Primary Health Care Workers' Views about Social Work

Summary SUMMARY A comparison of the views about social work held by 188 primaryhealth care workers—118 GPs, 31 health visitors and 39district nurses—working in the same teams is presentedhere.^* The study focussed particularly on their perceptionsof social workers, their role and performance. The data indicatea general acceptance of the social work role, but a lack ofknowledge of or extensive criticism about, social work performance.Significant differences of view emerged about social work training,role and clients, indicating occupation is a significant factorin perceptions held. In particular, the client group predominantlydealt with appears to have had an impact on perceptions. However,views about social work performance did not differ greatly,suggesting the influence of occupation on perceptions shouldnot be overstated.     

Applying for money The encounter between social workers and clients--A question of morality

Correspondence to Lars-Christer Hydén, Department of Social Work, Stockholm University, S-106 91 Stockholm, Sweden Summary The facts of household finances generally obtain their meaningfrom the moral standards of everyday life: it is in relationto these standards that we evaluate our personal finances. Personswho lack money and apply for social welfare compensation generallyhave to turn to a public social welfare bureau where their eligibilityis assessed by a professional social worker. The central questionfor the present study is how social workers and clients dealwith the morally delicate question of personal financial deficitsand how this question should be processed in a formal and institutionalsetting by formal means. This problem is discussed through ananalysis of conversations between social workers and clientsat social welfare bureaux in the municipality of Stockholm,Sweden. In pursuing a formal inquiry the social worker is conductinga moral search: the social worker has to determine the moralcharacter of the client and the circumstances around his/herhandling of his/her own financial situation. The ‘relevantcharacteristics of the citizen’ that the social workertries to match with the beneficiary rules are of a moral nature.In this respect, the social worker is not only a social workerbut also a moral worker. In order to define and defend his orher moral character the client has to pursue the financial issueas a moral issue. In the encounter, the client alludes to everydaycircumstances to account for his/her financial situation andto justify it by applying everyday moral standards.     

Welfare, Society and the Social Worker

Summary This article attempts to locate some common stereotyped transactionsbetween social workers and their clients as elements in theproduction of distinctive welfare identities. By comparing thisprocess to that of a rite of passage, the client is found tobe like a ritual subject frozen in the moment of transitionbetween social categories and thereby denied a place in society.An opposition is accordingly presumed to exist between Welfareand Society. The matrix of stereotyped expectations which derivesfrom this opposition is shown often to intrude on the relationshipbetween social worker and client, constituting a pressure toresolve the tensions produced by anomaly through the impositionof a welfare identity on the client. In this respect, the specialvulnerability of marginal groups is noted and a brief discussionthen follows of the characteristic qualities of ascribed welfareidentity. Through Welfare, Society is found to displace imaginativelyits sense of entropy beyond the moral community. But the essentiallink between Welfare and Society remains and increasing socialdisorder brings the paradoxical feature of this strategy tothe fore. The preservation of the social order requires increasingconcentrations of entropy to be symbolically located in Welfareand as a result Welfare comes to take on the aspect of a threateningand subversive entity. In conclusion, it is suggested that behindthe apparent ‘crisis’ in social work lies a crisisin the management of social entropy.     

A Comparative Study of the Management of Cases of Deliberate Self-Harm in a District General Hospital

Correspondence to Michael Bateson, Senior Psychiatric Social Worker, Lancaster Moor Hospital, Lancaster, Lanes. Summary A controlled study was undertaken of two services assessingand managing cases of deliberate self-harm admitted to a casualtydepartment. The first service featured psychiatrists only andthe second included psychiatric social workers as well as psychiatrists. A combination of standardized instruments, a structured questionnaire,a twelve month diary and medical and social work files wereused to collect information. Demographic factors, repetitionrates, types of help offered, client satisfaction, social circumstancesand general health were investigated. Few significant differences were found to have existed betweenthe client populations of the two services at initial assessment.Also, there were no apparent differences in factors interveningbetween initial assessment and follow-up. However, the analysisof outcome measures indicates that clients benefited substantiallyfrom the addition of a psychiatric social worker in the followingareas: help offered, client satisfaction, social circumstancesand general health. These results are discussed.     

