The Prevention of AIDS Among Injecting Drug Users

Correspondence to Dr Beth Crisp, School of Social Inquiry, Deakin University, Geelong, Victoria, Australia 3217 Summary There is great potential for the spread of HIV amongst injectingdrug users (IDUs) if they engage in unsafe injecting and sexualpractices. This paper identifies a range of obstacles to safebehaviour, including availability of sterile injecting equipment,legal/policy factors, social norms and personal factors suchas ignorance, beliefs, intoxication and craving. Two alternativepolicy options—harm reduction and use reduction—arediscussed along with specific strategies for ameliorating risk.Strategies include drug treatment, provision of sterile injectingequipment, bleach, promoting alternate methods of drug administration,HIV testing and counselling and peer endorsement of safe behaviour.The paper concludes by considering the implications of thesepolicy and programme options at the level of service delivery.     

Sleepwalking through an Epidemic--Why Social Work should Wake up to the Threat of Hepatitis C

Correspondence to Dr Ian Paylor, Department of Applied Social Science, Cartmel College, Lancaster University LA1 3HY, UK. E-mail: i.paylor1{at}lancaster.ac.uk Summary One of the many consequences of injecting drug use is the potentialrisk to infectious blood-borne viruses. There is evidence thatthe risk of contracting Hepatitis C (HCV) is greater than thatof HIV. Despite repeated warnings from a variety of sourcesand thousands of new infections among drug users each year andrising incidents of ‘'crack’ injecting, successivegovernments have failed to address a public health emergencyof immense proportions - the HCV epidemic. This article exploresthis issue and the implications it has for social work.     

User-Practitioner Transactions in the New Culture of Community Care

Correspondence to Nicky Stanley, Lecturer in Social Work, University of Hull, Hull HU6 7RX, UK. Summary This article describes the findings of a research project whichexamined the views and practice of social workers undertakingassessments in one local authority following the implementationof the NHS and Community Care Act 1990. While the assessorsexpressed dissatisfaction with some aspects of the new systemof care management, overall they appeared to be taking the newculture on board. Managers were consistently more enthusiasticthan practitioners. Both groups saw needs-led assessment, userchoice and keeping users in their own homes as central objectivesof care management. The shadowing of ten community care assessmentsallowed the degree to which these objectives were realized inpractice to be explored. Users' experience of the new culturewas also studied. The user-practitioner transactions observedsuggest that those users who were able to articulate their ownneeds forcefully were most likely to be able to exercise choice.It is argued that the new culture of community care embodies‘consumer choice’ rather than ‘user choice’.     

Perceptions of Stigma and User Involvement in Child Welfare Services

Correspondence to Dr E. M. Scholte, Department of Social and Behavioural Sciences/Centre for Research on Youth Welfare, University of Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands. Summary This paper explores the perceptions of social disqualificationor ‘stigma’ that service users attributed to publicchild welfare services in random samples of service users takenfrom the Netherlands, a part of Spain (Catalonia) and a partof the United Kingdom (Wales). It was found that, in all threesamples, foster and residential care invoked the greatest senseof stigma, while the health related and the preventive familyservices were perceived as the least stigmatizing types of publicwelfare services. Comparative analysis further revealed thata positive attitude towards the use of public welfare services,a perception of supportive or non-stigmatizing social normsregarding the use of such services, and a perception of publicwelfare services as helpful correlated in all three sampleswith higher levels of user satisfaction and involvement in theservices. It was further found that, in the British and Spanishsamples, a positive attitude towards public welfare services,as well as a perception of public welfare services as helpfulfor their recipients, were the predominating factors promotinghigher levels of satisfactory user involvement in the services,while, in the Dutch sample, a perception of supportive socialnorms was the factor that most promoted satisfactory user involvement.     

Intermediate Treatment and Adolescents' Perceptions of Social Workers

Summary This paper reports an exploratory study of perceptions of socialworkers. Information was obtained from adolescents involvedin intermediate treatment activity groups, their parents, andtheir caseworkers. The respondents were asked to complete acard-sort of adjectives which might describe the social workers.The results suggest that adolescents may have much more positiveperceptions of their social workers than either the parentsor social workers anticipated. Parents were also found to havepositive perceptions of their social workers, especially iftheir social worker also attended the activity groups with theiradolescent. Some of the variables which were seen to have influencedthe perceptions of the social workers are discussed.     

