Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

Substance Use and Disabilities: Experiences of Adults' Social Care Professionals and the Implications for Education and Training

This paper draws on data from a national survey of social workers and social care practitioners in England undertaken in 2010–2011. It focuses on practitioners working in services for adults with either learning or physical disabilities and, in particular, their experiences of responding to alcohol and other drug use among their service users. Based on secondary analysis of survey and focus group data from the earlier study, the paper outlines the extent to which workers in these areas of practice encounter alcohol and drug problems and discusses the key challenges this poses for them. The findings show that between 4% and 10% of adults' practitioners' service users have alcohol and drug problems depending on the nature of the disability. Regardless of the type of disability, practitioners reported difficulties in talking about substance use with their service users as well as identifying tensions around life-style choice and risk management. They also reported the need for education and training in a number of areas. Social work education and subsequent training in working with substance use problems needs to be available to adults' practitioners and it needs to address the specific issues and needs in different areas of social work practice.     

Employment-Based Training on Alcohol and Other Drugs in England: Bridging the Gap

The first of its kind in England, this study explored the extent and nature of employer-based training on alcohol and other drugs for social workers working in children's and adults' services. A national survey of workforce development departments was undertaken to find out how social workers are being prepared by their employers for engaging with people who use alcohol and other drugs. Based on a response rate of 46%, the findings show that a majority of departments (82%) provided training on these issues in the year 2011–2012. However, most of this training was not mandatory. These courses are targeted most often at those working in children's services rather than those in adults' services. Most courses are offered at basic or intermediary level, and content of training is covered inconsistently. These findings suggest a need to increase the priority of alcohol and other drugs' training across adults' services in particular and to make this training mandatory, as well as ensuring that staff have adequate time and incentive to attend. Effectiveness of social care practice for all social care practitioners around alcohol and other drugs use could be improved with more focus on training practitioners how to talk to service users about their substance use.     

Adolescent Substance Use Prevention Interventions Outside of Classroom Settings

Substance use prevention programs empowering individual adolescents to resist substance use through education and skills training are crucial to reducing substance use within this population. However, existing programs of this type are designed primarily for classroom use, and may not meet the needs of social workers intervening with adolescents outside classroom settings. A literature review identified six programs that have demonstrated statistically significant reductions in substance use when implemented outside the classroom. The current study describes these programs, identifies their common characteristics, and draws on additional prevention research to outline recommendations for practitioners seeking to apply the field’s most current knowledge base in community settings.     

The Development of Employment-Based Education on Substance use for Social Workers in England: Embedding Substance use Training in Frameworks of Continuing Professional Development

Service users in the social care sector affected by substance use need a workforce which is skilled at protecting and supporting them, and who are able to carry out their roles and responsibilities with confidence. Workforce/Learning Development departments in children's and adults' services in England play an important role in preparing social workers to engage effectively with service users and to develop as practitioners. Drawing on data from a survey of 94 Workforce/Learning Development departments, this article examines the development of employment-based education on substance use. Only 33% of these departments had a dedicated training strategy or series of programmes on substance use, although more than half (59%) provided tools for identifying and assessing substance use. A wide range of professionals were involved in the development of this training, particularly those in specialist safeguarding and substance use roles. Social work and substance use textbooks are the main source of materials accessed to support training development. A lack of strategic engagement with substance use in social care was one of the barriers cited to adequate training provision. Implications for social work education include the importance of embedding AOD education in post-qualifying training frameworks at both university and employer levels.     

Practising for Social Work Practice: Integrating Knowledge and Skills for Social Work with Children and Families

The UK Government has categorically stated in its Knowledge and Skills Statement for Children and Family Social Work what social workers need to know and be able to do when responding to concerns about children. The Hope for Children and Families modular systemic interventions programme provides evidence informed responses for targeting harmful parenting and the associated impairment of children. The training resources, developed by Bentovim et al., apply the ‘common elements approach’ and are aimed at qualified practitioners. However, there also appears to be scope for their use in social work qualifying programmes. This paper will review the development of an undergraduate children and families module using the materials. It discusses how these resources were incorporated into a learning, teaching and assessment strategy which aims to develop and test the interpersonal components of knowledge and skills alongside technical/procedural knowledge. The outcomes indicate that these resources have contributed significantly in closing the gap between study and practice by providing an applied starting point from which learners can critically engage in the complexities of what they need to know and be able to do to be effective practitioners. Further use of these resources across programmes is recommended.     

