Reflection on Systems Theory Intervention

Reflection on Systems Theory Intervention The aim of this assignment is to analyse my intervention with a service user and her family whilst on my 80-day placement. Whilst on placement I critically explored the social work value base, having demonstrated how I worked within the framework of the social work process. I used a variety of intervention methods, however, I am going to examine the effectiveness of one method in detail, systems theory. Before commencing this assignment I spoke to the service user, her family and placement agency, asking permission to write about my intervention with them and everyone agreed to this. I assured them of confidentiality, names have been anonymised, and no reports or confidential documents have been included. I understand the concept of respecting individuals, and will not disclosure any material that will result in a breach of a person’s integrity. Biesteck 1961, (cited in Dominelli, 2002) says confidentiality is a characteristic of the social work profession together with respect and self-determination. The agency was part of the voluntary sector, located in an area of regeneration, with high levels of deprivation, poverty, and homelessness, being established because there was a recognition that the area was particularly needy due to high levels of unemployment, crime, lone parents, pensioners, poor housing, and people experiencing health and social problems. The agency contributes to alleviating some of the pressures of everyday living helping a diverse group, and targeting those who are most vulnerable, offering a varied support system. To improve the well being of those suffering poverty, deprivation, discrimination and other forms of oppression services including generic/family support, housing support, young carers, farming and rural health, 50 forward, HIV/Aids, and Active 8 are offered. By providing free support and advice to the community the agency enables individuals to empower themselves to access a range of services putting them in touch with health, community care services, voluntary agencies and support groups. Underpinning the work of the agency is the legislation of the Every Child Matters/Youth Matters Framework and, working within this agenda, the agency hopes to improve the lives of children and young people. Listening and working in partnership with families, and young people, to provide support, enables development of opportunities and appropriate action plans to improve outcomes. Using case work and one-to-one individuals are empowered to develop strategies and plans to deal with issues such as parenting, schooling, behaviour, debt, housing, mental health, relationship breakdown, benefit support and domestic violence. The agency has a good working relationship with the Children’s Directorate and other organisations and continues to update it policies and procedures according to new government frameworks and agendas. The agency works in partnership with children’s centres, schools, social services, health teams, educational welfare teams, housing associations and variou s others, providing ongoing support and intervention. At the agency I worked within the Children and Families Team, my role being a Family Support Worker. Practicing my role, I collaborated with social services, school, and other support networks giving a holistic service to my clients, which was important to achieve positive outcomes (Trevithick, 2000). My intervention was with a 12-year-old girl, who I will refer to as Amy, who had been referred by social services; her behaviour was causing concern due to relocation with her father and stepfamily. Amy had previously lived with her mother, with whom she had a good relationship, however, she involved Amy in age inappropriate conversations, had depression, alcohol issues, and allowed Amy to witness scenes of domestic violence. Amy’s mother was unable to care for her, and she was fostered until a few months ago. For several months Amy had been living with her father and stepfamily, and was finding it difficult to adapt to her new living arrangements. Social services had previously been involved, albeit in another region, hence the local authority felt further support and guidance was necessary to alleviate some of the family’s problems. I have drawn a genogram to establish Amy’s direct family and stepfamily, a genogram enables â€Å" †¦ immediate visual representation of the individual or family being assessed.† (Parker and Bradley, 2006, pg.40). I did not attempt to include any extended family, the family being rather complex, as my main concern was to support Amy and her family to resolve their issues. (Please see appendix.) I supported Amy and her family to adapt to their new living situation, my work including one-to-one support, family support, advocacy and mediation, counselling skills, negotiation, adapting strategies and interventions to enable the family to adjust, supporting their emotional well-being and allowing them to move forward. My objectives were to resolve the conflict, address inappropriate behaviour, and support Amy with relationship issues with her father, boundary setting, and build her self-esteem. However, after my initial assessment, it became clear that all the family needed support; therefore, my interventions would