BTEC Level 3 Unit 5 Meeting Individual Care

BTEC Level 3 Unit 5: Meeting Individual Care And Support Needs Name: 1.

Assignment 1: Learning Aims A, B and C *Examine principles, values and skills which underpin meeting the care and support needs of individuals. *Examine the ethical issues involved when providing care and support to meet individual needs. *Investigate the principles behind enabling individuals with care and support needs to overcome challenges. 2

What Are Your Values? Learn how to Identify Values and Beliefs https: //www. youtube. com/watch? time_continue=44&v=Kz__q. GJm. TMY 3 Assertiveness Balance Being the best Belonging Boldness Calmness Carefulness Challenge Cheerfulness Clear-mindedness Commitment Community Compassion Competitiveness Consistency Contentment Continuous Improvement Contribution Control Cooperation Correctness Courtesy Creativity Curiosity Decisiveness Democraticness Dependability Determination Devoutness Diligence Discipline Discretion Diversity Dynamism Economy Effectiveness Efficiency Elegance Empathy Enjoyment Enthusiasm Equality Excellence Excitement Expertise Exploration Expressiveness Fairness Faith Temperance Thankfulness Thoroughness Thoughtfulness Timeliness Tolerance Traditionalism Trustworthiness Truth-seeking Understanding Uniqueness Unity Usefulness Vision Vitality Family-orientedness Fidelity Fitness Fluency Focus Freedom Fun Generosity Goodness Grace Growth Happiness Hard Work Health Helping Society Holiness Honesty Honour Humility Independence Ingenuity Inner Harmony Inquisitiveness Insightfulness Intelligence Intellectual Status Intuition Joy Justice Leadership Legacy Love Loyalty Making a difference Mastery Merit Obedience Openness Order Originality Patriotism Perfection Piety Positivity Practicality Preparedness Professionalism Prudence Quality-orientation Reliability Resourcefulness Restraint Results-oriented Rigor Security Self-actualization Self-control Selflessness Self-reliance Sensitivity Serenity Service Shrewdness Simplicity Soundness Speed Spontaneity Stability Strategic Strength Structure Success Support Teamwork

A 1 Promoting equality, diversity and preventing discrimination https: //www. youtube. com/watch? v=3 z. KADdgcf 14 Dementia : End of life care Northtraininguk Make notes on the clip above. What are your views on this topic. Is this the way you would wish to care for people? 4

A 1 Promoting equality, diversity and preventing discrimination Make notes on the following clips. https: //www. youtube. com/watch? v=2 Ec. YYMnd. HK 4 Equality, Diversity and Inclusion by BVS Training https: //www. youtube. com/watch? v=X--LMPZp 93 Y Equality and Diversity https: //www. youtube. com/watch? v=_Tbvuq. RMUO 4 Types of Discrimination https: //www. youtube. com/watch? v=Ucu. S 5 glh. Nto Equality, Diversity and Inclusion by What you need to know 5

A 1 Promoting equality, diversity and preventing discrimination Notes on videos 6

A 1 Promoting equality, diversity and preventing discrimination In pairs come up with a definition for equality, diversity and discrimination. You need to read information from the following websites and make notes from each one. https: //www. equalityhumanrights. com/en/equality-act-2010/what-equality-act http: //www. ed. ac. uk/equality-diversity/about/equality-diversity https: //www. equalityhumanrights. com/en/advice-and-guidance/what-discrimination 7

A 1 Promoting equality, diversity and preventing discrimination http: //www. nhs. uk/Conditions/social-care-and-support-guide/Pages/advocacyservices. aspx Read the information from the link above and write your own revision notes. 8

A 1 Promoting equality, diversity and preventing discrimination What is an advocacy service? What do they do? Why are they important? Research the following advocacy services. What do they do? • SEAP (Support, Empower, Advocate, Promote) • Mencap • Empower Me • British Institute of Learning Disabilities There also support services such as: Mind Age UK Headway What do these services do? Why are these important services? 9

Why is it important to prevent discrimination? Why is it important to promote a persons equality and diversity? How can health care professions do this? 10

https: //www. youtube. com/watch? v=Pr. Imwg. BFMYE Dignity in care: Choice & Control Watch the clip and see how professionals promote equality and diversity. Make notes 11

Coursework Time! Choose your 3 case study individuals and write their names here: Learning Aim A P 1 Explain why it is important to promote equality and diversity for individuals with different needs: EXPLAIN Clarify a topic by giving a detailed account as to how and why it occurs, or what is meant by the use of this term in a particular context. Your writing should have clarity so that complex procedures or sequences of events can be understood, defining key terms where appropriate, and providing proof with relevant research. (1) P 1. You will consider the importance of promoting equality and diversity, and preventing discrimination for each case study. (3). P 1. You must use the case studies to demonstrate your understanding of the importance of promoting equality. Learning Aim A M 1 Analyse the impact of preventing discrimination for individuals with different needs. Analyse Break an issue into its separate parts. Look in depth at each part using supporting arguments and evidence for and against as well as how these interrelate (connect) to one another. (19) M 1. You must use the case studies to demonstrate how professionals promote equality, diversity and anti-discriminatory practices. 12

Use this as your check list for the information you have just written! Have I included What discrimination is Give examples of discrimination Link the discrimination to individuals within a health/care setting Suggests ways in which discrimination can be overcome again giving examples that link to individuals Explain what equality means Give examples of equality Explain what diversity means Give examples of diversity Give examples of initiatives that are used to prevent discrimination (link to individuals) Explain what an advocate is Link advocates to individuals. 13 Yes No Not Sure

A 2 Skills and personal attributes required for developing relationships with individuals What are the 6 Cs? https: //www. youtube. com/watch? v=cc 0 zxs. Gj 104 What are the 6 C’s to you? Watch and make notes https: //www. youtube. com/watch? v=HVF 0273 i. Hus Compassion, dignity and respect in health care The Health Foundation What is meant by the term ‘compassion’ and what examples are given that demonstrate compassion? 14

Watching the two clips write some notes focusing on the things below: • What is meant by each of the 6 c’s? • What examples can you give for each one? • What attributes and skills does the trust look for in their staff? https: //www. youtube. com/watch? v=Vnn 1 Tl. Rlp. G 4 Compassionate care: delivering the Six Cs https: //www. youtube. com/watch? v=IPGn 0 p. V 3 d. U 0 Northamptonshire Healthcare NHS Foundation Trust 15

Watch the two clips about Winterbourne View and make notes. https: //www. youtube. com/watch? v=sub. Mgwy. JOK 8 Brutality by social workers in UK disablity centre Winterbourne View https: //www. youtube. com/watch? v=hh. Cx 3 K 8 XJJM Winterbourne View abuse scandal - DAMNING REPORT is published 16

How do you think the use of the 6 C’s would help to prevent this situation happening again? 17

Again watch the clip and make notes. How do the 6 C’s prevent this happening again? https: //www. youtube. com/watch? v=i. HXOFS 9 ec 2 Q Stafford- The Hospital That Didn't Care- Patients Left To Die- BBC Special 18

A 2 Skills and personal attributes required for developing relationships with individuals Produce a list of questions to ask someone working in a health and social care setting about the following things: • What skills they need to undergo their role • What qualifications they need to enable them to carry out their job • How they develop their skills • What skills and personal attributes they feel a health/social care worker needs to have to be able to carry out their role Undertake your interview and write up your results My Interview: 19

In Pairs take each of the following and explain why these skills are important and what type of situation may occur where someone needs to use these skills. Feedback to the class and record results. Importance of skills Empathy Patience Engendering trust Flexibility Sense of humour Negotiating skills Honesty Problem solving 20 Situations

https: //www. youtube. com/watch? v=8 DTr. VQIW 5 Cw Dignity in care: Communication Watch the video and make notes. Take into consideration they way in which the health care professional communicates with the service user. What type of language do they use? Why and how does it differ from person to person? 21

What is active listening? Watch the video and make notes, device your own definition. https: //www. youtube. com/watch? v=o. We_og. A 5 YCU 6 Tips for Active Listening #Little. Things 22

Observation skills: Watch the following clip. Why do you think it is important for a health care professional to observe the service user? https: //www. youtube. com/watch? v=y 1 F 35 m. Uk 4 Oo CNA 728 R - The Nursing Assistant: Recognizing & Reporting Changes in a Resident's Physical Condition 23

Monitor children’s development: Why is it important to monitor a child's development? How can you monitor a child development? https: //www. youtube. com/watch? v=Kr. UNBfyjl. Bk Early Recognition Of Child Development Problems / Educational Video 24

Coursework Time! Learning Aim A P 2 Explain what skills and personal attributes are necessary for professionals who care for individuals with different needs. (2). P 2. You must recall and relate knowledge of how the professionals in the case studies promote equality and diversity and the skills and attributes needed to do this. (4). P 2. You must explain the key principles of providing care, showing an understanding of the skills and attributes required by those professionals who meet the care and support needs of individuals. Checklist: • You need to give a detailed account of the skills a professional who cares for individuals with different needs should have. • For each skill explain why they need that particular skill. • Give examples of situations where they may need to adapt that particular skill depending on the needs of the individual. • Explain what personal attributes are. • For each type of personal attributes a professionals who cares for individuals with different needs should have you need to explain it. • Why are these attributes needed? • Give examples of when a professional may use these attributes. • Include relevant information to back up your work (6 C’s)! 25

