Into the Community: A Comparison of Care Management and Traditional Approaches to Resettlement1

The resettlement of people with learning disabilities (mental handicap) from long-stay hospitals has been under way for a number of years in England. This process has generally been dominated by the exigencies of the available services. A needs-led approach, emphasized in recent community care legislation, in which new services are sought on the basis of the specific requirements of service users, has been used infrequently for this purpose. This paper compares the process of implementing a needs-led care management approach to resettlement with the implementation of a more traditional service-led approach. It also suggests some important lessons for the application of a needs-led approach to hospital resettlement.     

Local authority family centre intervention: a statistical exploration of services as family support or family control

This paper sets out findings from a statistical exploration into services arising from child protection referrals which became open cases allocated to local authority child care social workers employed by a large local authority social services department in South Wales. The workers operate from six local authority family centres located in areas of high social need. They offer a range of family support services as well as carrying out child protection investigations and related activities. In analysing the data a probability ratio was created to identify which offered services were more likely to be taken up. An activity index for services offered and taken up was then constructed followed by an attempt to delineate families' likely orientation to a family support or 'protection and control' mode of intervention. This is achieved by creating a simple range of lower and upper bounds of perception by imputing service orientation from the position of three 'representative individuals': a 'very suspicious client', a 'neutral third party', and a 'very optimistic social worker'. These three positions allow manipulation of the questionnaire data to estimate the probable interpretation of services from provider and recipient standpoints. From these sources parameter estimates to explore key variables associated with worker views about the sufficiency of their service in relation to family support and/or more controlling forms of intervention are deployed. The study suggests that child protection cases receive a family centre service strongly orientated to support rather than a narrow policing activity. However, there remain some notable differences of perception between worker and 'representative individuals' that imply potential difficulties over the role of local authority family centres.     

Developing congruent children's services to improve child well-being

This paper explores whether different concepts of child well-being call for different 'service styles' and, if so, whether these styles can dovetail together to form a congruent pattern of children's services. The first part draws on the distinguishing features of five approaches to conceptualizing well-being – need, rights, poverty, quality of life and social exclusion – and their empirical manifestations ('conditions') to identify different emphases or 'styles' in service provision. The second, more discursive part of the paper explores potential contradictions between these service styles, for example, between needs-led and rights-based approaches or between policies to tackle poverty and combat social exclusion. The third part examines whether and how such contradictions can be minimized to achieve greater congruence and discusses the need to consider the orientation of children's services in respect of interpretations of child well-being.     

Caregiver involvement in behavioural health services in the context of child welfare service referrals: a qualitative study

Human service agencies serve a growing number of adults with behavioural health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioural health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioural health services. Researchers reviewed agencies' case records and conducted in‐depth interviews with 16 caregivers, 9 child welfare caseworkers and 12 behavioural health treatment counsellors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioural health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioural healthcare needs. Implications for managers and practitioners are discussed.     

Child Welfare in England: Problems, Promises and Prospects

This paper discusses developments in child welfare services in England in recent years and, particularly, the role and contribution of research. It is shown that a more significant and coherent body of child welfare research has been developed, which has linked formally to the policy process. Research programmes in England have highlighted specific problems in three areas: first, moving away from a narrow focus on child protection to an approach that provides broader family support for children in need; second, the absence of policies relating to services for adolescents; and, lastly, problems in the delivery of residential care for young people. A major programme of reform has been introduced by the new Labour government, consistent with research messages. It is concluded that research has had an impact on the development of child welfare services in England, although influencing the structure of services, social work practice and outcomes for young people are highly complex issues.     

Counting family support

Preventative family support approaches are positioned as central to child welfare policy reforms aiming to address the problems of relying upon investigation and out‐of‐home care as the main modes of intervention. Extensive claims are made for family support but relatively little is known about its scope, processes and impact. This study examines the provision of family support in one jurisdiction. A census‐type survey of family support services in one Australian state was conducted using a performance measurement framework in which inputs, outputs, processes and outcomes were measured. Family support services constituted a minor part of child welfare expenditure. They provided a narrow range of service types, and most families received short duration, low intensity services. Workers had difficulty identifying the specific child and family needs that were met by services. For family support to be a genuinely alternative response to concerns about the care of children, it must be capable of making an observable difference in the lives of families experiencing serious difficulties. The collection of aggregate performance data on family support would assist in understanding the nature and outcomes of service provision, as well as ensure family support is ‘counted’ in measurement‐orientated policy and budget processes.     

