The Experience and Practice of Approved Social Workers in Northern Ireland

Correspondence to Dr Roger Manktelow, School of Social and Community Sciences, University of Ulster Magee College, Derry, BT48 7JL, Northern Ireland. Summary This article reports on the first extensive survey of ApprovedSocial Worker (ASW) activity under the Mental Health (NorthernIreland) Order 1986. The integrated health and social servicesorganizational structure, the adverse effects on individualmental health of the legacy of thirty years of civil conflictand the move from hospital to community care are significantfeatures which have influenced the delivery of mental healthsocial work services locally. The practice and experience ofASWs was surveyed by postal questionnaire and user and carerexperience of compulsory hospital admission was investigatedby a series of focus groups. The study revealed that two-thirdsof ASWs had experience of acting as an applicant in compulsoryhospital admission during the past two years. Nearly half (42per cent) of these ASWs had reported experience of between oneand five admissions and one-tenth had completed over twentyadmissions in the two-year period. In only a small minorityof cases did joint face-to-face assessment with the GeneralPractitioner (doctor) take place; nearly half of ASWs reporteddifficulties in obtaining transport; and only one-fifth of ASWshad experience of acting as a second approved social worker.Half of ASWs reported experience of guardianship, either asapplicant or in making the recommendation. Both service usersand carers reported a lack of understanding about the role ofthe ASW and complained about the lack of alternative resourcesthat ASWs could use to prevent hospital admissions. These findingsare discussed and a number of recommendations are proposed forimprovements to approved social worker practice.     

Common Ground: The Development of a Support Group for Survivors of Homicide Loss in a Rural Community

ABSTRACT

Losing a loved one from human-perpetrated violence can lead to a debilitating process of stigma-generated isolation and trauma. Layers of social services are needed to support surviving family members, all secondary victims of homicide. Although urban populations have enriched access to victims-of-crime services, rural-bound populations often do not. This article describes homicide-specific trauma and the development of a community support group for rural-bound persons suffering homicide loss. The support group process offers potential for real help in areas where few trauma-informed options exist. The authors chronicle their journey of group-work practice with underserved persons coping with homicide loss.     

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.     

Developing Anti-Oppressive Empowering Social Work Practice with Older Lesbian Women and Gay Men

Summary Available studies suggest that around 10 per cent of the populationmight self-identify as a lesbian woman or gay man (Davies andNeal, 1996). It follows that social workers will engage witholder people who are homosexual. It does not follow that theywill know who they are, as this is a group often characterizedby its invisibility. This paper reports the results of a small-scale,exploratory study which examined how older lesbian women andgay men perceived their needs should they become ill or disabledas they age (Langley, 1997). Their concerns were viewed in thecontext of their past as well as present lives, and oppressionwas a unifying theme. Some of the findings are examined in orderto highlight key challenges for social work practice. Theseinclude: (i) working with invisibility and fear of oppression;(ii) developing awareness and recognition of lesbian and gayrelationships and supportive networks; (iii) the need for anti-oppressiveempowering services which match the needs and circumstancesof older lesbian women and gay men; (iv) importantly, the needfor greater awareness of the heterosexist assumptions whichinfluence institutional responses and individual practice.     

THE REVIEW OF THE COMPULSORY DETENTION OF THE MENTALLY ILL: WHO SHOULD DECIDE?

The Mental Health Act 1986 (Victoria) established the Mental Health Review Board to periodically review the detention of involuntary patients in State mental institutions. The purported rationale for the inclusion of two non-medical personnel on the Board is that compulsory detention decisions should not be made by doctors alone and should include social and legal considerations. It is argued that the effectiveness of non-medical members is restricted by the dominance of medical discourse within Board hearings, the lack of availability of community-based care and treatment facilities and a failure to identify the relevance of non-medical issues to the decision-making process.     

Challenges in recruiting parents to participate in child welfare research: implications for study design and research practice

Although research with hard‐to‐reach populations is necessary to deepen the social work knowledge base and improve services to these groups, recruiting members of hard‐to‐reach populations for research projects is often a challenging process. Frequently, non‐probability sampling is used to obtain participants. However, the difficulties and limitations associated with this process in quantitative research are rarely discussed in depth in the literature. Sampling issues can significantly impact a research project, delaying it, extending it or even causing the premature termination of a project. Challenges to recruitment can limit the type of research that is completed, impact the knowledge base or introduce threats to validity through sampling bias. Using a preliminary quantitative study on parental engagement with child protective services as an illustration for the discussion, the challenges of non‐probability sampling with a hard‐to‐reach population and the implications for research practice are explored and discussed. Implications for future research practice are considered.     

