Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

Prison Welfare and Voluntary After Care

Summary Some findings of a survey into the experiences of men releasedfrom prison are reported, where they relate to their use ofprison welfare and after care services. These are discussedin the context of issues such as through-care, rate of take-up,and the factors which may be influential in determining whethera man makes use of after care on release from prison. It isproposed that for more isolated men the probation service shouldadopt a ‘reaching-out’ strategy.     

The Protective Environment of Children: Towards a framework for anti-oppressive, cross-cultural and cross national understanding

Correspondence to Department of Social Work, School of Applied Social Studies, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary The article explores the strengths and limitations of existingcross-cultural, cross-national and anti-discriminatory theoryand research in the child protection field. The way in whichstructural, cultural, personal and inter-personal factors combineto create the child's protective environment is analysed anda framework for an integrated approach to anti-oppressive understandingand practice is suggested. The framework identifies four factorswhose impact at national, community and family levels needsparticular consideration. These factors are the value attachedto children, the status of women and carers, the social interconnectednessof children and carers, and the extent and quality of the protectivesafety nets available. Examples are provided to illustrate theframework's usefulness in practice. It is argued that childprotection theory and practice in Britain needs to take moreaccount of collective and community-based approaches if anti-oppressiveand user-empowering practice is to be achieved.     

Research Note: Developing Outcome Measures in Child Care

Correpondence to Dr Harriet Ward. Research Associate, University of Bristol, Social Policy and Social Planning. The Alfred Marshall Building, 40 Berkeley Square, Bristol BS8 1HY. Summary The complexity of the concept of outcome has discouraged researchinto the impact of the care experience on the child. This Notesummarizes the conceptual thinking behind a comprehensive systemof assessment which is being piloted in four local authorities,and reports on the preliminary results.     

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.     

Short Term Care for the Elderly in Residential Homes: A Research Note

Please address requests for reprints to Dr. D. Boldy, Division of Health Sciences, Centre for Advanced Studies, Western Australian Institute of Technology, Kent Street, Bentley WA 6102, Australia. Summary Short term care for the elderly has expanded rapidly in thelast five years. The study evaluates short stay care in fourresidential homes using interviews with 42 clients, their main‘carers’, officers-in-charge of the homes and socialworkers. Whilst the service worked reasonably smoothly and provideda break for family carers there remains further potential forimproving the quality of service in the context of a full rangeof services for elderly people.     

Placing Children on Child Protection Registers: Risk Indicators and Local Authority Differences

Correspondence to Dr David Gordon, School for Policy Studies, University of Bristol, 8 Woodland Road, Bristol BS8 1TN, UK. Summary Wide variation in rates of children on protection registersin different authorities has led to doubts about the reliabilityof local decision making. A study of 1,752 referrals, for suspectedabuse or neglect in eight English local authorities, found thatindicators of child and family vulnerability were more importantthan local area in explaining selection for initial child protectionconference and placement on registers. There appeared to beagreement on ‘common-sense’ risk indicators butstronger measurements of risk would enable child protectionprocedures to be better targeted.     

Key Issues for Social Workers Placing Children for Family Based Respite Care

Correspondence to Dr. Carol Robinson. Summary This paper seeks to address some of the issues surrounding theplacement of children with handicaps who, at their parent'srequest, go to stay with paid carers working in a family basedrespite care service. The content of the paper derives froma detailed evaluation of the Avon Respite Care Scheme. Thisevaluative study began in April 1984 and was completed in July1986. In order to provide an adequate picture of the contextin which the research was conducted, a brief outline of theliterature and the organization and philosophy of the serviceis provided. Thereafter, the aims of the research and the sourcesof the evidence used are described. In the latter part of thepaper. the results and their implications for social workersinvolved in placing children in family based respite care schemesare discussed.     

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.     

Implementing Care Management: Issues in Relation to the New Community Care

Correspondence to Professor Jane Lewis, All Souls College, Oxford OX1 4AL Summary The official guidance on the new policy of community care emphasizedcare management as the means of securing needs-led services,together with user empowerment and choice. This paper uses datafrom eighteen months intensive fieldwork in five local authorities,first, to examine the very different interpretations of caremanagement in these authorities; secondly, to examine two majorsources of difficulty in the implementation of care managementsystems—the simultaneous development of purchaser/providersplits, and the tension between needs and resources—and,finally, to draw some conclusions about the implications ofcare management for social workers.     

Informal care in farming families in Northern Ireland: some considerations for social work

Summary This paper is the result of a study of the dynamics of care-givingwithin farming families in Northern Ireland. It is argued thatwhilst much is known about informal care, existing knowledgeis largely urban based and quantitative, and therefore limited.Following in-depth interviews with 'farm wives' it is concludedthat for these women care-giving patterns are dependent on aparticular set of cultural expectations and norms. Within farmingfamilies there is much resistance to becoming involved withformal social services. Outside help with the care of one'selderly relatives is often seen as an admission of failure,as there is a pride in being able to look after one's familymembers. Users of social services, which still evoke associationswith the Poor Law, are highly stigmatized. It is claimed thatfor these women the concept of 'carer' has no bearing on theirlives and is not something to which they can relate. The paperchallenges the depiction of caring as a one-sided difficultrelationship where the person being cared for is a passive recipient.It is suggested that caring is not necessarily oppressive butmay be rewarding and positive. It concludes that if social workersare to support and facilitate informal care they must be awareof and fully understand the diversity of care provision andthe different contexts in which care is undertaken. If interventionis to take place then it must be sensitive to the deeply embeddedideas and perceptions that exist within farming families.     