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. John Bowlby Secure attachment characteristics A child will: • Be able to separate from a parent • Prefers parents to strangers • Seek comfort from a parent or caregiver if they are frightened • Become excited when they see their parent/caregiver Ambivalent attachment characteristics A child will: • Be wary of strangers • Become very distressed when a parent/caregiver leaves • Do not appear to be comforted in the return of a parent/caregiver Avoidant attachment characteristics Children may: • May avoid parents • Don’t really seek comfort from parents of caregivers • Show no real preference between a parent/caregiver or a stranger Disorganised attachment characteristics Characteristics change with age. A child of at age 1. • Mixture of avoidance and resistant behaviours • Can seem confused and apprehensive A child at 6 • May take on a parent role • Some may act as a caregiver towards the parent 26

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. Main points 1. A child has an innate (i. e. inborn) need to attach to one main attachment figure (i. e. monotropy). There should be a primary bond which was much more important than any other (usually the mother). 2. A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life. (Critical period) Bowlby believed that babies needed to have developed their main attachment by the age of 1 year. During a child’s first three to four years, prolonged separation from this person would cause long-term psychological damage. 3. Children need ‘parenting’ Simply meeting a child’s physical and care needs is not enough for health growth and development. Children need the main attachment in their early lives to give them consistent support. 4. Short term separation from an attachment figure leads to distress. Bowlby outline a pattern of distress that babies and children showed when separated from their carers. A) Protest: The child cries, screams and protests angrily when the parent leaves. They will try to cling on to the parent to stop them leaving. B) Despair: The child’s protesting begins to stop and they appear to be calmer although still upset. The child refuses others’ attempts for comfort and often seems withdrawn and uninterested in anything. C) Detachment: If separation continues the child will start to engage with other people again. They will reject the caregiver on their return and show strong signs of anger. 5. The child’s attachment relationship with their primary caregiver leads to the development of an internal working model (IWM) The first attachment between a baby and their caregiver provides the child with an internal working model or template for their future relationships. The attachment helps children to develop a view of themselves in relation to others. 27

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. Mary Ainsworth created an experiment to look at attachment in children. This was called ‘Strange situation’ https: //www. youtube. com/watch? v=m_6 r. Qk 7 jlrc&t=56 s Watch the clip and make notes on the experiment that you see. 28

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. Ainsworth categorised the behaviour into three types. 1. Insecure- Avoidant Attachment: (Type A) • Relationship style of babies involved keeping a distance and avoiding closeness. • Type A babies do not orient their behaviour towards their mother. • They showed some distress at mothers departure but did not seek comfort from her return. • They rejected the stranger’s attempts to comfort them. 2. Secure Attachment: (Type B) • Use their mother as a safe base and were happy to explore the room when she was there. • They showed distress by crying when she left the room. • They welcomed their mothers return and settled down to play quite quickly 3. Insecure-Ambivalent Attachment: (Type c) • These babies alternated between seeking closeness and wanting distance. • They were very distressed at separation. • They were not easily comforted when the mother returned, appearing angry and rejecting the mother’s attempt to comfort them. • They kept a close eye on the stranger. . Look at Bowlby’s 4 attachment types. For each one discuss how the adult might behaviour towards the child for the child to display that type of attachment. Secondly how could that affect the child as they become an adult? 29

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. 30

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. https: //www. youtube. com/watch? v=x. Sf 7 p. Rp. Ogu 8 In Brief: How Resilience is Built Centre on the Developing Child at Harvard University Research the definitions for the following words: Attachment Resilience Autonomy 31

A 3 Empathy and establishing trust with individuals The Triangle of Care guide was launched in July 2010 as a joint piece of work between Carers Trust and the National Mental Health Development Unit Professional Service user It enables all parties to be involved in someone's care. The individual, carer and professional all share information and work together to give a better quality of life for the individual. Carer https: //www. youtube. com/watch? v=JIj 22 Jjjwww Watch the clip and make some notes about the Triangle of Care. 32

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. https: //www. youtube. com/watch? v=2 Gsds. Axvi. Qc Patient Empathy: It Starts with You List all of the things that you see that show empathy. 33

A 3 Empathy and establishing trust with individuals Attachment and emotional resilience theory, to include the effect of secure attachments and support on emerging autonomy and resilience. https: //www. youtube. com/watch? v=8 BKN 7 RFhdq 4 The next revolution in health care? Empathy | Paul Rosen | TEDx. Wilmington Write some notes on the clip. What issues are mentioned and how can these be changed? 34

A 3 Empathy and establishing trust with individuals Empathy theories, e. g. Johannes Volkelt, Robert Vischer, Martin Hoffman and Max Scheler https: //www. youtube. com/watch? v=ba. Hrc. C 8 B 4 WM The power of empathy: Helen Riess at TEDx. Middlebury Watch the video clip and make some notes. It has some very good examples about empathy and how to be empathetic. 35

A 3 Empathy and establishing trust with individuals Empathy theories, e. g. Johannes Volkelt, Robert Vischer, Martin Hoffman and Max Scheler From watching the clip , how do you think empathy helps a professional to establish a trusting relationship with a person who needs care and support? 36

A 3 Empathy and establishing trust with individuals Empathy theories, e. g. Johannes Volkelt, Robert Vischer, Martin Hoffman and Max Scheler Johannes Volkelt (1848– 1930) was a German philosopher. He said that you could only really appreciate an object, such as a work of art or piece of music, if your personal identity and the object become one, so you not only see an object or hear music but also feel it with your body Robert Vischer (1847– 1933) was also a German philosopher. He invented the term Einfühlung, which was later translated in English as empathy. He said this word referred to when you imagine yourself as being one with a piece of art or literature and feel the emotions that the artist tried to reproduce, so imbuing the piece with relevant emotions. Max Scheler Another German philosopher, Max Scheler (1874– 1928) said that we should look at objects differently, so we didn’t just give the facts about an object, such as it being big and a particular colour, but also give our opinion of it, such as it being beautiful, ugly, bland or majestic. Martin Hoffman is a contemporary American psychologist. His work is based on social and emotional development, especially empathy, and its bearing on how we develop morally. Our moral development includes our principles, how we behave and our sense of right and wrong. Carry out some additional research into these theories. Why are these theories important? 37

Coursework Time! Learning Aim A M 2 Assess the different methods a professional might have to use to build a relationship and establish trust with an individual. ASSESS Weigh up to what extent something is true. Persuade the reader of your argument by citing (to mention something as proof for a theory or as a reason why something has happened) relevant research but also remember to point out any flaws and counter-arguments as well. Conclude by stating clearly how far you are in agreement with the original proposition. (14) M 2. You will relate the situation of the 3 individuals in the case studies with the possible effects of discrimination, and the skills, attributes and empathy theories that can be employed to prevent discrimination. (15) M 2. You will be expected to use vocational language to explore empathy and how professionals could establish trust with the individuals in their different care environments. (16) M 2. You could include a description of the six Cs of care and a range of communication skills that professionals use when building positive relationships. (17) M 2. You could consider the impact of these communication skills on individuals when preventing discrimination. (18) M 2. You must demonstrate the relevance of each selected empathy theory. You should analyse the value of each in explaining the importance of professionals building positive relationships with individuals. 38

Coursework Time! Learning Aim A D 1 Evaluate the success of promoting anti-discriminatory practice for specific individuals with different needs. EVALUATE Give your verdict as to what extent a statement or findings within a piece of research are true, or to what extent you agree with them. Provide evidence taken from a wide range of sources which both agree with and contradict an argument. Come to a final conclusion, basing your decision on what you judge to be the most important factors and justify how you have made your choice. (25) D 1. You will select material from the provided case studies which allows you to explore the issues surrounding equality and diversity, and preventing discrimination, and how successfully promoting anti-discriminatory practice has been achieved for each case study. (26) D 1. You will draw together your understanding of the empathy theories and how they are applied, together with personal skills and attributes, to successfully promote anti-discriminatory practice. (27) D 1. You must demonstrate clear understanding of the skills and attributes needed by professionals in order to meet individual care and support needs. (28) D 1. You must consider the advantages and disadvantages of theories and use detailed analysis and research to reach reasoned and valid conclusions and recommendations. (29) D 1. You must demonstrate clear understanding of all of the terminology used in a health and social care context. 39

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics Consequentialism It gives us this guidance when faced with a moral dilemma: • A person should choose the action that maximises good consequences And it gives this general guidance on how to live: • People should live so as to maximise good consequences Different forms of consequentialism differ over what the good thing is that should be maximised. Consequentialist ethics holds the view that the correct moral response is related to the outcome, or consequence, of the act. Utilitarianism states that people should maximise human welfare or well-being. Hedonism states that people should maximise human pleasure https: //www. youtube. com/watch? v=-a 739 Vjqd. SI Utilitarianism: Crash Course Philosophy #36 Notes on the clip above: If you were making a decision about a person’s health or social care using this theory, you would look at the likely results of your decision for that person’s wellbeing and the wellbeing of others. For example, a critically-ill child needs a very expensive surgical treatment and has low survival expectancy. DISCUSS Should the NHS do the operation or should the money be allocated to carry out hundreds of tonsillectomy operations? What are the consequences of spending the money either way? Which is the most important? 40

