Supporting people's cultural and spiritual needs

CHCCCS023

SUPPORT INDEPENDENCE AND WELLBEING

LEARNER RESOURCE

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T A B L E O F C O N T E N T S

TABLE OF CONTENTS ........................................................................................................................................ 2

COURSE INTRODUCTION .................................................................................................................................. 5

ABOUT THIS GUIDE ..................................................................................................... ERROR! BOOKMARK NOT DEFINED. ABOUT THIS RESOURCE ...................................................................................................................................... 5 ABOUT ASSESSMENT .......................................................................................................................................... 6

ELEMENTS AND PERFORMANCE CRITERIA ....................................................................................................... 8

PERFORMANCE EVIDENCE AND KNOWLEDGE EVIDENCE ............................................................................... 10

PERFORMANCE EVIDENCE ....................................................................................................................................... 10 KNOWLEDGE EVIDENCE .......................................................................................................................................... 10

ASSESSMENT CONDITIONS ............................................................................................................................ 13

PRE-REQUISITES ............................................................................................................................................. 13

TOPIC 1 – RECOGNISE AND SUPPORT INDIVIDUAL DIFFERENCES ................................................................... 14

RECOGNISE AND RESPECT THE PERSON’S SOCIAL, CULTURAL AND SPIRITUAL DIFFERENCES ......................... 14

COMMUNICATE INFORMATION IN WAYS THAT ARE UNDERSTANDABLE AND RELEVANT TO DIVERSE GROUPS ............................. 15 ENSURE WORK PRACTICES ACCOMMODATE A CLIENT’S MODESTY AND PRIVACY ACCORDING TO CULTURAL REQUIREMENTS ......... 16 OTHER ACTIONS .................................................................................................................................................... 17

AVOID IMPOSING OWN VALUES AND ATTITUDES ON OTHERS AND SUPPORT THE PERSON TO EXPRESS THEIR

OWN IDENTITY AND PREFERENCES ................................................................................................................ 18

CONSIDER THE PERSON’S INDIVIDUAL NEEDS, STAGE OF LIFE, DEVELOPMENT AND STRENGTHS WHEN

ENGAGING IN SUPPORT ACTIVITIES ............................................................................................................... 19

RECOGNISE, RESPECT AND ACCOMMODATE THE PERSON’S EXPRESSIONS OF IDENTITY AND SEXUALITY AS

APPROPRIATE IN THE CONTEXT OF THEIR AGE OR STAGE OF LIFE .................................................................. 20

SUPPORT THE PERSON TO EXPRESS THEIR SEXUALITY ..................................................................................................... 21

PROMOTE AND FACILITATE OPPORTUNITIES FOR PARTICIPATION IN ACTIVITIES THAT REFLECT THE PERSON’S

INDIVIDUAL PHYSICAL, SOCIAL, CULTURAL AND SPIRITUAL NEEDS ................................................................ 23

TOPIC 2 – PROMOTE INDEPENDENCE ............................................................................................................. 24

SUPPORT THE PERSON TO IDENTIFY AND ACKNOWLEDGE THEIR OWN STRENGTHS AND SELF-CARE CAPACITY

...................................................................................................................................................................... 24

Advocacy services ........................................................................................................................................ 24

ASSIST THE PERSON TO IDENTIFY OPPORTUNITIES TO UTILISE THEIR STRENGTHS, WHILE COMMUNICATING

THE IMPORTANCE OF USING AVAILABLE SUPPORT WHEN REQUIRED ........................................................... 26

PROVIDE INFORMATION AND ASSISTANCE TO THE PERSON IN ORDER TO FACILITATE ACCESS TO SUPPORT

SERVICES AND RESOURCES WHEN NEEDED ................................................................................................... 27

PROVIDE SUPPORT THAT ALLOWS THE PERSON TO SELF-MANAGE THEIR OWN SERVICE DELIVERY AS

APPROPRIATE ................................................................................................................................................ 28

ENCOURAGE THE PERSON TO BUILD, STRENGTHEN AND MAINTAIN INDEPENDENCE .................................... 30

TOPIC 3 – SUPPORT PHYSICAL WELLBEING .................................................................................................... 32

PROMOTE AND ENCOURAGE DAILY LIVING HABITS THAT CONTRIBUTE TO HEALTHY LIFESTYLE .................... 32

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SUPPORT AND ASSIST THE PERSON TO MAINTAIN A SAFE AND HEALTHY ENVIRONMENT ............................ 34

SECURITY SYSTEMS ..................................................................................................................................... 35 SHELTER AND PROTECTION ....................................................................................................................... 35 COMFORT AND SELF EXPRESSION ........................................................................................................... 35 SAFETY AND ADAPTATIONS....................................................................................................................... 36

IDENTIFY HAZARDS AND REPORT ACCORDING TO ORGANISATION PROCEDURES ......................................... 38

ASSESSING HAZARDS .................................................................................................................................. 38 SEVERITY ..................................................................................................................................................... 38

ANALYSING THE LIKELIHOOD AND CONSEQUENCES OF RISK ........................................................... 39 HAZARD RATING MATRIX CHART ............................................................................................................. 39 REPORTING RISKS AND HAZARDS ............................................................................................................ 40

IDENTIFY VARIATIONS IN A PERSON’S PHYSICAL CONDITION AND REPORT ACCORDING TO ORGANISATION

PROCEDURES ................................................................................................................................................. 41

RECOGNISE INDICATIONS THAT THE PERSON’S PHYSICAL SITUATION IS AFFECTING THEIR WELLBEING AND

REPORT ACCORDING TO ORGANISATION PROCEDURES AND IDENTIFY PHYSICAL HEALTH SITUATIONS

BEYOND SCOPE OF OWN ROLE AND REPORT TO RELEVANT PERSON ............................................................. 42

TOPIC 4 – SUPPORT SOCIAL, EMOTIONAL AND PSYCHOLOGICAL WELLBEING ................................................ 45

PROMOTE SELF-ESTEEM AND CONFIDENCE THROUGH USE OF POSITIVE AND SUPPORTIVE COMMUNICATION

...................................................................................................................................................................... 45

COMMUNICATION ................................................................................................................................................. 45 RECOGNISE AREAS WHERE THE PERSON REQUIRES ASSISTANCE ....................................................................................... 46

CONTRIBUTE TO THE PERSON’S SENSE OF SECURITY THROUGH USE OF SAFE AND PREDICTABLE ROUTINES . 47

ENCOURAGE AND FACILITATE PARTICIPATION IN SOCIAL, CULTURAL, SPIRITUAL ACTIVITIES, USING EXISTING

AND POTENTIAL NEW NETWORKS AND AS PER THE PERSON’S PREFERENCES ............................................... 48

IDENTIFY ASPECTS OF SUPPORTING A PERSON’S WELLBEING OUTSIDE SCOPE OF KNOWLEDGE, SKILLS

AND/OR JOB ROLE AND SEEK APPROPRIATE SUPPORT AND IDENTIFY VARIATIONS TO A PERSON’S

WELLBEING AND REPORT ACCORDING TO ORGANISATION PROCEDURES ..................................................... 49

VARIATIONS ......................................................................................................................................................... 49

IDENTIFY ANY CULTURAL OR FINANCIAL ISSUES IMPACTING ON THE PERSON’S WELLBEING ........................ 51

FINANCIAL ISSUES ................................................................................................................................................. 51 CULTURAL ISSUES .................................................................................................................................................. 51

