Professionals without a profession? Redesigning case management in Dutch local welfare agencies

This article explores the new roles of frontline workers in Dutch local welfare agencies against the background of recent active welfare state reforms, with a specific focus on frontline workers involved in activating social assistance recipients. The results presented in the article come from case studies in four local welfare agencies. The article investigates how active welfare state reforms have influenced the room for discretion of frontline workers, how discretion is managed in local welfare agencies, and how frontline workers cope with discretion. The article argues that the discretion of activation by frontline workers has increased significantly. The research results show a clear though not unambiguous shift from a bureaucratic towards a more professional treatment of frontline workers, combined with attempts to introduce a more performance oriented style of management. However, given the low level of institutionalisation of the profession of activation work, activation frontline workers still seem to be professionals without a profession. This not only makes activation work a rather individual project, it also entails risks for clients for whom activation services may become unpredictable and lacking in transparency.     

Activation,medicalisation and inter-organisational cooperation in health insurance – implications for frontline social work in Sweden

This paper focuses on tensions between activation principles and medicalisation in the Swedish sickness insurance and its implications for frontline caseworkers in Social Security Agencies and Public Employment Services. The right to sickness cash benefits has become stricter and more conditioned upon the person’s work ability and employability. The paper describes recent policy changes towards activation and stricter entitlement criteria for sickness benefits policy and explores the consequences of such new activation policies in terms of changed work modes for caseworkers dealing with long-term sick people’s return-to-work process. It is concluded that on the one hand frontline work contains a significant portion of discretion and professional assessment of work abilities, and on the other hand rule-bound administrative work. Furthermore, frontline workers need to apply organisational professionalism as inter-organisational cooperation is required in order to support long-term sick people to return-to-work. Medicalisation of ill-health, manifested in the right to sickness benefits has not been substantially circumscribed by new activation policies in the sickness insurance.     

Standardisation—the end of professional discretion?†

This article analyses and discusses standardisation in human service organisations and its implications for professionals and for professionalism in social work. The theoretical framework derives from neo-institutional theory and theories regarding professionalism. By highlighting the role of professionals within a field influenced by organisational demands and market endeavour, this article contributes to the understanding of increased standardisation as a way to reduce uncertainty and enhance legitimacy for human service organisations, but at the expense of traditional professional discretion. This development has been interpreted as de-professionalisation and as an adjustment to organisational demands. It could also be seen as a professional strategy to strengthen professional trust and provide a sense of certainty for professionals. It can also lead to professional uncertainty about how to handle the discretion in the light of standardised tools. This development might, depending on the organisational context and the individual professional's choices, result in a manual-mental specialised professionalism as well as a strictly mechanical form of work. Standardisation thus puts high demands on professionals and how they use the professional discretion, since professionalism requires professionals capable of handling a mix of logics without totally yielding discretionary power and making professional judgement.     

Vital tasks and roles of frontline workers facilitating job inclusion of vulnerable youth

Researchers and others are worried about the marginalization of vulnerable youth who drop out of school and work. Frontline workers are key support givers for vulnerable youth, but they have been described as professionals who lack a recognized body of knowledge they can rely on. This article investigates vital frontline roles and tasks related to job inclusion of vulnerable youth. Qualitative data are drawn from 16 Norwegian pilot projects aimed at developing social work approaches among vulnerable youth. The challenges and the support provided resemble those in other European countries. Cross-case analysis suggests four main support roles: (1) administration and securing of basic needs, (2) connection and relationship building, (3) job enabling, and (4) job customisation. Combining roles 1 and 2 with roles 3 or 4 seems to improve the outcomes, meaning that they improve the capabilities of vulnerable youth to find and master a job when that is something they have reason to value. Since this topic has been little explored for vulnerable youth, this article contributes to further developing job inclusion support for this target group in particular.     

Disjunctures for Women and Frontline Workers: Implementation of the Family Violence Option

This research uses analysis of qualitative interviews with 10 battered welfare clients and 15 frontline welfare workers to examine the implementation of the Family Violence Option (FVO) under welfare reform. States adopting the FVO agree to screen for domestic violence, refer identified victims to community resources, and waive program requirements that would endanger the women or with which they are unable to comply. The analyses find that none of the 10 clients in this study received these services. This lack of services reflects four critical disjunctures between the formal policy and the policy experienced by the clients. It also reveals several more basic structural factors that provide conflicting mandates to frontline workers. Frontline workers' discretionary behaviors enforce core rules related to welfare eligibility and reduce welfare caseloads but do not provide violencerelated services to victims.     