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics • • • Deontology is the opposite of consequentialism. This is concerned with what people do and not the results. So killing someone is always wrong regardless of the situation. It focuses on rules, obligations and duties. One of the key criticisms in healthcare is that applying a strictly deontological approach to healthcare can lead to conflicts of interest between equally entitled individuals which can be difficult or even seemingly impossible to resolve. Basically any rules about spending money on treatment should be the same for everyone. https: //www. youtube. com/watch? v=8 b. Iys 6 Jo. EDw Kant & Categorical Imperatives: Crash Course Philosophy #35 Deontology: 41

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics Principlism Commonly used ethical approach in healthcare. It emphasises four key ethical principles (autonomy, beneficence, non-maleficence, and justice) which most ethical theories share and blends these with virtues and practical wisdom. Autonomy – A person’s right to choose how they live their life. Beneficence – when a person is unable to make choices for themselves, health professionals have a duty to act in the best interests of that person. Non-Maleficence – means not causing harm Justice – moral obligation to act fairly. This is an attempt to bring together the best elements of ethical theories which are compatible with most societal, individual or religious belief systems https: //www. youtube. com/watch? v=fy 2 NUALX 4 Bg The four ethical principles: should we prioritise autonomy? (Watch the clip, make notes and discuss) 42

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics https: //www. youtube. com/watch? v=Prvt. OWEXDIQ Aristotle & Virtue Theory: Crash Course Philosophy #38 Make notes on the clip above Virtue ethics 43

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics https: //www. youtube. com/watch? v=p. VYSMe. Gioe. Q Love AND Death https: //www. youtube. com/watch? v=96 k. N 76 Pf. Se 0 Tony Nicklinson interview: Why I want to end my life The Suicide Act England Wales states that it is wrong to assist anyone to commit suicide. Watch the two clips. Assisted suicide is an ethical dilemma for all concerned. What are your thoughts? How does this affect your morals and your own values? 44

B 1 Ethical issues and approaches Ethical theories, to include consequentialism, deontology, principlism and virtue ethics Based on the two clips you have just watched, answer the following questions in detail. What would a consequentialism ethics view be based on each case? What would a deontological view be? What ethical principles are involved? 45

B 1 Ethical issues and approaches Managing conflict with service users, carers and/or families, colleagues. Conflict happens with service users, carers and/or families for reasons such as disagreement over care decisions, concern about the quality or cost of care, or the behaviour of staff. Conflict can also occur between colleagues, maybe over decisions made based on different ethical theories Things you can do to resolve conflict 46 Things you shouldn’t do, which could create conflict

B 1 Ethical issues and approaches Managing conflict of interests. When working with groups of vulnerable people in health and social care settings, there are times when care workers are faced with a conflict of interest for which they will need to find an ethical solution. Often, ethical dilemmas will not have a ‘correct’ answer and the solution will depend on a number of considerations. Nevertheless, the care worker is faced with a dilemma and is expected to make a decision. What type of things would a care worker need to consider before making their decision? 47

B 1 Ethical issues and approaches Balancing services and resources Some ethical issues people may face in a health/social care environment • • Disagreement between patients/families and health care professionals about treatment decisions Waiting lists Access to needed health care resources for the aged, chronically ill and mentally ill Shortage of family physicians or primary care teams in both rural and urban settings The ethics of surgical innovation and incorporating new technologies for patient care Withholding/withdrawing life sustaining treatment in the context of terminal or serious illness Ethical issues related to subject participation in research Medical error Take each one, of the above, in turn and discuss what these may mean. So e. g. waiting lists, if someone has been on a list for many years and is about to have a lung transplant but someone else needs this more urgently, but they smoke, then who should be at the top of the waiting list? 48

B 1 Ethical issues and approaches Balancing services and resources What are the ethical issues in this case? https: //www. youtube. com/watch? v=kl 1 yp 1 F ab. Dg Charlie Gard: "He'll fight till the very end“ 5 News 49 https: //www. youtube. com/watch? v=44 Xexltva. I 0 Charlie Gard's parents lose Supreme Court battle 5 Fast Facts

Discuss why these are ethical issues and conflicts that could arise. 50 Examples of ethical dilemmas Scenario Right to independence Laura has dementia and gets confused and disorientated when out. She wants to continue with her weekly visits to her daughters house who lives 3 miles away. Laura’s carer is concerned about Laura’s safety and the fact that she gets lost, sometimes for long periods of time. Right to choice Sam has depression and lives alone. He prefers to stay in bed all day and chooses not to get up until 6 pm. Sam’s mental health support worker is concerned about his well-being and lack of activity. Right to confidentiality Barbra is 75 and has a good relationship with her son who visits her daily. She tells her home carer that her son has asked her for money again and so she thought she had better give it to him. She tells her home carer not to tell anyone about it as she doesn’t want her son to find out. Right to respect Jackie is 20 and has a learning disability. She has found out that she is pregnant and wants to have a termination. She asks her support worker to accompany her to the hospital. Her support worker holds religious beliefs that do not agree with terminations. Right to dignity Frank is 85 and lives with his wife who is his sole carer. The social worker visits and notices that Frank is only partly clothed and not wearing any trousers. Frank’s wife explains that this is because it is easier for her to support him when she helps him go to the toilet.

B 1 Ethical issues and approaches Minimising risk but promoting individual choice and independence for those with care needs and the professionals caring for them When working with vulnerable people receiving social care services, there can quite often be a conflict of interest between the individual and the organisation. Example: A person with learning disabilities wishes to live on their own, however they have bouts of anger and become aggressive. A decision has to be as to whether or not the benefits of the person living alone and having their own independence or worth the possible risks to those around them. In a situation like this many policies, procedures and assessments have to be undertaken to access the level of potential harm to the individual themselves and other people. In small groups come up with your own situations where there could be a risk between an individuals choice and independence and the professional caring form them. 51

B 1 Ethical issues and approaches Sharing information and managing confidentiality • • • Confidentiality protects the rights of individuals. Within the health and social care sector confidentiality is vital. Confidentiality is ensuring all information is private and is not shared about an individual without their knowledge and agreement. This even applies to telling family and friends. A person working in health and social care must not disclose information to anyone. Maintaining confidentiality safeguards service users. There are occasions when confidential information has to be shared. When do you think information may need to be shared? DISCUSS https: //www. youtube. com/watch? v=n. J 84360 do 7 Y Legal and Ethical Aspects of Medicine – Confidentiality: By Nelson Chan M. D 52

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Organisations, legislation and guidance that influence or advise on ethical issues. All legislation and guidance must be current and applicable to England, Wales or Northern Ireland. Organisations, e. g. National Health Service (NHS), Department of Health (DH), National Institute for Care Excellence (NICE), Health and Safety Executive (HSE). • National Health • Service (NHS) • The Department of Health (DH) A ministerial department of the government Helps people to live better for longer Leads, shapes and funds health and care in England by creating national policies and legislation • • National Institute for Health and Care • Excellence • (NICE) Health and Safety Executive (HSE) • • 53 Launched in 1948 from the ideal that good health care should be available for all, regardless of wealth Provides a wide range of health services, the vast majority of which are free at the point of delivery for people legally resident in the UK Made up of four, mainly independent, publicly funded health care systems: NHS (England), Health and Social Care in Northern Ireland, NHS Wales and NHS Scotland Set up in 1999 to help prevent ill health and promote healthier lifestyles Provides national guidance and advice to improve health and social care, officially only in England, but does provide certain NICE products and services to Wales, Scotland Northern Ireland Accountable to its sponsor department, the DH, but operates independently from the government Role is to improve outcomes for people using the NHS and other public health and social care services Set up as the national independent watchdog for work-related health, safety and illness Executive public body, sponsored by the Department for Work and Pensions Acts in the public interest to reduce work-related death and serious injury across the UK’s workplaces Shapes and reviews policies, reviews regulations, produces research and statistics and enforces the law

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Legislation, e. g. Mental Health Act 2007, Human Rights Act 1998, Mental Capacity Act 2005, National Health Service Act 2006 Section 140, Equality Act 2010, Care Act 2014. Notes from other peoples presentations 54

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Legislation, e. g. Mental Health Act 2007, Human Rights Act 1998, Mental Capacity Act 2005, National Health Service Act 2006 Section 140, Equality Act 2010, Care Act 2014. https: //www. youtube. com/watch? v=pz 5 Ecovjs 4 w Human Rights Inquiry case study - The 'Bournewood' ruling (Make notes) Which parts of the Mental Health Act 2007, listed below, do you think came about as a result of the Bournewood Case? Do some research into the details of this case. Write an article for a magazine that covers the facts and ethics of this case, including how other Acts now help protect people like HL. • • • 55 Changes the definition of mental disorder Makes it no longer possible for patients to be compulsorily detained, unless appropriate treatment and all other information is available to that patient Broadens the role of practitioners Gives relatives and civil partners more rights Provides more help, such as age-appropriate services, independent mental health advocacy, quicker tribunals, more safeguards around electroconvulsive therapy (ECT), and supervised community treatment

