Protecting children: Four disadvantaged groups to focus on

By Jim Lim

MALAYSIA may have acceded to the Convention for the Rights of the Child in 1995 and passed the Child Act in 2001, but key challenges remained and have to date, shown few signs for optimism.

At the heart of the problem lies the country’s vague definition of “nationality” as derived from its founding Constitution, resulting in complex and exaggerated inconsistencies and contradictions over children in general. These problems are particularly acute in marginalised communities and among those from disadvantaged groups.

The difficulties can be seen at the legislative level on private law on children and on public law. This is where the definition of, criteria for and access to fundamental rights and services become even more confusing.

Orang Asli children: The community lacks in educational facilities and development
investments. Source: Muhammad Adzha, Wikimedia Commons

Legal practitioners will attest to the complexities and the absence of transparency in child care law, especially in fundamental rights and duties. For example, there is a disproportionate high number of years for a child to apply for and attain citizenship, only because Malaysia does not grant automatic citizenship by birth and its differential treatment on the sex and national status of the parents.

This private law conundrum above is not the purpose of this paper. However, it is the provisions and the denial of services through a fundamental human rights’ deficit in the public law aspects that is the subject of our current attention.

We refer to the situation of children at greatest disadvantage or “marginalised” by the circumstances of their birth, upbringing or status. The following groups have come to our attention and their current situation:

• Children, mostly orphans, brought up in state-run children’s homes,
• Children from the refugee communities,
• Children from rural and poor communities, e.g. the Orang Asli community
• Children in wedlock.

Children brought up in care in residential institutions

Orphans raised in care homes are common practice. They are placed in establishments run by private entities, by voluntary (NGO) groups, usually religious organisations, and by the social welfare department.

In general, children who become orphans fall under those abandoned or abused and would normally end up in residential establishments. The length of stay can range from a few weeks to many years, including up to 18 years old. As there is no formal legislative procedure for the rescue and safeguarding of vulnerable or children “at risk”, many different stakeholder agencies intervene in their own way to help.

There is no requirement (legislative compliance) on standards of care for these  establishments looking after/caring for such socially dislocated children. Whilst many home owners and management provide excellent to good care, there is no way to prevent abuse, physical, emotional or sexual, by a minority unsuitable care staff, especially against a backdrop of wider cultural  paternalistic views about children. There have been voices raised by some of the children themselves on their abuse.

Much of these concerns have come from “Perbak” (Pertubuhan Kebajikan & Sosial Malaysia) an organisation set up by an ex-resident child in care. The high-profile leader, Muhammad Khairul Hafiz Abdullah, had stayed at a place where it is alleged that there are hundreds of abused children now adults. They have come to recall their painful experiences. It is the government-run orphanages that Perbak is referring to, in this instance, and the majority are Malay-Muslim boys.

Furthermore, many of these former children in government care are deemed either undocumented or stateless. Being “stateless” means that access to many government services is denied. Moreover, most are left to fend for themselves once they reach the age of 18.

Read more about Perbak here, here and here in reports by The Star. Also a letter by this author here.

Children who have suffered abused whilst in “public care” should be appropriately compensated for the suffering endured. Nothing is worse than having one’s childhood heartlessly taken away. Discharging formal responsibility at the age of 18 or abandoning such young adults to fend on their own and further denying them “citizenship” undermines any concept of civility in a developed nation.

In terms of alternative substitute parenting and care, the concept of “family fostering” or professionally-paid fostering support is not well developed in Malaysia. In many developed countries, such family substitute care is widely promoted through government investment, with its suitability and popularity endorsed by child care experts over often large institutional/residential care.

Children from the refugee communities

Refugees in Malaysia are normally accredited through the UN resettlement programme and almost all are awaiting disposal to a third safe country as Malaysia restricts the numbers it accepts. Therefore, many are resident in situ pro-tem until a country in the West takes them.

Refugee children are sadly denied access to local schools and any education provided to them is from voluntary NGOs or local religious organisations like the church. Adult refugees are allowed to take some employment and local work but on limited reduced hours.

Children from the Orang Asli community

The plight of the Orang Asli (OA) community in Malaysia is well documented and the government’s acknowledgment is a positive sign that some help and resources are available. In short, this indigenous community is widely acknowledged as amongst the rural poor.

However, it remains the case that there is systemic discrimination against the community throughout the country and their resultant marginalisation has a negative impact in aspects of health outcomes, educational and positive social outcomes.

The OA community is largely in rural communities in most states of peninsular Malaysia and in East Malaysia. Most are employed in the agriculture sector although many OA are emerging as community activists campaigning for equal participation and representation and greater allocation of resources for their community. The government’s paid lip service over the years has gone hand-in-hand with the private sector continued labour-exploitation within the agricultural sectors. NGOs have complained bitterly about the disproportionate and unequal allocation of educational resources and lack of investment for the development of the community.

Child marriage

The issue of child marriage is a controversial one. The UN raised this as a concern as far back as 1995. The United Nations Sustainable Development Goals is calling for “global action to end this human rights violation by 2030” (read here). A pertinent matter in many Muslim countries is around the dual legal systems of civil law and shariah law; the latter permitting marriage in exceptional circumstances for a child. A local prominent NGO, “Voice of the Children” (read more here) publicised the issue as recent as 2013, together with “Girls not Brides” (read more here), a global organisation on girls being forced in wedlock.

The PH Government began to address the issue of child marriage, as well as reinforced “Help lines” for child safety. However, with the new PN government’s more conservative outlook, the outright ban widely sought for appears “on hold”.

Child marriages are abhorrent. It is a human rights issue. They deny and take away a child’s right to growing up and there is no rationale for not ending the practice by passing legislation and banning it outright.

Conclusion

It is difficult to defend the government’s record in matters on safeguarding and the protection for children. There remains a lack of regulation for the care of vulnerable groups in our society and much reliance is inappropriately placed on the shoulders of the voluntary or religious groups and where business and profits are to be made, on the private sector. Therefore, enforceable regulation and strict standards in operation when private sector companies provide services is necessary to promote safeguarding and well being.

With regards to legislative framework there is much to be getting on with, the Sexual Exploitation Act 2017 following from laws on prohibitive child employment, care centres, domestic violence etc but there is little evidence of effective co-ordination or collective responsibility on enforcement action. In short, existing laws are not effectively enforced and proposed social policy legislation suffers from inertia and delays.

Strikingly absent is also regulation for those seeking employment as care givers, care workers or wardens in residential institutions. For example, are they suitably qualified to care for children? Are those staff members adequately vetted?

Lack of compliance and enforcement on premises suitable and fit for purpose, i.e. safety access, fire escapes, was a contributory cause to the tragic fire at a tahfiz school or madrasa resulting in the deaths of 21 children and two teachers. Although it was a criminal act, there was evidence of neglect and non-compliance by the building owners. Read more here.

Finally, the much overdue recognition of social work as a profession, the Social Workers’ Act, all up and ready for legislative consent has been delayed yet further as the government ponders and treads along its various priorities.

Besides putting a proper framework for social care and assistance to vulnerable groups in society such as children, there is an equal need to obtain social justice for the country’s disadvantaged children most of whom were brought up in institutional settings as opposed to, in family settings.

• Jim Lim is a former Director of Social Services in a London Borough, a former CEO of a charity. He is retired and is from Penang. He is a Member of the Malaysian Association of Social Workers. Read more about him here. 

MySay: Wish list for a more comprehensive environment for social work

This article appeared in The Edge Malaysia
of Nov 11, 2019. Read here.

By Jim Lim Teik Wah 

SOCIAL WORK is an acknowledged activity of potential professional standing besides it being a study-subject of widespread academic interest. Its close relation “social care” is a broader and more generic activity representing a major lifeline for many. Both are mainstream occupational undertakings by practitioners and formal and informal care-givers, care workers, support workers, to name some common titles used elsewhere although social work is the more sophisticated form. 

