Chapter 31 – Garreth McCarthy (D2SOP8)
Domain 2 Standard of Proficiency 8
Be aware of and comply with local/national documentation standards including, for example, terminology, and signature requirements.
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KEY TERMS National documentation standards Local documentation standards Terminology Signature requirements |
Social care is … about meeting people at a particular stage in their lives and supporting them overcome their challenges and assist them with reaching their goals. |
TASK 1
Describe one relevant National Quality Standard Framework and discuss how this policy relates to a particular care setting. (Think of your last placement or previous social care position.)
Introduction
Social care workers in Ireland work with a diverse range of service user groups and/or individuals. They are therefore required to have an awareness and understanding of a variety of national standards. This chapter will focus on the National Quality Standards Framework (NQSF) that was devised for homeless services in Ireland. The themes and standards in the National Quality Standards Framework were predominantly adapted from those used by the Health, Information and Quality Authority (HIQA). The relevance of the HIQA standards in relation to homeless services will also be briefly discussed. There are many families with dependent children currently experiencing homelessness, so the 2017 Children First Guidelines will also be discussed; social care workers working with children have a statutory responsibility to comply with the guidelines. Challenges that social care workers experience when adhering to both the national standards and guidelines will be highlighted.
National documentation standards
The aim of the NQSF is to ensure that services that support individuals experiencing homelessness are well organised and are of a high standard. It also aims to accomplish appropriate co-ordination and integration between services, to ensure that services and practitioners are focused on supporting individuals and families to secure suitable long-term accommodation in a timely manner (within six months) (DRHE 2019). 
Section 10 permits local authorities to allocate funding to NGOs and private agencies to deliver and manage emergency and long-term accommodation for individuals/families experiencing homelessness on behalf of the government.
Interpreters contribute to assessment and intervention processes by facilitating communication, and by doing so, they gain insight into service users’ experiences, perspectives, wishes and feelings. Discrimination and oppression are common experiences for emergent bilinguals, thus facilitating communication is an anti- racist and anti-oppressive practice issue. Ensuring that services are provided in a suitable format and facilitating communication is helpful in recognising people’s language, history, culture, traditions and religion (Keating 2000). Using an interpreter when language is an issue is important to ensure understanding and gain clarity. This is particularly important when completing risk assessments, informing service users of their rights, in child protection issues, for consent to engage in services or share information to other services, and in line with General Data Protection Regulations (GDPR).
Homelessness has become a major social concern in Irish society, with both adults and children living in emergency accommodation (Hearne 2020). In 2015, the Dublin Region Homeless Executive (DRHE) devised and introduced the National Quality Standards Framework. The standards were developed in collaboration with other stakeholders, such as non-government organisations (NGOs), Tusla (the Child and Family Agency), HIQA, the Health Service Executive (HSE) and service users themselves. All statutory, NGO and private providers that receive funding under Section 10 of the Housing (Miscellaneous Provisions) Act 2009 must abide by the standards set out.
To address the overwhelming number of families entering homelessness, emergency accommodation (Family Hubs) was introduced in 2016 (O’Sullivan 2020). The NQSF was updated in 2018 to include family homeless accommodation. There is an inspection team who conduct inspections in each homeless service funded by the DRHE to ensure that organisations are adhering to the standards. There are currently 26 standards under eight themes. These are outlined on the DRHE’s website (www.homelessdublin.ie/content/files/NQSF-Standards.pdf). The terminology used in the NQSF is similar to that in the regulatory framework devised by HIQA. See HIQA’s website (www.hiqa.ie/sites/default/files/2018-11/national-standards-for-childrens- residential-centres.pdf).
Health Information and Quality Authority
HIQA is the sovereign authority accountable for ensuring safety, quality and accountability in social care and health settings. It is responsible for ensuring that children’s residential, child protection and fostering services are compliant with the standards and conducts frequent inspections (HIQA 2018). Although HIQA carries out inspections in residential homeless services for the under 18s, it is important to note that as of 2020 HIQA does not conduct inspections on family homeless emergency accommodation. The DRHE’s own inspection team is tasked with conducting assessments of family homeless services.
