Keyworkers Re-examined: Good practice, quality of care and empowerment in residential care of older people

Correspondence to Rosemary Bland, Department of Applied Social Science, University of Stirling, Stirling FK9 4LA, Scotland Summary Social work definitions of ‘good practice’ in residentialcare which were originally developed in work with children andyoung people have also been applied to residential settingsfor other user groups, including older people. However, anylink between such elements of practice and positive outcomesfor users has not always been demonstrated. The introductionof market principles and orientations into social welfare inthe 1980s re-defined the social work ‘client’ asa ‘consumer’ with the associated power to make choicesin the area of social care. The success with which such an approachcan be applied to services for people who are very often, notin a position to exercise much choice, is debatable. Alongsidethe notion of the ‘consumer’ or ‘user’of services has grown the ideology of ‘empowerment’of people who use social work services. Drawing on findingsfrom a recent study, this article explores the contributionof the keyworker role to good practice and the empowerment ofolder people living in residential homes. It concludes that,because their understanding of the concept and practice is largelyundeveloped, the role as currently interpreted is not consonantwith good practice and tends rather to reinforce the power ofstaff.     

From Emplaced Knowing to Interdisciplinary Knowledge

ABSTRACT

In this article, we discuss how experiential and unspoken ways of knowing produced through a video-based approach to sensory ethnography can be made meaningful and relevant to the applied practice of design and engineering scholars. We advance discussions of sensory ethnography by interrogating and making explicit the analytical processes that turn the sensory knowing of the ethnographic encounter into convincing accounts of everyday realities whilst engaging new sensitivities and ways of seeing that in themselves contribute to cross-disciplinary knowledge. We argue that through a more self-conscious appreciation of how and where experiential categories become applied knowledge the value of a sensory ethnography approach in design-centered energy research can be realized.     

A New Structure for Intake and Allocation in a Field Probation Unit

Summary From a background of practice and a post-qualifying fellowship,the author draws on the experiences of other Senior ProbationOfficers, as well as his own and his team members. In this article‘intake’ within the probation setting is taken asinitial agency impact as well as that part of team strategywhich has a bearing on allocating new work. Allocation and theconsequential deployment of resources are then seen as centralto the professional lives of team members. A structure is presentedwhich in practice pervades the totality of the team's life;most radical is the author's notion of allocating ‘workepisodes’. The model provides a structure for team membersto specialise in different forms of social work, and at thesame time allowing clients choice to be supervised without being‘sentenced to social work’. It also depends uponthe active use of a team as a group of interacting, interdependentprofessionals who share their work.     

An Unfinished Reflexive Journey: Social Work Students' Reflection on their Placement Experiences

The fieldwork placement is recognized as one of the major componentsof social work education and a major determinant of its quality.A key aspect of the learning process in the fieldwork placementis the exposition of practice encounters to the students’critical reflection. Given the importance of the process of‘reflection’ or ‘reflective learning’,a qualitative study based on the reflective logs of social workstudents was conducted to explore the meaning of social workfield education and the learning experiences of social workstudents during their placement. The study findings revealedthat disturbing events experienced by students in their fieldworkwere a catalyst to their reflective process. Meanwhile, theirundue concern with knowledge and skills application within acircumscribed knowledge frame suggests the dominant influenceof scientism and competence-based practice in social work, inwhich learning outcomes and instrumental and technical reasoningare highly emphasized. Discovery of ‘self’ was alsothe major premise in the students’ reflection logs, inwhich a majority of them took their prevailing self-identityas a constant state to be verified in interaction with othersin the fieldwork placement. Reflexivity is manifested in askingfundamental questions about assumptions generated by formaland practice theories; it addresses the multiple interrelationsbetween power and knowledge, and acknowledges the inclusionof self in the process of knowledge creation in social workpractice. Its realization in social work education requiresthe social work educators’ reflexive examination of thedynamics that influence the construction of curriculum, whichin turn construct our prospective social workers.     

