The Significance of Past Abuse to Current Intervention Strategies with Depressed Mothers in Child and Family Care

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon, PL6 7EW, UK. Summary There is now considerable evidence that a high proportion offamilies subject to child and family care social work interventioncontain depressed mothers. There is also evidence that the presenceof clinical depression is associated, amongst these clients,with child abuse. Vulnerability to both depression and childabuse have been traced back to the early child-care experiencesof those who are currently parents, expressed in child abusein terms of intergenerational transmission, although it is alsoclear for both that further factors also contribute to thisvulnerability. Despite the link between maternal depressionand child abuse, we have little evidence about the processesand mechanisms, based on social workers judgements about thesituation, by which families with depressed mothers are morelikely than other clients to be involved with intervention forchild abuse. This paper seeks to ‘map’ the pathwaysand the intermediate mechanisms which provide the link betweenthe experience of past abuse and social workers interventionstrategies. Drawing on theoretically significant factors, itfocuses on the following variables: the experience of past abuse,the mother's attributed character, attachment and bonding, childbehavioural problems and intervention strategy. The paper demonstratesa number of significant ‘paths’ through which familiesbecome subject to one or other intervention strategy. It showsthat, while an emphasis on needs assessment is to be welcomed(Department of Health, 1999), they need to be considered (i)within a theoretical framework which helps social workers makesense of, and respond to situations and (ii) through an understandingof longitudinal dimensions (key factors in mothers' earlierlife) which are aspects of this theoretical understanding.     

Poverty, Social Work and Social Justice

Correspondence to: Gary Craig, Professor of Social Justice, University of Hull, Hull, HU6 7RX, UK. E-mail: G.Craig{at}hull.ac.uk Summary The concept of social justice has become a common part of thepolitical lexicon in recent years, with New Labour identifyingit as a key goal of its social strategy. In this article, Iset out my understanding of what the elements of a social justiceprogramme should look like and apply it to the performance ofthe New Labour government in the policy area which has traditionallypresented a major challenge to social workers, the issue ofpoverty. Finally, I raise some questions about what this analysismeans for the future role of social work shaped by values ofsocial justice.     

Contact and Collaboration with General Practitioners: A Comparison of Social Workers and Community Psychiatric Nurses

Correspondence to Mr M. Sheppard, Department of Applied Social Science, Polytechnic South West, Drake Circus, Plymouth, Devon PL4 8AA. Summary For some years good communication and collaboration betweenhealth and welfare professionals has been emphasized as a desirablegoal by both official reports and relevant professions. Thisis as much the case in mental health as other areas. This papercompares communication and collaboration between social workersand general practitioners (GPs) with that between communitypsychiatric nurses (CPNs) and GPs. Both social workers and CPNswere based at a community mental health centre, and the contactwas interagency (with primary health care). Major differenceswere found between social workers and CPNs. CPNs were far morelikely to contact GPs than social workers, although GPs veryrarely initiated contact themselves. Differences reflected different‘philosophies of contact’. Social workers contactedGPs when this could be purposively related to their case management.In addition to this contact, CPNs also made contact to provideGPs with information, reflecting awareness of GPs' long-termcontinuing care responsibility. The excess of CPN contacts wasnot limited, but involved a wide range of problems. GPs, however,when contacted, exerted greater influence on social work casemanagement. The article concludes by explaining differencesbetween CPNs and social workers in terms of occupational culture.It suggests, furthermore, that the results arise at least inpart from assumptions of team leadership by GPs, and that socialworkers' and CPNs' behaviour represents different responsesto this.     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

Social Work, Social Science and Practice Wisdom

Correspondence to Michael Sheppard, Department of Applied Social Science, University of Plymouth, Drake Circus, Plymouth PL4 8AA. Summary Social work has for some time had an ambiguous and ambivalentrelationship with its social science knowledge base. However,this has arisen, at least in part, because of the emphasis onthe outcome or product of social science rather than the processby which research is conducted. This paper, focusing on assessment,argues that an emphasis on process goes some way to closingthe gap between social science and social work, that the methodsused by social researchers are, in many respects, simply refinementsof the methodology of everyday life, and that social workers,when conducting assessments operate rather like practical qualitativeresearchers. Using Analytical Induction as an heuristic device,it proceeds to explore critical characteristics of good practicein social work assessments. It concludes that practice shouldbe characterized by critical awareness, involving imaginativedevelopment of alternative hypotheses, a sceptical attitudetowards case assessments and a principle of adopting hypothesesleast likely to be in error.     