Family homelessness is complex
Families enter homelessness for a variety of reasons, including parental substance misuse, mental health problems, loss of employment, domestic violence and breakdowns in family relationships (Walsh & Harvey 2015). The role of the social care worker is to support family members with identifying specific needs for which they may need support and ensuring that appropriate services are provided to meet such needs. When working with families in homeless accommodation, the priority of the service is to support them to find suitable accommodation, while also ensuring that their individual needs are met. Building relationships enables the social care worker to develop trust with the service users and support them to meet those needs. Lishman et al. (2018) assert that creating positive relationships through displaying empathy and unconditional positive regard towards service users is an integral part of social care work.
Children First 2017 Guidelines
Tusla (2015) emphasise that each organisation and practitioner involved in homeless emergency accommodation has a statutory obligation to comply with the 2017 Children First Guidelines (Children First Act 2015). The economic crash in 2008 resulted in high unemployment, and over-reliance on the private housing market has caused family homelessness to soar in recent years (Kenna et al. 2018). In September 2020 there were 1,128 families with 2,583 dependent children residing in emergency homeless accommodation throughout Ireland (DHLGH 2020). The high number of children experiencing homelessness creates additional challenges for social care workers.
Children are at risk of many forms of abuse or neglect, and they can also experience bullying in social environments from other individuals or groups. Ensuring the safety of children is paramount, although it is essential for practitioners to strike a balance between safeguarding children and respecting the needs and rights of the parents and the family (DCYA 2017). There are many children from different backgrounds, nationalities and cultures living in homeless accommodation together. The Ombudsman for Children’s Office (2019) reported that living in communal areas in close proximity within family hubs caused tension among children, which led to numerous children experiencing bullying. One approach used by social care workers to address bullying in a family hub was to deliver a bullying education programme.
If a child is experiencing abuse or neglect it is imperative for practitioners to be aware it may not be intentional. The parent/carer may be struggling to cope themselves (Harris & White 2018).
This can be evident in family hubs – parents are experiencing emotional distress, which can lead to them feeling frustrated and becoming temperamental towards their children (Brand & Ciccomascolo 2020). When residing in family hubs, social care workers must ensure that children are safeguarded from any abuse or neglect, while also providing emotional support for the parents/carers.
Having to adhere to both the National Quality Standards and the 2017 Children First Guidelines can create challenges for practitioners. Completing documentations such as incident reports, risk assessments, observation logs and handovers increases the administrative workload for social care workers. Means et al. (2008) note that bureaucracy inhibits social care workers from engaging in direct practice. The NQSF places a strong emphasis on applying a person-centred approach. Each organisation and practitioner must ensure the service user is supported with developing their own independence and afforded the choice to make their own decisions. The 2017 Children First Guidelines state that it is essential that children’s safety is paramount and that all practitioners must report any concerns regarding the child’s welfare to Tusla. The NQSF was established to assist organisations and practitioners to ensure high-quality standards in the provision of services (Ombudsman for Children’s Office 2017); and Biesel et al. (2020) emphasise that the main objective of the Children First Guidelines is to protect the welfare of the child. Social care workers must ensure that the Children First Guidelines take precedence over any other framework. The following case study outlines a challenging situation typical of the kind that staff working in Family Hubs encounter.
Case Study 1
Jane is a single mother (34) who is living in a Family Hub. She has two children aged 10 and 16. Jane does shift work, which involves doing some night shifts, and she is not in a position to have someone mind her children while she’s working. On occasions, the staff team have noticed, she leaves the 16-year-old to mind his sibling while she is in work. The policy of the service states that children must be supervised at all times, and that if children are not supervised a report must be sent to Tusla.
Jane’s key worker discussed their concerns with her and Jane said that she is struggling to find people who can support her with minding the children. Jane is aware of the policy and procedure and told her key worker that she needs the job to be able to provide for her children; and the job is helping her to retain some normality in her life with the current situation she’s in.
Her key worker was unsure of the right course of action to take.
Task 2
What action would you take if you were faced with this situation? Refer to:
Tusla report forms (www.tusla.ie/children-first/publications-and-forms/)
Children First National Guidelines (2017) (www.tusla.ie/uploads/content/ Children_First_National_Guidance_2017)
Jane’s key worker brought the issue to management and was informed that a report had to be sent to Tusla in line with Children First Guidelines. Her key worker highlighted the National Quality Standards and said that the team needed to support Jane to maintain herown independence. A decision was made that the children could stay in the service with staff supervision until 10 p.m. Jane would have to be in the service at that time to ensure she is supervising her children.