Use of information systems in social work – challenges and an agenda for future research

ABSTRACT

In the age of digitalisation social work is transforming. With the increased use of information systems, social workers are meeting new professional challenges. In this paper, we report findings covering a nine-year longitudinal study on critical issues in the use of a Case Management System in a Swedish social work agency. The study includes a stakeholder-based evaluation, interviews and document analysis. Comparing the evaluation findings with the literature helped us identify six areas in need of intensified research: (i) Usability and interface design; (ii) Mismatch between social conceptualisation and system conceptualisation of the case; (iii) Skills and training for information systems use; (iv) Statistical production for accountability and quality assurance; (v) Terminology for interpersonal understanding; (vi) IT Governance. As can be seen from the areas above, this kind of research depends on professional knowledge from the social work field – but also from the field of information systems. Hence, we suggest deeper collaboration between the two areas of knowledge in order to scrutinize the complexity of social work information systems. Clearly, the intersection of social work and information systems is a neglected research area, and we attempt to contribute by providing guidance for intensified research and practical knowledge generation.     

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

ABSTRACT

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.     

The moral bases of social work

Social work's conventional “value-talk” presents a professionally neutral value-system for making moral judgements, but paradoxically neglects the professional social role of making moral judgements on behalf of society. Conventional statements of social work's moral values neglect economic, political, and aesthetic value judgements and issues of logic, rhetoric, and epistemology, which should also be included in value debate. Social work's value codes are not 'basic', because they are not usable in practice, are not distinctive, comprehensive, or universal. Historical and sociological evidence suggests that social workers make moral judgements of their clients on behalf of society. These judgements should be earned out within a more comprehensive and better articulated value system, which is applied in the detail of everyday practice.     

Child protection decision-making: social workers’ perceptions

ABSTRACT

Decision-making is located at the heart of social work as a core professional activity, because much of what social workers do concerns decisions about future courses of action. Drawing on elements of the learning together systems model and Falkov’s Systemic Family Model, this study investigated social workers’ perceptions regarding how child protection decisions are made. Evidence was drawn from a constructivist–-interpretivist qualitative research design, involving 16 semi-structured interviews with qualified and experienced social workers and 20 direct, non-participant observations of child protection meetings. Evidence from the study suggests that professionals and family members do not rely entirely on the guidance on the threshold criterion of the likelihood and significance of risk of harm when making decisions. Instead, they use discretionary intuition and analytical judgement, involving multidimensional criteria which includes consensus between professionals and with family members; individual professional’s state of mind; other agencies and professionals’ priorities as well as external factors such as the availability of resources. Conclusion can be drawn that existing guidance on decision-making is inadequate, hence the discretionary use of a combination of intuitive heuristics and analytical thinking in a complementary manner. This study, therefore, contributes to considerable conceptual clarity regarding the complex child protection decision-making process.     

The frontline delivery of activation: workers’ preferences and their antecedents

This article intends to contribute to the increasing body of academic literature on the frontline delivery of activation policies. In line with the broader literature on frontline work, this literature focuses attention on frontline delivery practices and preferences and how these can be explained. Activation work is an interesting case in this context, because activation workers’ jobs designs vary considerably and workers have a diversity of educational backgrounds (including but not limited to social work) in the many countries that have implemented activation policies. This article looks at workers’ preferences rather than actual delivery practices. It analyses how job design and educational background are related to workers’ preferences concerning servicing clients, managing activation workers and spending time on various activation-related activities. Although the findings of the research that are presented in the article show that educational background and job design play only a modest role as antecedents of workers’ preferences, future research into this issue remains interesting. For it may help to increase our insights into the optimal match between what activation aims to achieve and how the provision of activation is organized on the one hand, and workers’ skills/qualifications and job design on the other hand.     

The Interaction of Structural Variables and Discretion in Individual Outcomes: The Case of Length of Stay for Mental Patients

There is a long history or debate concerning the relative effects of external variables and individual discretion on individual outcomes. Yet, few attempts have been made to specify their cumulative effects on individual outcomes. Using length of stay in mental hospitals as our outcome measure, and type of commitment as our discretion measure, results from regression analyses indicate that discretionary and external variables (i.e., positions in the social structure) interact. Under conditions of low discretion, status resources have much stronger effects on length of stay than they do under conditions of high discretion. We conclude that external factors and discretionary variables can and should be included in the analysis of social action.     

The Case for the Welfare State: From Social Security to Social Equality,Social Security and National Policy: Sweden,Yugoslavia, Japan,the Study of Social Policy: A Comparative Approach

The question of whether social workers participate in continuing social work education because social service organizations regard continuing education of their staff essential for improved organizational performance, or because social workers regard it as essential for improved professional performance is examined using two data sources. The data suggest that social workers engage in continuing education programs primarily for professional rather than organizational reasons. The viability of these programs seems to depend on whether they are on the cutting edge of new knowledge and the opportunities they afford for intellectual stimulation. The discussion is set in an organizational environment perspective.     