Social Workers Talking to Clients: A Comment

Summary I read Baldock and Prior's article with interest in view ofthe shortage of studies examining day-to-day practice in socialwork, but the authors' analysis leaves me reflecting uneasilyupon the state of uncertainty into which social work has fallen.The authors conclude by describing as ‘skilled’,practices which they say resulted in confusion for clients andwhich only apparently reflected social work principles. We arenot told whether the authors checked their analysis with workersor clients and it is possible that the clients were not as confusedas we are led to believe, given their long term contact withthe workers. If, however, the picture is an accurate one, shouldit really be described as representing skilled social work?Baldock and Prior do so but neglect to examine the ends towardswhich interviewing skill should be directed in social work.The result is a strangely ambiguous statement about practice,particularly in the light of research findings on effectivenessand client satisfaction, and one which offers little scope forcomplacency.     

Client Perspectives in a General Practice Attachment

Summary In this study, 50 clients of social workers in an attachmentscheme were interviewed and their views compared with the assessmentsmade by the social workers. The results were very favourablefor the attachment; the clients were well satisfied with theservice given and the majority of clients felt that they hadbeen helped, especially with their emotional problems. However,there was much disagreement between the social worker's assessmentand that made by the client, especially regarding the type andnumber of problems helped.     

A Role for Anyone? A Description of Social Work with the Elderly in Two Area Offices

Summary This article analyses information from Case Review Forms completedby social workers on 199 allocated elderly clients. These peoplewere very frail, most were considered to be ‘at risk’and to require regular, reliable and frequent care. The questionof the client moving to a tafer setting arose in two-thirdsof the cases, concerning which there was often some dispute.It is argued that social workers require a high level of professionalskill in dealing with clients, and others involved, faced withsuch questions and that this requirement will remain with thedevelopment of ‘community social work’.     

The Fieldwork Team Response: An Investigation into the Relationship between Client Categories, Referred Problems and Outcome

Correspondence to Peter C. Burke, Lecturer in Social Work, Department of Social Policy and Professional Studies, The University of Hull, Hull HU6 7RX. Summary This paper concerns a study of the outcome achieved followingfieldwork responses to referred client problems within particularclient categories. The evidence from the study demonstratesthat while referred client problems initiate the social workresponse, administratively assigned client groups were a betterdeterminant of outcome. It is shown that the category of a caseis more directly related to outcome than is the problem referred.If social work is to be predominantly based on client categorizationthen polarization will result, represented by an increasinglyprofessional child care practice and a more basic servicingrole for the worker with elderly and handicapped people. Thispresents dangers for the organization of teams, the allocationof resources, and the training of social workers. Taking accountof client problems as part of caseload management should reducethis effect.     

Social Work and Self-determination

Correspondence to Department of Political Science and Social Policy, University of Dundee, Dundee DD1 4HN. Summary Self-determination is a curious concept, related to, but notquite the same as, freedom and autonomy. As an ethical principle,the principle of self-determination bears little relationshipto the way social workers behave. It is used as if clients werebeing allowed a free, independent choice; but clients are subjectto pressure, and the social work relationship is often conceivedwithin a structure of authority. As a guide to practice, theconcept of self-determination ignores the cases where directionis legitimate or desirable. Self-determination can be seen as a professional ideology—aninter-related set of values and ideas. The concept is derivedfrom a number of ideas and values outside social work, but itappears to have little direct relevance to social work in practice.The paper suggests that the concept of freedom may be more usefuland less remote from the realities than ‘self-detemination’is.     