Advocating the Clinical Social Work Professional Identity: A Biographical Study

Aiming to portray the clinical social work (CSW) professional identity, the present biographical study examines the CSW knowledge and practice domain boundaries as they appear from the perspectives of three Greek mental health social workers who have advocated for the professionalization of CSW. The practitioners' perspectives are studied in relation to their demographic characteristics, education and training, and multidisciplinary relationships. A thematic analysis of the in-depth interviews revealed that these practitioners retained their nuclear social work identity and felt their skills and interests to be different from those endorsed by the present generic social work education and practice system. The study also revealed differences in the educational qualifications and routes that each of the three practitioners followed in order to be able to identify themselves as ‘clinical social workers’. Although the common denominator in the practitioners' perspectives was their training in psychotherapy, the type of psychotherapy training pursued and the experience of personal psychotherapy differentiated each practitioner's ability to theorize on the CSW practice identity. The research data were filtered through a psychodynamic lens to reveal the dynamics of the unconscious processes within the relationships formed between individuals and organizations.     

UNDERSTANDING THE IMPACT OF THE MOTHER-CHILD RELATIONSHIP ON SEX WORKERS’ DECISION TO ENTER AND LEAVE THE STREETS – LESSONS FOR SOCIAL WORK PRACTICE

This paper focuses on ‘streetwalkers’ and ‘street sex workers’ who are unlicensed sex workers not belonging to a brothel and subject to criminalization. They often face great stigmatization and are usually considered victims by service providers. Five Singaporean ex-streetwalkers (n = 5), who had left the streets for at least six months and were currently receiving or had previously received skills training at a social service agency, participated in this study. Using an agentic framework and social relational theory principles, this qualitative study explored the impact of streetwalkers’ relationship with their children on their decision to enter and leave the streets and reasons for their successful help-seeking experiences. Findings revealed them to be agents who actively used strategies to meet their goals and to sustain close relationships with their children. The mother–child relationship context was a key influence on their decision to enter and/or leave the streets. Social work practice implications include tailoring service delivery to tap into their agentic capacities and identity as mothers; research and training in provision of proactive social services in a non-judgmental manner to preserve the dignity of these women while meeting both their own and their children’s needs.     

SUBSTANCE ABUSE TRAINING AND PERCEIVED KNOWLEDGE: PREDICTORS OF PERCEIVED PREPAREDNESS TO WORK IN SUBSTANCE ABUSE

As frontline mental health care providers, social workers need to be prepared to confront and properly manage substance abuse issues in practice. This study examined predictors of recent master of social work (MSW) graduates' perceptions of preparedness to practice in the area of substance abuse. A cross-sectional design was used, and 232 recent MSW graduates completed a mail-in survey (65.7% response rate). Respondents were more likely to perceive themselves as prepared to work with substance abuse issues if they received more formal academic training in substance abuse and had higher knowledge of substance abuse concepts and models. The findings support the need to include substance abuse education in social work curricula.     

Young people negotiating and maintaining boundaries in youth work relationships: findings from an ethnographic study of youth clubs

‘Professional boundaries’ set limits on appropriate behaviours in the relationship between the service users and practitioners. The professional literature often assumes boundaries are maintained by the practitioners, occupational bodies, or organisational policy. However in youth work this is under-researched. An ethnographic study of four youth clubs in the North East of England into ethical practice revealed that young people were surprisingly adept at maintaining boundaries with the youth workers. These boundaries were negotiated and maintained through the young people's use of space, their willingness to interact with the workers, the way they shared information with the workers, and their inclusion of youth workers into their social networking. Young people also showed a sophisticated awareness of the organisational boundaries youth workers were operating within, and often cooperated in maintaining them with the worker. The article concludes by arguing youth workers should take seriously young people's ability and willingness to set and work within boundaries, and see their negotiation and maintenance as a mutual endeavour. However, this may provide a challenge to organisations with rigid policy-defined boundaries.     

Young people's views of children's rights and advocacy services: a case for ‘caring’ advocacy?

This paper looks at some preliminary findings from research with young people in foster and residential care in the UK who have received advocacy services from a range of local authority and voluntary agencies. The study also includes the views of professionals, from both children's rights and social services. The initial findings highlight the importance to young people of their relationship with rights professionals. They speak about the value to them of care and respect, aspects not always seen as fundamental to rights work. Caring, in its various guises is seen by young people as a vital component of their relationship with children's rights workers. They also see this as important within advocacy work itself since caring about the outcome is often key. A pure individual rights focus with an emphasis on challenge and ‘being heard’ may not take account of the complexity of their situation and may pose difficult dilemmas for young people, especially in dealings with their carers. This ‘caring’ advocacy is not the paternalistic approach of a professional who ‘knows what's best for you’ but is a model based on a strong awareness of ways that young people are excluded and oppressed. It is also about placing a positive value on their contribution as citizens and links to a view of society that gives importance to an ethic of inter‐relationship and care as well as an ethic of individual rights. Copyright © 2007 John Wiley & Sons, Ltd.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

myCourtroom: Rosie’s family go to court; the use of simulations in preparing social workers for court

The role of social workers in court, how they prepare, train, write and present their reports, has been the focus of much debate. Key messages from research tell us that social workers often find court work stressful; they can lack confidence in writing reports giving evidence and being cross-examined. Pre-qualification training in this area can be patchy, with many workers reporting they often learn ‘on the job.’ This article documents the journey from analysing primary and secondary research findings, via a partnership between the University of Kent Centre for Child Protection and Children and Family Court Advisory and Support Service (Cafcass), to develop a training simulation for practitioners to increase their knowledge, preparation and practice for court. The partnership turned these research findings into an interactive, immersive simulation to give practitioners the space to reflect upon and critique their experiences of court. Findings from an initial evaluation of the simulation were positive with participants highly rating its usefulness in developing courtroom skills and knowledge.     