IDENTIFY THE PERSON’S RISK AND PROTECTIVE FACTORS IN RELATION TO MENTAL HEALTH ....................... 53

RECOGNISE AND REPORT POSSIBLE INDICATORS OF ABUSE OR NEGLECT AND REPORT ACCORDING TO

ORGANISATION PROCEDURES ....................................................................................................................... 55

IDENTIFY SITUATIONS BEYOND SCOPE OF OWN ROLE AND REPORT TO RELEVANT PERSON ......................... 58

ASPECTS OF PROCESSES AND AIDS OUTSIDE SKILLS AND KNOWLEDGE AND/OR JOB ROLE ....................................................... 59

TOPIC 5 - ADDITIONAL KNOWLEDGE .............................................................................................................. 61

SELF-ACTUALISATION..................................................................................................................................... 61

THE TWELVE STAGES OF THE HUMAN LIFE CYCLE .......................................................................................... 62

SERVICE DELIVERY APPROACHES ................................................................................................................... 64

WHAT IS INTEGRATED SERVICE DELIVERY? .................................................................................................................. 64 SERVICE STANDARDS .............................................................................................................................................. 65

FUNDING MODELS ......................................................................................................................................... 66

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DEPARTMENT OF HUMAN SERVICES FLEXIBLE FUNDING MODEL (2011 – 2012) .............................................................. 66 DEPARTMENT OF HEALTH BLOCK FUNDING MODEL ..................................................................................................... 66 ACTIVITY BASED FINDING ........................................................................................................................................ 67

DUTY OF CARE ............................................................................................................................................... 68

ROLE OF AGENCY POLICY AND PROCEDURE ......................................................................................... 68

DIGNITY OF RISK ............................................................................................................................................ 69

CONFIDENTIALITY, PRIVACY AND DISCLOSURE .............................................................................................. 70

WHAT IS CONFIDENTIALITY ....................................................................................................................... 70

DISCRIMINATION ........................................................................................................................................... 72

WORK ROLE BOUNDARIES ............................................................................................................................. 73

RELATIONSHIP BETWEEN HUMAN NEEDS AND HUMAN RIGHTS.................................................................... 74

WHAT ARE HUMAN RIGHTS? ................................................................................................................................ 74 HUMAN NEEDS ..................................................................................................................................................... 74

HUMAN RIGHTS FRAMEWORKS, APPROACHES, INSTRUMENTS..................................................................... 76

HUMAN RIGHTS FRAMEWORK ................................................................................................................................. 76 HUMAN RIGHTS APPROACH ..................................................................................................................................... 76

MANDATORY REPORTING .............................................................................................................................. 77

SUMMARY ..................................................................................................................................................... 86

REFERENCES ................................................................................................................................................... 87

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U N I T I N T R O D U C T I O N

This resource covers the unit CHCCCS023 - Support independence and wellbeing.

This unit describes the skills and knowledge required to provide individualised services in ways that support independence, as well as, physical and emotional wellbeing.

This unit applies to workers in a range of community services contexts who provide frontline support services within the context of an established individualised plan.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

ABOUT THIS RESOURCE

This resource brings together information to develop your knowledge about this unit. The information is designed to reflect the requirements of the unit and uses headings to makes it easier to follow.

Read through this resource to develop your knowledge in preparation for your assessment. You will be required to complete the assessment tools that are included in your program. At the back of the resource are a list of references you may find useful to review.

As a student it is important to extend your learning and to search out text books, internet sites, talk to people at work and read newspaper articles and journals which can provide additional learning material.

Your trainer may include additional information and provide activities. Slide presentations and assessments in class to support your learning.

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ABOUT ASSESSMENT

Throughout your training we are committed to your learning by providing a training and assessment framework that ensures the knowledge gained through training is translated into practical on the job improvements.

You are going to be assessed for:

 Your skills and knowledge using written and observation activities that apply

to your workplace.

 Your ability to apply your learning.

 Your ability to recognise common principles and actively use these on the job.

You will receive an overall result of Competent or Not Yet Competent for the assessment of this unit. The assessment is a competency based assessment, which has no pass or fail. You are either competent or not yet competent. Not Yet Competent means that you still are in the process of understanding and acquiring the skills and knowledge required to be marked competent. The assessment process is made up of a number of assessment methods. You are required to achieve a satisfactory result in each of these to be deemed competent overall.

All of your assessment and training is provided as a positive learning tool. Your assessor will guide your learning and provide feedback on your responses to the assessment. For valid and reliable assessment of this unit, a range of assessment methods will be used to assess practical skills and knowledge.

Your assessment may be conducted through a combination of the following methods:

 Written Activity

 Case Study

 Observation

 Questions

 Third Party Report

The assessment tool for this unit should be completed within the specified time period following the delivery of the unit. If you feel you are not yet ready for assessment, discuss this with your trainer and assessor.

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To be successful in this unit you will need to relate your learning to your workplace. You may be required to demonstrate your skills and be observed by your assessor in your workplace environment. Some units provide for a simulated work environment and your trainer and assessor will outline the requirements in these instances.

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E L E M E N T S A N D P E R F O R M A NC E C R I T E R I A

1. Recognise and support individual differences

1.1 Recognise and respect the person’s social, cultural and spiritual differences

1.2 Avoid imposing own values and attitudes on others and support the person to express their own identity and preferences

1.3 Consider the person’s individual needs, stage of life, development and strengths when engaging in support activities

1.4 Recognise, respect and accommodate the person’s expressions of identity and sexuality as appropriate in the context of their age or stage of life

1.5 Promote and facilitate opportunities for participation in activities that reflect the person’s individual physical, social, cultural and spiritual needs

2. Promote independence 2.1 Support the person to identify and acknowledge their own strengths and self-care capacity

2.2 Assist the person to identify opportunities to utilise their strengths, while communicating the importance of using available support when required

2.3 Provide information and assistance to the person in order to facilitate access to support services and resources when needed

2.4 Provide support that allows the person to self- manage their own service delivery as appropriate

2.5 Encourage the person to build, strengthen and maintain independence

3. Support physical wellbeing 3.1 Promote and encourage daily living habits that contribute to healthy lifestyle

3.2 Support and assist the person to maintain a safe and healthy environment

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3.3 Identify hazards and report according to organisation procedures

3.4 Identify variations in a person’s physical condition and report according to organisation procedures

3.5 Recognise indications that the person’s physical situation is affecting their wellbeing and report according to organisation procedures

3.6 Identify physical health situations beyond scope of own role and report to relevant person

4. Support social, emotional and psychological wellbeing

4.1 Promote self-esteem and confidence through use of positive and supportive communication

4.2 Contribute to the person’s sense of security through use of safe and predictable routines

4.3 Encourage and facilitate participation in social, cultural, spiritual activities, using existing and potential new networks and as per the person’s preferences

4.4 Identify aspects of supporting a person’s wellbeing outside scope of knowledge, skills and/or job role and seek appropriate support

4.5 Identify variations to a person’s wellbeing and report according to organisation procedures

4.6 Identify any cultural or financial issues impacting on the person’s wellbeing

4.7 Identify the person’s risk and protective factors in relation to mental health

4.8 Recognise and report possible indicators of abuse or neglect and report according to organisation procedures

4.9 Identify situations beyond scope of own role and report to relevant person

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P E R F O R M A N C E E V I D E N C E A N D K N O W L E D G E E V I D E N C E

This describes the essential knowledge and skills and their level required for this unit.