The Impact of New Labour Health Policy on Social Services: A New Deal for Service Users' Health?

Summary The health policies of the Labour Government of 1997–2001included an increased emphasis on social services departments'(SSDs) contribution to promoting health. Three dimensions ofthis policy shift are discussed: first, the drive towards organisationalfusion between elements of the NHS and SSDs; second, the newmechanisms for conjoint funding of health and social services;and, finally, the new policy focus on tackling health inequalitiesby combating social inequalities on a national and localitybasis. In each case, the touchstone of our analysis is the consequencesfor the health and well-being of SSD service users as membersof socially disadvantaged groups. We conclude that New Labourhas taken some steps, particularly reducing child poverty, whichwill have long lasting health and social benefits for actualand potential service users. However, inadequate funding ofSSDs undermines their effectiveness as a partner in integratedhealth and social care. As signalled by service user initiatives,SSDs potential for promoting more equal chances of health andwell-being in ill-health will also not be realised without substantialchanges to current SSD policy and practice.     

Speaking in Tongues: Involving Users in Day Care Services

Correspondence to Dr Karen Ross, Centre for Policy and Health Research Cheltenham and Gloucester College of Higher Education, The Park Campus, The Park, P.O. Box 220, Cheltenham, Glos. GL50 2QF. Summary The new focus on the importance of user involvement within arange of public services, as witnessed by legislation and policysuch as the NHS and Community Care Act (1990) and the Citizen'sand other Charters, has significant implicaions for the wayin which users will be encouraged to have a voice in serviceplanning and delivery. A crucial factor in the success of participativestrategies is training for both users and workers, to enableinvolvement and participation to be something more than token.This paper is based on a study which set out to explore thereality behind the rhetoric of user involvement in day careservices. It found that the most significant factor in determiningthe extent of user involvement in day centres was the organizationalculture of individual establishents. Empowering strategies weremore likely to exist in those centres where staff felt valuedand where senior officers were committed to the principle ofpower-sharing and partnership between users and workers: trainingwas rarely provided for users and workers as a matter of routine.A number of suggestions are made as to ways forward, in thelight of research findings.     

Ambiguity and User Involvement: Issues Arising in Assessments for Young People and their Carers

Correspondence to Peter R. Day CRSP, Department of Social Sciences, Loughborough University of Technology, Loughborough, Leicestershire LE 11 3TU. Summary Issues for service users and professional staff arising fromcontemporary community care policies emphasizing user involvementare reviewed. Against the background of a key expression ofthese policies, the Disabled Persons' Act of 1986, methods ofproviding assessments involving young people with learning disabilitieswere analysed. Problems identified for further study includeddifficulties arising for young people due to lack of experienceand immaturity, the low expectations of their parents or carers,problems arising from the culture of services and how assessmentsmay be developed which provide seriously disabled users themselveswith ways of expressing their wants and needs.     

Service users' knowledges and social work theory: conflict or collaboration?

Summary So far, service users have not been systematically involvedin social work theorizing. However, disabled peoples's movements,mental health service users/survivors and other service usershave developed their own knowledges based on direct experienceand they have generated their own conceptual frameworks andbodies of theory. There are fundamental problems in social workseeking to interpret service user knowledges. Their developmentsand interpretation require the direct involvement of serviceusers and their organization in social work theorizing. Thereare strong practical, philosophical and political argumentsfor involving the knowledges and theories of service users andtheir organizations in the process of social work theory-building.This paper considers an inclusive approach to social work theorizing.While highlighting the importance of service users and theirorganizations being effectively included in social work theorizing,it also argues the need for them to have support and opportunitiesto develop their own prior and separate discussions about theory,including social work theory.     

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.     

User Involvement in Services--Incorporation or Challenge?