Training together: An exploration of a shared learning approach to dual diagnosis training for specialist drugs workers and Approved Social Workers (ASWs)

This paper is the first of two linked articles exploring a shared learning approach to developing 'professional collaboration' as one way of improving care for people with complex inter-related mental health and substance misuse needs. The target groups for the training in this study are Approved Social Workers (ASWs) and specialist drugs workers. The article describes the social and professional contexts that shape the different training agendas for the respective groups of workers in an attempt to identify common themes that can be used as a foundation for developing training solutions. The relevance of a shared learning method of training delivery is critically discussed and the way in which this was adapted to respond to training needs identified in Birmingham is outlined. The paper concludes by suggesting that training providers should be encouraged to identify the common agenda for drugs workers and ASWs working with people with mental health and substance use needs and utilise a shared learning methodology to respond in a proactive way to improving service delivery through effective training. The second paper provides an in-depth exploration of the training delivered. Using a formative evaluation framework the paper reflects upon the methods employed to: ” identify curriculum content; ” promote collaborative working through different approaches to interprofessional learning; and ” demonstrate how the training is impacting on practice outcomes.     

Evaluation of Alcohol Screening,Brief Intervention,and Referral to Treatment (SBIRT) Training for Social Workers

Social work education is well positioned for workforce development initiatives that prepare practitioners to use Screening, Brief Intervention, and Referral to Treatment (SBIRT) with people at risk for alcohol use disorders. This article presents preliminary process and outcome evaluation data from the first year of a three-year grant which suggests that the training is acceptable and results in significant changes in trainees’ knowledge, attitudes, and self-perceived SBIRT skills. Training was embedded within the curricula of an urban school of social work, which includes a Bachelor of Social Work (BSW) program and a single-concentration clinical Master of Social Work (MSW). Trainees included social work students (n = 134) and field instructors (n = 38). More than 90% of students were very satisfied or satisfied with the training, and 100% of field instructors rated the training as excellent or good. Students demonstrated significant changes from pre- to posttraining in substance use knowledge, confidence in SBIRT skills, and attitudes about integrating SBIRT into practice. Field instructors reported increased confidence in screening. Integrating SBIRT training into social work curriculum is a promising method of developing a workforce that can effectively prevent and alleviate alcohol misuse.     

Life's a Gas? The Training Needs of Practitioners and Carers Working with Young People Misusing Volatile Substances

Volatile substance abuse (the deliberate inhalation of substances such as gas fuels, glues, aerosols or other solvent‐based products) by young people does not attract high level attention within the broader arena of drugs education and prevention programmes. Given the prevalence of volatile substances in the lives of vulnerable groups of young people, however, and the risks associated with their misuse, social work education and training might justifiably give a higher profile to the associated needs of young people in need and/or in public care. This paper reports on the findings from a study in England of the training needs of social workers, residential and foster carers in relation to volatile substance abuse by young people, and identifies the implications for further development of training materials and resources.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.     

Evidence-based practice knowledge and utilization among social workers

In this study the researchers examined the knowledge, skills, and use of Evidence-Based Practice in a sample of social workers from different practice settings. Using an electronic survey, data were collected from a group of social work practitioners (N = 200). Participants in their 30s and 40s demonstrated the most knowledge and use of Evidence-Based Practice. In addition, a high percentage of social workers reported to be knowledgeable about social work research databases; a smaller percentage actually used online resources in their practice. Through this study the researchers add to what is currently known about social workers' perceptions, knowledge, and use of Evidence-Based Practice.     

Refusing to Listen: Are We Failing the Needs of People with Alcohol and Drug Problems?

This paper argues that social work education in the UK has persistently failed to equip its social workers with the knowledge to work effectively with people with alcohol and drug problems. In spite of continuing criticism of the profession's unwillingness or inability to engage with substance use issues, social work education has failed to respond to the calls for better training on this subject, even when specific guidance has been issued about course content. This results in a failure to meet the needs of our service users as well as social work staff who remain frustrated at their inability to intervene. The paper explores the historical and current debate about social work training in relation to alcohol and drugs and identifies the barriers to its inclusion in qualifying and post‐qualifying (PQ) curricula. Finally it offers a strategy for improving social work training as well as an overview of programme content requirements.