The decision caused Jane to lose trust in the team as she felt her parenting ability was being undermined. It also limited the number of shifts Jane could do, which created a financial burden on the family. The positive relationship between Jane and her key worker allowed for them to discuss the situation and Jane acknowledged the gravity of the situation and appreciated the flexibility the team had provided to try support her. Jane complied with the agreement andno additional reports or further action needed to be taken. Jane was supported with securing suitable accommodation for her and the children and moved out within the next two months.
Local Documentation Standards: Holistic Needs Assessment
Organisations and practitioners working with individuals who live in emergency homeless services are provided with Housing Needs Assessment (HNA) books. The forms provide clear advice regarding the services user’s rights to give consent in relation to their information being shared. If the service user does not give or wishes to withdraw their consent, practitioners would not have the legal right to discuss any information regarding the service user. The HNA permits the service user and practitioner to develop a person-centred care plan and identify a plan to secure suitable independent accommodation. The HNA also enables the service user and practitioner to identify any additional needs for which the service user may need supports. The HNA assessment is a voluntary system and service users are given the choice of whether they wish to engage in the process. The system was introduced to ensure that service users and staff are not having to continuously engage in initial assessments. The focus is to encourage consistency within the service user’s assessment and care plan and enhance the sharing of information between organisations (DRHE 2017).
Two social care workers – Eoin, working in a homeless residential service; and David, in a community addiction service – emphasise the importance of relationship-building and communication:
‘The HNA and the Initial and Comprehensive Assessment systems are similar in design; both take a holistic approach. Both books are appropriate tools to assist the social care worker and service user with identifying specific needs and developing suitable care plans.’ Care Plans may need to be adapted or a new one devised if additional needs arise. The establishment of a good relationship between the social care worker and the service user enables honest discussionon such issues. Building a good rapport with other services will place social care workers in a good position to develop good communication between other practitioners, which prevents duplication and repetition of the work and ensures the right actions are taken to support the service user’s needs.’
A majority of people experiencing homelessness have many and complex needs. No one service has the capacity to support individuals to meet all their needs. Homeless residential services are limited in their facilities, which prevents them from being able to deliver appropriate supports to individuals who want to overcome addiction our mental health issues (O’Sullivan 2008). When engaged in the HNA system while residing in homeless accommodation the service user, with support from the practitioner, may identify specific needs in relation to addiction issues. To ensure the service user gets the appropriate support needed to overcome their addiction the practitioner would need to refer the service user to either a community or residential addiction service, whichever is deemed appropriate.
Initial and Comprehensive Assessment Book System
In 2014, an Initial and Comprehensive Assessment Book system was developed to support addiction services and practitioners to conduct initial and comprehensive assessments (Kirby 2014). The 2017- 2025 National Alcohol and Drug Strategy suggests community and residential addiction services use this system as an appropriate tool to assist with identifying suitable supports to assist and address complex needs (DoH 2017).
The book is designed with questions which are devised under specific themes including substance use, accommodation, medical, financial, treatment history, education/employment, legal and relationships. The concerns identified may change either positively or negatively and additional issues may arise. The role of the practitioner is to have an understanding and awareness of each need that was initially identified, and compare and contrast these with the service user’s current status.
Establishing specific needs ensures an appropriate care plan is devised to assist the service users with accessing the right supports. Displaying empathy and transparency towards the service user assists with building a trusting relationship. This will help the service user to feel comfortable and encourage them to disclose the precise nature of their current circumstances. Establishing a positive relationship supports the development of an effective care plan.
An example of the Initial and Comprehensive Assessment Book can be found at: www.corkdrugandalcohol.ie/wp-content/uploads/2015/04/Case-management-manual-2014.pdf.
Engaging in both the HNA and Initial and Comprehensive Assessments Care Plan systems supports social care workers and service users with identifying specific needs, which assists with devising appropriate support plans. Good communication and collaboration between all parties involved in the service user’s care plan can lead to productive outcomes for the individual.
Example
When engaging in an initial assessment the service user may not feel comfortable revealing the exact extend of their substance use. The service user may say they are engaged in a methadone programme and adhering to the prescribed dose and that their goal is to seek detox residential treatment. The care plan would be developed with the aim of making a referral to a residential detox unit and providing therapeutic supports while they are waiting to access the residential service. However, while engaged in a comprehensive assessment, which happens over time, the service user may disclose that they are also using additional substances such as benzodiazepine and cocaine. This would mean that the care plan would need to be revised and the goalmay change to suggesting the service user attend a residential or community stabilisation programme.
