Accommodation without Resident Staff for Ex-Psychiatric Patients: Changing Trends and Needs

Summary This paper deals with accommodation without resident staff providedin the community for ex-psychiatric patients. Existing evidenceabout this kind of accommodation shows that it is provided largelyfor an elderly, institutionalised, chronically handicapped group.Recent trends in hospital provision (especially the closureof long stay beds) would seem to suggest that in the futuresuch accommodation may have to provide more for a younger, morelively population coming from the community itself. A survey of such accommodation in one metropolitan local authorityarea was carried out in 1977–78 to investigate if suchchanges were being reflected in the population and regimes ofhomes. The results indicate that to some extent, this is thecase. Policy implications arising from these findings are discussed.     

Residential Care for Elderly People: Characteristics of Patients Admitted To Residential and Nursing Home Care from Hospital

Correspondence to Mr W. Power, Department of Social Work, Kingston General Hospital, Hull HU3 IUR Summary Fifty consecutive admissions to residential and nursing homecare from hospital were examined and the results discussed.Patient profile fitted the general pattern expected of frailelderly people with high dependency needs. There was a noticeableshift towards placements in private establishments but onlyabout half the patients were likely to have satisfied criteriafor local authority placement or require nursing home care.Breakdown in care-giver arrangements was found to be a majorreason for entry to care. Apart from a significant number ofwheelchair users going into nursing homes, there were no sharpdivisions between the residential care and nursing homes groups.     

A Qualitative Study of Social Work Assessment in Cases of Alleged Child Abuse

Correspondence to Dr Dorothy Scott, School of Social Work, University of Melbourne, Parkville, Victoria, Australia 3052. Summary While there has been considerable theorizing about how socialworkers think and act, there has been relatively little researchin this area. In the study reported in this paper, in-depthinterviews and observations of practice were used to explorethe process of assessment undertaken by Australian social workersin a hospital specialist service and in a statutory child protectionservice. Using a semi-longitudinal approach which ‘shadowed’10 families (17 allegedly abused children), highly detaileddata were collected from 42 observations of practice and 123interviews with 12 hospital social workers and 15 child protectionworkers on how their assessments evolved over the life of thesecases. While there were some individual differences betweenpractitioners within each organization, of greater significancewere the marked differences between the two groups in the variablesto which they attended. Both groups tended to adopt a proceduralizedmodel of practice which narrowed the range of factorsconsideredin assessment.     

The Characteristics of Children with a Disability Looked After away from Home and their Future Service Needs

Correspondence to Professor Roy McConkey, School of Nursing, University of Ulster, Newtownabbey, N. Ireland BT37 0QB. E-mail: r.mcconkey{at}ulster.ac.uk Summary Little is known about the characteristics of children with disabilitieswho meet the British legal definition of ‘looked after’children. Data were obtained on 108 such children living withinone geographical area in Northern Ireland and who spent 90 daysor more in a 12-month period living away from the family home.However, this figure may under-estimate the numbers, given thedifficulties in tracking children aged over 14 years who wereadmitted to hospitals on a short- or long-term basis. The medianage of the children was 14 years; most had learning disabilitiesallied with challenging behaviours, communication difficulties,autism and some were technologically dependent. Many of theirfamilies experienced a range of problems. One-third of the childrenwere accommodated in various residential settings but half ofthese placements were in hospital or adult residential accommodation.However, there were marked differences in the services providedto this client group by the four provider agencies. Future serviceneeds included increased respite breaks for families and theprovision of both more residential placements and more appropriateaccommodation, especially for teenagers. The dilemmas in reconcilingthe need for local, but specialized, service provision are discussed.     

Aspects of Old Age

Summary The opportunity of growing old has extended but it is an opportunityattended by risks. When old age is accompanied by infirmity,ill-health and economic or social difficulties, many problemsarise for the individual and for society. This paper looks atsome aspects of the incidence and nature of old age and at thesupport provided by social services, and the discussion is illustratedby reference to seven elderly hospital patients. The identityof the person found to be most at risk was predictable.     

Accommodation and Homelessness on Release from Prison

Summary This paper presents some of the results of a Home Office sponsoredresearch project in which men discharged from prison were interviewedbefore and after release. The findings compare pre-arrest andpost-release accommodation and demonstrate than many men arelikely to be in poorer accommodation after release than theywere before arrest.     

Research Note: An Attempt to Classify Adolescent Parasuicide Attempters

Correspondence to David Gilliland, Principal Social Worker, The Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast BT12 6BE. Summary This paper examines some of the literature available on thesubject of adolescent suicide attempts. It discusses the extentto which it is possible to identify sub-groupings within groupingsof young people who took overdoses. It suggests on the basisof the study undertaken (and in reference to other studies)that it may be possible to identify sub-groupings. The paperalso discusses in detail a study carried out examining characteristicsof two groups of young people—one who had been admittedto hospital following a single overdose attempt, and a secondgroup who had several admissions to hospital following repeatedoverdose attempts. The implications of these findings are discussedin terms of the possibilities of identifying young people whoare at an increased risk of repeating an overdose attempt, andthe issues for practitioners and service managers are identified.     