Outline of a Critical Best Practice Perspective on Social Work and Social Care

Correspondence to Harry Ferguson, Faculty of Health and Social Care, University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD. E-mail: harry.ferguson{at}uwe.ac.uk Summary This article seeks to lay the foundations for a new, more positiveperspective on critical practice, research and learning in socialwork and social care. A ‘critical best practice perspective’seeks to move the literature beyond a ‘deficit approach’where the focus is on what does not get done (well), to createa perspective where learning occurs in terms of best practicewhich is set out as a model for developing systems and practicecompetencies. This requires a focus on the actual critical practicesthat are ‘best’ demonstrating the very practicethrough which positive outcomes were achieved. A detailed case-studyis offered drawn from a large scale research study which typifieshow a critical best practice perspective can provide for learningin key areas such as how to engage service users, advocate ontheir behalf, promote protection, establish empowering relationshipsand conduct longer-term therapeutic work in an antioppressivemanner. The research method uses critical theory as an interpretativeframework for reaching an operational definition of 'excellence’and what is ‘best’, which is drawn from the perspectivesof the range of stakeholders who construct practice. This requiresa broadening of the concept of evidence-based practice to includequalitative research methods and the experience of professionals,service users and the production of ‘practice-based evidence’.     

Endangered Children: Experiencing and Surviving the State as Failed Parent and Grandparent

The state removes children from ‘failed’ parentsto give them a better experience of parenting. This articleexamines the role that the state plays as parent to young mothersin care and grandparent to their children, drawing on a small-scalestudy undertaken in western Canada using grounded theory methodology.The findings were bleak: the state as parent and grandparentalso fails these children. We consider why this is the caseand make suggestions for ways forward by critiquing the ideologyof familialism that underpins the state’s punitive approachto these young mothers and their children. We also call forpolicies and a practice that enable practitioners to addressstructural inequalities such as poverty and racism alongsidethe capacity to respond to the personal needs of the young womenand their children as young people with dignity and rights.     

Government, Social Services Departments and the Health of Children and Young People: Which Way Forward?

Summary Despite the dearth of research into the health of children andyoung people in contact with or ‘looked after’ bylocal authorities, a series of official and quasi-official reportshave begun to raise awareness of this issue. There are goodreasons to believe that this group of children will be disadvantagedin terms of health as they are in other aspects of their lives.The evidence suggests that local authorities do not live upto the standards of ‘good parents’. Current notionsof good practice are critically appraised and the article concludesthat social work is unable to do more than mitigate the effectsof Government policies which affect health and social servicesand which have lead to widening social inequalities.     

Conceptualizing Community Social Work--a Response to Alan York

Summary This note takes further the task of conceptualizing communitysocial work begun by Alan York in his paper for the June 1984edition of this Journal. York's approach is criticised firstlyfor unhelpfully conflating ‘community work’ and‘community social work’ and, secondly, for developinga schema unable to satisfactorily theorise the range of communitywork approaches currently to be found within social work. Buildingupon York's suggestion that ‘dichotomous formulations’provide an appropriate way forward for analysing community practice,three, distinct, dichotomies are elaborated, and recommendedas a basis for locating and comparing current approaches tocommunity social work.     

Technicality and Indeterminacy in Probation Practice: A Case Study

Correspondence to Department of Law, Crookesmoor Building, Conduit Road, Sheffield S10 1FL, UK. E-mail: g.j.robinson{at}sheffield.ac.uk Summary ‘Technicality’ is a theoretical construct which,in the context of professional practice, refers to those aspectsof the work which can be prescribed, ‘programmed’or subject to routine practices. This paper considers the purportedrise of technicality in probation practice, with particularreference to the relationship between increasing technicalityand perceptions of ‘professionalism’. The paperpresents a case study of one ‘technical’ initiativein the probation context: namely, a structured risk/needs assessmentinstrument. The case study examined the implementation of thisinstrument in two area probation services, with a view to establishingits impact both on the exercise of professional judgement (‘indeterminacy’),and on perceptions of professionalism among users and theirmanagers. On the basis of the case study it is argued that,contrary to many recent commentaries, neither significant reductionsin indeterminacy nor an inevitable process of deprofessionalizationcan be automatically ‘read off’ from attempts tointroduce greater structure and/or standardization to socialwork and probation practice. The tentative conclusion of thispaper is that the professional future lies not in a wholesalerejection of technicality, but rather in achieving a positive,workable balance between technical and indeterminate aspectsof practice.     

