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.     

Problems in the Perinatal Prediction of Child Abuse

Summary The aim of this paper is to consider and comment criticallyupon the recommendation by some eminent authorities that effortsbe made to design and implement procedures to predict the abuseof children. My view is that this move toward prediction—‘sponsored’largely by American paediatricians—is less of a new departurethan an extension of the dominant conceptual tradition wherebychild abuse is seen as analogous to a disease. However, in spiteof its basis in a medical model, it is clear that the idea thatthe abuse of children can be accurately predicted has greatappeal for many social workers. I shall argue, however, thatserious obstacles stand in the way of prediction; that theseobstacles are insufficiently appreciated by the advocates ofprediction; and that—consequently—social workers(and others) should temper with scepticism their enthusiasmfor these developments.     

Care Programming in Mental Health: assimilation and adaptation

Correspondence to Justine Schneider. PSSRU. University of Kent, Canterbury CT2 7NF. Summary Two years after the care programme approach in mental healthwas introduced there is still widespread confusion about itsmeaning and its relation to other changes in the arena of communitycare. This paper looks at how care programmes are being implementedand at whom they are being targeted. It also examines the relationbetween care management and care programming and raises somequestions about future developments in the light of communitycare reforms. It draws on data collected during 1992 from threecontrasting health districts, all of which had made considerableprogress in care programming. Sixty practitioners were interviewedabout the theory and practice of care programming. Their experienceis presented here in the context of a review of community careplans for 1992/93 which characterizes the responses of differentlocal authorities to the approach.     

Social Work with Single Parent Families: Consumer Views

Summary The article describes a research project undertaken to determinethe satisfaction of a particular client group—single parents—withthe service they were given. The research examines five kindsof problems—legal, accommodation, financial, child care,and emotional-and concludes that problems were likely to arisein all these areas, and that, whatever the problem, the socialworker's ability to help solve it depended to a large extenton the quality of the relationship with the client.     

Foster and Residential Care Practices Compared

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford OX1 2ER Summary This paper reports what is, remarkably, the first systematic,in-depth, comparative study of foster and residential care practices.The overall research objectives were: (1) to delineate and comparecare practice in special foster homes (i.e., homes accommodatingchildren traditionally considered too old or disturbed for fosterplacement) and Children's Homes for older children in localauthority care; and (2) if possible, ascertain whether the responsesmanifested by children in such settings can be related to thecare practices they experience. The approach adopted was essentially sociological. A lengthyperiod of field-work in two local authorities featured the useof a range of research instruments and included the collectionof data on the following: the management of recurrent–mainlydaily–social events; children's community contacts; theprovision of physical amenities; the controls and sanctionsused by caretakers vis-à-vis children; the roles of caretakersand their behaviour and attitudes towards children; and thecharacteristics of children, their behaviour towards caretakers,perceptions of their social environments and progress duringplacement. Quantitative methods were used in data analysis becausethey provide a useful guide to the import of observed differencesbetween foster homes and Children's Homes. Care practice in the foster homes was, overall, significantlymore child-oriented than in the Children's Homes. Moreover,the responses of residential children appeared to fall shortof offering justification for the ways that the lives of suchchildren seemed to differ from those of foster children.     

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’.     

The Supply of Foster Families for Children in Care

Correspondence to John Miles, Institute of Social and Applied Psychology, The University, Canterbury, Kent CT2 7LZ. Summary The family circumstances of 2694 foster homes in England arecompared with representative families from the 1985 GeneralHousehold Survey. Foster families typically include a womanin the 31–55 age group, live in homes with three or morebedrooms, are two parent families with one parent working full-timeand the other not, and they have older children only. The incidenceof families with these characteristics is used to develop anestimator of the relative supply position of local authorityareas for foster care, from which a number of conclusions aredrawn. Over the last thirty years some social changes have improvedthe supply, others decreased it, and on balance the nationalsupply position is little changed. Ironically, supply is bestin those areas which have the lowest need for fostering services.Ways in which local authorities can improve their supply positionare considered. The supply estimator reveals that the averageboarding out payments made by authorities show clear signs ofresponsiveness to the local supply position for foster families.     

The Witch-Hunt Metaphor (And Accusations against Residential Care Workers)

Correspondence to Mr Chris Beckett, Anglia Polytechnic University, School of Community Health and Social Studies, Cambridge CB1 1PT, UK. Summary This Critical Commentary examines the widespread use of themetaphor of the witchhunt in relation to child sexual abuseinvestigations when they are perceived as being unjustified.The use of this metaphor can be seen to be part of a backlash,part of a widespread desire to discredit the evidence that sexualabuse is widespread. However, it is argued here that the metaphoris actually quite apt in the case of the recent wave of convictionsof residential care workers, where the methods used have beenquite suspect—and genuinely reminiscent in some respectsof those used in historic witch hunts. It is suggested thatlegitimate child protection will ultimately be the loser ifthis is not addressed.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.     

Research Note: Developing Outcome Measures in Child Care

Correpondence to Dr Harriet Ward. Research Associate, University of Bristol, Social Policy and Social Planning. The Alfred Marshall Building, 40 Berkeley Square, Bristol BS8 1HY. Summary The complexity of the concept of outcome has discouraged researchinto the impact of the care experience on the child. This Notesummarizes the conceptual thinking behind a comprehensive systemof assessment which is being piloted in four local authorities,and reports on the preliminary results.     

