Aspects of Social Work on a Cancer Research and Treatment Unit in a London Teaching Hospital

Summary With the rapid growth of technology and science in society today,an increasingly large number of people are becoming patientsin specialized research and treatment units. The reorganizationof social work support to the health service is upon us, andgreat care must be taken to ensure that this important groupof clients will receive the social work help it needs. The paper is based on work in a cancer unit in a London teachinghospital and seeks to illustrate ways in which the work is specialized     

Adolescents Who Sexually Abuse and Residential Accommodation: Issues of Risk and Vulnerability

Summary This article, arising out of quantitative and qualitative researchstudies conducted by the authors, begins with a brief overviewof current knowledge about male adolescent sexual abusers andassociated policies, procedures and services. A particular concernraised by professionals and welfare agencies, who are strugglingto develop appropriate responses to young sexual abusers, concernsthe circumstances and problems of young people who are placedin residential accommodation as a result of their sexually abusivebehaviour, often where there are also child victims of sexualabuse. The vulnerability of young sexual abusers and the riskthey pose to others is considered in the light of the findingsof qualitative research by one of the authors into the constructionand control of children and their sexualities in residentialchildren's homes. This research suggests that the inadequateways in which sexual behaviour in children's homes is perceivedand managed, serves to compound the problems of both the sexuallyabusive and non-abusive adolescents placed there. The findingsfrom both authors' research are then theorized within broaderconceptual frameworks about the nature of childhood, childhoodsexuality and institutionalization and its links with peer sexualabuse.     

Keeping the Probation Service Whole: The Case for Discretion

Summary The function of the probation service has been the discretionarymanagement of the tension between control and care. There wasa time when officers could make these discretionary decisionswith relative confidence, but structural pressures, togetherwith the decline of the correctional/treatment model have madethis more difficult. This has led to arguments for the separationof control and care functions. A recent attempt has been madeto re-instate the correctional/treatment model and this is discussedbut found to be unconvincing. The author presents his own argumentfor retaining discretion and describes how he believes it shouldbe managed.     

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.     

The Treatment of Enuresis amongst Child Clients of a Social Services Department

Summary The adoption of an ‘outpatient’ model of supervisingthe treatment of bedwetting amongst child clients of a socialservices department is described. The treatment technique usedwas the generally effective ‘enuresis alarm’, or‘bell-and-pad’. Fifteen out of a total of 25 concludedcourses of treatment were successful, with an average treatmentduration of 14.9 weeks. Both this outcome, and the rate of drop-outbefore completion of treatment (ten cases) are comparable withthose obtained with non social services clients, and the useof the enuresis alarm with children in care (including thosein residential establishments) was found to be quite practicable.A high relapse rate (43%) was, however, found for social servicesclients, relapse usually following a placement change or othermajor stress.     

Deprived Adolescents: A Use for Groupwork

Summary This article describes a group for deprived adolescent boysreferred to a child guidance unit for violent, anti-social andwithdrawn behaviour in school. The referred behaviour is relatedto its aetiology in environmental and fragmented family conditionsand the suitability of group work as providing a containingor 'holding' situation is discussed in relation to other formsof treatment available. The behaviour and role of the therapistis considered, as are the limitations of what can be achievedin provision of this kind     

Factors Predicting Admission of Elderly People to Local Authority Residential Care

Correspondence to Dr Ian Sinclair, Director of Research, National Institute for Social Work. Mary Ward House, 5–7 Tavistock Place, London WCIH 955 Summary Successful community care may partly depend on identifying thoseat risk of entering residential homes and targeting servicesto them. This article is concerned with how this identificationcan be achieved. It considers a sample of old people livingalone. in touch with home helps or social workers and followedup for between two and four years. The research examined thefactors likely to produce admission, and used discriminant analysisto predict it.     

Entry into Residential Care

Summary This paper examines the interaction between the organizationalstructure of social services departments and procedures foradmission into residential care. By drawing on research experiencea 'placements table' is proposed which contains the key operationaldecisionstaken by the department when the client becomes a resident.It is argued that, in accordance with the structure of the department,it is possible to suggest appropriate staff to make each keydecision in order that departmental criteria for admissionsmay be met.     

Residential Care for Elderly People: Characteristics of Patients Admitted To Residential and Nursing Home Care from Hospital

Correspondence to Mr W. Power, Department of Social Work, Kingston General Hospital, Hull HU3 IUR Summary Fifty consecutive admissions to residential and nursing homecare from hospital were examined and the results discussed.Patient profile fitted the general pattern expected of frailelderly people with high dependency needs. There was a noticeableshift towards placements in private establishments but onlyabout half the patients were likely to have satisfied criteriafor local authority placement or require nursing home care.Breakdown in care-giver arrangements was found to be a majorreason for entry to care. Apart from a significant number ofwheelchair users going into nursing homes, there were no sharpdivisions between the residential care and nursing homes groups.     

Behavioural Approaches to Child Care

Summary One approach to child care found to be of value elsewhere inthe world has been the use of techniques of behaviour modification.Although application of the behavioral model has generated anever expanding variety of techniques of intervention with children,the use of the model in this country has perhaps been limitedby the failure of residential care workers to draw a clear distinctionbetween the technology and the practice of behaviour modification,a failure which may have been compounded by the highly technicalnature of much of the literatue. An analysis of the context in which behavioural techniques arepractised in the United States and Canada shows that the highlevel of technical competence developed in various programmeswith adolescents and children has been the product of highlyfunded and carefully researched treatment projects. If the behaviouralmodel is to be developed as a basis for intensive and effectiveintervention in the lives of disadvantaged, disturbed childrenand adolescents in this country, it will be essential to gofurther than simply attempting to replicate the techniques describedand evaluated from American projects. Substantial resourceswill have to be devoted to evaluation of the context and practiceof specific treatment techniques and the development of appropriatetraining as well as the development of techniques themselves.     