Their standing as a profession has not grabbed headlines as such, nor interest amongst the Malaysian rakyat or its major news media. For reasons not unsurprising, many are either unaware of what the professional activity (social work and social care) encapsulates – beyond general altruistic intent and interventions for and on behalf of individuals and families.

The campaigns over the years to advance social work as a practice-led profession, suitably “fit for purpose”, present to us an opportunity to significantly improve lives and protect the vulnerable. The social work fraternity collectively must redouble its efforts to promote its activities to increase public education and recognition, not forgetting the vital role social care plays too. 

It is with great excitement and relief that I hear that “social work” will soon become a recognised profession following plans to table laws to upgrade the status of social workers. The Women, Family and Community Development Minister, Datuk Seri Dr Wan Azizah Wan Ismail said on October 9 in Parliament, the move is aimed at improving efficiency in case management of targeted groups while ensuring adequate qualified social workers for the country. 

“The ministry is taking several steps to ensure that the Welfare Department will change its focus on social worker’s job scope so that they will conduct case management for the targeted groups. Among the changes is the introduction of the Social Workers Profession Act, which is expected to be tabled in the Dewan Rakyat in December this year (2019).”

The recent budget 2020 does not allocate any specific funds towards the development of social work. There are, however, related themes towards creating inclusive and a more equitable society and general measures to address low wage, to raise income benefits for specified groups, to increase maternity leave and to improve access to housing. 

In the light of this much awaited proposed legislation, the following is an illustration of the impact of the profession on the lives of the most vulnerable in our society. In other words, it is my “wish list” for a more comprehensive environment where social work is weaved meaningfully, usefully and inextricably, as it should, into various areas of need:  

Child protection: The social work role in this area is enormous and significant – social workers would primarily be involved in assessments for eligibility for help and services, and they would be the front-line of child protection activity leading the prosecution, when working closely with enforcement agencies such as the police.

Courts dealing with children can also rely on reports from social workers and in many developed countries, social workers are regularly appointed as guardians’ ad litem to assist the courts in the determination of the child’s welfare and future. This happens, for example, in cases involving matrimonial disputes, in fostering and adoption cases. Social workers are often approached for their assessment with families, ranging from sentencing and disposal cases with offending juveniles to complex decisions on wardships (in the higher courts). They underpin the principle that the interest and welfare of the child is paramount.

Social workers would also intervene directly, with judicial powers to remove children from family households where the children’s safety and welfare appears compromised. They would seek suitable substitute families for abandoned babies, work with neglected children and assist those in long-term children’s homes in promoting their life chances. 

Care for the children with disabilities: The social work task here is primarily to assess, support and enable care-givers and families to obtain assistance and respite in their care tasks. The government intervenes only to lessen the burden, not to assume care, unlike cases of child neglect and abuse where governmental bodies may assume parental duties or loco parentis. 

In some instances, the professional social work task of assessment will end with the assignment of a care worker (care-giver) to assist the family coping with the severely disabled child as part of a time-limited support plan.

Women: Social workers are common in this area of activity because women play a vital and yet often “taken-for-granted” primary role in families with regards to safeguarding, protection and nurturing. The social work task would be offering advice and support, including assistance in prosecution in domestic violence cases and in measures to uphold both the children’s welfare and the interest of the main care-giver. 

Social workers and care workers may work from community advice centres, women’s aid shelters and community homes to support the victims and their dependents.

Adults with disabilities, including HIV/Aids and drug dependency:  Social workers will be “case managers” in this field to ensure that support, treatment and care is effectively targeted, followed-up and monitored, as current legislation provides. There is scope for joint approaches including shared supported housing placements in order for a streamlined service (including health and welfare services). Social workers in community-based drug rehabilitation centres as well as NGOs would perform outreach work as well as in public education. Many day-care staff or support workers would also perform duties which overlap the social work task.

Mental health: Social workers are a major occupational stakeholder in mental health. In developed countries, they hold powers which can over-ride an individual’s civil rights through involuntary admissions to a place of safety, e.g. a hospital, for observation and treatment. They also work within the judicial process, in matters such as the protection of property and, safeguarding and protecting individuals and the public.

Social workers are considered part of a multi-disciplinary team in specialised psychiatric facilities, including direct involvement in therapeutic programmes alongside other paramedics such as occupational and speech therapists, to name a few. The social worker’s main tasks are to undertake assessments of the individual’s living conditions and family circumstances and contribute to the medical team in drawing up individual treatment plans.

In mental health services for children, social workers have a crucial role in providing the link between the medical and psychological staff and the patient/family. In developed countries, children and adolescent mental health services are common and often jointly provided by the government health and welfare ministries. 

Elderly: The social work role in the area of elderly support and care is again, enormous. Social workers often assist the medical team in providing social histories and provide on-going reports on rehabilitative treatment regimes. They can be pivotal in convincing elderly people on facing daily-living realities and in coping with the significant changes in their lives, including residential care and perhaps away from immediate family members. They can act independently to prevent forms of elder abuse, either within the family or outside, including matters related to inheritance and finance.

Crime and probation and after-care services: Suffice it to say that, within the constraints of this area, probation officers in my view are essentially social workers in a criminal justice setting. The social work aptitudes and skills share commonalities although “conservatively inclined” law makers would prefer to see probation officers move away from a social work welfare perspective and towards more of a criminal management one.

Working in partnership and inter-agency: As was referred to earlier, social workers play a key role in medical settings especially in severe terminally-ill cases or, where legal decisions rests on balancing risks as to complicated continuing care. Likewise, social workers are relied upon as a service to the courts and protection tribunals. In adoption panels, the social worker’s recommendations are part of the essential prerequisites for a successful permanent placement decision. Social workers are often also integral members of multi-agency disaster relief teams. 

In many Western countries inter-agency working is the norm. Their joint activities range from basic information sharing to joint planning at the strategic organisational level. This is the established modus operandi in child protection work, i.e. social work, police, schools and health personnel work in tandem. There is considerable overlap in services among different departments and breaking down any barrier among them can only be positive for the consumer or service user. 

• Jim Lim Teik Wah is former Director of Social Services (UK), CEO of a London-based mental health charity, UK judiciary member on protection and regulation and in academia. He is a Fellow of the Institute of Directors (UK).  Retired now, Jim spends his time within his beloved Penang, UK and Italy. 
• Read more about him here.
• Word count: 1,440 words

Sustaining the right quality of life for individuals with challenging needs in ageing

The elderly: Caring for them can be a viable
industry with expanding job opportunities. 
Source: Johannes Jansson, Wikimedia Commons 
 

By Teoh Ai Hua, Jim Lim Teik Wah & Dr Thomas Khor

MANY ELDERLY people, suffering from age-related disabilities, some of which are substantive, rely exclusively on family members and close community organisations to help tend to their daily needs and well being. A significant number will continue to remain in their own homes and live with their family members. However, it is not uncommon, judging from media reports, that many older people are neglected, living out their twilight years in miserable circumstances or in situations of severe indifference within their households. There have been cases of abuse too. This paper aims to highlight key responsibilities that the government should assume in improving the support and care services for the elderly, including ways to encourage and facilitate new “service providers” to address the needs of this growing vulnerable population. This paper argues that these measures, when comprehensively put in place, will expand and improve services as well as develop the social care industry as a viable sector for new job creation. More importantly, we believe it will eventually lead to improving and sustaining the quality of life for older people living in the community.

• Teoh Ai Hua is Senior Lecturer, School of Applied Psychology, Social Work and Policy, Universiti Utara Malaysia
• Jim Lim Teik Wah, Former Director of Social Services in the UK
• Dr Thomas Khor, Managing Director, Home MediCare, Penang
• This paper was presented at International Social Work Symposium organised in collaboration with a number of universities and the Malaysian Association of Social Workers (MASW), April 27-28, 2019. Read here.

