Emergency department social work in the UK and Sweden: evaluation by older frequent emergency department attenders Kuratorsarbete på akutmottagning i förenade kungadömet Storbritannien och Sverige: en utvärdering utifrån brukarperspektivet hos äldre mångbesökare på akutmottagningen

Social work based in hospital emergency departments (EDs) in Sweden and the UK reflects a wider European social/health care policy trend. A key focus is on diverting older frequent ED attenders from ‘inappropriate’ hospital re-attendance or emergency admission, because of social care problems. However, previously there has been no evaluation of the significance of ED social work for health and well-being, from the standpoint of older frequent ED attenders themselves. In a preliminary way, our paper provides this through drawing on a small scale Swedish/UK study. Its comparative account of service user feedback underscores the importance of ED social work as a facet of European social work. It indicates that ED social work contributes to the quality of care within emergency departments, acts as a key access point to social services, and can promote both short and longer-term health. At the same time, some serious shortcomings emerge. These include under-developed referral systems, and limitations to community based services following ED social work assessment, which reflect the under-resourcing of social care provision in both countries. Moreover, service users’ experience in both Sweden and the UK reveals the risk of ED social work with older frequent ED attenders being used as a substitute for follow-up medical/nursing care when that is also required.     

An equality of condition framework for user involvement in mental health policy and planning: evidence from participatory action research

Discussions about user involvement in the mental health services tend to throw up four major areas of concern: the capacity of service users to participate, their lack of participation skills, the need for a positive organisational culture and the need for arenas of participation. This article presents evidence from participatory action research with Irish mental health service users which explored how they could more equally participate in advisory committees. Participants identified barriers to their equal participation due to unequal cultural, physical, mental and economic resources, time, power, ‘stigma’(prejudice) and lack of respect for their experiential knowledge and emotional expression. These barriers fall within the ‘equality of condition framework’ developed by Baker and colleagues. Enabling equal user involvement in strategic decision‐making requires more than arenas of participation – it requires comprehensively addressing service users’ structural disadvantages throughout the process of involvement.     

Making it ‘APP’en: service user feedback: developing and implementing a service user APP: reflections from Northern Ireland,England and Scotland

Despite the advent of social media and increasing use of smart phone technology amongst global and UK populations, APP’s for social work remain in their infancy. Several have been developed which focus on the education of social workers and practitioners providing information on specific social work issues, and one we are aware of that explores ethics and values using a games-based approach. In this paper, we discuss the importance of service user perspective in social work practice and how this informed the development of the feedback App. We reflect on developing this instrument using digital technologies which social workers can use to gather anonymous feedback from service users about their experiences of social work interventions. This project, developed in response to demands placed on social work agencies to evidence the effectiveness of service interventions, provide robust data from service users for inspection regimes and sustain service user involvement in improving services. The evaluation model is designed to document the implementation process, exploring what works and what barriers, challenges and lessons were learned by the project team together with how some of the tensions in the process were addressed and resolved.     

Service users and carers’ involvement in social work education: lessons from an English case study

Within the larger context of the search to improve social work practice in Europe, this article presents a case study of a UK innovation in social work education with the potential to radically change social work practice. Following governmental requirements, Anglia Ruskin University has introduced systematic involvement of service users and carers in the training of a new undergraduate degree since September 2003. The conceptual and value base, the structure, staffing, and main activities are outlined; the main achievements and obstacles are highlighted. Mindful of the danger of slipping into tokenistic involvement, the project has included an action research evaluation component exploring the views of all the project's stakeholders thus establishing the project as an evidence-based educational innovation. The findings highlight the value of service users and carers’ involvement on the qualifying social work degree, of the action research design of the evaluation, and the steps needed for the cultural change required for such an involvement to become more comprehensive and embedded in the degree.     

Involving Services Users in Social Work Training on the Reality of Family Poverty: A Case Study of a Collaborative Project

In the last five years there has been an increased drive to include the perspectives and contributions of service users in social work education in the United Kingdom. In this paper we discuss the experience of one project that attempted to bring together service users, academics and practitioners to jointly develop and deliver a module that sought to examine the perspectives of families living in poverty who were in receipt of children and families social work services. Through doing this it was hoped that it would be possible to raise practitioners’ awareness of how poverty impacts on parenting and how they could develop an approach that was non‐punitive and genuinely supportive. The paper starts by exploring the context of service user involvement in social work education and then describes the development and process of this collaborative project. The paper concludes with recommendations for both projects seeking to engage service users in empowering and meaningful ways, as well as social work practice within an anti‐oppressive framework.     

