Focusing on Empowerment: facilitating self-help in young people with arthritis through a disability organisation

Young people with arthritis face a number of disabling barriers when negotiating their way through contemporary society. A national disability organisation, Young Arthritis Care YAC , has established a Contact network, whereby young people with arthritis provide support to similar others in the community. To improve the service, YAC initiated Contact Training Courses in the fields of advocacy and counselling. An appropriate research methodology was required that enabled the efficacy of this training to be examined in a disability framework. Focus group technique was selected as a research methodology set within an emancipatory paradigm that can in itself be an empowering experience for participants. Results illustrated that focus group technique enabled young people with arthritis to freely articulate their views concerning the efficacy of training set within the framework of self-help.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.     

Social work and applied theatre: creative experiences with a group of homeless people in the city of Seville

This article presents a series of creative social intervention experiences developed with a group of homeless people in the Spanish city of Seville. These experiences are part of an applied research project that uses theatre as a tool to aid social work, and they are led by a group of homeless people who have become actors through this initiative. The group is known as ‘Theatre of Inclusion’ and has been running for a decade now. Using group social work and applied theatre techniques, this initiative creatively exposes the needs of this collective and also generates spaces in which they can reclaim their dignity. The systematisation of these experiences highlights the potential of combining disciplines such as social work and theatre to work with vulnerable collectives, in the same way Jane Addams did. The aim is also to move beyond the dominant welfare proposals in place in Spain currently, which are intended to meet the needs of homeless people.     

Mental health support needs of people with a learning difficulty: a medical or a social model?

People with learning difficulties, like all disabled people, face social oppression. Much recent policy and practice are underpinned by at least some understanding of this oppression, and the social model of disability has been influential in discussions of services and supports for people with learning difficulties. However, in the area of mental health, the picture is somewhat different. This paper argues that the medical model has predominated in discussions of mental health support for people with learning difficulties, and that a social model approach could have much to offer. The paper draws on an ongoing action research study in which service providers, families and young people with learning difficulties are working together to articulate what is needed, in order to find routes to improve the support offered to young people with learning difficulties and mental health support needs.     

Promoting reflective practice with older people: Learning and teaching strategies

Social work with older people is often characterised as low status employment and is dominated by medicalised constructions of old age. Consequently, there is a need for educational responses that address students' negative attitudes toward older people and enable the development of practice skills in this area. The present paper evaluates an elective course for third year social work students that challenged their perceptions of their own and others' ageing, and stimulated a reflective approach to practice with older people. Reflective learning techniques were employed in the course, including observations in aged care service settings. Students in the course showed a high degree of interest in working with older people in the future and, although this did not increase much throughout the course, they evaluated it positively, noting greater awareness of issues affecting older people.     

A Hitchhiker's Guide to caring for an older person before and during coronavirus‐19

Coronavirus‐19 (COVID‐19) has reconfigured working lives with astonishing velocity. Older people have suffered the worst effects of the pandemic, with governments marginalizing or overlooking their needs. Women perform the majority of care for older people, often compromising their working lives and health. Yet in academic articles their voices are often filtered or aggregated in quantitative studies. Based on a weave of personal experiences and secondary research, the article traces a path through UK forms of care and shows how the inadequate response to COVID‐19 stemmed from existing policies embedded in health and social care. COVID‐19 has severed important informal care work, rendering the vulnerable yet more exposed and carers anxious and bereft. Longitudinal research capturing the trajectory of care from the perspective of older people and their carers would lead to improved support hence gender equality.     

‘Stuck In The Middle With You’: Towards Enabling Social Work with Disabled People

This article explores progress to date in embedding enabling social work understandings and practices with disabled people by reviewing the UK social work curriculum. Based on these observations and the ideas from UK disability studies, it will offer possible solutions or at least better pathways to enabling practice with disabled people. As Meekosha has pointed out in a global context, to date social work has been experienced as an ambivalent practice [Meekosha, H. & Dowse, L. (2007) ‘Integrating critical disability studies into social work education and practice: an Australian perspective’, Practice, vol. 19, no. 3, pp. 59–72], often both enabling and disabling; an intervention that can both lock and unlock resources, and challenge and reaffirm traditional notions of the ‘disability problem’ [Finkelstein, V. (1993) ‘Disability: A Social Challenge or an Administrative Responsibility?’, in Disabiling Barriers ‐ Enabling Environments, eds J. Swain, V. Finkelstein, S. French and M. Oliver, Sage Publications in association with the Open University, London]. Social work also has the potential to both challenge, but also be an (inadvertent) apologist for contemporary social support and welfare systems. Indeed it is clear that social work as a profession and social care as a policy area have been the poor relations of healthcare and health professions [King's Fund (2011) Social Care Funding and the NHS: An Impending Crisis?, King's Fund, London]. Viewed anthropologically, social work remains a largely non-disabled workforce ‘ministering’ to disabled clients (BCODP, 1997). This might reinforce the perception of ‘us and them’ in some social work encounters. As Paul Longmore questioned, can we begin to go ‘beyond affliction’ (2003) in our work with disabled people? Can social work help support the collective struggles of disabled people or is their role inevitably to reinforce that of individual(ised) clients?