‘An individual who resided in our service was supported with accessing supports regarding his addiction and is now entirely abstinent from all substances and secured his own accommodation with our supports. His positive journey is inspiring.’ (Tracey, a social care worker in a residential homeless service)
Terminology Used
When discussing individuals, the terminology we have used throughout this chapter is ‘service user’. Martin (2010) asserts that the phrase ‘service user’ has for many years been the most common term in social care literature and practice settings. But it is not the preferred term in all services. Because different terms are used to describe service users in different social care settings, the language used in documents and reports is not always consistent. Homeless residential services refer to individuals as residents. Residential addiction services are primarily staffed by the medical and therapeutic professions, which means that the individuals are known as clients. Community addiction treatment (day programmes) may categorise individuals as clients or participants. As a social care worker, it is important to be fully aware of the terminology used both in the field in which you work and other fields which you engage with. Social care workers liaise with multiple agencies and professionals, which involves a diverse range of correspondence in relation to care plans, reports and referrals. Knowing and complying with the terminology used is part of being a competent professional.
Signature Requirements
In 2018, the Irish Data Protection Act was devised following the introduction of the 2018 European General Data Protection Regulations. Under the Act, all organisations, agencies and practitioners must ensure that they receive written consent from each individual who engages with their service. The individual’s right to confidentiality is at the forefront of both the HNA and Initial and Comprehensive Assessment systems. It is imperative when requesting consent that the service user is aware and fully informed of the reason why they are being asked to give their consent. As a social care worker it is important to note, as highlighted by Morley et al. (2014), that service users must be informed that their confidentiality cannot be assured if there is a disclosure of potential risk of harm to the service user or to others.
Ireland has become a multicultural society, which has led to many nationalities from different ethnicities experiencing homelessness (IHREC 2019). There can be language barriers, creating difficulties for non-Irish national service users and social care workers when seeking consent (O’Connor & Ciribuco 2017). Having a professional translator present would ensure adequate communication between both parties. Since this is not always possible, another tool used by social care workers is a translation device on their mobile phone. In addition, the HSE (2013) emphasises that service users may have limited literacy skills and difficulties with communicating, so it is important to give individuals time before they give their written consent. If the service user finds it problematic to provide written consent, having them place a mark (e.g. ‘X’) on the document to indicate consent would be sufficient.
Some useful information on this subject includes:
- Migrant Integration Strategy 2017-2020 (DoJ 2019)
- Guide to the General Data Protection Regulations (ICO 2018)
- National Consent Policy (HSE 2013)
- GDPR Consent (Intersoft Consulting website)
Some individuals who experience homelessness and/or substance misuse would have experienced mistrust, which makes them more cautious about signing any type of document. The service user could refuse their consent for the social care worker to contact specific others, as it is their legal right to do so. This can create challenges, because if consent forms are not signed the social care worker would not be in a position to discuss the service user’s case with other professionals. This in turn would prevent the social care worker from gathering or relaying relevant information needed to implement appropriate supports outlined in the care plan. This is another reason why it is so important for the social care worker to form a good positive relationship with the service user. Riggall (2012) emphasises that this is the first requirement for a practitioner when working with a service user. A positive working relationship encourages trust to develop between the two parties. It is imperative to reassure the service user that any information relayed to others is to support them to achieve their goals. You can learn more about how to develop a positive working relationship in Chapters 35, 36, 38 and 39.
Tips for Practice Educators
The basis for this proficiency is for the student to acquire an awareness of the national and local documents that outline the standards that practitioners must adhere to in social care settings. The proficiency places an emphasis on the ability to understand the requirements needed in relation to obtaining the service user’s signature, and the differences in the terminology used in specific social care settings (particularly documentation). Identifying, outlining and discussing the different national and local documents would assist the student to develop an understanding and awareness on what is required of them when on placement or working in the relevant fields.
Having the student’s complete case studies would help them develop an awareness and knowledge of national and local standards documentation and an understanding of the documents used to conduct assessments. This would encourage confidence and prepare them to be in a position to be able to apply their learning in practice.
Throughout their studies students will encounter a multitude of literature and textbooks that use the phrase ‘service user’ when discussing individuals availing of social supports. This terminology may create challenges for students as this term is seldom if ever used in the work setting. As highlighted in this chapter, there are a variety of terminologies used in different social care sectors. Identifying and discussing the various terms used in specific sectors would enable the student to be self-confident when undertaking their placement practice.
