Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

Social Work within a Community Discourse: Challenges for Teaching

This paper considers the continuing debate about the relationship between social work and community work. We write about our collaboration as educators, one from a social work background and the other from a community work background and discuss the challenge of teaching community work to social work students in a way that is relevant for contemporary practice, and that embraces community work principles and values. Our paper explores Ife's framework of competing discourses of human services and discusses how it has helped us to articulate our thinking and teaching practice in the Irish context. For us, the framework integrates social work and community work within a community discourse that provides a language transcending disciplinary boundaries. This approach represents a means of familiarising students with the community work process and enabling them to take action on issues of social justice. The framework represents four competing models of human service delivery: the managerial, the market, the professional and the community. We discuss how we use this conceptualisation to teach and engage students in a process of critical reflection. The paper discusses methods we use to undertake this process, and the development of our teaching practice over the last two years.     

Bridging the gap between social work practice and community based welfare agencies

This article argues that social work in the UK needs to renegotiate its relationship with community welfare agencies. It begins by examining what we mean by local community and how welfare needs reflect complex non-linear dynamics unique to the local circumstances. It is argued that these are not always recognised in centralised policy agendas. The article broadly draws a parallel between policy issues for the European Community and for the national state. The drive for both is towards uniformity, which potentially fails to acknowledge the unique circumstances at both the national level between nations and the local level between communities.

The focus of the analysis is the lack of engagement with the subtleties of the local within the arena of social work education and practice. With the opportunity presented by the introduction of a new social work degree in the UK, the authors describe how a social work programme in Liverpool undertook a piece of research with the aim of creating an appropriate place for community welfare agencies in practice placements, the academic curriculum and, ultimately, with the next generation of social work practitioners. Eight welfare agencies within the proximity of Liverpool University, an area known as Toxteth, agreed to participate in the research to investigate what kind of placement module would enable local welfare agencies to engage meaningfully in the social work degree. Out of this process emerged a model for research based curriculum development involving local community agencies and academic institutions. More specifically for Liverpool, it placed the notion of social work's relationship with local community welfare at the heart of professional development for qualifying social workers, paving the way in this region of England for closer links between welfare agencies associated with civil society and professional social workers.     

Social learning within a community of practice: Investigating interactions about evaluation among zoo education professionals

The accessibility and ubiquity of zoos and aquariums—which reach over 700 million people worldwide annually—make them critical sites for science and environmental learning. Through educational offerings, these sites can generate excitement and curiosity about nature and motivate stewardship behavior, but only if their programs are high quality and meet the needs of their audiences. Evaluation is, therefore, critical: knowing what works, for whom, and under what conditions must be central to these organizations. Yet, many zoo and aquarium educators find evaluation to be daunting, and they are challenged to implement evaluations and/or use the findings iteratively in program development and improvement. This article examines how zoo education professionals engage with one another in a learning community related to evaluation. We use a communities of practice lens and social network analysis to understand the structure of this networked learning community, considering changes over time. Our findings suggest that individuals’ roles in a networked learning community are influenced by factors such as communicative convenience and one’s perceptions of others’ evaluation expertise, which also contribute to forming and sustaining professional relationships. This study illuminates how project-based professional networks can become communities of practice.     

Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

Forging an Identity as a Newly Qualified Worker in the Non-government Community Services Sector

Forging a professional identity is commonly assumed to be a key objective for new graduates transitioning to work. However, the extant literature on professional identity development gives minimal consideration to the role of contemporary work conditions such as increased contract-based employment and occupational instability in carving out a work identity. These workforce trends are particularly pronounced in the non-government community services sector, where worker mobility is high and workers often occupy roles that are not profession-specific. In light of these trends, this article seeks to broaden existing understandings of professional identity development. Focus groups were conducted with 24 newly qualified workers with degree-level qualifications in social work and the human services employed in the community services sector in Queensland. The findings suggest that these workers held a variety of allegiances, which were not necessarily aligned with a profession but instead shaped by the interplay of personal, professional, and organisational factors.     

Insights on Professional Identification and Licensure from Community Practice Social Workers

ABSTRACT

This article describes a qualitative study designed to explore both how community practice social workers identify professionally and to examine their view towards professional regulation. Thirty-five MSW-level social workers in a large metropolitan region who self-identified as community practice social worker participated in in-depth interviews. The respondents shared their views regarding professional identification as social workers and the impact of professional identity on their work as community practitioners. Approximately half of the respondents indicated that they only sometimes or never identify as a social worker. The respondents were generally critical of the licensing burden placed upon them as community practice social workers.     