Communication in Care and Coercion: Institutional Interactions between Family Supervisors and Parents

Summary In this study the interaction of 51 videotaped professionalcommunications between Dutch family supervisors and parentsof children under family supervision were analysed. Family supervisionlies at the interface of care and control. This is evident inthe communication of professional child welfare workers withtheir clients for whom they have to clarify their rights. Theanalysis shows some of the strategies used by Dutch family supervisorsin cases of formal decisions and other interactions where theyanticipate confrontation with the client. In this way, familysupervisors separate their caring from their repressive functions.Nevertheless care and control were found to be successfullyintegrated in some communications.     

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’.     

Quality Control in Child Care

Correspondence to June Thoburn, School of Ecnomics and Social Studies, University of East Anglia, Norwich NR4 7TS Summary This article takes as its starting point recent evidence aboutpoor practice in child care social work. It identifies a largenumber of mechanisms for ensuring quality control, and considerswhy they appear to be having so little effect. The writer suggeststhat because of the complexity of cases and the need for direction,and also because of disagreements about what is ‘quality’in child care, bureaucratic or procedural mechanisms have seriouslimitations as the major means for ensuring good practice. Shefocuses on the statutory review as the solution most frequentlysuggested but concludes that too much is being expected of it. Whilst accepting the need for procedural, inspectorial, judicial,and political checks and for more appropriate resources forfamily support, she suggests that the main remedy for poor practicemust lie in professional mechanisms. These include increasedspecialization, more time, improved training, and consultation.The weight of evidence and the intractable nature of the problemmay call for drastic measures, such as the introduction of theApproved social worker(child care).     

An Evaluation of Social Support Intervention with Depressed Mothers in Child and Family Care

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK. Summary The significance of maternal depression to social work practicein child and family care has become increasingly apparent inrecent years. Social support, furthermore, is a concept (aswell as a reality) which provides a major focus for social workpractice. Indeed, social support, it is also clear, is of considerableimportance in helping prevent depression. This paper seeks toexamine social support work carried out by social workers inrelation to depressed mothers in child and family care. In particularit seeks to evaluate the quality of that intervention in thelight of key problem areas associated with high levels of supportneeds, the extent to which social workers target support needsthrough direct, indirect and informal supports, and the extentto which particular interventions are associated with a higheradequacy of support experienced by these depressed women. Thepaper finds a certain degree of haphazardness in social workers’targeting of support needs, although in some areas of indirectsupport, in particular, their targeting is reasonably accurate.There is little evidence of any one form of intervention beingassociated with more adequate support with one significant exception,relief care of children. The paper concludes that social workersneed to develop a keener awareness of support deficits so thatthey are targeted better; they need to monitor more carefullyinterventions carried out by other agencies and professionals;and they should look to relief care of children as a major formof intervention to support these women.     

Gender and the Child Protection Process

Correspondence to Dr Elaine Farmer, Centre for Family Policy and Child Welfare, School for Policy Studies, University of Bristol, Block F, 8 Woodland Road, Bristol BS8 ITN, UK. Summary In the debates about finding a new balance between child protectionand family support, there has been silence on the issue of theimpact of gender on child protection work. Using data from oneof the studies in the Department of Health (1995) child protectionresearch programme, this article examines the impact of genderat each stage of the child protection process. It shows thatmothers have tended to be under-represented in relation to offersof service and over-included in respect of agencies' effortsto control them. When social work practice in cases of physicalabuse by men focuses exclusively on mothers, this allows men'sviolence to their female partners to be ignored. This practicehas been sustained in recent years, even though the child protectionsystem itself developed in response to public anxiety aboutchild deaths caused by men.     

Informal Care in Asian and Afro/Caribbean Communities: A Literature Review

Correspondence to Karl Atkin, Social Policy Research Unit, University of York, Heslington, York YO1 5DD. Summary The multi-racial nature of British society can no longer beignored by those responsible for planning and implementing socialcare policy, particularly since community care is presentlyat a crossroads. Informal care provides a useful starting pointfrom which to introduce the notion of race into social caredebates. The paper, by reviewing a mix of empirical studiesand policy debates emerging from the literature on informalcare and black communities, examines the experience of informalcare within black communities. By discussing topics such asthe demography of care, the nature of informal care, and serviceprovision to black carers, it gives coherence to a fragmentedliterature and illustrates gaps in present understanding.     

Two Value Positions in Recent Child Care Law and Practice

Summary This paper aims to explore two contrasting viewpoints on stateand agency intervention in child care, and the major pointsof divergence and similarity between these viewpoints. Materialis drawn from literature and from interviews conducted by theauthor with individuals prominent in the child care field.¹Simply put, one viewpoint emphasizes the prevention of the break-upof ‘natural’ or biological families and the restorationof biological ties where severed, while the other advocatesthe readier removal of children from natural families and theprovision of permanent, secure substitute families when naturalparenting is unsatisfactory. At attempt is made to place thesetwo positions in a wider intellectual context.     

The 'New Careers' Experiment in Rehabilitating Offenders: Last Messages from a Fading Star

Correspondence to Brian Caddick, Department of Social Work, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary This paper traces the history, and assesses the impact, of aninnovatory project in which current and ex-offenders were providedwith the opportunity to gain practical social work experienceand training for long-term rehabilitative purposes. Based onearlier American schemes in which members of disadvantaged ordiscriminated against groups received training and support fornon-professional careers in human services agencies, the projectcan claim a measure of success. But the evidence also suggeststhat a demonstrated potential for individual change is not alwaysmatched by agency interests and ideologies. The findings areconsidered in relation to the philosophy and provisions associatedwith the 1991 Criminal Justice Act.