The aim of this assignment is to discuss critically the principles of working with vulnerable children or young people by using an anonymousness case study. The plan is to illustrate the key concepts of vulnerability and resilience, consider the impact on the child’s mental health and to look at different legislations.
Mary is a five-year-old child who lives at home with her Mum and Dad. In view of the recent recession, Mary’s Dad has lost his job and is displaying negative emotions and this is causing friction with his wife. Mum has mild learning difficulties but is able to hold down a part time job, taking on more hours to compensate for the loss of earnings and leaving Dad to attend to Mary. Mary attends school but recently her attendance has been erratic, on several occasions Mary’s homework as not been done. School staff has noticed Mary turning up to school dirty, smelly and appears to have lost weight in recent weeks. The teacher has tried on several occasions to arrange a meeting but Mum claims to be too busy with work and Dad shows no interest.
An explanation by Appleton (1994) describes vulnerability as a complex concept where there are many interacting factors. Appleton (1994) suggests vulnerability can be viewed as a scale where families at different periods in life can be more susceptible to both “internal” and “external” stress factors. In comparison, The United States Agency for Health Care Policy and Research (USAHCPR 1998) suggests that the environment may contribute to the vulnerability of people through various phases of life. More specifically different people may be vulnerable in a variety of ways due to health issues, age, communication problems and the house and community where they live. Equally important a recent concept of vulnerability suggests that parents or carer’s inability to provide basic needs, such as love, warmth, shelter and a healthy diet may affect the child’s all round development. (Cleaver et al 2007).
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One cannot deny that everybody at some point in his or her life may be vulnerable. However, according to some experts how old you are can also be an influence. In other words, infants and children are considered more vulnerable because they rely on parents or carers to provide their basic needs. The reason for this is young children do not have the verbal language to communicate for their own needs (Aday 1993, Gitterman & Shulman 1994, Miller 1995). Nevertheless all concepts advocate a similar meaning and according to the Convention on the Rights of the Child (1990) article nineteen, states that every child has the right to be protected. Young children need to be nurtured and guided by parents or caregivers to provide them with the basic needs to develop into participating young adults in society (Cleaver et al 2007). So it is vital that all nurses, midwifes and health visitors should have the skill and knowledge to identify indicators of vulnerability in children and be responsible to pursue any concerns with the appropriate person (Stower 2000).
In the science of human development, resilience has comprehensive and different meanings, including recovery from traumatic experience, overcoming divorce and withstanding stress to function well in the tasks of life. It is clear from those facts that resilience refers to patterns of positive adaptation or development manifested in the context of adverse experiences (Masten& Gewirtz 2006). Masten and Gewirtz (2006) suggest that resilience is a dynamic balance between risk and positive factors. In addition, how individuals, children, and families cope in the face of adversity. This led us to believe through research that early childhood is a significant time where parents can nurture the characteristics of the children in promoting and understanding resilience (Masten & Gewirtz 2006). Furthermore, Masten and Gewirtz (2006) suggest that resilience may come naturally to some children where other children may need help in acquiring those skills. One should, nevertheless consider resilience from another angle where existence of protective factors may explain why one child may cope better with adverse life events than another (Getting it Right for Every Child 2008).
Protective factors are those variables that safeguard against the effects of risk factors, the presence of one or more factors of negative outcome for a child or young person. Protective and risk factors can be divided into four groups, child, family, school, and community factors (Durlak 1998). An example of a risk factor would be insecure attachment and the protective factor would be attachment to a family (Durlak 1998). With new information and understanding of resilience in individuals there seems to be a shift from the emphasis on factors and variables to mechanisms and processes. This shift looks at how well an individual processes and copes in the face of adversity (Rutter 2007). Furthermore, this refers to mental operations, for example coping skills, as well as individual characteristics and experiences (Rutter 2007). On reflection, it seems more accurate to say that considering not only characteristics and experiences but also the age and stage of development of the child. In addition, for example children aged five and less has a reduced repertoire of coping mechanisms. Similarly, Schoon (2006) suggest resilience is not only dependent on the characteristics of the individual but interactions from the family and the wider community may also play a part. On the other hand, Brooks (2006) points out that the family is at the centre of providing care and this has the greatest influence on the development of resilience in children.
In relation to the scenario, Mary’s all round development at this moment may be vulnerable. As highlighted above how old you are can also be an influence because children aged five and less has a reduced repertoire of coping mechanisms and the increased of vulnerability in this age group in terms of physical and emotional development. Mary is dependent on her parents to provide her basic needs, food, warmth, shelter, and love. The effects of neglect can have a long-term influence on Mary’s quality of life. However, some children cope with and overcome the socio-emotional effects of child neglect. Mary may have protective factors within the family, such as a Grandmother, who may help to reduce the effects of neglect and foster resilience.