Adopting a financial capability and asset-building curriculum at historically Black colleges and universities

ABSTRACT

Social workers currently engage in financial capability practice with low-income and financially vulnerable individuals and families in diverse practice settings, but typically lack professional preparation for this work. In response, several schools of social work have begun adopting financial capability curricula. Using an in-depth interview methodology, this study examines the adoption of a curriculum in financial capability and asset building (FCAB) from the perspectives of faculty and administrators (N = 19) at four historically Black colleges and universities (HBCUs). Findings show that key reasons for curriculum adoption are prior working relationships and trust, relevance of FCAB content to student and community needs, and alignment with program, institutional, and professional goals. Using the diffusion of innovation theory to understand curriculum adoption in HBCUs suggests that perhaps trust and relationship building are particularly important in the case of minority serving institutions.     

Building School,Family, and Community Partnerships: Developing a Theoretical Framework

School, family, and community partnerships are among the suite of strategies advocated for improved school outcomes in which social workers can play a valuable role. Such partnerships are complex to implement in practice and there is little systematic research to guide the practitioner. This study evaluated an early intervention partnership program involving school, family, community, and philanthropic partners implemented in two primary schools in rural Victoria, Australia. The findings highlighted challenges in the process of evaluation and program implementation and in the opportunities this provided to identify key enabling factors. These involved having: a shared vision and aims; democratic governance; a supportive policy and organisational environment including external funding; workers with skills and clear roles; activities for project momentum; and ongoing review and evaluation. These factors can be used by social workers and others working with schools as a valuable conceptual framework to facilitate school, family, and community partnership processes.     

Community development and community renewal: tracing the workings of power

Although Third Way community programmes produce practice opportunitiesthat appear familiar to community development workers, theyalso produce a play of power that is significant in the deliveryof some crucial neoliberal shifts in governance and subjectconstitution. This paper juxtaposes current theorizing of howpower works within advanced liberal polities with stories oflocal practice in urban and community renewal sites. The argumentis that practice stories are often positioned in relation toa narrow spectrum of power relations, and this obscures theways we are currently governed or exercise power in relationto ourselves and each other. A narrow gaze may point to successfuloutcomes of an immediate kind, yet contribute to wider agendasthat more broadly undermine local people and processes. Thequestion posed by the paper is not whether to engage in renewalactivities, but rather how to interrogate the power dynamicsof such engagements in the stories we tell of practice.     

Mobile skilled workers: Making the most of an untapped rural community resource

Many small rural communities have a flow of skilled people through the community, including employees from the government, non government and private sectors on fixed-term contracts, and a range of professionals, often attracted by amenity and seeking a sea change or tree change. The aim of the study reported in this paper was to investigate how rural communities can optimise benefits from professional and other highly skilled workers in the context of an increasingly mobile and transitory workforce. The paper examines the characteristics and attributes of mobile skilled workers from six different Australian rural communities and one Canadian rural community. It overviews the reasons why mobile skilled workers become involved in rural communities, the process of integration, and the reasons why they decide to stay or leave. If rural communities better understand the characteristics and motivations of mobile skilled workers, they will be able to better harness the potential of this group. Community settings and, to a lesser extent, policy, make a difference to mobile skilled worker integration and community participation. Community settings such as culture, interactional infrastructure and leadership influence the integration process for mobile skilled workers. Effectiveness of the integration process determines the nature and extent of mobile skilled worker contribution to the community and the likelihood that the worker will be retained in the community. Rural communities that make the most of the available pool of skills provided by mobile skilled workers can increase resilience, community capacity, identification and uptake of opportunities such as new enterprises, good practice in natural resource management, enhanced social and leisure opportunities, and the quality and range of local services.     

Framing Service Learning in Social Work: An Interdisciplinary Elective Course Embedded within a University–Community Partnership

While academic service learning has grown in popularity across disciplines and universities, the pedagogical strategies for service learning courses vary greatly, especially for courses focused on development in underserved communities. Ideally, service learning pedagogy should place equal importance on student and community benefits, build reciprocal relationships with community partners, and engage students in deep reflection about social cultural and economic issues. In designing a new service learning elective course to engage students in a rural town revitalization project, we intentionally framed the course to meet the aforementioned goals. We used a three-component service learning pedagogy model that: (1) embedded the course in an existing university–community partnership; (2) mobilized interdisciplinary teams of students for community-identified projects; and (3) promoted reflection on complex economic and social justice issues by integrating students' processing through blog, faculty–student–community discussions, and community feedback. Benefits to students and community based on two qualitative studies are discussed, as are implications for social work education and research.     