An Evaluation of Social Support Intervention with Depressed Mothers in Child and Family Care

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK. Summary The significance of maternal depression to social work practicein child and family care has become increasingly apparent inrecent years. Social support, furthermore, is a concept (aswell as a reality) which provides a major focus for social workpractice. Indeed, social support, it is also clear, is of considerableimportance in helping prevent depression. This paper seeks toexamine social support work carried out by social workers inrelation to depressed mothers in child and family care. In particularit seeks to evaluate the quality of that intervention in thelight of key problem areas associated with high levels of supportneeds, the extent to which social workers target support needsthrough direct, indirect and informal supports, and the extentto which particular interventions are associated with a higheradequacy of support experienced by these depressed women. Thepaper finds a certain degree of haphazardness in social workers’targeting of support needs, although in some areas of indirectsupport, in particular, their targeting is reasonably accurate.There is little evidence of any one form of intervention beingassociated with more adequate support with one significant exception,relief care of children. The paper concludes that social workersneed to develop a keener awareness of support deficits so thatthey are targeted better; they need to monitor more carefullyinterventions carried out by other agencies and professionals;and they should look to relief care of children as a major formof intervention to support these women.     

General Practice, Social Work, and Mental Health Sections: The Social Control of Women

Michael Sheppard, Senior Lecturer in Social Work, Polytechnic South West, Drake Circus, Plymouth, Devon PL4 8AA. Summary A survey was undertaken of all referrals for compulsory admissionreceived by a city mental health centre over a one year period.The centre receives the overwhelming majority of all these referralsin the city. Referrals from GPs were compared with other referralsfocusing particularly on women. The results indicate GPs discriminatedagainst women, referring considerably more women than men withless emphasis on major (psychotic) mental illness. The involvementof approved social workers (ASWs) in the assessment processwas associated with diversion of many of the women away fromcompulsory admission, although even they appeared affected bypatriarchal assumptions. GPs' behaviour with regard to sectionsis consistent with reports about sexist practice in other areasof work. This, however, is particularly grave with sectionsbecause of civil liberties implications. The article concludesthat ASWs need be aware of potential sexist GP practice, thattheir psychosocial perspective is critical to assessment andthat ASW training should include gender issues.     

Care Management and Information Provision: Towards a Reasoned Method of Assessing the Range and Extent of Problems and Needs in Child-Care Social Work

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA Summary The new managerialism associated with care management has, aswith other areas of health and welfare work, promoted ideasof efficient use of resources, quality assurance and the capacityto audit the work of welfare agencies. This approach placesa high premium on measurement, and emphazises a long-standingdesire to develop instruments the use of which would providethe basis for resource allocation. This paper presents a methodby which such data can be rigorously generated and analysed.It uses as its basis an instrument of established reliabilityand validity, designed to collect data on problems identifiedin clients in the child and family care social work group. Ituses a combination of principal component and cluster analysisto provide a clear picture of the nature and range of problemsand the grouping of cases with similar characteristics. Thesedata provide a quantitative basis upon which judgements aboutresource allocation can be made.     

Value Bases in Social Work Education

Correspondence to Elisabeth Lynn, Lecturer in Social Work, Centre for Applied Social Studies, 9th Floor, Chemistry Tower, University of Wales Bangor, Bangor, Gwynedd LL57 2UW, UK. Summary In this paper the two values of social justice and personalcaring are identified as key ideologies within social work education.Their presence is traced within a historical ebb and flow oftheory and practice and it is argued that this dialectic isembedded in social and individual systems. Based on fieldworkresearch with social work lecturers and practice teachers, itis argued that anti-oppressive social work needs a reflexivetheory/practice model to provide an understanding of how structuralpower affects all aspects of an individual. This demands a workingsynthesis of the two values of Personal Canng and Social Justicewithin an understanding of a multiple approach.     

Social Work: Gender, Care and Justice

Correspondence to: Joan Orme, Department of Social Policy and Social Work, Lilybank House, Bute Gardens, University of Glasgow, Glasgow G12 8RT, UK. Summary This article, in examining gender and justice, seeks to examinethe relationship between feminist theory and social work. Specificallyit reviews writings on social work ethics and suggests thatlittle attention has been paid to feminist scholarship thatresonates with social work practice. Focusing primarily on communitycare, it demonstrates how debates within feminism have becomemore complex and have problematized understandings of both careand justice. It argues that for social work it is unhelpfulto dichotomize justice and care; we should aspire to just socialwork practice.     