have to involve the family as a whole. My work involved implementing positive strategies to support relationship building, empowering the family to change and become accustomed to the new family unit. I worked within the guidelines of Every Child Matters, green paper published 2003, underpinned by The Children Act, 2004 (Parker and Bradley, 2006) in order to recognise areas of need, and work with the family to try and achieve positive outcomes. Using the ASPIRE model, an essential tool which links assessment, planning, intervention, review and evaluation (Parker and Bradley, 2006), enabled me to highlight my client’s needs and work effectively with them to improve their life opportunities. The social work process begins with referral, from which I acquired as much knowledge as possible in order to assess Amy’s family background, and the environment I was entering. It is important to identify any potential danger or risk before making home visits, for yourself and colleagues, (Trevithick, 2000) so in order to avoid mistakes I adhered to the lone worker policy of the agency, checking this with my work based supervisor. For all visits I detailed the address, time schedule, base contact, making sure to have my mobile on me at all times, and was responsible for entering details onto the agency case management database. By undertaking this responsibility I achieved Key Role 4 of the National Occupational Standards (NOS) â€Å"Manage risk to individuals, families, carers, groups, communities, self and colleagues† (cited in Higham, 2006). Assessment is a continual process, and changes with circumstances, so is central to making a difference. It concerns making judgements whilst remaining non-judgemental (Middleton, 1997). I found myself reflecting on this when undertaking the assessment. According to Milner and O’Byrne (2002) â€Å" If assessment is effective then it makes it more likely that intervention will succeed† (cited in Parker and Bradley, 2006 pg.8) My first visit to the family was with a social worker from the initial assessment team, enabling her to inform me of the family background. The social worker wanted to introduce me to the family and explain my involvement, and her subsequent withdrawal. As this intervention was early on in my placement I felt reassured having the social worker present, and it made the first contact less ‘nerve racking’. I asked key questions, gathered factual evidence in preparation for my intervention, meeting Key Role 1 of the NOS, enabling me to build a picture, examine all factors, focus and prioritise. Consequently, by looking at the wider picture and other social environmental elements I was able to work together with the family, and apply appropriate strategies to resolve their issues. First contact is very important, and I used my interpersonal skills to establish good engagement, â€Å" †¦ communication is a central feature of interaction.† (Thompson 1996, pg.8). During assessment, and throughout my interventions, I demonstrated the core conditions of empathy, congruence and unconditional positive regard (Rogers, 1951) effectively by listening, showing respect, being open and honest as to how much we could achieve, whilst demonstrating anti-oppressive and anti-discriminatory practice. This is the initial stage of systems theory, building a trusting, safe, understanding relationship, where we were able to identify goals, plan, make recommendations and negotiate to achieve the desired outcomes. I felt it was important to establish a relationship built on mutual trust and respect so I conducted my assessment, and subsequent visits, in the family home so that they all felt comfortable (Koprowska, 2005). I asked questions, actively listening and observing interaction at the same time, as according to Coulshed and Orme (1998, pg.48) â€Å"Systems theory requires interviewing, assessment skills and counselling skills.† Assessing the family dynamics, I made the decision to first and foremost support Amy and focus on her well-being, as I feel children are owed a greater duty of care. I wanted to make her feel secure and rebuild her confidence to enable her to flourish, and also because she was the presenting problem for the family. It was apparent that social, personal and economic factors were impacting on the family and they needed to overcome these obstacles in order to achieve positive outcomes. Using systems theory made it difficult to identify where to intervene. The complexity of their lives made it difficult to address single issues as they were interrelated, but if they could manage some issues maybe it will enhance their lives to some extent. Amy in particular was suffering intellectually, emotionally, and socially due to her feeling isolated, having relocated. At the same time Amy was also trying to cope with her past traumas, including the impact of witnessing domestic violence. Using myself as supplementary support I hoped to assist Amy to achieve permanent, stable, emotional and social relationships, allowing her to manage the transition from one family unit to another. Accepting there were multiple needs, I assessed that work with the family, as a whole, was also needed, in particular Amy’s father. He was in denial concerning Amy, and regarding the conflict and tension the situation was creating. Hence he was unable to find a solution to his own problems. I empathised with their situation, as their own strategies were proving ineffective. We discussed how to achieve an improvement building on their strengths, adapting and incorporating them to make a realistic goal plan. Looking at their positives and strengths promoted not only anti-oppressive practice but increased the family’s motivation allowing them more potential, â€Å"†¦builds on people’s strengths rather than analysing their defects, providing help rather than treatment.