Inter‐professional Learning to Prepare Medical and Social Work Students for Practice with Refugees and Asylum Seekers

Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi‐agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services.

This paper describes the genesis and implementation of a series of innovative inter‐professional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter‐professional learning and practice in relation to socially excluded groups are highlighted.     

“A lot of work needs to be done”—Service provider perspectives of mental health services available to Croatia- and Bosnia-born migrants

Research suggests that migrants have higher rates of mental health disorders but are less likely to access mental health services, which highlights both their vulnerability to mental illness and inequity in service provision. Despite being large and established culturally similar migrant cohorts in Australia, Croatians and Bosnians are invisible in mental health research. This qualitative study collected practice-based evidence from eight mental health service providers who have had direct professional contact with these communities, in order to understand how they engage with services, barriers to uptake and provide suggestions for service improvements. Thematic analysis was used to identify themes across interviews, which were then compared against Yang and Hwang's Migrant Mental Health Service Utilisation Model. The study identified unique factors specific to Croatia- and Bosnia-born migrants that impact how they engage with services, including mandated/prescribed services, religious resources, knowledge resources, referral pathways and procedures, and service provider competencies. This study will promote a better understanding of the limitations of the current mental health service offerings for Croatia- and Bosnia-born migrants, making it significant to practitioners, mental health organizations, policymakers and the general public.     

Project Discovery: Social Work Research @ Southern Health

Abstract

The health sector uses a “person-in-environment” perspective reflected in multidisciplinary teamwork to understand and influence human lives. This standpoint accords closely with social work's knowledge and theory base, recognising that material, economic, political, organisational, and social structures interact, creating a complex array of factors impacting on individuals and families. Practice research activities are an effective way of exploring social work's particular contribution to health service provision. We describe and critique various models of practice research reported in the literature. A unique model of practice research that we are developing is discussed. Called Project Discovery: Social Work Research @ Southern Health 18 June 2011, this model demonstrates ways in which practice research may exemplify theoretically-driven and service-based research and in so doing advance social work's knowledgebase.     

Role-played interviews with service users in preparation for social work practice: exploring students’ and service users’ experience of co-produced workshops

Abstract

Within a Theory and Practice of Social Work module, prior to embarking on practice placements, social work students practised professional communication skills with people who had used social work services. They undertook role-played interviews with service users about real issues, which had led individuals to seek assistance in the past. Using principles of co-production, the workshop was developed in partnership with members of the University’s social work service users and carers’ group. Care was taken to safeguard service users’ well-being, as well as developing an effective learning opportunity. Drawing on evaluations by students and feedback from service users, this paper discusses the process of planning and delivering the workshops, as well as perceived outcomes for both groups. Findings indicate that students valued the opportunity to engage with service users, gaining key learning about their own practice skills. Service users described a boost to self-esteem through contributing to students’ learning. The workshop provides an example of how service user involvement in social work education has evolved from a primary focus on sharing personal testimonies to active participation in student skill development. It underlines the importance of investment in service user involvement to achieve an appropriate context for such projects to develop.     

Culturally Competent Social Work Practice with Veterans: An Overview of the U.S. Military

Despite social work's longstanding history of serving veterans, few resources support culturally competent practice with this population. If social workers are to serve veterans effectively and efficiently, a basic understanding of the U.S. military is essential. This article presents a basic overview of U.S. military including its structure and history, the propensity to enlist in the armed forces, culture, and training methods and objectives. With an understanding of these aspects of military service and continued effort to learn about their client's military experience, social workers will be prepared to provide culturally competent services consistent with the profession's values and ethics.     

