Ambiguity and Cooperation in the Implementation of Adult Protection Policy

Using a classification of public policy developed by Matland, we examine implementation of policy on adult protection as outlined in ‘No Secrets’, the government's guidance to local agencies. This policy appears to exemplify a ‘high‐ambiguity/low‐conflict’ model. Detailed interviews with staff charged with developing multi‐agency procedures, in local authority departments, health authorities, the police and the voluntary sector, confirmed the ambiguity of the policy and the uncertainty experienced by staff as a consequence. However, the interviews also revealed a number of areas of conflict, particularly as people gave precedence to their own professional norms and organizational priorities over partnership working.     

Child and family social work: organizational context and identity

In the years since 1948, child and family social work has, to differing degrees at different times, sought to identify itself with a national centrally directed service, with the local service organization, with its clientele and with an independent source of professional regulation. Changes in the organizational context in which the work has been carried out over this period have affected the prospects for the development of a secure identity. The effects of the following are considered: national structures, particularly in relation to children's departments between 1948 and 1971; the corporate local authority; the managerial function in social services departments; social care; specialization; the detailed scrutiny of practice; care management and the Children Act 1989.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

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.     

Chronic Child Abuse: The Characteristics and Careers of Children Caught in the Child Protection System

The introduction of the Quality Protects initiative in Englandand the focus on performance management has challenged socialservices departments to examine the systems, processes and outcomesfor children who have their name on a child protection register.Research indicates that approximately one-quarter of the situationsin which children are registered could be described as chronic—thatis, they remain on the child protection register for significantperiods of time, experience more than one period of registrationor suffer a further incident of significant harm whilst subjectto a child protection plan. In this article, the findings froma research study conducted into this group of vulnerable childrenare reported, focusing on the characteristics of the childrenand their families, and their careers in the child protectionsystem. The paper concludes with observations about the weakconceptualization of performance management and the need torecognize the complexity of the factors that influence children’scareers in the child protection system.     

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

‘Street‐level Bureaucracy’ Revisited: The Changing Face of Frontline Discretion in Adult Social Care in England

This reassessment of the continuing significance of Lipsky's (1980 ) work on ‘street‐level bureaucracy’ for frontline decision making is based on a retrospective review of the author's research on assessment practice in adult social care in England. The studies span the past two decades during which time successive governments have restructured and modernized social services departments. When these were established in 1970, they represented the high watermark of bureau‐professionalism – a mode of administration which dominated social welfare at the time Lipsky was writing. The subsequent dismantling of bureau‐professionalism calls into question the validity of his findings, and the author draws on her own research to assess conflicting views about the impact of social care reforms on the discretion which social workers exercise as street‐level bureaucrats. She concludes that the distinct types of discretion to emerge from her findings, represented in a taxonomy, are shaped by the differing micro environments of frontline practice which, in turn, affect the relative force of managerialism, professionalism and user empowerment in countering the defensive exercise of discretion described by Lipsky. Whilst her analysis affirms the continuing significance of Lipsky's analysis, it also points to the need for some revision to accommodate major shifts in welfare administration since the publication of his work. She highlights the potential relevance of these insights for investigating the next planned transformation of adult social care, personalization, as well as for the implementation literature more widely.     

The New American Social Work Gospel: Case Management of the Chronically Mentally III

Correspondence to Dr R. A. Cnaan, School of Social Work, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA. Summary Case management is currently the most popular mode of servicedelivery in the United States, especially in community programsfor chronically mentally ill people. Proponents of case managementclaim that it is cost-effective and that it assures provisionof necessary services to clients. In this paper I do not challengeits effectiveness but argue that case management neither empowersclients nor is it free of drawbacks. Given that many countriestend to model the United States, foreign social workers andother human service professionals should first examine the usefulnessof case management vis-à-vis their own cultural and economiccontexts, especially in the light of its many drawbacks.     

