Enhancing Learning and Quality Care

Introduction

The critical incident report is referred to reporting of observations, reactions and impressions of a thought-provoking incident that occurred during team or patient interaction in healthcare or social environment. The report is important to understand the significant learning and growth required in case of tackling similar incidents so that better quality care can be provided. The current critical incident report is to be presented by following Kolb’s reflective cycle which contains four stages that are concrete experience, reflective observation, abstract conceptualisation and active experimentation (McLeod, 2017). The Kolb’s model is to be used because it helps in connecting and appreciating the link between experience, feelings, thoughts and behaviour which leads to the holistic appreciation of the experience (Morris, 2020).

Concrete Experience

Description of Incident

The Data Protection Act 1998 mentions confidentiality and privacy of the individuals are to be maintained (gov.uk, 2019). Thus, pseudonyms are used to indicate the mother and her children. The incident is regarding a divorced mother named A of 35 years old with two children (8 years (S) and 11 years old (E) respectively) who is found to be suffering from bipolar disorder and is involved in drug abuse. A’s mother has died, and her father lives in the city outskirts and calls her daughter once a month. The social care authorities have contacted A to make her receive mental health care and support to overcome drug abuse. However, she has refused acceptance of any form of care from the authorities and trying to live on her own.

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In dealing with the situation, my intention as a member of the Children and families safeguarding team was to arrange healthcare services for the mother to improve her mental and physical well-being and ensure the safeguarding of the children for better health and enhanced future. The legislation applicable to the context is Mental Health Act 1983 and Mental Capacity Act 2005. This is because both the Act assist in acting against the mentally ill individuals to offer them enhanced care for their health improvement (assets.publishing.service.gov.uk, 1983; legislation.gov.uk, 2005). Thus, the Act support acting for the mother to be forcefully involved in accessing mental care by authorities for her benefit and the family. The Children Act 2004, Working Together to Safeguard Children 2018 and Children Safeguarding Policy are the other legislations and policy applicable in the current situation in acting to safeguard the children. This is because the Acts and the policy provide authority to the care providers in taking actions to ensure safeguarding of children and families under all conditions (legislation.gov.uk, 2004; gov.uk, 2018; savethechildren.org, 2018).

Importance of the Incident

The incident was important for me because it was a daring situation in which the mentally ill mother who has bipolar disorder, as well as drug abuse habit, was showing unacceptance of care services important for her better health and safety as well as her well-being of the family. It created challenge for me regarding the way justice for both the family and children to be executed without showing oppression or discriminative attitude towards them due to my person beliefs. As a member of the Children and Families Safeguarding team, the role is to work closely with children and their families in need to protect the child and the family along with ensuring care proceedings in partnership with other professionals (Peckover and Appleton, 2019). Thus, the incident was interesting as it provided me with the opportunity to learn regarding the way my role is to be played in complex and challenging environment.

The incident led me to be reminded of Susie who was an 11-year-old girl showing up with dirty clothes, express bossy behaviour and irregular attendance at the school. It was found that her mother was suffering from bipolar disorder and has been avoiding taking provided medication due to which she was incapable to remain psychological and emotionally stable to effectively take care of Susie. It led Susie to react inappropriately at school and face hindered development as she was required to be in-charge of care for herself and her mother (rcpsych.ac.uk, 2021). During this incident, I felt the lack of acceptance of mental care by A would led her to act in similar way to inappropriately care and support her children development which would make children also act in vulnerable way in the society. Thus, my involvement as a member of the Children and Families Safeguarding team is necessary to work with efficiency in avoiding negative consequences along with ensuring protection for A and her children.