The family dynamics have changed within the family where Mum is now working full time and Dad is the main caregiver. In view of the recent recession, Mary’s Dad has lost his job and is displaying negative emotions. This may have an impact on Mary’s all round development and her mental health because are social skills and needs is not being met.
In relation to the scenario, Mary is showing signs of neglect. To begin with, according to Horwath (2007) there have been many publications about neglect. However, not one was able to give a clear definition on what is neglect. In addition, analysis from these definitions agrees that neglect is an omission, or failure on part of the parent or carer to provide the basic needs for the child, such as healthy diet, and love (Horwath 2007). Likewise, the National Society for the Prevention of Cruelty to Children (NSPCC 2007) agrees that neglect is difficult to define and describes it as a “complex phenomenon”. However, both the NSPCC (2007) and Horwath (2007) agree that neglect in practice can present short term to chronic and severe neglect. Furthermore, periodic failure or one-off incidents can have a significant effect on a child. These periodic and one-off incidents may be indicative of developing neglectful behaviour. Another possibility it may be an indication that the family is suffering from stress, or a temporary crisis because of parenting issues (Horwath 2007) such as Mary’s Dad has been made redundant.
When people hear the word neglect, they usually think of parents not providing their children with food, clothes, or a safe environment to live in. Alternatively, parents can neglect their children (Horwath 2007) in other ways. Furthermore, Horwath (2007) suggests that there are a variety of parenting behaviours that may be classed as forms of neglect such as, medical, nutritional, education and emotional. Parents or carers who emotionally neglect their child fail in providing physical or emotional affection and do not develop the child’s sense of self-worth and positive identity (Horwath 2007). More specifically, it affects the child’s all round development including their mental health.
Mental health can mean different things to different people. For children to be mentally healthy they need to be loved, healthy diet, and opportunities to make choices, protection from risk, and shelter. However, the list is exhaustive but more specifically according to young minds (2002) children who live life to the full, creative and sociable lives, cope with difficulties and frustrations are mentally healthy.
The foundation for building emotional understanding skills has been found to develop within the parent-child relationship (Parke et al 1992). According Edwards, Shipman, and Brown (2005) through the parent-child relationship children learn from their parents how to label and interpret motions in different situational contexts, when it is appropriate, how to show and evade emotional experiences as culturally indicated. The ability to interpret the emotional behaviours of others may mean reading their facial expressions, by the tone of voice or body language, not necessarily words (Edwards, Shipman, and Brown 2005).
In addition, children who developed emotional development at a young age are more likely to settle well into school, work cooperatively, confidently and independently, and behave appropriately (Townley 2002). A child with poor social and emotional development is at risk of poor relationships with peers, academic problems (Horwath 2007). There is a difference between emotional neglect and emotional abuse. According to Iwaniec (1995) suggests that emotional neglect is non-deliberate where abuse is deliberate. Furthermore, parents or carers can emotionally neglect their children in a number of ways such as, inadequate attention to the child’s needs, need for affection, and lack of emotional support (Iwaniec 1995).
All children are individuals and may experience mental distress in different ways, such as the inability to cope with problems and feelings, low self-esteem and self-confidence, worsening school performance, and social withdrawal (Honeyman 2007). Emotional resilience is a valuable skill for all children. It is about being in control and believing in one’s ability to work through setbacks and risk situations in a capable, effective manner. This capacity for resilience empowers the child to develop coping behaviours, to persist in the face of failure, to bounce back with confidence and a healthy self-esteem (Townley 2002).
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Children need a certain amount of resilience to be able to cope with the difficulties that occur as part of living and other strong emotions, in order to do this children develop a number of coping strategies (Landy 2002). For the first five years, children rely on their parents or caregivers to provide support in dealing with intense negative emotions and eventually learning to control or manage their emotions alone by using a range of emotional resilience or coping strategies (Landy 2002). Therefore, children need to understand how to regulate their emotions, recognize emotions in others, and handle relationships with others if they are to be well-adjusted, contented, positive, and resilient individuals (Townley 2002). They need to learn that all emotions are okay, and that they are entitled to their emotions (Cassidy et al 1992). However, it is also important children recognise that other individuals’ emotional needs can differ from their own (Horwath 2007). Another aspect to consider is how the parents socialize with their children and display emotions. If the parent or caregivers display positive life skills rather than displaying anxiety or depression therefore the child’s capacity to emotionally regulate would not be impaired (Landy 2002).
