Carers of People with Learning Disabilities, and their Experience of the 1995 Carers Act

Summary This paper seeks to highlight the impact of the Carers (Recognitionand Services) Act of 1995 on carers of people with learningdisabilities. It draws on research conducted in the south westbetween 1997 and 1999, which examined the views and experiencesof carers who had an assessment of their needs, together withthose of the person they care for and the professional conductingthe assessment. It concludes that the Carers Act is not widelyused, or understood, by this group of carers. Recommendationsfor improving practice include changes to the current terminology,new triggers for a carer's needs assessment, and a greater inputfrom other agencies, especially health services. Although thecurrent paper focuses on the views and experiences of carers,an exploration of the Carers Act, and its effect on potentialconflicts of interest with the person with learning disabilities,is available elsewhere (Williams and Robinson, 2001).     

A Model for the Comprehensive Assessment of Older People and Their Carers

Correspondence to Beverley Hughes, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL. Summary Although local authorities and social service departments arein the process of developing systems of assessment in relationto care management, there has been little debate about the principleswhich ought to underpin assessment processes, nor about thepurpose, scope, and content of comprehensive assessment witholder people. This article discusses these issues and proposesa framework for comprehensive assessment with older people andtheir carers, derived from development work with social workersin a number of local authorities. Of particular importance isthe need for comprehensive assessment to embody meaningful mechanismsfor user and carer participation and empowerment; to acknowledgenot only need and risk but strengths and resources; to regardthe older person as the centre of a network of personal, familial,and social factors which together determine her or his qualityof life and level of risk. The implications for practitionersare examined.     

Aspects of Old Age

Summary The opportunity of growing old has extended but it is an opportunityattended by risks. When old age is accompanied by infirmity,ill-health and economic or social difficulties, many problemsarise for the individual and for society. This paper looks atsome aspects of the incidence and nature of old age and at thesupport provided by social services, and the discussion is illustratedby reference to seven elderly hospital patients. The identityof the person found to be most at risk was predictable.     

Social Policy and the Prevention of Suicidal Behaviour

Summary This paper is an attempt to answer the following questions.Can we, and should we, try to prevent suicidal behaviour; howsuccessful are the efforts at suicide prevention of lay andmedical agencies; and what social policies could be employedto prevent suicidal behaviour?     

Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.     

The Effort Involved in Finding Employment for White-Collar Offenders

Summary Ex-offenders are notoriously difficult to place into employment.However, the efforts needed to help such clients find work varyenormously and an important question to consider is whetherit is more appropriate to help a larger number of clients bylimiting the amount of placing effort for each client or tocontinue to try to assist those who prove much more difficultplacing propositions. The present study indicates some of thepotential dangers in concentrating upon short-term aid and thefindings have relevant implications for other areas of socialwork where there is a need to ration efforts made on behalfof clients. The present paper also stresses that the difficultiesof while-collar es-offenders finding work have not been fullyrecognized by other comtnentators.     

The Limits of Radical Social Work

Summary Doubts raised by research evaluation of traditional caseworkhave been increased by the perception by radical social workersthat some clients' difficulties derive from their involvementwith state machinery rather than personal capacity or circumstances,and that many can be helped by working collectively with othersin their community rather than striving alone in a dependentrelationship with a caseworker. Radical aspirations, however,assume that all clients have the capacity to overcome theirdifficulties and that none are so damaged as to be able realisticallybarely to cope with them. The radicals' doubts about the usefulnessof individual support and emphasis on collective self help raisethe danger of neglecting those who are unable to participateeffectively and gain from such efforts.     

Tricks of the Trade: Questionable Theory and Practice in Family Therapy

Summary This paper looks at certain over-systematizing trends in familytherapy, and at a group of practices, connected with such systems-thinking,which espouse manipulation and deception. It is argued thatthese theories and methods, couched in a language of scientism,represent a questionable and cynical direction in therapeuticwork. This technocratic approach not only disfigures personaland social being, but erodes social work principles foundedmorally upon a respect for persons. An alternative view is advocatedin which the value of the person is considered as central toan adequate human science. This regards the nature of understandingas based upon the finitude of experience, and therefore offersan appreciation of the person not as an ‘object’fit for technocratic manipulation, but in terms of his subjectiveand historical being.     

