Statistical Errors in Papers in the British Journal of Social Work (Volumes 1-14)

Summary This paper examines the statistical error rate in the BritishJournal of Social Work (BJSW), volumes 1–14. Half of thepapers (n=175) contain empirical data and half do not. Fifty-nineof the empirical articles are quantitative with statisticalanalysis; they account for 17% of the papers in the first 14volumes. Thirty-nine of these papers (66%) make 57 errors, arate which is comparable to that reported in the British Journalof Psychiatry. Nineteen papers (32%) make serious errors. Examplesof the type of errors are described. The wider use of reliablestatistical advice, prior to undertaking data collection, isrecommended.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

A code of ethics for social work and social care research

Summary This Critical Commentary is the final product of the Economicand Social Research Council sponsored seminar series, TheorisingSocial Work Research to appear in the BJSW. The special editionof the British Journal of Social Work published in August 2000carried several key papers arising from the seminar series aswell as reports of some of the events themselves. The responsibilityfor drafting the Code of Ethics for Social Work and Social CareResearch fell to me and although discussed at the Luton Seminarand at the final conference in Manchester, the text presentedhere is much as it first appeared. This is simply to reaffirmthat it has no particular status and is reproduced in the Journalas a prompt to further discussion, precisely the purpose itwas to serve for the seminar series. Before reproducing the Code, it might be helpful to revisitsome of the main points which were raised in the paper presentedat the Luton Seminar which set the context for the Code (Butler,2000).     

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.     

The Quality of Life of the Chronically Mentally Ill: A Comparison of Public, Private, and Voluntary Residential Provisions

Correspondence to J. P. J. Oliver, Lecturer in Psychiatric Social Work, Department of Psychiatry, University of Manchester, Rm 11.11, Mathematics Tower, Oxford Road, Manchester, M13. Summary A pilot survey was undertaken as part of a long-term investigationof the needs which people with chronic mental illness have forcommunity support. The main purpose of this preliminary exercisewas to develop relevant measures of need. particularly measureswhich give due weight to the assessments which chronic patientsmake of their own quality of life. Results have particular relevancein the light of the ‘White Paper’ on community care,Caring for People and the National Health Service and CommunityCare Act, 1990 because the survey considered patients' experienceof life in three distinct types of resettlement facility: thepublic, the private and the voluntary. While differences inregimes, the personal characteristics of residents and objectivequality of life were noted, no differences in subjective qualityof life (either in general or in specific domains of life) werenoted from one type of facility to another. These results andtheir implications are discussed.     

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.     

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.     

Applying Single-Case Evaluation in Social Work

Summary This article reports on a research project involving the useof single-case designs on an agency-wide basis within KirkleesMetropolitan Education Social Work Service. Following a programmeof training, 21 social workers (69 per cent of the service)applied the methodology in 83 cases. The extent of practitionerinvolvement in this project prompted Bruce Thyer (Professorat the University of Georgia, USA and editor of Research onSocial Work Practice and author of Thyer, 1993) to state ina letter to the authors, ‘Please allow me to offer mycongratulations on a most valuable project. To my knowledge,this is the largest agency-based study of this type which hasever been conducted. Your agency social workers are especiallyto be commended for their implementation of single-case designswith real life clients and families’ (6 May 1994). Theproject's strategy was to concentrate on the prerequisites ofsingle-case methodology which include specifying target problemsand selecting an appropriate measure to monitor progress. Thetype of single-case design used was determined by the courseof natural practice, hence indicating the flexible nature andviability of this methodology in the evaluation of social workpractice. The use of single-case designs encouraged a systematicapproach in the definition of target problems, identificationof goals, selection of intervention procedures and in monitoringoutcomes. The practitioners found that single-case designs enabledcontinuous assessment of outcome data by both the clients andthe practitioners, providing a model of accountability and collaborativeworking. A paper based on this article was presented by MansoorKazi at the ADSS Research Group Conference, Stafford, 17–18November 1994.     