Mental health affects all aspects of life how Mary forms relationships, interact with her peers and how she copes with the rough and tumble of life. A child who is ignored may seek other ways to draw attention, and the ability to cope may be hinder leading the child to have a strong tendency to use externalizing and maladaptive coping skills. Mary’s life is loaded with tension, negative moods, unpredictable parenting at this moment in time. In addition, the school have contacted both parents to discuss issues relating to Mary’s education and well-being however, her father is not interested and Mum claims to be busy with work. The expression both parents are portraying now about school is indicating to Mary that school is not important and she may be less likely to seek emotional support from teachers or her peers. On the other hand, up to now one may assume Mary has had a stable upbringing and with additional support and with protective factors in place may help her through the present crisis within the family.
There are different legislations in place to protect children and young people in today’s society. Such as, Protecting Children and Young People: Framework for Standards (Scottish Executive 2004), The Children (Scotland) Act 2004, and Sharing Information About Children at Risk of Abuse and Neglect: A Guide to Good Practice (Scottish Executive 2004). There are many more policies but advocates that all children have the right to be protected. According to CAMHS Standard, National Service Framework for Children, Young People, and Maternity Services (2004) suggests multi-agency services work in partnership to promote children’s mental health, provide early intervention, and meet the needs of the children that are identified with problems. It also goes on to say that, staff who are working with children and young people have sufficient knowledge, training and support to promote the psychological well-being of children, young people and their families and to identify indicators of difficulty. However, this seems not to be the case and according to Honeyman (2007), it is a much-neglected subject in child health. The Nursing and Midwifery Code (2002) states that this lack of knowledge in mental health may be seen as a barrier
When making decisions about a child it is paramount, they are at the heart of the discussion in all considerations and decisions. Professionals throughout the planning and actions taken must demonstrate this (Edinburgh and Lothian’s Inter-agency Child Protection Procedures Section 2, 2007). Furthermore, working with a family where they may be issues of the child or development professionals must co-operate to enable proper assessment of the child’s circumstances, provide any support needed, and take action to reduce the risk to the child. Sometimes this may require sharing information with other professionals. In addition, all professionals or agency’s are required to keep confidential information given by parents and must not be shared without the person’s permission (Edinburgh and Lothian’s Inter-agency Child Protection Procedures Section 2 2007).
Getting it right for every child (2008) is a network of support to promote the well-being of every child or young person to get help at the right time. This network will also include the family or carers. This may involve other agencies to be involved and if this is the case a lead professional will be nominated and they will co-ordinate help, such as making sure the family, child or young person understands what is happening and to promote teamwork between the agencies and with the family, child or young person.
The Getting it right for every child Practice Model consists of three elements, Eight Well-being Indicators, My World Triangle, and The Resilience Matrix.
The Eight Well-being Indicators, this identifies all areas where a child or young person needs to progress in order to do well now and in the future. This enables professionals to structure information that may highlight areas of concerns and needs and to structure planning (Getting it Right for Every Child, Section 4, 2008).
My World Triangle introduces a mental map, which enables the professionals to understand the whole world of the child or young person. In relation to Mary, using My World Triangle can be used at every stage to think about Mary’s world. Information may be used from other sources, possibly school, to identify the strengths and pressures in Mary’s life. This will not only identify the negatives but also the positives as well. My World Triangle looks at the whole child, physical, social, educational, emotional, spiritual, and psychological development (Getting it Right for Every Child, Section 4, 2008).
Using My World Triangle, the professionals can consider systematically how Mary is growing and developing, what Mary needs from the people around her, and the impact on Mary in the wider community, family, and friends.
To conclude the professionals may use The Resilience Matrix. The Resilience Matrix can be used in a single or multi-agency environment. This allows the professionals to gather the information on Mary, from My World Triangle and other sources and plot it on a blank matrix so that the balance between vulnerability and resilience, and adversity and protective factors can be weighed.
The City of Edinburgh Council, Guidelines for Pupil Support Groups (2004) are committed in working in partnership with the parents, Social Work, Education and others to provide integrated support to children or young people and their families. Mary is in Primary one at school and the teachers and staff are in a good position to observe Mary in her education, socialising with her peers and her general well-being.
Many researchers have highlighted that vulnerability and resilience are difficult to define. Through my research for this assignment, I have been introduced to a number of concepts in relation to vulnerability, resilience, and mental health in relating to a young person or child. It is the job of any paediatric nurse not to diagnose but be able to recognised symptoms of children with mental distress in order to refer them to the appropriate professional or agency. In addition, how important it is for the nurse to understand the age and stage of development the child goes through. Prolonged emotional neglect or any type of abuse may be harmful to the child. It has been highlighted through research that it may affect the child’s all round development and the presence of protective factors may explain why some children are resilient and why others are not. Resilience can be enhanced through extensive and appropriate practical and emotional support, intervention, and life chances. In order to enhance resilience professionals must establish the vulnerabilities and protective factors that exist for the child them consider the course of action to take to enhance resilience.