Child Placement Policy: Some European Comparisions

Summary There is consensus among European countries that the first aimof a social policy for families should be to enable childrento remain in their own homes. However, in all countries somechildren require placement apart from their parents, but thereis no agreement as to the best mode of care for these children.Some countries rely entirely on residential care, others almostentirely on family placements in the community. The articlecompares Sweden (high fostering) with Belgium (low fostering),and England and Wales, which is midway between the two, andsuggests that some European models are relevant to English practice.     

Informal Care in Asian and Afro/Caribbean Communities: A Literature Review

Correspondence to Karl Atkin, Social Policy Research Unit, University of York, Heslington, York YO1 5DD. Summary The multi-racial nature of British society can no longer beignored by those responsible for planning and implementing socialcare policy, particularly since community care is presentlyat a crossroads. Informal care provides a useful starting pointfrom which to introduce the notion of race into social caredebates. The paper, by reviewing a mix of empirical studiesand policy debates emerging from the literature on informalcare and black communities, examines the experience of informalcare within black communities. By discussing topics such asthe demography of care, the nature of informal care, and serviceprovision to black carers, it gives coherence to a fragmentedliterature and illustrates gaps in present understanding.     

Implementing Care Management: Issues in Relation to the New Community Care

Correspondence to Professor Jane Lewis, All Souls College, Oxford OX1 4AL Summary The official guidance on the new policy of community care emphasizedcare management as the means of securing needs-led services,together with user empowerment and choice. This paper uses datafrom eighteen months intensive fieldwork in five local authorities,first, to examine the very different interpretations of caremanagement in these authorities; secondly, to examine two majorsources of difficulty in the implementation of care managementsystems—the simultaneous development of purchaser/providersplits, and the tension between needs and resources—and,finally, to draw some conclusions about the implications ofcare management for social workers.     

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.     

Private Children's Homes

Summary The paper provides survey and intensive research material onthe private children's homes sector. It is shown that this sectoris currently in decline. Private homes are found to be shelteringchildren with long and complex care histories and to adopt adistinctive residential style. Although private homes providevaluable long term continuity, they are less likely to offerthe same range of community services as do residential settingsmanaged by the local authority and voluntary child care agencies.     

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.     

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.     

Group Homes for the Mentally Handicapped--an Examination of the Effects of Group Interactions

Summary The past decade has witnessed a move towards increased communityresidential care for the mentally handicapped, essentially involvingan expansion of hostels and group homes. The latter has beenviewed as a serious alternative only for the more able members:those sufficient in a modicum of independence and behaviouralskills. The present paper explores the importance of group interactionaldynamics within the framework of providing residential carein ordinary houses for groups of up to five mentally handicappedadults. The use of group theory perspectives concentrates onthe potential of individuals to achieve effective social skillsthat contribute to adequate group harmony. The findings illustratethe potential of meeting the needs of the less able within grouphome settings through an emphasis on assessment of total groupneeds rather than on an aggregate of individuals comprisingthe group. These are discussed within the contest of currentefforts both at policy and provider level to expand care withinthe community.     

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.     

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.     

SETTING OBJECTIVES AND MEASURING ACHIEVEMENT IN SOCIAL CARE

Correspondence to Tony Bovaird, Public Sector Management Research Centre, Aston University, Aston Triangle, Birmingham B4 7EJ Summary This paper examines a systematic approach to formulating andevaluating policies for social work practice in social care.A hierarchy of aims and objectives is advocated, based on theassumption that a clear statement of desired outcomes in socialwork practice with groups of service users is required, togetherwith the establishment of indicators by which their achievementmay be measured. The purpose of the hierarchy is to generatean integrated policy for change and to give a full sense ofdirection to all staff involved, both in policy making and insocial work practice.     

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.     