Psychological Disturbance Following T-Groups:: Relationship between the Eysenck Personality Inventroy and Family/Friends Perceptions

Summary This study assessed the psychologically disturbing effects ofsensitivity training. Two different measures of disturbanceor distress were used, the Eysenck Personality Inventory (astandardized personality test) and a Behaviour Change questionnairecompleted by the participant and his close family and friends.The relationship between the two measures was explored. Participantsshowed increases in neuroticism as a result of training butthis was not confirmed by the participants' family and friendstwo weeks after the T-group (the most likely period of heighteneddisturbance from training). In fact, a large number of traineessaw themselves and were seen by their family, friends and childrenas slightly better able to cope with personal and family problems,more happy, better able to get on with their children and/orsignificant person/s, and better able to communicate     

Deprivation and Drug Addiction: A Study of a Vulnerable Sub-group

Summary The results of this survey confirm those of an earlier one,5and suggest that a young person who both uses illicit drugsand has a history of court findings, either for delinquencyor for 'being in need of care and protection', should be lookedupon as at considerable risk for future progression to narcoticuse. This progression is not simply a correlate of delinquencyor of remand home admission, as only one out of 100 controladmissions was discovered to have subsequently used narcotics.Moreover, this risk is not borne equally by all drug takersas, even on admission, there were significant mean differencesbetween the progressor and non-narcotic groups. The items whichwere most effective in distinguishing the three groups werethose relating to prior personality abnormality, prior psychiatricreferral and difficulty in relating to their peers and to adultsevidenced in their school and work reports. These differencesare thus of prognostic importance and may aid the identificationat an early stage of those soft-drug takers who are most vulnerableto the dangers of subsequent progression to narcotic and intravenousdrugs     

Social support in later life: a study of three areas

Summary The research reported in this article examines elderly people'sfamily and community networks in three urban areas of England:Bethnal Green, Wolverhampton and Woodford. These were the locationsfor a number of major studies in the 1940s and 1950s. Four decadeson from the original studies, a social network approach wasused to explore changes in the social relationships in thesethree areas. The research sought to assess whom older peopleidentified as 'important' in their lives, and the role suchpeople played in the provision and receipt of support. The studyfound that respondents do not mobilize the whole of their socialnetwork when looking for support. Instead, a section of thesocial network is drawn upon (mainly immediate family) to providespecific kinds of assistance. In addition, locally availablefriends offer complementary or alternative sources of help.This is a change from the earlier Wolverhampton and BethnalGreen studies, although it is consistent with the significanceof friendship highlighted in the original study of Woodford.The paper also reports clear evidence of older people beingactive in reciprocal exchanges across their networks, particularlyin respect of confiding in and talking to people about healthissues but much less so in relation to instrumental support,such as help with household chores, transport and financialadvice.     

Man-made Care: Community Care and Older Male Carers

Correspondence to Mike Fisher, Department of Social Work, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary Recent evidence about the extent of caring for older peopleby older people themselves, and about the importance of spousecare, has challenged existing debates about gender and care.Male carers, particularly older husbands, have been ‘discovered’.This paper attempts to reconceptualize the debate about genderand caring to take account of these developments, particularlyto develop an understanding of the caring activities of oldermale carers and to elaborate the implications for communitycare policy. The evidence suggests there are circumstances where men acceptthe obligation to care, undertake intimate personal care, andderive identity and reward from their caring work, driven bysimilar motives and experiencing similar struggles as women.Rather than seeking maximum distinction between the motivesand experiences of women and men carers, the paper suggeststhat one important way to promote non-sexist community careis to explore the conditions where men's caring is undertakenand how it can be understood and developed.     

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.     