PERFORMANCE EVIDENCE

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be demonstrated evidence that the candidate has:

 Safely supported at least 3 people to enhance independence and wellbeing

 Performed the activities outlined in the performance criteria of this unit

during a period of at least 120 hours of direct support work in at least one

aged care, home and community, disability or community service

organisation

KNOWLEDGE EVIDENCE

The candidate must be able to demonstrate essential knowledge required to effectively

complete tasks outlined in elements and performance criteria of this unit, manage tasks and

manage contingencies in the context of the work role. This includes knowledge of:

 Basic human needs:

o Physical

o Psychological

o Spiritual

o Cultural

o Sexual

 Concept of self-actualisation

 Human development across the lifespan

 Wellbeing, including:

o Physical

o Psychological

o Social

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o Spiritual

o Cultural

o Financial

o Career/occupation

 Individual differences, how these may be interrelated and impact on support

provided

 Basic requirements for good health for the person, including:

o Mental health

o Nutrition and hydration

o Exercise

o Hygiene

o Lifestyle

o Oral health

 Mental health issues and risk and protective factors

 Indications of neglect or abuse:

o Physical

o Sexual

o Psychological

o Financial

 Reporting requirements for suspected abuse situations

 Service delivery models and standards

 Relevant funding models

 Issues that impact health and well-being

 Impacts of community values and attitudes, including myths and stereotypes

 Issues surrounding sexuality and sexual expression

 Indicators of emotional concerns and issues

 Support strategies, resources and networks

 Legal and ethical requirements and how these are applied in an organisation

and individual practice, including:

o Duty of care

o Dignity of risk

o Human rights

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o Discrimination

o Mandatory reporting

o Privacy, confidentiality and disclosure

o Work role boundaries – responsibilities and limitations

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A S S E S S M E N T C O N D I T I O N S

Skills must have been demonstrated in a relevant workplace with the addition of simulations and scenarios where the full range of contexts and situations have not been provided in the workplace. Where simulation is used it must reflect real working conditions and contingencies by modeling industry operating conditions and contingencies, as well as using suitable facilities, equipment and resources, including:

 Individualised plans and any relevant equipment outlined in the plan

 Modelling of industry operating conditions including real interactions with

the person and their carers

Overall, assessment must involve some real interactions with the person and their families/carers.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

P R E - R E Q U I S I T E S

This unit must be assessed after the following pre-requisite unit:

There are no pre-requisites for this unit.

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T O P I C 1 – R E C O G N I SE A N D S U P P O R T I N D I V I D U A L D I F F E R E N C E S

RECOGNISE AND RESPECT THE PERSON’S SOCIAL, CULTURAL AND SPIRITUAL DIFFERENCES

In all cases when working in a community service or health environment you will need to consider and respect a person’s social, cultural and spiritual differences if you are going to work with them effectively.

A client’s cultural preferences may include:

 Ceremonial and festive observances

 Dress and dietary observance

 Need for continued interaction with cultural community

A client’s spiritual preferences may include:

 Ceremonial observances

 Formal and informal religious observance

 Need for privacy

 Need for an appropriate environment to reflect and / or participate in

spiritual activities

It is essential that you demonstrate acceptance of a client’s cultural and spiritual preferences. Consider the following information on how you can demonstrate acceptance of a client’s cultural and spiritual preferences:

Community and disability services workers need to be alert to the possible differences in religious ritual and the impact of a person’s religious practice on their beliefs and value system. Dominant religion may regard other religions as cults rather than official religions however people of any religion have a right to respect.

The following points may assist you to become sensitive to different religious practices:

 Clarify the client’s… religious practice.  Consult others who know or follow the same religious practice to gain further

understanding.

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Read the complete article here: http://legacy.communitydoor.org.au/resources/etraining/units/chccs405a/section1/section1topic06.ht

ml

Demonstrating acceptance of a client’s cultural and spiritual preferences also involves supporting the client to worship when and how they choose. It also requires you to support the client to access appropriate equipment and resources to allow them to participate meaningfully in festive and ceremonial observances. Additionally, demonstrating acceptance of a client’s cultural and spiritual preferences involves enabling the client to maintain links with their cultural and spiritual communities.

It is important that you are able to demonstrate cultural sensitivity in communication practices. This means recognising and responding effectively to cultural differences when you communicate with others. There are a number of strategies you may use to demonstrate cultural sensitivity in communication practices:

COMMUNICATE INFORMATION IN WAYS THAT ARE UNDERSTANDABLE AND RELEVANT TO DIVERSE GROUPS

This may involve providing multi-lingual brochures or, for people who have low levels of literacy, producing DVDs or using other media, or other visual / iconic strategies (e.g. diagrams, tables, graphs, pictures), etc. This ensures that health services deliver their messages in ways which are most likely to have a positive impact on the client groups they service.

 Understanding and utilising appropriate methods of cross-cultural

communication - for example, avoiding eye contact when discussing certain

topics. This increases the client's comfort with the communication process,

and improves the likelihood that they will communicate openly with you.

 Respecting that people may be uncomfortable communicating with people

outside their cultural group and / or of a different gender, and wherever

possible responding to this. This demonstrates respect for the client's cultural

preferences, and again increases their comfort in engaging with the service.

 Avoiding patronising communication, such as mimicking accents / patterns of

speech, etc. This not only has a negative effect on communication (often

resulting in complete communication breakdowns), but it also further

disempowers vulnerable groups of people.

 Taking responsibility for the on-going development of your own cross-

cultural communication skills.

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Monitoring and reflecting on your own actions in the workplace to ensure your cultural values are not imposed on others during communication and interaction.

ENSURE WORK PRACTICES ACCOMMODATE A CLIENT’S MODESTY AND PRIVACY ACCORDING TO CULTURAL REQUIREMENTS

Modesty and privacy are fundamental rights of all people. Privacy, in particular, is a legal obligation outlined in The Privacy Act (1998) (Commonwealth) and related state / territory legislation. Modesty is just as important – particularly for clients who require assistance with activities of daily living.

It is important that you ensure your work practices accommodate a client’s modesty and privacy according to cultural requirements. Consider the following information on ensuring work practices accommodate a client’s privacy and modesty:

Privacy is a basic right for all humans. We like to have our privacy, and so do our residents and clients. Each person is different and what might be 'personal' to one person may not be to another. For example a resident or client may be trying to do something they have trouble with, like eating, and prefer to be in a private place, so they feel they are not being watched by everyone in the room. Whereas another resident or client may feel encouraged by seeing others struggle with the same tasks, and feel that being with a group makes things more fun.

Therefore, it is important to know our individual resident or client's personal needs and wishes. This information should be outlined in their individualised care plan. It is then the care workers role to ensure that dignity is respected by giving them the privacy they require.

In a residential facility or a client's home it is important to consider the following:

1. Keep doors closed, draw curtains or screens when the resident or client is undressing, showering/bathing or using the toilet/commode.

2. Maintain the personal dignity of the resident or client. Do not discuss issues that may cause distress and embarrassment in front of other residents/clients or staff. If the person is overcome with emotion, do all you can to retain their privacy and dignity.