Participation of Disabled Children and Young People in Decision Making Within Social Services Departments: A Survey of Current and Recent Activities in England

A survey of all social services departments in England was undertakenin order to identify and investigate current work concerningthe participation of disabled children within decision makingregarding their own care and in service development. Developinga culture of, and good practice in, children’s participationis integral to government policy. Results demonstrate that disabledchildren are being involved in a range of decision-making areas;however, participation is not yet embedded or sustained acrossall social services departments, and the involvement of disabledchildren at a higher strategic level is still rare. The participationof disabled children needs further development including moreevidence on which factors can support and promote disabled children’seffective participation.     

Attachment and Coping Strategies in Middle Childhood Children whose Mothers Have a Mental Health Problem: Implications for Social Work Practice

Mental health has implications for the quality of relationshipswithin a family, particularly between parents and children,but also between other family and non-family members. Previousresearch has investigated parental reports of attachment infamilies with mental health problems, but relationship representationsas experienced by these children, especially in middle childhood,have not been so frequently investigated. An understanding ofchildren’s representations of attachment relationshipsand the different coping strategies that may result is importantfor social work practice when offering support, not only tothe children, but also other family members. Methods of investigatingattachment, such as the Separation Anxiety Test, have been usedto understand the relationship issues, fears and coping strategiesof other vulnerable children, and this study was designed specificallyto investigate relationship issues in middle childhood childrenwhose mothers had previously been hospitalized with mental healthproblems. We found that these children tended to be less emotionallyopen and secure, and generated fewer adaptive coping strategiesthan children whose mothers had never had mental health problems.Other themes also emerged from the interviews, such as a senseof trust in the parent–child relationship and the ‘containment’of fears. Implications for social work practice are discussed.     

Stagnation as a Distinct Clinical Syndrome: Comparing 'Yu' (Stagnation) in Traditional Chinese Medicine with Depression

Background: Depression was translated into Chinese as yiyu,with reference to the yu syndrome in traditional Chinese medicine.Literally meaning ‘not flowing, entangled or clogged’,yu, or ‘stagnation’ in English, is, however, a constructdistinct from depression. Objective: The study aimed to explorethe construct of stagnation through scale development. Method:A concept-driven approach was adopted to generate candidateitems for the Stagnation Scale. Other measures were a validitychecking item, a Beck Depression Inventory (BDI) and a twelve-itemGeneral Health Questionnaire (GHQ-12). Respondents were recruitedby convenience and snowball sampling, resulting in 602 questionnairesbeing completed by adults between the ages of eighteen and sixty-five.Results: Exploratory factor analysis provided a three-factor,sixteen-item solution. The three factors were named Overattachment,Body-Mind Obstruction and Affect-Posture Inhibition. Cronbach’salphas of the entire scale and subscales ranged from 0.82 to0.91. Correlations of the scale total with the validity checkingitem, BDI and GHQ-12 were 0.71, 0.53 and 0.48, respectively.Stagnation showed a pattern of associations with demographicvariables different from depression. Conclusion: The StagnationScale has good psychometric properties, and has meaningful factorstructures. The evidence supports the contention that stagnationis a clinical syndrome distinct from depression. The new concepthas important implications for social work practice.     

