The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

Work Activation Regimes and Well‐being of Unemployed People: Rhetoric,Risk and Reality of Quasi‐Marketization in the UK Work Programme

Well‐being and employment activation have become central and intertwined policy priorities across advanced economies, with the mandation of unemployed claimants towards employability interventions (e.g. curriculum vitae preparation and interview skills). Compelled job search and job transitions are in part justified by the well‐being gains that resulting employment is said to deliver. However, this dominant focus within the activation field on outcome well‐being – the well‐being improvement triggered by a transition to paid work – neglects how participation in activation schemes can itself affect well‐being levels for unemployed people – what we term ‘process well‐being’ effects. Combining theoretical literature with empirical work on the UK's large‐scale quasi‐marketized Work Programme activation scheme, we develop the limited existing academic discussion of process well‐being effects, considering whether and how activation participation mediates the negative well‐being effects of unemployment, irrespective of any employment outcomes. We further relate variation in such process well‐being effects to the literature on activation typologies, in which ‘thinner’ work‐first activation interventions are linked to weaker process well‐being effects for participants compared to ‘thicker’ human capital development interventions. Confirming these expectations, our empirical work shows that Work Programme participants have, to date, experienced a largely ‘thin’ activation regime in which participants are both expected to, and empirically demonstrate, similar if not lower levels of process well‐being than those who are openly unemployed. These concerning findings speak to all nations seeking to promote the well‐being of unemployed people and particularly those perusing ‘black box’ activation schemes based around quasi‐marketization, devolution and New Public Management.     

Advocacy for disabled children and young people: benefits and dilemmas

Recent policy has emphasized the need for advocacy services for children and young people, developments that have gone hand‐in‐hand with greater levels of participation of young people in decision‐making. Advocacy for disabled young people is especially important, as they are a particular vulnerable group and have, traditionally, been even more excluded from decisions about matters affecting their lives. This paper reports the findings, as they relate to disabled young people, from a study that investigated the role of advocacy for looked‐after children and children in need. The paper highlights some of the benefits of advocacy for disabled children, the dilemmas facing advocates between advocating and acting in someone's ‘best interests’, identifying the client and the boundaries between advocacy and social work. It argues that time given to establish a close relationship with a disabled child or young person is crucial if advocacy is to be effective and participation in decisions affecting their lives a reality.     

Towards Understanding Variations in Social Care for Older People in England

Indicators of the public provision of old age social care are routinely recorded in England and have been used for diverse purposes including performance monitoring. Despite long‐term policy guidance promoting more homogeneous service provision, large variations can still be observed between local authorities (the providers of state‐funded social care). Our aim is to better understand such variations in a small selection of key aggregate indicators. Drawing on multiple data sources and pursuing a two‐step strategy, we first assess the explanatory power of a set of structural predictors and then add to the models a set of specific care management ‘process’ predictors. We find that structural factors beyond the control of local authorities explain a considerable share of the observable variation. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when aggregate indicators of service provision are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. Past attempts to influence the aggregate pattern of service provision – apparently seeking greater ‘territorial justice’– are likely to have had adverse implications for service users and the uniformity of service delivery across England. Questions are raised about the adequate role of central government in a policy environment characterized by longstanding local government responsibility.     

Understanding the Downshifting Phenomenon: A Case of South East Queensland,Australia

A quality of life survey of a sample of households across the Brisbane‐South East Queensland region has identified about 28 percent of people as ‘downshifters.‘ They are defined as people who voluntarily make a long‐term change in their lifestyle – other than planned retirement – which reduces income and adjusts their lifestyle conditions. A typology of downshifters is developed on the basis of their motives for downshifting and their socio‐economic and demographic characteristics using a Two Step Cluster Analysis. Results indicate that the social and economic circumstances and the reasons and methods of downshifting tend to vary substantially across the clusters.     

Are Quasi‐markets in Education what the British Public Wants?

In the context of inconclusive evidence on the extrinsic successes of quasi‐markets, policy defences of school choice and competition in education have often discussed the intrinsic, empowering value of choice for consumers, arguing that school choice for parents is ‘what people want’. Discourses often imply that choice is desired for its own sake rather than merely as a means by which families can escape what are deemed to be poor quality schools. Support for an idealistic, abstract notion of ‘choice’ is also taken to imply support for quasi‐markets overall and is not considered alongside possible competing values that people may hold at the same time as they value choice. Additionally, views of parents are often examined without considering possible differences in views between parents and non‐parents. Contributing to debates about how far a public desire exists for quasi‐markets in education, this article draws on data from newly designed questions fielded as part of the 2010 British Social Attitudes survey. The article finds that while choice ‘in the abstract’ is supported widely by both parents and non‐parents (albeit slightly more so by parents), a valuing of choice among the British public appears to be more instrumental than intrinsic – potentially problematic given evidence on the extrinsic benefits of quasi‐markets is mixed. Support for choice is tempered among parents and non‐parents by clear opposition to vouchers, school diversity, government spending on transport costs to facilitate choice and by strong support for the idea of sending children to the ‘nearest state school’.     