Hidden Gems: Systematically Searching Electronic Databases for Research Publications for Social Work and Social Care

Correspondence to Brian Taylor, Queen's University Belfast, Department of Epidemiology and Public Health, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland. E-mail: b.j.taylor{at}qub.ac.uk Summary Context: Electronic bibliographic databases are an importantsource for professional publications about social work and communitycare more generally. This article describes and evaluates amethod of identifying relevant articles as part of a systematicreview of research evidence. Decision making about institutionaland home care services for older people is used as an example.Method: Four databases (Social Science Citation Index, Medline,CINAHL and Caredata), which abstract publications relevant tohealth and social services, were searched systematically toidentify relevant research studies. The items retrieved wereappraised independently using a standard form developed forthe purpose. The searches were compared in terms of sensitivity,precision, overlap between databases and inter-rater reliability.Results: The search retrieved 525 articles, of which 276 wererelevant. The four databases retrieved 55 per cent, 41 per cent,19 per cent and 1 per cent of the relevant articles respectively,achieving these sensitivities with precision levels of 54 percent, 48 per cent, 84 per cent and 94 per cent. The databasesretrieved 116, 73, 24 and 15 unique relevant articles respectively,showing the need to use a range of databases. Discussion: Ageneral approach to creating a search to retrieve relevant researchhas been developed. The development of an international, indexeddatabase dedicated to literature relevant to social servicesis a priority to enable progress in evidence-based policy andpractice in social work. Editors and researchers should considerusing structured abstracts in order to improve the retrievaland dissemination of research.     

What do Care Managers do?--A Study of Working Practice in Older Peoples' Services

Correspondence to A. Weinberg, School of Community Health Sciences and Social Care, University of Salford, Allerton Building, Frederick Rd Campus, Salford, Greater Manchester M6 6PU, UK. Summary This paper explores the principal activities of local authoritystaff undertaking the role of care manager. It is based on asample of staff in a social services department specializingin older people's services. Data were obtained by asking staffto complete a diary schedule in which thirty-four job relatedactivities were grouped into five broad categories on the basisof previous research. A 57 per cent response rate was achieved.Analysis of the data revealed several findings of note. First,excluding travel, care managers spent 64 per cent of their workingweek in direct and indirect user and carer related activities.Second, administrative tasks occupied 32 per cent of their time.Third, care managers spent 27 per cent of their time in assessmentactivities compared with 7 per cent in monitoring and reviewingactivities and 5 per cent in counselling and support. Fourth,care managers spent 4 per cent of their time liaising with healthstaff. These findings are discussed in the light of previousresearch and a shift is noted in the nature of the direct contactwith the service user. The methodological limitations of thestudy are explored and the implications of these findings forusers and carers and the development of care management arrangementsare discussed.     

Parton, Howe and Postmodernity: A Critical Comment on Mistaken Identity

Correspondence to Carole Smith, School of Social Work,, Department of Social Policy and Social Work, Dover Street Building, The University of Manchester, Oxford Road, Manchester M13 9PL Summary In their contributions to the debate about social work, modernityand postmodernity Parton(1994) and Howe (1994) argue that therecent changes in social work practice can best be understoodas features of, or responses to, the postmodern social orderin which it is located. This has led, they argue, to an increasingfragmentation of the profession and an undermining of its formalknowledge base. We will argue here that, not only does suchan argument oversimplify the nuances of the ‘postmodernity’question, but it represents a misreading of the pressures affectingpractice at this time, which are more properly attributableto the operation of the discourses and ideologies of a particularphase of late capitalism and high modernity.     

Determinants of Substitute Child Care Practice

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford CX1 2ER Summary The first part of this paper attempts to examine the factorswhich help to define foster and residential care practices.The discussion is informed by a comparative study of fosterhomes and Children's Homes, which was reported in the previousissue of this journal (BJSW 18:1). Overall, care practices inthe foster homes compared very favourably with those observedin the Children's Homes. It is argued that this finding owesmuch to the bureaucratization of Children's Homes. The secondsection considers the implications of my work for policy andpractice in the field of substitute child care. Use is madeof the insights provided by the preceding section to suggestways by which the major shortcomings identified by empiricalresearch might be ameliorated. This statement includes an argumentin favour of a significant expansion of family placement forolder children in public care, and a proposal for a child-orientedalternative to the sorts of Children's Homes visited.     