Have Child Protection Efforts Reduced Child Homicides? An Examination of Data from Britain and North America

Correspondence to Duncan Lindsey, School of Public Policy and Social Research, Department of Social Welfare, University of California, Los Angeles, 247 Dodd Hall, Los Angeles, CA 90024-1452, USA. Summary In a recent British Journal of Social Work article examiningtrends in child homicide statistics collected by the World HealthOrganization (WHO), Colin Pritchard attributes a reduction inchild homicides in England and Wales to improved effectivenessof child protection services. However, further analysis of theWHO data show that the decrease in England and Wales is dueto an unusual single-year drop in homicide rates, and that thereis no evidence of a long-term downward trend. Examination oftrends in Europe and North America show that there are no consistentpatterns in fluctuations in child homicide rates, and in particular,no evidence that fatality statistics have been influenced bythe rapid expansion in child protection efforts.     

Movers and Stayers in Care Management in Adult Services

Professional biographies of care managers in the mid-ninetiesand, seven years on, their profiles and career choice are thefocus of this article. The work draws on two linked studiesbased on adult services in two social services departments.The profile of those who stayed in post and those who movedon raises issues for the social work profession, for managersand for policy makers. Those who stayed constitute an experiencedworkforce of middle-aged, predominantly female practitionerswith mixed views about the changing nature of the work. Thosewho moved include a group of females who became managers bydefault. The work raises issues concerning work pressures, genderprofiles within an ageing workforce, and succession planning.The findings link to more extensive workforce studies and contributetowards debates concerning the occupational identity and thefuture of qualified practitioners within a human services landscapewhich is constantly being reshaped within a culture of new managerialism.     

Ethical Assessment of the Use of Influence in Adult Protective Services

The role of influence in social work practice has been generally understated despite its importance to the course and outcome of the clinical process. This paper examines the influence strategies used by adult protective service workers with clients who refuse the services that the workers think the clients need for their own protection. It then discusses the moral justifications provided by the workers for using influence to overcome their clients' reluctance to comply with their recommendations. Finally it suggests questions to guide an ethical assessment of the use of influence in practice.     

Implementing the Children Act: The Regulation of Day-care Services for Young Children

Correspondence to Julie Bull, Research Officer, Thomas Coram Research Unit, University of London, Institute of Education, 27/28 Woburn Square, London WC1H 0AA Summary This article presents the findings of the first stage of a studyundertaken by the Thomas Coram Research Unit at the Universityof London for the Department of Health. The study aims to monitorand evaluate the implementation of Parts III and X of the ChildrenAct, which relate to the provision of dhy-care and pre-schooleducation for children under eight. The article reports thefindings of the first stage of the study on the aspects of implementationinvolved in the regulation of children's services, which isone of the most significant of the changes heralded by the Actfor under-eights' services. Based on the findings of a studyin eighteen English authorities and eight Welsh counties, thearticle outlines the different approaches taken to regulationin terms of organizational structures, degree of consultationwith providers, and overall approach to implementing the newsystem. The response of providers as reported by local authoritystaff is also discussed. The findings of the study are set inthe context of the current policy debate about the role of regulationand the status of the recommendations in the Guidance accompanyingthe Act. As well as outlining the degree of vanation found amongauthorities and indicating some of the ‘pressure points’in implementation, the article raises issues of critical concernabout the role of regulation in the context of the private marketof day-care provision.     

Specialism, Genericism and Others: Does it Make a Difference? A Study of Social Work Services to Elderly People

Correspondence should be addressed to Roger Fuller, Social Work Research Centre, University of Stirling, Stirling, FK9 4LA Summary A previous paper published in this journal (Fuller and Petch,1991) described a preliminary feasibility study designed toinvestigate the effects of organizing social work teams alongspecialist or generic lines. The main study which developedfrom this work is here reported. The study, using modified casereview forms, compares the way samples of referrals of elderlypeople (n=1232) were dealt with at initial assessment and forup to a year subsequently by 15 social work teams of contrastingorganizational approach. The latter include specialist and genericteams, and comparisons are also drawn with teams adopting aself-styled community social work approach. Although the organizationalagenda has moved on since the study began, the issues are ofcontinuing relevance for the implementation of community care,particularly in view of its growing focus on specialist services.While not arguing that there is any one optimal model of teamorganization, the paper sets out some of the measurable consequencesof opting for the various models; in particular, it emergesthat the strengths of specialization are more clearly apparentin certain aspects of their engage ment with clients than inothers and at certain stages of that engagement than at others.     

