A children's space? Participation in multi‐agency early intervention

The common assessment framework provides a model of early intervention, which is familiar in local authorities throughout England, and asserts a participatory framework of child and family engagement. This article draws on data from a research project undertaken in 1 local authority in the Midlands of England, to explore the experiences of children, young people, and their families, who were engaged in the process of multi‐agency early intervention. The article considers the young people's involvement, including their accounts of attending common assessment framework meetings, and their engagement by practitioners. The research found that young people's participation was limited. The findings suggest that this is, in part, a response to disciplinary discourses around schooling and attendance. In addition, the narratives of parents and young people showed that under‐resourcing of work with young people meant that the time taken to build relationships and engage them in a process of self‐assessment, planning, and decision making was constrained and rationed. The article concludes that to achieve a participatory children's space, an active and more engaged model of childhood needs to be facilitated by practitioners and parents outside the school‐dominated space found in this study.     

Children taken into care and custody and the ‘troubled families’ agenda in England

Children taken into care and custody are arguably the most vulnerable and problematic groups within the wider debate and responses developing to the ‘troubled families’ agenda in England. They represent what the state most wants to avoid when it intervenes in the life of a family. This paper is based on an analysis of the service involvement and needs of the 196 children taken into care or custody over a 3‐year period (2008–2011) in one city local authority in England. The research was undertaken to inform the response to prevention of entry into care and custody which was the original focus of the most intensive part of the troubled families programme in the city. Interviews with 10 senior professionals from a range of agencies involved in setting up this local programme, explored the way the emerging troubled families agenda was shaping ideas about the understanding of and response to the needs of these children and their families. Key findings of the study illustrate the range and complexity of need as well as the sequence and amount of agency involvement. Professionals were often critical of the thinking behind the troubled families agenda, but were positive and creative about new ways of working with these families.     

Choice,Competition and Care – Developments in English Social Care and the Impacts on Providers and Older Users of Home Care Services

This article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for‐profit and charitable) organizations and local authority providers of long‐term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets. The article presents early evidence of these changes on:

• The commissioning and contracting of home care services by local authorities and individual older people.
• The experiences and outcomes for individual older people using home care services.

Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalized within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalized home care, in which the quality of care‐giving relationships can also be optimized. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organizations providing home care services and for individual older service users.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

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

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

Ambiguity and Cooperation in the Implementation of Adult Protection Policy

Using a classification of public policy developed by Matland, we examine implementation of policy on adult protection as outlined in ‘No Secrets’, the government's guidance to local agencies. This policy appears to exemplify a ‘high‐ambiguity/low‐conflict’ model. Detailed interviews with staff charged with developing multi‐agency procedures, in local authority departments, health authorities, the police and the voluntary sector, confirmed the ambiguity of the policy and the uncertainty experienced by staff as a consequence. However, the interviews also revealed a number of areas of conflict, particularly as people gave precedence to their own professional norms and organizational priorities over partnership working.     

An evaluation of a groupwork intervention for teenage mothers and their families

This paper describes the implementation of a specific, community‐based, multi‐family group (MFG) intervention strategy (Families and Schools Together [FAST] babies) aimed at improving the outcomes for infants of teenage mothers in 11 Canadian communities. The aims of this social work group intervention were (1) to engage the teenage mothers into a socially inclusive experience that might challenge the social disapproval they often experience, (2) to enhance the mother–infant bond, while increasing feelings of parental efficacy, and (3) to enhance the social context of the teenage mother by reducing stress, social isolation and intergenerational family conflict. Groups were co‐led by teams of service users (a young mother, a grandmother of the baby of a teenage mother and a father of the baby of a teenage mother) collaborating with multi‐agency professionals (health visitors and social workers). Teams that reflected the ethnic diversity of the participating family members were trained to facilitate eight weekly group meetings. They showed respect for the young women's ‘voice’, and supported her ‘choice’ to prioritize motherhood as her defining identity. The meetings comprised a range of activities, including crafts and singing, discussion of ‘conflict scenarios’ in cross‐familial, cross‐generational groups, infant massage delivered to babies by the young mothers, grandmother support groups, and a shared community meal. Where necessary, teams made referrals for specialist help. One hundred twenty‐eight young mothers came once to 17 groups, and 90% graduated having attended a minimum of six sessions. Evaluation data from mothers and grandmothers showed positive change when comparing pre and post, based on standardized questionnaires. One‐tailed, paired t‐tests showed statistically significant increases in parental self‐efficacy for the teenage mothers, improved parent–child bonds, reductions in stress and family conflict, and increases in social support. Given that rates of teenage pregnancy in the UK are among the highest in Europe, this paper concludes with a discussion of the feasibility and possible merits of introducing FAST babies to England.     