Is Personalization the Right Plan at the Wrong Time? Re‐thinking Cash‐for‐Care in an Age of Austerity

As personalization has dominated the policy agenda for reform in social care, its roll‐out as a mainstream option has coincided with global programmes of austerity which have targeted services for disabled people. Was this simply bad timing or was its implementation always part of the agenda for reform? Whilst the principle of cash‐for‐care schemes drew strongly on promoting the independence and autonomy of disabled people, early incarnations of direct payments policy in the UK were initially at least in part rolled out in light of potential cost savings to social care budgets. This article explores these and other issues in light of evaluations of the Scottish government's self‐directed support (SDS) test sites (2009–11) and implementation of subsequent legislation enforcing models of SDS in Scotland from April 2014. Discussion draws on the authors’ recent book (Pearson et al. 2014) to reflect on what the evidence can tell us about radically transforming social care at a time of global austerity.     

Person‐centredness in the community care of older people: A literature‐based concept synthesis

‘Person‐centredness’ is a ubiquitous term, employed in modern care services to signify policies and practices that attend to the uniqueness of each individual user. Despite being highly regarded in older adult community care services, there is much ambiguity over its precise meaning. Existing reviews of person‐centredness and its attributes have tended to focus on the medico‐nursing literature, neglecting other interpretations, such as those relevant to community social care. A new literature‐based concept synthesis reported here identified 12 common attributes within the broad themes of ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’. The review also contrasts how these attributes are applied across different interpretations of person‐centredness. The article argues that not all attributes necessarily pull in the same direction, and that older adults may require them to be delivered in different ways than they are to younger people. Thus, a ‘one‐size‐fits‐all’ approach should be discouraged in community care. Key Practitioner Message: ? ‘Person‐centredness’ is open to multiple interpretations, causing difficulties for services trying to gauge performance and quality; ? Three themes are central to person‐centred services: ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’; ? A ‘one‐size‐fits‐all’ approach to applying person‐centredness is to be discouraged.     

Social investment,social service and the economic performance of welfare states

This article begins with an examination of the role of social services as the key instrument of social investment strategy, presenting an empirical analysis of its impact on economic performance. A pooled time series, cross‐section analysis was conducted with the data of 15 welfare states from 1990 to 2007 under the ‘social investment hypothesis’ that more social service orientedness brings about a greater positive effect on the economy. The results show that a larger share of social service spending in the total social expenditure – more social service orientedness – contributes to economic growth and labour market performance, whereas a larger aggregate size of the welfare state may have a negative effect on employment. In conclusion, this study suggests that the relatively ambiguous welfare strategy of social investment could be clarified as a ‘transition from income security to livelihood security’ in which emphasis is placed on social service. Key Practitioner Message: ● This study suggests that the key instrument of social investment strategy is social service; ● The results show that more social service orientedness contributes to economic growth and labour market performance.     

Sen and Aristotle on Wellbeing

A significant body of research and analysis concerning wellbeing has emerged across a number of social research disciplines, yet the concept of wellbeing does not admit of any unified meaning. Philosophical accounts of wellbeing are traditionally divided into three categories: hedonistic, desire‐satisfaction and objective list theories, reflecting longstanding doctrinal divisions in normative ethics. Rejecting the foundational monism associated with these approaches, Amartya Sen has proposed a pluralist ‘capabilities’ approach to personal wellbeing based on freedom of choice and the Aristotelian notion of a ‘function’. Recent Australian wellbeing research also shows promising signs of moving beyond reductive income‐based metrics towards plural indicators of poverty and social disadvantage. This paper reprises Aristotle's distinctive account of perfect wellbeing (eudaimonia) in the Nicomachean Ethics and investigates Sen's approach in its light, suggesting that future Australian research in the spirit of Sen's pluralism may benefit from Aristotelian insights into the ‘thickness’ of freedom implicated in personal wellbeing.     

