Aspects of Social Work on a Cancer Research and Treatment Unit in a London Teaching Hospital

Summary With the rapid growth of technology and science in society today,an increasingly large number of people are becoming patientsin specialized research and treatment units. The reorganizationof social work support to the health service is upon us, andgreat care must be taken to ensure that this important groupof clients will receive the social work help it needs. The paper is based on work in a cancer unit in a London teachinghospital and seeks to illustrate ways in which the work is specialized     

Residential Programmes for Children and Youth: An Exercise in Re-framing

Summary The key functions of residential programmes for children andyouth irrespective of their location in the health care, education,social welfare or criminal justice system are identified inthis paper. The issues of mandate for and status of those servicesis addressed. Finally, a series of propositions are offeredwhich seek to show how those factors influence the social positionand public credibility accorded to those important componentsof the group care field.     

Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

Summary The delivery of health and social care has undergone massivechange in the UK in the 1990s. A key factor in the drive forreform was the failure of joint working arrangements betweenhealth and social services and the need to provide integratedcare for people who have overlapping health and social careneeds. This article draws on a research study investigatingthe community care provided to people with Parkinson's diseasein the wake of the 1990 National Health Service and CommunityCare Act. As a chronic progressive disease predominantly affectingolder people, the management of Parkinson's provides an exemplarof some of the key features of supporting people with continuingcare needs. This study found serious deficits in the assessmentand meeting of need, arising from weaknesses at the health andsocial care interface. The article concludes by consideringan approach which resources and supports the service user/carerin managing their own care pathway.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

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.     

Tackling Inequalities in Physical Health: A New Objective for Social Work

Correspondence to Eileen McLeod, Department of Social Policy and Social Work, University of Warwick, Coventry, CV4 7AL, UK. Summary We argue that tackling the impact of social inequality on physicalhealth should become a central objective of social work andintrinsic to the development of anti-oppressive practice. Thisis on three grounds. First, the suffering embodied in inequalityin physical health should be a cause of concern to social workers,as a pervasive social problem. Secondly, awareness of socialwork's complicity in contributing to such a problem, throughits historical role in implementing state policies, needs toinform assessment of social work outcomes. Nevertheless, thirdly,social work—not confined to health care settings—whichredresses social disadvantage and tackles its consequences forphysical well-being can contribute to greater equity in health.Indicative examples of such practice are provided in relationto health maintenance, living with ill health and terminal illness.Finally, consideration is given to the current wider politicalcontext in which social work addressing health inequalitiesis embedded and to the need for complementary organizational,professional and political initiatives to buttress its development.     

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.     

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.     

Social Work and Child Mental Health: Psychosocial Principles in Community Practice

Correspondence to Steven Walker, Senior Lecturer, School of Community Health and Social Studies, Anglia Polytechnic University, 2nd Floor, Ashby House, Brook Street, Chelmsford, Essex CM1 1SQ, UK. E-mail: s.walker{at}apu.ac.uk Summary The increased prevalence, complexity and earlier onset of childand adolescent mental health difficulties, has prompted governmentinitiatives to reconfigure current provision for this clientgroup, their parents and the carers who try to support them.Social workers have an important part to play in respondingto the needs of these individual children and families. A residual,care management role is not adequate in these circumstances.This paper describes the development of social work in childand adolescent mental health, and suggests that a synthesisof psychosocial principles and community practice, offers theoptimum social work model of assessment and intervention. Sucha model embraces the most useful aspects of psychodynamic theoryin the context of practice consistent with anti-discriminatory,children's rights and partnership principles.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

Ethnicity and Caring for a Disabled Child: The Case of Children with Sickle Cell or Thalassaemia

Correspondence to Waqar Ahmad or Karl Atkin, Ethnicity and Social Policy Research Unit, University of Bradford, Bradford, BD7 1DP, UK Summary Services for haemoglobinopathies have been a major site of strugglesfor the black communities, yet the social research literatureon haemoglobinopathies remains patchy and fragmented. We providean overview of the literature on sickle cell disorders and thalassaemiamajor in the broader context of debates on childhood disabilityand chronic illness, and on ethnicity, racism and health care.     

Primary Health Care Workers' Views about Social Work

Summary SUMMARY A comparison of the views about social work held by 188 primaryhealth care workers—118 GPs, 31 health visitors and 39district nurses—working in the same teams is presentedhere.^* The study focussed particularly on their perceptionsof social workers, their role and performance. The data indicatea general acceptance of the social work role, but a lack ofknowledge of or extensive criticism about, social work performance.Significant differences of view emerged about social work training,role and clients, indicating occupation is a significant factorin perceptions held. In particular, the client group predominantlydealt with appears to have had an impact on perceptions. However,views about social work performance did not differ greatly,suggesting the influence of occupation on perceptions shouldnot be overstated.     