Pawns or Pioneers? The Logic of User Participation in Anti‐poverty Policy‐making in Public Policy Units in Belgium

Since anti‐poverty policy‐making in Belgium is embedded in a logic of user participation, social policy has shown interest in employing users with experience of poverty as experts in public policy units in order to implement and monitor anti‐poverty policies. In this article, we discuss this recent development as a relevant case for contemporary public service delivery in the European context. In the light of the ambiguous practices of user participation in Belgium, the enacted logic of involving service users in public service delivery is discussed, and potential risks and opportunities identified: do these individuals function as pawns or as pioneers? In search of opportunities for the implementation of anti‐poverty policies, we explore different ways in which public policy units can act upon the participation of employed service users in public service delivery. On the level of public service delivery, we argue that the participation of expert users risks their use as a mere blind, de‐responsibilizing those who work in public policy units in providing high‐quality services and being responsive to all service users including those living in poverty. On the level of these individual experts, we argue that the employed service users risk becoming pawns, acquiring a tragic‐optimistic outlook on life. We conclude that enabling service users to participate as pioneers requires the joint and mutual responsibility of the employed service users and those who work in public policy units for implementing and monitoring anti‐poverty strategies rather than exclusive responsibility assigned to individual service users.     

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

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

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

The Paradoxes of Recovery Policy: Exploring the Impact of Austerity and Responsibilisation for the Citizenship Claims of People with Drug Problems

This article critically examines the implications accompanying the introduction and implementation of recovery‐based policy. The article draws upon research conducted in Lancashire, England, where commissioners have been at the forefront of recent developments in ‘whole system’ models of commissioning. Empirical data are drawn on to make a series of new arguments about the tensions and practice implications of the new recovery agenda. The article has three main objectives. First, it explores current shifts in England, in which drug service commissioning has moved from being centrally funded and directed, to locally determined. Second, it references the rise of the well‐informed user in the reconfigured landscape of recovery and the ways in which commissioning models may enhance or negate the contribution of user activists to local cultures of recovery. Third, it references the changing political context, in which austerity is being used to increase the pressure on provider services to demonstrate social value, utility and effectiveness. The article argues that there is a palpable need to re‐politicize drug debates and recognize the structural and demographic factors which frame problem drug use, as well as the social and cultural factors which support or negate their opportunities for recovery.     

Administrative Buy-in for User Participation in Managing Social Services

Abstract

This paper reports the findings of a study conducted in Hong Kong on the value position of the social service providers regarding user participation in service management. Using a survey instrument to collect data from 642 service providers in an elderly service organization, the study explored whether or not the value position had an effect on the views of the service providers on the structural set-up for user participation, and whether the value position of the professional staff was significantly different from that of the non-professional staff. Exploratory factor analyses (EFA), confirmatory factor analyses (CFA) and structural equation modeling (SEM) were applied in the analysis. The findings identify that administrative buy-in needed to support shared decision-making with the welfare service users has not been achieved in the studied organization, owing to the absence of value commitment to the user participation cause. As the professional staff was more supportive of values favoring user participation, the paper calls for an acculturation process that would be stimulated and led by professionals to develop a participatory culture. The paper also recommends conducting similar study on a larger scale and qualitative inquiry into factors influencing the formation of values about user participation in future research.     