This is the full paper (3,200 words in all):

INTRODUCTION

Malaysia is estimated to become an “aged” nation by 2030 when 15% of its population will be over 65 years old (United Nations, 2015). The majority of older people will be living with and cared for by their families. In Malaysia, it has been reported that between 60% to 70% of the older persons live with their children or extended family (Pala, 2005; Hamid, 2015; Kooshair, Yahaya, Hamid, Abu Samah and Sedaghat, 2012). While living with their children does not imply dependency on the part of the older persons, there are differences between the main carers for older men and older women. Older men normally rely on their wives and/or daughters while older women rely mostly on their children only (Hamid, 2015). However, the biggest challenge for most families is coping with the care-giving burden for older persons with certain degree of dependency due to frailness or dementia (Choo et al., 2003; Nikmat, Howthorne and Al-Mashoor, 2015)

It is not uncommon to read in the media about older people being neglected, living out their twilight years in miserable circumstances or in situations of severe indifference within their households. The burden of care on caregivers may lead to the abuse of the elderly (Choo et al., 2003). One particular research has shown that 26% of the respondents (older persons) have experienced at least one incident of abuse, with emotional abuse being the most prevalent (Hamid, Abdullah and Yahaya as cited in Hamid, 2015) yet the health professionals demonstrated poor understanding of signs of elder abuse and neglect (Ahmed et al., 2016). Nevertheless, the absence of data on such matters in Malaysia is an indicator of low awareness and priority of the subject matter (Hamid, 2015).

Past research in Malaysia have also focused on the quality of life of older persons in institutions or at their own home, the burden on caregivers, and nursing care and social care services (Aziz and Ahmad, 2017; Choo et al, 2003, Nikmat, Howthorne and Al-Mashoor, 2015, Tey et al, 2016). One report pointed out that having a maid or providing nursing care for the elderly living with their families may not reduce the burden on the caregivers (Choo et al., 2003). However, most were focused on the public sector perspective, and not much has been written on social care services provided by  independent players or the private sector where the elderly or their caregiver can pay for services as an option of care. There is certainly a need for care services for those who can afford to pay for them.

METHODOLGY

The growing population of older people can have a major impact on health and social service provision, including social care. The repercussions, both social and economic, will be major and far reaching if resources are not planned or distributed properly. Some questions that need to be addressed are:

1. Who can older people with challenging needs (and their families) engage, if they can afford paid home help services?
2. Are these services available?
3. Are these services regulated?
4. What are the qualifications of the caregivers or care workers, if available?
5. What can the government do to ensure quality and availability?

This paper aims to examine the existing ecosystem of social care services, relevant legislation and training programmes for elderly care in Malaysia. At the end, several recommendations will be presented and implications for social work practice will also be discussed. 

FINDINGS

THE PRESENT SCENARIO

(1) Underdeveloped social care services for elderly care

In general, social care services for the elderly provided by the public sector, i.e. the Department of Social Welfare, can be divided into three types, namely, (i) cash and in-kind benefits, (ii) institutional care, and (iii) home care (Hamdy and Yusuf. 2018). However, the government direct services (provided by its own welfare officers or assistants) are mainly from category (i) and (ii), while home care services are indirect services where the government giving funding to non-government organisations and volunteers to run free home help programmes, activities centres (e.g. Pusat Aktiviti Warga Mas, PAWE) and transportations services (e.g. Unit Penyayang Warga Emas, UPWE). The volunteers involved in home help programmes are mainly retirees or old persons themselves, and the service is still limited to a few areas. As at March 2017, there were 2,150 volunteers providing services to 5,892 older persons (Mohd Salleh, 2017).

The health service also provides care services for older people in the form of outpatient care and hospitalisation. Although there are more private hospitals compared to public ones in Malaysia, over 70% of all admissions are to public hospitals where older persons make up over 20% of the total admissions (Tey et al., 2016).  However, the health service also faces limited resources and they are not able to provide a continuum of care including home care, day care and respite care (Ambigga et al., 2011).

As a result, scarce medical resources may be directed inappropriately. One example is the need to care for older people following admissions via accident and emergency facilities, resulting in what is termed as “bed blocking”. Many hospitals are facing difficulties in discharging these people, sending them home. This is mainly due to the lack of supporting services in the community.

In addition, most of the services provided by the voluntary and private sectors are residential homes (free or low fee) or nursing homes (more expansive). They do not cater to the needs of older people who want to remain at home. In essence, services for older persons with challenging needs who live independently or with their families are rather limited. 

Due to an under-developed aged care infrastructure, many private unlicensed residential homes have sprung up, especially in big cities, to meet the demand. There are glaring examples of such establishments operating without due regard to safe environment or operating safeguards despite the existence of the Care Centre Act 1993 and the Private Aged Healthcare Facilities and Services Act 2018 (Serving seniors requires passion, 2019: para 9). Stories of elder abuse are not uncommon. Other problems include inadequate staffing ratio, depersonalised rooms and unattractive environment and sometimes, they use public hospitals as dumping grounds for residents they are unable to care for.

(2) Undefined qualification of caregivers under existing legislation on elderly care

Offering shelter and care on a commercial basis and operating at standards as yet  undefined or unquantifiable, the care facilities have left many elderly people at some risk. This problem is compounded by the lack of choice. Although the Care Centre Act 1993 and the enactment of the Private Aged Healthcare Facilities and Services Act 2018 have provisions for the government to regulate the service providers in terms of number of residents, staff-resident ratio, health and safety measures etc, monitoring and enforcement remain wanting. 

Moreover, the qualification requirements of staff and care workers remain ambiguous. For example, Section 7 of the Care Centre Act 1993 gives power to the Director General of Social Welfare to impose conditions for registration yet it was undefined when comes to qualifications of persons employed as in 7(b) and 7(c), and without additional schedule or by-law:

“7(b) to ensure that any person employed at the care centre, whether in its management or otherwise, is a fit and proper person, whether as regards age or otherwise, to be employed at the care centre; and 

7(c) to ensure that the care centre will be adequately staffed by a sufficient number of persons with suitable qualifications or experience.”

On the other hand, the Private Aged HealthCare Facilities and Services Act 2018 defines caregiver as “anyone, other than health professionals, who provides personal care to any care recipients” and all licensee of healthcare services must ensure that caregivers are trained and competent (Section 20(b)) and the training of caregivers in basic life support (Section 26(4)), and the licensee can be revoked of his or her license if the licensee employs unqualified person as a caregiver (Section 30(e)). However, it only spelt out healthcare services provided by health professionals and para health professionals (Schedule 1) and qualifications of those healthcare professionals that are currently being regulated by legislation (Schedule 2). Again, no specific qualifications are mentioned for the caregiver.

While nurses are seen as qualified in providing nursing care, experience on the ground has shown that many of the elderly who require home care services may not need nursing care all the time. Research has also shown the importance of social support in achieving better quality of life for those living at home (with proper support) in comparison with those at nursing homes (Nikmat, Howthorne and Al-Mashoor, 2015). The role of caregivers must be valued and their capacity must be enhanced.

(3) Underdeveloped and unregulated training courses for caregivers or care workers

Currently, only one university, Universiti Putra Malaysia, offers a postgraduate programme in gerontology. It does not address the needs of trained care workers. Such needs are normally not addressed at the tertiary level (Hamid, 2015). The National Council of Welfare and Social Development Malaysia (MAKPEM), in collaboration with the Open University Malaysia (OUM), has offered a Professional Certificate for Caregiver which is a 16-module programme (MAKPEM, 2014). However, only one module is on elderly care. The MAKPEM-OUM Professional Certificate serves more as a self recognition for NGO workers. It is not accredited by the Malaysia Quality Agency (MQA). It is also not getting any recognition from the underdeveloped social care sector.