The development of the personalisation agenda and self-directed support is clearly welcome in this context [DoH (2006) Our Health, Our Care, Our Say: A New Direction for Community Services, Department of Health, London; DoH (2007) Independence, Choice and Risk: A Guide to Best Practice in Supported Decision-Making, Department of Health, London; DoH (2009) Personalisation of Social Care Services, Department of Health, London]. Such developments reflect the changing service user–professional relationship. The temptation to see these developments as the icing on the social support cake needs, however, to be resisted. Arguably, with the increased rationing of social support, the continued role of social workers in assessment and monitoring of support could be seen to require a yet more reflexive and enabling professional education and training in an age of austerity, one where previously supported disabled people are being told that their needs can no longer be met.     

Full-service community schools: cause and outcome of public engagement

Public Education Network (PEN)-a national organization of local education funds (LEFs)-along with individuals working to improve public schools and build citizen support for quality public education, embarked on an initiative to address the academic, enrichment, and social support needs of young people to ensure their success in and out of school. PEN's Schools and Community Initiative called for the active participation of broad constituencies-policymakers, stakeholders, and the public-at-large-to create and implement their common vision for full-service community schools. By engaging broad constituencies across communities, LEFs have been able to build strong relationships between and among community institutions under a common vision.     

Serving the U.S. Work Force: A New Constituency for Schools of Social Work

Almost 90 million working people and their families have great unsatisfied needs for services. They pay for most present and potential U.S. human service structures in at least seven ways. Working people constitute a great challenge and potential growth area for the profession and for schools of social work. Developments in present industrial social work and social work education are discussed in this paper. Specific new proposals are presented. These include suggestions for meeting urgent needs and opportunities during the economic crisis.     

Representing the Views of Disabled People in Community Care Planning

The 1990 NHS and Community Care Act requires social services departments in Britain to involve representatives of service users in the preparation of their annual community care plans. This paper gives a critical account of the different ways in which the views of disabled people are sought and represented in community care planning; and of the organisational and practical barriers which disabled people and their organisations are likely to encounter in representing their views to service planners. People with learning disabilities, older disabled people, people with sensory impairments and disabled people from Black and ethnic minority communities are particularly likely to be excluded from current consultation procedures. The paper concludes that present methods of representation place considerable burdens on both individual disabled people and on their organisations. Consequently, disabled people may increasingly question the effectiveness and usefulness of their involvement in community care planning, in the light of the many other issues which are important to them.     

Powerlessness of older people in Hong Kong: a political economy analysis

Gerontologists agree that old age can be associated with an increase in powerlessness both in the personal domain and in the social and political fields. This paper is an attempt to understand the concept of powerlessness in old age within a political economy theoretical framework. The paper argues that the powerlessness of older people is not biologically determined. Rather, it is socially constructed. It has its roots in the social, economic, and political structure of society. For this reason, the paper argues that (a) the capitalist economic system discriminates against and marginalizes older people in the labor market. The current unfavorable economic climate will make the economic situation of older people worse. (b) The residual welfare system does not counteract the unfavorable impact of the economic system. Rather, it deprives older people of the necessary financial resources and social service supports that would enable them to lead independent and dignified lives. (c) The authoritarian political system creates adverse conditions that make it very difficult for older people to participate in the decision-making process on issues that affect their lives, as well as on broader political issues that affect the whole of society. It is the interplay among these economic, social, and political forces in Hong Kong that creates the political economy of powerlessness in old age and prevents older people from using their powers to master and control their lives.     