Conceptualising disability: A critical comparison between Indigenous people in Australia and New South Wales disability service agencies

The lack of culturally appropriate services contributes to the low participation rate of Indigenous people in disability services. Understanding how disability is conceptualised is essential to developing culturally appropriate disability services. This study aimed to critically compare the conceptualisation of disability between Indigenous people and NSW government and non‐government disability service agencies. Indigenous and policy sources were obtained from purposive and snowball sampling. The Indigenous conceptualisation of disability was understood through representations by Indigenous spokespeople in journal and newspaper articles and audiovisual materials. The disability service agency conceptualisation of disability was represented through the annual reports and programme guidelines of the NSW government agency and seven non‐government disability agencies. The occupational justice framework guided critical analysis at the cultural interface. Four themes were identified: power and self‐determination, eligibility, otherness, and identity and labels. Data showed disability agencies promote self‐determination for Indigenous people and conceptualise disability as impairments affecting functioning, when assessing service access eligibility. Most Indigenous people do not self‐identify as disabled and are categorised as culturally different within policies. Indigenous people experience marginalisation due to their cultural identity. Indigenous people are required to conform to the conceptualisation of disability proffered by agencies to access services. To develop culturally appropriate services, agencies must collaborate with Indigenous communities.     

Early intervention and holistic,relationship‐based practice with fathers: evidence from the work of the Family Nurse Partnership

This paper seeks to add to the literature on working with fathers by focusing on early intervention. It draws on research into fathers involved in a home visitation service delivered by the Family Nurse Partnership in England and evaluates the men's experiences of the intervention. The vulnerability of fathers was striking and many were helped to develop their practical skills and confidence in caring for their babies. The intervention was effective because of the quality time that was invested in developing relationships with fathers (as well as mothers), the focus on their strengths as well as areas for improvement and the skilled, therapeutically oriented, holistic approach through which the service was delivered. The ‘early’ nature of the help was crucial to its success because of how it so effectively tapped into the men's redefinition of themselves as caring fathers during pregnancy and following the birth. We argue that there is important learning here for social care and health services in general about how to engage men and promote fathers' capacities to care for their children.     

The Common Assessment Framework: does the reality match the rhetoric?

The Common Assessment Framework (CAF) is an important part of the procedures envisaged in the government's Every Child Matters: Change for Children (ECM: CFC) programme. Implementation of CAF, in particular, raises many important questions, not least those arising from the inconsistencies apparent between government rhetoric around the development of multi‐agency services provided to all children with ‘additional’ needs and the actual experiences of children, young people, parents/carers and practitioners in ‘real world’ situations. This paper explores the extent to which the actions of practitioners and the experiences of service users with regard to CAF mirror or differ from those which would be expected in view of the content of government guidance and policy documents. The data used is taken from an evaluation of CAF processes in two locations in northern England over a period of 6 months. It concludes that very small numbers of children and young people actually received the service; that, despite genuine enthusiasm from practitioners for them to be so, the processes observed could not yet be described as fully ‘child centred’; that fathers were insufficiently involved; and that CAF was, in reality, another service ‘rationed’ according to resources available and according to agencies' priorities.     

Safeguarding children: challenges to the effective operation of core groups

Founded on an evaluative review of core group practice in a northern metropolitan borough of England, this paper highlights the tensions and difficulties that might inhibit the quality of post‐registration services to children and their families. Insights from the empirical data as well as theoretical literature have been explored in the light of current and developing policies. This exploration is focused on inter‐agency coordination; inter‐professional relationships; and partnership with parents and children. The recruitment and retention of social workers, the potential contribution of Children's Trusts, as well as unconscious processes relating to child abuse and child protection, are all given consideration.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

Towards Understanding Variations in Social Care for Older People in England

Indicators of the public provision of old age social care are routinely recorded in England and have been used for diverse purposes including performance monitoring. Despite long‐term policy guidance promoting more homogeneous service provision, large variations can still be observed between local authorities (the providers of state‐funded social care). Our aim is to better understand such variations in a small selection of key aggregate indicators. Drawing on multiple data sources and pursuing a two‐step strategy, we first assess the explanatory power of a set of structural predictors and then add to the models a set of specific care management ‘process’ predictors. We find that structural factors beyond the control of local authorities explain a considerable share of the observable variation. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when aggregate indicators of service provision are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. Past attempts to influence the aggregate pattern of service provision – apparently seeking greater ‘territorial justice’– are likely to have had adverse implications for service users and the uniformity of service delivery across England. Questions are raised about the adequate role of central government in a policy environment characterized by longstanding local government responsibility.