Touch, Sexuality and Power in Residential Settings

Summary This paper examines areas of concern surrounding touch, sexualityand associated power in residential establishments. The placeof touch and the expression of sexuality are considered in relationto residents and staff. It is suggested that these are importantfactors in framing a concept of residential care based on rightsand duties, and that current practice often takes a limitedperspective of some of the fundamental needs of residents     

Good Practice in the Education of Children in Residential Care

Correspondence to The Directors, New Horizons (Child Care) Ltd., Unit B, Silkmoor, New Street, Frankwell, Shrewsbury, Shropshire SY3 8LN, UK. E-mail info{at}new-horizonschildcare.co.uk Summary Research shows that the education of children in residentialcare is generally poor, in terms of both process and outcome.This has highlighted the uncertainty over how best to educatethese children and a pessimism over what they can achieve. Drawingupon the findings of an evaluation of a children’s home,this paper argues that children in residential care can havegood educational outcomes. It also shows that it is possibleto identify the processes by which these outcomes can be broughtabout. However, this largely positive assessment is predicatedupon education being defined broadly in respect of ‘process’and ‘outcome’. Moreover, it is important not tounderestimate the formidable challenges inherent in this work.While the multi-agency nature of this work gives rise to oneof the most significant, it has to be recognized that responsibilityfor the education of children in residential care falls primarilyto children’s homes. If children’s homes are tomeet the increasing expectations that are being made of them,national and local government will have to undertake a radicaltransformation of residential childcare, especially in termsof attitudes towards, and resources invested in, this sector.Central to this is the establishment of a qualified and properlysupported workforce.     

Interaction Between Field and Residential Social Workers

Summary This paper is based upon collaborative project work with a socialservices department aimed at improving interaction and collaborationbetween field and residential social workers. It describes theprinciples upon which it was agreed that interaction shoulddevelop. These include notions of case-accountable staff, acollateral model of interaction between staff and the idea ofone party being identified as a prime care agent. Based on theseprinciples it sets out a model arrangement for clients enteringresidential care which recognizes the need for precision aboutthe nature of key decisions that need to be taken with clientsand the way these decisions should be taken.     

The Witch-Hunt Metaphor (And Accusations against Residential Care Workers)

Correspondence to Mr Chris Beckett, Anglia Polytechnic University, School of Community Health and Social Studies, Cambridge CB1 1PT, UK. Summary This Critical Commentary examines the widespread use of themetaphor of the witchhunt in relation to child sexual abuseinvestigations when they are perceived as being unjustified.The use of this metaphor can be seen to be part of a backlash,part of a widespread desire to discredit the evidence that sexualabuse is widespread. However, it is argued here that the metaphoris actually quite apt in the case of the recent wave of convictionsof residential care workers, where the methods used have beenquite suspect—and genuinely reminiscent in some respectsof those used in historic witch hunts. It is suggested thatlegitimate child protection will ultimately be the loser ifthis is not addressed.     

Foster and Residential Children's Perceptions of Their Social Environments

University of Oxford, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford OXI 2ER. Summary This paper compares foster and residential children's perceptionsof their social environments (placements). The exercise formedpart of a larger examination of care practice in special fosterhomes and Children's Homes. The application of a combinationof quantitative and qualitative techniques showed that the fosterchildren's perceptions of their placements generally comparedfavourably with those of the residential children.     

Differential Assessment of Residential Group Care for Children and Young People

Summary Twelve qualitative variables frame the production of outcomesin residential group care for children and young people. Theseare used to examine contemporary themes in social care practicewith children and families. This assessment typology offerssocial workers, managers, researchers and policy-makers bothvalid and reliable baseline measures for use in evaluating residentialservices for children and young people. The typology also providescomparative interval measures for use in longitudinal evaluationsof quality. Close attention needs to be given to the impacteach of these variables has on the quality of residential groupcare services offered to children, young people and their familiesor significant others.     

Caring for Troubled Children in Flanders, The Netherlands, and the United Kingdom

Correspondence to Dr Matthew Colton, Lecturer in Applied Social Studies, Centre for Applied Social Studies, University College of Swansea, Singleton Park, Swansea SA2 8PP. Summary This article reviews research on residential care and otherservices for troubled children in Flanders, the Netherlands,and the United Kingdom. We begin by looking at Flanders andthe Netherlands. This includes an account of the organizationof services and a critical evaluation of initiatives resultingfrom the growing dissatisfaction with residential care overrecent years. We then compare the evidence from these two countrieswith the situation in the United Kingdom. Notwithstanding importantdifferences, there are clear similarities in the issues surroundingthe residential care of children in the three countries. Weconclude by outlining likely future developments in residentialchild care.     

Including Families in Residential Work: Educational and Agency Tasks

Correspondence to Stephen Casson, Social Services Department, Civic Centre, Newcastle upon Tyne, NE1 8PA, England. Summary This paper identifies obstacles to the inclusion of familiesby residential establishments. A review of the literature indicatesthat the notion of including families is a worthwhile consideration,but that few programmes have committed themselves with sufficientenergies over time to test the worth of this assumption. Tobring families centre stage a set of obligations is proposedto managers and certain principles from the family dynamicsliterature are identified for inclusion in the training curriculumof residential workers.     

A Combined Approach to Parental Coping

Summary The development of coping strategies by a combination of behaviourmodification, casework and milieu therapy is discussed withreference to the case of a nine-year-old boy admitted to a childpsychiatric in-patient unit. Admission had been precipitatedby his violent and uncontrollable behaviour at home. The plannedreturn of the child to his family is stressed as an importantpart of the treatment.     

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.