The Caring Experience: Learning about Community Care through Spending 24 Hours with People Who Use Services and Family Carers

This paper describes a teaching and learning initiative developed in a UK social work programme that has involved carers, service users, academic social work staff and practitioners. Post‐graduate student social workers spend 24 hours in agreed periods with family carers or people who use social work services. The paper explains the origins of this initiative, rooted in a model of service user and carer involvement established over a number of years within the social work programme at the University of Dundee, Scotland. The development of this teaching and learning method is outlined and an account is given by a family carer describing their experience of being involved in the programme. Findings from the evaluation of this first year of operation are reported.     

Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

'I know I signed something': older people,families and social workers' understanding of the legal aspects of entry to residential care

This purpose of this paper is to report findings that older people are legally vulnerable when entering an aged care facility, that social workers lack knowledge of the legal aspects of this move and do not necessarily view this information as core to their practice. The structure of social work services mirror the disjuncture older people and their families experience at this time and this may, in part, explain social work's lack of attention to these issues. Although many social workers are in contact with older people, the profession in Australia has been slow to develop a knowledge base to support effective practice with this group.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

Practising partnership--participative inquiry with older people

This paper examines the importance of approaching research with minority groups of older people in an inclusive way. For older people, ageism is a key feature of the discrimination and marginalisation they experience, but some are excluded and marginalised further on the basis of their ethnicity and sexuality. The 'invisibility' of these groups poses a challenge to social workers and social work educators, as assumptions about their experiences and needs may be made which do not reflect the subjective experiences of these older people. The use of Participatory Action Research as a method of including service users in knowledge and theory development will be analysed, and a research proposal undertaken in partnership with a local voluntary agency will be explored. The importance for social work education of pursuing 'inclusive' methods of research so that service users have more power over knowledge produced about their lives, will be discussed.     

Equal or individual treatment: contesting storylines in needs assessment conversations within Swedish eldercare

This article examines the role of care managers and their work in putting policy into practice in micro-interactions with older people in Swedish eldercare. The care managers assess the individual needs of older people, and decide what type of social care and services will be given. Dilemmas in care management are often related to the gap between needs and resources. The aim was to study the positioning of care managers within different storylines advanced in needs assessment conversations. Positioning theory was applied to study discursive practices and discursive strategies within Swedish eldercare. Audio-recorded needs assessment conversations among care managers, older people and their relatives at care planning meetings in connection with hospital discharge were analyzed. Two overall positions were identified for care managers—as ‘professional experts’ and as ‘organizational representatives’—allowing the care managers to maneuver within two contesting storylines: ‘distribution of scarce eldercare resources based on the principles of eligibility and equal treatment’ and ‘older people entitled to eldercare according to their own perceived individual needs’. For social work, the results showed the importance of discussing how care managers might move towards exercising greater professional autonomy, becoming less dependent on their position in the organization.     

Social work values,anti-discriminatory practice and working with older lesbian service users

It has been suggested that social workers are not adequately meeting the needs of lesbians and gay men. This paper explores some of these concerns with reference to social work's theoretical underpinnings and value-base in relation to working with older, non-heterosexual women. The paper considers some of the particular issues that affect the lives and needs of older women whose primary relationships are or have been with other women. It concludes with a discussion of ways in which such issues may be addressed in social work education, training and practice.     

Coalition-Based Social Change Initiatives

ABSTRACT

This paper presents a model for establishing and maintaining social change coalitions. The model, based on the authors' study of a successful coalition-based social change initiative, highlights the potential contribution of a neutral, external support agency whose goal is to help a group of organizations collaborate in an effort to promote change in social policy in an area of shared concern. The external agency brings knowledge and experience in working with coalitions, needs to be trusted by all the coalition partners, and should be perceived as not competing for recognition or resources, and as having only the common goal in mind. The components of the model and the methodology employed to develop it are presented, followed by assessment of its generalizability to other settings. Experts, from different disciplines, countries and ethnic backgrounds, advised that this model has great potential for solving social problems in many different areas.     

Inclusive Innovations Through Social and Solidarity Economy Initiatives: A Process Analysis of a Peruvian Case Study

This paper seeks to explain the process by which an innovative social and solidarity economy initiative allowed a marginalized population that had no say in development activities to meet certain urgent needs and bring about sustainable social and institutional change. The article looks at the case of a solid waste management program initiated by a group of residents and structured around a third sector organization in Cerro el Pino, a hillside slum located in the La Victoria District of Lima, Peru. We analyze this project through a processual model that focuses on three dimensions: context, process, and consequences. The results highlight the role of social and human capital and the presence of various types of knowledge in the implementation of an initiative driven by locals.