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.     

Evaluating Social Work and Medical Practice with Black and Ethnic Minority Groups Using the Clinical Audit Model

Correspondence to Kish Bhatti-Sinclair, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Summary This paper is based on the External Audit-Ethnically SensitivePractice (EA-ESP) project which was undertaken within six primaryand secondary health care settings. This project is used asan example of how the clinical audit model can be used to monitorand review health and social work practice in the UK. The paperexamines quality, compares approaches to evaluation, and suggeststhat audit can be a useful tool for agencies in obtaining userand staff views on many areas of practice but in particularon equal opportunities, anti-racism and anti-oppression. Attentionis drawn to audit within broader evaluative and review approachesalready employed by social work academics and practitioners.The issue of quality and how it can be measured is consideredthrough an analytical comparison with approaches which employaction research and other evaluative means in the process ofreview. Audit is explored in the context of a growing need for the developmentof monitoring and review systems which provide evidence to supportand develop professionalism within social work. External auditis explored and compared to internal audit. Finally, the needfor the development of quality services in anti-racist and anti-oppressivework is highlighted and it is suggested that audit can be acost-effective and efficient way of achieving this.     

Children's Homicide and Road Deaths in England and Wales and the USA: An International Comparison 1974-1997

Correspondence to Professor Colin Pritchard, Department of Mental Health, University of Southampton, Southampton SO14 OYG, UK. Summary Child murder often leads to demands for new legislation. Todetermine relative risks and the need for such change, children's(0–14) homicide and road deaths were compared internationally.All data were extrapolated from WHO standardized mortality statisticsand ratios of change were calculated. Five-year summed actualnumbers and rates for 1974–78 and 1993–97 were usedfor comparison. The findings indicate that children's road deathsfell substantially everywhere across the two periods; Englandand Wales had the lowest rate, and the fifth biggest reduction.In addition, in every country, the figures for children's homicidewere substantially lower than road deaths. England and Waleshad been fourth highest but by the later period were the thirdlowest. While children's homicide rose substantially in Franceand the USA, the biggest reductions were found in Japan andin England and Wales. For every country considered, road deathsfell proportionately more than deaths by homicide, althoughthe latter remained considerably lower than road deaths. Thestatistics led to the clear interpretation that the averagechild is substantially more at risk of being killed on the roadthan being murdered.     

Search for an Indicator of Effective Child Protection in a Re-analysis of Child Homicide in the Major Western Countries 1973-1992: A Response to Lindsey and Trocme and Macdonald

Correspondence to Professor Cohn Pritchard, Department of Social Work Studies, University of Southampton, Southampton, SO17 1 BJ England Summary An analysis of child homicides published in the British Journalof Social Work, demonstrated major falls in child deaths inEngland and Wales between 1973 and 1988. The results were seenas one indicator of improved child protection (Pritchard, 1992a).That study, and a reply to a critique by Creighton (1993), werechallenged by Lindsey and Trocmé (1994) and Macdonald(1995). This paper is a response, and takes advantage of thecriticisms and new data to present evidence which confirms thatthere have been reductions in child homicide in England andWales between 1973 and 1992 and that the Anglo-Welsh improvementswere the best of all the major Western countries.     

Unemployment, Age, Gender and Regional Suicide in England and Wales 1974-90: A Harbinger of Increased Suicide for the 1990s?

Correspondence to Prof. Colin Pritchard, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 SNH. Summary The Department of Health's Health of the Nation aims at a substantialreduction in suicide; this is a ‘vote of confidence’in the effectiveness of the community psychiatric and healthservices. However, it will be shown that a number of socioeconomicchanges have occurred which may lead to increased suicide; forexample British male suicide rose in the 1980s, significantlyassociated with unemployment. Though female suicide fell substantiallyover the period, across the regions suicide rates for both menand women were worse amongst the ‘work age’ bands,16–44 years, than the older groups. In respect to therelatively poorer rates amongst younger women, this may be linkedto unemployment and their unfulfilled job expectations. If thesuicide targets are not met, it is feared that the ‘failure’will laid at the door of the community and health services.     

Towards an Alternative Model of Social Groupwork

Summary This paper arose from our disagreement with some of the suggestionsin an earlier article in this journal (Brown et al., 1982).Before and since, we have both worked in and studied numerousexamples of groups of a type which, according to Brown and hiscoauthors, scarcely exists in British social work practice.This paper explains what we believe to be the actual significanceof the type of group work we refer to as ‘self-directed’,together with our view of its place within wider social work,community work, and groupwork practice. We also give examplesof such groups and conclude that their proliferation would enableworkers to go beyond the alleviation of individual distressinto the achievement of external change.     