3. Do not touch a resident's or client's personal property without permission. Some people may see this breach of their space as touching them without permission.

4. Ask the resident or client for permission before you open their drawers, cupboards or wardrobes.

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Read the complete article here: https://nationalvetcontent.edu.au/alfresco/d/d/workspace/SpacesStore/3973a53f-00c9-4d22-9a84-

4844a817f302/602/shared/resources/director/induction/personal_care/privacy_and_dignity.htm

Cultural requirements have a significant impact on a client’s perception of appropriate modesty and privacy. For example, clients of certain cultures may require that parts of their body remain covered or that they are only bathed by same-sex carers, for example. It is important that you ensure your work practices take into account a client’s cultural requirements for modesty and privacy.

OTHER ACTIONS

Below are some other things that you might think about to support people from other cultures:

 Accept cultural and religious ceremonies and link in to them

 Celebrate different cultures by sharing food from that culture or having

cultural days

 Get guest speakers to talk about different cultures

 Learn a language (even a few words) to make people feel more welcome

The most important thing is that everyone feels accepted and welcome and that no-one is discriminated against or made to feel insecure when in your care.

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AVOID IMPOSING OWN VALUES AND ATTITUDES ON OTHERS AND SUPPORT THE PERSON TO EXPRESS THEIR OWN IDENTITY

AND PREFERENCES

From the discussion above, it is clear that you should avoid imposing your own values and attitudes regarding sexuality on others, including your clients. Your own values may not be consistent with those of your client, and if you impose these conflicting values on your client this can cause them problems – including psychological harm. Reflect on the following information:

As human beings, we all have our own values, beliefs and attitudes that we have developed throughout the course of our lives. Our family, friends, community and the experiences we have had all contribute to our sense of who we are and how we view the world. As community services workers, we are often working with people who are vulnerable and/or who may live a lifestyle that mainstream society views as being different or unacceptable. If, as community services workers, we are to provide a service that meets the needs of our target groups and helps them to feel empowered, we need to be aware of our own personal values, beliefs and attitudes and be prepared to adopt the professional values of our industry—and not impose our own ideas on our clients.

Read the complete article here:

https://sielearning.tafensw.edu.au/MCS/CHCAOD402A/chcaod402a_csw/knowledge/values/values.htm

In some cases, you may find you have strong values and attitudes regarding sexuality which conflict with your capacity to provide the best care and support to a particular client. If this is the case, you must raise this issue promptly with your manager. You can then work with your manager to develop a plan of action to enable you to respond effectively to this problem; this might involve you seeking supportive counselling or being rostered so that you do not work with the client in question, etc.

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CONSIDER THE PERSON’S INDIVIDUAL NEEDS, STAGE OF LIFE, DEVELOPMENT AND STRENGTHS WHEN ENGAGING IN SUPPORT

ACTIVITIES

Social and recreational activities should “support, challenge and enhance the psychological, spiritual, social, emotional and physical well-being of individuals”, in addition to promoting confidence, empowerment and fulfillment (Diversional Therapy Association of Australia 2012). As such, you must recognise that some recreational activities may need to be modified or adapted to meet clients’ specific needs. Taking the time to consider your clients’ specific needs and modify or adapt activities to better suit these needs is important; this ensures that the activities you provide will be more meaningful and beneficial to your clients.

How you modify or adapt activities ultimately depends on the types of activities you provide and the specific needs of the clients with whom you work. For example, an activity such as bowling may need to involve smaller and / or lighter balls to enable the participation of physically disabled clients. Similarly, when delivering an arts-and-crafts activity you may need to provide non-toxic paints and glues to protect the safety of intellectually impaired clients who may inadvertently consume these items. If you are running a sing-along for elderly clients, you may need to consider the volume of the music for those who are hearing impaired. These are just some of many thousands of different examples!

Whenever you modify or adapt an activity, it is important that you report this to an appropriate person. Doing so ensures that the modifications or adaptations you implement are appropriate and consistent with your organisation’s expectations. Examples of appropriate people to whom you may report include your direct supervisors and managers, colleagues who also provide care to the client, the client’s family members (providing the client’s confidentiality is maintained), external agencies (such as advocacy services), health professionals, law enforcement officers and legal guardians, etc.

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RECOGNISE, RESPECT AND ACCOMMODATE THE PERSON’S EXPRESSIONS OF IDENTITY AND SEXUALITY AS APPROPRIATE

IN THE CONTEXT OF THEIR AGE OR STAGE OF LIFE

A client’s circumstances may have a significant impact on their expression of identity and sexuality. Expression of identity and sexuality may include:

 Access to assistive / protective devices

 Love and affection

 Need for privacy and discretion

 Physical appearance

 Touch

Read the following about the importance of sexuality to people – including, in this example, people with an intellectual disability:

Sexuality is a key part of human nature. People with intellectual disability experience the same range of sexual thoughts, attitudes, feelings, desires, fantasies and activities as everyone else… Sexuality has psychological, biological and social aspects and is influenced by individual values and attitudes…. Healthy self-esteem and respect for self and others are important factors in developing positive sexuality.

Most people with intellectual disability can have rewarding personal relationships. However, some may need additional support to develop relationships, explore and express their sexuality and access sexual health information and services.

Read the complete article here:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Intellectual_disability_and_sexuality?o pen

The expression of identity – that is, ‘who’ the individual perceives themselves to be – is also important for people, including your clients, regardless of their circumstances. However, a client’s circumstances may restrict their individual expression of identity and sexuality in a number of ways. Read through the following examples relating to a client with an intellectual disability:

 A lack of privacy

 Being dependent on others for daily living

 A lack of confidence about their physical appearance and ability

 Less knowledge of how to negotiate relationships and express their sexuality

 A limited social circle and a lack of social experience

 Physical or cognitive limitations

 Carers who wrongly think of them as childlike or asexual

 Carers who view their sexuality as something to be feared and controlled

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Read the complete article here:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Intellectual_disability_and_sexuality?o pen

The impact a client’s circumstances may have on their expression of identity and sexuality are complex. However, it is important that you are able to demonstrate a basic understanding of the impact a client’s circumstances may have on their expression of identity and sexuality. As discussed, this is important because it enables you to provide services which are more reflexive to a client’s needs, and, therefore, more effective at supporting a client to achieve desired outcomes.

SUPPORT THE PERSON TO EXPRESS THEIR SEXUALITY

Supporting a client to express their sexuality is an important aspect of your role. But how can you do so in ways that are both legal and meaningful? Consider the following information from Victoria’s “Personal relationships, sexuality and sexual health policy and guidelines” for disability workers in the state about how you can support clients to express their sexuality:

All people access a wide variety of support and materials to meet their individual needs. Sexuality is just one of many life areas where people may seek such support. The role of support workers is to provide assistance, where needed, so people with a disability can experience the same life opportunities as other people. As part of their role, support workers are expected to be able to respond to sexuality and sexual health issues by:

 Answering simple questions.  Supporting people with a disability to understand their rights and

responsibilities in this area.  Supporting people in accessing services where needed. This may include helping

people access information and services or attend appointments.  Being aware of, and able to respond appropriately to, duty of care issues.  Ensuring sexuality and sexual health are considered in individual planning for

people with an intellectual or cognitive disability

Read the complete article here:

http://www.dhs.vic.gov.au/__data/assets/pdf_file/0008/604583/dsd_personal_relationships_sexual_heal th_policy_250506.pdf

It is essential that you find a suitable balance between supporting a person to express their sexuality and remaining within the boundaries of your legal obligations to your client. Read the following:

…There are still many barriers that stand in the way for people like David [who have physical and intellectual impairments]. One problem is that third or fourth parties may have to be involved if people cannot even undress themselves or get into bed without assistance. And that is where barriers like official policies can come into play.