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Guidance, e. g. : the DH Decision Support Tool, five-step framework, NICE and NHS guidance on Care Pathways and Care Plans, Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups (2013) (NHS), HSE guidance on risk assessments. • • • If an individual needs extra support from a healthcare setting there will be an assessment by a professional using a screening tool called the NHS Continuing Healthcare Checklist. If results suggest that the individual is eligible for NHS continuing healthcare, a full up -to-date assessment of their needs will be arranged using a tool called the Decision Support Tool. Multi-disciplinary teams set out the individual’s needs in relation to twelve care domains, and then make a recommendation as to whether the person is entitled to NHS continuing health care. https: //www. youtube. com/watch? v=ml. Ir. KEHP-WU 06 Step 2 – the Full Assessment: NHS Watch the clip. What is the care needs assessment? What is a multi-disciplinary team? What is the ‘Decision support tool’? What are the 12 care domains? (Give some examples). 56

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Guidance, e. g. : the DH Decision Support Tool, five-step framework, NICE and NHS guidance on Care Pathways and Care Plans, Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups (2013) (NHS), HSE guidance on risk assessments. https: //www. psychologytoday. com/blog/am-i-right/201207/five-steps-better-ethicaldecision-making Additional reading Five-step framework Step 1 Recognise the decision or issue: What is the actual issue or problem? Are you being asked to do something that is wrong or illegal? Are you aware of others involved who are behaving unethically or illegally? Step 2 Think before you act: Think about the issue and summarise so that it is clear to you. Consider the various options and consequences. Consider who may be affected and ask others for their views. Step 3 Decide on a course of action. What is your responsibility in this process? Review all of the relevant information Assess any risks Decide on the best course of action Step 4 Test your decisions: Review your decision against ethics and values. Consulate relevant policies and procedures/legislations/law etc. Consult others about your actions Step 5 Proceed and evaluate: Review and move on Communicate the decision Celebrate achievement Measure the impact 57

B 2 Legislation and guidance on conflicts of interest, balancing resources and minimising risk Guidance, e. g. : the DH Decision Support Tool, five-step framework, NICE and NHS guidance on Care Pathways and Care Plans, Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups (2013) (NHS), HSE guidance on risk assessments. NICE and NHS guidance on Care Pathways and Care Plans • The steps taken to care for and treat a service user are called care pathways; care plans are drawn up for the service user based on the care pathway. • pathways implement national standards of care, such as those produced by NICE and the NHS. • They are developed by multi-disciplinary teams. • They identify who carries out key parts of the care or treatment and where care or treatment should be delivered. • pathways usually include decision support systems to help make ethical decisions about appropriate care in specific circumstances Managing Conflicts of Interest: Guidance for Clinical Commissioning Group (2013) (NHS) Clinical Commissioning Groups: Organisations that are responsible for the provision of NHS services in England. They manage conflicts of interest as part of their routine. The Health and Social Care Act 2012 sets clear guidelines for CCG’s to manage conflicts of interest. This allows the CCG to demonstrate that they act fairly and transparently and in the best interests of their patients and local community. (On You. Tube you can search for the CCG in your local area and see what types of things they do) HSE guidance on risk assessments The Health and Safety Executive (HSE) provides guidance to businesses about carrying out risk assessments. They look at in order to: 1) control risks in the workplace 2) keep everyone working in the business as safe as possible 3)ensure that businesses do not break health and safety laws There are factors that need to be taken into account when using this guidance, including religion, personal choice and government policies. • Personal choice: For example, someone may be entitled to free care but may decide to pay for their care instead. • Religion: Someone may refuse to have a blood transfusion that they need because of religious beliefs. • Government policies: A healthy eating campaign may be put on hold whilst resources are directed at stopping people from smoking in public places. 58

Coursework Time! Learning Aim B P 3 Explain how to incorporate ethical principles into the provision of support for individuals with different needs. (5) P 3. You must show that you have planned and carried out research on the different ethical principles using appropriate search techniques. (6) P 3. You should produce evidence of your understanding that is up-to-date, wellreferenced and relevant. (7) P 3. Your conclusions about the impact of ethical principles must be supported by examples from your research. Checklist: • Explain the ethical principles of consequentialism, deontology, principlism, virtual ethics. What do they mean? • Can you link them to an individual’s care? Use your case studies. • Explain how that particular ethical principle would work with the individual. • Explain what conflicts of interest are. How are these overcome? What issues can you find in your case study? • How can a carer incorporate ethical principles when dealing with an individual? Learning Aim B M 3 Analyse how an ethical approach to providing support would benefit specific individuals with different needs (20) M 3. You will carefully consider different ethical theories and approaches and draw conclusions about how the application of each one may impact on meeting individual care and support needs. (21) M 3. You must demonstrate understanding of more complex influencing factors such as the ethical issues on maintaining confidentiality. 59

Coursework Time! Learning Aim B D 2 part Justify the strategies and techniques used to overcome ethical issues and challenges experienced by individuals with different needs when planning and providing care. (30) D 2. You will make reasoned judgements about different ethical issues and their influence on planning support to meet individual care and support needs. (31) D 2. You must suggest how professionals could best minimise risk and balance resources, to reach a justified conclusion of how this can have a positive impact on the individual. Justify Give a reason to support an argument/ give an explanation for something/ defend a point of view. This might reasonably involve discussing and discounting alternative views or actions. There may be positives and negatives. Look at the legislation you have covered! What ethical issues may you face? How can these issues be overcome? What strategies can be used to overcome some individual’s ethical issues? 60

C 1 Enabling individuals to overcome challenges Different types of challenges faced by individuals with care and support needs, to include: awareness and knowledge, practical challenges, skills challenges, acceptance and belief challenges , motivational challenges, communication challenges People who have care and support needs face different types of challenges. Awareness and Knowledge: Examples: People may not be aware of any funding that they can obtain to help them with their needs. The service provider may not be keeping up to date with government policies or polices within their establishment meaning that the service user will not get the care or support that they are entitle to. Practical challenges Some people may need help with cooking or washing themselves. Skills and challenges Someone who is elderly and has mobility issues may wish to find out what help is available to them locally but cannot work a computer to find information online or perhaps cannot use a phone. 61

C 1 Enabling individuals to overcome challenges Different types of challenges faced by individuals with care and support needs, to include: awareness and knowledge, practical challenges, skills challenges, acceptance and belief challenges , motivational challenges, communication challenges Acceptance and belief Someone may have had an accident which has had an impact on their mobility. Perhaps they have lost a limb. They may find this hard to accept and they may feel like they have lost their independence. Motivation Someone may be very obese and find they don’t have the motivation to exercise or diet. Communication If someone is losing their sight or vision they may find it more challenging to communicate to other people. Taking each of the headings add other examples in a mind map. 62

C 1 Enabling individuals to overcome challenges Methods of identifying challenges, to include observation, focus groups, talking to individuals informally or via questionnaires. Explain what is meant by the terms below in relation to identifying challenges, and give examples. • Observation • Focus groups • Talking informally • Providing questionnaires . 63

C 1 Enabling individuals to overcome challenges Strategies used to overcome challenges, to include educational information materials, training courses, opinion leaders, clinical audits, computer-aided advice systems, patientmediated strategies. List the forms of educational informational material which are available to individuals. E. g. DVD These educational information materials inform people about current thinking on how to live healthily and they give advice on how to overcome challenges. They help to raise awareness and knowledge. Training courses • These are for carers and professionals. • They allow people to understand certain conditions and the needs of the people with those conditions. • They can help carers to learn how to care for a certain individuals needs, such as someone with dementia or autism. • If you care for someone who is unable to move you can learn how to move them without injuring yourself. • Organisations such as local councils and hospitals run these courses, and there also courses available online, covering a wide range of challenges. • Training courses are also used to educate service providers about the latest developments in their area of care Opinion leader • Well-known individual or organisation Anyone who has an active voice in a community, who speaks out and is often asked for advice. • Chief executives of bodies such as the NHS, Skills in Care or Care England • They can use their influence to motivate health and social care service providers to achieve the best possible care for service users. • Famous people can influence public opinions and make changes. 64

C 1 Enabling individuals to overcome challenges Strategies used to overcome challenges, to include educational information materials, training courses, opinion leaders, clinical audits, computer-aided advice systems, patientmediated strategies. Clinical audits • A systematic review of care based on standards of best practice and explicit criteria. • Based on the results, changes are then implemented, wherever necessary. • Check that organisations are acting fairly without discrimination. Computer-aided advice systems • Online decision support systems that supply service providers with specific information, such as to pharmacists and doctors when they are prescribing medication. • These systems provide prompts designed to reflect best practice and remind service providers to take or avoid a certain action. Patient-mediated strategies • Provide information via mass-media campaigns to service users and the wider public about the latest evidence-based practice. • These strategies also educate and motivate service providers about changes in practice. 65