 

Seeing the lack of training and recognition of qualifications in the social welfare sector, the Department of Social Welfare has actually started an initiative to develop relevant training and standards through the National Occupational Skill Standards (NOSS) framework several years ago (Jabatan Pembangunan Kemahiran, 2016). Elderly care (27.4) is placed under Sector 27 Care and Community Services, and three (3) levels of NOSS have been identified: 

• Level 3: Elderly Care Centre Operation
• Level 4: Elderly Care Centre Administration
• Level 5: Elderly Care Centre Management

From the titles given, it seems that the skill standards set for the three (3) are meant for operators or managers of care centres, and not so much for caregivers or care workers. The latter needs Levels 2 and 3 competencies in providing direct care and support for the elderly. In Australia, one needs a qualification in Certificate III in Individual Support (Ageing, Home and Community) to become an aged care worker (www.opencolleges.edu.au). In the United Kingdom, it has set standards at Level 2 and Level 3 Diploma in Health and Social Care (Adult), as well as up to Level 4 Diploma in Adult Care that can be offered through many accredited institutions like City and Guild (www.cityandguilds.com).

In this regard, Malaysia has no social care qualifications set at Levels 2 and 3, the nearest equivalent would be the Professional Certificate for Caregiver by MAKPEM-OUM. Its relevant standards and competencies have yet to be examined and accredited by a regulatory body. 

 

(4) Historical and cultural factors

In Malaysia, as in many other Asian countries, looking after elders is a family duty. It is very difficult to send an elderly person to a residential care home. This familial responsibility is prevalent amongst all the races. Nevertheless, modernisation trends and societal changes are altering mindsets. Lower fertility, higher rates of childlessness, and increases in the number of divorces and people remaining single, have all contributed to a shrinking pool of potential care-givers within the family setting. 

Care for the elderly could be headed for a crisis in terms of the availability and accessibility of essential services. As mentioned earlier, services outside the family remain fragmented. They are also of varying quality and scattered inconsistently across the country. Many families now use foreign domestic helpers as “caregiver”, adding onto their other job tasks. Many of these helpers are not trained or properly compensated, resulting in the elderly person making do with a second rate service.

RECOMMENDATIONS AND IMPLICATIONS

The roles of the government

The government should undertake to improve support and care services for older persons, including ways to encourage and to facilitate new “service providers” to address the needs of this growing vulnerable population. These include:

 

(1) Developing a more active and diversified social care sector

This can be done by generating conducive conditions including developing business-friendly policies in the social care market that encompasses a mix of service provision by the public, private, non-profit and voluntary sectors. This diverse care provision, offering a range of care to meet different needs will be able to offer “choice, appropriateness and sensitivity” in the light of the country’s multi-diverse communities. 

(2) Setting and regulating standards for practice in social care

1. Enhancing existing legislation, such as the Care Centres Act 1993, by developing regulatory mechanism that sets standards for practice of care workers and for quality service by service providers. Skills applicable include managing elderly people with sensitivity whilst assisting with all aspects of daily living, hygiene, nutrition, mobility and basic one-to-one counselling. Caregivers would also need to cope with those with multiple medical needs. 
2. Therefore, we would like to propose the establishment of an Inspection and Registration Unit, within the Department of Social Welfare Malaysia. Its main role is in implementing, safeguarding and protection for elderly people living in residential care. As demand for care-giving inevitably rises, the unit must also have adequate powers to apply sanctions on underperforming organisations and on those who employ untrained staff.

(3) Setting and regulating the training courses in social care

1. The role of a caregiver or care worker must be a recognised occupation, assuming the status of vocational level standards under the National Occupational Skills Standards (NOSS) framework. These caregivers who are trained would have a recognised certificate which they can usefully take with them to another employer, an individual, a family or a residential home. In this regards, the Department of Social Welfare may seek to appoint established educational and training institutions to approve courses. 
2. Training and accreditation must follow and further education providers must be encouraged to provide basic short courses, encompassing syllabus which are fit for the purpose of individual care-giving. (There are any examples of such courses run in developed countries). Educational pathways should be created for qualified caregivers to pursue more advanced professional qualifications at the tertiary level when they want to move up in their career.
3. It is important to note that setting training and practice standard as well as creating occupational pathway for caregivers is to get more locals into the social care sector instead of relying on foreign workers or maids to look after the well being of older persons in the country.

(4) Establishing a Commission for Social Care

1. The government may not regulate social care qualifications through enacting legislation like how the health professionals and para-professionals are being regulated. However, the government can set up a Commission for Social Care as a national body for all forms of social care, so as to (1) ensure that standards are maintained, (2) regulate training of social care workers and (3) provide relevant accreditation. The commission will, through regular monitoring and inspections, ensure that providers undertake service quality improvements. 
2. Before setting up such a commission, the government may prepare a consultation paper for the care of elderly people and adults with disabilities and should review all current services for elderly people with a view of implementing positive changes to ensure long term sustainability and to enhance individual dignity and purpose.

Implications for social work practice

When the above suggested measures are in place, and the numbers of qualified caregivers have increased, it can actually help to enhance the practice of social work in the following way:

1. Assessment and care planning: Social workers will be able to do needs assessment which can be met with suitable services as there will be more resources or choices available for social workers to consider in formulating care plan with older persons. 
2. Interventions: Besides being able to conduct psychosocial assessment and interventions, the skills and practice standards in social care are essential for social workers who provide direct service to older persons. Even if the social worker is not the key worker to the older person, they would be able to supervise family members or other caregivers of proper ways in supporting the daily living of older persons at home.  
3. Inspection: This can be the role of the social workers in the Department of Social Welfare to ensure quality service delivery by trained caregivers or care workers in institutional or community care for older persons.

CONCLUSIONS

Our elders deserve more and should not be discarded once their working lives are over, as they are entitled to continuing support, care and love for as long as their bodies and mind can sustain them. With great shifts in attitudes and an accompanying increase in recognised community of caregivers, the quality of existence of elderly people will be immeasurably enhanced. This is without a shadow of doubt. We owe it to our elders.

REFERENCES

Ahmed, A., Choo, W. Y., Othman, S., Hairi, N. N., Hairi, F. M., Mohd Mydin, F. H., & Illiani Jaafar, S. N. (2016). Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey. Journal of Elder Abuse & Neglect, 28 (3), 163-177.

Ambigga, K.S., Ramli, A.S., Suthahar, A., Mohd Tohit @ Mohd Tauhid, N., Clearihan, L., & Browning, C. (2011). Bridging the gap in ageing: Translating policies into practice in Malaysian primary care. Asia Pacific Family Medicine, 10 (1), [2]. https://doi.org/10.1186/1447-056X-10-2

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Looking back and moving forward: Social work in the new Malaysia

The MASW was set up in 1973
almost half a century ago

By Jim T W Lim and Zaharom Nain**

SOCIAL WORK in Malaysia, we will argue in this paper, unfortunately, has not been accorded much credit, even credibility, for many years up until arguably perhaps today. Indeed, since it was formally and legally established in March 1973, and despite its membership of many international agencies, the Malaysian Association of Social Workers (MASW) and its members, and the profession itself, do not appear to be as well understood by the Malaysian public – and possibly even by the government – compared to more “established” professions, like nursing and physiotherapy. It is as if the problems that social workers attempt to resolve are seen either as unresolvable or too petty to entertain.

In this paper, we critically examine this scenario. It is, we argue, a sad scenario that needs to be addressed urgently by the state (government). Malaysia is part of a global system sharing similar socio-economic structures and institutions all of whom result in social problems of varying complexities as each nation in the system seeks to “progress” and maintain their own social sustainability against the pace of rapid development.

Our paper is made up of three parts. In Part I, we provide a “mapping” of social work in Malaysia, outlining its history, development, possible misconceptions, and contemporary concerns and directions. We ask here: Is there really “buy-in” by the various stakeholders? And if there isn’t, why not?