Practice Validity, Reflexivity and Knowledge for Social Work

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK Summary In the last few years there have been significant developmentsin conceptualizing the role and nature of knowledge in socialwork. This has been based on a fundamental review of epistemological,ethical and theoretical facets of social work and its knowledgebase. Amongst some of the most significant developments havebeen the emergence of new concepts (for social work) such asprocess knowledge, reflexivity and a range of ideas relatingto hypotheses. In a recent article, Susan White (1997) soughtto critique some of my ideas on this matter. This article representsa response to her paper; one which uses the opportunity to drawout wider issues for a general theory of social work knowledge.In particular, it focuses on three key dimensions: the centralityof the concept of practice validity, the importance of a conceptof reflexivity which is not simply transferred from the disciplineof sociology but which has a social work-specific meaning, andthe dangers of an unrestrained relativism.     

Maternal Depression, Child Care and the Social Work Role

Correspondence to Michael Sheppard, Principal Lecturer, Department of Applied Social Science, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA. Summary This article reviews findings on the relationship of maternaldepression and child care problems, a relationship which haslargely been ignored in social work. These findings are of particularimportance in view of the philosophy in the Children Act 1989that the best place to bring up a child is usually with theirfamily and the duty of local authorities to promote this. Thefindings consistently identify a clear relationship betweenemotional and behavioural child care problems and maternal depressionshowing that depression is likely to affect the mother's childcare abilities and also her perceptions of the child's behaviour.These have important implications for education, training andpractice, and these are discussed.     

Taking Rights Structurally: Disability, Rights and Social Worker Responses to Direct Payments

Correspondence to: Tim Stainton, School of Social Work and Family Studies, University of British Columbia, 2080 West Mall, Vancouver, BC, Canada, V6T 1Z2. E-mail: timst{at}interchange.ubc.ca Summary This article examines the link between a justice and rightsdiscourse and disability policy and practice. Specifically,it considers social worker responses to direct payments, a policywhich has been linked to a discourse of social justice and rights.The article initially considers the nature of justice and rights,arguing that these can plausibly be seen to be grounded in theidea of autonomy and that a rights or justice based social policyand practice must be grounded in the protection, enhancementand development of the capacity for autonomous action. The articlethen presents partial findings of a research project, whichsampled social workers' views and attitudes towards direct paymentsin three local authorities. The findings suggest that socialworkers are aware of the link between direct payments and autonomyand are generally very supportive of the move to a rights basedapproach to policy and practice as evidenced by programmes suchas direct payments. The paper also concludes that structuralconstraints limit social workers' ability to fully functionfrom a rights based approach to disability.     

Social Work and the Justice Model

Summary Three sets of ideas, which I am calling justice, welfare, andcommunity approaches interact in the criminal justice systemsof England and Scotland. Social workers are usually most influencedby a welfare approach but this approach is always in dangerof becoming arbitrary. The essential values of a welfare approachmight in fact be strengthened by introducing from the justiceapproach ways of structuring discretion. This idea will be examinedin relation to juvenile justice and parole where compulsorypowers back the application of welfare ideas. Ways of ensuringthat social work discretion is confined, structured and checkedwill be considered.     

Tackling Inequalities in Physical Health: A New Objective for Social Work

Correspondence to Eileen McLeod, Department of Social Policy and Social Work, University of Warwick, Coventry, CV4 7AL, UK. Summary We argue that tackling the impact of social inequality on physicalhealth should become a central objective of social work andintrinsic to the development of anti-oppressive practice. Thisis on three grounds. First, the suffering embodied in inequalityin physical health should be a cause of concern to social workers,as a pervasive social problem. Secondly, awareness of socialwork's complicity in contributing to such a problem, throughits historical role in implementing state policies, needs toinform assessment of social work outcomes. Nevertheless, thirdly,social work—not confined to health care settings—whichredresses social disadvantage and tackles its consequences forphysical well-being can contribute to greater equity in health.Indicative examples of such practice are provided in relationto health maintenance, living with ill health and terminal illness.Finally, consideration is given to the current wider politicalcontext in which social work addressing health inequalitiesis embedded and to the need for complementary organizational,professional and political initiatives to buttress its development.     