Show Me the Way to go Home: A Narrative Review of the Literature on Delayed Hospital Discharges and Older People

Correspondence to Jon Glasby, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Edgbaston, Birmingham B15 2RT, UK. E-mail J.Glasby{at}bham.ac.uk Summary This Research Note reports findings from a narrative reviewof the literature on the rate and cause of delayed hospitaldischarge in the UK. In addition to summarizing our knowledgeto date in this important area, the Research Note raises a seriesof questions about aspects of current hospital discharge policyand practice (and in particular, the recent reimbursement policyto charge social services departments for delayed discharges).     

Towards the Disintegration of Child Welfare Services

This paper examines market issues in the provision of children's services in the light of the changing role and practice of local authorities contracting for welfare services. In adult services, where there has been a legal requirement to reorganize on market lines, the services have had to modify some of their earlier contracting practices to take account of the complex requirements of health and welfare services and it is argued that relational contracting offers a more appropriate paradigm for these. Following the implementation of the Children Act 1989, although not a requirement of the Act, many of the organizational systems in relation to markets, originally developed for adult services, have been adopted for children's services. Two areas of services for children, day care and fostering services, are discussed in order to demonstrate that these contracting systems are inappropriate and often dysfunctional for the children concerned. It is argued that there is a widening gap between contracting systems in adult and children's services which needs to be addressed. In general, it is concluded that the philosophies of the market place are flawed when applied to children's services.     

地方治理与农民工保护

本文从地方治理的角度分析了国家的农民工保护政策在珠江三角洲地区未能得到有效执行的原因。并揭示了国家的农民工保护政策主要是通过地方政府来执行的,但是如今地方政府的权力和合法性基础已经受到了削弱,限制了地方政府在监管劳动力市场、为农民工提供社会保障和公共服务方面的能力。本文还提出了如何将农民工进一步纳入地方治理结构,充分组合各种社会组织和市场力量来保护农民工权益的政策建议。     

A Study of a Total Social Services Care Population and its Inter-Agency Shared Care Populations

There are very few large population studies and little informationabout the characteristics of social services populations andthe inter-agency populations that social services departmentsshare with other agencies. This study fills this gap. It examinesa total social services adult care population, excluding residentialcare homes (N = 19,461) in the context of its general co-terminoushealth authority population (N = 646,239). Approximately two-thirds(61 per cent) of the social services population were women,compared to the health authority population of 51 per cent.Sixty-two per cent were over sixty-five years compared to 23per cent of the health authority. Age groupings and genderedpatterns of service use are then identified for different caregroups. The study then examines care populations shared betweensocial services and other agencies, identifying the amount ofshared care and the characteristics of specific shared caresubgroups. Forty-two per cent of the social services populationwere shared with the community health trust and 19 per centwith the mental health trust. The proportion of the social servicespopulation in contact with Criminal Justice and accident andemergency was nearly twice that in the overall health authoritypopulation. The limitations of these data are examined and thepotential of this method to inform inter-agency planning andshared care is discussed.     

The Supervision of Child Protection Work

Correspondence to Alan Rushton, Course Director, M.Sc. in Mental Health Social Work, Social Work Department, The Maudsley Hospital, 101 Denmark Hill, London, SE5 8AZ, UK Summary It has frequently been recommended that statutory child protectionservices in Great Britain need greater provision of specialistsupervision to support front line social workers. This qualitativestudy, based in social services departments in London, usedthe focus group method to explore the provision of supervisionby team managers in a very pressurized work environment. Thestudy highlights the difficulty of protecting adequate supervisiontime but shows how supervisors can use their skills to conductcase related discussion concerned with developing professionalskills. ‘Inquisitorial’ and ‘empathic-containing’functions are identified and an approach is proposed for combiningthem in training courses for child protection supervisors. Thepaper recommends that supervision training needs to be expanded,to be more precisely targeted, and that outcomes need to berigorously and appropriately assessed.