In Part II, we (re)introduce the almost forgotten, yet admirable, Vision 2020, tabled by Tun Mahathir in 1991, during his first stint as Malaysia’s Prime Minister. More specifically, we focus on just one of the nine challenges, the challenge to create a “caring society” by 2020. Using this as our go-to goal for social work – and looking at specific areas, e.g. children with disabilities, community foster families, safeguarding and protection of children, including bullying and drug addiction and elderly support and care – we examine and evaluate if there is sufficient professional and official concern and support for social work in contemporary Malaysia, and perhaps more suitably, ask if there has been sufficient political will. Our explicit aim here is to highlight these issues and to suggest better attention through “mainstreaming many of those services” as this may be a way to bring about equal justice to the victims, sufferers as well as improved services for the vulnerable sections of the community. Otherwise, they will always be marginalised in terms of any service uptake in a diminished resource pool.

This leads us to Part III, where we map out directions for the future, suggest types of developments which have been successful in neighbouring and international countries. Here we will also outline what would be the ethos and institutional support needed for social work to be provided professionally, for all Malaysians who may need such services.

• This is an abstract for a paper presented at the MASW-JKM-ISM international Social Work Symposium 2019, Kuala Lumpur, 27-28 April. Read here. Jim TW Lim (read more about him here) was a former Director of Social Services (UK). Zaharom Nain is Professor of Media and Communication Studies at the University of Nottingham in Malaysia.

Read the complete paper below (about 4,000 words):

1. Introduction

Good afternoon, colleagues. Thank you for giving us this opportunity to present what we may call a “think paper”, designed to provoke, to challenge and, hopefully, to suggest some ways forward for the profession of social work in Malaysia.

Our paper begins with the proposition that social work in this country has been woefully “stuck in the middle ages” (to borrow a phrase). We contend that its practice throughout the country remains mostly unseen and unheard – and unappreciated – despite the fact that there are at least nine higher education institutions producing graduates “fittingly” for this profession that is still widely unrecognised amongst the public. Is this an academic study, then, one of choice? Especially when there are few and far between opportunities in pursuance of a worthwhile career?

But, as always, perhaps it is pertinent to start from the beginning.

Zulkarnain and Zarina (2014), in a rather bland and descriptive chapter titled “Social work in Malaysia”, begin with the observation that [1]:

A few decades ago, the majority of the Malaysian public had never actually heard of the term ”social work”. The most familiar terms were for the welfare department, community, and voluntary work (gotong royong), which are closely knitted and often used interchangeably. 

What is evident is that, the situation has hardly changed. Indeed, as the authors themselves state towards the end of their chapter (ibid.), 

Social work as a profession is still relatively unknown to the public. Many still see it as welfare-related work (giving charity and dole-out by ministers’ wives), or volunteer work (gotong royong). There is a paradox among the policymakers; while they are concerned with the affairs of social issues in the country and see the need for social work programmes, there exists a certain vagueness of understanding of what social work education and practice really entails.

Indeed, to elaborate, social work in Malaysia is currently represented in the main platforms. That is to say, the majority of practitioners work in the Department of Social Welfare (Jabatan Kebajikan Masyarakat), now under the Ministry of Women, Family and Community Services. These personnel are followed by hospital-based welfare officers, while the rest of social workers work in civil society organisations (CSOs). There are allied and related occupations in the criminal justice systems and within religious societies/charities serving their particular communities.

Unlike most western countries where family and child care law feature more prominently and social workers’ intervention often influence case outcomes, Malaysia’s family law for Muslims (who make up 60% of the Malaysian population) is largely governed by the Shari’a courts and the civil courts mainly handle such cases for the minority non-Muslim communities. Given this situation, it is not surprising that social work does not feature prominently as a recognised profession nor social workers as recognised professionals.

The Jabatan Kebajikan Masyarakat (JKM) social work “workforce” assesses and dispenses a whole range of assistance to individuals and families. It is commonly reported that many of the kind of assistance available is often not easily publicised and hence, uptake and publicity is through individual initiatives by the social workers.

Just as medical social workers (working from hospitals), undertake their functions strictly within that hospital’s policies (some hospitals, mainly private ones, are known to assess financial circumstances regarding ability to pay for treatment), the CSO-based workforce would operate within the organisation’s main operational service delivery arrangements. 

Likewise, within Malaysia’s criminal justice system, there are staff who perform various duties of probation monitors or parole enforcers, divided between juvenile and adult categories. 

Allied social work occupations may also be found in correctional and training establishments and the many large Government run children’s homes. As a consequence, many people frequently misconceive the social work function with counselling. This may well explain the lack of impetus in defining precisely what is social work and its potential benefits to the communities and to the institutions and agencies in Malaysia.

2. So, what do we have?

Principally, what we have is a range of tasks and activities which closely resemble the “social work function”, but so far have not been fully recognised. Such recognition, we contend, is crucial not so much for formality’s sake, but to ensure that the occupation is formally recognised and legalised. This would go a long way towards protecting the rights and interests of the public, while at the same time, upholding and maintaining the quality competency standards of social workers, like other professions in the service of the public.

Now, evidently, the whole idea and practice of care, protection, nurturing and support for sections of the Malaysian community is not highly regarded. They are, instead, widely seen as activities not for professionals but rather for families; and this usually means women and housewives. There is, thus, of course gender bias.

Since independence in 1957, Malaya – and, later in 1963, Malaysia – quite rightly prioritised its economic development, focusing on its abundant natural resources, later on industrialisation, and now supplementing all that with the service, tourism and other professional industries.

In the rush towards developed status, it would seem that the country’s duty of care for its vulnerable, aside from education, health and child care, has been left largely to community and voluntary efforts. Thus far, these efforts, quite often have had to be shouldered by religious organisations and CSOs.

The Alliance and later the expanded Barisan Nasional (BN) government for the past 60 years evidently saw its role as only intervening for those with the highest need and, perhaps, those who could command huge public concern. There was seemingly little or no thought given to the idea of universality in social or welfare benefits and care.

We would therefore argue, given this scenario that, despite the formation of the Malaysian Association of Social Workers (MASW), almost half a century ago, in 1973 and the setting up of a social work academic programme in 1975, that there is still much to be done.

Indeed, at this stage – and in this first part of the paper – we would argue that there has not been enough “buy-in” by the various stakeholders and communities in contemporary Malaysia, leaving social work and social workers still very much unappreciated, unrecognised and unattractive in a very real sense – as a profession by wider society and as a viable area of study by potential students.

3. So, where can we go from here?

In 1991, during his first stint as Malaysia’s Prime Minister, Dr Mahathir Mohamad, announced his Vision 2020. It captured the imagination of the Malaysian public and the “Vision” was widely discussed, if not adopted, in similar developing countries. Of the nine challenges the nation needed to overcome in order to become “developed”, the challenge to become a Caring Society is instructive and of concern in this part of our discussion.

After he stepped down from his stint as PM in 2003, his Vision clearly took a backseat under both Abdullah Ahmad Badawi and later, the now internationally famous (for the wrong reasons) Najib Abdul Razak. 

But since Mahathir has returned as PM, perhaps it is time to revisit one component of Vision 2020, the creating a Caring Society component, even if 2020 is just around the corner. We believe that the concept of a Caring Society should – and will – go beyond 2020. It should therefore be the basis for the development of potential directions social work can take.

It is a simple enough concept – that apart from economic and political development (also targeted in the Vision), Malaysia and Malaysians also need to be humane and take responsibility for looking after each other, caring for each other. The concept recognises that (Malaysian) society is not monolithic and that, generally, the strong must take care of the weak, the poor, the vulnerable (the elderly, the disabled, the young, for example). The marginalised must no longer remain marginalised. It is to be a commitment and duty by all in Malaysian society.

In a Caring Society, we cannot merely allow “social work” to be narrowly defined as the welfare of charity activities, like those headed by groups like the “wives of ministers” group, publicly committing themselves to performing patronage to various selective social welfare CSOs and “doing their bit”. 