Social Work and the Medical Profession--Arguments Against Unconditional Collaboration

Summary The history and major texts of medical social work emphasizethe need for collaboration with the medical profession. Howeverthere is a less visible history of conflict between medicineand social work. It is proposed that a critique of medicine’scontribution to health provides the foundation for a statementof principles for a social model of health for social work practice.Collaboration with medicine should be negotiated on the basisof such principles, rather than unconditional.     

Non-Statutory Mental Health Social Work in Primary Care: A Chance for Renewal?

Correspondence to Malcolm T. Firth, Honorary Research Fellow & Senior Psychiatric Social Worker, 'DEAL', Department of Psychiatric Social Work, 12th Floor, Mathematics Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: malcolm.firth{at}mhsc.manchester.nhs.uk Summary The current status of evidence-based practice in the field ofmental health has led some to question the potential for innovationif social work practice is organizationally proscribed or reducedto a dogged adherence to methodological orthodoxy. Conversely,social work's value base is esteemed disproportionately to itsevidence base. Changing service contexts in the UK, particularlythe emergence of Primary Care Trusts as gatekeepers and commissionersof health and social care services, are providing opportunitiesfor social work to develop a new presence and purpose. The authorsdescribe their work in a small-scale service based in primarycare that anticipated these opportunities, by a retrospectivestudy of 120 cases. A new evidence base that derives directlyfrom practice is suggested as a way forward for social workeducation and training, as well as for service and professionaldevelopment.     

Tolerating Stress in Social Work Practice: The Example of a Burns Unit

Summary Social work in a burns unit exposes the practitioner to continuousand extreme stress, which arises both from the nature of thecaseload and from the nature of the setting. Burned patients,and the staff who care for them, tend to adapt in characteristicways to the suffering they encounter. The social worker, bygoing through a similar process of adaptation, can perhaps becomeable to offer sensitive help to patients without becoming overwhelmed.Stress can be contained more readily if informed personal supportis available to the worker; however, because of certain featuresof the setting, such support is not always easily obtained.     

The Bereavement of Parents and Their Search for Meaning

Summary The emotional relief of bereavement is generally recognizedas being the primary task of mourner and caregiver, but lessattention has been given to the ways in which the bereaved understandtheir experience and reconstitute family life. Recent studiesof parents whose children have died in traumatic circumstances,from murder, suicide and operation, suggest that it is an essentialpart of griefwork to resolve the meaninglessness of the crises.Those whose children die from chronic disease, handicaps, oraccidents, also need to find a meaning in their tragedies. Bereavementis thus a total psychophysical experience of suffering, andthe renewal of family life depends on the acceptance of separationand the regenerative use of its pain. Insights from psychiatrists and sociologists are acknowledgedand related to those of bereaved parents, and to the developmentof their self-help association, The Compassionate Friends. Theseprovide models of mourning and a collective response to familyloss which offer hope, support and varieties of meaning to thenewly bereaved. The roles of health and social workers involved in pre- andpost-bereavement care are explored, and ideas are offered formaking the social network more supportive. It is suggested thatthis will not be costly in material resources, but in thoseneeded for the more therapeutic involvement of the caregiver.     

Caring for the Elderly Widowed--the Burden on their Supporters

Summary This paper examines how caring for elderly widowed people affectsthe lives of their ‘familiars’. This study is partof a larger national study on widowhood in old age carried outby the Institute for Social Studies in Medical Care. The familiarstended to be the children of the widowed, particularly theirdaughters. Children of the widowed, again often daughters, weremore likely than other familiars to suffer life restrictionsbefore and after the death because of the care and support givento the deceased and the surviving spouse. In addition to theircaring role familiars were often committed to full or part-timeemployment and most also had their own families to support.The care they provide for the elderly is not always withoutcost. The contribution towards community care given by suchinformal helpers deserves greater recognition and the social,psychological and financial costs thus incurred merit greaterrelief. As the help is needed by a minority only of such informalcarers, adoption of a policy relieving them as far as possibleof the costs they incur, would not involve intolerable financialoutlays.     

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.     

Nearest and Dearest? The Neglect of Lesbians in Caring Relationships

Correspondence to Jill Manthorpe, Social Care Workforce Research Unit, King's College London, 150 Stamford St, London SE1. E-mail: jill.manthorpe{at}kcl.ac.uk Summary The article argues that caring within lesbian relationshipshas been ignored in social and health care studies and practice.It critiques the dominance of caring debates by relationshipsbetween parents and children and partnerships, but with theunspoken presumption that those involved are heterosexual. Thepaper concludes that social workers should engage with lesbiancarers in supporting individuals and networks. It draws outa range of implications for policy, practice and research agendas.     

Source and Nature of Social Support given to Women at Divorce/Separation

Summary Thirty divorced or permanently separated women rated 12 differentsources of social support (including family and friends as wellas professional and religious bodies) for their importance inproviding 17 different types of help or support during the firstsix months of the separation/divorce. Friends proved to be thesingle overall important source of support, but the differentialimportance of social support as a function of type of help given,points to the multidimensional aspect of social support.