C 1 Enabling individuals to overcome challenges Role of policy frameworks in minimising challenges, including: NHS Patient Experience Framework, in particular understanding of the eight elements that are critical to the service users' experience of NHS services. Health Action Plans and how they are used to minimise challenges. Adult Social Care Outcomes Framework (ASCOF). Common Assessment Framework (CAF) https: //www. gov. uk/government/uploads/system/uploads/attachment_data/file/21515 9/dh_132788. pdf NHS Patient Experience Framework Read the information in the link. Explain each of the 8 elements. http: //www. jpaget. nhs. uk/media/186362/health_action_plans. pdf NHS Health Action plan Using the information in the link, explain what a Health Action Plan is. And how they are used to minimise challenges. If you need more information just google NHS Health Action Plan and you will see a number of examples. https: //www. gov. uk/government/publications/adult-social-care-outcomes-frameworkascof-2015 -to-2016 Adult Social Care Outcomes Framework How are these used to minimise challenges? http: //www. project 6. org. uk/information-advice/a-guide-to-the-common-assessmentframework-caf/ Common Assessment Framework http: //greatermanchesterscb. proceduresonline. com/pdfs/caf_guidance_practitioners. p df Working in small groups research and create a presentation, for the rest of the class, on one of the above. Make sure you include a short test on the information you have provided and a handout. 66

C 1 Enabling individuals to overcome challenges Impact of not enabling individuals to overcome challenges. If people are not helped in anyway to overcome the challenges and difficulties they face then this could have an impact on their health. Challenges people may face. In pairs pick three from this list: • Awareness and Knowledge • Practical challenges • Skills and challenges • Acceptance and belief • Communication • motivation Pick one of the policies you have studied and state which challenges the policy may help to overcome. 67 Strategies to overcome challenges. Pick one strategy to overcome three challenges you picked. Explain how the strategy might help a person overcome those challenges. • Educational information • Training courses • Opinion leaders • Clinical audits • Computer aided device systems • Patient-mediated strategies

C 2 Promoting personalisation Personalisation – ensuring that every person receiving care and support is able to set their personal goals and has choice and control over the shape of their care and support Methods of recognising preferences, to include care plans, learning plans, behavioural plans, specialist support from health and social care professionals The importance of promoting choice and control and the financial impact of this on care provision. https: //www. england. nhs. uk/wp-content/uploads/2016/04/core-info-care-supportplanning-1. pdf Additional reading! https: //www. youtube. com/watch? v=m. Que-_fq 0 Ag Care and Support Planning and The Care Act 68

https: //www. youtube. com/watch? v=bdtwe-A 2 O 60 Personalisation – making it happen: the social worker’s perspective Social Care Institute for Excellence 69

https: //www. youtube. com/watch? v=PCb. T 31 L-og. A Personalisation for someone with a physical disability 70

C 3 Communication techniques Different approaches for effective communication, to include humanistic, behavioural, cognitive, psychoanalytical and social. There a range of different approaches for effective communication: • Humanistic • Behavioural • Cognitive • Psychoanalytical • Social In small groups pick one of the approaches above. Research the approach and produce a presentation to the rest of the class. Think of one example of a situation in a health and social care setting where a professional could use theory to work with a service user. . 71 Strengths Weaknesses Humanist Personcentred Non-intrusive, meet as equals • Unconditional, depends on basic trust in the service user • Uses a positive manner, thoughts and actions, empathy, shows respect • Gives person choices and believes they can change their lives • Positive approach • Used in lots of situations Ignores behaviour • Short term • Relies on good communication skills • Uses complicated terms • Hard to be non-judgemental Behavioural Looks only at observed behaviour Objective, so people can agree about what is happening • Easy to understand • An approach that comes naturally • Doesn’t rely on communication skills, so works with all ages and abilities, eg a baby imitating adults to acquire language skills Doesn’t look at what’s going on inside someone’s head, so limited • Deals with symptoms not causes, so can be short term • Can only be used to change behaviour Cognitive Structured approach of understandi ng and changing behaviour Easy to understand, logical and makes sense to service users • Takes notice of what service users think and feel • No interpretation or hidden meaning Relies on good communication skills, need to express thoughts and to understand what service providers want the individual to do • Rational approach, so not suitable for those who don’t have a rational mind • Only one problem worked on at a time

C 3 Communication techniques Different approaches for effective communication, to include humanistic, behavioural, cognitive, psychoanalytical and social. Psychoanalytical Interprets what the person says and does Effective • Gives service users insight into why they think or feel as they do, so gets deeper into problems • Can change many parts of lives, not just behaviour • Can be used for a wide range of problems Very complicated to use • Needs specialist training • Based on service providers’ analysis Lengthy Social Studies individuals in a social context Uses real-life situations when studying behaviour • Uses the results from experiments, such as the BBC prison study, to explain and offer solutions to an individual’s problems • Helps understanding of social behaviour in genera Presence of observer may have a negative effect on participants • Findings are generalised • Members of the group being studied may not be representative of population as a whole, ie they may be more motivated Psychoanalytical https: //www. youtube. com/watch? v=6 n. EL 44 Qk. L 9 w Getting Help - Psychotherapy: Crash Course Psychology #35 Crashcourse 72

C 3 Communication techniques Types of communication examples, to include verbal, body language, written, formal and informal. For the following headings discuss ways in which people communicate through body language. Use the video clips to help you. • Posture • Facial Expression • Eye Contact • Use of touch • Gestures • Personal space (add extra detail if possible) 73

C 3 Communication techniques Types of communication examples, to include verbal, body language, written, formal and informal. Verbal communication is important. It is vital that we think about our tone of voice, pitch and that the language that we use is appropriate for the person that we are communicating with. For example, using slang can cause confusion. If we have an accident and we are speaking in our local dialect it can be difficult for other people to understand us. There are many occasions in health and social care where emotions are involved. It is important for a professional to assess the situation by reading the body language of the person they are speaking to and listen to what is said to ensure the two do not contradict each other. Holly gave birth 3 months ago. She has struggled to bond with her baby. A health visitor is having a conversation with Holly. She asks if she if feeling ok. Holly says that she is fine but then breaks down in tears. She again states to the health visitor that she is ok. The health visitor comforts Holly and through questioning establishes that Holly is probably suffering from postnatal depression and arranges for her to see her doctor. Can you think of any barriers that could affect verbal communication? What is the barrier and how could you overcome this? 74

C 3 Communication techniques Types of communication examples, to include verbal, body language, written, formal and informal. Written communication • This can be used to keep records and write reports. • Different types of communication need different styles of writing and different ways of presenting information, but all require literacy skills. • written information must be clear and writing needs to be well structured and legible, with grammar, spelling and punctuation used correctly. • A more formal style of writing and language are needed when recording information about a patient • Written communication could be used by a Doctor who has to write to another consultant about a patient. • When else may written communication be necessary? Formal communication • Think of the way your doctor speaks to you. ‘Good afternoon. How are you feeling today? ’ • This show respect for others. • Formal conversation is often used when a professional person speaks to a service user. • They use clear language to avoid misinterpretation. • Informal communication is the way in which you probably speak to your friends and family. It is much more relaxed. People often use slang and local dialect. ‘Hi, how are you? ’. • Informal communication is warm and friendly. • 75 Watch the Ali G clip https: //www. youtube. com/watch? v=SZ 6 k 8 tdd. Dxg. Parkinson uses a very different style of language compared to Ali G.

C 3 Communication techniques Alternative communications, to include Makaton, British Sign Language (BSL), braille, communication boards and symbol systems. Makaton is a method of communication that uses signs and symbols. Unlike British Sign Language, it uses speech as well as actions and symbols. Makaton uses picture cards, and ties facial expressions to a word to make the word more easily recognised by those with learning difficulties. Watch the clips. How can Makaton be used in the health care and early years professions? 76

C 3 Communication techniques Alternative communications, to include Makaton, British Sign Language (BSL), braille, communication boards and symbol systems. British Sign Language • BSL is a language in its own right. • It was first recognised in the UK in 2003. • BSL uses visual signs instead of sounds. • These are made up of the shapes, positions and movements of the hands, arms or body and facial expressions. • Sign language is commonly used by families and friends of deaf people, as well as by those who are deaf or hard of hearing • • • The Braille system is a method used by blind people to read and write. It was devised in 1821 by Louis Braille, a Frenchman. Braille is a system of raised marks that can be felt with the fingers. Each Braille character is made up of six dot positions, arranged in a rectangle. A dot may be raised in any of the six positions to form sixty four possible combinations and these raised dots are read by touch Pictures can be used to communicate with people who have no ability to speak or use a language • People with autism use picture cards as they tend to learn visually and communicate with images and pictures. • Communication boards are also used with people who have suffered a stroke or other brain injury. (Watch video clip 1 and 2 to see examples of this) • Makaton and communication boards are examples of systems that use symbols. Symbol systems are used with children and adults who are either not able to use speech effectively or cannot use speech at all. • These systems enable them to share information with others and to receive messages back, by pointing to the symbol that conveys what they want to communicate. • Some symbols are pictures or photos and others may be tactile – actual objects or parts of objects to touch. • Symbols can be arranged in order to let the person know what will be happening on a particular day. Commercial symbol systems are also available (Watch video 3 and 4 for examples) • • 77 https: //www. youtube. com/watch? v=RO 6 dc 7 QSQb 4 Using Visuals to Teach Autistic Students (VIDEO 1) https: //www. youtube. com/watch? v=kiq. Yapgu 69 g Using an Aided Language Support During Direct Instruction (VIDEO 2) https: //www. youtube. com/watch? v=ICa 2 g_F_c. Ts Tangible Symbols (Chapter 2 of 6) (VIDEO 3) https: //www. youtube. com/watch? v=Vin. L 5 cx. TCDs Using Picture Symbols for Communication (VIDEO 4)