Caring for Citizenship

Correspondence to Dr John Harris, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. E-mail: j.harris{at}warwick.ac.uk Summary Official articulations of caring are socially constructed bytheir emergence from particular contexts. As a consequence,the political positioning of caring has the potential to varyin accordance with changes in welfare regimes. In Britain, aparadigm shift has occurred. In the social democratic welfarestate, caring was a taken-for-granted resource to which socialservices were added. Following the community care reforms ofthe early 1990s, caring is the core resource and is seen asrequiring management by social workers. Caring arrangementsin households are actively identified, publicly negotiated,carefully organized and subject to formal agreements about thescope and nature of the care provided, often with the goal ofaverting service provision. This paradigm shift was an integralcomponent in the formulation of the community care reforms bythe New Right. It emerged from a concept of citizenship in whichdependency was to be avoided and support by informal carerscame to the fore. New Labour has consolidated the shift andrefined its ideological basis. Caring is an expression of citizenshipobligation.     

A 'Missed Opportunity' Re-assessed: the Influence of the Day Training Centre Experiment on the Criminal Justice System and Probation Policy and Practice

Correspondence to Maurice Vanstone, Department of Social Policy and Applied Social Studies, University of Wales College of Swansea, Swansea SA2 8PP. Summary In 1973 four probation day training centres were set up in Liverpool,London, Sheffield and Pontypridd as part of an experimentalproject which focused on providing a community based trainingprogramme for offenders who would otherwise have been imprisoned.The experiment, which lasted from 1973 to 1981, has never beenproperly evaluated. This paper, whilst not purporting to fillthat gap, is an attempt to critically review its significancewithin the context of the criminal justice system from botha policy and practice perspective. It further reflects on thereasons for the formulation of the training centre model asa community based semi-institution. It examines its originalpurposes of diverting offenders from custody and helping them,against the charge that they not only failed to achieve thosepurposes but had the unintended consequence of drawing inappropriatepeople into a burgeoning network of state control. Throughoutthe paper a distinction is drawn between the day training centresand the numerous day centres that were established in the probationservice during the late 1970s and the 1980s.     

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.     

Changing Practice: Participation, Rights and Community Care

Correspondence to Nina Biehal, Department of Adult Continuing Education, University of Leeds, Leeds LS2 9JT. Summary Participation is a key term in current debates about socialservices, reflecting often contradictory concerns with consumerismand rights. Drawing on findings from the Social Work in Partnershipresearch and development project (funded by the Joseph RowntreeFoundation), this paper explores the possibilities for participationin the field of community care. It argues that a clear frameworkof rights for service users must be accompanied by practicestrategies which ensure those rights in the day to day contactsbetween users and professionals.     

Residential and Foster Care in the European Community: Current Trends in Policy and Practice

Correspondence to Dr Matthew Colton, Department of Social Policy and Applied Social Studies, University College, Swansea SA2 8PP. Summary This article compares residential care, foster care and theiralternatives in the countries of the European Community. Thefollowing common trends in policy and practice are examined:the decline of residential child care; changes in the populationof separated children; the trend towards small-scale provision;the development of an ecological perspective; increasing differentiationof care provision; professionalization; and alternatives toresidential and foster care. The pace of development is uneven across EC countries. Overall,the trends high-lighted are more apparent in the northern countriesthan in the southern states.     

Contract Management and Community Care: A Negotiated Process

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. Summary Drawing on a wider study of community care arrangements forvisually impaired people in England and Wales, this paper exploresthe implementation of contractual arrangements as part of thedeveloping formalization of partnerships between local authoritysocial services departments and voluntary organizations. Itargues the importance of conceiving contract management as acomplex set of social processes involving a diversity of interestsand inequalities of power, where skills in negotiation are centralto promoting greater participation in community care policyand practice. It concludes with a brief discussion of the relevanceof social work to the implementation of this key area of contemporarycommunity care arrangements.     

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.     

Determinants of Substitute Child Care Practice

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford CX1 2ER Summary The first part of this paper attempts to examine the factorswhich help to define foster and residential care practices.The discussion is informed by a comparative study of fosterhomes and Children's Homes, which was reported in the previousissue of this journal (BJSW 18:1). Overall, care practices inthe foster homes compared very favourably with those observedin the Children's Homes. It is argued that this finding owesmuch to the bureaucratization of Children's Homes. The secondsection considers the implications of my work for policy andpractice in the field of substitute child care. Use is madeof the insights provided by the preceding section to suggestways by which the major shortcomings identified by empiricalresearch might be ameliorated. This statement includes an argumentin favour of a significant expansion of family placement forolder children in public care, and a proposal for a child-orientedalternative to the sorts of Children's Homes visited.