I am currently on placement and have been working with a 28-year-old male I shall call him Mr A, he has Autism and a moderate learning disability. I will also be reffering to a lady I will call Mrs B for this Assessment.
Erikson looks at how personality develops in a set order through eight stages of psychosocial development in his Lifespan theory, the stages are from infancy through to adulthood.
Erikson’s psychosocial theory of development considers the impact of external factors, parents and society on personality development from childhood to adulthood.
(Learning Theories. (2014))
At each stage, an individual will experience a psychosocial crisis which could have a positive or negative outcome for the development of their personality. When looking at the term psychosocial, this refers to a persons psychological needs that can conflict with the needs of society. When looking at stage 4 of the lifespan theory which is middle childhood (school age 6 – 11) the conflict at this stage is Industry versus Inferiority and the favourable outcome for a person would be competence.
It is at this stage a child will start to learn new things and develop their cognitive skills and enable them to accomplish new tasks, their teachers and peers will become a vital part of their life and their peers will become a major source of their self-esteem and will have an impact on them socially. If a child feels that they are doing well and are being encouraged and praised for this within society, they will feel a sense of Industry or competence, on the other hand, if a child receives unfavourable reactions from others for example their parents, teachers or their peers they may experience feelings of inadequacy which can lead to inferiority, which is a negative outcome. Stage 5 is the Adolescence stage; the conflict is Identity versus Role Confusion. This stage represents the transition between childhood and adulthood, this is a time when an individual will search for a sense of self and their own identity there will also be many physical changes in their body. They will develop a sense of right and wrong whilst trying to fit in with society and their peers, this can be a time for many emotional changes and can sometimes lead to them pushing the boundaries within society. If an individual gains a sense of self this has become a positive outcome, however, Role confusion may result if an individual cannot choose a role in life and are unsure where they fit in within society. The stage Mr A is at is the 6th stage of the lifespan theory which is Young Adulthood, the conflicts are Intimacy versus Isolation and the favourable outcome would be love. This stage centres on forming intimate, trusting and loving relationships with other people. According to Erikson if an individual did not gain a sense of self in the stage prior, they will find it hard to make committed meaningful relationships during this stage. Mr A struggles with his social skills and it is something he wanted to work on whilst in respite he at times finds it difficult to engage with others especially new people. During his time with us he wanted to visit the local pub with a female resident for an evening out although due to him being a vulnerable adult he needed a support worker with him this frustrated him, and he found it hard to regulate his emotions. We decided that if I accompanied them and sat at a table nearby this would give them time on their own to build a friendship which will help with both of their social and emotional wellbeing.
50 years ago, Mr A may have been treated very differently than he is today due to many legislations, guidelines and policies put in place to support and protect him. When Mr A was young his condition may have been undiagnosed, and he may have been labelled as slow or stupid, he may have been left out of mainstream education or it may have been hindered due to his disability not being supported properly at school. In his community Mr A could have been labelled and discriminated against due to ignorance around his disability this may have had a significant impact on his life chances. Fortunately, the Introduction of the Disability Discrimination Act 1995 was the first far reaching legislation and it sought to eliminate the discrimination of disabled people like Mr A. The Act came into force at the end of 1996 and was amended a decade later. The Disability Discrimination Act 2005 expanded the rights of disabled people, striving for equality in all areas of their life. These new amendments came into force in April 2006, it subsequently went on to become the Equality Act 2010.
Unfortunately, there are some disabled people from a variety of backgrounds that have suffered some level of discrimination in life from society. In 1995, a key piece of legislation was introduced to tackle the issue of discrimination against disabled people.Aboutlearningdisabilities.co.uk. (2018).
The Disability Discrimination Act 1995 paved the way in how disabled individuals were treated regarding employment and helped change the attitude during recruitment and in the workplace for Mr A this would have ensured that he was not discriminated against during the interview process and that provisions for him were met in the workplace. Following on from The Disability Discrimination Act 1995 The Human Rights Act 1998 was introduced.
Human rights are based on important principles like dignity, fairness, respect and equality. They protect you in your everyday life regardless of who you are, where you live and how you chose to live your life.Citizensadvice.org.uk. (2018).