Social Work as Uncommon Sense

Summary Social work needs to resist pressures to identify itself solelyat a superficial level of common sense responses to social problems.It has to go beyond this to recognize its use of ‘uncommonsense’ as the means by which social workers cross therelationship gap and respond to their client's needs. The importanceof doing this in the early stages of relationship, as in crisisintervention, are considered, and stress is placed on holdingtogether both the explicit task-related aspect of the relationship,and the less obvious emotional interchange. By means of theiruncommon sense, social workers are enabled to reflect for, andshare with clients their areas of pain, in such a way as torender them more tolerable.     

An Interview: Constructing Reality

Summary This paper is concerned with the relevance of interactionistperspectives in sociology to social work practice. Crucial tothese perspectives are the ‘meanings’ that peoplegive to situations and the ways they interpret actions. Basically,they are grounded on the assumption that there is no such thingas a single social reality. There are many different constructionswhich depend on the identities of the different people involvedand on the context in which they occur. The paper is based ontape recorded excerpts from an interview between a client, MrsSmith, and a social worker, from a discussion about some aspectsof that interview between the social worker and the writer,and from a discussion about the case between the team leaderand the writer. This material suggests different interpretationsof the situation, information gained in the discussion withthe social worker providing new ideas about the original interview.The views of the different people involved indicate that itis helpful to take into account the organizational context ofthe interviews. It is also suggested that conceiving of interviewsas ways of constructing reality has implications for the studyof social work practice.     

Intermediate Treatment and Adolescents' Perceptions of Social Workers

Summary This paper reports an exploratory study of perceptions of socialworkers. Information was obtained from adolescents involvedin intermediate treatment activity groups, their parents, andtheir caseworkers. The respondents were asked to complete acard-sort of adjectives which might describe the social workers.The results suggest that adolescents may have much more positiveperceptions of their social workers than either the parentsor social workers anticipated. Parents were also found to havepositive perceptions of their social workers, especially iftheir social worker also attended the activity groups with theiradolescent. Some of the variables which were seen to have influencedthe perceptions of the social workers are discussed.     

Voices From the Front Line: State Social Workers and New Labour

Summary The article explores the condition of state social work in Englandtoday. It is based on interviews with experienced social workersemployed by local authority social services departments acrossthe north of England. These front line state social workersprovide a penetrating insight into the diverse ways in whichtheir work has been transformed and degraded and the mannerin which the needs of clients have been largely ignored. Fromtheir perspective, the election of a Labour government in 1997proved to be a massive disappointment and many social workersreported that it has further undermined state social work practice,workers and clients. The paper seeks to offer an explanationby noting the neo-liberalism of Labour's social policy and thedire consequences which flow from New Labour's fixation withwaged work as the principal solution to social exclusion andpoverty. Above all, it seeks to provide an opportunity for theviews of front-line state social workers to be heard.     

Worker Participation and the Social Service Agency

Summary Is there real sharing of decision-making responsibility withinsocial service agencies? What hope is there for participationby the consumer of services if the agency worker nearest andmost relevant to him has little voice or leverage within theorganization? This paper examines the notion of worker participationwithin the context of the social services department and theprobation service, noting the imperfections of the ‘publicmandate’ behind the authority structure of these organizations.Above all it looks for continuity between the values socialservice agencies publicly represent and the values in theirday-to-day dealings with their own staff and clients. Currenttrade union proposals for worker representation at committeelevel are considered, and Dutch experience in extending theworkers' council from the industrial to the social welfare sphereis presented as one alternative model.     