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White said while the Spastic Centre supported clients’ rights to sexual expression, it had a policy that staff could not help them overcome the physical limitations that could make this possible. ‘‘Some people may need assistance in order to express their sexuality due to their disability but our policy is that staff can’t assist people in any sexual activity,’’ he [Spastic Centre CEO Rob White] said…

This interpretation of the law means staff could not even phone on a client’s behalf to make an appointment with a sex worker, let alone provide the further help that may be needed in cases of severe disability to position a couple for sex. That means options are extremely limited. …Unless they had an understanding family member or friend prepared to help, one who wasn’t constrained by the same duty of care, they had no chance of being able to have sex.

Read the complete article here: http://www.touchingbase.org/resources/library/sexual-liberation

As noted above, it is essential that you find a suitable balance between supporting a person to express their sexuality and remaining within the boundaries of your legal obligations to your client. Ensure you seek support from your supervisor or manager where required.

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PROMOTE AND FACILITATE OPPORTUNITIES FOR PARTICIPATION IN ACTIVITIES THAT REFLECT THE PERSON’S

INDIVIDUAL PHYSICAL, SOCIAL, CULTURAL AND SPIRITUAL NEEDS

As noted above, an important aspect of demonstrating acceptance of – and respect for –a client’s cultural and spiritual preferences involves supporting the client to worship when and how they choose. Facilitating a client’s participation in cultural and spiritual practices and celebrations is an essential aspect of your role. Read the following section on ways to facilitate a client’s participation in cultural and spiritual practices and celebrations:

Culturally appropriate spiritual support assists care recipients to express their unique spirituality in an open and non-judgemental environment by helping them to maintain important practices, beliefs and networks. Identifying current and desired practices and beliefs will assist you to meet the needs of your care recipients from culturally and linguistically diverse backgrounds; simply asking to which religion a person belongs does not adequately determine spiritual needs.

The religious beliefs of some of your care recipients may require strict adherence to ritual and influence all aspects of their daily life. The needs of your care recipients may also change over time; some people may become more aware of and interested in spiritual matters, perhaps for the first time in their lives. Regular reviews of your care recipients' spiritual needs will ensure the support you provide is relevant to their needs.

Read the complete article here: http://www.culturaldiversity.com.au/resources/practice-

guides/spiritual-support

Facilitating a client’s participation in cultural and spiritual practices and celebrations may also involve more practical aspects of support – such as providing transport, ensuring the availability of required resources and arranging access to relevant spiritual advisors, etc. Also, you may research suitable opportunities online and in local newspapers / magazines or religious organisation bulletins, etc.

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T O P I C 2 – P R O M O T E I N D E P E N D E N C E

SUPPORT THE PERSON TO IDENTIFY AND ACKNOWLEDGE THEIR OWN STRENGTHS AND SELF-CARE CAPACITY

In order for the client to make appropriate decisions about the care and services, they require, workers should assist them to identify their own strengths, and realise what their capacity might be.

By supporting the individual in this way, it is possible for them to assess what their level of independence may be. However, if the client is already accessing a service, it is pertinent that an assessment be performed to determine their capabilities. Identification of strengths and capacity may include:

 The activities of daily living

 The capacity for employment

 The capacity to live independently

In order to exercise choice and maximise independence, people require access to accurate information that will help them manage their own lives, understand their options and engage with and actively participate in their community.1

ADVOCACY SERVICES

Advocacy services are designed to actively assist people in the decision-making process. Advocates listen to the goals of the client, and aim to help them to identify ways they can maintain and increase their independence, and confidence to represent their own best interests.

By assisting the client to recognise their strengths and capacities, you will be assisting them to establish goals that are realistic and attainable.

The strengths capacities of the client should be clearly documented in the client’s care plan so that all relevant staff are aware of their capabilities.

1 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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As part of your role within your organisation, you may be involved both the designing of their individualised plan, along with accessing and linking the client with the services they require according to their plan.

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ASSIST THE PERSON TO IDENTIFY OPPORTUNITIES TO UTILISE THEIR STRENGTHS, WHILE COMMUNICATING THE IMPORTANCE

OF USING AVAILABLE SUPPORT WHEN REQUIRED

Each of us has areas of ability and other areas of function that we find difficult. The way that a person functions in their life will depend on many factors. Factors that may influence the strengths and capabilities of the client may include:

 The ability to effectively communicate

 Personality

 Social circumstances

 Psychological problems

 Mental health issues

 Disabilities

 Available support mechanisms such as o Family o Friends o Support workers o Advocates

Workers need to be able to effectively assess and interpret the strengths and abilities of the clients they are supporting. Strength may be defined as the ability to cope with difficulties, to effectively function under stressful conditions, the ability to bounce back from stressful situations, to accept challenging situations as an opportunity for personal growth as and to use social supports as a source of resilience.

The Strength, however, is more complex than just how the individual reacts to vulnerable situations. It is also important to note that a person who is vulnerable is not necessarily weak.

For example, a person who is experiencing a significant crisis in their life such as the death of a loved one may be vulnerable, particularly in the period closely following the event. This does not imply that they are weak, but may require some assistance in developing the necessary coping mechanisms.

Part of the role of the community services worker is to assist the client in recognising their strengths and capabilities so that they may be better equipped to face the challenges of life.

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PROVIDE INFORMATION AND ASSISTANCE TO THE PERSON IN ORDER TO FACILITATE ACCESS TO SUPPORT SERVICES AND

RESOURCES WHEN NEEDED

As discussed above, an important part of enabling your clients to access and engage with social networks is to provide them with information on the networks and activities available to them. The types of networks available to your clients may include:

 Clubs

 Community centres

 Community welfare groups

 Ethno-specific organisations

 Sport and recreational groups

 Support groups

 Veterans / war widows organisations

 Voluntary organisations

To be able to provide information to your clients on the activities available to them, it is important that you are aware of the activities available in your local community (including both existing and new activities, as they occur). Networking – that is, engaging – with other professionals in the community services and in related fields – is important in this respect, as this will provide you with valuable information on events and services which might be suitable for your clients. Also, you may research suitable opportunities online and in local newspapers / magazines, etc.

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PROVIDE SUPPORT THAT ALLOWS THE PERSON TO SELF- MANAGE THEIR OWN SERVICE DELIVERY AS APPROPRIATE

The older person’s willingness and ability to direct the processes relating to the provision of their care may be attributed to both how well informed they are and a recognition that they have the right to refuse services.

In order to exercise choice and maximise independence, people require access to accurate information that will help them manage their own lives, understand their options and engage with and actively participate in their community.2

The client has the power to determine the direction that their care takes. Those providing support services should not presume what direction their care will take. As it is the older person who makes the ultimate decision regarding the provision of their care and services, they are the person who is providing direction to the support worker.