In a Caring Society, the Ministry of Women, Family and Community Services must do more. The ministry was seemingly established for all – often uncontroversial - matters affecting women and families and anything vaguely classified as “community affairs”.

Its history and uneventful performance under the BN government, suggests that it is a convenient ministry which dispenses aid and welfare as circumstances dictate. It has not really plotted viable and sustainable strategies and even policies for social work and social workers, to provide recognition and help elevate the profession and its professionals.

But let us look briefly at what services segments of Malaysian society currently receive and which are found wanting.

3.I Children with disabilities

Services are infrequent and sometimes non-existent depending on where you live. Many parents cope well, often with the families’ own resources and many rely on the charitable organisations or religious groups within their neighbourhood. 

The Welfare Department will only become involved if there is an urgent referral due to a service shortfall. As we know, the key issue with those children living with disabilities is the capacity of the families/carers and we feel that such parents should be given more help and support.

**The strategic aim here must be to professionally and substantially support carers of children who suffer from significant and substantial disabilities. 

There appears to be a trend, seemingly following trends and practices in early western societies, for children at risk, such as orphans and children whose interests are better served away from their natural parents, to be placed (housed) in government homes. These institutions are large and often resemble state “prisons” for children.

We would endorse the efforts of the national charity, Orphan Care, whose key objective is to enable children to remain within families instead of being raised in an institution.

Again, we would urge the new Pakatan Harapan (PH) government to rethink BN regime’s practice of placing children under 18 years into such residential homes. They are inappropriate and deny many children the necessary personal and relationship skills development often found in small family group arrangements. 

We feel that, as a first step, the PH government, must begin a serious audit into both the financial and non-financial costs of maintaining these types of homes, and undertake research into residents’ outcomes.

Alongside this – and perhaps as urgent – is the need for government efforts to promote “fostering” as a worthwhile and legitimate task by the community in caring for the less fortunate. 

Fostering, as an activity, is the provision of a “family substitute” for the child, capable of offering asylum and care. Herein would lie a crucial (new) role for trained social workers – carrying out systematic and rigorous checks and assessments on these “foster families” as is done in many developed countries.

The government, in partnership with CSOs, must begin a campaign to promote the concept of fostering and allocate resources for the task. After all, an “abandoned child” or a “child deemed in need” in the country, must be the responsibility of the government.

**Hence, the strategic aim here is to ensure the all children or young citizens are entitled to – and given – good care and parenting and the majority are satisfactorily cared for by their own families and in their own family settings.

However, where there are those whose less fortunate lives are denied this entitlement, it is incumbent upon the state to take over a corporate parenting role. In the case of Malaysia, it does do that. But we feel that the institutional residential care provided is inappropriate and, instead, such children should be in foster care homes or in registered small family group homes. And professional social workers would play a key role in monitoring and supervising these homes.

Children are vulnerable and they always need protection and they often need safeguarding. By this, we mean that all institutions that cater for children must have operating procedures which do that without compromise. 

Malaysia has legislated for child protection and that is a start. However, it seems to have failed in developing any programme for monitoring its efficacy in enforcing the legislation as there are reported child deaths and injuries either at homes or at institutions which care for children.

So, is the legislation failing? Or is there a deficit in understanding its operational requirements amongst the multi-agencies concerned? We suspect it is the latter. We also feel that at the heart of this is the lack of urgency or importance attached to this amidst the many other functions the agencies undertake. We are referring to schools, children’s centres, clubs and such like. Being CSOs, most are not professionally vetted or even licensed due to confusion and apathy between state and federal agencies. Here again, well-trained teams social workers would be welcome, indeed necessary.

Malaysian secondary schools for older children have been under the spotlight for their failure to protect their own pupils from bullying and intimidation. Reports have surfaced that some teachers turn a blind eye to such instances due to their own fear, or a lack of confidence in their own school management’s ability and desire to deal with such matters. This is unacceptable and it boils down to poor discipline due poor management in such schools which can also result in instances of illicit drug-taking.

** The strategic aim here is to ensure all agencies with children as a service user must be rigorously inspected and monitored, to ensure that children are safeguarded and protected as far as possible. We contend this is currently not being down systematically. And, once again, it is not that difficult to envisage professional social workers coming into the picture and taking up the slack.

3.II Elderly support and care

We contend that many of the services catered for elderly people are either poorly resourced residential establishments or hospitalised care. There is little publicity or priority given to services which may extend an elderly person’s life, based on their own choosing. Or if there was a better range of services. We are thinking of the yet undeveloped area of community based care.

There are many elderly persons who would do anything, if only they could continue to remain in their own homes for as long as they physically and mentally can, but for want of the right support services.

We propose a “care-giver” service that will perform this role. For many, this would be life-changing and it would enhance the quality of the person’s life. This care-giver would perform all the tasks necessary to maintain “aid to daily living” and would act to befriend, to assist and to provide for the individual person.  We need to pursue, in this regard, routes to secure basic training and accreditation for this new workforce, to end in attaining vocational qualifications. 

We wish to distinguish this role from that of being a maid or a nurse. Their primary task is not purely domestic nor is it dispensing action in accordance with a medical treatment plan. Theirs is the role of confidante, a professional companion well versed in the needs of their “client”. Once again, here, we see that crucial role that a trained – and preferably experienced – social worker can and must play.

**The strategic aim here is to extend options in service provision for the elderly in our community, so as to enable them to live life with greater dignity and independence and to enhance their quality of life in their advancing years. Here again, residential confinement should be a preferred last resort.

4. Moving forward Post-GE14

We started by outlining the beginnings of social work in Malaysia. In the second section of our presentation, we discussed some the problems social work faces in contemporary Malaysia, alluding to Vision 2020 as providing a possible road map. We conclude here by trying to chart out directions for the future.

Here we will also outline what would be the ethos and institutional support needed for social work to be provided professionally, for all Malaysians who may need such services. 

Social work, as a profession befitting of an advancing nation like Malaysia, needs full recognition by the various communities and institutions in Malaysian society. The profession needs affirmation by the government of the day.

Given that we now have a new, purportedly reform-minded government, we feel the first step that needs to be taken is to table the languishing and virtually abandoned Social Workers Bill in parliament. This proposed “Social Workers Act” having been scrutinised through its technical committee for years now simply needs passing.

We contend that the passing of this piece of legislation will immediately boost the morale of countless social work personnel in Malaysia. It would give notice that Malaysia recognises the contribution this newly approved profession has made to the peoples of this country, including, but not exclusive to, children and families.

More, those universities which have been running graduate programmes will feel vindicated. Official and legal acknowledgement through the Act, we believe, will help make social work climb up the popularity ladder, thus helping its programme and courses to be presented as “preferred ones”, as opposed to those less popular ones often “still available”.

At the same time, it will help open up new research opportunities in a complex sociocultural and political environment like Malaysia in this long-neglected area of the social sciences. 

This will in all likelihood also signal the beginning of more carefully “thought-out” social services which are safe, appropriate and sensitive to users, almost all of whom are vulnerable and in great need. Importantly it will ensure that mainly, if not, only the committed and genuine, will be “entrusted” with the task of protecting, supporting and caring. This, in turn, will provide opportunities for greater innovation in service delivery from all sectors involved in social care.

The present set-up of government provision, supplemented by the voluntary not-for-profit sector will most likely change, as service users will begin to dictate the changes in provision to suit their needs.

In many developed countries, social work and social care services are localised. They are run by local authorities following prescribed frameworks set by government so that services can be consistent and comparable, in quality terms. The belief behind this is that local people are best placed to identify needs and arrange provision.

Similarly, services will not necessarily be all state provided as other providers oftentimes can do a better job. Hence, a mixed economy of care is often the case in many developed countries.