C 3 Communication techniques Theories of communication, to include Argyle, Tuckman, Berne Sender Encoding Message Received Decoded Nose Feedback https: //www. youtube. com/watch? v=Btj 94 IHVc 6 I&t=97 s The Communication Process Model Captioned Argyle Watch the clip and explain the diagram above. 78 Response

C 3 Communication techniques Theories of communication, to include Argyle, Tuckman, Berne Michael Argyle (1925– 2002), a social psychologist, specialised in the study of interpersonal behaviour, social skills and body language, or non-verbal communication. He found that non-verbal signals can be more important than verbal communication in conveying people’s attitudes. His research showed that, when you talk to a stranger, your gaze tends to be averted but, with a close friend, you make direct eye contact more often. Argyle said that feelings of friendship and a positive attitude can be encouraged simply by looking at people in the right way. He also said that it was important not to let verbal and non-verbal signals conflict Stages: 1. There is an idea or aim that an individual wishes to pass to another person. 2. Message coded: the individual decides how the message is going to be sent, this could be verbally or on-verbally. 3. Message sent: The message is conveyed to another person. 4. Message received: the message is received by another person or people. This could be hearing the message or reading it. 5. Message decoded: the person who receives the message makes sense of this. This can cause problems as it may be misinterpreted, e. g. body language. 6. Message understood: The message is understood in the way it is intended. This could be demonstrated by feedback, questions etc. 79

C 3 Communication techniques Theories of communication, to include Argyle, Tuckman, Berne Psychologist Bruce Tuckman first came up with the memorable phrase "forming, storming, norming, and performing" in 1965. He used it to describe the path that most teams follow on their way to high performance. Forming • A group of strangers come together; there is high dependence on the group leader. • They talk about themselves and share information. Storming • The members of the group starts to fall out with each other as they compete for position, so there are tensions within the group. • There is disagreement about how the group acts Norming • Things calm down in the group. • The group comes to an agreement on group values, either consciously or unconsciously. Performing • The group is sorted, with any disagreements resolved positively. • The group works effectively and members look after each other. https: //www. youtube. com/watch? v=n. FE 8 Iao. In. QU Forming, Storming, Norming, and Performing: Bruce Tuckman's Team Stages Model Explained 80

C 3 Communication techniques Theories of communication, to include Argyle, Tuckman, Berne Theory of Transactional Analysis – Eric Berne A transaction occurs when people meet and communicate. Berne’s suggests that we have three alter ego states. He believes that when we communicate we are in one of the states. These are not age related. All three are present without any one being more dominate than another Parent The parent state is the one of authority. Positive - Nurturing Negative - Controlling Adult The adult state is one of maturity and being able to act responsibly Child The child state is one of dependence. Positive – cooperative and spontaneous Negative – Resistant and immature Berne suggests that we function in one of these modes depending on the situation we are in at the time. At the core of Berne's theory is the rule that effective transactions (i. e. successful communications) must be complementary. . For example an adult might ask another adult a simple question which has a factual interchange. E. g. ‘Have you seen my socks? ’, response, ‘No’. They must go back from the receiving ego state to the sending ego state. For example, if the stimulus is Parent to Child, the response must be Child to Parent, or the transaction is 'crossed', and there will be a problem between sender and receiver. If a crossed transaction occurs, there is an ineffective communication. This can cause one or both people to become upset. For Example: (Adult mode question, expecting Adult response) “What time are you back later? ” (Child mode responding to perceived Parent figure) “I dunno, your always having a go at me!” 81

C 3 Communication techniques New technologies and communication techniques Voice output communication aids (VOCA) Turn small movements into written word and then into speech. Watch the two clips below and make notes. https: //www. youtube. com/watch? v=OTm. Pw 4 iy 0 hk Stephen Hawking's Voice and the Machine That Powers It https: //www. youtube. com/watch? v=Xq 1 a. PKSn. Y Speaking for Myself Notes: 82

C 3 Communication techniques New technologies and communication techniques Maggie has Retts syndrome. This is a neurological disorder that affects mainly females. It leads to severe impairments, affecting nearly every aspect of the child's life: their ability to speak, walk, eat, and even breathe easily. Maggie now uses a VOCA to communicate to others. Watch the two clips. How has the VOCA had an impact on her life and that of her family? https: //www. youtube. com/watch? v=P 6 ql. Av. FSH 10 How To Talk to A Non-Verbal Kid Magnolias Hope https: //www. youtube. com/watch? v=R_1 U 4 Jma. YB 8 An Actual Conversation With Maggie | Rett Syndrome Magnolias Hope Voice activated software can turn spoken and written words into movement, such as instructing the user’s wheelchair to move. 83

C 3 Communication techniques New technologies and communication techniques Text relay service is operated by the charity Action on Hearing Loss. This service makes it possible for a person who can’t speak and/or hear to text their message to an operator, who then reads it to a hearing person. The operator types the reply so that the original sender can read it https: //www. youtube. com/watch? v=dk-F 3 uxy 9 RE What is a relay call? Mobile phones can vibrate so that someone know that they have received a message. Hearing aids. are devices with small microphones that pick up and increase the volume of sound. They are battery operated, very small and light and many are hardly noticeable as they are tucked behind the ear. https: //www. youtube. com/watch? v=CJk. H 31 uy 8 xo My deaf child and hearing technology National Deaf Children's Society https: //www. youtube. com/watch? v=PO 05 Wq. Hx 8 rk Deaf boy listens to music through his hearing aids How has a hearing aid and technology improved Alex’s quality of life? 84

C 3 Communication techniques New technologies and communication techniques A loop system • A hearing loop (sometimes called an audio induction loop) is a special type of sound system for use by people with hearing aids. • It boosts the signal in someone’s hearing aid. • They help those with hearing loss to focus on particular sounds, like a person talking, near the loop’s internal microphone. • In conditions without a hearing loop, all sounds including background noise are amplified making it sometimes difficult to focus on one sound. https: //www. youtube. com/watch? v=hlnx 3 ZIm. Tw 0 How Hearing Loops Work: What is a Hearing Loop and how does it work? OTOj. OY - Your Hearing Loop Experts Braille software is used by those who are visually impaired. It creates Braille that is printed out using a special printer. The software comes in a wide range of packages, including those that create mathematical, musical and text Braille, and those that translate different languages https: //www. youtube. com/watch? v=Nxs 369 C 2 Wl. E Unified English Braille - A Beginner's Guide from Dolphin Watch the clip. Look at how this piece of software aids the user. Speech recognition software Can be used by the visually impaired, or those with dyslexia, to generate messages without using a computer keyboard. Speech recognition is the ability of a machine or programme to identify words and phrases in spoken language and convert them to a machine-readable format 85

Coursework Time! Learning Aim C P 4 Explain the strategies and communication techniques used with individuals different needs to overcome different challenges. Explain Give reasons for how or why something happens; you need to give examples. • • • What strategies are there? Explain each one. What communication techniques are there? How are they used to help people to communicate? What type of different needs to people have when it comes to communicating? Give examples For each example what is used to help/overcome the communication difficulty of the individual? (8) P 4. You will recall and relate in some detail, knowledge of the strategies and communication techniques used by professionals. (9) P 4. Evidence must be supported by examples of the challenges faced by the individuals in each case study and you must state whether the approach used was successful or not. (10) P 4. You could also explain the relevant legislation or codes of practice. (11) P 4. You must explain the key principles of the communication techniques that each professional used and explain, using reasoned arguments, the impact that these have had on each individual. 86

Coursework Time! Learning Aim C P 5 Explain the benefits of promoting personalisation when overcoming challenges faced by individuals with different needs. Explain Give reasons for how or why something happens; you need to give examples. (12) P 5. You will recall knowledge relating to the care and support needs of each individual and relate it to how each professional promotes personalisation and recognises individual preferences and promotes choice when enabling individuals to overcome challenges. (13) P 5. When explaining the benefits of this approach, you could contrast it with the possible outcome for individuals if preferences and choices were not taken into account. 87

Coursework Time! Learning Aim C M 4 Assess the strategies and communication techniques used to overcome different challenges faced by individuals with different care and support needs. Assess Consider several options or arguments and weigh them up so as to come to a conclusion about their effectiveness or validity This ties in closely with learning aim C P 4. Explain the strategies and communication techniques used with individuals different needs to overcome different challenges. What is the difference between the two. What extra do you need to include to reach LA C M 4? (22) M 4. You will use vocational language to analyse the success of strategies and communication techniques when used by professionals to overcome the challenges faced by individuals with care and support needs. (23) M 4. You will also explore the impact of challenges on individuals and how professionals use a variety of approaches to enable individuals to overcome such challenges. (24) M 4. You could research the range of legislation and codes of practice used when overcoming challenges, using information from recognised sources. 88