Disabled Children's Experience of Permanency in the Looked After System

Research with seven local authorities in England provided dataon the ‘care careers’ of 596 foster-children overthree years (Sinclair et al., 2005). One part of this studylooked at the experiences of disabled foster-children comparedto non-disabled foster-children. The research aimed to identifyif there were any particular difficulties in pursuing permanencyfor disabled looked after children. This article introducesa concept developed by the author from this work: the idea thatdisabled children may be at risk of experiencing a ‘reverseladder of permanency’; being less likely than their peersto receive permanent placements such as adoption and returnhome. The results of the study partially supported this hypothesis,reinforcing existing findings and highlighting some new ones.Foster-children with learning but not other impairments wereless likely to be adopted. All disabled children were less likelyto return home and therefore remained in foster-care for longer.Disabled children who were adopted, or who returned home, didso after a greater delay compared to non-disabled children.By contrast, children who were ‘clearly disabled’achieved a greater degree of permanence within the care system.The article concludes by considering the implications of suchfindings for policy and practice.     

Child Abuse, Social Anxiety and Welfare

Summary This article attempts to locate the ‘moral panic’concerning child abuse within the context of broader changesin the material conditions and ideological forces in Britainin the early 1970s. It argues that the development of a senseof social anxiety amongst certain sections of the populationand the appeal of the New Right were crucial in the processof establishing the problem as the major issue for social workers.As a consequence social workers have been constrained into amore punitive and interventive relationship with children andfamilies, particularly the poor. The analysis illustrates thatthe way social workers experience role conflict and tensionin this area of their work reflects much wider historical andcultural confusions and contradictions.     

Preventing Suicide: A Neglected Social Work Research Agenda

Social workers encounter suicidal clients; however, little isknown about social work’s empirical knowledge base forsuicide assessment and treatment. In the first comprehensivestudy of social work’s contribution to the suicide literature,the authors conducted systematic electronic and manual searchesfor suicide research published in peer-reviewed journals bysocial work investigators for the period 1980–2006, withthe purpose of ascertaining the state of clinical knowledgerelated to suicide risk factors and effective treatments. Thesefindings reveal that despite recent increases to the study ofsuicide by social work researchers, they have contributed limitedevidenced-based knowledge in the last twenty-six years on thetreatment or prevention of suicide or suicide-related behaviours.The article outlines the risk factors for suicide and discussesthe implications for clinical social work practice and research.     

Mapping the Needs of Children in Need

This paper reviews the literature on mapping needs, with particularreference to children in need, and locates this within the legalmandate for children’s services planning and New Labour’smodernization policies for social care work. The paper surveyspossible approaches to mapping needs and highlights the challengesinvolved. One research project, which collected informationon children in need from a variety of different agencies withinone geographical location, is then used to question mapping’scontribution to the achievement of quality, co-ordination andresponsiveness in modernized child care services. The paperincludes a critical review of the extent to which mapping researchinforms practice, of the contested nature of need, and of anapproach that rests on identifying those in greatest need andtargeting available resources at those most at risk.     

Social Work Students' Perceptions of Child Abuse: An International Comparison and Postmodern Interpretation of its Findings

Correspondence to R. James Christopherson, School of Social Studies, University of Nottingham NG7 2RD, UK. Summary The decision about whether behaviour with children is acceptablehas far-reaching consequences for those involved. Social workersmust decide what behaviour leads people into the child protectionsystem. This study aims to identify how far social work studentsachieve a consensus on the acceptability of behaviour, and whethersimilar items achieve agreement between groups in Sweden andEngland. Forty-four vignettes of behaviour with children whichmight be seen as unacceptable were administered to 52 first-yearsocial work students in Ume, Sweden, and 50 English students.They were asked to rank the behaviour on a 5-point scale, where‘1’ represented ‘Fine’ and ‘5’‘Totally unacceptable'. Key findings were that there is little consensus within societiesabout what is acceptable behaviour towards children, and significantdifferences between them. It is argued that this is the resultof the many different discourses operating in the field. Theauthor points out the difficulties this can cause, and arguesfor the acceptance of a postmodern approach, which though stressingthe importance of consensus in decision making, ultimately positsthat effective and ethical practice must be based on relationship.Such an approach would resolve paradoxes which have challengeda more modernist understanding of social work.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.