Substance Use and Disabilities: Experiences of Adults' Social Care Professionals and the Implications for Education and Training

This paper draws on data from a national survey of social workers and social care practitioners in England undertaken in 2010–2011. It focuses on practitioners working in services for adults with either learning or physical disabilities and, in particular, their experiences of responding to alcohol and other drug use among their service users. Based on secondary analysis of survey and focus group data from the earlier study, the paper outlines the extent to which workers in these areas of practice encounter alcohol and drug problems and discusses the key challenges this poses for them. The findings show that between 4% and 10% of adults' practitioners' service users have alcohol and drug problems depending on the nature of the disability. Regardless of the type of disability, practitioners reported difficulties in talking about substance use with their service users as well as identifying tensions around life-style choice and risk management. They also reported the need for education and training in a number of areas. Social work education and subsequent training in working with substance use problems needs to be available to adults' practitioners and it needs to address the specific issues and needs in different areas of social work practice.     

Employment-Based Training on Alcohol and Other Drugs in England: Bridging the Gap

The first of its kind in England, this study explored the extent and nature of employer-based training on alcohol and other drugs for social workers working in children's and adults' services. A national survey of workforce development departments was undertaken to find out how social workers are being prepared by their employers for engaging with people who use alcohol and other drugs. Based on a response rate of 46%, the findings show that a majority of departments (82%) provided training on these issues in the year 2011–2012. However, most of this training was not mandatory. These courses are targeted most often at those working in children's services rather than those in adults' services. Most courses are offered at basic or intermediary level, and content of training is covered inconsistently. These findings suggest a need to increase the priority of alcohol and other drugs' training across adults' services in particular and to make this training mandatory, as well as ensuring that staff have adequate time and incentive to attend. Effectiveness of social care practice for all social care practitioners around alcohol and other drugs use could be improved with more focus on training practitioners how to talk to service users about their substance use.     

The Development of Employment-Based Education on Substance use for Social Workers in England: Embedding Substance use Training in Frameworks of Continuing Professional Development

Service users in the social care sector affected by substance use need a workforce which is skilled at protecting and supporting them, and who are able to carry out their roles and responsibilities with confidence. Workforce/Learning Development departments in children's and adults' services in England play an important role in preparing social workers to engage effectively with service users and to develop as practitioners. Drawing on data from a survey of 94 Workforce/Learning Development departments, this article examines the development of employment-based education on substance use. Only 33% of these departments had a dedicated training strategy or series of programmes on substance use, although more than half (59%) provided tools for identifying and assessing substance use. A wide range of professionals were involved in the development of this training, particularly those in specialist safeguarding and substance use roles. Social work and substance use textbooks are the main source of materials accessed to support training development. A lack of strategic engagement with substance use in social care was one of the barriers cited to adequate training provision. Implications for social work education include the importance of embedding AOD education in post-qualifying training frameworks at both university and employer levels.     

The Nature and Extent of Substance Use Education in Qualifying Social Work Programmes in England

Alcohol and other drug (AOD) use is a common feature of modern social work practice. Concerns about the problematic use of such substances cross all areas of social work practice, including adults' and children's social care. In England, surveys have highlighted social workers' experiences of AOD education during their qualifying social work training. However, this study sought the perspectives of the social work educators. Its primary aim was to explore the nature and extent of education on AODs on the qualifying social work programmes in England. Using an online survey tool, all qualifying social work programme leads were invited to take part (n = 157). Fewer than half responded (40%, n = 63). Initial findings appeared positive suggesting that 94% of responding qualifying programmes provided some teaching and learning on AODs. Further analysis revealed significant variation in what is taught and the depth of coverage. It highlighted a lack of consistency across programmes and possible over-reporting. However, the majority of respondents felt that teaching and learning on AOD use should be a higher priority for their qualifying social work programmes.     

Substance Use Training Experiences and Needs: Findings From a National Survey of Social Care Professionals in England

For more than 30 years there have been calls in the UK to improve training for social workers in relation to substance use. Yet very little research has explored what training practitioners have received or what their training needs are. This study sought to establish practitioners' experiences of previous training in substance use and identify their current training needs. An online survey was disseminated to 3,164 practitioners in adults' (AS) and children's (CS) social care and 12 vignette-based focus groups were also held. Of the final sample of 597, more than a third of social workers had not received any training and a further fifth only received between one and four hours. Other social care staff fared worse. Overwhelmingly, respondents said that substance use knowledge and skills were very important to their practice but their professional education had not prepared them well. They identified a number of training needs including ‘how to talk to people about substance use’ and ‘the types of intervention and treatment available’. Most social care professionals report not being adequately prepared for working with substance use, particularly basic knowledge and skills which would help them to conduct assessments and signpost people to specialist substance services.     

