For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Perspectives on Social Care Practice in Romania: Supporting the Development of Professional Learning and Practice

This paper examines the authors’ experiences of developingand delivering training for workers in social care servicesin Romania, through a European Union PHARE¹ funded project.The authors use their experiences to draw on the past and currentpractices of those social workers who were participants in thetraining and to explore their understanding of the emergingissues and themes for social work in Romania. There is alsoan exploration of the potential opportunities for the furtherdevelopment of professional social work learning and practicewithin Romania. The case is made that learning and developmentof social workers could be supported through the encouragementof participatory networks and ‘communities of practice’.     

Calling Social Work

New Labour has promoted the use of information and communicationtechnology. Call centres are a key development in this strategyand are now in use for accessing social services. In officialpolicy, the use of call centres is presented as an aspect ofattempts to change the relationship between service users andthe purchasers and providers of services. In contrast, we suggestthat the use of call centres in social care does little to shiftthe balance of power. Call centres bring together four dimensionsof New Labour discourse: learning from the private sector, cuttingcosts, technology and consumerism. Three issues emerge fromtheir development: the undermining of social work’s senseof place; the circumscribing of service user participation;the rationalization of social workers. The call centre servesas a signifier of what, it is claimed, the combination of NewLabour’s consumerism and technology can achieve. Thissignification disguises call centres’ properties of efficiency,calculability, predictability and control. Contrary to the rhetoricthat accompanies them, call centres may be curtailing serviceuser participation, as well as delimiting the social work role.Accordingly, their use has important, but as yet largely unresearched,implications for service users and social workers.     

Euthanasia: Israeli Social Workers' Experiences, Attitudes and Meanings

Correspondence to Dr Ronit D. Leichtentritt, Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel. E-mail: ronitl{at}post.tau.ac.il Summary Sixteen social workers in Israel were interviewed about theirexperiences with and attitudes towards various forms of euthanasia,as well as the meanings they ascribe to them. Using phenomenologicalanalysis, seven themes were identified, emphasizing individual,interpersonal, organizational, social and therapeutic considerations,and suggesting a holistic and integrative structure of the phenomenon.The themes were arrived at by identifying distinctions and similaritiesbetween different forms of euthanasia. Two themes suggestingsimilarities were revealed: ‘diminishing the value oflife’ and ‘a call for help’. Three themeswere found to distinguish between passive euthanasia (withholdingand withdrawing life-sustaining treatment) and active forms(active euthanasia and assisted suicide): ‘legality’,‘social acceptance’ and ‘concern for the sickand dying’. The last two themes distinguished betweenwithholding treatment and assisted suicide, on the one hand,and withdrawing treatment and active euthanasia, on the other:‘the involvement of others as executor’ and ‘thepublicity of the act’. Further research and training isrequired to better inform social workers in this ethical area.Given their unique position, social workers should activelyparticipate in legal, social and therapeutic discussions concerningend-of-life decisions, for the benefit of clients, their familiesand health-care providers.     

Someone who Treats you as an Ordinary Human Being ... Homeless Youth Examine the Quality of Professional Care

Professor dr. Micha de Winter, Utrecht University, Department of Child and Adolescent Studies, POB 80.140, 3508 TC Utrecht, the Netherlands. Summary In this article we describe a peer-research project, in whichnineteen homeless youngsters interviewed 190 of their ‘colleagues’about the quality of professional care and the improvementsthat, according to them, should be made. The interviews werefollowed by discussion meetings with social workers and policymakers. The youngsters report mixed feelings about the professionalcare system. On the one hand they think they should do morethemselves, there should not be too much professional interferenceand certainly not a patronizing attitude. On the other hand,they want better advice and assistance which is rather basedon a joint effort. The essence of professional care is, accordingto both the young and the professional participants, to finda balance between independence and assistance. From an educationalpoint of view, social workers and adolescents operate at daggersdrawn. Conflict and opposing views are often an inherent partof the road to gaining autonomy. This process, which is oftenpainful, can only be successfully completed in an atmosphereof sincerity, mutual trust and consultation. Dialogue at alllevels is believed to be a sine qua non in the improvement ofprofessional care for homeless youth.     

Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.     

Contact and Collaboration with General Practitioners: A Comparison of Social Workers and Community Psychiatric Nurses

Correspondence to Mr M. Sheppard, Department of Applied Social Science, Polytechnic South West, Drake Circus, Plymouth, Devon PL4 8AA. Summary For some years good communication and collaboration betweenhealth and welfare professionals has been emphasized as a desirablegoal by both official reports and relevant professions. Thisis as much the case in mental health as other areas. This papercompares communication and collaboration between social workersand general practitioners (GPs) with that between communitypsychiatric nurses (CPNs) and GPs. Both social workers and CPNswere based at a community mental health centre, and the contactwas interagency (with primary health care). Major differenceswere found between social workers and CPNs. CPNs were far morelikely to contact GPs than social workers, although GPs veryrarely initiated contact themselves. Differences reflected different‘philosophies of contact’. Social workers contactedGPs when this could be purposively related to their case management.In addition to this contact, CPNs also made contact to provideGPs with information, reflecting awareness of GPs' long-termcontinuing care responsibility. The excess of CPN contacts wasnot limited, but involved a wide range of problems. GPs, however,when contacted, exerted greater influence on social work casemanagement. The article concludes by explaining differencesbetween CPNs and social workers in terms of occupational culture.It suggests, furthermore, that the results arise at least inpart from assumptions of team leadership by GPs, and that socialworkers' and CPNs' behaviour represents different responsesto this.     

A Role for Anyone? A Description of Social Work with the Elderly in Two Area Offices

Summary This article analyses information from Case Review Forms completedby social workers on 199 allocated elderly clients. These peoplewere very frail, most were considered to be ‘at risk’and to require regular, reliable and frequent care. The questionof the client moving to a tafer setting arose in two-thirdsof the cases, concerning which there was often some dispute.It is argued that social workers require a high level of professionalskill in dealing with clients, and others involved, faced withsuch questions and that this requirement will remain with thedevelopment of ‘community social work’.     

The Psychiatric 'Caseness' of Clients Referred to an Urban Social Services Department

Correspondence should be sent to Dr. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Manchester University, Stopford Building, Oxford Road, Manchester M13 9PT. Summary Of 158 clients referred to two area offices and six generalpractice attached social workers, 141 weré interviewedusing standardized social and psychiatric research interviews.The General Health Questionnaire (GHQ) was completed by 138clients. Their social worker completed the Case Review Form.Scores of 5 or more on the PSE Index of Definition (for theclient) were used to indicate psychiatric caseness. Using IDscores of 5 or more, 53% of the sample were identified as ‘cases’.The GHQ (cut-off 4/5) identified 73% of the clients as cases;and the GHQ (cut-off 10/11) identified 51% cases. Morbidity was significantly greater in the general practicesetting. Social workers' judgement (about the presence or absenceof mental illness/emotional disorder) was not significantlybetter than chance in the identification of specific disorders,but was significant in relation to the whole sample. The results are discussed and further studies are being conductedusing more sophisticated judgements of ’caseness’,and extending the enquiry beyond an inner city population.     

Understanding Adolescent Female Prostitution: A Literature Review

Correspondence to Dr Jill Jesson. Aston Business School, Aston Triangle, Birmingham B47 7ET. Summary Sexual behaviour and sexuality are currently topical issuesof concern for child care social workers. Social workers arespending more and of more of their time with children who comeinto care because of sexual abuse, or who have an involvementin the ‘rent’ scene or Prostitution. In additionmany teenage young women come into care because of social orparental concern over their lsquo;promiscuous’ behaviour.The review of research on adolescent prostitution offers severalexplanations for involvement in prostitution. which vary accordingto the discipline of the author. Explanations vary from pathologicaland personal psychology factors to the wider social aspectsof the family and local environment. This literature reviewwas used as a basis for research which examined the incidenceof female prostitution for a social services department. Thisis a relatively new field of interest and consequently thereis very little British research published on the issue of adolescentprostitution, or on under age (16) prostitution. There is nopublished research on girls in care and prostitution. We needto know much more about the reality of young people's livesbefore social workers can offer a meaningful response.     