NASW Involvement in Legislative Advocacy

NASW serves as the professional association for social workers, yet little is known about how NASW chapters engage social workers and social work students in policy practice. This article presents the results of a survey of 40 NASW state chapters, describing how NASW engages social workers in legislative advocacy, the role of legislative advocacy days, and the involvement of social work students in NASW advocacy efforts. Findings indicate state chapters are very involved in policy practice and legislative advocacy days appear to be one prominent vehicle in engaging members and social work students in legislative advocacy.     

Measuring Rational and Organizational-Political Planning Activities of Community Organization Workers

Abstract

Social planning in community organization work reflects two dominant planning styles-a rational style and an organizational-political style. Drawing upon literature from related disciplines, this article describes the development of an expert test that identified indices for the measurement of rational planning activity on the one hand, and organizational-political planning activity on the other. These indices were then applied to investigate the patterns of planning activities of a sample of 138 community organization workers in Israel. The findings show varying tendencies of workers in implementing planning activities, and indicate a lack of homogenous consolidated task patterns. Workers also were found to focus more on traditional planning activities than upon activities based on new knowledge. The findings underscore the importance of identifying factors which influence the tendency of workers to engage in planning activities in the two styles, rational and organizational-political.     

Changes in Community Organization Practice in Quebec (Canada)

Abstract

This paper examines the changes that occurred in community organization practice in the public establishments of Quebec (Canada) in the 1990s. The results of replicated statistical research show that many changes in community organization practice occurred during this period. Most of these changes can be explained by the socioeconomic crisis that took place in the 1990s that affected part of the middle class, driving the reorganization of public social services organizations and important cuts in the government's budget. In this context of crisis, the government of Quebec more easily accepted the local development strategy to overcome unemployment and poverty. These changes can also be explained by a change in community organizers' perceptions of their profession and their strategy for professional recognition observed in the creation of a professional association.     

Sustainable Social Work: An Environmental Justice Framework for Social Work Education

Environmental degradation is not experienced by all populations equally; hazardous and toxic waste sites, resource contamination (e.g., exposure to pesticides), air pollution, and numerous other forms of environmental degradation disproportionately affect low income and minority communities. The communities most affected by environmental injustices are often the same communities where social workers are entrenched in service provision at the individual, family, and community level. In this article, we use a global social work paradigm to describe practical ways in which environmental justice content can be infused in the training and education of social workers across contexts in order to prepare professionals with the skills to respond to ever-increasing global environmental degradation. We discuss ways for social work educators to integrate and frame environmental concerns and their consequences for vulnerable populations using existing social work models and perspectives to improve the social work profession's ability to respond to environmental injustices. There are significant social work implications; social workers need to adapt and respond to contexts that shape our practice, including environmental concerns that impact the vulnerable and oppressed populations that we serve.     

Gendered Perceptions of Community Needs and Concerns

Abstract

Acentral tenet of feminism is that women engage in community practice differently than men. This study explores whether gender differences exist in perceptions of community needs, strengths, problems and responsibilities. Also examined are differences within male and female groups along the dimensions of race, location, years at current address and ownership status. This analysis is based on survey responses from 191 residents in one urban community. Contrary to feminist theory, findings reveal strong agreement between men and women. There were, however, numerous differences within gender groups, especially among women. Implications for feminist scholarship, community practice, and social work education are discussed.     

Strengths and Pathological Perspectives in Community Social Work

ABSTRACT

Current social work theory distinguishes between the traditional pathology-oriented perspective and the strengths perspective. This paper posits that the working model of community social workers is grounded in a strengths perspective, which, in relation to community work, is compatible with and supplementary to empowerment models, providing a methodological base for the values and practice of the macro method of social work. The current study aimed to assess the prevalence of each of these two perspectives towards community activity, and to examine the differences between them regarding the sense of empowerment and professional skills acknowledged by community social workers in Israel. The findings revealed that while the majority of community social workers adopt a strengths perspective in their work, they experience a greater sense of empowerment and of professional skills when adopting a pathology-oriented perspective.     

Diversity training for the community aged care workers: A conceptual framework for evaluation

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older people’s experience of healthcare.