† (Doel in Hanvey Philpot 1994, pg.23) After completing my assessment of the family we worked together to construct a plan of action, which according to Coulshed and Orme, (1998) are essential practice skills when using systems theory, allowing me to achieve Key Role 2 of the NOS. My work with Amy and her family included identifying problems, acknowledging that change was needed, listening to what the family wanted, implementing survival strategies enabling them to cope, whilst being non-judgemental and non-directive. We clarified and prioritised what issues needed addressing, empowering the family. This enabled me to ascertain what help they thought they needed, not necessarily what I thought. I felt this was important, as I wanted to work with the family, not for them, to achieve positive outcomes. Dominelli (2002) reinforces this, â€Å"change is easier if the directions that professionals and users wish to follow coincide.† (Pg. 25) The second stage of systems theory, is where I worked with the family to address their needs, engaging them to work with me and achieve their potential. Using my communication skills I gained their trust, which allowed me to get the family to co-operate and participate in determining the direction of change. My role as a professional was not to take sides, but to treat all members with respect, promote negotiation, and offer assistance with goals. These had to be realistic and achievable so together we came up with the following plan: Introducing strategies to help address Amy’s behaviour Advocating, acting as a confidant for Amy, enabling her to feel less isolated and able to speak freely about her mother Relationship building with Amy’s father using attachment theory Family support working together to remove barriers – implementing positive parenting, and building relationships Work with step-mother to address feelings of inadequacy, and low moods (she was mildly depressed about the family situation) Weekly visits to discuss how the changes were working, and if not adjust accordingly, offering emotional support. The aim was to improve Amy’s behaviour and integrate the family, building relationships, so that they could live peacefully together â€Å"†¦ block ‘dysfunctional’ interaction patterns, and coach the family in new behaviours.† (Davies 2002 pg.149) My interventions consisted of a number of methods, the family structure being complex. It was important to understand their needs, as not all families comply with the nuclear family structure, and have differing needs. My original referral was to work with Amy but this was deflected and became the whole family, therefore, I had to adapt using such methods as systems theory, person-centred, attachment and some task centred. I chose these methods to identify the needs of the whole family, as I felt certain methods would work well with the different individuals. The methods of intervention I used were to some extent influenced by agency policy, although the approaches used were unrestricted. I would have liked to have spent longer with this family but the agency remit is for effective short-term work, supporting families with early intervention. Prevention and well-being are important agency agendas so as to avoid dependency. The agency has funding to perform certain types of work; therefore, a cost centred approach is used, closely monitoring business and action plans to establish outcomes. The agency uses the person centred approach to empower individuals, working within Every Child Matters, Youth Matters and Local Area Authority agendas, making the services accessible to all so it has to limit expenditure and distribute evenly across all projects. Within the family support project the agency preferred to use positive parenting strategies to empower families. I tried this method with Amy and her family but felt it was ineffective and to some extent patronising; hence I adopted my own interventions. The interventions I used were not questioned, as positive results could be demonstrated, although regular case reviews were carried out to monitor progression, discuss ways forward, and the effectiveness of methods used. If no progress was visible it would be suggested that the case be closed or referred to another agency. I used systems theory, which evolved from biology and engineering and was developed by Pincus and Minahan, 1973, being further developed by Goldstein, 1974, (Coulshed Orme 1998), in my intervention as it is interactive and focuses on the consequences of one person’s actions on another. The background to this method is scientific and complex, suggests all organisms are made up of subsystems, which in turn are affected by environmental factors, super-systems. Each system will have its own subsystem, with different objectives, enabling functioning. Although