Whilst the support person can provide the client with information and suggestions which they feel may be beneficial to their care, the older person has the right to refuse these suggestions and choose the path they wish to take. They may wish to determine their ongoing care on a daily basis or institute planning for their needs in the future. In the case where the support worker identifies potential issues in the way the care in being planned or instituted then they may wish to raise this with the client, but ultimately they need to respect the client’s decision.

Providing information to the older client, may assist them in making decisions about how they may improve their lifestyle. The information needs to be relevant to their needs and lifestyle, how improvements might be made, and should identify the services which could be of assistance to them in meeting their needs. This information may be in relation to issues such as the provision of health care services, equipment which might be beneficial to them, financial services or perhaps referrals that might provide them with the further information they need. Providing this information enable the individual to gain a better sense of control over their life.

If the older person is not given the responsibility of directing their care then there is a risk that they will become compliant with the direction of the person or organisation providing the services. Subsequently, this can negatively impact upon their independence. In this situation the provision of care and services is directed by the

2 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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provider and the older person risks losing their sense of empowerment. Whilst the support worker may be compliant with respect to the provision of care and services, the overall effect may be detrimental to the older person in that they can become reliant on others making decisions for them.

There may be compliance issues arise when the support worker who is in a position of influence promotes what they see as being beneficial to the client. If the worker promotes their ideas in such a way that they are perceived to be insistent of intimidating to the older person, then this may result in the older person feeling disempowered and having to do what they are told.

A more appropriate way of approaching the client regarding the way in which they utilise a particular service would be to explain not only what services are available to them but how they might be beneficial. I.e. there should be reasoning behind the suggestions given.

If the support worker identifies the need for an intervention which will be of benefit to the client, and the client subsequently refuses, then there should be supporting documentation outlining the refusal as well as the reasoning behind the refusal. Instances of non-compliance without the appropriate supporting reasoning can sometimes be viewed as the client being merely obstinate or irrational. Providing the reasoning behind their choice to refuse the implementation of services can assist in validating their decision.

The older person may wish to consult with an advocate before making a decision based on the suggestions of a support worker.

Advocacy services support people to actively participate in decision-making processes and conversations that impact on their lives.

Advocates will listen and act in the best interests of the individual and support people with the aim to increase independence and confidence to represent their own interests, and help them to be aware of the different ways they can have a say.3

3 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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ENCOURAGE THE PERSON TO BUILD, STRENGTHEN AND MAINTAIN INDEPENDENCE

Whilst an older person may still be able to attend to most or all of their activities of daily living, as they age, they may find it necessary to adapt their lifestyle and perform the tasks with which they are familiar differently to what they have been used to.

The client may indeed experience difficulties in adapting to the changes both physically and psychologically, and the support worker can be instrumental in helping them to make the necessary modifications and adaptations necessary to maintain their independence.

The type of modifications and adaptations that they might encounter may be associated with the use of new or replacement of old equipment, changes in their behaviour related to the state of their health, learning new ways to do things, or possibly engaging I the use of extra support services in order to meet their needs.

Once the changing needs of the client have been identified, the next step is to seek out the relevant sources that might be able to provide the required assistance. If the assistance seems to be relevant to the needs of the client, then they can then be presented with the information that may address their needs and then make an informed decision about the changes that they might need to make.

Let’s take for example a situation where an older client is experiencing difficulties in accessing part of their home because it is upstairs, and they are now, due to health issues, experiencing difficulties in climbing the stairs each day. After being assessed the support worker might suggest to the client that there are mechanisms available such as stairlifts to assist them, or possibly they might consider transferring to different premises, where movement around their environment would require considerably less exertion. The client in this situation may choose one of the possible alternatives that have been suggested, or elect to reject them entirely. It is important to note, that such changes are significant in the life of the individual, both from a financial perspective, as well as having to deal with a major change in their environment.

Regardless of the scenario, support workers need to assist the client in making the changes they need to maintain their independence. When doing so, it is necessary for the worker to us the communication techniques necessary for the older person to understand the information provided.

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Once the information has been provided, it is important to follow up with the client, particularly if no changes have been instituted. The client may have the need for further information before making a decision, or they may well decide to take no action. Whatever decisions they make, it is important that they receive the appropriate information they need

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T O P I C 3 – S U P P O R T P H Y S I C A L W E L L B E I N G

PROMOTE AND ENCOURAGE DAILY LIVING HABITS THAT CONTRIBUTE TO HEALTHY LIFESTYLE

The extent to which the older person is able to maintain their environment is largely dependent on the state of their physical well-being. However, consideration should also be given to their psychological and emotional state.

Whilst there may come a time in their life when the older person is no longer able to manage their environment by themselves, they may still have the capacity to live at home if they are provided with assistance to deal with the tasks that they find more challenging.

In order to maintain their independence as much as possible, and remain in the home environment, providing them with information about the services available to them enables the client to seek out the necessary services they need. This process in itself is empowering for the older person. Not only are they making decisions about their lifestyle, but they are also engaging with other members of the community when they seek assistance, thus showing that they are still capable of exercising their communication and negotiating skills.

Try to identify the areas that the client is able to manage without assistance. Communicating this to the client is likely to boost their self-esteem, particularly if they are feeling emotionally vulnerable as a result of realising that they may require assistance in other aspects of their lives. Another way that the client can elevate their self-esteem is knowing that they have the capacity and ability to delegate tasks to others who are providing them with assistance.

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Recognise areas where the older person requires assistance. By communicating appropriately with the person, you can help them to identify areas in which they feel that they might need assistance. Reinforce to the client that they still have the power to make the decision about what services they see as being as beneficial to them. This too will help them maintain a sense of empowerment. It may be that the assistance required is only minimal, or that the support services they engage will be infrequent, thus not encroaching excessively on their privacy. This enables the older person to see that whilst they are receiving some assistance; they are still able to function independently in many other areas of their life.

It is important to develop a plan that identifies how the maintenance of the environment is to happen. Throughout the establishment of the plan, the older person should be continuously consulted so that they have a sense of involvement, and that they have the ultimate control over their environment.

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SUPPORT AND ASSIST THE PERSON TO MAINTAIN A SAFE AND HEALTHY ENVIRONMENT

Regardless of the environment in which they live, the older person needs to feel that they are secure and safe in their living situation. They should feel secure in the knowledge that they are able to move around in their surroundings without feeling that they are vulnerable to harm. Older people, particularly those who live at home alone, may sometimes feel that they are easy targets for criminal activity such as violence and robbery.

When working with older people it is important to try and establish a sense of security and confidence so that they may maintain their sense of confidence and empowerment. The client needs to feel that they have a sense of control over their security and that they have the ability to use strategies to protect their well-being. Whilst the older person may not able to defend themselves well from physical violence, there are other measures they can take to improve their security.

Security does not just mean being able to ward off offenders. It incorporates other issues such as ensuring their own personal safety when they are moving around in their environment, having shelter and protection, feeling comfortable in their environment and knowing that they are free to express themselves as they desire.