Reflective Observation

Influence of Practice role

The role of the member of Children and Families Safeguarding team is to protect the children from maltreatment to ensure their enhanced well-being and keep the families together when situation is safe (Chisholm and Coulter, 2017). The role has contributed me to act for involving A to accept mental health services in any condition for the safety and well-being of the family and children. As mentioned by Jones (2021), mentally-ill people refusing treatment are to be actively communicated as well as listened to and politely suggested with empathy and compassion to accept care. This is because effective communication and listening lead the care workers understand the reason for refusal of the treatment. Moreover, polite suggestions with showcasing compassion to the mentally ill individuals make them comply to gradually accept the care out of feeling of being understood and supported without judgement for their mental health. Thus, polite communication and active listening along with showcasing of compassion and empathy to accept care is to be done for A to gradually influence her to accept care. As asserted by Haselden et al., (2019), involvement of immediate family members and friends to influence mentally ill people in accepting care is effective. This is because the mentally ill people has increased trust over their family member which make them listen and accept their views. Thus, as a Children and Families carer, A’s parents are to be connected to involve in making A accept the mental healthcare and drug abuse management services needed for her current well-being.

The section 22(3) of Children Act 1989 mentions it is the responsibility of the local authorities to look after a child to safeguard and promote their welfare (legislation.gov.uk, 1989). It has contributed me to act in oppressive way of avoiding A to have the opportunity to take responsibility for the children who is suffering from bipolar disorder and showing hindered drug abuse behaviour leading her to neglect care for the children. The action taken to overcome my oppressive behaviour of avoiding A the responsibility of S and E is that I evaluated and observed the social and personal background of A to determine her efficiency in protecting the children for the time. The decision is developed based on using Social Learning Theory which mentions that social behaviour is developed through observation of the social environment and imitating others’ behaviour (Chen et al., 2017). According to the theory, developing a new behaviour through observation requires grabbing attention and creating motivation in the individual to retain and enact the behaviour (Howe, 2017). During my observation of A’s social background, I identified that though she is suffering from bipolar disorder and has drug abuse behaviour, yet she has maintained social connection with her parents and her neighbours report her of showing good behaviour in the society. It made to be attentive towards recreating behaviour where supportive childcare services are provided to A to make her have assistance in effectively care for S and E while accessing mental healthcare.

As a member of the Children and Families Safeguarding team, to overcome my discriminative behaviour of avoiding the responsibility of the children with the mentally ill mother I framed communication with the children and the mother. This is to assess the mother’s capability in caring for the children and view of the children to receive care from their mother or others (Florange and Herpertz, 2019). The decision was influenced by Piaget’s Cognitive Development theory which mentions that children of 7-11 years can execute effective organised thinking with logic. They can use indicative logic in presence of specific information regarding any situation (Bormanaki and Khoshhal, 2017). Since S and E are both within 7-11 years of age which indicates they have developed effective reasoning power, I asked them to provide their consent regarding remaining with their mother or moving with their grandparents. They reported preference to remain with A which led me to assess A’s additional need to be capable of effectively caring for the children and herself while managing her drug abuse behaviour and mental illness. It also helped me in abiding by article 12 of the United Nations Convention of the Rights of the Child which mentions that the rights of the children to make decision are to be heard (ohchr.org, 2009).

The Mental Health Act 2007 mentions that there are provisions of home-based rehabilitation services for mentally ill people to support the family (legislation.gov.uk, 2007). Thus, home-rehabilitation services for mental health treatment of A is to be provided to her so that she is capable of availing the care while taking care of the family. The Mental Health UK mentions that parents with mental illness are to be provided organised support by the local authorities so that they can effective take care of their children while coping with their mental illness (mentalhealth.org.uk, 2021). Thus, in case of A, additional child support services on her demand are to be provided so that she can provide care and ensure safety of her children while coping with her bipolar disorder and drug abuse behaviour.

Theoretical understanding of the issues

In social work, the Cognitive theory mentions that dysfunctional thought pattern influences negative and problematic behaviour in people (Vourlekis, 2017). The theory led me to understand that dysfunctional thoughts pattern caused due to bipolar disorder in A may lead her to be incapable in effectively caring and ensuring safety for self as well as the children (S and E). It is evident as bipolar disorder causes immense mood disorder in individual due to which they are incapable to effective concentrate in properly executing everyday activities that compromise their safety and well-being (Carvalho et al., 2020). Thus, it is determined that effective therapeutic interventions are required for A in overcoming the dysfunctional thoughts which could help her in showing positive behaviour towards managing her own care and assure better well-being of the children.