Public authorities for example a person local authority or the NHS must follow The Human Rights Act 1998, if an authority was to beach a persons human rights that person can take action under the act. There are many rights that are protected under the act for example a persons right to life, their right to respect for private and family life and the right not to be tortured or treated in an inhuman way. Under this act Mr A must be treated with fairness, equality, dignity and respect in all areas of this life including the care he receives for his disabilities. The Regulation of Care Act (Scotland) 2001 was set up to improve standards of our social care services. The Health and Social Care Standards are a framework that came from the Regulation of Care Act (Scotland) 2001 and are what care workers must work by to ensure everyone, no matter where they come from, receive the same quality of care. The SSSC was also introduced under the act and sets out codes of practice for social service workers, social care, early years, young people workers and their employers need to meet. The SSSC also ensure that all social workers are registered with them which in turn protects the public. These codes set out the standard to which all their employees must adhere to. They are clear and concise on how individuals conduct themselves in their everyday work. Employees must be able to promote the independence of an individual whilst still protecting them from harm or danger. They must work to establish the trust of the individual and maintain that trust. They are also held responsible for their quality of work and if these standards are not followed legal action can be taken. Under all these legislation Mr A’s care will now be human rights based, it will give him a greater opportunity to participate in the decisions that impact his human rights.
Behaviour that challenges us can present itself in many ways, when I first started on placement there was an individual who would lash out or act aggressively towards support workers and her own family. I was unaware that she had Dementia and was taken aback at her aggression, she would shout, throw things and often wander off. Once I was informed she had Dementia I then understood that an individual who has dementia may have the same needs as everyone else, however, they may be unable to recognise their needs, know how to meet them, or communicate what they need to others. This may cause them to act in ways that are seen as challenging, including aggression and lashing out.
Carl Rogers (1902-1987) was a humanistic psychologist who agreed with the main assumptions of Abraham Maslow but added that for a person to “grow”, they need an environment that provides them with genuineness (openness and self-disclosure), acceptance (being seen with unconditional positive regard), and empathy (being listened to and understood).McLeod, S. (2018).
Rogers proposes that without these core conditions healthy personalities and relationships may not develop as they should which could lead to an individual not feeling totally fulfilled within their life. Rogers also looks at our self-image, this is the way we see our self at any given moment, our self-esteem or self-worth, is how much value we place on our self and our ideal self which is what we want to be. When looking at Mr A using this theory, we sat and had a coffee together at the start of his stay as he seemed unsettled and his mood was low, using the core conditions when listening to him he told me that he is a keen gardener and gets a lot of pleasure and relaxation from it, unfortunately his parents moved recently into a flat and there is no garden for him to tend to and that he is missing pottering in his old garden as this is where he gets the most happiness. Mr A’s ideal self is tending to his garden and now his actual self or self-image is not having a purpose anymore as this was an activity he enjoyed most days. We spoke about ways that we could raise his self-esteem by bringing his ideal self and his self-image closer together, we decided that Mr A could tend to the raised beds that are at the respite home whilst he is here, as they needed weeding and new bulbs planted and he asked about planting some strawberries that we could all eat once they were ready. This has given him great pleasure since starting and we also spoke about him getting some window boxes for his parents flat that he can look after in the home environment.
When looking at the Behaviourist approach, it argues that as humans we are born a blank slate and that our behaviour is learned through interaction with the environment around us and is shaped by external rather than internal factors and that principles of classical and operant conditioning are used to explain our behaviour. The ABC model has been built from the approach and is used in CBT therapy today in relation to what is learned can be unlearned and that our thoughts and behaviours can be changed as our minds are pliable.
ABC stands for Antecedent-Behaviour-Consequence. The ABC model involves understanding the stimuli for behaviour and the subsequent events that may act as reinforcement. Analyse a behaviour not just by looking at what happened but also at what happened beforehand to trigger the behaviour and what happened afterwards to reinforce it, encouraging the pattern to repeat again in the future.Changingminds.org. (2018).