Some of the requirements of the older person in relation the establishment and maintenance of their security are:

 Security systems and how they work

 Support staff that recognise the need for the older person to feel secure in

their environment

 To have the information relative to security issues close at hand, easy access

to security and emergency contacts

 That the environment is suitably adapted to ensure the security and safety of

the older person

The support worker is able to link the client with the appropriate mechanisms so that they will be able to maintain their safety and security in the following ways:

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SECURITY SYSTEMS

There are numerous ways that the support worker in conjunction with the client can promote and ensure that security is established and improved. Examples are:

 Installing alarm and emergency systems

 Security patrols

 Regular visits from support workers to ‘check -up’ n the client

 Ensuring that entrance doors have adequate locking mechanisms including

dead bolt locks.

 Having emergency numbers close by to every telephone in the house and

where appropriate stored in mobile phones

 Ensuring that safety mechanisms such as thermostats, smoke alarms and

electrical protection devices are in place and are regularly serviced and

maintained

 Having adequate and emergency lighting available at all times

 Ensuring that all mobility assistance devices e.g. handrails are securely fitted,

fastened and appropriately placed according to the needs of the client

SHELTER AND PROTECTION

Older people need to know that they are able to live in an environment that provides them with shelter, where they are sheltered from the outside environment when they need to be and that they are protected from the elements. Likewise, they should feel that they are assured in the knowledge that there are others to protect them should they require assistance. This might include having access emergency services if necessary, and the support of friends, family, and support services to assist them in times of need.

COMFORT AND SELF EXPRESSION

Not only should the environment of the older person reflect their physical comfort, but the person should also feel emotionally comfortable in their environment. The support worker can help the older person to be surrounded by the things that they enjoy in life. For example; an important aspect of the older person’s life might be the ability to have regular interaction with others. The support worker can assist by helping to organise a

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carer to visit the client on a regular basis so that they have someone with whom they a have regular, meaningful conversations.

SAFETY AND ADAPTATIONS

The older person’s safety is of paramount concern in relation to their well-being. The client should feel that they are not at risk from harming themselves as a result of the very environment in which they live. Accidents in the home can be a prime source of injuries, possibly even result in death if the appropriate measures are not taken to eliminate or minimise potential hazards.

As a person ages, their bones become more brittle, their sense of sight, smell and touch tend to deteriorate, as does their sense of judgement and reaction time. For these reasons, they are more prone to injuring themselves in any environment. The following is a list of measures and modifications that can be implemented to minimise the risk of harm in their living environment:

 Inside and outside door handles and locks are easy to operate

 Door handles are lever-action instead of round knobs

 Carpeting and rugs are not a trip hazard

 Appliances, lamps and cords are clean and in good condition.

 Electrical overload protection is provided by circuit breakers, fuses

 Electrical cords are placed out of the traffic flow and are not underneath rugs

and furniture

 Ensuring the kitchen area is well lit

 Making sure that there is adequate ventilation, particularly near heating and

cooking areas

 Cabinets and shelving should be easily accessible to the client

 Non-slip flooring is in place

 Temperature limiters for the hot water system

 Smoke detectors are fitted and working

 Telephones are easily accessible in the event of an emergency

 Light switches should be easily accessible

 Emergency lighting such as torches are available

 Handrails and handles are appropriately placed and securely fastened

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 Garden areas and aces paths are kept clear of obstructions

People working with older clients need to be aware of their role in ensuring that the security of the older person is maintained wherever possible. This will, of course, be dependent upon the person being willing and able to implement the suggested changes and adaptations to their environment.

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IDENTIFY HAZARDS AND REPORT ACCORDING TO ORGANISATION PROCEDURES

When working in any organisation, it is imperative that the staff comply with Work Health and Safety legislation and adhere to organisational policies and procedures at all times.

As part of your role when working in the community services sector, you are responsible for the identification and prevention of potential hazards which might adversely affect the health and well-being of your clients, co-workers and yourself.

When working in your organisation, you should:

 Be aware of the procedure for reporting hazards

 Know who to report hazards to so that they will be actioned appropriately

 Know your role if the hazard is not addressed

 Know the legislative requirements and your role where these are concerned

 Know your role in addressing hazards when you find them; can you resolve

the hazard or does it need to be someone else

ASSESSING HAZARDS

There are a number of factors that play a part in the probability and degree of injury or illness for a particular hazard. For example, contact with blood & body fluids exposure.

The significance of the risk of injury or illness may be influenced by the level of a worker's exposure to a hazard. For example, the hazard posed by exposure to a solvent increases with the frequency and duration of exposure.

SEVERITY

Severity refers to the extent of the injury or degree of harm which might be caused by a hazard. Death, permanent disability or an illness such as cancer or hepatitis are all classed as severe. Some examples are electrical hazards and machinery; chemicals such as acids, and dust particles such as asbestos.

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ANALYSING THE LIKELIHOOD AND CONSEQUENCES OF RISK

Let’s now look at the likelihood of the risk happening. We need to assess how likely it is that the risk will happen and what the consequences of this could be.

Consequence is measuring the consequences of being exposed to a hazard. As a risk assessor you are asking whether the hazard is so:

 Severe = E.g. Death, extreme injury or permanent disability

 Major = E.g. Long-term injury or illness

 Medium = E.g. Medical attention required with time off work

 Minor = E.g. First aid required/hazard or near miss report completed with

follow-up action

 Insignificant = E.g. No Injury or near miss follow-up action required

The likelihood is assessing how likely it is that a hazard will harm someone. This likelihood will range from:

 Rare

 Unlikely

 Possible

 Likely

 Almost certain

HAZARD RATING MATRIX CHART

If you line up the likelihood and consequences on this chart, you will see that it will guide you to the type of risk i.e. low, medium, high or extreme.

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REPORTING RISKS AND HAZARDS

Ensuring you report all hazards and risks is an important part of anyone’s role when working with children. All incidents and hazards must be reported using your centres Pro-forma for reporting.

You must complete a hazard report and issue this report to the authorised person. This will usually be your supervisor or manager but in the case where you are the centre manager you may have to report to a higher authority, either way the report must be submitted and the process of eliminating or controlling the hazard commenced.

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IDENTIFY VARIATIONS IN A PERSON’S PHYSICAL CONDITION AND REPORT ACCORDING TO ORGANISATION PROCEDURES

One of the most important aspects of your job role is to identify variations in a client’s physical condition – particularly when the client is unable to do so. Variations in a client’s physical condition may include changes in:

 Aches,

 Pain

 Nail status

 Oral health anomalies

 Skin tone and colour

 Weight gain

 Weight loss

Or, perhaps the client might just report or appear to be feeling ‘unwell’.

You are able to identify variations in a clients’ physical condition by getting to know your clients’ normal physical condition well, and carefully observing changes in their physical condition. Documentation (e.g. written records of weight or temperature, or photographs of skin conditions, etc.) may also assist you in identifying variations in clients’ physical condition.

When you identify variations in a client’s physical condition, it is essential that you report these to your supervisor. This is a key aspect of your duty of care – that is, your legal and ethical responsibility to ensure, to the greatest possible extent, the health and safety of your clients. It is also important in terms of ensuring the client’s wellbeing – and this is the most fundamental aspect of your job.

It is likely that your report of variations in a client’s physical condition will be made to your supervisor verbally in the first instance. However, your supervisor may also require you to complete additional written documentation and, depending on the circumstances surrounding the variation in the clients’ physical condition, you may also be required to make reports to others.