Modernity, Postmodernity and Social Work

Correspondence to Prof. David Howe, School of Social Work, University of East Anglia, Norwich NR4 7TJ. Summary For so long in search of a common base, there are early signsthat social work's intellectual outlook is fragmenting. Theunity that was once sought in both theory and practice as wellas policy and organziation is being abandoned. A child of modernity,social work now finds itself in a postmodern world, uncertainwhether or not there are any deep and unwavering principleswhich define the essence of its character and hold it togertheras a cohernt enterprise. The article outlines some of the characteristics of modernityand postmodernity, relating them to the rise of social work,its formation within modern society, and its current conditionin what many observers believe is a postmodern world. Thereare three ‘visions’ within which people look toleam the ’truth‘ of things, including matters offact and matters of value: those centred in God's word (revelation);those centred in the minds of men and women (reason); and thosede-centred and dispersed withing language, meaning and culture(relativism).     

Cost and Stakeholder Views: A combined approach to evaluating services

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 5NH Summary This paper focuses on the decision-making process at a strategiclevel in the context of implementing a ‘community care’policy for older people with mental health problems. It is basedon the findings of an evaluative study of the implementationof one district health authority's strategy for the decentralizationof its mental health services for older people. The study wasan attempt to develop an evaluative approach which acknowledgedthe importance of cost, but also the need to include the viewsof the several ‘interested parties’, not least thosewho used the service. The reconciliation of what might be seenas the conflicting interests of the wider public for a carefulutilization of resources with the individual's needs for anaccessible and responsive service represents a major challengefor planners, managers and practitioners within the public sector.This paper argues the need for dialogue as the basis for partnershipbetween those with a primarily financial focus to their workand those more intimately concerned with individual needs.     

Integration and Inclusion: Illusion or Progress in Services for Disabled People?

This paper analyses the meanings of "integration" and "inclusion" in the context of disability services to determine the extent to which the latter signals a change in perspective rather than simply a change in terminology. It is argued that integration implies that disabled people need to be integrated into "mainstream" society and that it is they rather than society which is required to change. The policy response which results from this approach may thus be a technical one which focuses on physical integration alone. In contrast, inclusion takes as its starting-point the fact that a just state of affairs is one in which disabled people are included in society and hence the required policy response is a broad one which includes comprehensive civil rights legislation, an analysis of the effects of present and future policy on disabled people and the participation of disabled people in the democratic decision-making process. However, as disabled people are currently excluded from many aspects of society, the potential for an inclusive approach to be dismissed as being too idealistic is noted, and a number of possible barriers to its realization are discussed. It is concluded that whilst such barriers exist they should not, in themselves, provide a reason for inaction as an understanding of the implications of inclusion for policy and practice can provide a useful starting-point from which to bring about change.     

A Comparison of Child-sex-abuse-related and Mental-disorder-related Suicide in a Six-year Cohort of Regional Suicides: The Importance of the Child Protection-Psychiatric Interface

Correspondence to: Professor Colin Pritchard, Department of Mental Health, School of Medicine, Southampton University, Royal South Hants Hospital, Southampton SO14 0YG, UK. E-mail: cp1{at}soton.ac.uk Summary The study compares Mental-Disorder-Related (MDR) suicide rateswith Child-Sex-Abuse-Related (CSAR) suicide of ‘Victims’and ‘Perpetrators’ of child sex abuse, based uponan examination of all Coroners’ inquest files over a six-yearperiod (n = 1,017). Census data, psychiatric case register andpolice records were used to calculate the potential MDR andCSAR populations. There were five main findings: (i) male andfemale CSAR victim suicide rates were 2.2. and 2.5 times theGeneral Population Suicide Rate (GPSR), respectively; (ii) everyfemale, and 80 per cent of male CSAR victim suicides, also hada mental disorder but none of the CSAR perpetrator suicides;(iii) male and female MDR suicide rates were 5 and 6 times theCSAR Victim rates; (iv) the sex abuser perpetrators’ suiciderate was more than 3 times the male MDR rate; (v) the intra-and extra-familial perpetrator suicide rates, were 25 and 78times the GPSR, respectively. Possible explanations for thesesurprising results are briefly discussed. They confirm the overrepresentationof people with mental disorder amongst suicides, and identifyan overrepresentation of CSAR suicides, particularly perpetrators.The results have implications for suicide prevention programmes,whilst highlighting the importance of the child protection-psychiatricinterface, and indicates the futility of simple explanationsin an area of practical and moral complexity.     

Adolescents in Care and their Social Workers: A Research Note

Summary There has recently been an increasing concern that young people,and especially those in residential care, should be encouragedto express their views, and that the views expressed shouldbe used in improving the care which they receive. The publicationof the Who Cares? booklet (Page and Clarke¹), and the emergenceof ‘Who Cares’ groups and the ‘Voice of theChild in Care’ organisation, is evidence of this concern.In sympathy with these developments has been a study of adolescents'perceptions of social workers, and a part of this research hasincluded a pilot study of the views of adolescents living intwo family group homes.     

Advocacy for disabled children and young people: benefits and dilemmas

Recent policy has emphasized the need for advocacy services for children and young people, developments that have gone hand‐in‐hand with greater levels of participation of young people in decision‐making. Advocacy for disabled young people is especially important, as they are a particular vulnerable group and have, traditionally, been even more excluded from decisions about matters affecting their lives. This paper reports the findings, as they relate to disabled young people, from a study that investigated the role of advocacy for looked‐after children and children in need. The paper highlights some of the benefits of advocacy for disabled children, the dilemmas facing advocates between advocating and acting in someone's ‘best interests’, identifying the client and the boundaries between advocacy and social work. It argues that time given to establish a close relationship with a disabled child or young person is crucial if advocacy is to be effective and participation in decisions affecting their lives a reality.     