GPs and Contracts: Bringing General Practice into Primary Care

This paper argues that the terms on which GPs entered the NHS, as self-employed contractors, have proved remarkably resistant to the managerial pressures which have come to dominate other sections of the National Health Service. However, this traditional mode of financing and organizing the delivery of a key element of the National Health Service has become increasingly incompatible with wider health policy objectives—the development of an integrated network of good-quality, equitable and well-coordinated primary and community health services which are responsive to local needs. Furthermore, primary health services have themselves come to play a crucially important role in securing other strategic changes in the wider health policy arena, such as securing and sustaining a shift in the traditional balance between hospital and community-based health services and controlling expenditure in a needs-led service. The paper argues that, notwithstanding the change of government, the 1997 NHS (Primary Care) Act and the White Paper "The New NHS" are both integral to the achievement of wider strategic health policy objectives, such as improving the quality and coherence of services, and increasing professional accountability for the financial consequences of clinical decisions. However, the greatest significance of these and other related measures is that they shift the emphasis of health policy from commissioning and purchasing by primary care to commissioning and contracting for primary care. They thereby extend the exposure of GP-based services to managerialist scrutiny and control.     

Family support and the Scottish children's hearings system

ABSTRACT Evidence from a study of 1155 children referred to the children's hearings system in Scotland in 1995 found many of the children could be characterized as ‘children in need’. As found in other child care research, limited voluntary help was available to them, the majority received ‘no action’ and a substantial group a compulsory supervision requirement. The critical need for the strategic development of family support services in child welfare policy in Scotland for children referred to the hearings system is argued. The potential misuse of compulsory measures of supervision as a key to accessing resources is examined.     

Patterns of family service needs and caregiver–child relationships among families at risk of child welfare involvement

Caregivers at risk of involvement in the child welfare system report high levels of need for multiple types of services, and their children have high levels of mental health need. Caregivers from families with more service needs, as well as unmet needs, are less likely to be engaged with child welfare services and may have diminished capacity to care for their child. This study takes a family‐centered approach by using latent class analysis to identify patterns of both caregiver and child service needs among families at risk of child welfare involvement. Using data from the LONGSCAN consortium (N = 957), we identified 4 classes of service needs among child welfare‐involved families. We then examined differences between the 4 classes based on demographics, maltreatment histories, unmet service needs, and caregiver–child relationship. The caregivers were split fairly evenly among the 4 classes: low needs, medical needs, poverty support, and high needs. There were significant differences between classes on assessed variables, with higher levels of needs associated with diminished caregiver–child relationships.     

Mapping the journey: outcome‐focused practice and the role of interim outcomes in family support services

Longitudinal costly evaluations will always be important in order to understand the factors that impact on child, family and community well‐being over the long and medium term. However, in a policy era that accords major importance to the achievement of outcomes, e.g. payment by results, ‘outcome theology’ can pose threats to service access and professional morale in family support. It is essential therefore, to ascertain the short‐term outcomes of services in order to capture the trajectory of progress by families under stress. This paper critiques the concept of ‘the outcome’. It traces the development of this trend in policy and describes an alternative but complementary approach, which is based on capturing interim outcomes in family support services.     

Elderly Consumers and Social Care Policy

The development of social care policy for elderly Australians is proceeding with little regard for the preferences and perspectives as expressed by the elderly themselves. The likely consequence is a continuation of policies based largely on other people's assumptions about what elderly people actually need and the extension of service categories into which many elderly people do not easily fit. Discussions with 71 elderly consumers during 1983 in Queensland established that they have input to make into policy and service delivery issues such as the provision of information on services, the determination of needs, the extension of choices between alternative services and choice of appropriate service providers. Social care policy should not continue to develop around singular and untested assumptions concerning what elderly people need and prefer.     

Working and caring for a disabled adopted child during a pandemic

Integrating work and family demands can be challenging for families caring for a child with one or more disabilities. The pandemic and its changes to work, schooling and service delivery potentially added to these challenges. This exploratory mixed methods study sought to understand how the pandemic affected adoptive parents' work–life fit and service use. A total of 200 participants responded to survey questions about parenting an adopted child with a disability prior to, and after, the onset of Covid-19. More than half of the parents (59.2%) reported that it was somewhat to very difficult to integrate both work and family demands. Parents with greater access to workplace flexibility and supportive supervisors had significantly less difficulties combining work and family. Families who reported more problems with accessing mental health services, special education and respite care reported significantly more challenges with work–family fit. Parents reported increased stress due to the pandemic changes, but many also shared positive changes such as more time for family. Online services were experienced as effective for some children and reduced time spent driving to appointments. Recommendations for workplace and social service practice and policy supporting adoptive parents of children with disabilities are discussed.     

Family support: past, present and future challenges

Section 17 of the 1989 Children Act incorporates a new legal framework for the delivery of services to support children in their own homes, and is a crucial part of the act, both in its own right, and in terms of its significance for other aspects of child care such as child protection activity. However, while "children in need" represents a new legal phraseology, the policy and professional issues addressed by the clause have a long history. This paper traces the evolution of the current approach to family support, and provides a brief account of its impact on policy and practice.     

Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service‐users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services – a setting where conflicting objectives to manage risk and meet need are apparent. Media‐driven pressure to ward against the ‘risk’ represented by service‐users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service‐user engagement and hinder risk management. Drawing on qualitative data from interviews with service‐users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter‐productive, trust plays a significant role in service‐users' initial and ongoing engagement, communication and co‐operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in‐patient care.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

Promoting child protection, welfare and healing: the case for developing best practice

This paper presents a 'best practice perspective' on child and family work. This involves moving beyond the 'deficit perspective' which dominates how the literature examines practice negatively in terms of what is not being done well to one which sets out best practice positively as a model for learning and developing systems and practice competencies. The paper focuses specifically on the meanings and development of best practice in family support in the context of child protection work. This involves work that is not only sensitive to achieving child protection and empowering practice in the context of power differences, but which meets the challenges of engaging therapeutically with and ultimately helping (often resistant) service users. The paper argues that issues of trauma and healing, and self-actualization more broadly, need to move to the centre of how family support and child protection are theorized and done. The aim should be to promote child protec-tion, welfare and healing through the development of egalitarian relationships in what Giddens calls the 'democratic family'.     

Closing the gap? The effectiveness of referred access family support services

This paper presents findings from a study of the effectiveness of family support services provided through two family centres run by a voluntary agency in partnership with a South Wales local authority. It evaluates the effectiveness of family support services by looking at both the family views and a number of measurable outcomes in terms of reported changes in family functioning and the well‐being of children and parents. Interventions were monitored over 6 months using a pre‐test post‐test non‐equivalent groups design, incorporating quantitative and qualitative methods. Child well‐being, family functioning and some aspects of parental well‐being (related directly to the child) did improve over the intervention period for family support service users. This improvement resulted in the family support service users ‘closing the gap’ with non‐service users (comparison group), to such an extent on some measures, as to be statistically significant. The qualitative evidence confirmed these improvements. The only area that did not improve, according to the quantitative findings, was that of parental well‐being (not related directly to the child). This includes important factors around social support networks, such as parental confidence, social interaction and social contact. The reasons for lack of improvement in these areas are discussed, emphasizing the importance of monitoring the impact of using the service and incorporating a focus on the quality of the nature of the relationship between the worker and the service user.     

Service user participation in diverse child protection contexts: principles for practice

Promoting the participation of children and parents in child protection practice is one of the most complex and sensitive areas of social work practice. Increasingly, child protection legislation and policy in many parts of the world enshrines ideals of service user participation. Yet, with the exception of extensive discussion about family group conferencing, the principles and methods for achieving participatory practices in child protection work remain underdeveloped. We use the term 'child protection' to refer to a broad spectrum of child and family welfare services aimed at prevention of (or intervention to address) child abuse and neglect. This spectrum of services includes intensive family support, family support, domestic violence, statutory child protection and child and family advocacy services. In this paper, we present findings from the first phase of a 3-year study into participatory practice in child protection. In this paper, we present findings from a qualitative analysis of interviews with 28 child protection practitioners across five domains of child protection work. Our analysis reveals three core principles of participatory practice underpinning these practitioners' accounts as well as contextual differences among them. We conclude with a discussion of the educational implications of our findings.     

The Impact of New Labour Health Policy on Social Services: A New Deal for Service Users' Health?

Summary The health policies of the Labour Government of 1997–2001included an increased emphasis on social services departments'(SSDs) contribution to promoting health. Three dimensions ofthis policy shift are discussed: first, the drive towards organisationalfusion between elements of the NHS and SSDs; second, the newmechanisms for conjoint funding of health and social services;and, finally, the new policy focus on tackling health inequalitiesby combating social inequalities on a national and localitybasis. In each case, the touchstone of our analysis is the consequencesfor the health and well-being of SSD service users as membersof socially disadvantaged groups. We conclude that New Labourhas taken some steps, particularly reducing child poverty, whichwill have long lasting health and social benefits for actualand potential service users. However, inadequate funding ofSSDs undermines their effectiveness as a partner in integratedhealth and social care. As signalled by service user initiatives,SSDs potential for promoting more equal chances of health andwell-being in ill-health will also not be realised without substantialchanges to current SSD policy and practice.     

Research Review: Parents' service experience – a missing element in research on foster care case outcomes

A large body of child protection literature focuses on termination of parental rights, family reunification, and children's re‐entry into care as outcomes for children in foster care. Studies have investigated child, placement, family, and parent variables as predictors of case outcome. However, one important group of variables remains largely unstudied: factors related to parents’ service experience. Parents’ service experience includes parents’ perceptions of and involvement in the various services in which they must participate in order to recover their children from foster care (e.g. mandated treatment programmes such as substance abuse rehabilitation, parenting skills classes, etc.). The parental perspective on the foster care process is a critical element in the life of a child protection case, and its influence on case outcome must be explored. A brief review of the current literature on case outcome predictors is provided and parents’ service experience is highlighted as an area in need of investigation. Suggestions for the measurement of parents’ service experience are also offered.