Correspondence to Joan Forbes at The School of Social Work, The University of Leicester, 107 Princess Road East, Leicester, LE1 7LA Summary In recent years, users of social work, like those of psychiatry,have been increasingly drawn into the organization and deliveryof social work and mental health services. This has been largelywelcomed as a desirable development by planners, academics andpractitioners in the field. In this article, we reappraise thebroad issues raised by user involvement and consider the implicationsof this trend. Despite the attractiveness of the user perspectivein the policy and delivery of social work and psychiatric services,we point to the dangers of incorporation and moderation of anoppositional position, from which, we argue, users can bestchallenge existing practices and connect with wider politicalstruggles.     

Commonality and Diversity in Feminist Social Work

Correspondence to Vicky White, Department of Applied Social Studies, University of Warwick, Coventry CV4 7AL. Summary The relationship between feminist social workers and women serviceusers is a central concern in the feminist social work literature.The literature's discussion of feminist social worker/womanservice user relationships, along the dimensions of commonalityand diversity, is compared with the experiences and understandingsof feminist social workers who participated in a small-scalequalitative study. Two main themes are considered: first, commonalityin feminist social worker/woman service user relationships;secondly, diversity amongst women service users. Issues forfuture work are drawn out of the discussion of these themes:the problematic nature of feminist social worker/woman serviceuser commonality; the impact of social divisions other thangender on women service users' lives; the importance of unpackinggeneralizations about both women service users and feministsocial workers; the need to explore the intersections of thestatutory context and feminist social work identities. It isargued that in addressing these issues future work would beenriched if greater prominence were given to feminist practitioners'perspectives, experiences and understandings.     

Gender and Illicit Drug Use

Correspondence to Dr Joanne Neale, Department of Social Policy and Social Work, University of York, Heslington, York Y010 5DD, UK. E-mail: jsn3{at}york.ac.uk Summary There has been no recent large-scale systematic UK investigationof differences between male and female drug users seeking treatment.Equally, there has been no debate within the social work fieldregarding how best to address any gender-specific needs of drug-usingclients. This is despite the fact that social workers frequentlywork with both drug-dependent individuals and members of theirfamilies. This paper examines differences between men and womenbeginning a new episode of drug treatment in Scotland and considerssome of the implications of the findings for social work practice.Data were collected from structured interviews conducted with1,033 individuals (715 males and 318 females) in a range oftreatment settings. Chi-square statistics were computed to investigatesex differences on key categorical variables relating to: (i)patterns of drug use; (ii) education, employment and income;(iii) offending behaviour; (iv) housing circumstances; (v) healthstatus; and (vi) personal relationships. Analyses identifiedmany differences between the men and women interviewed, butalso many common difficulties faced by respondents of both sexes.Additionally, the extensive range of problems and stressfullife circumstances encountered suggested that the lives of individualsseeking drug treatment were extremely heterogeneous. It is concludedthat social workers can employ a range of practical interventionsand theoretical approaches when working with both male and femaledrug-using clients.     

Returning to Normality: Substance Users' Work Histories and Perceptions of Work During and After Recovery

Correspondence to Andreas Cebulla, National Centre for Social Research, 35 Northampton Square, London EC1V 0AX, UK. E-mail: a.cebulla{at}natcen.ac.uk Summary New service provisions designed to improve the employment prospectsof former substance users will enhance the roles and responsibilitiesof Drug Action Teams (DATs), Jobcentre Plus offices and otherproviders and co-ordinators of support services for substanceusers. This paper discusses the findings of a study of 30 currentand former drug and alcohol users, exploring past substanceuse histories and current employment aspirations. The researchinforms new policy initiatives designed to assist substanceusers’ entry or return to work. Differences in presentperceptions of work-readiness were observed, which reflectedusers’ perceptions of the nature of their addiction. Theattribution of blame for the substance dependency to either‘the drug’ or the individual’s psychologywas a critical influence on users’ work-readiness assessments.Work was perceived to benefit recovery from substance dependency.The evidence suggests that substance users’ return towork might be helped by their staged (re-) introduction to thelabour market as well as encouraging the primary labour marketto employ (more) recovering substance users. The research highlightedthe need for joint working between employment services and DATsto help substance users into work and to support their recovery.It also highlighted the need for mutual understanding and recognitionof each collaborator’s expertise.     