Bilingual Social Workers in Mental Health Service Provision: Cultural Competence,Language, and Work Experience

Many agencies actively recruit bilingual social workers. This study presents the reactions of 10 Chinese bilingual social workers to the expectations and demands of their agencies. The study employed a qualitative design with a phenomenological approach. The participants’ responses provide insight into how they manage ethnic and cultural mental health issues in Chinese populations. This study aims to improve social service delivery for clients with limited English proficiency by identifying effective, culturally competent services. The findings suggest that when hiring bilingual social workers, it is just as important for them to be culturally competent as it is for them to be an ethnic or language match with the client base. Having all of these qualities will result in staff members who can provide more effective services by making accurate diagnoses and identifying appropriate treatment plans. In addition to employing bilingual social workers, it is important to maintain good supervision as this will allow supervisees to have a unique perspective on what is involved in providing effective delivery of services to clients with limited English proficiency. Implications for research, practice, and policy are discussed.     

Changing Places: Men Replace Women in Mental Health Beds in Britain

Based on census materials collected in England and Wales from 1921 to 1991, this study focuses on gender differences in occupancy rates in hospitals and other mental health facilities in Britain. The results suggest that since 1991, or for the first time in the twentieth century, there are more males than females in residential mental health facilities in Britain. Furthermore, this pattern of association holds for all age groups except those aged 65 years and over. Second, there are currently two distinct subpopulations in mental health facilities—a male group which is predominantly of working age, and a female group, which is predominantly of retirement age. The existence of these two "care" populations will impact significantly on current and future resourcing of mental health services. The policy implications of the research findings are discussed within the context of the debates on the changing relationship between gender and mental health.     

‘Poor prison flowers’: convict mothers and their children in Ireland, 1853–1900

Pregnant women and mothers were among the thousands of individuals who were sentenced to at least three years’ penal servitude and admitted to the nineteenth-century Irish female convict prison. While some babies were born behind bars, others were permitted to accompany their convicted mothers into the prison after the penal practice of transportation had ceased. Other dependent children were separated from their convicted mothers for years, cared for by family members or friends, or accommodated in Ireland’s growing web of institutions. Using individual case studies, this article focuses on convict mothers and their young offspring. It draws attention to the increasing restrictions on the admission of infants that were imposed as the nineteenth century progressed, the problems that children of various ages in the penal system seemed to pose for officials, and the difficulties faced by incarcerated mothers who wished to maintain communication with their offspring. This article argues that while there were benefits to parenting within the confines of the prison, sentences of penal servitude had a significant impact on the lives of dependent offspring by dislocating families, separating siblings, or initiating institutional or other care that broke familial bonds permanently. In so doing, the article reveals attitudes towards motherhood as well as female criminality and institutionalization generally during this period and sheds light on an aspect of convict life unique to the women’s prison.     

A Qualitative Study of Non-Affiliated,Non-Scientist Institutional Review Board Members

In addition to outlining criteria for the approval of human subjects research, federal regulations provide guidance regarding local institutional review board (IRB) membership. IRBs are mandated to include “at least one member whose primary concerns are in nonscientific areas” and “at least one member who is not otherwise affiliated with the institution.” Often a single individual serves both of these roles simultaneously. Although there have been calls for increased representation of lay community members on IRBs, little is known regarding their experiences or their perceptions of human subject protections and the IRB process. Using an ethnographic interview approach, this study seeks to gain a perspective from non-affiliated, non-scientist (NA/NS) IRB members about the process in which they participate. Findings suggest a need for clarification regarding whom NA/NS IRB members represent. They also suggest that NA/NS IRB members’ experiences could be improved by an increased show of respect from the IRB chair, other members, and staff; efforts to make participation more convenient for these volunteer members; and training tailored specifically to NA/NS members. Further research on this important and understudied topic is needed to determine best practice and policy recommendations.     