I used this method, to work positively with the family and its subsystems, it is debateable in relation to its significance to social work (Healy, 2005) as it uses complex language, relies heavily on science and maths, and does not fit in with human activity according to Germain, (1979) (cited in Payne, 2005). All systems have inputs, throughputs, outputs and feedback loops (Payne, 2005), which can be applied to social systems, with all elements interconnected and mutually dependent. The action of one part not only affects others but may rely on them for it’s continued existence and undoubtedly the survival of the complete system, although according to Siporin, (1980) in practice this does not seem to happen, and it should not be assumed all parts are interrelated to maintain equilibrium. Families connect as a unit; go through life cycles, and what each member does effects the rest of the family, â€Å"†¦ circular causation†¦Ã¢â‚¬  (Davies 2002 pg. 148). Problems arise because of inadequacies in the functioning of the system, or family. Consequently I had to assess contributing factors, such as the home, friends, family, school and neighbourhood as to why the ‘malfunction’ had occurred, as exchanges between these systems will effect change in the family. Using this method I identified the family as a system with subsystems to see how it was impacting on Amy. All systems have boundaries and in the family’s case I needed to assess if these were permeable or rigid. Boundaries are complicated, and by encouraging social workers to look at other issues which may be irrelevant, personal issues can get neglected (Siporin, 1980 cited in Payne, 2005). Systems theory was valuable, as it dealt with everyone rather than each individual, and improved functioning as a whole. Hanson, 1995, argues â€Å"†¦ the value of systems theory is that it deals with ‘wholes’ rather than with parts of human or social behaviour †¦Ã¢â‚¬  (cited in Payne, 2005). I felt this method would benefit the whole family as effective communication had broken down, and it involves all members, the family hierarchy, rules, boundaries, and promotes change and stability During this period of adjustment to the new family unit Amy’s family had their own individual challenges and struggles. When change occurs families often struggle, finding it difficult to interact. Systems theory concentrates on interactions and relationships (Koprowska), therefore, offering this method enabled me to assist the family, supporting them while they restructured. â€Å"Social worker’s are the maintenance mechanics oiling the interpersonal wheels of the community.† (cited in Howe, 1996 pg.54) Pincus and Minahan (Payne, 2005 pg.145) identified 3 helping systems: informal or natural systems i.e. family formal systems i.e. community group societal systems i.e. schools and 4 systems within social work; the change agent system, the client system, the target system and the action system. Using this method I identified myself as the change agent system, Amy, her father, and stepmother as client/target systems, with the whole family, myself and school as the action system. Working alongside other members of the action system provided support, allowing me to use them as a resource to achieve the aims of the intervention. Amy’s behaviour was the family’s main priority as this was having an adverse effect, resulting in ‘dysfunction’ of the system. Her behaviour was a way of gaining attention and linked to the separation from her mother. Amy felt rejected, not part of the family, resulting in her feeling isolated and alone. I felt Amy needed nurturing, a self-esteem boost and attachment to her father. We needed to work together to address Amy’s behaviour, before it became ‘unmanageable’, and allow her to change being conscious of the â€Å"feedback loop† that works within the family, or system, allowing â€Å" capacity for change† (Coulshed and Orme 1998, pg.47). Amy expressed a desire to be heard, feeling no one cared and everyone was against her, especially her father. I suggested weekly family meetings to allow the family to adapt to their new situation, air their views, without interruption, and to establish boundaries. This proved extremely effective, was enjoyable for them, and provided all the family with a role, addressing issues together. The family were able to support each other integrating each system to some extent. To manage Amy’s behaviour I gathered some information off the agency’s positive parenting website to present to Amy’s parents, as I thought these would be useful and of interest. I did not wish to patronise or preach but open up their options, offering more tools and empowering them to set goals for themselves. I reassured them of their strengths, discussed expectations and to expect setbacks, however, by being realistic, persevering, and with support the outcome could be favourable. I assured them that children are extremely resilient, can thrive, and if a child resides in a safe, nurturing environment they will grow to feel secure. A bad start does not always necessarily mean a bad future. I noticed Amy reacted differently in the presence of her father and appeared a little apprehensive. After a number of visits it became apparent that Amy’s father was oppressive and belittling towards her, making her feel inadequate and useless (Dominelli, 2002). On one occasion he actually said to me â€Å"Have you read her story? It’s useless, it’s all about herself.