Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

The Social Work Role in Assisted Conception

¹ Eric Blyth, The University of Huddersfield, Huddersfield HD1 3DH, UK. Summary The provision of assisted conception has become a major industryin most industrialized countries, buttressed by powerful professionaland commercial interests. Assisted conception has significantimplications not only for those directly involved or affected,but also for wider society. The paper summarizes the contributionsocial work has made to the debate and to service development,especially in the UK. The author argues that the ethical valuesunderpinning social work, and the Knowledge and skills possessedby social workers, provide both an opportunity and a mandatefor social workers to influence the development of assistedconception services, in particular to ensure that the humanimplications of providing children for people who are involuntarilychildless are not subordinated to the pursuit of technical efficacy.     

A Survey of Approved Social Work in England and Wales

Correspondence to Prof. P. Huxley, Department of Psychiatry, University of Manchester, Mathematics Tower, Oxford Road, Manchester M13 9PL. Summary A survey of approved social workers (ASWs) was undertaken withlocal authorities in England and Wales, to review the provisionand organization of ASW services, and the contribution theymake towards the establishment and maintenance of a comprehensivemental health service. The findings show some variation in provisionwhich is in itself indicative of a variety of factors operatingto produce local and regional patterns of provision. Some ofthese are related directly to policy decisions, others to demographicand geographic variables, while still more are related to teamstructure, workload demands, and generic/specialist issues.The future pattern of mental health social work following theimplementation of the NHS and Community Care Act is consideredin the light of the findings from the survey.     

Dying and Bereavement, Spirituality and Social Work in a Market Economy of Welfare

Correspondence to Margaret Lloyd, School of Social Work, University of Manchester, Oxford Road, Manchester M13 9PL Summary This paper examines the contribution of social work practiceto the care of people who are dying or bereaved. It considerscurrent challenges to traditional practice arising from societaland organizational change, reaffirming the importance of thesocial work role but arguing that, in order to face those challenges,social workers must broaden their perspective to incorporatea spiritual dimension. The paper draws on a research study conductedby the author.     

The Need for a New Social Work Perspective in an African Setting: The Case of Social Casework in Zambia

Correspondence to Geoffrey W. Silavwe, Dean of Students Department, The Copperbelt University, P.O. Box 21692, Kitwe, Zambia. Summary This article discusses traditional social casework principlesand how some of these principles are irrelevant for social caseworkpractice in an African setting or culture. The principles onwhich social casework is based involve western concepts foreignto the cultures of most developing countries. They are thereforeinappropriate for social work practice in an African settingbecause they are based on values (especially self-determinationand confidentiality) which assume concepts of individualitynot applicable in an African society, particularly in Zambia.     

Disability and Social Work: Applications from Poststructuralism, Postmodernism and Feminism

Correspondence to Barabara Fawcett, Department of Applied Social Studies, University of Bradford, Bradford, West Yorkshire BD7 1DP, UK. Summary In this article it is argued that poststructural and postmodernperspectives have something useful to offer social work, providedthese orientations are informed by the ‘social criticalpower of feminism’ (Fraser and Nicholson, 1993, p. 428).A case study is used to consider the utility of applying feministpoststructural and postmodern perspectives. It is contendedthat these orientations not only serve to link practice to theoryin a different way and to open up new avenues for exploration,but can also be seen to make a contribution to the debate aboutthe current constitution of social work.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.     

Social Programme Evaluation in the USA: Trends and Issues

Correspondence to Edward Allan Brawley, Professor of Social Work, The Pennsylvania State University, Department of Sociology, 211 Oswald Tower, University Park, Pennylvania, 16802 USA. Summary This paper reviews the emergence of social programme evaluationas an important and frequently controversial topic in the UnitedStates during the last three decades. Political, practical,epistemological, and ethical Issues involved in the evaluationof social service programmes are discussed, as well as the strengthsand shortcomings of a range of specific evaluative approachesand techniques. Current trends towards evaluation strategiesthat take greater account of the special attributes of the socialservices and social work practice and that produce informationthat is more useful to policy-makers, programme administra torsand social work practitioners than has been true in the pastare identified. Some cautionary remarks are included about thedangers of overemphasizing ‘hard’ quantitative methodologies,goal attainment, and efficiency at the expense of alternativeapproaches that can produce other and sometimes more appropriateindicators of programme perform ance and results. This paper examines the evolution over three decades in theUnited States of efforts to evaluate social programmes, socialservices and social work practice. Some lessons that can bedrawn from the failures and successes of this experience aresuggested and the strengths and weaknesses of various evaluativestrategies and techniques are discussed.     

Commonality and Diversity in Feminist Social Work

Correspondence to Vicky White, Department of Applied Social Studies, University of Warwick, Coventry CV4 7AL. Summary The relationship between feminist social workers and women serviceusers is a central concern in the feminist social work literature.The literature's discussion of feminist social worker/womanservice user relationships, along the dimensions of commonalityand diversity, is compared with the experiences and understandingsof feminist social workers who participated in a small-scalequalitative study. Two main themes are considered: first, commonalityin feminist social worker/woman service user relationships;secondly, diversity amongst women service users. Issues forfuture work are drawn out of the discussion of these themes:the problematic nature of feminist social worker/woman serviceuser commonality; the impact of social divisions other thangender on women service users' lives; the importance of unpackinggeneralizations about both women service users and feministsocial workers; the need to explore the intersections of thestatutory context and feminist social work identities. It isargued that in addressing these issues future work would beenriched if greater prominence were given to feminist practitioners'perspectives, experiences and understandings.     