Coursework Time! Learning Aim D 2 part Justify the strategies and techniques used to overcome ethical issues and challenges experienced by individuals with different needs when planning and providing care. Justify Give a reason to support an argument/ give an explanation for something/ defend a point of view. This might reasonably involve discussing and discounting alternative views or actions. There may be positives and negatives. (32) D 2. You will draw together your understanding of strategies that can be used to overcome the challenges faced by individuals. (33) D 2. You must consider the advantages and disadvantages of the strategies and use detailed analysis and research to reach reasoned and valid conclusions and recommendations. (34) D 2. You must also explore a range of legislation and codes of practice and their influence in overcoming challenges, the ethical issues, the resulting conflicts of interest and how they can be resolved. (35) D 2. You must consider the different approaches used by professionals when communicating with individuals with care needs and make reasoned judgements about the success of the communication techniques used. 89

Assignment 2: Learning Aim D Investigate the roles of professionals and how they work together to provide care and support necessary to support individual needs. 90

D 1 How agencies work together to meet individual care and support needs Role of organisations responsible for commissioning healthcare services, e. g. Clinical Commissioning Groups in England, Local Health Boards in Wales, Health and Social Care Board in Northern Ireland; formation, organisation roles and members Clinical Commissioning Groups: • Created following the Health and Social Care Act 2012. • Replaced Primary are Trusts in 2013. • Enabled GPs to commission services for their local community along with other health professionals. • CCGs’ governing bodies are made up of GP, Nurse and secondary care representatives and at least two people who are not part of the NHS. • All GP practices have to be a member of a CCG. Local Health Boards in Wales: • Formed in October 2009 • Consists of seven Health Boards working alongside three NHS Trusts • To redesign the delivery of the NHS in Wales, • to improve health outcomes and deliver care effectively with its partners. • Responsible for planning, funding and delivering primary care services such as GPs, pharmacies, • Strong emphasis on public health and long-term planning • Also look at complaints against GPs, dentists, pharmacists. Health and Social Care Board in Northern Ireland: • Accountable to the Health Minister • Formed in April 2009 • Consists of five Local Commissioning Groups and five Health and Social Care Trusts (covering the same local areas) • To reform and modernise the management of health and social care services • To integrate provision of services in an efficient, effective and economic manner • Effective commissioning of health and social care services, resource management, performance management and service improvement Role of organisations responsible for commissioning social care services, e. g. Local Authorities. • • • 91 Local authorities’ statutory responsibilities for public health services are set out in the Health and Social Care Act 2012 Local authorities commission social services to achieve personalised, community based support that promotes health and wellbeing by using evidence, local knowledge, skills and resources as best they can. Local authorities work in close partnership with other organisations, such as housing and NHS partners, using guidance such as the Adult Social Care Outcomes Framework, Making it Real statements and the Public Health Outcomes Framework.

D 1 How agencies work together to meet individual care and support needs Role of bodies responsible for integrating health and social care, e. g. Health and Wellbeing Boards (HWB). • • • Health and wellbeing boards were established under the Health and Social Care Act 2012 to act as a forum in which key leaders from the local health and care system could work together to improve the health and wellbeing of their local population. The HWBs enable different organisations to work together in planning and delivering local services. For example, the NHS, Adult social care services, Children’s services and Youth services. Health and Wellbeing Boards are where representatives from the health and social care sector work together to improve the health and well-being of their local population. They report to the clinical commissioning groups and local authorities. These boards are at the centre of the Care and Health Improvement Programme, introduced in April 2015, which aims to help HWBs develop their leadership and better support the integration of services https: //www. kingsfund. org. uk/publications/health-wellbeing-boards-explained Read the information in the link and add to the notes that you have. 92

D 1 How agencies work together to meet individual care and support needs Role of assessment and eligibility frameworks, to include Common Assessment Framework (CAF), the National Eligibility Criteria (Care Act 2014), Department of Health, National Framework for NHS Continuing Healthcare. The Education, Health and Care plan (EHC http: //greatermanchesterscb. proceduresonline. com/pdfs/caf_guidance_practitioners. pdf Additional reading Common Assessment Framework https: //www. youtube. com/watch? v=ZFb_lvqz. JXw CAF Training video Watch the clip and make notes. What is CAF? Record some of the examples given about some of the people they have helped, why that person needed help, what help they received etc. 93

D 1 How agencies work together to meet individual care and support needs Role of assessment and eligibility frameworks, to include Common Assessment Framework (CAF), the National Eligibility Criteria (Care Act 2014), Department of Health, National Framework for NHS Continuing Healthcare. The Education, Health and Care plan (EHC National Eligibility Criteria (Care Act 2014) or the Care and Support (Eligibility Criteria) Regulations 2014. Sets out national eligibility criteria for access to adult care and support and for access to carer support. http: //www. legislation. gov. uk/ukdsi/2014/9780111124185 Additional reading Make notes from the additional reading 94

D 1 How agencies work together to meet individual care and support needs Role of assessment and eligibility frameworks, to include Common Assessment Framework (CAF), the National Eligibility Criteria (Care Act 2014), Department of Health, National Framework for NHS Continuing Healthcare. The Education, Health and Care plan (EHC The Department of Health • Sets national policy • Creates legislation • Allocates funding for health care https: //www. gov. uk/government/organisations/department-of-health/about (Additional information) 95

D 1 How agencies work together to meet individual care and support needs Role of assessment and eligibility frameworks, to include Common Assessment Framework (CAF), the National Eligibility Criteria (Care Act 2014), Department of Health, National Framework for NHS Continuing Healthcare. The Education, Health and Care plan (EHC https: //www. youtube. com/watch? v=Ki 520 q. Aj. NTg Education, Health and Care plans Educationgovuk Make notes from the clip. 96

D 2 Roles and responsibilities of key professionals on multidisciplinary teams Multidisciplinary teams, members and formation https: //www. youtube. com/watch? v=BGk. I 49 l. IA 2 I Health and Social Care Multi-Disciplinary Team Meetings NHS Newham Clinical Commissioning Group What is a multidisciplinary team? What type of things do they discuss? Who is involved? 97

D 2 Roles and responsibilities of key professionals on multidisciplinary teams Specific roles and responsibilities relating to meeting individual needs of a variety of health and care professionals in a multidisciplinary team, to include: Health Care professionals Social Care professionals Education Professionals Allied Health Professionals Voluntary Sector workers In groups research the roles and responsibilities of each of the health care professionals in RED, identified in the Power. Point. Example below. Nurse 98 Roles Responsibilities • Provide hands-on care to patients • Provide emotional support to patients and their families Help patients, e. g. by administering medicines, monitoring conditions, maintaining records, providing health promotion and other information, communicating with doctors

How multi-agency and multidisciplinary teams work together to provide co-ordinated support, e. g. an autistic child may have involvement with the following agencies and professionals: NHS (GP, paediatrician, clinical psychologist, counsellor, speech and language therapist), local authority and education services (social worker, SENCO, educational psychologist), and the voluntary sector (family support officers from the National Autistic Society). Each of the following people need support from a multi-disciplinary team. Who would be in each team and what help would they provide? Sarah is 13 and suffers from Anorexia Kamal is 40 and has recently been diagnosed with diabetes. Ben is 7 and has Attention Deficit Hyperactivity Disorder (ADHD) and is Dyslexic. Lucy is 3 years old and says very few words. Most things that she says are not clear or easily understood. 99

How multi-agency and multidisciplinary teams work together to provide co-ordinated support, e. g. an autistic child may have involvement with the following agencies and professionals: NHS (GP, paediatrician, clinical psychologist, counsellor, speech and language therapist), local authority and education services (social worker, SENCO, educational psychologist), and the voluntary sector (family support officers from the National Autistic Society). Tim is 45 and lives alone. He suffers from epilepsy and can often have fits. Tim suffers from depression and often doesn’t bother to take his medication as he can’t see much point. Carole is 19 and lives at home with her mother. She is morbidly obese and doesn't go outside. She has very few friends and spends most of her time on social media in order to communicate with others. Her mother is worried about her and often gives into Carole when she wants to eat ‘junk’ like foods such as chocolate and crisps. Carole says that she eats because it comforts her when she is feeling down. 1. 2. 3. 4. 100 What input might each person require from the NHS, Social Services and Voluntary Services? Why is the involvement of different agencies necessary to meet the needs of each individual? Explain the roles and responsibilities of different members of the multidisciplinary team that you have identified. Assess the benefits of multi-disciplinary and multi-agency working for these individuals with care and support needs.