Videotaped Evidence of Children: Application and Implications of the Memorandum of Good Practice

Correspondence to Penelope Welbourne, Senior Lecturer, Department of Social Policy and Social Work, University of Plymouth, Devon PL4 8AA, UK. E-mail: p.welbourne{at}plymouth.ac.uk Summary A sample of videotapes carried out in accordance with the ‘Memorandumof Good Practice’ in one Child Protection Unit was evaluatedto ascertain any factors associated with disclosure of abuseduring the interview. The sample of children selected for interviewwas compared with the group of all children referred to theUnit during the study period. It was found that such interviewsare used primarily for victims of suspected sexual abuse. Onlyvideotaped interviews of children who had made a prior disclosureof abuse contained disclosures on video. It is argued that useof the Memorandum as an investigative technique in child protectionand criminal justice is problematic because of the inflexibilityof the Memorandum procedures. It is proposed that they be reviewedin light of information now available about the impact of theirapplication.     

Practitioners as Rule Using Analysts: A Further Development of Process Knowledge in Social Work

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. E-mail M.Sheppard{at}plymouth.ac.uk Summary A new paradigm of ‘process knowledge’ has emergedin recent years, distinct from the dominant ‘product knowledge’paradigm in social work. While the latter refers to existentknowledge, which may be applied, the former refers to the developmentof knowledge about the ‘methodology of practice decisionmaking’, focusing on the processes by which judgementsare made. At its heart is the emerging idea of a reflexivityfor practice, but studies have been, until recently, theoretical.A very small number of empirical studies have begun to identifysome key elements of process knowledge. These have developeda range of concepts relating to critical appraisal, hypothesisdevelopment and hypothesis testing which characterize socialwork process knowledge. These include, for example, focusedattention, querying information, causal inferences, partialcase, procedural, and speculative hypotheses. A process of quasitriangulation is characteristic of social work practice methodology,together with a combination of inductive and deductive thinking.This paper seeks to develop our understanding by focusing onhow social workers develop and appraise hypotheses, and in particularhow the substantive content of hypotheses emerges (these enablesocial workers to make sense of, define, and respond to, situations).To understand this, the notion of rules is used, and socialworkers emerge as analysts employing three types of rules: substantive,application, and practice rules. A significant link betweenprocess knowledge and the content of product knowledge is identifiedin the form of technical language. The concept of ‘probabilisticcausation’ is identified as a key epistemological dimensionin the conduct of rigorous practice.     

Evaluating Social Work and Medical Practice with Black and Ethnic Minority Groups Using the Clinical Audit Model

Correspondence to Kish Bhatti-Sinclair, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Summary This paper is based on the External Audit-Ethnically SensitivePractice (EA-ESP) project which was undertaken within six primaryand secondary health care settings. This project is used asan example of how the clinical audit model can be used to monitorand review health and social work practice in the UK. The paperexamines quality, compares approaches to evaluation, and suggeststhat audit can be a useful tool for agencies in obtaining userand staff views on many areas of practice but in particularon equal opportunities, anti-racism and anti-oppression. Attentionis drawn to audit within broader evaluative and review approachesalready employed by social work academics and practitioners.The issue of quality and how it can be measured is consideredthrough an analytical comparison with approaches which employaction research and other evaluative means in the process ofreview. Audit is explored in the context of a growing need for the developmentof monitoring and review systems which provide evidence to supportand develop professionalism within social work. External auditis explored and compared to internal audit. Finally, the needfor the development of quality services in anti-racist and anti-oppressivework is highlighted and it is suggested that audit can be acost-effective and efficient way of achieving this.     

Government, Social Services Departments and the Health of Children and Young People: Which Way Forward?

Summary Despite the dearth of research into the health of children andyoung people in contact with or ‘looked after’ bylocal authorities, a series of official and quasi-official reportshave begun to raise awareness of this issue. There are goodreasons to believe that this group of children will be disadvantagedin terms of health as they are in other aspects of their lives.The evidence suggests that local authorities do not live upto the standards of ‘good parents’. Current notionsof good practice are critically appraised and the article concludesthat social work is unable to do more than mitigate the effectsof Government policies which affect health and social servicesand which have lead to widening social inequalities.     

Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.