Social Workers' Experience of Distress--Moving Towards Change?

Correspondence to Martin Smith (Emergency Duty Team), The Katharine Knapp House, Stretton Close, Tylers Green, High Wycombe Bucks, HP10 8EW, UK. Summary Recognizing the current concern relating to social workers facingdistressing experiences, a qualitative research investigationwas undertaken which asked workers of grade 3 or above withina social services department to recall one distressing experienceencountered in their working life. Each was asked to describethe experience and recount the immediate and longer term impactsof the experience. They were then asked to evaluate what hadbeen helpful and unhelpful in their attempts to deal with, andprocess, the experience. Finally, they were asked what organizationalstructures they thought should be in place to help workers affectedby distressing experiences. Both qualitative and quantitative evidence is presented. Anunexpected repercussion of the study was that the interviewerwas asked to share the findings with his employer's DivisionalManagement Team who expressed interest in making appropriateprovision for staff care.     

Keyworkers Re-examined: Good practice, quality of care and empowerment in residential care of older people

Correspondence to Rosemary Bland, Department of Applied Social Science, University of Stirling, Stirling FK9 4LA, Scotland Summary Social work definitions of ‘good practice’ in residentialcare which were originally developed in work with children andyoung people have also been applied to residential settingsfor other user groups, including older people. However, anylink between such elements of practice and positive outcomesfor users has not always been demonstrated. The introductionof market principles and orientations into social welfare inthe 1980s re-defined the social work ‘client’ asa ‘consumer’ with the associated power to make choicesin the area of social care. The success with which such an approachcan be applied to services for people who are very often, notin a position to exercise much choice, is debatable. Alongsidethe notion of the ‘consumer’ or ‘user’of services has grown the ideology of ‘empowerment’of people who use social work services. Drawing on findingsfrom a recent study, this article explores the contributionof the keyworker role to good practice and the empowerment ofolder people living in residential homes. It concludes that,because their understanding of the concept and practice is largelyundeveloped, the role as currently interpreted is not consonantwith good practice and tends rather to reinforce the power ofstaff.     

Applying a community needs profiling approach to tackling service user poverty

Summary Poverty across the United Kingdom is a growing phenomenon. Itsimpact on the users of social work services is well documented.This paper puts forward the argument that poverty is a legitimatepart of the social work agenda rather than being seen as a complexproblem which is somehow outside the scope of social work agenciesand best left to politicians and policy makers. Social workpractitioners and managers must not only begin to accept andacknowledge that poverty is a social work issue but also tobegin confronting this challenge in a changing society whereexclusion, social inequality, racism and oppression deny peopletheir citizenship. The community needs profiling approach is proposed as a usefultool in addressing service user poverty whereby practitionersand their agencies can become more aware of the needs of usersand the communities in which they live. It is argued that, armedwith this knowledge, social workers have the potential to becomepart of the solution rather than remaining on the margins ofthe lives of poor people. Using evidence and ideas drawn froma range of community needs profiling research studies and texts,the author offers working suggestions for applying the approach.     

What do service users think of evaluation? Evidence from family support

Programme evaluators increasingly strive to capture how service users experience child and family welfare programmes. Yet user involvement is rare in a more routine form of evaluation: performance measurement. This paper considers how service users' perspectives can help improve the performance indicators that inform child and family service funding, management and planning. Qualitative research, conducted in family support contexts in New South Wales, Australia, identifies five user‐defined domains upon which indicators can be based. As well as showing how parents judge service quality and outcomes, the findings also show how they experience data collection, and how they prefer to participate in the routine performance measurement and monitoring that informs child and family welfare provision.     

Towards the Use and Development of Games for Social Work Practice

Summary This paper reviews games that may be of use to social workersin their work with individuals, couples, families and groups.A typology of games is presented, which categorizes games accordingto their structure and their function. Games are seen as eitherunstructured or structured, and as stressing either cognitiveor behavioural goals. Selected games are presented in more detailas examples and others are presented in brief in an annotatedbibliography. Issues relating to designing games are discussedas well as issues in applying games to social work practice.