Managing Human Services in a Market Environment: What Role for Social Workers?

Correspondence to Karen Healy, Department of Social Work, Social Policy and Sociology, Building A26, University of Sydney 2006, New South Wales, Australia. Summary International research suggests that the market reform of humanservices is leading to reduced opportunities for social workersto achieve organizational management positions. This paper exploresthe future of social workers as managers of human service organizations.It examines the tensions between the social justice principlesthat guide social work and the emerging contexts of social welfaremanagement. The exploration draws on in-depth interviews withthirty-four social welfare managers working in the non-profitsector in Australia. These managers were identified by theirpeers as progressive, that is, as championing social justicevalues such as access, equity and social inclusion. This paperwill report on their approaches to social welfare managementand their perceptions of the threats and opportunities for progressivemanagement practices in a climate of public sector reform. Thepaper will consider how social work educators can better prepareservice professionals for social welfare management positions.     

Organization and Professionalism: The Social Work Agenda in the 1990s

Dr R. Hugman. Dept. of Applied Social Science. Cartmel College. Lancaster University. Lancaster LAI 4YL. Summary The professionalization of social work in the UK during thiscentury has led to an occupational unity, but one in which therehas been continued struggle over the form and content of professionalism.This paper summarizes the key points of developments in thelast two decades, in which debates between professionalism andanti-professionalism and between specialization and localizationcan be discerned. Further changes in the welfare state haveprovided the impetus for continuing developments which, it isargued, integrate aspects from opposing sides of the previousdebates. The failure of social work to address issues of genderand of racism is considered, and related to the possibilitiesof greater service user participation. The implications forsocial work professionalism are outlined.     

Social Work and Blood Vengeance: The Bedouin-Arab Case

Correspondence to Alean Al-Krenawi, Department of Social Work, Ben-Gurion University of the Negev, Israel Summary The practice of blood vengeance, the obligation to kill in retributionfor the death of a member of one's family or tribe, is illegalin most countries of the world; however, many traditional culturesstill demand this form of maintaining honour. This paper outlinesthe cultural and historical contexts of the practice of bloodvengeance among the Bedouin of the Negev of Israel. It considersthe consequences for the targeted family and details the copingstrategies adopted by the family, especially the children, underconditions of extreme social, emotional and economic deprivation.It discusses social work intervention, from initial contactto partial resolution; strategies of cultural sensitivity arealso outlined.     

Probation and Social Justice

Correspondence to: David Smith, Department of Applied Social Science, Lancaster University, Bailrigg, Lancaster LA1 4YL, UK. E-mail: d.b.smith{at}lancaster.ac.uk or Maurice Vanstone, Centre for Criminal Justice and Criminology, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, Wales, UK. E-mail: m.vanstone{at}swansea.ac.uk Summary The paper considers the past and potential contribution to socialjustice of the probation service in England and Wales, withinthe context of the service's complex origins and tradition,in which humanitarian and disciplinary concerns have long co-existed.The paper explores the service's connections with processesof categorization and governance of the dangerous, and its alignmentwith the ‘psy’ disciplines in developing its claimsto professional expertise. The implications of the recent reassertionof the centrality of psychological understandings of offendingand its prevention, in the form of cognitive-behavioural programmes,are discussed, and the circumstances in which the movement for‘effective practice’ can and cannot contribute tosocial justice are discussed. The paper then explains the groundsfor believing that a concern with social justice entails a commitmentto crime prevention at a level beyond that of direct work withknown offenders, and explores the potential of restorative justiceas a means of achieving a reintegrative and participatory approachto community safety. The paper concludes with a discussion ofthe service's successes and failures in anti-discriminatorypractice, and the feasibility of a social justice agenda inthe current policy context.     

Citizenship, Social Inclusion and Confidentiality

Correspondence to Tony Evans, Oxford Brookes University, Social Work Department, Heritage Gate, Sandy Lane, West Oxford OX4 6LB. E-mail: tevans{at}brookes.ac.uk Summary Confidentiality has tended to be disconnected from wider debatesabout citizenship and social inclusion. It has been hived offinto self-referential legal and professional discourses concerningthe principles that should inform social workers' conduct. Thelacuna concerning the significance of confidentiality in widerdebates is made more remarkable by the shift towards consumercitizenship, a shift that has ostensibly emphasized serviceusers' rights, including their capacity for active participationin service provision. The rights discourse, as a component ofactive consumer citizenship, is considered in relation to theperspectives of ‘interests’ and ‘will’.The arguments that support moving in the direction of a critical‘will’ perspective, through deliberative processesthat involve service users in developing and framing informationrights, are highlighted and linked to data from a small-scaleempirical study. This perspective is regarded as consistentwith a politically dynamic formulation of social citizenship.Such a formulation involves seeing citizenship as a practicethat requires on-going debates about claims to rights, movesin the direction of seeking to rectify imbalances in power andrecognizes the capacity of service users to act in their owninterests as citizens.     