In contrast, the Family System theory by Bowen mentions that they believe the emotions, personalities and behaviour of a grown adult can be tracked back from their family interaction. This is because the family acts as an emotional unit and play formative role in the behaviour development of the adult (Bridge, 2019). In this context, the family interaction of A was analysed which informed that she faced physical abuse in her childhood from her mother as punishment for getting disciplined that may contribute to her current development of bipolar disorder. This is because childhood traumatic event acts as risk factor for dipolar disorder development in adults (Dauvermann and Donohoe, 2019). Thus, during the therapy, A is to be assisted in overcoming childhood trauma to gain better mental health as it may be the key risk factor for her current condition.

The task-centred practice model of social work informs that a social worker is required to break down issues into parts of manageable task. This is because it would help in setting deadlines for each task and make constant gains towards improving the lives of the service users (Doel and Marsh, 2017). The use of the model helped me to understand way the care and safeguarding necessities of A along with S and E are to be fragmented into small task so that holistic support to both the mother and children is provided. Therefore, I fragment my tasks into mental healthcare support, drug abuse management service delivery and supportive childcare services arrangement for A. In social work, the crisis-intervention model is used when the individual or service user is expressing a crisis. The model has seven steps which are assessing the safety and lethality, rapport building, identification of problem, addressing feelings, generating alternative, action plan and follow-up process (Al-Ma’seb and Alaslawi, 2021). The assessment of safety and lethality is executed to determine level of risk regarding the issues identified in the service users (Luo, 2021). According to this aspect of the model, safety analysis for A and her children is made which led determining that currently there are no lethal or major safety issues present as the children feel protected under the mother irrespective of A being suffering from mental illness and drug abuse. It is evident as S and E solely mentioned their approval to remain with their mother.

Rapport building involves the development of interaction with service users to make them understand and trust the social workers that they are present to assist them in overcoming issues (Watson and Compton, 2019). However, hindered rapport building leads to create mistrust between service users and social workers which leads the service users to avoid accepting care services from the professionals (Gönültaş et al., 2020). This aspect of the model indicated that through open communication and active listening along with showing compassion enhanced rapport with A is to be developed so that she can trust us as the being non-discriminative social worker intending to provide safe care to her and her children. It would make her comply in accepting the mental health services for herself to overcome her mental issues. The identification of problem is determining the key issues that are required to be resolved in relation to the service users to ensure their enhanced well-being (Al-Ma’seb and Alaslawi, 2021). This part of the model helped me to understand that issues to be faced by A due to her drug abuse and bipolar disorder are lack of energy, depressive mood, low interest in executing everyday activities and hindered safety and care management of children.

The dealing with feelings steps of the model indicates that the clients are to be allowed to vent and express their emotions to heal as well as allowed to mention their story that has led to the crisis situation (Watson and Compton, 2019). The application of this part of the model helped me understand the emotions of A that influenced her not to comply in accepting the social services. Moreover, it helped me understand the reason that led to develop drug abuse. This is evident as she expressed being unable to control her negative emotions and mental health she intended to involve in drug abuse. The alternative generation stage of the model includes development of strategies in overcoming the negative emotions and issues among the service users to improve their health and well-being (Al-Ma’seb and Alaslawi, 2021). This aspect helped me to determine alternative action to be developed so that bipolar disorder and drug abuse behaviour of A can be resolved. Thus, I arranged drug deaddiction services and psychological counselling for A to her cope with her current health condition. The action plan and follow-up action of the model helped me in determining the way actions are to be scheduled and monitored to ensure stable mental health and social progress of the mother (A)

The issue of safeguarding for me as social worker is that I may be verbally abused by A for continuously asking her to access the care for her mental health and drug abuse treatment. This is because she was seen to have previously refused to accept care. In contrast, the risk of careless support is present for the children where they would make them face hindered ability to attend school regularly, remain unhygienic, wear dirty clothes, have lack of food to eat and others out of hindered support from A who is their primary caregiver. This is because mental illness along with drug abuse causes cognitive failure in people which makes them unable to rationalise their action and face hindered in effectively perform everyday activities without hindrance (Maldonado, 2018). The continued drug abuse by the mother also creates risk for her to face fatal consequences. This is because drug overdose leads to hinder functioning of the body parts that results in death of the individuals (Kariisa et al., 2019).