Learning from mistakes in social work

A growing number of cases of professional errors in the realm of health and social services appear on media and raise significant public debate. This article focuses on mistakes in social work and looks at how their negative impacts might be reduced through the lens and framework of reflective practice. Using conclusions from the most relevant literature on this topic and some of the outcomes of recent research, the author describes errors in social work in terms of causes (e.g. lack of time and training, etc.) and results (e.g. damaged relationship with users, failure of action plans, burnout, etc.). Learning occurs when social workers conduct an in-depth reflection, alone or together with colleagues. Since human beings will always err, paradoxically reflection on mistakes (with the consequent drop in the harm produced) and not the reduction of their number is the most powerful factor to improve the quality of health and social services. The culture of blame and punishment is one of the main obstacles to an effective social work animated by the genuine culture of responsibility and ethically driven by the overriding interest of service users.     

Service users’ involvement in social work education: focus on social change projects

ABSTRACT

This article presents and analyzes four projects focusing on diverse forms of service users’ involvement in social work training and research in different countries (Israel, Italy, Slovenia and UK). It highlights the value of service user involvement (SUI) to specific social change objectives and to social work education. The conceptual framework focused on the Standpoint Theory, while methodologically participatory action research was applied, and evaluation measures were developed. Key findings, facilitators and limitations to the involvement, students’ views of it and similarities and differences among the four projects are outlined. The challenges embedded in introducing and sustaining social change objectives in a co-production framework within social work education are identified, alongside the added value of meeting them. The differentiated impact the projects had on students is highlighted as well as their significance for health and social care providers were relevant. It is encouraging that in each project SUI was positively valued. The projects indicate the wide range of SUI in the content and format of social work education, as well as its applicability cross-culturally to a range of key issues pertaining to both training and research in social work.     

Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system

While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.     

INSIDE–OUT: RESOCIALISATION FROM PRISON AS A BIOGRAPHICAL PROCESS. A LONGITUDINAL APPROACH TO THE PSYCHODYNAMICS OF IMPRISONMENT1

The social and economic regeneration of inner-city housing estates has been a common feature of successive UK government policies for a number of years. However, their focus has primarily been on the physical regeneration of communities to the exclusion of individuals' emotional and personal problems. Community-based counselling projects are still a rarity in regeneration projects. This article describes the establishment and subsequent history of a counselling project based on an inner-city housing estate in East London, which was undergoing extensive regeneration. It discusses how the service originated from the ongoing work of a participatory action research project and how it challenged stereotypical images of counselling. It demonstrated that free, accessible and locally based counselling services are needed in the regeneration of communities; that extensive planning is necessary both within the organisation and in relation to funding before the project begins; and that on-going core funding is essential to sustaining such innovative and much-needed projects.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Hospital response to the legalization of abortion in New York State: an analysis of program innovation

The reorientation of hospital services in the state of New York to accommodate women's constitutional right to elective abortion was investigated. Market and resource constraints, the social orientations of the organization, and the values of physicians were examined in the effort to evaluate hospital response between 1971 and 1973. Analysis indicates that program innovation in obstetrical and gynecological services to include elective abortion was inhibited by economic factors that generally determined the feasibility of diverting finite resources to a new service and social orientations and values that determined the compatibility of elective abortions with the dominant values underlying hospital operations. The reform of New York abortion statutes and the subsequent ruling by the Supreme Court reiterating the right of women to terminate pregnancy failed to standardize the delivery of health care so that individual rights to service could be obtained everywhere in the state. The social changes ultimately realized through legislative and judicial action were essentially conditional upon the responsiveness of local health care providers. Legal action that failed to specifically address the administrative role of hospitals in social change qualified local access and could not be completely effective in legitimizing the redefinition of abortion in society.     

Socialising disease: medical categories and inclusion of the aged1

When older peoples’ troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over‐socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as 'social problems’. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.     

Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

Narrative social work: conversations between theory and practice

This paper begins by reviewing the current situation in social work practice. It is contended that much of the literature around social work consists of diverse models of practice that urge social workers to take up various theoretical positions. Equally, social workers are often encouraged to listen to the views of service users. In this complexity, it is often difficult for social workers to know which approach to take. This paper goes on to propose a narrative-based approach to social work practice. Narrative social work is defined as a conversation between theory and practice, which can lead to development in both social workers and service users. An example from the lead author's practice is used to outline the model in action. The paper concludes with some comments about the values inherent in narrative based social work.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.