At the Edge of the Frame: Beyond Science and Art in Social Work

Correspondence to Dean Emilia E. Martinez-B raw ley. School of Social Work, Arizona State University, PO Box 871802, Tempe, Arizona 85287–1802, USA. Summary The central argument in this article is that social work hasalways been a practice at the fringes. The phrase is used inits best sense and in at least two meanings: (1) that socialwork has been at the edges of the mainstream of scientific discourse,not because of any intrinsic deficiency in the profession butbecause of the nature of the practice; (2) that, in the postmodernsense, social work has been a collage where science, art, rationalityand intuition, systematic and asystematic knowledge meet. Inthis latter sense, this article proposes, social work can representa very desirable convergence of paradigms that needs to be acknowledgedand celebrated. Perhaps the most significant contribution ofpostmodernism is that it accommodates this possibility.     

Beyond Retroduction? -- Hermeneutics, Reflexivity and Social Work Practice

Correspondence to Susan White, University of Manchester, Department of Social Policy and Social Work, Williamson Building, Oxford Road, Manchester Summary Over the last three decades qualitative research methodologieshave been in the ascent within social science. Yet social workevaluation studies have tended to be quantitative in nature,conventially relying upon the generation of criteria againstwhich interventions are retrospectively judged. The generationof such criteria inevitably depends upon pre-suppositions, whichin themselves go unresearched. As a consequence the .sense makingactivities on which social work interventions depend are renderedimmune from critical analysis. This reflects a broader tendencyfor social work to cling to naive realist epistemologies, whichare arguably obsolete within the interpretive paradigm in whichits activity is properly located. By examining the debates withininterpretive social science, this paper argues for an approachto social work assessment which avoids the pitfalls of naiveobjectivism and the nihilism of anarchic relativism, whilstretaining creativity, imagination and hope.     

Social Adjustment: The Design and Use of an Instrument for Social Work and Social Work Research

Please address correspondence and reprint requests to: Dr. R. Corney, General Practice Research Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5. Summary This article discusses some of the problems encountered whentrying to assess social adjustment and describes a standardizedsemi-structured interview designed to measure social adjustmentand dysfunction. The interview can be used by social workersas a research tool, a screening device or in making an assessmentThe interview is composed of items grouped under the three headingsof ‘Material conditions’, ‘Social management’and ‘Satisfaction’. Ratings are made on a four-pointscale by interviewers standardized in its use. The interviewwhich takes 40 minutes to one hour to administer, covers housing,finance, occupation, social and leisure activities, and relationshipswith significant individuals in the subject's life.     

The Current Status of Social Work Research

Summary This article reviews the range of research relevant to socialwork. It suggests a tentative framework within which differentstudies can be viewed, and particular emphasis is placed onthe importance of exploratory research. There is an evaluationof the contribution of research findings to current thinkingin casework, and it is argued that the researcher's task isto compel the practitioner, the teacher, the student, the administrator,always to re-define aims and activities in the light of accumulatingknowledge     

The Social Work Task in an Acute Psychiatric In-Patient Unit

Summary This paper reports the results of monitoring all admissionsfrom a prescribed geographical area to an acute psychiatricin-patient unit for a six month period. Members of the hospitalsocial work department assessed all admissions and selectedapproximately one-half of these for high social work input Demographicdata for the whole subject group is examined and compared tothe high input group. The case review system outlined by Goldbergand Fruin (1976) is used to describe the clients' social problemson admission, as well as the social work task, in terms of practicalservices and other social worker activities. These findingsare compared to those of Goldberg et al. (1977) who examinedthe social work task in an area office social services departmentintake team. Despite differences in demographic profiles ofthe two groups and consequently differing social problems, thesocial work task in both settings was found to be similar. Inboth studies 53% of clients were offered some practical (althoughdifferent service) and the most common social work activitieswere found to be assessment, information and advice, and mobilizingresources.     

1998 Human Rights Act: Social Work's New Benchmark

Summary The 1998 Human Rights Act makes the European Convention on HumanRights directly enforceable by the United Kingdom's courts andtribunals. This represents a major constitutional change andwill allow statute law and common law to be assessed, or reassessed,according to the rights laid down in the Convention. This hasmany implications for social work policy makers, managers andpractitioners. It will require the Convention rights to be atthe heart of social work practice. The ability of service usersto challenge decisions by social services departments will nolonger be dependent upon the traditional approach to judicialreview. Compliance with the Convention will now feature in legalchallenges. It is essential that the practice of social workembraces the principles outlined in the Convention. In manyrespects, they are rights that practitioners and others recognizeas being basic expectations of service users, and making themdirectly enforceable can only be for the good. However, we shouldnot underestimate the effect that the legislation will have.This article outlines the legal effects of the 1998 Human RightsAct and illustrates them by reference to examples from socialwork practice.