Statistical Considerations in Social Work Research

Correspondence to David Goda, School of Computing and Information Technology, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1SB. Summary Guidelines are presented in an attempt to assist those consideringsubmitting to this Journal papers containing quantitative data.     

Religion and Spirituality in Social Work Education and Direct Practice at the Millennium: A Survey of UK Social Workers

Correspondence to Dr Leola Furman, 1201 Yale Place, Minneapolis, Minnesota, 55403, USA. E-mail: furmanlfurman{at}aol.com Summary In recent years, an expanding body of social work publicationsand professional conference presentations has materialized inthe United States due to a resurgence of interest in spiritualityand religion. In order to explore the level of interest in theUnited Kingdom, a random sample of 5,500 practising social workersfrom the British Association of Social Workers (BASW) membershipwere mailed a questionnaire that examined religious and spiritualbeliefs, practices and affiliations. A total of 789 BASW membersin direct practice from England, Scotland Wales, and NorthernIreland returned questionnaires, a response rate of 20 per cent.The majority of respondents believed that spirituality was afundamental aspect of being human. More than three-quartersof the sample reported little or no content on religion andspirituality in their training programme. Respondents stronglyapproved of raising the topic of religion and spirituality withclients who are experiencing terminal illness or bereavement.This also held true in matters of adoption and foster parenting.Approximately 47 per cent of all respondents believed that includingreligion and spirituality in direct practice was compatiblewith social work’s mission. This sample may representthose social workers with a stronger interest in religion andspirituality than a random sample of the general populationof UK social workers. These findings, nevertheless, raise concernabout the availability of practice models and training curriculafor social work practitioners and students.     

Integration and Targeting of Community Care for People with Severe and Enduring Mental Health Problems: Users' Experiences of the Care Programme Approach and Care Management

Correspondence to Professor John Carpenter, Director, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.ukJ.S.W.Carpenter@dur.ac.uk Summary We report the experiences of different models of community careof random samples of 262 people with severe and enduring mentalhealth problems living in four districts in the north of England.The districts were characterized in terms of the extent of (1)integration between the health service-led Care Programme Approach(CPA) and social services Care Management, and (2) targetingof services on people with severe mental health problems. Themajority of service users felt involved in planning their owncare and considered that they had choice in their care and treatmentwhen in the community, but not in hospital. Although all theseusers were formally subject to the CPA, the proportions of usersin the districts believing they had a written care programmeranged between 37 per cent and 60 per cent. Of these, the greatmajority were very positive about their care programmes andfelt that they were being helped to become independent. Theseresults were replicated when 87 per cent of the original samplewas re-interviewed six months later. There were significantdifferences between the four districts and evidence that userspreferred an integrated health and social care service. In addition,a higher proportion of users in inclusive districts were satisfiedcompared to those in targeted districts. Notwithstanding thesepositive findings, there is still considerable room for improvementin relation to the involvement of family carers and the provisionof adequate information about prescribed medication and makingformal complaints.     

A Consumer Study of Young People's Views on their Educational Social Worker: Engagement as a Measure of an Effective Relationship

Correspondence to Colin Pritchard, Mental Health Group, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton, SO14 0YG, UK. Summary This, the first ever consumer study of education social workers(ESWs), uses qualitative material and quantitative analysisby examining the views of 110 users of a county ESW service.Most pupils belonged to families with long-standing disadvantage;e.g. 53 per cent had unemployed fathers; over 70 per cent hadparents with disturbed personal and social relationships, 39per cent had a single parent; 30 per cent plus had mental healthproblems; and 10 per cent of parents had been in care as children,i.e. more than ten times the national average. The young people also had considerable disruption in their lives:for example 78 per cent frequently missed school; over 50 percent had school and peer difficulties; 30 per cent offended;over 30 per cent experienced bullying; 5 per cent were the subjectof child protection enquiries, 10 per cent had previously beenin care and 2 per cent had had an incident of ‘attemptedsuicide’ (50 times the national rate). They averaged sixmajor difficulties each. Despite these antecedents, 91 per cent of the young people demonstratedan ‘engaged’ relationship with their social worktrained ESW, with many examples of practical psychosocial helpbeing received. The concept of ‘engaged’ was statisticallyvalidated in the comparison of views between the ‘engaged’and ‘non-engaged’ research participants. The resultsindicate the value and effectiveness of a supportive rapport/relationshipas a vehicle to reach and to be of practical assistance to disturbedand disturbing young people.     