Who volunteers?

Summary The 1990 NHS and Community Care Act outlined an extended rolefor volunteers and voluntary organizations in the provisionof services for disabled adults and older people. In broad terms,the Act assumed an untapped pool of volunteers, ready to contributeat little additional cost to the provision of care. More recentpolicy developments, including Millennium Volunteers (ScottishOffice 1997) have made similar assumptions. For organizationswhich involve volunteers, the expectations of their increaseduse in service provision present considerable challenges, notleast in attracting new recruits and retaining existing volunteers.The research presented in this paper builds on previous workto explore the current practice and organization of volunteeringand to examine critically how far the reality matches the politicalrhetoric about the role of volunteers in the mixed economy ofcare. The paper begins with a critical review of recent policyand practice in volunteering to set the context which providedour key questions. The research methodology is briefly describedand the findings from a survey of 117 active volunteers workingwith adults with learning difficulties, mental health problemsand physical disabilities, and with older people in the Northof Scotland are presented. The research examines the demographyand personality profiles of the volunteers. It examines theirperceptions of volunteering as these relate to motivation, recruitment,selection, training, support, rewards and reasons for leaving.Finally, it examines volunteers' perceptions of the organizationof volunteering. The results are reviewed in relation to thepolicy assumptions about volunteering in the mixed economy ofcare.     

Social Work, Liberty and Law

Correspondence to Professor John Williams, Department of Law, University of Wales, Aberystwyth, SY23 3DY, UK. E-mail: jow{at}aber.ac.uk Summary The relationship between law and social work is complex. Doeslaw assist practitioners to promote rights, or is it confinedto ensuring accountability and regulating practice? This articleexplores law's role, and its limitations, in promoting liberty,or more accurately ‘constitutional liberty’. Doeslaw provide practitioners with liberty-based values capable,if necessary, of legal enforcement? The paper argues that thereis no simple answer; law impacts on social work in differentways and there is little consistency across and within clientgroups. However, it concludes that law is one of the tools thatsocial workers can use to promote liberty.     

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.     

Probation and Social Work

The paper considers the representation of probation themes inthe British Journal of Social Work (BJSW) since the early 1990s,and reviews developments in probation policy and practice sincethen, with a focus on the relationship between probation practiceand social work. It argues that emerging research evidence supportsthe view that effective probation practice is likely to be informedby values and skills that are recognizably within the traditionof social work, and concludes that despite pressures to abandonsocial work as a basis for probation practice, it is not obviouswhat the alternative could be.     

Temporary Foster Care

Summary In order to improve outcomes in temporary foster care the authorbelieves there is a need to develop alternative models for practicethat would (a) define the social work task (b) specify in operational terms how that task would be accomplishedand thus would be amenable to empirical testing. (Temporaryfoster care is defined as the provision of substitute familylife for a child received into care, where there is a clearintention to re-unite the natural family at a future date). This article deals with the essential preliminaries to the developmentof a practice model. The first part surveys the relevant literature;part two develops a theoretical framework for practice aroundthree themes which are considered central to a considerationof foster care. These are the separation experience, the placeof the natural family, and role clarification. Other crucialvariables such as the age of the child, the nature of the problem,or the parents' potentiality for change are not dealt with withinthese papers, but are nevertheless seen as important issuesto be considered at the stage of designing a model for practice.     

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.     

Children's and young people's experiences in various residential arrangements: a longitudinal study to evaluate criteria for custody and residence decision making

Summary The child's welfare or the child's best interest is, in manycountries, the court's paramount consideration for determiningcustody and residence of a child after parental separation ordivorce. This longitudinal study evaluates the custody criterionchild's relationships and residence preferences. Based on aqualitative study design including interviews with childrenand parents, the experiences of 62 children of separated ordivorced parents in various residential arrangements are analysed.The main findings are: (i) a residential arrangement in accordancewith the child's relationships and residence preferences accordswith the child's welfare and represents a positive living situationwith loved people in the family and social environment; (ii)the personal relationships of the child are in no way static,but demonstrate a noticeable dynamic as they change under theinfluence of internal and external factors. Therefore a timelychange of residence, which occurs in accordance with the changedemotion preferences of the child, is beneficial; (iii) a residentialarrangement contrary to the child's relationships and residencepreferences represents for the child involved a difficult situation,which can lead to one of three different processes: adjustment,a trajectory of suffering or initiatives to change the livingsituation. This means that some children adjust, others experiencetrajectory processes of suffering, and those in the remainingcases act as competent social agents, who can autonomously representtheir own interests and pursue them in order to initiate orcontribute to a change of their residence. Findings of the studyare discussed, and suggestions are offered for substantive andprocedural laws to guarantee the child's welfare in custodyand residence settlements and for further research.