Man-made Care: Community Care and Older Male Carers

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

Social Work: Gender, Care and Justice

Correspondence to: Joan Orme, Department of Social Policy and Social Work, Lilybank House, Bute Gardens, University of Glasgow, Glasgow G12 8RT, UK. Summary This article, in examining gender and justice, seeks to examinethe relationship between feminist theory and social work. Specificallyit reviews writings on social work ethics and suggests thatlittle attention has been paid to feminist scholarship thatresonates with social work practice. Focusing primarily on communitycare, it demonstrates how debates within feminism have becomemore complex and have problematized understandings of both careand justice. It argues that for social work it is unhelpfulto dichotomize justice and care; we should aspire to just socialwork practice.     

Defending Community Care: Can Normalization do the Job?

Correspondence to Helen Smith, Lecturer in Mental Health, Centre for the Applied Psychology of Social Care, The University, Canterbury, Kent CT2 7LZ. Summary One of the major reasons for the confusion around communitycare is the lack of an ideology to guide and influence its implementation.Normalization is probably the most relevant theory in this fieldyet it is riven with contradictions and conflicts. This articleexamines these conflicts and proposes that normalization needsto develop a perspective on power and powerlessness if it isto respond adequately to the challenges of providing communitycare in the 1990s.     

'A Pair of Stout Shoes and an Umbrella': The Role of the Mental Welfare Officer in Delivering Community Care in East Anglia: 1946-1970

via e-mail: sherolph{at}hotmail.com Summary In this paper we describe an oral history research project whichexplored a little-known aspect of the history of social work:the history of mental welfare officers and their role in communitycare. We interviewed former MWOs and analysed both private andpublic documents to explore this history in East Anglia between1946 and 1970. In the paper we address three themes. In thefirst place, we argue that MWOs, as well as carrying out theirstatutory function in overseeing hospital admissions, had asignificant role in community care for people with learningdifficulties and psychiatric problems. They began to advocateon behalf of clients, often making a case for home support andthey supported parents' groups. Increasingly, they carried outcase-work and painstaking social work with families. In thesecond place, we explore the surprising finding that, amongMWOs, genericism was not as new a concept in 1970 as many writershave assumed. Finally, we analyse some gender issues that emergedfrom the research and the way they influenced attitudes to communitycare held by some MWOs. The paper looks at the gradual developmentof a profession from one with little consistent training, toone in which specialist education began to be seen as an importantaspect of the role of the MWO.     

Community Care for the Elderly -- Rhetoric and Reality

Correspondence to A.C. Bebbington, Assistant Director, Personal Social Services Research Unit, Cornwallis Building, The University, Canterbury, Kent CT2 7NF. Summary This paper investigates the management and delivery of carefor 176 elderly people receiving both community health and socialservices. These people represent a crucial group if the communitycare policy is to become a reality, and they receive high serviceslevels. The study provides both quantitative and qualitativeevidence of inadequate case management and lack of co-ordinationin providing care. Assessment, determining services, and reviewwere all inefficiently managed. Liaison was non-existent forthe majority, and opportunities for substitution were missed.There could be conflict over role, particularly in relationto personal care. Innovations designed to tackle these problemsremain limited in scale. These difficulties are recognized andaddressed by the 1989 White Paper ‘Caring for People’which makes a number of proposals to clarify responsibilitiesand accountability. The different professional assumptions andwork practices among the plurality of agencies providing carewill need to be resolved if community care is ever to offera realistic alternative to care in institutions for increasingnumbers of people with high levels of dependency.     

Compulsory Persuasion: A Problem for Correctional Social Work

Summary Social work risks being misused as a technique for controllingundesirable behaviour, regardless of clients' expectations orchoices. This approach to social work involves certain underlyingassumptions about human nature which raise considerable ethicaland practical difficulties. Recent trends in the probation andafter care service are considered, together with some researchstudies of the effectiveness of social work in reducing offendingbehaviour. From these it is argued that social work servicesfor offenders are more likely to be effective when the emphasisis on helping with perceived problems and difficulties ratherthan on crime prevention.     

Hidden Gems: Systematically Searching Electronic Databases for Research Publications for Social Work and Social Care

Correspondence to Brian Taylor, Queen's University Belfast, Department of Epidemiology and Public Health, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland. E-mail: b.j.taylor{at}qub.ac.uk Summary Context: Electronic bibliographic databases are an importantsource for professional publications about social work and communitycare more generally. This article describes and evaluates amethod of identifying relevant articles as part of a systematicreview of research evidence. Decision making about institutionaland home care services for older people is used as an example.Method: Four databases (Social Science Citation Index, Medline,CINAHL and Caredata), which abstract publications relevant tohealth and social services, were searched systematically toidentify relevant research studies. The items retrieved wereappraised independently using a standard form developed forthe purpose. The searches were compared in terms of sensitivity,precision, overlap between databases and inter-rater reliability.Results: The search retrieved 525 articles, of which 276 wererelevant. The four databases retrieved 55 per cent, 41 per cent,19 per cent and 1 per cent of the relevant articles respectively,achieving these sensitivities with precision levels of 54 percent, 48 per cent, 84 per cent and 94 per cent. The databasesretrieved 116, 73, 24 and 15 unique relevant articles respectively,showing the need to use a range of databases. Discussion: Ageneral approach to creating a search to retrieve relevant researchhas been developed. The development of an international, indexeddatabase dedicated to literature relevant to social servicesis a priority to enable progress in evidence-based policy andpractice in social work. Editors and researchers should considerusing structured abstracts in order to improve the retrievaland dissemination of research.     