A Comparison of Child-sex-abuse-related and Mental-disorder-related Suicide in a Six-year Cohort of Regional Suicides: The Importance of the Child Protection-Psychiatric Interface

Correspondence to: Professor Colin Pritchard, Department of Mental Health, School of Medicine, Southampton University, Royal South Hants Hospital, Southampton SO14 0YG, UK. E-mail: cp1{at}soton.ac.uk Summary The study compares Mental-Disorder-Related (MDR) suicide rateswith Child-Sex-Abuse-Related (CSAR) suicide of ‘Victims’and ‘Perpetrators’ of child sex abuse, based uponan examination of all Coroners’ inquest files over a six-yearperiod (n = 1,017). Census data, psychiatric case register andpolice records were used to calculate the potential MDR andCSAR populations. There were five main findings: (i) male andfemale CSAR victim suicide rates were 2.2. and 2.5 times theGeneral Population Suicide Rate (GPSR), respectively; (ii) everyfemale, and 80 per cent of male CSAR victim suicides, also hada mental disorder but none of the CSAR perpetrator suicides;(iii) male and female MDR suicide rates were 5 and 6 times theCSAR Victim rates; (iv) the sex abuser perpetrators’ suiciderate was more than 3 times the male MDR rate; (v) the intra-and extra-familial perpetrator suicide rates, were 25 and 78times the GPSR, respectively. Possible explanations for thesesurprising results are briefly discussed. They confirm the overrepresentationof people with mental disorder amongst suicides, and identifyan overrepresentation of CSAR suicides, particularly perpetrators.The results have implications for suicide prevention programmes,whilst highlighting the importance of the child protection-psychiatricinterface, and indicates the futility of simple explanationsin an area of practical and moral complexity.     

Assessment and Action Records: Will they Promote Good Parenting?

Correspondence to Theo Knight, Department of Applied Community Studies, Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 2RR. Summary In this article the authors seek to provide a critical lookat Looking After children: Good Parenting and Good Outcomes(Department of Health, 1995). They welcome the sentiments underpinningthis major contribution, which recognizes the many disadvantagesfaced by children and young people who are looked after by localauthorities, and acknowledge that local authorities have notbeen positive parents of those in their care. The writers alsoacknowledge the thoroughness which has gone into the detailof the Action and Assessment Records contained in the abovepack. What is questioned is the normative view of parentingand family life which is seen to be at the heart of these documentsand the lack of consideration of the resourcing of action plans.The checklist approach is criticized for the way in which itwill enhance the bureaucratic nature of being in public care,which in turn affects the relative power positions of parentsand children in relation to the local authority and which willimpact on the development of a partnership model of care. Thewriters conclude that children and young people in care arebut one group of young people facing disadvantage and deprivationin British society. An examination of their plight and how toaddress it need to be based within a clear framework of children'srights and a recognition of the power adults hold over them.     

Psychological Distress in Staff of a Social Services District Office: A Pilot Study

Correspondence to High Winnard, Church Road, Bishopsteignton, Devon TQ14 9QH, UK Summary This comparison study of fieldworkers and administrative workersin a social services district office addressed three researchquestions. Would fieldworkers show more internality and wouldthey perceive higher job demands than administrative workers,and would there be a positive relationship between perceivedstress and perceived job demands for all workers? The GeneralHealth Questionnaire 28 was administered, in addition to a jobdemand inventory. Self-reported absenteeism due to illness wasconsidered, and locus of control was considered as a moderatorof stress, as were years of service, age, and whether the employeeworked part- or full-time. Because fieldworkers might generallybe thought to be under more stress due to their work contentthan their support staff, data from fieldworkers were comparedwith those from administrators. Gender differences were alsosought. Statistical tests showed no significant differencesfor gender or between the administrative staff and fieldworkstaff for internality or job demand. A positive relationshipwas evident between perceived stress and perceived job demandwith a correlation of 0–40 (p <0·05). In addition,over 72 per cent of the sample scored above the cut-off pointon the GHQ 28 indicating psychiatric morbidity. The implicationsof the results are discussed.