Parental Reactions to Stillbirth

Summary The reactions of both parents to the experience of a stillbirthin hospital are studied during three social work visits madeduring a period of six months after discharge from hospital.Social and emotional responses are discussed and also the implicationsfor social work in hospital and the community.     

Attitudes of Medical School Workers Towards Reorganization

Summary This paper arises from a four-year project funded by the Departmentof Health and Social Security, concerning the social needs ofthe physically sick—a study of some aspects of the socialneeds of the physically sick and of the services designed tomeet needs. The present focus is on social work services andin this part of the project a development study has been undertakenand postal questionnaires have been sent (a) to all medicalsocial workers employed in the Hospital Service and in localauthority Health and Welfare Departments, and (b) to all otherhospital social workers engaged in helping the phsically sickand handicapped persons. In addition, a Survey is being carriedout through records of 9,000 admissions to a number of hospitalsto see how many of these patients are referred to the hospitalSocial Work Departments in a nine-month period, at what stagein their hospital careers they are referred, etc. A Survey is being carried out in four hospitals using a randomsample of patients and another sample referred for social workhelp. These patients are being interviewed in hospital and afterdischarge to see what kind of problems are encountered in hospitaland after discharge and what services are provided. Interviewswith medical, nursing, administrative and social work stabstractand included in this survey. The overall objectives of the Survey are to study needs andservices and to indicate how closely services respond to needs.     

The Social Work Task in an Acute Psychiatric In-Patient Unit

Summary This paper reports the results of monitoring all admissionsfrom a prescribed geographical area to an acute psychiatricin-patient unit for a six month period. Members of the hospitalsocial work department assessed all admissions and selectedapproximately one-half of these for high social work input Demographicdata for the whole subject group is examined and compared tothe high input group. The case review system outlined by Goldbergand Fruin (1976) is used to describe the clients' social problemson admission, as well as the social work task, in terms of practicalservices and other social worker activities. These findingsare compared to those of Goldberg et al. (1977) who examinedthe social work task in an area office social services departmentintake team. Despite differences in demographic profiles ofthe two groups and consequently differing social problems, thesocial work task in both settings was found to be similar. Inboth studies 53% of clients were offered some practical (althoughdifferent service) and the most common social work activitieswere found to be assessment, information and advice, and mobilizingresources.     

Toward a Theoretical Framework for Perinatal Bereavement

Correspondence to Dr Keith Brownlee, School of Social Work, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, P7B 5E1 CANADA. E-mail: keith.brownlee{at}lakeheadu.ca or oikonenj{at}imail.tbh.net Summary For many women a foetal or neonatal death is a significant life-alteringevent. Modern medicine has offered pregnant women an early awarenessof their developing foetus coupled with an opportunity for advancedfeelings of attachment, which, in most cases, accentuates thegrief and sense of loss. While crisis intervention serviceshave become standard practice in hospital settings and typicallymeet many clinical and short-term needs of bereaved parents,conventionally held theories of grief fall short of the realitiesdescribed by such parents. This paper critically examines theclinical and research support for current approaches to perinatalgrief and argues that theory development specific to perinatalloss is needed within the field and that social workers canplay an important role in this respect. Some emerging ideasare discussed that appear to hold promise for establishing modelsthat would be more responsive to the particular complexitiesof perinatal bereavement.     

The Care Programme Approach: Dimensions of Evaluation

Correspondence to Barbara Hatfield, Mental Health Social Work Research Unit, School of Psychiatry and Behavioural Sciences, University of Manchester, 12th Floor, Mathematics Building, Oxford Road, Manchester M13 9PL, UK. Summary The study examined the first six months of implementation ofthe Care Programme Approach (the CPA) at a psychiatric unitof a district general hospital. From an analysis of the researchliterature on case management, and from current policy, a frameworkwas developed which was used to analyse the implementation understudy. The framework included such features as: a keyworkeroffering a continuous relationship and co-ordinated care; assessmentand intervention over a range of ‘needs’; multidisciplinaryworking in the community; and involvement of user and carer.The objectives were to ensure continuity of care and reducehospital admission. The targeted service users were to be thosewith severe and enduring mental health problems. The study showsthat most of these features were achieved in the implementation,although there is no evidence that hospital admission was avoided.A number of factors were found to be associated with re-admission,and these are discussed in the light of the findings of otherstudies.     

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.     