Parenting with Learning Difficulties: Lessons for Practitioners

Correspondence to Dr Tim Booth, Department of Sociological Studies, University of Sheffield, Western Bank, Sheffield S10 2TN. Summary Parents with learning difficulties form an underserved needsgroup whose numbers are steadily increasing and are likely tocontinue to do so as a result of deinstitutionalization, communitycare and the acceptance of ‘ordinary life’ principlesas a basis for service provision. This article reviews the researchliterature on parenting by people with learning difficultiesin order to draw out the lessons for practitioners and to assistthem in developing a clearer view of their aims and approachwhen working with these families. Case vignettes from an ongoingstudy of mothers and fathers with learning difficulties areused to illustrate the common themes. The authors conclude thatservice providers still have much to learn about how best theycan secure and uphold the citizenship rights of these parentsas well as protect the welfare of their children.     

Taking Care of Later Life: A Matter of Justice?

Correspondence to: Julia Johnson, Senior Lecturer, School of Health and Social Welfare, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK. E-mail: j.s.johnson{at}open.ac.uk Summary This paper reviews current policies and practices regardingthe provision of long-term care for older people. In particularit focuses on three aspects which are central to social workand care management: current developments in residential andnursing home care; charging for care; and the shifting boundarybetween health and social care. It argues that, in all respects,these policies and the ways in which they are being implementedare incompatible with the notion of social justice. Over thelast fifty years, the older generation has invested heavilyin the welfare state and continues to make a significant contributionto it. The security and well-being of those in need of long-termcare is, however, being threatened by the marketization andcommodification of care provision.     

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.     

Building Care Management Competence in Services for People with Learning Disabilities

Correspondence to Paul Cambridge, Tizard Centre, The University of Kent at Canterbury, Canterbury, Kent CT2 7LZ, UK. Summary This paper examines care management arrangements in servicesfor people with learning disabilities. Its perspective is informedby research on the long-term outcomes and costs of care in thecommunity for people with learning disabilities (Cambridge etal., 1994) and by earlier experimental approaches to care managementin Britain. Building on arguments developed by the author ina position paper in 1992 (Cambridge, 1992), the focus here shiftsto the performance of mainstream care management in servicesfor people with learning disabilities, with an identificationand review of critical dimensions for reviewing competence.Lessons from earlier experimental and demonstration approachesare used to inform the analysis and to construct pointers forcommissioners or providers who are looking to assess the effectivenessof care management arrangements in learning disability withintheir own service systems.     

The Post- and the Anti-: Analysing Change and Changing Analyses in Social Work

Correspondence to Dr Liz Lloyd, School for Policy Studies, University of Bristol, 7 Priory Road, Bristol BS8 1UA Summary This article considers some of the issues raised by criticsof postmodern analyses of social work. It analyses the waysin which social services departments have changed to a ‘post-fordist’organizational form and considers the implications for equalitypolicies and anti-oppressive practice. It challenges the viewthat preserving a more professional approach to social workoffers greater opportunities for anti-oppressive practice thanthe more deprofessionalized approach currently being developedand argues that social workers committed to the principles ofanti-oppressive practice can develop new tactics appropriateto the changing organizational context It also argues that postmodernistanalyses offer new insights into experiences of power, oppressionand inequality. In particular, it stresses the importance ofunderstanding the linkages between broader, political and economictrends and the experiences of individual social workers andservice users. Drawing on research in Avon Social Services, it considers theways in which race equality strategies in community care continueto reduce issues of race and racism to culture and identity.Reflecting critically on anti-oppressive and anti-racist actionit argues that the limitations placed on anti-oppressive practiceunder the postfordist context of community care are unlikelyto differ greatly from those felt under previous organizationalregimes.     

Interaction Between Field and Residential Social Workers

Summary This paper is based upon collaborative project work with a socialservices department aimed at improving interaction and collaborationbetween field and residential social workers. It describes theprinciples upon which it was agreed that interaction shoulddevelop. These include notions of case-accountable staff, acollateral model of interaction between staff and the idea ofone party being identified as a prime care agent. Based on theseprinciples it sets out a model arrangement for clients enteringresidential care which recognizes the need for precision aboutthe nature of key decisions that need to be taken with clientsand the way these decisions should be taken.     

