Reflective Case Analysis on Adult with Learning Disability
Reflective Case Analysis
My placement was in the statutory sector, the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS) Team for a Local Authority. Referrals to the MCA/DoLS team came from hospitals, care homes, supported living settings and occasionally other independent organisations. The role of the team is to assess the mental capacity of the individual and whether they can make an informed decision as to the most appropriate care for themselves. When the individual lacks capacity to make decisions regarding their care a best interest decision would be made on their behalf. The Mental Capacity Act (2005) and the code of practice provided the statutory guideline on how specific decisions would be made. I worked with service users who had learning disabilities and the elderly. More specifically, my role involved completing the following; a social care and wellbeing assessment, which evaluated their needs under the Care Act 2014, a mental capacity assessment, creating personalised support plans for these individuals, liaising with professionals and other agencies and working with the service users families.
In this essay I will reflect on my experiences gained during my placement with reference to a specific case study. I am aware that an must constantly ask the question why to help develop their practice (Thompson, 2009). This required me to explore the models of reflection that have informed my practice as a student social worker to answer the why question.
I found Schons theory of reflection (Schon, 2002) the most useful model to reflect on my practice (PCF8). Schon enforced 2 types of reflective practice. Firstly, reflection-on-action, which relates to experience gained or action already undertaken. It requires an individual to reflect on what could have been done differently, also looking at the strengths from that session (Schon, 2002). Secondly, Schon refers to reflection-in-action, i.e., reflecting on your actions as you are doing them, being mindful of issues such as best practice throughout the process. For this essay, my focus was mostly reflection-on-action. However, this type of reflection should also be used to inform future practice and should a similar situation arise in the future.
The service user
F1 is a 25-year old female with a learning disability and acquired brain injury sustained during an attempt to alleviate severe epilepsy when she was younger. At the age of 16, F1 lived in a specialist residential provision for people with a learning disability and autism. At 21 years of age, she moved to a different placement but was later evicted after she assaulted staff. F1 then lived at home with her mother and two younger siblings. Currently, she stays in a supported living residence. F1 likes to keep busy and enjoys going to Bingo.
F1 was placed on Section Two of the Mental Health Act (2007) meaning that she needed an assessment for a mental health disorder. F1 was admitted to a mental health service due to paranoid ideation, mood instability and increased aggressive and destructive behaviour. F1 was discharged by tribunal. When in crisis, F1 can be verbally abusive, violent towards members of staff and make racist comments.
F1 also behaves in ways which suggest that she is vulnerable so that others might take advantage of her. For example, she has occasionally stood in the middle of the road outside her mothers house, laid down and taken off her clothes. When upset or angry, F1 prefers people to leave her alone to calm down which reduces the risk of harm towards others. F1 also threatens to harm herself by standing or laying down naked in the road though always moves away from approaching cars.
My involvement with F1
I became involved with F1 as it was recognised that she needed additional support to reduce these potentially harmful behaviours. F1 behaviours were identified to be due to boredom, lack of stimulation and therefore it was felt increasing in her care package/ daytime activities would help. F1s previous social worker allocated the task of helping her to find meaningful activities to fill in her time to me.
According to Parker and Bradley (2010), an assessment is a process in which social workers work in partnership with service users to recognise areas of development and change. In carrying out my initial assessment with F1, I considered the Milner & OByrne (2009) model of how to approach an assessment. The model identifies five stages of an assessment, namely; preparing for the task; gathering data, applying professional knowledge; making judgements and deciding what is to be done. I had no prior experience of assessing a student and felt anxious about this process. I prepared myself for the task by reading material that relates to social work assessments and working with people who have a learning disability (PCF1).
I am aware of the capabilities statement for working with adults who have learning disabilities states how to assess the needs of such adults(PCF5). Social workers must enable and promote the same access to adults with lived experiences learning disabilities as for any other citizens, embedding their values and ethics into rights-based practice that makes a difference to peoples lives (BASW, 2019) (PCF2).
I was reminded by Trevithick (2012) who points out the importance of preparations before an assessment. l, therefore, gathered information from F1s case notes and sought clarification from colleagues who had worked with F1 previously(PCF1). I was mindful not be judgemental(PCF1) about F1 and her behaviour, for example, racist remarks to her support workers when shes angry or when they do not agree with something she wants to do. She made comments a black woman could find offence. While I avoided labelling, I was conscious that she needed to be taught and realise that her comments could be inappropriate. This knowledge improved my cultural awareness and what could be perceived as offensive to people of different races and culture(PCF2).
Knowledge of the Care Act (2014) guided my assessment, as this states that the local authority has a duty to promote an individual wellbeing and assess their needs. With support from F1s previous social worker, I was able to promote equality of opportunity for F1. This empowered me to advocate with, and on behalf of F1, to receive the extra hours she required from the support workers to help her with her day to day routine such as cleaning and cooking(PCF3). I was reminded of Trevithick (2007) who highlights that advocacy attempts to make the voices and interests of the service-users heard. Thus by advocating on her behalf F1s voice was heard and listened to ensure her needs were met.
The Mental Capacity Act (2005) also guided my assessment and intervention with F1. Williams and Evans (2013) state that professionals often wrongly assume that people with learning disabilities lack capacity to make decisions due to their cognitive impairment (PCF4). This guided me to ensure that I did not make assumptions about F1s needs, wishes and feelings.
A mental capacity assessment (MCA) was completed prior to my work with F1 which determined that F1 has the capacity to make decisions about her care and finances. Using the five principles of the MCA, I am aware that just because F1 makes unwise decisions does not mean she lacks capacity (PCF4). Principle 3 of the MCA states a person who makes a decision that others think is unwise should not automatically be labelled as lacking the capacity to make a decision (SCIE, 2009).
F1 would make unwise decisions with respect to her finances. For instance, during one visit with F1, she told me that she is struggling financially and as a result, she planned to pawn some of her belonging to help pay for other activities she wanted to undertake.
The Human Rights Act (1998) emphasises the importance of upholding peoples rights, especially when they have the capacity to make financial decisions (PCF4). It was also important that I did not impose upon her my views, i.e., that I felt she is being irresponsible with her money; my role was to support her and advise her and not try an influence her in how she chose to spend her money. I found this very challenging as naturally, I am a person who always wants to help someone by listening and giving advice and I was hoping she would listen to my suggestions. Jenkinson and Chamberlain (2019) state even though people make unwise decisions, the role of a social worker is to support them to acknowledge that their decision is unwise and look for alternatives.
I learned to accept and acknowledge her unwise decision though however, I supported her to make informed decisions while ensuring that she was protected and remained safe. I was reminded of my social work values which were not to be judgmental and to accept that not all the advice or support that I might offer, will be acceptable to a service user (PCF2). It is working in an anti-oppressive practice and respect her decisions as ultimately it is about her wishes and feelings. The capabilities statement for working with adults with learning disabilities encourages social workers to respect and follow individuals expressed wishes, feelings and choices also previously expressed wishes where they do not have capacity to make a decision (BASW 2019) (PCF3).
I endeavoured to meet F1s needs by working in partnership with other professionals (PCF8). The Human Rights Act (1998) and The Equality Act (2010) reminded me that all work should be done in an anti-oppressive and anti-discrimination manner (Brammer, 2007). Due to different agencies sharing information, I felt that F1 would benefit enormously if she was able to have a routine and a clear view of whats going on with her life. For instance, as a result of sharing the information I was able to help F1 not to miss her appointments and I would do this by reminding her the day before a scheduled appointment with another agency.