High Thresholds and Prevention in Children's Services: The Impact of Mothers' Coping Strategies on Outcome of Child and Parenting Problems--Six Month Follow-Up

High thresholds characterizing the provision of Children’sServices have become increasingly apparent in recent years,and concerns that these thresholds mean that high need familiesdo not receive a service have been expressed in key policy documents.This is despite a commitment, in policy and practice, to Preventionas an underlying theme for services. When referral is followedby a failure to access services, the coping strategies of theparents, in particular the mother, who is generally the primarycaregiver, become of particular practical importance. Thesecoping strategies are also of theoretical interest, being akey element of the newly developed concept of Proto Prevention,which extends our previous understanding of this area. Thispaper focuses on the coping strategies of families who wereunsuccessful applicants for Children’s Services, and asks:Which coping strategies were most effective in securing positiveoutcomes? It was found that the direct actions of the mother,and avoidance strategies such as denial or acceptance had littleeffect. However, seeking social support was associated withmore positive outcomes in child development and parenting, anddenial and disengagement with an increase in depression symptoms.The implications of these findings, for policy and practice,are discussed.     

Everything for the Children: Orphans Growing Up in Informal Adoptive Families in China

Most orphaned children in China are cared for by their extended families or become state wards under the guardianship of child welfare institutions. Some exceptions are children who are found and cared for by families in the community, without a formalized adoption or foster relationship. In some locations, institutions now accept guardianship for these children and support the informal adoptive family to continue to care for them. This article examines the outcomes for these children as they became young adults by comparing these 12 children raised within the system as they approach or have approached young adulthood (now aged 16–40 years-old). Some of the participants were either informally adopted or lived in institutional care. The results of this study found that the family environment was more conducive to the young people’s wellbeing as they approached or entered adulthood. The participants raised in informal care appeared to be treated similar to the biological children in these families. When the institution formalized the state guardianship responsibility, it also meant the families had state resources for support to protect the children’s rights to economic security, education, health care, and social participation. This practice by the institution supported the addition of informal adoption, as one step closer to permanency than foster care. Future implications include considering this option to help promote the family system assisting these children, families, and the state.     

Life values,family support and psychosocial adaptation among older people in Taiwan: an institutional and community comparison

The purpose of this study was to investigate the psychosocial adaptation among elderly persons in institutional and community settings, and to explore factors influencing their adaptation. A cross-sectional survey was conducted with a convenience sample of 165 residents of four institutions (two assisted-living facilities and two nursing homes) and 209 community-dwelling elders served by a primary care centre, all located in middle Taiwan. A structured interview questionnaire was used to collect data. Results: community-dwelling elderly had significantly higher adaptation scores than those in institutional settings. Factors related to adaptation differed between institutional and community settings, with more variables influencing adaptation in the community than in the institution. Physical functional status was the major influence on adaptation of the elderly in institutions. Dietary support from family was negatively associated with adaptation in this group. Influencing factors for community-dwelling elders were more complicated, including perceived family emotional and economic support, personal life values and physical functional status. Implications: greater support from government, including economic resources and assistance in community care are needed to achieve the policy goal of ‘aging in place’. Further investigation of the influence of family interaction on elders' adaptation is needed.     

The paradox of inter-country adoption: analysing Romania's experience as a sending country

This article explores the effects of inter-country adoption on the development of in-country services to protect children and support families in Romania. The country's child care legislation gives formal priority to domestic alternatives to institutional care – preventive services, family reunification, foster care and in-country adoption. Despite this, inter-country adoption continues to play a central role in Romania's child welfare system. The article analyses the multiple and complex factors at policy and practice levels that lie behind this situation. It is concluded that whilst inter-country adoption may be used to secure some resources for the development of in-country services, it paradoxically undermines the effectiveness of those services for the children who are left behind.     

A qualitative study of non-affiliated, non-scientist institutional review board members

In addition to outlining criteria for the approval of human subjects research, federal regulations provide guidance regarding local institutional review boards (IRB) membership. IRBs are mandated to include "at least one member whose primary concerns are in nonscientific areas" and "at least one member who is not otherwise affiliated with the institution." Often a single individual serves both of these roles simultaneously. Although there have been calls for increased representation of lay community members in IRBs, little is known regarding their experiences or their perceptions of human subject protections and the IRB process. Using an ethnographic interview approach, this study seeks to gain a perspective from non-affiliated, non-scientist (NA/NS) IRB members about the process in which they participated. Findings suggest a need for clarification regarding whom NA/NS IRB members represent. They also suggest that NA/NS IRB members' experiences could be improved by an increased show of respect from the IRB chair, other members, and staff; efforts to make participation more convenient for these volunteer members; and training tailored specifically to NA/NS members. Further research on this important and understudied topic is needed to determine best practice and policy recommendations.     

