the service. Home First’s operation has also coincided with significant savings locally on emergency hospital services against the forecast spending levels.
Reflection/critical analysis in case of X
I arrived at the appointed time at X office, where a social worker welcomed me. I showed respect by greeting them politely and waited for the social worker to show me my desk for the day. I was introduced to the team, and I made the purpose of my visit known.
I noticed that the team comprised professionals, such nurses, pharmacists and occupational therapists, I felt that this depicted a multi-disciplinary team that worked together to ensure optimum functioning of the team and efficient service-user outcomes. I also felt that working in this way would help address service user needs as much as possible. Besides, it could result in improved outcomes and enhanced service satisfaction for the service user.
A few hours into my visit, the hospital called in to advise that a 91-year-old lady was due for discharge after being treated for an accidental fall. The social worker approved the discharge and subsequently requested all the paperwork. However, when the care agency was contacted to request for carers to attend to X at her home, the social worker was informed that the agency was short of staff and could not send anyone over to attend to X.
I was alarmed by the fact that the social worker did not first check the availability of carers with the agency before approving the discharge of X. However, I felt that this may have been because the agency is usually able to provide carers each time they are requested.
I spoke to the team leader about the incident, and she confirmed that the agency has an excellent history of providing carers when needed. However, the social worker should have first checked on the availability of carers before approving the discharge.
A social worker and a nurse were dispatched to access X’s needs at home a few hours later. The nurse assessed X’s physical well-being, and she was in good shape. X was identified as needing 2 hours care a week. The need to have a befriender from Age UK to visit her once a week and take her out shopping was also identified as she felt gloomy.
I felt the whole process happened fast. Although we were unable to provide agency staff to care for X, I was pleased to see that the integrated nature of the team meant that a nurse was able to step in to provide the required care.
Back in the office, I observed that the social worker checked the availability of carers before approving a discharge. I also learned from the incident, as it taught me the importance of being proactive and curious, in order to safeguard people’s well-being.
Looking back on the incident, I can see that I should have questioned the social workers’ actions to approve the discharge before calling the care agency. I feel that my inaction could have put X’s well-being at risk, as she would have gone home with no care arrangements in place. However, this risk was minimised due to the integrated nature of the team.
After discussion with the team leader, I recognise that I need to develop the confidence to challenge the practice of colleagues, putting the well-being of the service users at the forefront of my practice. I realise that I need to be supportive to colleagues, understanding the pressures that they may be under, but ensuring that their practice does not put service -users at risk.
In the future, I will aim to develop my proactive and curiosity skills when working with colleagues, to ensure that the well-being of the service user is maintained. In my next placement, I will make this a goal for my learning, and will discuss this with my practice educator to work out strategies for how I can achieve this.
Theories and methods of intervention
Many social work theories can be applied to procedures within the X Team.
According to Roberts (2005), a time of crisis may give an opportunity to maximise the ability to intervene rapidly, suggest goals, build upon strengths and suggest alternative coping methods (Teater, 2010).
Crisis intervention was applied in X’s case.
The social worker and nurse visited her and suggested goals, build upon strengths and recommended coping strategies such as the need to use a volunteer from Age UK to help her recover from her depression.
Strengths-based social work practice is to mobilise the service user’s strengths and resources. When working with X, there was an emphasis on resilience, wellness, and empowerment.
One major problem that was identified was the fact that X was demotivated and needed a befriender. An agreement was made and an action plan developed.
The resilience theory was applied throughout the interaction because X’s strengths were nurtured by providing her with opportunities to take part and develop her social relationship. They encouraged her to interact with volunteers at Age UK and to engage more in community activities.
Section 9 of the Care Act 2014 places a duty on local authorities to carry out assessments on adults who may appear to have needs for support regardless of the carer’s financial resources. Assessing X will determine the care and support required for her to live her life the way she wants in the community.
Abraham Maslow’s hierarchy of needs theory was also applicable. X’s basic psychological and self-fulfillment needs were considered when recommending action plans. Interventions that could motivate her to live life willfully at the same time meeting her needs, aspirations and circumstances were considered.
The interaction was also person-centred, as X was allowed to direct her own support and was given the choice as well as encouraged to express her views. She was given the choice in the kind of care she preferred by creating a person-centred care and support plan in accordance with the values of social work.
Also, applicable in the case of X is the National Service Framework (NSF) for older people, article 14 of the Human Rights Act and the Equality Act 2010.
Adams (2009) suggests that the elderly should be empowered to make informed decisions. X was included in the decision-making process as her views and opinion on intervention strategies, therefore empowering her.
Applying the Virtue Ethics Principles, social workers have a moral obligation to value and respect the elderly. X was accorded with respect.
Her aspirations, needs, abilities and priorities were understood in order to provide her with the best support and care.
Social work values were also upheld during the intervention, as the professionals practiced in an anti-discriminatory and anti – oppressive manner.