Discourse and Resistance in Care Assessment: Integrated Living and Community Care

Correspondence to Mark Priestley, Disability Research Unit, University of Leeds, Leeds, LS2 9JT, UK Summary This paper illustrates how value conflicts between the competingphilosophies of community care and integrated living are playedout at a micro level. The experiences of service users in Derbyshireshow how the process of care assessment can perpetuate traditionaldiscourses of disability based on dependency, individualizationand segregation. By contrast, self-assessment within an integratedliving approach opens up new possibilities for resistance throughthe supported self-empowerment of service users. Moreover, theparticipation of disabled people in managing their own affairschallenges established cultural values about the role of disabledpeople in society.     

Understanding 'Going Missing': issues for social work and social services

Correspondence to Malcolm Payne, Professor of Applied Community Studies, The Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 8RR. Summary Recent research about young people and adults who ‘gomissing’ raises important issues for social work and thesocial services. Large numbers of young people go missing eachyear, becoming vulnerable to exploitation and at risk of committingcrime and suffering from other social difficulties. Adults leavebehind families with practical and emotional difficulties. Adefinition of ‘going missing’ should focus on absencefrom social expectations and responsibilities. Five groups ofmissing person are identified: runaways, pushaways, throwaways,fallaways and takeaways, reflecting different social situationsin which going missing occurs. It is argued that going missingis one of a range of choices which people in difficulties maymake, depending on their approach to problems in their livesand the availability of opportunities. Effective local co-ordinationto focus on reasons for going missing, on reunions and returnsto residential care or home, and to provide emotional and practicalhelp to people ‘left behind’, are required, providedthat care is taken to protect people who go missing becausethey are subject to abuse and violence.     

Gender, Ethnicity and Vulnerability in Young Women in Local Authority Care

Correspondence to Sue Lees, University of North London, 9 Northolme Road, London N2 2VZ, UK. E-mail: S.Lees{at}unl.ac.uk Summary This paper analyses the impact of gender and ethnicity, takentogether, on the experience of being looked after away fromhome. It presents the findings from a study of young women,aged over 12, who came into care in one local authority between1990 and 1999. It reports that the over-representation of youngblack women in care is associated with the greater tendencyof African-Caribbean and mixed heritage young women to run awayfrom home rather than put up with abusive relationships; thelack of cross-generational support resulting from migrationand the effects of poverty and racism which place added strainon family relationships. The implications of these findingsfor social work practice are considered.     

The Place of Fostering in Social Work

Summary To foster children is no longer regarded as the main objectiveof the child care services. However, fostering is once againa matter of social work and public debate. The paper explainsthat more types of children are now being assessed as requiringfostering at a time when social service departments are findingit difficult to expand their number of foster homes. This greaterdemand for foster homes coincides with recent researches whichhelp to clarify the nature of fostering. Accordingly, a distinctioncan be made between 'exclusive' and 'inclusive' fosterings.It is considered that a conflict exists between popularity ofexclusive fostering and research findings which stress the valueof inclusive fostering. Research is also identifying the contributionwhich social workers can make in the fostering field. But thedesired inputs of training, low caseloads and staff stabilitypose problems for social work management. Finally, the researchfindings discussed in the paper are used to argue that the forthcomingChildren Bill is not only based on false assumptions about thebehaviour of natural parents but will also promote exclusiverather than inclusive fosterings. A plea is made that childwelfare policy be seen in a larger context of social reform     

Poverty: Consensus and Alternatives

Summary The purpose of this article is to examine the published viewsof two leading politicians who can claim to speak for theirparties. From their discussion of poverty and social deprivation(and the terms will be used interchangeably) an attempt willbe made to emonstrate that their policies or proposals reston similar assumptions about society and a similar model ofpoverty. Their consensus of approach will mean that no alternativepolicies are being seriously mooted within the party politicalsystem. Their assumptions will be examined critically and thesuggestion made that an approach deriving from an alternativemodel is required to counter poverty.     

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

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

Assessment and Action Records: Will they Promote Good Parenting?

Correspondence to Theo Knight, Department of Applied Community Studies, Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 2RR. Summary In this article the authors seek to provide a critical lookat Looking After children: Good Parenting and Good Outcomes(Department of Health, 1995). They welcome the sentiments underpinningthis major contribution, which recognizes the many disadvantagesfaced by children and young people who are looked after by localauthorities, and acknowledge that local authorities have notbeen positive parents of those in their care. The writers alsoacknowledge the thoroughness which has gone into the detailof the Action and Assessment Records contained in the abovepack. What is questioned is the normative view of parentingand family life which is seen to be at the heart of these documentsand the lack of consideration of the resourcing of action plans.The checklist approach is criticized for the way in which itwill enhance the bureaucratic nature of being in public care,which in turn affects the relative power positions of parentsand children in relation to the local authority and which willimpact on the development of a partnership model of care. Thewriters conclude that children and young people in care arebut one group of young people facing disadvantage and deprivationin British society. An examination of their plight and how toaddress it need to be based within a clear framework of children'srights and a recognition of the power adults hold over them.