Long Term Social Work in a Primary Health Care Setting

Summary This study was designed to explore which factors characteriselong term clients and to investigate the relationship betweenthe burden on medical and welfare resources in a general practicesetting. Two groups of clients were studied; 135 long term clientsreferred over a five year period, where contact was maintainfor a minimum of one year and 157 cases referred during a sixmonth period, in all of which the duration of social work interventionwas less than 12 months. Few differences were found betweenthe characteristics of the two groups, nor did any individualsocial worker emerge as being particularly predisposed to maintainlong term contact However, a significant change in the proportionof referrals which became long term was found over the fiveyear period under consideration, and policy regarding the handlingof cases was therefore felt to constitute a major influenceon the length of contact with any particular client Relationshipswith other members of the primary health care team were generallyfound to be good, especially in relation to the long term clients.Moreover, the OPs' workload with regard to these clients wasfound to be reduced following social work intervention. Theseclients' consultation rates dropped significantly after receivingsocial work help, and continued to drop when the case had beenclosed.     

Social Work Tomorrow: Towards a Critical Understanding of Technology in Social Work

Correspondence to Bob Sapey, Department of Social Work, University of Central Lancashire, Preston PR1 2HE Summary This paper makes use of theoretical ideas that have been developedto understand the impact of new technology on organizationsand applies them to its use within social work agencies. Thesedeveloping theories employ ideas that are familiar to socialworkers—organization theory, decision making theory, andcommunication theory. The paper therefore argues that socialworkers are in a good position to understand and influence theuse of computers within welfare agencies and do not need tobe inhibited by a lack of technological knowledge. It is furtherargued that, unless social workers do become involved in theways in which new technologies are used within organizations,they will fail to influence its impact upon their clients andmay further fail to control the way in which computers affectthe nature of social work itself in the future.     

Models of Assessment in Social Work

Summary The provision of a social work service depends significantlyupon assessment of the social situation of clients as determinedby social workers. It is argued that the social worker's ‘understanding’of the social situation is framed within a particular way ofthinking about cause and effect. Three different models of suchthinking are used in practice. They are identified as the linearmodel, systems analysis and the management model. The originsand attributes of each model are described and related to thesocial, economic and political environments which have influencedtheir separate developments. The value base underlying eachmodel is explored. Issues relating to the present position ofsocial work are clarified.     

An Interactionist View of the Social Work Interview

Summary The paper considers the relevance of the five sub-branches ofthe interactionist perspective to the social work interviewand suggests a model incorporating all five. Such a model illustrateshow conflict between the social worker and the client may ariseand the author tentatively suggests how such conflict may beresolved     

The Psychiatric 'Caseness' of Clients Referred to an Urban Social Services Department

Correspondence should be sent to Dr. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Manchester University, Stopford Building, Oxford Road, Manchester M13 9PT. Summary Of 158 clients referred to two area offices and six generalpractice attached social workers, 141 weré interviewedusing standardized social and psychiatric research interviews.The General Health Questionnaire (GHQ) was completed by 138clients. Their social worker completed the Case Review Form.Scores of 5 or more on the PSE Index of Definition (for theclient) were used to indicate psychiatric caseness. Using IDscores of 5 or more, 53% of the sample were identified as ‘cases’.The GHQ (cut-off 4/5) identified 73% of the clients as cases;and the GHQ (cut-off 10/11) identified 51% cases. Morbidity was significantly greater in the general practicesetting. Social workers' judgement (about the presence or absenceof mental illness/emotional disorder) was not significantlybetter than chance in the identification of specific disorders,but was significant in relation to the whole sample. The results are discussed and further studies are being conductedusing more sophisticated judgements of ’caseness’,and extending the enquiry beyond an inner city population.     

Defensive Social Work

Correspondence to Nigel Harris, Department of Philosophy, The University, Dundee DD1 4HN. Summary Social workers with child clients face the possibility thatsome mistake or oversight of theirs could lead to a child abusetragedy, for which they may suffer opprobrium and blighted careers.How can they guard against such risks? This paper shows howsocial workers might use different types of ‘defensive’measure to protect themselves. These parallel the types of measureused by some doctors, particularly in the United States, facedwith risks of litigation on grounds of malpractice. Becausedefensive practices have undesirable consequences, it is importantto find ways to eliminate their use by protecting social workersby other means.