Care Management and Professional Autonomy: The Impact of Community Care Legislation on Social Work with Older People

Correspondene to Mark Lymbery, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. e-mail: Mark_Lymbery{at}nottingham.ac.uk Summary The 1990 National Health Service and Community Care Act appearedto herald a new dawn for social work with older people, whichhad previously been a relatively neglected and undervalued areaof social work practice. The legislation proposed a new rolefor social workers as ‘case managers’, with considerableautonomy and flexibility about the way in which the ‘casemanager’ responded to need. By the time community carepolicy was implemented, the role of ‘case manager’had been transformed into that of ‘care manager’,with a focus which emphasized procedural and managerial requirementsrather than a more flexible professional practice. This paper explores the extent to which this shift has substantivelyaltered the nature of social work practice with older people.It outlines key theories of professions and their applicabilityto social work, and critically analyses the impact of the ‘newmanagerialism’ within social services departments. Thepaper also examines the nature of social workers' practice witholder people following the impact of community care legislation,and concludes that the impact on the social work professionhas been to locate an increasing control of practice with socialwork managers, with potentially serious consequences for thecontinuation of a distinctive social work role in relation toservices for older people.     

Understanding 'Going Missing': issues for social work and social services

Correspondence to Malcolm Payne, Professor of Applied Community Studies, The Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 8RR. Summary Recent research about young people and adults who ‘gomissing’ raises important issues for social work and thesocial services. Large numbers of young people go missing eachyear, becoming vulnerable to exploitation and at risk of committingcrime and suffering from other social difficulties. Adults leavebehind families with practical and emotional difficulties. Adefinition of ‘going missing’ should focus on absencefrom social expectations and responsibilities. Five groups ofmissing person are identified: runaways, pushaways, throwaways,fallaways and takeaways, reflecting different social situationsin which going missing occurs. It is argued that going missingis one of a range of choices which people in difficulties maymake, depending on their approach to problems in their livesand the availability of opportunities. Effective local co-ordinationto focus on reasons for going missing, on reunions and returnsto residential care or home, and to provide emotional and practicalhelp to people ‘left behind’, are required, providedthat care is taken to protect people who go missing becausethey are subject to abuse and violence.     

'No Irish Need Apply': Social Work in Britain and the History and Politics of Exclusionary Paradigms and Practices

Correspondence to Paul Michael Garrett, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. E-mail: paul.garrett{at}nottingham.ac.uk Summary In Britain, Irish people have continually been excluded fromthe discourse of anti-discriminatory social work theory. Themain reason for this centres on the dominant tendency to exclusivelycentre on ‘race’ and visible difference. Recentpolicy documents in relation to social work with children andfamilies illustrate the fact that Irish people are omitted indiscussions seeking to promote culturally appropriate services.Conceptually this approach is founded on implicit ideas aboutBritish identity and erroneously suggests that white ethnicitiesare homogeneous, unified and clearly demarcated from a (new)black presence. Historically, ideas associated with ‘theproblem family’ can be related to the racialization ofIrish people. Archival research examining responses to unmarriedmothers travelling to Britain to have ‘illegitimate’babies adopted also highlights how Irish women have been subjectto exclusionary social care practices. Whilst rejecting an essentialistconceptualization of ‘Irishness’, the article goeson to suggest that the mainstream and hegemonic discourse on‘race’ needs to take specific account of Irish peopleand other minority ethnicities not identifying as ‘black’,particularly during a period of globalization and new migrationinto Britain by refugees and asylum seekers.     

Social Networks and Social Service Workers

Correspondence to Peter Sharkey, School of Law, Social Work and Social Policy, Liverpool Polytechnic, 98 Mount Pleasant, Liverpool, L3 5UZ. Summary ‘Networks’ is a word often used in the discussionof social work practice and within social services departments.It was a word which was central to the Barclay Report (1982)and important within the more recently published Griffiths Report(1988) on community care. It is a word also known to sociologistsand anthropologists through the development of ‘networkanalysis’. There is, however, a fairly wide gap betweenits use within social work and its use within social science.This article tries to explore this gap and the ways in whichsocial science ideas might have some use and relevance to socialservice workers. It does this by using some illustrative datafrom a study done of the personal networks of thirty elderlypeople who were all clients of a social service district office.     