Inter‐professional Learning to Prepare Medical and Social Work Students for Practice with Refugees and Asylum Seekers

Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi‐agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services.

This paper describes the genesis and implementation of a series of innovative inter‐professional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter‐professional learning and practice in relation to socially excluded groups are highlighted.     

The Meaningful Involvement of Service Users in Social Work Education: Examples from Belgium and The Netherlands

This article links the development of service user involvement championed in the United Kingdom to two examples in Dutch-speaking qualifying social work programmes: one from Belgium and one from the Netherlands. In both projects, a longer lasting cooperation with more marginalised service users was established. The Belgium project highlights social work lecturers and service users living in poverty, working in tandem to deliver a module to social work and socio-educational care work students. The example from the Netherlands involves young people from a homeless shelter as peer-researchers, working together with social work students.

Both projects, one focusing on social work education and on social work research, highlight striking similarities in the positives and challenges of working with service users including how this challenges both groups preconceptions of the other, deepens learning but also creates greater potential for confrontations which need to be managed creatively. The article also identifies the pre-requisites for this to be effective including appropriate resourcing, training, facilitative skills and acknowledges that collaborations can be extremely fragile. However, such projects need further investment, experimentation and implementation on an international scale to share learning and promote creative approaches for the development and learning of social work students.     

Social work students in the aftermath of Hurricanes Katrina and Rita: correlates of post-disaster substance use as a negative coping mechanism

Social work students’ post-disaster coping while in the field is an important workforce issue with ethical implications. The current study utilized secondary data collected in a previous study examining post-disaster alcohol and other drug (AOD) use among social work student volunteers (N = 416) in the wake of Hurricanes Katrina and Rita (HKR). The current sample included participants from the original study who responded to a single-item measure of AOD use as a negative coping mechanism (N = 290). The present study examined potential explanatory variables of AOD use in the aftermath of HKR, including demographic (age, gender, and race) and psychosocial characteristics (hurricane-related stressors, previous traumatic stressors, and post-traumatic stress). The multivariate logistic regression model distinguished between students who never or rarely used AOD and those who used AOD often to cope with HKR, accounting for 24% of model variance. Social work students who report post-disaster AOD use may risk experiencing additional, trauma-related vulnerabilities, should be further assessed, and provided necessary specialized supports to enable their well-being and to prevent impaired practice.     

Complexities of cultural difference in social care work in England

The ageing of the ethnic minority population in Britain has led to a more ethnically diverse older client group for social care services than has ever been the case. This article focuses on the issue of how social care staff in England experience working across differences of culture, ethnicity, religion, and language. First, the article critically discusses the concept of cultural competence. Then, it reports on the perspectives of social care staff on their attempts to work in a culturally competent way. Individual in-depth qualitative interviews were carried out with 39 social care practitioners, and thematically analysed. Themes related to professional competence, appropriate behaviour, and training needs. Some practitioners felt unable to perform to their accustomed skill level when working across diversity, which has implications for the quality of care provided and job satisfaction. Other practitioners were confident in working across diversity. The key difference between these practitioners was a degree of cultural reflexivity. Recommendations for training are provided.     

Evaluation of Alcohol Screening,Brief Intervention,and Referral to Treatment (SBIRT) Training for Social Workers

Social work education is well positioned for workforce development initiatives that prepare practitioners to use Screening, Brief Intervention, and Referral to Treatment (SBIRT) with people at risk for alcohol use disorders. This article presents preliminary process and outcome evaluation data from the first year of a three-year grant which suggests that the training is acceptable and results in significant changes in trainees’ knowledge, attitudes, and self-perceived SBIRT skills. Training was embedded within the curricula of an urban school of social work, which includes a Bachelor of Social Work (BSW) program and a single-concentration clinical Master of Social Work (MSW). Trainees included social work students (n = 134) and field instructors (n = 38). More than 90% of students were very satisfied or satisfied with the training, and 100% of field instructors rated the training as excellent or good. Students demonstrated significant changes from pre- to posttraining in substance use knowledge, confidence in SBIRT skills, and attitudes about integrating SBIRT into practice. Field instructors reported increased confidence in screening. Integrating SBIRT training into social work curriculum is a promising method of developing a workforce that can effectively prevent and alleviate alcohol misuse.     