In the above scenario, which Malaysia could successfully emulate, the federal government will provide service frameworks, set service and practice standards, regulate and monitor management and service delivery, and enable local authorities to deliver services in partnership with a range of local or national specialist social services providers.

In practical terms, the developments will hopefully see the establishment of a professional agency concerned with regulating the profession and with licensing of the services related to this field. 

All social workers will require registration for practice, for employment, just as doctors, nurses, and others do. All service providers, from child services to adult support and to elderly care services will also be subjected to fee licensing and inspections.

This proposed Social Care Commission will also be concerned with determining the minimum standards of education and training and will collaborate with the Education Ministry on accreditation and quality assurance matters. 

We have suggested a road map and a broad workable framework; we hope the government will give the long awaited matter its deserved consideration. We believe this will lead to the wide-scale recognition and development of social work and the enhancement of this area as a deserving profession and its practitioners marked out as respected professionals.

[1] Zulkarnain A Hatta and and Zarina Mat Saad (2014): “Social work in Malaysia”. Book chapter in Christine Aspalter (ed), Social Work in East Asia. Routledge: London. https://ebrary.net/2165/sociology/resources_structure

Child abuse: We need a registry of the offenders

Reprinted from Malaysiakini,
Nov 9, 2018, with the permission
of the author. Read original here.

By Jim Lim

DEPUTY Minister for Women, Family and Community Development Hannah Yeoh made an important policy intention regarding the key issue of safeguarding children, that is, the screening of those who work with children.

For far too long, those unsuitable and those deemed “undesirable” have been allowed to destroy young lives, through a combination of general apathy on the part of adults and a lack of diligence by some children-affiliated agencies such as schools, care centres and orphanages.

Citing the high recorded cases of child abuse in the country — at more than 20,000 in the last five years — Yeoh rightly advised parents to exercise greater monitoring, to give them education on sex and care, and promised to provide greater support and counselling for victims.

Therefore, will focused attention and encouragement of parents and caregivers, with the strengthening of counselling resources at schools as well as widespread information about the Talian Kasih helpline be enough? Prevention efforts, access to the helpline and a post-trauma rescue service are a good start.

I hope the “work in progress”, as Yeoh stated, will spell out the message that child protection is the responsibility of all. It is not only the government alone but everyone! Sure, the government must show the lead, and must allocate resources to underpin its importance, but all sections in society must also act in support.

To start with, the government needs to get all the statutory key agencies to act together and to develop a joint policy with the sole objective of safeguarding and protecting children. Unlike the sexual offenders' registry, which has list of those convicted of a criminal offence, this process of eliminating those unsuitable is a “vetting and barring” scheme. The UK government does operate a scheme for this purpose and their own development and experience can be shared and adapted to the Malaysian context.

In my experience, the existence of a similar type of registry rests on the principles of civil law and the evidence sought is not along the desirability as with criminal law, which seeks a “beyond reasonable doubt” conviction. Rather it is loosely based on employment law, where evidence gathered is based around the “balance of probabilities”.

In the UK, there was a registry maintained by the Education Ministry of teachers who had been dismissed for gross misconduct (not criminally convicted) or medical/para-medical staff dismissed for professional misconduct. Details of such individuals would be stored in a register. All employing authorities (Education, Social Care and Health) would check with those lists prior to recruiting staff.

With such a safety-cum-screening resource in place, it would be “reassuring” to the public that service providers to children comply with this requirement. The ministry in Malaysia must proceed to set up such a register as a way of screening.

To further extend and continue the quality assurance of the establishments concerned, the registration of a service provider, e.g. a nursery (taska, tadika), children’s home (orphanage), all public and private schools and tahfiz schools, must be mandatory.

Unless establishments are subjected to checks and inspections, they should not be allowed a licence to operate. The registration requirements, therefore, must be strengthened and rigorously enforced and perhaps, as a sweetener to encourage good practice, tax incentives could be offered in return for strict compliance to those accepted standards.

I am sure many will look forward to an announcement on further details or an implementation timetable.

• Jim Lim is a former director of Social Services in a London borough and a former CEO of a charity.  He is a member of the Malaysian Association of Social Workers.  Read more about him here.

Letter to Wan Azizah, Minister for Women and Community Development, on improving social care in Malaysia 2018

Datuk Seri Dr Wan Azizah
Source: Wikimedia Commons

Dear Datuk Seri Dr Wan Azizah

As the Minister for Women and Community Development, I am writing to you as I wish to convey my observations and concerns regarding social work and the social care sector in our country. The main concern is on child protection and the protection of vulnerable adults.

I returned to Malaysia from the UK over 6 years ago and was very much hoping to contribute to the development of the professional social work service. I applied for my return through (and which was subsequently endorsed by) the Talent Corp “Returning Expert Programme.” 

My entire working career in the UK was in social work, particularly in London Local Authorities (20+ years) ending up as Chief Officer/Principal Advisor and a Director of Social Services. I was a CEO of a “mental health and supported housing” Charity in South East London. I was also a Judicial Member of the Care Services Tribunal, set up to protect children and vulnerable adults and was an External Examiner for Universities programme for social work education and qualifications. Prior to returning to Malaysia, my own Government-approved UK Company provided services to children/young people with special needs and challenging behaviour (including child refuges or unaccompanied minors). 

This letter is in some ways an appeal to you, to implement in my view, much overdue action towards the improvement of services for our fellow citizens, in particular those least able to care for themselves.

Perhaps you are aware that the Care Services sector (specialist day care and residential care) for children with disabilities/special needs and for “vulnerable” adults is variable in standards and quality and remains unrecognised and neglected. Apart from the few Government-run establishments, most of specialist provisions are within the private and the voluntary sector (NGOs). 

It is the case that social care and support services currently provided are not formally “registered or regulated” over the way it delivers its services. Without any proper safeguards, there is a real risk that service users may not be adequately protected. As reported in the media there have been instances over the years of abuse and institutional neglect of residents in many of the care services establishments. Therefore, this is a public safety issue.

There is a need in my view to introduce “regulation” in order to instil not only public confidence, but also promote good services. If clinics, hospitals and schools are regulated why are social care provider-establishments exempt?  

My next main concern is towards a professional service that is sadly (woefully) least understood and so far unrecognised in our country. I am referring to the current disappointing situation regarding mainstream professional “social workers”.

Social workers, although unqualified in this country are at best university degree-trained and at worst, untrained. This occupation involving “social care” needs to be accorded appropriate recognition by the country and this could come about through the draft Social Worker’s Act, currently going through its technical assessment process.

This proposed legislation sets up registration for those using the legal title of “social worker” and sets standards and competency for practice. To be called a social worker, one needs both the required academic qualification brought about through higher education and appropriate practice experience. In short, the country needs to professionalise the social work service, of which the Social Workers Act is only a necessary beginning.

In summary, a statutory agency, that is a “Care Services Commission” needs to be considered, whose regulatory duties embrace “fitness to practice (people) and fitness to operate (organisations)” criteria. We would benefit from enacting legislation to ensure there are suitably qualified and professionally trained social workers in this country. I hope therefore, that you are able to review the current draft legislation with the aim of expediting parliamentary approval. It has been delayed through endless bureaucracy for far too long.

In the longer term, the way which social work and welfare services are provided could benefit with further decentralisation and localisation “at the point of delivery” for greater accountability and transparency. This bold re-organisation could compliment PH’s longer term plans to restore local government elections and accordingly, give greater duties and powers to Local Authorities. In my view, local communities often know what they need and the best ways to provide for those needs. 

I have attached an Appendix (see below) which provides some background and context around my concerns. I am a member of the Malaysian Association of Social Workers, an organisation that has been campaigning on the issues above although this letter is written in a personal capacity.

Finally, I would be delighted to provide further clarification and details if necessary.

Yours sincerely

Jim Lim Teik Wah

Read more about Jim here.