Coursework Time! Learning Aim D P 6 Explain why meeting the needs of the individuals requires the involvement of different agencies Learning Aim D P 7 Explain the roles and responsibilities of different members of the multidisciplinary team in meeting the needs of specific individuals Explain Give reasons for how or why something happens; you need to give examples. (36) P 6/7. You will determine the level of impact that the roles and responsibilities of three members of the multidisciplinary team from the case studies have in meeting individual support needs, and how organisations work together to commission and provide care for individuals. (37) P 6/7. You must show that you understand how support from different disciplines can be combined to provide a full package of care for the individuals. Have you explained the difference between a role and a responsibility? For a particular individual which professionals are involved in their care? Why have they not got just one professional? Have you explained what multidisciplinary means? Have you explained each professional that is involved with one individual’s care and what that professional’s role and responsibility is? What else could you include here? 87

Coursework Time! Learning Aim D M 5 Assess the benefits of multidisciplinary and multi-agency working for specific individuals with care and support needs. Assess Consider several options or arguments and weigh them up so as to come to a conclusion about their effectiveness or validity (41) M 5. You will give supported reasons for the benefits of organisations and professionals on multi-agency and multidisciplinary teams providing co-ordinated care and support for individuals. (42) M 5. You must make reasoned, analytical judgements on the benefits of multidisciplinary working, showing the way that the roles of different team members interrelate and work together to meet individual needs. Have you discussed the difference between multidisciplinary and multi-agency? What benefits are their to certain individuals with this type of approach? 87

D 3 Maintaining confidentiality Definition of confidentiality. Can you create a definition for the term ‘confidentiality’? How do health care workers maintain confidentiality? 103

D 3 Maintaining confidentiality Codes of practice for care workers establishing importance of confidentiality • • • Confidential information refers to information that is of a personal or sensitive nature and that is not available to the public domain. All information sharing in health and social care is guided by the Caldicott Principles. These were revised in 2013 to take into consideration the boundaries of confidentiality in relation to safeguarding. Caldicott Principles : A set of standards aimed at improving information handling in health and social care from a review commissioned by the Chief Medical Officer of England. https: //www. youtube. com/watch? v=xb. Vfz. MSZt. J 8 Make some notes on some of the rules of confidentiality and Caldicott principles NHS Information Governance 104

D 3 Maintaining confidentiality Relevant aspects of legislation, e. g. Health and Social Care Act 2012. Human Rights Act 1998 Data Protection Act 1998 Health and Social Care Act 2012 Find information on the legislations listed opposite. How can you link confidentiality to those pieces of legislation? https: //www. health-ni. gov. uk/articles/human-rights-act-1998 http: //www. scie. org. uk/care-act-2014/safeguarding-adults/sharinginformation/what-does-the-law-say. asp https: //www. gov. uk/data-protection/the-data-protection-act http: //content. digital. nhs. uk/media/12822/Guide-to-confidentiality-in-health-andsocial-care/pdf/HSCIC-guide-to-confidentiality. pdf Use the links above to get you started. Notes 105

D 3 Maintaining confidentiality Role of the Health and Social Care Information Centre (HSCIC) https: //www. gov. uk/government/organisations/health-and-social-care-informationcentre/about Read the information in the link above. Who are the HSCIC? What do they do? How do they help to maintain confidentiality? 106

D 4 Managing information Working practices for managing information There are several working practices for managing information. Take each one of the following 4 headings and explain why the procedure is important when managing information and what rules may be in place when gathering information in this way? Identifying why information is needed Identifying what information is needed Searching for the information Using information ethically and legally So for example on “Searching for the information”, answers could include : When asking for personal information, a service provider should inform the individual that the information will be recorded and that it may be shared, in order to provide appropriate care. 107

D 4 Managing information Impact of new technologies on managing information https: //www. youtube. com/watch? v=s. D 4 Qiqu. LZiw We share because we care: sharing Health records in the NHS What are the advantages of electronic patient records? • • • 108 The HSCIC’s vision is that, by 2020, there will be full service user access to national and local data. Individuals will be able to view and manage their own records, communicate with care providers and increasingly manage their own health, care and wellbeing. The HSCIC has set out a strategy with five objectives towards achieving this vision • Ensure that every citizen’s data is protected. • Establish shared architecture and standards so that everyone benefits. • Implement services that meet national and local needs. • Support health and care organisations in getting the best from technology, data and information. • Make better use of health and care information

D 4 Managing information Bodies that control the management of information, e. g. the National Adult Social Care Intelligence Service (NASCIS) The National Adult Social Care Intelligence Service (NASCIS) • Single national resource of social care information for England. • Website has a collection of data, tools and resources designed to meet the needs of service planners, managers, researchers and policy makers and others. You can view and download data on: • Referrals, assessments and packages of care • Adult social care activity • Social care expenditure • Abuse of vulnerable adults • Adult and Social Care Outcomes Framework • User experience survey • Joint strategic needs assessment • • 109 The Information Commissioner’s Office (ICO) Upholds information rights in the public interest, promoting openness by public bodies and data privacy for individuals. https: //ico. org. uk/about-the-ico/what-we-do/ Additional reading

D 4 Managing information Legislation and codes of practice that relate to the storage and sharing of information in health and social care. Legislation and codes of practice must be current and applicable to England, Wales or Northern Ireland Data Protection Act 1998 • Main piece of legislation that governs the protection of personal data in the UK • Controls how your personal information is used by everyone responsible for using data, by providing rules called data protection principles • Provides legal protection for more sensitive personal data • Gives you the right to access to your own personal data • Enables health and social care providers to share information with other professionals directly involved in providing clinical care Freedom of Information Act 2000 • Provides public access to information held by public authorities in England, Wales and Northern Ireland, and UK-wide public authorities based in Scotland • Does not give access to your own personal data • Makes public authorities accountable for their actions. Allows public debate to be better informed and, therefore, more productive Care Quality Commission (CQC) codes of practice • CQC is an independent body that speaks up for the rights of people who use care services, their families and carers, and checks that services stick to the Health and Social Care Act 2008 • One example is the 2010 code of practice for health and adult social services in England, which: • sets out the practices to be followed in obtaining, handling, using and disclosing confidential personal information • is based on a set of nine principles • includes a necessity test to decide whether it is necessary to obtain, use or disclose personal information Mental Health Act 2007 • Allows people in England Wales to be admitted to hospital, detained and treated against their consent, for their own health and safety and for that of others, so allows the storing and sharing of their personal information without their consent Mental Capacity Act 2005 • Requires professionals to consider a person’s mental capacity to consent to share information • Outlines correct procedures for making decisions in the best interest of a person who lacks the mental capacity to consent 110

D 4 Managing information Legislation and codes of practice that relate to the storage and sharing of information in health and social care. Legislation and codes of practice must be current and applicable to England, Wales or Northern Ireland. The Health and Care Professions Council (HCPC) codes of practice • • 111 HCPC is a regulator set up to protect the public, by keeping a register of health and social care professionals who meet HCPC standards for training, professional skills, behaviour and health Confidentiality – guidance for registrants 2008, slightly amended in 2012, sets out the standards of conduct, performance and ethics expected from the professionals it regulates, including management of information

Coursework Time! Learning Aim D P 8 Explain the arrangements for managing information between professionals. Explain Give reasons for how or why something happens; you need to give examples. (38) P 8. You must recall and relate knowledge and understanding of how members of the multidisciplinary team manage information. (39) P 8. You could include examples of legislation and codes of practice that the team is bound by when managing information and resolving conflicts of interest, in order to show your understanding of the issues involved. (40) Your research must be relevant to the given case studies and information must be selected and organised to reach suitable conclusions. What arrangements are in place for professionals when it comes to passing information from one person to another? For each arrangement, state why this is important. Does this link to any other areas you have studied, for example confidentiality? What else can you include in this section? 87

Coursework Time! Learning Aim D M 6 Analyse the impact of legislation and codes of practice relating to information management on multidisciplinary working. Analyse Break an issue into its separate parts. Look in depth at each part using supporting arguments and evidence for and against as well as how these interrelate (connect) to one another. (43) M 6. You will actively reflect on how codes of practice and legislation impact on multidisciplinary working. (44) M 6. You must analyse how legislation and codes of practice provide guidance for managing information, including who information can be shared with and when to share it, and this must be related to the situations in the case studies. 87

Coursework Time! Learning Aim D D 3 Justify how organisations and professionals work together to meet individual needs while managing information and maintaining confidentiality. Justify Give a reason to support an argument/ give an explanation for something/ defend a point of view. This might reasonably involve discussing and discounting alternative views or actions. There may be positives and negatives. What do you need to include in this section? (45) D 3. You will consider how different organisations and professionals on the multiagency and multidisciplinary teams work together to justify the suitability of each in providing support to meet each individual’s needs, while managing information and maintaining confidentiality. (46) D 3. You could then discuss how effective the team’s working practices are for meeting individual needs. (47) D 3. You could go on to make reasoned judgements about the importance of legislation and codes of practice in managing information and maintaining confidentiality. (48) D 3. You could draw on the roles and responsibilities of three professionals in a variety of care environments to demonstrate proficient understanding of complex situations such as end-of-life plans or child-protection cases when maintaining confidentiality becomes an ethical issue. 114

Coursework Time! Learning Aim D D 4 Evaluate how multi-agency and multidisciplinary working can meet the care and support needs of specific individuals. EVALUATE Give your verdict as to what extent a statement or findings within a piece of research are true, or to what extent you agree with them. Provide evidence taken from a wide range of sources which both agree with and contradict an argument. Come to a final conclusion, basing your decision on what you judge to be the most important factors and justify how you have made your choice. (49) D 4. You will draw on and bring together your knowledge and understanding across learning aims to make suitable judgements on how successful multi-agency and multidisciplinary working meets individual needs. (50) D 4. You must evaluate how an individual’s right to equality and independence can be promoted by multi-agency and multidisciplinary teams through enabling individuals to overcome challenges, but that this must be balanced with overcoming ethical issues. 115