Social Gerontology and Social Work

Summary This paper reviews developments in the study of ageing as anindividual and social experience and it considers recent studiesof practical services for the elderly. In so doing it aims tohighlight the ways in which social work skills and helping techniquescan be developed. It also relates the findings of studies ofservice delivery to the elderly to the development of futurepolicy.     

The Professional Standing of Work with Elderly Persons among Social Work Trainees

Correspondence to Dr Howard Litwin, Paul Baerwald School of Social Work, The Hebrew University, Mount Scopus, 91905, Jerusalem, Israel. Summary A random sample of 93 students of social work in Israel werequeried regarding their perception of the professional standingof work with older people. The general ranking given by traineesto this field of practice was moderate to low. Relatively positiveevaluation of the status of gerontological practice, however,was found to be explained by: (1) a traditional view of therole of the elder in society; (2) the perception that peersattribute prestige to such work; and (3) having had a fieldpracticum in the area of ageing; and was inversely related tounderstanding of work with elderly persons as mainly indirectintervention. The implications of these findings for the promotionof social work practice with elderly people in an ageing societyare discussed.     

Stress and Coping in Social Workers: A Preliminary Investigation

Correspondence to Dr Paul Bennett, School of Psychology, University of Wales College of Cardiff, P.O. Box 901, Cardiff CF1 3YG. Summary Three groups of social workers (child, adult mental health orhandicap, elderly or physical handicap) completed a questionnaireexamining sources of stress, coping strategies, and stress outcomes(e.g. anxiety, depression). All respondents reported high levelsof stress, although stress resulting from factors intrinsicto the job, relationships with other people, and from the organizationalstructure were greatest among childcare workers. In addition,these workers reported greater emotional involvement with theirclients and higher levels of general anxiety and depression,as well as job related mental distress. The implications ofthese findings are discussed in relation to training, job designand support of social workers.     

Beyond Social Constructionism: Critical Realism and Social Work

Summary Theories within the social and psychological sciences continueto shape social work practice. However, recent debates withinthese sciences on the shortcomings of ‘social constructionism’,and the attempt to overcome them through a critical realistposition, have so far failed to capture social work's attention.This paper provides a critical overview of these theoreticaldebates, highlighting the shortcomings of social constructionismfor social work. The critical realist challenge to social constructionism,as articulated by the British philosopher Roy Bhaskar, is consideredand its relevance to social work formulated in terms of a returnto ‘depth’ in practice.     

Mental Health and Social Justice: Gender, Race and Psychological Consequences of Unfairness

Correspondence to: Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. Summary It is not immediately obvious how social justice might relateto mental health. Mental health or ill health is, by some, thoughtto be inherent within the individual, whereas social justice,as its name indicates, resides within the realm of the social.However, where we understand social justice as, on the one hand,an issue involving equality and fairness, and on the other ashaving both material and symbolic dimensions it becomes clearthat there is an important link. In particular groups whichsuffer disadvantage and discrimination may be expected to sufferhigher rates of mental ill health. However, the key to understandingthis is by identifying the mechanisms by which this can happen.In order to do this it is necessary that we do not look at mentalhealth (or illness) in an undifferentiated way, since thereare different processes involved for different forms of mentalill health. We shall, therefore, look at this by focusing onthe issue of social justice through two significant relationships:gender and depression, and race and schizophrenia. We shallexamine the mechanisms which link these together, and show howthey are significant psychological consequences of social injusticearising in both material and symbolic form.     

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.     

Assessing Child Protection Risk

Correspondence to Lorraine Waterhouse, Lecturer, Edinburgh Centre for Social Welfare Research, 23 Buccleuch Place, Edinburgh EH8 9LN. Summary The article outlines a set of child protection criteria usedby social workers for the evaluation of risk in sexual abusecases. The criteria were distilled from research findings basedon a sample of 51 child sexual abuse cases drawn from ChildProtection Registers in Scotland in 1987/89. Criteria dividebetween two types: primary (child care) criteria which concentrateon assessing circumstances prevailing within the family home;and secondary (disclosure) criteria which serve to either substantiateor refute disclosure. Primary criteria include attitude of non-abusingparent to alleged perpetrator; access between referred childand alleged perpetrator; type of abuse; age of child or youngperson; attitude of alleged perpetrator to allegations; andparental attitude to social work investigation. Secondary criteriainclude belief or disbelief of child; psychological symptomsin child; physical signs of abuse; children's attitudes towardsremaining at home; and criminal or psychiatric history includingalcohol or drug abuse. In practice the criteria tend to be usedlike a set of building blocks: tall towers represent higherrisk; low towers lesser risk. Given the enormous stakes involvedin child protection decisions, front-line practitioners wereunder considerable pressure to ‘play it safe’.     

Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.     

The Fieldwork Team Response: An Investigation into the Relationship between Client Categories, Referred Problems and Outcome

Correspondence to Peter C. Burke, Lecturer in Social Work, Department of Social Policy and Professional Studies, The University of Hull, Hull HU6 7RX. Summary This paper concerns a study of the outcome achieved followingfieldwork responses to referred client problems within particularclient categories. The evidence from the study demonstratesthat while referred client problems initiate the social workresponse, administratively assigned client groups were a betterdeterminant of outcome. It is shown that the category of a caseis more directly related to outcome than is the problem referred.If social work is to be predominantly based on client categorizationthen polarization will result, represented by an increasinglyprofessional child care practice and a more basic servicingrole for the worker with elderly and handicapped people. Thispresents dangers for the organization of teams, the allocationof resources, and the training of social workers. Taking accountof client problems as part of caseload management should reducethis effect.     

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’.     

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.     

A Natural Locally-Based Networking Approach for Singleton Disabled Elderly: Implementation and Case Illustration

Correspondence to Dr. Yip Kam-shing, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: SSKSYIP{at}POLYU.EDU.HK Summary Hong Kong is a high industralized and commercialized city-sizedregion. Within such a business-orientated and competitive lifestyle,the elderly usually are the ones who have poor social supportand social networks. Many singleton elderly lead lonely liveswithin the community. The Good Neighbour Centre of the UnitedChristian Nethersole Community Health Service in Hong Kong hasimplemented a natural locality-based supportive networking approachfor disabled singleton elderly in a public estate (1991-2000).As part of this approach, various psycho-social interventionswere developed over nine years to strengthen mutual supportamong neighbours, able-bodied elderly, outpatients sufferingfrom mental illness and volunteers who were matched and integratedwith the disabled singleton elderly person to form a locality-basednaturally supporting community. Different stages of developinga natural, supportive community by networking were identifiedin this project: network assessment, network matching, networkformation and network strengthening. The concepts of stableand constant mutual support, mutual development and mutual concernwere stressed. Feedback from stakeholders was encouraging andthe demonstrated improvement in the functional and psycho-socialwell-being of disabled singleton elderly and mental health outpatientswas impressive and clear. Also, according to the principlesof the strengths perspective, the approach was strength oriented,that is it cultivated the potential strengths within a locally-basedcommunity: challenging the care and concern of members withinthe community through the loneliness of singleton elderly; developingthe mutual support and nurturing new supportive resources withina locally-based community. Further research may help to consolidatethe effectiveness of this approach through new strategies.     

Social Work as an Aspect of Primary Health Care: The Social Workers' View

Summary This study is based on an analysis of social workers' viewsof their work with 168 clients referred over a six month periodin 1977 in a health centre setting. A wide range of referralswas made and there was close collaboration with other primaryhealth care professionals as well as outside agencies. Far morepsycho-social problems were encountered by the social workersin the course of their intervention than were apparent on referral,although most of the work was short term. Social work with theindividual predominated and a variety of traditional socialwork skills were employed, although the elderly received relativelylittle help with emotional problems and were offered mainlypractical help. Social workers' perceptions of their clientsare discussed in relation to their choice of methods of interventionand feelings of efficacy. The attachment scheme emerges as generallyfruitful both in terms of social workers' job satisfaction andclients benefitting from a multi-disciplinary approach; howeverthe need for closer inter-professional collaboration in meetingthe needs of the elderly is highlighted.     

The Act of Understanding

Summary Attention is drawn to experience that much social work has beenundertaken on a base of common sense, personal intuition andfeelings that the client's situation has been 'understood'.Medical, sociological and psychological sources for theory whichhave given status to objectivity and implicitly deterministicways of thinking are criticized as sometimes contrary to usefulunderstanding and not supportive to constructive change. Itis claimed that a goal of social work theory should be to disciplinethe 'understanding' which exists in the practice and it is suggestedthat this might be based upon the investigation of the meaningwhich people give to the world in which they live and to theirself within that world. This phenomenologkal approach placessubjectivity and the role of the self-concept at the focus ofattention. As a working philosophy it incorporates the formativeinfluences of past experiences whilst also asserting the primacyof the person who may impose a new significance upon both thosepast events and his immediate situation. It is claimed thatsuch an approach might be the source of a discipline which couldrelate more intimately than hitherto the theory and good practiceof all concerned with social welfare and social change.     