Access to Disaster Services

ABSTRACT

This study uses geographic and network analysis, and regression techniques, to examine access to services for vulnerable populations in disaster, and offer potential interventions to improve access. The population for this study is 67 organizations providing disaster social services in a U.S. metropolitan area, and an additional 25 organizations which are willing to provide these services but do not have a formal disaster relief function. The findings from this study indicate a lack of relief services for vulnerable populations, including African-Americans, people over 75 years old, and female-headed households with young children. During a disaster, a type of social injustice results from (a) the vulnerability of these populations to disaster, (b) the higher vulnerability to disaster of the areas in which these populations reside, (c) the smaller number of organizations serving these areas, (d) the lower capacities and network interaction of these local organizations, and (e) the formidable geographic barriers slowing redistribution of resources in a disaster. If connectedness of smaller, informal organizations to the disaster network were improved, otherwise isolated organizations could be a source of substantial resources for the metropolitan area. Suggestions are offered for interventions, based on services coordination (Provan & Milward, 1995) and community organization models (Soliman, 1996), for correcting the lack of access to services documented by this study.     

Leaving an Institution in Flanders (Belgium): A Road to Homelessness?

People living in an institution will leave this residential context one day and have to proceed to a stable independent way of living. This transition is not without difficulties as it turns out this socially vulnerable group runs an increased risk of becoming homeless. Research in Flanders (Belgium) has shown that a considerable share of the homeless population has previously stayed in an institutional setting, mostly in youth care (48.7%), psychiatric (34.4%) and penitentiary (33.1%) institutions. Moreover, the share of homeless people with a history in one of these institutions has increased in the past decades. Institution leavers, face at least three obstacles to a stable housing situation in Flanders: a lack of affordable housing, a lack of access to (non-residential) social assistance and personal difficulties in coping with living independently. Yet, there are several programs that support institution leavers and prepare them for the transition to an independent living situation and legal developments that strengthen their position in society and on the housing market. In this paper, we explore these initiatives and developments in three case studies (Antwerp, Ghent and Leuven). Based on in-depth interviews with “street-level bureaucrats” who work in these institutions (youth care, psychiatric and penitentiary settings), social support services and social housing organizations, we reconstruct the pathways of institution leavers to the housing market, the support they receive and the experienced difficulties.     

An exploration of the differential usage of residential childcare across national boundaries

The use of residential placements for children needing out‐of‐home care remains controversial. This article considers the discourse of ‘residential’ and ‘institutional’ care before describing, mainly through administrative data sources, the wide variations in group‐care usage in different jurisdictions. In some countries, its use is minimal, with foster care, kinship care and in some cases, adoption being the preferred options. This is not so in other countries where a high percentage of children in care are in residential placements. There is also diversity in the type of residential services, ranging from small group homes to large institutions. The challenges inherent in making process and outcome comparisons across national boundaries are explored. The authors concur with those who argue for more systematic ways of describing and analysing the aims and characteristics of residential settings. Only then can meaningful comparisons be made between outcomes from group‐care regimes in different jurisdictions.     

Who's Calling the Shots? Women Coaches in Division I Women's Sports*

Objective. During the past 30 years, women have become an increasingly small proportion of coaches of women's sports. We test several explanations for why some institutions have women coaches and others do not. Methods. Taking the 329 NCAA Division I institutions with women's sports programs as the cases in point, we explore possible explanations for the dearth of women coaches: the resources and prestige of an institution or sport; the gender of the athletic director; and institutional traditionalism. Results. Within Division I schools, women coaches are more frequently found in more prestigious, resource‐richer institutions and those that devote more resources to women's sports. Conclusions. Although the analysis is confined to Division I schools, it appears that more institutional and organizational efforts need to be made to increase the number of women in the eligible pools for head coaching jobs.