The 'Dole or Drudgery' Dilemma: Education, the Work Ethic and Unemployment

Before the recession, Labour ministers claimed that much unemployment in the UK was voluntary. While social policy authors have repeatedly countered such claims by stressing that unemployed people generally possess a strong work ethic and employment commitment, their accounts typically neglect the role that choosiness in job search behaviour plays in deciding individuals' employment status. Fifty in‐depth interviews with both unemployed and employed respondents exposed considerable diversity in attitudes towards ‘dole’ (being unemployed and claiming unemployment benefits) and ‘drudgery’ (doing less attractive jobs). The more educated were more likely to prefer ‘dole’ to ‘drudgery’ (this was also found using National Child Development Study survey data), yet they usually found jobs despite their greater choosiness. Those with very low educational attainment often desperately wanted jobs but could not find them due to their low employability – which might offer an explanation for the often replicated (yet paradoxical) finding that unemployed people generally exhibit a strong work ethic and pro‐employment attitudes and behaviours. Furthermore, the findings indicate that the scope for many Jobseeker's Allowance claimants to increase their net income by undertaking an unattractive job is greater than social policy authors often imply. The question of ‘who must do the least attractive jobs?’ has been neglected by both social policy academics and policy‐makers.     

‘More time for what?’ Exploring intersecting notions of gender,work, age and leisure time among people with cognitive disabilities

This article explores intersecting notions of leisure among middle‐aged people with intellectual disabilities in the setting of the Swedish welfare state. The participants are recipients of long‐term disability services and have experienced the changing ideological frameworks of the welfare effort, which has recently focused on normalisation, inclusion and participation. Structured activities are arranged by disability services in order to normalise living conditions and provide recreation for disabled people. However, the range of activities is constrained by financial resources, by notions of gender and age and by an institutionalised emphasis on the work ethic – leading to constructions of leisure partly as ‘time beside’ where ‘free time’ activities should not interfere with the duties of the working week. The participants' limited resources and their lack of a strong voice limit their ability to demand their legal rights and leave many of them with ‘too much time with too little to do’. Key Practitioner Message: ● A common idea of leisure is the relationship between social and physical activities, well‐being and health; ● People with disabilities, regardless of age, engage in fewer leisure activities than the general population due to a lack of resources; ● Even with legal rights, the lack of a strong voice as well as institutional constraints limit their leisure opportunities.     

Integrating the teaching,learning and assessment of communication with children within the qualifying social work curriculum

Qualifying social work education must provide students with a variety of experiential, personalized, participatory, didactic and critically reflective learning opportunities across both the taught curriculum and in practice placements if deep learning of the capabilities needed for effective communication with children and young people is to be ensured. At present, programmes in England are not consistent in the curriculum structures, content and pedagogical approaches they are employing to teach and assess this topic. This paper discusses first how current proposals for the reform of qualifying education in England do not address the ambiguities and discretion in regulatory guidance, which have meant that the place and relevance of this topic within the curriculum remain uncertain and contested. It then draws on a model of the sequencing of students' learning and development in qualifying training, developed through the author's recent empirical research, to present an integrated and coherent approach to the teaching, learning and assessment of this topic. It is proposed that this strategy will enable students to develop the generic, ‘child‐focused’ and ‘applied child‐specialist’ capabilities they need for the ‘knowing’, ‘being’ and ‘doing’ of effective communication with children.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Beyond Symptoms: Crime Prevention And Community Development

Crime and crime prevention are currently ‘hot’ political and social issues. Fuelled by public calls for ‘solutions’, the responses by politicians and planners are typically ‘quick‐fix’ with emphasis on management of particular problems as, and where, they arise. We argue for longer term strategies aimed at dealing with the political, social, economic and cultural factors associated with crime. In doing so, we explore the potential of community development to contribute to crime prevention, particularly ‘community’ or ‘street’ crime and violence. Theoretical and practice intersections between community development and certain crime prevention approaches are identified – notably those which link crime and violence with dis‐empowerment, poverty, inequality, exclusion, the learning of violence within families and communities, and lack of opportunity for children and young people to develop their potential. We conclude that there is plenty of evidence to support the view that community development processes should be used more frequently in crime prevention programmes.     

A Comparative Discussion of the Gendered Implications of Cash-for-Care Schemes: Markets, Independence and Social Citizenship in Crisis?

There are moves across many countries away from state-led provision of services for disabled people towards cash-based systems, which have been welcomed by disabled people as increasing choice and control over services and support, and increasing independence and social participation. However, feminist scholars have long warned about the implications of commodifying care for women, and the possible consequences of substituting cash for services for social citizenship have remained underexplored, for both disabled people generally, disabled women and mothers more particularly, and for personal assistants/care workers. This article will attempt to address that gap by carrying out a comparative literature review and policy analysis of the role of policy development and outcomes in cash-for-care schemes, looking comparatively across policy developments in several countries, as well as developed welfare states beyond Europe to examine: (a) the impact of the tensions between various governance levels, particularly local and national government; (b) the gendered impact of such policies on (for example) gendered divisions of paid and unpaid work, citizenship and social participation; (c) the impact such policies have, or are likely to have, on different groups of men and women across the life course and across different social and economic groups; and (d) how such policies can contribute to the well-being and/or detriment of different groups of women (and men) within different social, political, economic and historical contexts.     

