Having cared for adults with psychiatric disorders in a previous career, I can
attest to the pressure not to make friends with those with whom one is working.
At the time, the justification seemed to be that one's objectivity was lost if
one got too close to "patients", and that somehow something "bad" would happen
if this happened. Maintaining a "professional distance" was inculcated from day
one of the Registered Nurse training. The concern seemed to be that one would
be "manipulated" into taking risks that might put the hospital - not the client
- at risk. The underlying message was that they were "different", and could not
know what was best for themselves. At the time Crown Immunity was in place in
the UK, so there was little or no risk to the hospital of being sued. I was
regarded as naive, because I, like John who wrote the original posting, thought
that there was a lot to be said for allowing people to take calculated risks in
their own treatment. (Of course, there was also the Mental Heath Act to take
into account in some cases).
Why this continues, I do not know. Risk of litigation maybe plays a part, but
the doctrine was in place long before the changes to the system. If I were put
on the spot, and forced to give an answer, I'd have to come down to it being an
exercise of power - what can an untrained patient tell a trained professional?
I hope this adds something to the debate.
Yours,
Jeremy.
--
Jeremy Wickins,
PhD Researcher, Biometrics and Social Exclusion,
Sheffield Institute of Biotechnological Law and Ethics (SIBLE),
Department of Law,
University of Sheffield,
169/171, Northumberland Road,
Crookesmoor,
Sheffield. S10 1DF
UK.
Tel: +44 (0)114 222 6881
Fax: +44 (0)114 222 6886
Quoting John Homan <[log in to unmask]>:
> Good morning all,
>
> My partner Sandy and I argued strongly in a paper delivered at the
> International Conference for Community Engagement in Brisbane Qld Australia
> last year (Paton, S., Homan, J., 2004, 'Learning with Amanda') that the
> criticals in the quality of life for people who are intellectually impaired
> (and everybody else for that matter) are, apart from respectful
> relationships:
> 1.. The ability and opportunity to make choices, and
> 2.. The opportunity to form relationships.
> We based this opinion on existing literature as well as empirical evidence
> with my daughter Amanda who for more than four years has been supported by a
> self directing team whose culture lead them to do just that, individually and
> collectively.
>
> Team members have built strong relationships with Amanda and a natural part
> of that is that they 'hang out' in different places, including each others
> homes, and that of friends and family. This has been demonstrably to Amanda's
> benefit, and also that of team members as it expanded opportunities for
> 'community access' beyond shopping centres and public parks.
>
> We have found it necessary to codify this natural practice in policy to
> demonstrate to service providers that:
> 1.. Life is risky, but risk may be managed, and by sharing it can be
> further reduced,
> 2.. The policy is discretionary (further reducing risk): there needs to be
> a clear benefit to the client, he family/advocates favour it, the individual
> support worker wants it, and the service provider agrees to it.
> 3.. In principle it is no different than the widely practiced Host Family
> model: 'client visits paid carers home'.
> 4.. By having appropriate insurance cover and conducting an Occupational
> Health and Safety check in support workers homes, risk may be further
> reduced.
> In spite of demonstrated benefit, more than four years of practical
> experience (involving more than 15 support workers at different times),
> credibility through the literature, and a clearly articulated policy, many
> service providers are reluctant to consider the 'Friendship Policy' as an
> option. No reasons have been given to me other than that it is not part of
> their 'policies and procedures'.
>
> Why?
>
> I would welcome some constructive discussion on this matter, through the
> lists or direct with me on [log in to unmask]
>
> rgds John
> (in sunny Yeppoon, where the Tropic of Capricorn intersects with the East
> coast of Australia)
>
> Post script: Below the actual 'Friendship Policy'.
>
> 'Friendship Policy'
>
>
>
> FlexiOptions believes that friendships are an important contributor to the
> quality of life of all people, including people with intellectual
> disabilities.