Questions Raised for Local Authorities when Old People are Evicted from their Care Homes

Correspondence to Peter Scourfield, School of Community, Health and Social Studies, Anglia Polytechnic University, Cambridge CB1 1PT, UK. E-mail: p.scourfield{at}apu.ac.uk Summary Successive government policies have created a situation wheremost residential and nursing care is provided by the independentsector. It is in the nature of a marketized and privatized caresystem that homes will periodically close or change ownership.The physical and mental well-being of elderly residents experiencingeviction and relocation can be seriously damaged by the experience.No policy and practice guidelines have been issued from centralgovernment to cover how care home closures should be managed.Local authorities are therefore dealing with such events onan ad hoc basis. Understandably, the main emphasis is oftenput on actually finding appropriate alternative placements.Practices vary across different local authorities. This articleasks whether the necessary work required to minimize the harmfuleffects caused by the stress of relocation is actually beingcarried out properly. It also raises the questions of what exactlyshould be offered to older people when they are given noticeto quit, who is best qualified to do the work and whether caremanagement as it has developed within the ‘purchaser/providerframework’, is adequate to the task. In short, where cansocial work for older people be found when it is needed?     

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.     

Patterns of Provision in Respite Care and the Children Act

Summary This article presents the findings of a three-year study intorespite care services to disabled children and discusses thesein the light of the 1989 Children Act. The aims and methodsof the research are first outlined and the various servicesincluded in the study are described. Access to services was found to be uneven, with families fromlow socio-economic groups and from black and ethnic minoritycommunities apparently having less choice. The characteristicsof users are identified: some of these varied according to typeof facility used or amount to care received. Agency records and registers were often found to be inaccurate:the Children Act will require authorities to maintain updatedregisters. New powers to charge for services may create furtherbarriers to access although requirements to take account ofchildren's racial and cultural background should extend it.The Act will help authorities regulate the amount of respitecare children receive and introduces certain safeguards. Itsemphasis on consulting young people is to be welcomed. Overall,the new legislation has the potential to improve many aspectsof respite care; its ability to do so will depend on havingadequate resources.     

Prison Welfare and Voluntary After Care

Summary Some findings of a survey into the experiences of men releasedfrom prison are reported, where they relate to their use ofprison welfare and after care services. These are discussedin the context of issues such as through-care, rate of take-up,and the factors which may be influential in determining whethera man makes use of after care on release from prison. It isproposed that for more isolated men the probation service shouldadopt a ‘reaching-out’ strategy.     

Depressed Mothers' Experience of Partnership in Child and Family Care

Summary Partnership is a key dimension of social work practice in childand family care, reflecting the significance attached to workingwith parents. While, however, considerable attention has beenfocused on the role of the social worker in encouraging partnership,rather less attention has been focused on the capacity of themothers to engage in partnership. Depression, known to affecta considerable proportion of mothers in this client group, is,because of its debilitating psychological effects, of considerablepotential significance, yet its effect on partnership has notbeen examined. This article focuses on exactly this issue. Findingsshow that depression has highly significant relationships witha number of facets of partnership. It shows also that partnershipmorale and quality of consultation mediate between depressionand, respectively, participation in decision making and involvementin decision implementation—action by the mother to helpresolve the situation. Depression and partnership are, furthermore,related in a complex way to the authority role invoked in casesof children ‘at risk’. The data indicate that theelements of low self-esteem, vulnerability to criticism, andself-blame are key factors in the mother's capacity to workin partnership. Social work practice must take these into account,requiring very high degrees of sensitivity and skill in workingwith mothers. Indeed, unlocking these pernicious cognitionsmay frequently require specialist techniques, such as the useof cognitive behaviour therapy. Overall, being ‘socialworker for the child’ means also being ‘social workerfor the parents (in particular the mother)’, who may wellrequire high levels of encouragement.     

The Field Social Work Implications of Residential Child Care

Summary The workloads of field social work staff vary markedly, andlittle is known about the ‘burdens’ imposed by differentgroups of clients or cases. The research study reported hereset out to examine the extent to which field social work involvementin residential child care varied between individual childrenand to attempt to explain that variation in terms of the characteristicsof children, the characteristics and workloads of staff andtheir teams, the packages of services received by children andtheir families, and some general features of the residentialplacements. Field social worker involvement was measured interms of the number of contacts between ‘caseholders’and ‘case’ and the total amount of time spent onthe case over a three month period. The observed variationsin these two indicators were found to be significantly associatedwith the characteristics of cases and other factors. Indeed,these characteristics explained almost two-thirds of the variance.The empirical results have a number of policy implications whichare discussed under six heads: supply constraints, caseloadweighting, fieldwork organization, coordination and monitoring,out-county placements and travelling time, and comparative costings.     

Maternal Depression, Child Care and the Social Work Role

Correspondence to Michael Sheppard, Principal Lecturer, Department of Applied Social Science, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA. Summary This article reviews findings on the relationship of maternaldepression and child care problems, a relationship which haslargely been ignored in social work. These findings are of particularimportance in view of the philosophy in the Children Act 1989that the best place to bring up a child is usually with theirfamily and the duty of local authorities to promote this. Thefindings consistently identify a clear relationship betweenemotional and behavioural child care problems and maternal depressionshowing that depression is likely to affect the mother's childcare abilities and also her perceptions of the child's behaviour.These have important implications for education, training andpractice, and these are discussed.     

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.     

Informal Networks of Care: Issues Raised by Barclay

Summary In calling for the creation of ‘community social work’,the Barclay Report argues that social workers should aim todevelop informal caring networks. This entails exploiting anindividual's informal social contacts, such as kin, friends,and neighbours, to provide care. This paper firstly examinesthe assumptions and thinking behind the concept of informalcaring networks. It then assesses the feasibility of using differentinformal relations in care provision by analysing the normativepatterning and exchange content underlying them. It concludesthat strategies like Barclay's are unlikely to be successfulbecause they entail a transformation of these relationshipsthat is incompatible with their normal organisation.