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RECOGNISE INDICATIONS THAT THE PERSON’S PHYSICAL SITUATION IS AFFECTING THEIR WELLBEING AND REPORT

ACCORDING TO ORGANISATION PROCEDURES AND IDENTIFY PHYSICAL HEALTH SITUATIONS BEYOND SCOPE OF OWN ROLE

AND REPORT TO RELEVANT PERSON

This unit has previously discussed that it is essential for you to have a basic understanding of the impact a client’s circumstances may have on their health. It is also important for you to consider the impact the client’s circumstances may have on their emotional and psychological wellbeing. The client’s circumstances may result in a range of emotional and psychological needs.

A client’s emotional needs may include: A sense of security and contentment

 Acceptance of loss

 Dealing with degenerative issues

 Dealing with pain, grief, bereavement, acceptance of death

 Freedom from anger, anxiety, fear, guilt loneliness

 Love and affection

 Veterans’ / war widows’ issues

A client’s psychological needs may include:

 A sense of control

 Acceptance of disability

 Freedom from undue stress

 Life stage acceptance

 Personal identity

 Self-determination

 Self-esteem

 Sense of belonging

 Veterans’ / war widows’ issues

How a client’s circumstances impact on their emotional and psychological needs is often complex. For example, an elderly client may be grieving the loss of their former lifestyle

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as a result of a degenerative disease, a client with a newly-acquired spinal injury might be feeling anger at the cause of their injury and subsequent loss of control, and a person with a chronic disability might by experiencing a lack of self-determination and self- esteem.

You should demonstrate a basic understanding of the impact a client’s circumstances may have on their emotional and psychological wellbeing. Again, this is important because it enables you to provide services which are more reflexive to a client’s needs, and, therefore, more effective at supporting a client to achieve desired outcomes.

The experience of pain can have a significant negative effect on a clients’ wellbeing. Consider the following case study:

Mandy Nielsen understands how chronic pain drives some people to the point of desperation. On maternity leave from her job as a social worker and plagued by chronic back pain, Nielsen used to stand in the shower each morning and think, "How many more months can I do this?"

With painkillers providing no relief and doctors unable to offer a solution, Nielsen was unable either to care for her baby son or to return to work. The scepticism she sometimes encountered from others and the attitude that it was "just psychological" also took their toll… Struck down by this disabling and often stigmatised condition, people lose their jobs, suffer family breakdown and end up watching in bewilderment as their lives fall apart. Some even reach the point of suicide.

Read the complete article here:

http://www.abc.net.au/health/features/stories/2010/03/11/2842912.htm

It is important that you recognise indications that a client’s experience of pain is affecting their wellbeing. Indicators that a client’s experience of pain is affecting their wellbeing are provided following:

 Be less able to function  Feel tired and lethargic  Lose [their] appetite or have nausea  Not be able to sleep, or have [their]sleep interrupted by pain  Experience less enjoyment and more anxiety  Become depressed, anxious, or unable to concentrate on anything except pain  Feel a loss of control  Have less interaction with friends; be less able to enjoy sex or affection  Have a change in appearance  Feel that [they] are more of a burden on family or other caregivers

Adapted from "Management of Cancer Pain" by the Agency for Health Care Policy and Research.

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When you recognise indications that a client’s experience of pain is affecting their well- being, it is essential that you report this according to organisation policy and protocol. This may involve formal reports, both in written and verbal format, to your supervisor and other senior persons in your organisations, as well as your clients’ other caregivers (such as their doctor or chronic pain specialist, etc.). You should familiarise yourself with your organisations policies and protocols for reporting instances which negatively impact a clients’ wellbeing.

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T O P I C 4 – S U P P O R T S O C I A L , E M O T I O N A L A N D P S Y C H O L O G I C A L

W E L L B E I N G

PROMOTE SELF-ESTEEM AND CONFIDENCE THROUGH USE OF POSITIVE AND SUPPORTIVE COMMUNICATION

It is a fundamental aspect of your role that you provide support in a manner that promotes the client’s self-esteem and confidence. How you do so ultimately depends on your unique clients and the context in which you work (including the types of services provided by your organisation). Consider the following list of ways you can promote the self-esteem and confidence of a client with a physical disability:

• Assert her right to make choices about her body • Feel ownership of her body • Restrict the limitations resulting from her disability to physical functioning

only and not impose those limitations on her sexual self • Be accepting, not ashamed of her body • Take action to enhance her attractiveness

Read the complete article here: http://www.spinalcord.org/pdf/body-image-self-esteem-webinar.pdf

Depending on your unique clients and the context in which you work (including the types of services provided by your organisation), you may be able to think of many other ways of providing support in a manner that promotes the client’s self-esteem and confidence.

COMMUNICATION

The extent to which the person is able to maintain their environment is largely dependent on the state of their physical well-being. However, consideration should also be given to their psychological and emotional state.

Whilst there may come a time in their life when the person is no longer able to manage their environment by themselves, they may still have the capacity to live at home if they are provided with assistance to deal with the tasks that they find more challenging.

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In order to maintain their independence as much as possible, and remain in the home environment, providing them with information about the services available to them enables the client to seek out the necessary services they need. This process in itself is empowering for the person. Not only are they making decisions about their lifestyle, but they are also engaging with other members of the community when they seek assistance, thus showing that they are still capable of exercising their communication and negotiating skills.

Try to identify the areas that the client is able to manage without assistance. Communicating this to the client is likely to boost their self-esteem, particularly if they are feeling emotionally vulnerable as a result of realising that they may require assistance in other aspects of their lives. Another way that the client can elevate their self-esteem is knowing that they have the capacity and ability to delegate tasks to others who are providing them with assistance.

RECOGNISE AREAS WHERE THE PERSON REQUIRES ASSISTANCE

By communicating appropriately with the person, you can help them to identify areas in which they feel that they might need assistance. Reinforce to the client that they still have the power to make the decision about what services they see as being as beneficial to them. This too will help them maintain a sense of empowerment. It may be that the assistance required is only minimal, or that the support services they engage will be infrequent, thus not encroaching excessively on their privacy. This enables the person to see that whilst they are receiving some assistance; they are still able to function independently in many other areas of their life.

It is important to develop a plan that identifies how the maintenance of the environment is to happen. Throughout the establishment of the plan, the person should be continuously consulted so that they have a sense of involvement, and that they have the ultimate control over their environment.

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CONTRIBUTE TO THE PERSON’S SENSE OF SECURITY THROUGH USE OF SAFE AND PREDICTABLE ROUTINES

Throughout their lives, people develop a set of routines. They learn to recognise what it is they find enjoyable in their lives and become accustomed to doing things their own particular way. In order for older people to maintain their sense of independence, it is important that they be able to maintain their routines and have the freedom to think the way they are used to, according to their abilities.

To assist the older person in maintaining their independence, this may involve bringing other people into their lives to maintain the objectives and goals of their service delivery plan. Those providing the required services need to take into consideration the routines of the client prior to the commencement of the services. This way the services can be provided at a time which is not intrusive to the client. Whilst the client may need to exercise some degree of flexibility, they are the person who really decides how and when the services are best provided.

Service delivery should be provided in accordance with the service plan. The service plan should indicate both how and when the services are to be provided. It should clearly identify areas of significant importance to the client such as their cultural, social and religious values, significant others in their lives, events of importance, and other interests and activities in their lives. These factors are important determinants of the style in which the services are provided and the way they are timed.