Promises and Pitfalls: Involving Service Users and Carers in Social Work Manager Education

Partnership working occupies an increasing amount of social work managers' time and budget, requiring skills and abilities not always developed previously within social work programmes. Much discussion around partnership working centres on building collaborative inter-agency and inter-professional relationships with less emphasis on the need to ensure good working relationships with service users and carers, despite their being the ultimate recipients of the process. This article explores efforts to develop a focus on service users and carers within a module for social work managers as part of post-qualifying (PQ) social work education. It documents a process where, initially, service users and carers provided personal testimonies of being recipients of services and then subsequently occupied more authoritative roles within teaching, to the current position when they are again less actively involved.

In describing these developments it explores possible reasons why involving service users and carers within this module has proved challenging. The article acknowledges that there is relatively limited literature about the involvement of service users and carers in PQ education. It suggests that lessons learned from involving service users and carers in qualifying social work training cannot directly be transposed to the post-qualifying context.     

Triage and Ethics: Social Workers on the Front Line

ABSTRACT

This article highlights the results of an international qualitative study examining the impact of terrorism and other disasters—both human-made and natural—on social work agencies and their labor force. The study was conducted with focus groups of social workers in health care and social service settings. The major research question concerned the impact of disaster—both natural and human-made—on agencies and social work practitioners. Focus was placed on the ethical dissonance experienced by social workers under pressure to prioritize how services and resources are distributed to those in need.     

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

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

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.     

Refusing to Listen: Are We Failing the Needs of People with Alcohol and Drug Problems?

This paper argues that social work education in the UK has persistently failed to equip its social workers with the knowledge to work effectively with people with alcohol and drug problems. In spite of continuing criticism of the profession's unwillingness or inability to engage with substance use issues, social work education has failed to respond to the calls for better training on this subject, even when specific guidance has been issued about course content. This results in a failure to meet the needs of our service users as well as social work staff who remain frustrated at their inability to intervene. The paper explores the historical and current debate about social work training in relation to alcohol and drugs and identifies the barriers to its inclusion in qualifying and post‐qualifying (PQ) curricula. Finally it offers a strategy for improving social work training as well as an overview of programme content requirements.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

A ‘Tripadvisor’ for disability? Social enterprise and ‘digital disruption’ in Australia

ABSTRACT

We explore how social enterprises can use platform technologies to plug ‘informational gaps’ in the provision of disability services. Such gaps are made more apparent by policies promoting self-directed care as a means of giving service users more choice and control. We use a case study of a start-up social enterprise seeking to provide a TripAdvisor style service to examine the potential for social innovation to ‘disrupt’ current models of service. The case study suggests that any disruptive effects of such changes are not due to new digital technology per se, nor to novel platform business models, but rather rest in the manner in which the moral orders which justify current patterns of social disablement can be challenged by social innovation.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

US Social Work Students' Attitudes Shift Favorably Towards a Harm Reduction Approach to Alcohol and Other Drugs Practice: The Effectiveness of Consequence Analysis

Given the increasing numbers of people in need of treatment for problems associated with Alcohol and Other Drugs (AOD) problems and the concomitant likelihood that social worker caseloads currently reflect this increase, a critical analysis of social work student attitudes towards different approaches to AOD treatment is warranted. Our study examined United States' social work students' (n = 100) attitudes towards treatment approaches to practice with people who misuse/abuse AOD and enlisted a Consequence Analysis (CA) intervention designed to shift attitudes towards considering a harm reduction approach. The Harm Reduction Acceptability Scale (HRAS), as well as a two-item response measure, measured pretest and posttest attitudes. Findings demonstrate that at pretest both intervention and comparison groups were willing to consider a goal of moderation (a proxy for the acceptability of a harm reduction approach and a client-centered perspective), and neutral on the effectiveness of an abstinence-oriented approach. At posttest, the intervention group became more flexible and open to the broader philosophical perspective of a harm reduction approach while the comparison group became less so. Consequence Analysis appears responsible for producing the observed changes in attitude towards harm reduction. Implications for international social work education and training are discussed.