Networked lives

Social network analysis has grown tremendously across a wide range of disciplines and is now regarded as a road‐map in strengthening links with the life‐course perspective. ‘Linked lives’ is often cited as a key principle of life‐course theory, but there is still much to be learned about the significance of these links for the life course. Network theory refines our understanding of the properties of these links, their emergence as structures in daily life, and the mechanisms underlying the inequalities that arise from social relationships. This paper clarifies why networks can be conceptualised as meso‐level structures that bridge the micro‐macro gap. It thus addresses four processes of particular interest for the integration of life‐course and network research: (a) the problem of tie formation; (b) the activation of ties as social capital; (c) their resilience through segments of a life course; and finally, (d) the problem of their loss. In so doing, we highlight innovative approaches for each of these issues in order to propose a research agenda we call ‘Networked Lives’, which emphasises promising avenues for advancing the integration of these two important fields in the social sciences.     

Externalizing an ‘Asset Model’ of Activation: Creative Institutional Work by Frontline Workers in the Norwegian Labour and Welfare Service

The past two decades have brought significant shifts in Norwegian activation policy towards a joined‐up and employability‐enhancing approach to labour market inclusion in order to promote return‐to‐work despite health problems or disabilities. Utilizing a concept from health promotion, we term this approach an ‘asset model’ of activation. The Norwegian Labour and Welfare Service (NAV) and its local offices are the main agents implementing the new policy. This article aims to investigate the strategies that the frontline workers of NAV engage in, in order to externalize an ‘asset model’ in the adjacent medical field and to the general practitioners (GPs) in particular. We analyze these strategies as forms of creative institutional work – the purposive actions undertaken to change existing presumptions and opinions among relevant actors. We argue that although the new activation policy is not theirs to develop, in order to bring about changes in practice, ‘creating’ institutional work by the frontline workers is required. Our findings show that the frontline workers develop strategies in order to externalize an asset model to the GPs, as part of operationalizing an ‘activation’ reform into practice. We identify four forms of ‘creating’ institutional work undertaken by the frontline workers: ‘defining’ – enacting legislation and regulation in relation to GPs; ‘constructing normative networks’ – creating a more collaborative relationship with the GPs; ‘educating’ – teaching the GPs about the rules and regulations, and the opportunities and assistive measures they can offer to the injured; and thereby also ‘changing normative associations’ of GPs towards the activation policy.     

Social ontology,practical reasonableness,and collective reasons for action

I argue that the ontology of human social institutions and collective intentionality could be anchored in the normative notion of ‘practical reasonableness’ as collective reason for action. This involves the deontic idea of mutuality, accepted rules, and shared attitudes of other‐regardedness. I examine John Searle's three primitive notions of social ontology: collective intentionality, assignment of social functions, and constitutive rules and procedures. I use these notions to provide a plausible basis for understanding how people reason, in order to arrive at practically reasonable decisions and collective agency. Searle argues that social reality, institutions, processes, and facts are grounded in collective intentionality and the acceptance of social rules, procedures, and functions. I argue that collective intentionality and socially accepted rules are anchored in the need for human interdependence that engenders the social rules and norms or attitudes of ‘practical reasonableness’. I analyze the concept of ‘practical reasonableness’ as a representation of human mode of reasoning that involves collective intentionality.     

Increasing Choice and Control for Older and Disabled People: A Critical Review of New Developments in England

This paper critically examines new policies currently being implemented in England aimed at increasing the choice and control that disabled and older people can exercise over the social care support and services they receive. The development of these policies, and their elaboration in three policy documents published during 2005, are summarized. The paper then discusses two issues underpinning these proposals: the role of quasi‐markets within publicly funded social care services; and the political and policy discourses of consumerism and choice within the welfare state. Despite powerful critiques of welfare consumerism, the paper argues that there are nevertheless very important reasons for taking choice seriously when considering how best to organize and deliver support and other services for disabled and older people. A policy discourse on consumerism, however, combined with the use of market mechanisms for implementing this, may be highly problematic as the means of creating opportunities for increased choice and, on its own, risks introducing new forms of disadvantage and social exclusion.