The Best Interests of the Child

Summary The purpose of this article is to clarify the concept of ‘thebest interests of the child’. It is argued that its usehas often confused rather than helped debates on child careand family work, creating the illusion that ‘the bestinterests of the child’ constitute an objective fact. Different assumptions of ends and means in interpreting the‘best interests of the child’ are discussed followedby an examination of the issues of parental authority and influencein decision making, the rights of the child to have a voicein his or her own future, and the authority of professionalsto weigh and balance all the factors. It is argued that more attention should be given to the complexityof the decision-making processes, that decision making shouldbe shared between children, parents and professionals, and thatviews of ‘the best interest of the child’ are alwayscontingent, depending on the particular position and assumptionsof the person expressing them, as well as the objective circumstances.     

Researching social care for minority ethnic older people: implications of some Scottish research

Summary The paper explores issues raised by research on patterns ofwelfare and mutual care among older Pakistani people and theirfamilies, with particular reference to their use, or lack ofuse of social care services. Qualitative interviews were conductedwith (self-defined) minority ethnic older people, professionalsin statutory services and in minority-led community-based groups.The organization of services is discussed, with special referenceto issues of power and control, the role of the voluntary (non-profit)and statutory sectors, the debate regarding the possible needfor specialist versus generic services, and the role of minority-ledinitiatives. Secondly, issues of service staffing are examined,and the dangers of marginalizing minority services and staffreviewed, especially with reference to divisions of labour inservice provision and staff's own perspectives. Thirdly, themethodological implications of the work are explores, includingissues of linguistic and cultural communication and workingwith relatively powerless social groups, whose views are sought.Examining the views of professional social care workers is alsoproblematized, with reference to their gate-keeping role. Itis argued that user perspectives are essential to the developmentof appropriate services for minority ethnic groups. In conclusion,the need to raise these issues in other work is discussed.     

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.     

Strategies for the Management of Stigma through Social Work

Summary Stigma management should be part of social work practice, inaddition to attempts to combat stigma by social policy initiatives.The objectives of stigma management are to reduce awarenessand length of dependence on social services, to demonstrateclients' contribution to society, and to reduce social and spatialdistance between clients and others. Strategies are identified,which include the selection of various combinations of targetsfor intervention from three aspects of stigma (the attribute,the stereotype and the relationship between them) and from thepossibilities of work with the audience, both public and professionaland the stigmatised person, or both. Factors to evaluate inassessment; methods of intervention, including help in passing,group identification, social exchanges, public reviews, theuse of agents, benefactor relationships and elevation ceremonies;and reducing stigma at the end of social work intervention areconsidered.     

Closing the Circle: Social Workers' Responses to Multi-Agency Procedures on Older Age Abuse

Correspondence to Professor Michael Preston-Shoot, School of Law and Applied Social Studies, Liverpool John Moores University, Liverpool, L7 4DN, UK. E-mail: m.prestonshoot{at}livjm.ac.uk Summary This paper reports findings from a project which examined howinter-agency procedures on older age abuse in domestic settingswere used in one local authority. Observations about the useof procedures and about practice with older people who had beenabused are placed in the context of national policy developmentsand are reviewed alongside the available literature. The researchquestions the extent to which guidance is effective in providingdirection for practitioners who encounter older age abuse, andhow well guidance and practice combine to protect victims.     

The Long-term Outcome of Reunions Between Adult Adopted People and their Birth Mothers

Summary Increasing numbers of adult adopted people are searching forand having reunions with their birth relatives. Although a growingnumber of studies now exist that have looked at the search andreunion process, few have examined reunion outcomes over thelong term. The present study investigated the experiences of48 adult adopted people who first had contact with their birthmothers at least eight years prior to the survey. Outcomes wereexamined in terms of the adopted person's evaluation of theirown adoption experience, and the frequency of contact, if any,currently occurring between the adopted person and their adoptiveand birth mothers. Although over half of adopted people werestill in contact with their birth mother eight years or morepost reunion, the number still in touch with their adoptivemothers was higher still. Furthermore, of those still in contactwith both their adoptive and birth mothers, the frequency ofcontact was more likely to be higher with the adoptive motherthan with the birth mother. The results are discussed in termsof the search for identity, filial relationships, genetic relatednessand affectional bonds formed during childhood.