Gaps in the Practice

One of the gaps identified in care is that no physical and mental assessment of S and E was executed to determine if the mental illness of their mother created any negative physical or psychological impact on them. This is because children with mentally ill parents are seen to show increased risk of developing emotional, social and behavioural problems due to the inconsistent and unpredictable family environment caused by the illness (Wiegand-Grefe et al., 2019). In future, the gap is to be resolved by ensuring compulsory implementation of holistic health assessment of the children at early stage who have and are living with mentally ill parents. The other gap identified that holistic scenario of the parenting problems to be faced by A due to her mental illness and drug abuse was not effectively explored. This is important as mental illness like bipolar disorder leads the parents show the challenge of irregular sleep, lack of attention, irritability and others which makes them act as less available parent for the children (Lauritzen et al., 2018). Thus, in future, the gap is to be resolved by creating holistic analysis of parenting issues to be faced by parents due to their mental illness. The other gap identified is lack of specific indication of the strategies to be implemented for A to ensure her safety while being cared for her mental health and drug abusive nature. The failure to maintain safeguarding of vulnerable mentally ill patients makes them prone to cause self-harm or abuse along with move away from the care facility to cause harm to others. This is because without protective services and actions, the mentally ill individual has the ability to exploit resources available to them to cause harm to self and others as they do not have ability to make rational decisions (Morgan and Ho, 2017). In future, the gap is to be resolved by making risk evaluation of the service users and developing safeguarding strategies to be implemented in protecting the individual from causing self-harm as well as harm to other once in care. The thing which went well is that effective compassionate and empathetic behaviour led me as the children and family carer to be successful in making A accept the care. Moreover, effective family involvement was achieved in case of A which is inclusion of her father to influence her in accepting the care for her mental health and drug abuse that she previously rejected.

The thing that went well is that I was able to use relatable legislations and policies to take action in making the mother (A) continue the care services. It is evident as section 5(4) of Mental Health Act 1983 indicates nurses can detain a patient for 6 hours until the physician is-charge of the treatment of the patient have reviewed the patient and decided to provide them leave (assets.publishing.service.gov.uk, 1983). The use of the Act helped me in making A remain for holistic health assessment and care planning in the hospital which she tried to avoid by trying to leave the care as early as possible to go home. The Children Act 2004 informs that local authorities are to work in safeguarding as well as promoting the well-being of children (legislation.gov.uk, 2004). The Act was used to engage the local authorities in support A and caring for the children S and E so that their well-being and safety is ensured.

The other thing which went well is that appropriate social theory are used in limiting oppressive and discriminative practices while caring for the mother and children. This is because presence of oppressive and discriminative care causes violation of the Equality Act 2010 as well as violates the ethical principles of beneficence and non-maleficence in social work. It is evident as oppressive care leads to forceful support while neglecting the rights of the service users that cause harm to their dignity and value making them show hindered compliance in care (Marsiglia et al., 2021). However, the other thing which did go well is that effective action is taken to ensure A is capable of taking care of the children who are willing to remain with her. Moreover, parenting capability of A is also assessed and required support of childcare services are provided which is a positive aspect of the care. This is because it ensured irrespective of accessing care for mental illness and drug abuse behaviour of A, she would provide enhanced care to the children and would not compromise on their well-being and safety.