† There was tension in the room and I felt concerned at his remarks but contained myself by focusing on Amy’s vulnerability. Amy was unable to speak for herself so I advocated for her, meeting Key Role 3 of the NOS, and replied â€Å"Yes I’ve read her story and it’s really good. Many bestsellers are often autobiographical.† I felt it was of utmost importance to deal with this ‘system’ sooner rather than later. Payne (2005) suggests it helps to identify the source of oppression to work in an anti-oppressive way, incorporating an anti-discriminatory persp ective. One of the benefits of systems theory is that it is very broad; hence, you are able to integrate it with other theories to promote positive outcomes. Giddens, 1984, argues by incorporating theories it â€Å" †¦ allows for a strong emphasis on people’s capacity for influencing their social situation.† (Payne, 2005 pg.149) In order to enhance Amy and her father’s relationship I introduced attachment theory alongside systems theory. Attachment, defined by Ainsworth (1989) as an â€Å"affectional bond† (Prior, 2006, pg.57), and according to Bowlby, (1951) is when a strong bond does not develop at an early age affecting a child’s social and emotional development. Amy’s father, being absent from her life, played no active role, therefore, she had not attached. Amy had a negative attitude towards her father as he ignored her, did not listen and prevented communication with her mother. He was unknowingly oppressing Amy with his negativity, and he thought by ignoring her she would be quiet. I encouraged building a relationship, being more positive towards each other, with her father praising her for good behaviour etc. To improve Amy’s behaviour we devised a reward chart, using token economy, although criticised by some as unethical, it worked because the action system was consistent, and Amy enjoyed it. This method worked, improved her well-being, boosted her self-esteem, allowing her to identify her difficulties, empowering her to acknowledge that she needed and wanted to change her behaviour. We set realistic, achievable tasks for gradual change, encouraging Amy to participate, boosting her confidence. Occasionally Amy found the tasks difficult so we reviewed and adapted them as necessary, giving her praise and incentives. Amy was crying out for love, approval, and abasic need for acceptance, however, communication had broken down. Re-building Amy’s relationship with her father established trust, and she felt secure enough to express her feelings.   Amy’s father became more positive and accepting, making me question my thoughts and feelings towards him earlier in the intervention. I believe it is important to be aware of your feelings, recognising changes in order to manage them. Thompson, (2000) states: â€Å"It is also important to note that a non-judgemental attitude is important as a basis for a sound working relationship †¦Ã¢â‚¬  (pg.110). To support them I used emotion cards allowing communication of thoughts, feelings and understanding of one another, which worked really well. It allowed them to spend more time together, getting to know each other, and form an â€Å"affectional bond† (Prior, 2006, pg.57), enabling Amy to talk freely about her mother. The experience benefitted Amy providing security and enabling her to grow in confidence (Bowlby, 1951). Leaving the cards with the family, I suggested they spent time exploring their thoughts and feelings to address underlying issues. In order to move forward Amy needed to talk about what happened with her mother and these cards were beneficial to her emotional well being, giving her coping skills. We reviewed events weekly and it was encouraging to hear that the family used the cards during a family meeting, empowering themselves. Although, systems theory was the foundation for my intervention I also used Carl Roger’s (1951) person centred approach to establish an open, honest relationship with the family (Koprowska, 2005). I chose this method with Amy and her stepmother, who I will refer to as Susan, as I felt it would be individual to each member and they would drive it, also it would encourage depth and exploration of their feelings (Mearns and Thorne, 1999, pg.51) â€Å"†¦ shows that she understands the feelings and thoughts being expressed by the client.† I wanted to support them both emotionally empowering them to embrace change and move forward. Using person centred counselling with Amy was extremely important, allowing her thoughts and feelings to be heard, and promoting anti-oppressive practice. By asking Amy what she wanted, listening, keeping her informed, giving feedback, and involving her in the process I counteracted her negative image of adults, allowing her to take control and empower herself, building her self-esteem. This approach allowed me to create conditions of trust to overcome constraints and see the situation from her perspective. This was important as it allowed me to build a positive relationship with the family. I presented Amy with a secret diary to record her thoughts and feelings to discuss weekly. We discussed her behaviour and how this impacted on the family. Causing rifts within her stepfamily