>
>
>
> S. Paton and J. Homan wrote:
>
>
>
> Operating on a traditional paradigm, many support services and government
> departments actively discourage the development of close personal
> relationships between carers and clients. It is seen firstly, as 'not
> professional' and, in line with the medical model of disability, appears
> aligned to the doctor/patient model of relationships and in many instances is
> focused solely on maintaining the physical integrity of the person. Secondly,
> relationships between staff and clients are frequently presented as placing
> the staff member in the position of 'conflict of interest.' We must ask
> ourselves: "How can this be?", if the institution, agency or service provider
> is truly focused on working in the client's best interests and providing
> quality of life, as well as physical care. The traditional paradigm assumes
> that the intellectually disabled either do not require love or friendship or
> that they are able to meet these needs outside the care network. The
> perception from the medical community that 'children like that don't need
> love' (Smith 1997 cited Croft 2000, p. 170) was in the past also used as
> justification for institutionalizing them.
>
>
>
> Work done with intellectually disabled people supports the Schalock study
> (cited McConkey R., Walsh D. and Sinclair M. n.d., p.3) which notes that the
> two most important aspects of quality of life for intellectually disabled
> people in residential care are: 'the quality and breadth of interpersonal
> relationships with family and relatives, and the extent of residents'
> involvement with their local community and their social inclusion in it.'
>
>
>
> O'Brien (1999, p.2) notes that for many intellectually disabled, 'friends'
> include individual care workers who have a strong personal commitment to the
> wellbeing of their client, and are identified by that person as a friend. He
> further suggests that excluding people from the possibility of friendship on
> the basis of their role alone runs contrary to the personal experience of
> many disabled people and their families, noting: 'Such exclusion by
> definition denies the fact that some service workers do transcend their
> roles.'
>
>
>
> The reality for many cognitively disabled people is that they do not have the
> consciousness, capacity or opportunity to initiate meaningful relationships
> for themselves. Yet, as previously noted, it is the quality of our human
> interactions and the depth of our relationships, which add real value to our
> lives. However the development of equal and respectful relationships does not
> just 'occur'. Relationships require an initial and continuing commitment of
> energy from both parties. Paton (2002, p. 8) notes that effective
> relationships are not warm, fuzzy options but require work to keep
> functioning efficiently. The level of the input into each relationship is of
> course inherently linked to the capacity of the people involved. Yet
> paradoxically while people with intellectual disabilities may be limited in
> the conscious contribution they make, many, when provided with the
> opportunity to form relationships give everything they have to give in love,
> loyalty and commitment
>
>
>
> Learning with Amanda, Paton, S., Homan, J., 2005. Pages 9 and 10
>
> (Paper presented at the International Conference for Community Engagement,
> August 2005, Brisbane)
>
>
>
>
>
>
>
>
>
> This policy addresses:
>
>
>
> 1.. Relationships between clients and support staff, and
> 2.. Access by clients to support staff's homes and properties.
> Although friendships and visiting each others homes are part of every day
> living and community expectations, there are occasions where this is not
> appropriate, and for this reason the policy is discretionary.
>
>
>
> The process is;
>
> 1.. There is recognition of the need to
> 1.. encourage a friendship between client and support worker, or
> 2.. it is considered beneficial for the client to access the support
> worker's home, or
> 3.. all of the above
> 2.. A Memorandum of Understanding is entered into between:
> 1.. Family/advocate,
> 2.. Support staff (individually or collectively)
> 3.. he service provider.
>
> When access to the support worker's home is included:
> 1.. The service provider has appropriate insurances in place.
> 2.. The WH&S Officer is asked to arrange an audit of the support worker's
> house
> 3.. The WH&S Officer works with the support worker to establish a safe
> environment.
> 4.. If there is contact with other family members of the support worker
> over 18 then register them as volunteers and request they obtain a 'Blue
> Card'
> 5.. WH&S Officers issues a Certificate of Inspection after the house has
> passed the audit.
> 6.. Where a house does not comply under the standard inspection, the
> offending matter is put in writing for the consumer/family to sign an
> agreement that they are willing to accept this risk.
> 7.. Certificate lasts 12 months
> As this system may be abused, regular discussion with all parties are
> desirable
>
>
>
> JH, 170106
>
>
>
>
>
>
>
> ________________End of message______________________
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