Abstract Conceptualisation

Learning from the Incidence

The current scenario led me to learn that critical thinking is essential part of social working. This is because critical thinking helps the social worker to objectively examine the different factors influencing the course of action and way actions are to be maintained in non-biased manner to retain professional standards (Fenton and Smith, 2019). I also learned that effective communication and active listening is important for social working. This is because without open communication the social workers are unable to understand the needs of the service users and informatively communicate the importance of care practices as necessity for them to be accepted. Moreover, communication and active listening help social workers makes the service users feel valued out of understating and focussing on their opinion and decision-making (Chichirez and Purcărea, 2018). The incident led me to learn that in social working effective knowledge of the legislation and policies along with professional standards in care are to be present among the workers. This is because it helps them to maintain professionalism and ensure quality care delivery to the service users that results in creating best outcome for users (Taylor, 2017).

The other thing in social work identified to be essential is organising appropriate care support for holistic safety and well-being of the children and families. This is because wide number of needs of families and children are identified during social working which are required to be effectively prioritised and analysed to effectively organise various strategies in a limited time (Šćepović, 2021). The incident also led me to learn regarding social work that adequate patience and empathy is to be shown to the service users to make them accept care. This is because empathy leads individuals to develop perception that their problems are being understood by the social worker who would involve in effectively supporting them (van Rhyn et al., 2021). In addition, patience in social worker helps the workers to critically analyse complex cases to determine the action to be taken for long-term benefit of the service users and way to avoid violation of professional standards at work out of anger (Ferguson, 2018). However, keeping patience was most challenging in social work as often inappropriate and abusive actions and comments from the service users are unable to be accepted to remain calm. Moreover, due to restriction posed by legislations, many obligations are to be maintained which are unable to be managed with patience at times due to continuous non-compliance from the service users (Meadows and Moran, 2021).

Active Experimentation

Way to improve learning

The key learning points from the incident is that empathy, communication, patience, critical thinking, knowledge of legislation, anti-discriminative care and other skills are to be present in social workers in executing effective social work. I also learned that I have effective knowledge regarding the way family involvement is to be made in making mentally ill individuals accept care. I also expressed effective ability to make risk assessment and enhanced safeguarding of service users. In order to develop my practice in the long-term and in the next placement phase, I intend to abide by SWE professional standards which mention promoting strength, rights and well-being of people and families (socialworkengland.org.uk, 2018). This is because it would help me in showing value to the service users which would assist me in delivering satisfactory care to them. Moreover, I intend to establish as well as maintain trust along with confidence of the people as mentioned in SWE professional standards to deliver care in the next phase (socialworkengland.org.uk, 2018). This is because it would help me avoiding conflict of interest along with create easy acceptance of my care by the service users due to my honesty and integrity.

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According to BASW professional standards, the social workers are to work with enhanced professionalism and maintain diversity as well as equality in delivering care (BASW, 2018). The actions are already maintained in this incident and will be carried forward to be executed in next phase as it ensures me to avoid poor care delivery and violation of equality rights of the people. The BASW professional standards mention that relevant knowledge and practices experience for working are to be applied by social workers in executing better quality delivery of services (BASW, 2018). Thus, in future placement, I intend to implement the experience gathered from this incident to avoid making similar mistake and enhancing the quality of care for the service users. In future placement, I intend to make continuing professional development and delivery care by abiding with ethical obligations (BASW, 2018). This is to be executed by accessing better social work training and interacting with experienced social workers to learn additional skills for better progress.

Conclusion

The above discussion informs that the mother named A with children if two named S and E has refused to access care for mental health and drug abuse. The incident led me to indicate that I have the power to make use of legislation and policies and execute professional role to assist in safeguarding the children as well as their mother. Moreover, it leads to determine that family intervention and empathetic communication are effective in making mentally ill people refusing care to accept the support needed for them. I used Family System theory, Social Learning Theory, Cognitive theory, Piaget’s Cognitive development theory, Crisis Intervention model and others in making best practice in social care of the family and children. The key challenge faced in the incident is keeping patience as due to certain behaviour of the patient and increased pressure of work it was hard to remain calm.

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