APPENDIX: Social Workers’ Act and social care services regulation

Social workers, despite years of trying to “be heard” have been unsuccessful in securing the previous government’s commitment to the required legislation to professionalise their status and the consequent steps towards regulating the social care sector.

Social work is a professional activity recognised throughout the world but unfortunately, the roles and functions appear least understood in our country. In addition, social workers often deal with complex problems affecting individuals and families and those problems, or its resolution or treatment can carry considerable social stigma.

There are six universities in Malaysia running undergraduate degree programmes in social work and a shorter Diploma in Social Work programme at a further education college in KL commenced a year ago. 

In spite of this and despite international recognition for our local social work professionals, both in academia and in practice, there have been little progress achieved in terms of formal recognition or, in terms of “professionalising” the service, and with it, the standards, quality and regulation that follow.

What is the current state of play?

Jabatan Kebajikan Masyarakat (under the Ministry of Women, Family and Community Development) is the statutory agency for a range of generic welfare services dispensing services and, intervening into the lives of individuals and families, principally “to protect, to assist and provide”. In addition, there are numerous voluntary organisations (NGOs) providing a wide range of services and to a many sections of the community. Malaysians are fortunate to have the many voluntary and charitable services evolving from its diverse religious and temperate societies.

However, there is a need to improve overall service delivery and this concerns public safety. How is the public to understand or be assured of a service which at the moment does not subject itself to inspection or regulation? For some services there is minimal registration for administrative purposes only but not regulation in terms of service standards and quality. 

As social work services are often delivered by “people to people” directly, is it not reasonable that we understand the professional ethics which govern its practice and ensure there is appropriate regulation over their professional conduct and suitability or fitness for practice of the social work practitioner, in the same way of doctors, dentists, nurses and other Para-medical staff?

The draft Social Workers Act which I believe is currently undergoing its technical appraisal processes have been rigorously ‘peer-examined’ too. In my view, this important piece of legislation is long overdue. 

The Act essentially legalises the job title of “social worker” and sets out mandatory standards for qualification as well as practice competencies. In line with many developed countries, it is time Malaysia join the wider community of social work.

There are numerous areas for improvements and existing social policies covering vulnerable adults, the elderly and children and families can benefit for an updated review and assessment as to its take-up as well as effectiveness. Some may require “replacement legislation” to reflect and accommodate the rapid social changes.

What is essentially the concern for social workers?

To simply put it, “social work intervention and social work services” fall under 2 distinct categories, warranting action and service provision.

The first covers services “safeguarding and protection” and,

The second is concerned with “maintaining dignity and enriching lives”

Safeguarding and protection services would be particularly relevant for children who are abused, families under stress, living with disabilities as well as vulnerable adults with disabilities. 

Maintaining dignity and enriching lives would relate to people with severe handicaps, elderly people living with dementia and in some cases, marginalised communities.

At present, most social work intervention is effective when there is high quality practice or professionally competent services, supported by well managed teams and organisations. Social workers must be “competent” in undertaking assessments and formulating plans working with relevant multi-disciplinary agencies and client/user groups. Social workers can make a difference to people’s lives working in different settings, statutory (government, judicial, educational) and non-statutory (social, community, NGO).

The main concern of social workers throughout the country is formal recognition of the work they do or can do. They are operating without formal professional recognition and often, other public service agencies fail to appreciate their role. The public can be at risk if there is no formal register which bars those unsuitable to work with children or vulnerable people. The recent Sexual Offenders Act is a case in point although there has not been any evaluation published since.

The short-term: To urgently have the draft Social Workers Act passed by Parliament. Equal Consideration must be given to establishing the institutional resources to effectively fund and manage the implications and consequences arising from the Act. To introduce appropriate regulation to the social care sector to protect the public.

The longer-term: To reorganise current “institutional” welfare provision with the aim of decentralisation or localisation of services to the respective state level. 

• I presented a paper on “social services planning” with the theme of decentralising services to local level at an ASEAN conference on Child Protection in KL in November 2012. Read here.

The longer-term may also focus on further education and training matters and the setting up of a working framework for inspection and regulation of establishments, centres and homes as well as statutory mechanism for vetting and barring schemes on suitability. 

I know that this may appear a long wish list but as social work had been accorded scant attention in the past, the new Government must try to “catch up” in order to help raise standards and improve responses and services to all categories of vulnerable and disadvantaged citizens.

• There was a study by external consultants commissioned by Agensi Inovasi Malaysia with their findings report for consultation in March 2017, called Innovating Malaysia’s Social Sector. This study attempted to calculate financial costs in social interventions and services and my criticism is that it hardly mentioned social workers or to the many unsung heroes working in the social care sector. The results or outcomes of this study have so far not been shared.

Letter to Dr S Subramaniam, Minister of Health, on the definition of ‘medical social worker’ 2017

Datuk Seri Dr S Subramaniam
Source: Wikimedia Commons

Dear Datuk Seri S Subramaniam

I am writing to you in your role as Health Minister, on a matter of genuine concern to “social workers” in the country. 

Perhaps you will remember me, Lim Teik Wah (Jimmy) as we were at one time in the same class at the Penang Free School. I would like to meet with you on an informal basis, with the aim of seeking your support regarding the Allied Health Professions Bill. In the bill, which has over 40 occupations, is a post titled  “medical social officer”. We understand that the proposed Bill is on the verge of imminent enactment.

I hope you can grant me and a few eminent social work professionals a meeting, to hear our concerns over this most inappropriate job title in the context of this primary legislation .

The social work fraternity in this country is unhappy with the introduction of a job title being so “generic and vague” Medical Social Officer because the duties and responsibilities outlined in the job mirrors that of a “social worker” operating in a medical or health care setting. Therefore “medical social worker” would be the appropriate and more suitable title. In Penang, I know that the Lam Wah Ee and the Adventist Hospitals have signage for Medical Social Worker. Being hospitals with a history of social and charitable work, medical social workers largely undertake assessments and compile social history reports towards eligibility for financial assistance and other help. Medical social workers also undertake valuable personal case management on behalf of the patient’s family, and are active in contributing their knowledge and skills towards the patient’s overall recovery, including subsequent rehabilitation. Medical social workers often assist in the assessment of disability or for sheltered forms of employment, perhaps SOCSO? 

In international circles, medical social work is a recognised job title whereas an “Officer” can imply, refer and encompass any tasks or duties deemed desirable by the employing health provider. The term itself does not convey a “profession” but rather a generic administrative, clerical or even a business support-related one. 

In the wider picture, social work is a profession widely recognised in many developed countries. It is a legal title regulated by its own professional body, with practice standards meeting suitable levels of competency and, with social work practitioners fulfilling suitable person specifications for the profession. This statutory recognition and the establishment of minimum standards would then “kick start” the long awaited road towards proper regulation of establishments and residential homes which care for vulnerable sections of our community. The revelations of the paedophile Richard Huckle exposed the frailty the situation in our country with regards to safeguarding and protection. 

Therefore, although the specific concern may be trivial to some, (so what's in a name, they say) but our general objective is towards the establishment of a comprehensive strategy for protection and care and a plan to eventually professionalise “social work” as a recognised occupation. Social workers can and do work in the public, private and third sector.

As you may know, I spent my entire working career in the UK, principally in London, working for a number of local authorities in the area social work (attached a short resume) and related fields. I returned to Malaysia in 2011 under Talent Corp, listing my area of expertise as  “social work” in the main, but in service regulation and education. I was a conference speaker at a UNICEF/JKM sponsored “Child Protection Conference”  in 2012 in KL, involving ASEAN countries.

I have been involved with the Malaysian Association of Social Workers for a few years now. I have been helping them with raising the profile of social work in our country. I hope for, along with them, the enactment of the Social Workers’ Bill, which I understand has been in the AG's office for many years.  That is another story which we hope you can help, perhaps for another day. 

I look forward to hearing from you.

Yours sincerely,

Jim Lim Teik Wah

Read more about Jim here.