The model looks at the Antecedent, Behaviour and Consequence- there is a trigger or a stimulus which impacts the way we behave and depending if that behaviour is rewarded or reinforced either positive or negatively, will lead to whether or not we repeat that behaviour. When looking at Mr A’s behaviour with the ABC model he has many triggers or the antecedent for example, certain sounds, words or noises his behaviour can change dramatically at these triggers ranging from high pitched screaming to self-harming himself by biting the back of his hand. We try as much as possible to create an environment for him that this may not happen although if it does, he likes to go to a quiet room with his Nintendo until he feels able to rejoin the group.
I found the following similarities between the Person-Centred Approach and the Behaviourist approach in that they both deal with the conscious mind, the here and now and focus on current problems and issues that an individual may have. In contrast the Behaviourist theory sees behaviour as being a learned response from paretnts, peers and society as a whole whereas Carl Rogers looks a way of finding where a person is and where they want to be with regards to self-image and their ideal self and this is more to do with free will.
In recent decades the sciences of the brain have been transformed by new technologies. These let researchers understand in unprecedented detail how brains change during dementia.Taylor, D. (2018).
Before this new technology was introduced the only way to look at what effect dementia had on the brain was dissecting it after death. The name dementia is an umbrella term for a group of progressive neurological diseases for example, Alzheimer’s, Lewy body or Vascular dementia to name a few and dementia has risen significantly in recent years due to the population now living longer. Mrs B has Alzheimer’s and with this plaques start to build up between nerve cells and prevent their ability to send messages to each other in the proper way. Tangles are formed out of dead and dying nerve cells that bunch together and twist around each other to form tangles of nerve cell fibers. As these grow within the brain it causes other nerve cells to die and that part of the brain will start to shrink and be unable to perform its functions properly for example memory, coordination, communication and behaviour. This helps me to understand why Mrs B may keep repeating questions, she may act inappropriately or lash out at individuals as those areas of her brain in not functioning the way they should as the cells and pathways are dying.
Resilience is what gives people the psychological strength to cope with stress and hardship. It is the mental reservoir of strength that people are able to call on in times of need to carry them through without falling apart. Psychologists believe that resilient individuals are better able to handle such adversity and rebuild their lives after a catastrophe.Verywell Mind. (2018).
This was Mr A’s first time in respite and being away from his family for any length of time and his resilience was already low as he was feeling isolated within his community due to his Autism and learning disability. Mr A had not long moved into a flat in a new area with his mum and dad and he was finding the social events he used to attend hard to get to now with being further away, on entering respite his mood was very low. Ensuring he felt socially included and welcomed with us was of importance as this can help build his resilience whilst with us and enable him to feel he is part of something and accepted fully. With Mr A moving to a new house he no longer has a garden to potter in and this is also having an impact on his resilliance, he feels he has lost a sense of purpose in his life since moving. During his time with us we got him involved it weeding and planting new bulbs in the raised beds we have in the outside area and saw a marked difference in his demeanor every morning, he was up and ready to face the day with a smile on his face.
The Human Rights Approach is important in care to enable us to enhance the wellbeing of individuals in a person centred way. Taking a human rights based approach is about using international human rights standards to ensure that people’s human rights are put at the very centre of policies and practice. This approach recognises that it is not only people who use services whose rights are to be promoted and upheld, but staff, representatives and communities. It empowers people to know and claim their rights and it increases the ability and the accountability of individuals and institutions who are responsible for respecting, protecting and fulfilling rights.
A human rights based approach empowers people to know and claim their rights. It increases the ability of organisations, public bodies and businesses to fulfil their human rights obligations. It also creates solid accountability so people can seek remedies when their rights are violated.Scottishhumanrights.com. (2018).
The PANEL principles break down what this means in practice and are fundamental in applying a human rights base approach. The PANEL principles are Participation which means everyone has the right to participate in decisions that affect them, for example, in a care setting a person should be at the centre of their own care plan. Individuals may have their own views and ideas on what they feel is best for them and in the case of Mr A he wanted his family to be included in his care plan, so as health care workers, we had to be flexible as this will enable us to meet his needs better and made our system suit him, rather than the other way around. Accountability is being able to ensure that a persons rights are being upheld, there are a range of regulatory bodies that insure this takes place for example the care inspectorate will visit our respite home and we must ensure that the standards set are being met in all areas. Mr A’s care plan also makes us accountable as we must ensure it is followed and that his rights are met during his stay with us. Non-discrimination and equ
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