References
Biesel, K., Masson, J., Parton, N. and Pösö, T. (2020) Errors and Mistakes in Child Protection. Bristol: Policy Press.
Brand, S. and Ciccomascolo, L. (2020) Social Justice and Putting Theory into Practice in Schools and Communities. Hershey: IGI Global.
DCYA (Department of Children and Youth Affairs) (2017) Children First: National Guidance for the Protection and Welfare of Children. Dublin: Stationery Office.
DoH (Department of Health) (2017) Reducing Harm, Supporting Recovery: A Health-Led Response to Drug and Alcohol Use in Ireland 2017-2025. Dublin: Stationery Office.
DHLGH (Department of Housing, Local Government and Heritage) (2020) Homelessness Report September 2020. Dublin: Stationery Office.
DoJ (Department of Justice) (2019) Migrant Integration Strategy 2017-2020. Dublin: Stationery Office. Available at <https://www.gov.ie/en/publication/5a86da-the-migrant-integration-strategy-2017-2020/>.
DRHE (Dublin Region Homeless Executive) (2017) National Quality Standards Framework for Homeless Services in Ireland. Dublin: Stationery Office.
(2019) National Quality Standards Framework for Homeless Services in Ireland. Dublin: Stationery Office. Available at <https://www.homelessdublin.ie/content/files/NQSF-Standards.pdf>.
Harris, J. and White, V. (2018) A Dictionary of Social Work and Social Care. Oxford: Oxford University Press.
Hearne, R. (2020) Housing Shock: The Irish Housing Crisis and How to Solve It. Bristol: Policy Press. HIQA (Health Information and Quality Authority) (2018) National Standards for Children’s Residential Centres. Dublin: Stationery Office. Available at <https://www.hiqa.ie/sites/default/files/2018-11/national- standards-for-childrens-residential-centres.pdf>.
HSE (Health Service Executive) (2013) National Consent Policy. Dublin: Stationery Office. Available at <https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/consent/>.
ICO (Information Commissioner’s Office) (2018) Guide to the General Data Protection Regulations. Dublin: Stationery Office. Available at <https://ico.org.uk/media/for-organisations/guide-to-the-general-data- protection-regulation-gdpr-1-0.pdf>.
IHREC (Irish Human Rights and Equality Commission) (2019) Comments on Ireland’s 16th National Report on the Implementation of the European Social Charter. Dublin: Stationery Office.
Intersoft Consulting (online) GDPR Consent <https://gdpr-info.eu/issues/consent/>.
Kenna, P., Nasarre Aznar, S., Sparkes, P. and Schmid, C. (2018) Loss of Homes and Evictions across Europe. Cheltenham: Edward Elgar Publishing.
Kirby, J. (2014) Case Management Manual/Interagency Protocols Cork and Kerry. Cork: HSE. Available at <https://www.corkdrugandalcohol.ie/wp-content/uploads/2015/04/Case-management-manual-2014. pdf>.
Lishman, J., Yuill, C., Brannan, J. and Gibson, A. (2018) Social Work: An Introduction. London: Sage. Martin, R. (2010) Social Work Assessment. Exeter: Sage.
Means, R., Richards, S. and Smith, R. (2008) Community Care: Policy and Practice. Basingstoke: Palgrave Macmillan.
Morley, C., Macfarlane, S. and Ablett, P. (2014) Engaging With Social Work: A Critical Introduction. Sydney: Cambridge University Press.
O’Connor, I. (2006) Social Work and Social Care Practice. London: Sage.
O’Connor, A. and Ciribuco, A. (2017) Language and Migration in Ireland. Dublin: Immigrant Council of Ireland.
Ombudsman for Children’s Office (2017) Children Homeless for Two Years after Suffering Domestic Abuse. Dublin: Stationery Office.
(2019) No Place like Home: Children’s Views and Experiences of Living in Family Hubs. Dublin: Stationery Office.
O’Sullivan, E. (2020) Reimagining Homelessness: A Blueprint for Policy and Practice. Bristol: Policy Press. O’Sullivan, K. (2008) Primary Care Access for Homeless People. Dublin: Combat Poverty Agency.
Riggall, S. (2012) Using Counselling Skills in Social Work. London: Sage. Tusla (2018) Corporate Plan. Dublin: Stationery Office. Walsh, K. and Harvey, B. (2015) Family Experiences of Pathways into Homelessness. Dublin: Housing Agency.