Mental Health and the Asian Communities: A Local Survey

Correspondence to Barbara Hatfield, Lecturer in Psychiatric Social work, Department of Psychiatry, 12th Floor, Mathematics Building, Manchester University, Oxford Road, Manchester M13 9PL Summary The survey of people from the Asian communities in ‘Milltown’included people who used mental health services, family membersof service users, and members of the Asian general public. Personaland social stresses of the group were explored, as were theirperceptions of the ‘causes’ of mental ill-healthand appropriate responses. Although most people saw family andsocial stress as central, a religious dimension was also prominent,in terms both of causes and treatment of mental ill-health.There was no evidence of rejection of mainstream services becauseof a choice on the part of Asian families or communities tobe self-servicing. A range of issues identified by respondentssurrounded the cultural acceptability of services in ‘Milltown’to Asian people. A lack of knowledge of service availabilitywas also apparent, with a heavy reliance upon GP services formental health care in the community. The findings of the surveyare compared with similar studies, where available, which focuson indigenous white British service users. Some findings arecommon; other issues are specific to this Asian group.     

Supervision, Role Strain and Social Services Departments

Correspondence to Department of Social Work and Social Administration, University of Western Australia, Nedlands, Western Australia, 6009 Summary The paper analyses the potential for ambiguity and ambivalencetowards the supervision of practice in social services departments.While supervision may be integral to much social work practicein clinical settings, the culture and tradition of supervisionin social services departments looks to be permeated with confusionabout ‘supervision’ or ‘consultation’,the nature of accountability and the functions of supervisionof qualified and experienced practitioners. To move beyond anideology prescribing supervision, the paper considers evidenceof the effectiveness of supervision practice, analysing thetransition from practitioner to line-manager/supervisor andthe subsequent strain on the supervisor's authorities of positionand of expertise in some current arrangements for supervisionin field-work ‘teams’. Finally, there is an unequivocalassertion that effective supervision is an essential componentin the monitoring of client service and the maintenance of practitionersengaged in stressful forms of practice. Such supervision needsto recognize the managerial and administrative tasks necessaryto protect the agency and the client from poor quality practice,while also respecting the emotional and educational needs ofnewly qualified and experienced practitioners exposed to thedemands of high-risk judgement and practice.     

The State of Welfare

Summary The word ‘welfare’ is difficult to define becauseit combines within it a range of ideologies and actions. Twoconclusions are drawn from this: first, that social servicesshould be regarded as contributors to, but not providers ofwelfare; second, that the study of social work and social administrationshould be concerned not only with the relationship of ‘service’to ‘need’ but also with societal movements and pressureswhich determine the emergence of both. The article reviews theprofessed values of the welfare state, particularly ‘socialequality’ and the problems associated with its achievement,namely public attitudes, and the discontinuity between intentionand practice in the welfare services. The implications for socialwork education and practice are considered.     

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.     

A Political Critique of Kantian Ethics in Social Work

Correspondence to Stephen A. Webb, Department of Social Work, University of Dundee, DD1 4HN. Summary This paper addresses the Kantian theory of the subject whichis found in contemporary social work discourse on ethics andvalues. It is argued here that the Kantian idea of persons as(i) rational, (ii) autonomous, and (iii) ends-in-themselvesis wholly inadequate to the social work doctrine of ‘respectfor persons’. To show this, we counterpose a Foucauldianview of history, moral codes and theory of the person, and themeaning this can have in the social worker-client relation.This alternative reading claims that social work is essentiallya political practice which is constructed by various discursiveand institutional strategies of power. Therefore, it is suggestedthat social work needs a political reading of its own discourse.To this end we outline a Foucauldian micro-political analysisof the social work ‘subject’ or person as a pointwithin a field of discursive-knowledge based strategies.     

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.     

Practitioners as Rule Using Analysts: A Further Development of Process Knowledge in Social Work

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. E-mail M.Sheppard{at}plymouth.ac.uk Summary A new paradigm of ‘process knowledge’ has emergedin recent years, distinct from the dominant ‘product knowledge’paradigm in social work. While the latter refers to existentknowledge, which may be applied, the former refers to the developmentof knowledge about the ‘methodology of practice decisionmaking’, focusing on the processes by which judgementsare made. At its heart is the emerging idea of a reflexivityfor practice, but studies have been, until recently, theoretical.A very small number of empirical studies have begun to identifysome key elements of process knowledge. These have developeda range of concepts relating to critical appraisal, hypothesisdevelopment and hypothesis testing which characterize socialwork process knowledge. These include, for example, focusedattention, querying information, causal inferences, partialcase, procedural, and speculative hypotheses. A process of quasitriangulation is characteristic of social work practice methodology,together with a combination of inductive and deductive thinking.This paper seeks to develop our understanding by focusing onhow social workers develop and appraise hypotheses, and in particularhow the substantive content of hypotheses emerges (these enablesocial workers to make sense of, define, and respond to, situations).To understand this, the notion of rules is used, and socialworkers emerge as analysts employing three types of rules: substantive,application, and practice rules. A significant link betweenprocess knowledge and the content of product knowledge is identifiedin the form of technical language. The concept of ‘probabilisticcausation’ is identified as a key epistemological dimensionin the conduct of rigorous practice.     