Negotiating personal engagement and professional accountability: professional wisdom and ethics work

This article examines the relationship between personal engagement and professional accountability in social work—considering whether the increasing focus on professional accountability in the context of the new public management, public austerity and market-based systems of welfare is incompatible with the personal engagement of social workers with service users and with their work. After undertaking a conceptual analysis of the terms, it is argued that both personal engagement and professional accountability are essential features of social work. Indeed, it is this negotiation of the creative tension between them that constitutes the subject matter and work of professional ethics. This requires a capacity and disposition for good judgement based in professional wisdom and a process of practical reasoning or ‘ethics work’ to find the right balance between closeness and distance, passion and rationality, empathic relationships and measurable social outcomes. It also requires a space for the exercise of professional wisdom.     

Mandates for a changing practice: PSRO and P.L. 94-142.

Federal legislation in the fields of education and health care now requires the development of systems of professional accountability. This accountability to the sponsoring system and to the client is making profound changes in practice. Implications of these changes are reviewed with a challenge to social workers to assume leadership in translating these changes into effective practice models.     

Promoting Creative Practice through Social Work Education

It has been suggested that the essence of professional work lies in the balance between the performance of technical tasks and the exercise of judgement and discretion—the ‘technicality/indeterminacy’ debate. A skilled social worker must be capable of applying a range of knowledge, skills and values in a variety of practice circumstances, the precise nature of which cannot always be predicted. This presents a challenge for social work education, previously governed by a reductive notion of ‘competence’ in its planning and delivery. This paper will explore the nature of judgement and creativity in practice, identifying why such concepts are essential in contemporary social work. Accepting that qualified social workers must be capable of acting independently and autonomously, it will then examine the task that this presents for social work education—the need to prepare students (at both qualifying and post‐qualifying levels) to exercise judgement and discretion in professional practice. The paper will argue that the development of innovative forms of social work will depend upon the existence of forms of education that can foster and enhance students' ability to work creatively, and present ways in which this can be managed within both academic and practice curricula.     

Living on the edge? Professional anxieties at work in academia and veterinary practice

ABSTRACT

Through empirical research on academics and veterinary surgeons, this article focuses on identity and how it is reflected in, and reproduced by, anxiety and insecurity at work. Three analytical themes – perfection, performativity and commodified service – each of which generates anxiety indicates a loss of autonomy as academics and vets are subjected to competitive market forces as well as an intensification of masculine managerial controls of assessment, audit and accountability. We see these pressures and their effects as reflecting a commodification of service provision where the consumer (student or client) begins to redefine the relationship between those offering some expertise and those who are its recipients, partly achieved through the performative gaze of constant and visible rating mechanisms. Our empirical research also identifies sources of anxiety concerns in their attempts to achieve perfection against this background of uncertain knowledge and precarious contexts of the performative nature of professional expertise.     

Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

Towards sustainable hybrid relationships in cash-for-care systems

Welfare state services are currently challenged by a key contemporary issue relating to citizens’ independence. But very little attention has been paid to how this affects the relationships between providers and receivers of welfare services. As the objective of cash-for-care systems is to enhance users’ independence by giving them the role of an employer in relation to their care workers, this article focuses on the implications of this system for user–care-worker relationships. Based on the findings of a qualitative cross-national study in Norway and the United Kingdom, the article suggests that the British system tends to foster one of two kinds of relationships – a master–servant type of relationship or a strong solidarity/emotionally-based relationship – while the Norwegian system rather tends to encourage a more professional type of relationship. In everyday practice, however, relationships can be mixed types or they can even resist the direction more usually taken within the particular cash-for-care system.     

The Myth of Global Social Work: Double Standards and the Local-Global Divide

The push towards “global standards” in social work is part of a movement to generate uniformity, quality control, and benchmarking for professional education programs. It acts as a powerful vestige of modern institutions and professional associations to prescribe through processes of standardization, formalization, and technical specificity. In social work “global standards” attempt to create a fixed set of minimal requirements to which all professional programs should adhere. Standards are viewed along two dimensions: (i) as a necessity due to the changes and scale of complexity in social work; and (ii) as a vehicle for importing dominant forms of knowledge, values, and skills. Those parties who enthusiastically underwrite attempts to construct “global standards” in fact create a powerful network of allies that undermine local or cultural differences and fail to reconcile them. Global standards in social work undercut indigenous skills and values and negate the expertise of professional judgement. They constitute an unnecessary and politically motivated intrusion in the world of social workers. Ultimately, standards such as these are an illegitimate, impersonal, and voluntary means of regulation. As such, global standards are inherently political because their construction and application formally regulates the local practices in which they become embedded. Over time, they modify the position of social work practitioners and alter relations of accountability to the standards themselves.