A New Approach to Community Care for the Elderly

Summary Organisations can absorb successfully only a few fundamentalinnovations within a short period of time. It is therefore importantfor the designers of innovations to ensure that they directlyand substantially contribute to solving important problems,and for agencies to concentrate their innovative activity onthose that do so contribute. The first aim of this paper isto analyse the policy context so as to clarify the nature ofthe problems that make innovation in the care of the elderlyimperative and show how features of the Community Care Projectcontribute to their solution. The second aim is to provide somepreliminary evidence of the success of the scheme. The analysisof data for seventy persons in the experimental and controlgroups shows that the experimental group fared better in a numberof important ways; and that the gains appear to have been madeat no extra cost to the social services department. Therefore,it is concluded, the adoption of the scheme may contribute tothe technical progress needed in the provision of social serviceto the elderly with needs at or above the margin for residentialcare.     

A System for Monitoring Social Work Activity with the Frail Elderly

Summary This paper describes the development of a recording system foruse by social workers in the long term care of elderly peopleat home. The system can be used by individual staff to plottheir caseload activities and by management in considering problemsof resource deployment. The system consists of Assessment Document,Periodic Case Reviews, a Monitoring Chart and Costing information.The analysis of a cohort of cases in the early phase of theircare are discussed and the possible range of uses for such arecording system considered.     

Controlling for Care: Private and Voluntary Homes Registration and Inspection--A Forgotten Area of Social Work

Summary The size and growth of private and voluntary residential careprovision for the elderly make it, despite past neglect, a subjectof great importance to social workers. Drawing on exploratoryresearch data, the origins and role of registration and inspectionare discussed and some of the shortcomings of the present systemhighlighted. The paper discusses necessary requirements to preventfinancial exploitation of the elderly and makes two modest suggestionsfor improving and maintaining the quality of care-designatedliaison officers and a complaints procedure. In conclusion,however, it is pointed out that quality is not the only issuein the regulation of the private and voluntary sectors, thereare also issues of quantity, type and location. None of theseare being addressed by recent legislation and Code of Practice,but their resolution is important in ensuring that elderly peoplereceive the care they want and need, when and where they wantit.     

Explanation and Education in Social Work

Summary Social work education has to confront the problem of workingwith students in developing an understanding of the range ofexplanations that exist in the social sciences and the differentbases of these explanations. One pedagogic approach is to explorea map of categories of explanation based upon different conceptionsof the nature of social science knowledge itself. Such a map,outlined in the paper, would distinguish between physical scienceparadigms and human science paradigms and identify the differentimplications for social work of the various viewpoints. Theteacher cannot remain neutral with regard to explanation inthe social sciences; the author therefore indicates that hisown account is based on a marxist perspective     

The Impact of Religiousness,Spirituality, and Social Support on Psychological Well-Being Among Older Adults in Rural Areas

Summary

This paper presents the results of a study on the impact of spirituality, religiousness, and social support on the psychological well-being among rural elderly. With a rural community sample of 215 older adults, hierarchical regression analyses found significant associations between dimensions of spirituality/religiousness, social support, and psychological well-being, with spirituality/religiousness inversely related to depression and social support, positively related to life satisfaction. Findings of this study suggest that practitioners need to develop programs or services that are congruent with religious/spiritual beliefs and practices in order to better enhance the psychosocial well-being and improve the quality of life among older persons in rural areas.     

Sexual Abuse by Men who Work with Children: An Exploratory Study

Correspondence to Dr Matthew Colton, Department of Social Policy and Applied Social Studies, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK. Summary This paper reports findings from an exploratory study on sexualabuse by men who work with children. As a first step towardsfilling a major gap in the relevant research literature, in-depthinterviews were carried out with a small sample of men servingprison sentences for sexually abusing children in their trust.The paper focuses on their accounts of their life histories,including their experiences of prison treatment programmes,and provides a detailed picture of their thinking, feelingsand motivations. In revealing how the men construct their ownsense of masculine identity within social and professional contextsthat are dominated by a heterosexual, white male hegemony, thepaper challenges purely psychological explanations of why mensexually abuse. It concludes that sexual abuse in organizationalsettings is less likely to be challenged if masculinity is notfocused on as an issue of power.