put her at risk of isolation, and also of possibly being put into foster care again, as Susan felt unable to cope. I highlighted to Amy that the family situation was not ideal for all members, not just herself, however, by working together to achieve a compromise issues could be resolved. Persuading her this was the way forward was a skill, according to Coulshed and Orme, (1998), essential to applying systems theory. By showing Amy respect, valuing her and maintaining confidentiality she reflected on her behaviour and saw how this affected her family. Supporting Amy and Susan allowed emotional development, as both were in a vulnerable position regarding their family situation. Being empathic and understanding encouraged them to feel secure enough to share information knowing I would respect their confidentiality, at the same time unburdening themselves. Using Roger’s principles alongside systems theory built up trust between us, with no barriers, encouraging an equal relationship. Mearns and Thorne (1999, pg.97) sum this up, â€Å"Mystery evokes the illusion of power; transparency dissolves it.† This contributed to sustaining a good working relationship. Susan found issues within the family really stressful and felt unable to cope, being in the middle of all the arguments. This affected her mental well-being, and I felt she was close to walking out on the family. I had to rectify this ‘system’ fairly quickly or risk the subsequent breakdown of all the systems. Susan was the pivotal ‘system’ holding the others together so I worked alongside her to seek solutions. She actively engaged in other activities such as using the emotion cards and spending time with Amy in order to build a relationship but she was finding the situation draining. We talked openly enabling Susan was able to express her thoughts and feelings, although tearfully. I supported Susan showing empathy and told her not to expect too much of herself. I felt the family demanding too much of her, and she was trying a little to hard to please everyone. I suggested some ‘time out’, leaving the family for an hour or so to cope on their own, even if it was only going round to her dad’s or a friend. Susan needed a break from the stress factors to recharge herself. She felt unburdened talking to me, as I was actively listening, and she was really appreciative, so I suggested that she talk to her husband, explaining her feelings. This was effective as her husband had not realised how she was feeling, being caught up in his own thoughts, resulting in her feeling calmer and more able to cope. To support Susan further I intimated to Amy that maybe the rest of the family could cook a meal for Susan to show how much they loved and appreciated her, which would boost her self-esteem. This would enable each sub system to carry out a task, working together achieving a family purpose, and improve functioning. As a result of the intervention the family interacted more optimistically, which is the central aim of systems theory (Healy, 2005). I regularly reviewed the work undertaken with the family, and my assessor, adjusting and adapting strategies to suit their needs. Mediating between the different systems enabled me to re-establish less destructive relationships. My intervention with this family was very intense and I became very close, and maybe a little too friendly, with Amy and Susan, going home mentally drained. I used my supervision to express these feelings, asking for guidance on professional boundaries and methods of detaching. My assessor, acted as a container (Froggett, 2002), providing me with direction. This helped me focus on my strengths instead of my weaknesses. Learning is an ongoing process; hence I was able to develop new skills to effectively manage my practice. The final stage of systems theory is the ending, a significant element of the structure (Healy, 2005). At the outset I explained to the family that my intervention was only short term, avoiding dependency. Coulshed and Orme (1998) suggest termination is ‘built in from the beginning’ (pg. 118). Systems theory is only a temporary solution and families often need more support, therefore, not wishing to leave Amy without support, I put in place, with her family’s consent, other networks at school for when my placement ended. Amy was sad I was leaving, however, systems theory enabled me to explore her feelings and we discussed the benefits of continued support, and she was happy to be referred to a school counsellor. â€Å"Abrupt endings, in which the service user has no part in the decision-making, leave room for the event to be interpreted as a rejection or abandonment.† Miller (2006, pg.45) Amy had made good progress at home and school, and the family were adapting and managing their new family unit with the tools provided, attaining equilibrium for the present. My last two weeks were in a supporting role rather than an intervention and as Trevithick (2000) states providing the right kind of support we could ‘release the momentum and motivation towards self- sufficiency and independence’ †¦ called ‘self-actualization’ (p.33). Implementing systems theory allowed me to understand the family, respond appropriately, and highlight their strengths (Healy, 2005) whilst promoting anti-oppressive practice. Systems theory helped each system with