The Field Social Work Implications of Residential Child Care

Summary The workloads of field social work staff vary markedly, andlittle is known about the ‘burdens’ imposed by differentgroups of clients or cases. The research study reported hereset out to examine the extent to which field social work involvementin residential child care varied between individual childrenand to attempt to explain that variation in terms of the characteristicsof children, the characteristics and workloads of staff andtheir teams, the packages of services received by children andtheir families, and some general features of the residentialplacements. Field social worker involvement was measured interms of the number of contacts between ‘caseholders’and ‘case’ and the total amount of time spent onthe case over a three month period. The observed variationsin these two indicators were found to be significantly associatedwith the characteristics of cases and other factors. Indeed,these characteristics explained almost two-thirds of the variance.The empirical results have a number of policy implications whichare discussed under six heads: supply constraints, caseloadweighting, fieldwork organization, coordination and monitoring,out-county placements and travelling time, and comparative costings.     

The Treatment of Enuresis amongst Child Clients of a Social Services Department

Summary The adoption of an ‘outpatient’ model of supervisingthe treatment of bedwetting amongst child clients of a socialservices department is described. The treatment technique usedwas the generally effective ‘enuresis alarm’, or‘bell-and-pad’. Fifteen out of a total of 25 concludedcourses of treatment were successful, with an average treatmentduration of 14.9 weeks. Both this outcome, and the rate of drop-outbefore completion of treatment (ten cases) are comparable withthose obtained with non social services clients, and the useof the enuresis alarm with children in care (including thosein residential establishments) was found to be quite practicable.A high relapse rate (43%) was, however, found for social servicesclients, relapse usually following a placement change or othermajor stress.     

Mapping Child-Care Social Work in the Final Years of the Twentieth Century: A Critical Response to the 'Looking After Children' System

Correspondence to Paul Michael Garrett, c/o, British Journal of Social Work, University of Warwick, Coventry, CV4 7AL Summary This paper explores aspects of the Looking After Children: GoodParenting: Good Outcomes system (LAC) (Parker et at., 1991).It is suggested that the scheme, to be used with children andyoung people who are ‘looked after’ by local authorities,needs to be subjected to greater critical scrutiny. The paperseeks, therefore, to situate the LAC system in a social andpolitical context and highlights how it also relates to thedominant operational modalities of social work interventionin the late 1990s. In addition, the paper explores how ‘troublesome’children and ideas centred on ‘parenting’ featurein the LAC discourse. The discussion concludes with an examinationof Action and Assessment Records (Ward, 1995b), the centrepieceof the LAC system.     

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’.     

The Supervision of Child Protection Work

Correspondence to Alan Rushton, Course Director, M.Sc. in Mental Health Social Work, Social Work Department, The Maudsley Hospital, 101 Denmark Hill, London, SE5 8AZ, UK Summary It has frequently been recommended that statutory child protectionservices in Great Britain need greater provision of specialistsupervision to support front line social workers. This qualitativestudy, based in social services departments in London, usedthe focus group method to explore the provision of supervisionby team managers in a very pressurized work environment. Thestudy highlights the difficulty of protecting adequate supervisiontime but shows how supervisors can use their skills to conductcase related discussion concerned with developing professionalskills. ‘Inquisitorial’ and ‘empathic-containing’functions are identified and an approach is proposed for combiningthem in training courses for child protection supervisors. Thepaper recommends that supervision training needs to be expanded,to be more precisely targeted, and that outcomes need to berigorously and appropriately assessed.     

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.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

Depressed Mothers' Experience of Partnership in Child and Family Care

Summary Partnership is a key dimension of social work practice in childand family care, reflecting the significance attached to workingwith parents. While, however, considerable attention has beenfocused on the role of the social worker in encouraging partnership,rather less attention has been focused on the capacity of themothers to engage in partnership. Depression, known to affecta considerable proportion of mothers in this client group, is,because of its debilitating psychological effects, of considerablepotential significance, yet its effect on partnership has notbeen examined. This article focuses on exactly this issue. Findingsshow that depression has highly significant relationships witha number of facets of partnership. It shows also that partnershipmorale and quality of consultation mediate between depressionand, respectively, participation in decision making and involvementin decision implementation—action by the mother to helpresolve the situation. Depression and partnership are, furthermore,related in a complex way to the authority role invoked in casesof children ‘at risk’. The data indicate that theelements of low self-esteem, vulnerability to criticism, andself-blame are key factors in the mother's capacity to workin partnership. Social work practice must take these into account,requiring very high degrees of sensitivity and skill in workingwith mothers. Indeed, unlocking these pernicious cognitionsmay frequently require specialist techniques, such as the useof cognitive behaviour therapy. Overall, being ‘socialworker for the child’ means also being ‘social workerfor the parents (in particular the mother)’, who may wellrequire high levels of encouragement.