Social Work and a Relatives Support Group in a Psychogeriatric Day Hospital: A Research Note

Summary During the course of an evaluative study of a new psychogeriatricday hospital we encountered the fact that amongst the staffthere is very widespread support, in general terms, for theimportance of offering a service to the relatives of patients.A Relatives Group, in which the social worker attached to thehospital plays a leading role, is a major component of thisservice. However, the Group remains comparatively self-contained,is organised somewhat separately from the main body of hospitalactivities, and in practice systematic liaison with relativeshas not formed any major part in the planning and design ofthe organisation as a whole. Apart from the Relatives SupportGroup, there are only a small number of occasions on which relativeshave any regular contact with hospital staff. In this note we shall summarise our research which describesthe nature of social events which are encompassed within theGroup meetings. The research concludes that the Relatives SupportGroup sustains an ideology of service to relatives while confiningmany of the practical tasks so entailed to an organisationallocale which limits the degree of ‘relatives disturbance’to the rest of the institution. An implication of this thesisfor social work in medicine is that, in so far as social workersplay a significant part in running such groups, their attemptsto introduce relatives in this way as significant consumersmay, ironically, serve only to limit the impact of this groupwithin the system of medical care.     

Feminism and Social work: Resistance or Dialogue?

Summary This paper seeks to explore some of the factors underpinningsocial work's apparent resistance to feminism and to dilineateways in which a more active relationship might benefit socialwork's women consumers. It argues that, by marginalizing feminism,social work has perpetuated individualistic explanations andresponses to women's specific needs and problems. Finally, insuggesting some practical strategies for making use of feministideas and experiences, particular consideration is given tosome of the contradictions which may be engendered for thosesocial workers who are actively endeavouring to integrate feministperspectives into their practice.     

A Role for Anyone? A Description of Social Work with the Elderly in Two Area Offices

Summary This article analyses information from Case Review Forms completedby social workers on 199 allocated elderly clients. These peoplewere very frail, most were considered to be ‘at risk’and to require regular, reliable and frequent care. The questionof the client moving to a tafer setting arose in two-thirdsof the cases, concerning which there was often some dispute.It is argued that social workers require a high level of professionalskill in dealing with clients, and others involved, faced withsuch questions and that this requirement will remain with thedevelopment of ‘community social work’.     

'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 Work: Social Realities and Ethical Dilemmas

Summary This article reviews the contributions of sociology and politicalsciences to the understanding of communities and relates theseto some of the key problems facing community workers. It suggeststhat an effective assessment of some of the ethical dilemmasfacing community workers must be based upon a cool appraisalof those urban social structures which are commonly and largelymisleadingly regarded as communities     

Supervision, Role Strain and Social Services Departments

Correspondence to Department of Social Work and Social Administration, University of Western Australia, Nedlands, Western Australia, 6009 Summary The paper analyses the potential for ambiguity and ambivalencetowards the supervision of practice in social services departments.While supervision may be integral to much social work practicein clinical settings, the culture and tradition of supervisionin social services departments looks to be permeated with confusionabout ‘supervision’ or ‘consultation’,the nature of accountability and the functions of supervisionof qualified and experienced practitioners. To move beyond anideology prescribing supervision, the paper considers evidenceof the effectiveness of supervision practice, analysing thetransition from practitioner to line-manager/supervisor andthe subsequent strain on the supervisor's authorities of positionand of expertise in some current arrangements for supervisionin field-work ‘teams’. Finally, there is an unequivocalassertion that effective supervision is an essential componentin the monitoring of client service and the maintenance of practitionersengaged in stressful forms of practice. Such supervision needsto recognize the managerial and administrative tasks necessaryto protect the agency and the client from poor quality practice,while also respecting the emotional and educational needs ofnewly qualified and experienced practitioners exposed to thedemands of high-risk judgement and practice.     

The Role of Assertiveness in Clarifying Roles and Strengthening Job Satisfaction of Social Workers in Multidisciplinary Mental Health Settings

Correspondence to Dr Claire Rabin, Tel Aviv University, Bob Shapell School of Social Work, Ramat Aviv, 69 978, Tel Aviv, POB 390470, Israel. Summary Eighty-seven social workers, working in nine different mentalhealth settings, were administered four questionnaires tappingthe following variables: assertiveness in daily life; assertivenessin the job setting; role clarity; and job satisfaction. Stepwiseregression analysis showed assertiveness in the job settingto be strongly correlated with role clarity. Assertiveness indaily life was also significantly correlated with role clarity.Assertiveness in the work setting was significantly correlatedwith job satisfaction, although it was riot as powerful a predictorof satisfaction as of role clarity. Number of years of job experiencewas the most powerful predictor of job satisfaction. The implications for social work training and supervision aredescribed in light of the importance of assertive communicationin maintaining job clarity and job satisfaction within multidisciplinarysettings.