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between serviceuser and professional social work discourses and provides acritical commentary on their respective contributions to therecent review of mental health policy and legislation in NorthernIreland. The analysis indicates that dominant trends in mentalhealth care, as mediated through service structures and institutionalidentities, have tended to prioritize the more coercive aspectsof the social work role and reinforce existing power inequalitieswith service users. It is argued that such developments underlinethe need for a ‘re-focusing’ debate in mental healthsocial work to consider how a more appropriate balance can beachieved between its participatory/empowering and regulatory/coercivefunctions. Whilst highlighting both congruence and dissonancebetween respective discourses, the paper concludes that opportunitiesexist within the current change process for service users andsocial workers to build closer alliances in working togetherto reconstruct practice, safeguard human rights and developinnovative alternatives to a traditional bio-medical model oftreatment.     

A Consumer Study of Young People's Views on their Educational Social Worker: Engagement as a Measure of an Effective Relationship

Correspondence to Colin Pritchard, Mental Health Group, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton, SO14 0YG, UK. Summary This, the first ever consumer study of education social workers(ESWs), uses qualitative material and quantitative analysisby examining the views of 110 users of a county ESW service.Most pupils belonged to families with long-standing disadvantage;e.g. 53 per cent had unemployed fathers; over 70 per cent hadparents with disturbed personal and social relationships, 39per cent had a single parent; 30 per cent plus had mental healthproblems; and 10 per cent of parents had been in care as children,i.e. more than ten times the national average. The young people also had considerable disruption in their lives:for example 78 per cent frequently missed school; over 50 percent had school and peer difficulties; 30 per cent offended;over 30 per cent experienced bullying; 5 per cent were the subjectof child protection enquiries, 10 per cent had previously beenin care and 2 per cent had had an incident of ‘attemptedsuicide’ (50 times the national rate). They averaged sixmajor difficulties each. Despite these antecedents, 91 per cent of the young people demonstratedan ‘engaged’ relationship with their social worktrained ESW, with many examples of practical psychosocial helpbeing received. The concept of ‘engaged’ was statisticallyvalidated in the comparison of views between the ‘engaged’and ‘non-engaged’ research participants. The resultsindicate the value and effectiveness of a supportive rapport/relationshipas a vehicle to reach and to be of practical assistance to disturbedand disturbing young people.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

Consistencies and Inconsistencies: Mental Health, Compulsory Treatment and Community Capacity Building in England, Wales and Australia

In relation to mental health, it is clear that medicalized underpinnings,the provision of a clinically orientated evidence base for practiceand the need to contain ‘risk’ continue to be prioritized,particularly when compulsory intervention is considered. Thisis despite the increasing influence of a citizenship and socialjustice agenda which is being promoted by psychiatrists involvedin the development of ‘postpsychiatry’, as wellas by service users/survivors. These drivers are not mutuallyexclusive, but in the context of compulsory treatment, thereare clear tensions. In this article, the policy surroundingmental health and compulsory intervention in Australia and inEngland and Wales is explored. In the context of this discussion,three ways in which current government policy can be interpretedare examined and links made between these interpretations anddifferent ways of viewing the relationship between mental healthand community capacity building. With regard to social workpractice, it is argued that a response to mental ill healthwhich concentrates on an individualized ‘diagnose andtreat’ approach, which particularly comes to the foreat times of compulsory intervention, has limited capacity tofacilitate community engagement, foster social inclusion andgenerate reciprocal dynamics between positive mental healthand community capacity building.     

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.     

Informal Networks of Care: Issues Raised by Barclay

Summary In calling for the creation of ‘community social work’,the Barclay Report argues that social workers should aim todevelop informal caring networks. This entails exploiting anindividual's informal social contacts, such as kin, friends,and neighbours, to provide care. This paper firstly examinesthe assumptions and thinking behind the concept of informalcaring networks. It then assesses the feasibility of using differentinformal relations in care provision by analysing the normativepatterning and exchange content underlying them. It concludesthat strategies like Barclay's are unlikely to be successfulbecause they entail a transformation of these relationshipsthat is incompatible with their normal organisation.     

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.     

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.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.