‘Like walking on eggshells’: service user views and expectations of the child protection system

This paper reports on a study of service users' views on Irish child protection services. Qualitative interviews were conducted with 67 service users, including young people between 13 and 23. The findings showed that despite refocusing and public service management reforms, service users still experience involvement with the services as intimidating and stressful and while they acknowledged opportunities to participate in the child protection process, they found the experience to be very difficult. Their definition of ‘needs’ was somewhat at odds with that suggested in official documentation, and they viewed the execution of a child protection plan more as a coercive requirement to comply with ‘tasks’ set by workers than a conjoint effort to enhance their children's welfare. As in previous studies, the data showed how the development of good relationships between workers and service users could compensate for the harsher aspects of involvement with child protection. In addition, this study demonstrated a high level of discernment on the part of service users, highlighting their expectation of quality standards in respect of courtesy, respect, accountability, transparency and practitioner expertise.     

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.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Befriending Services for Culturally Diverse Older People

Befriending services may address loneliness and social isolation amongst older people. However social diversity is rarely reported in investigations of befriending services. The views of non-users are also rarely explored. In this research, we explored older adults’ experiences of, and attitudes towards, a befriending service, among service users and non-service users, drawing on interviews and focus groups with 76 older adults, 10 volunteer visitors, and 20 service providers. Participants agreed that the befriending service helped alleviate social isolation and loneliness and that supportive services to foster connection are needed. Barriers to engagement included lack of knowledge, appropriateness of services and feeling undeserving. The befriending service was most successful when a match went beyond a transactional ‘professional-client’ relationship to resemble genuine friendship, underpinned by mutual interests and norms of reciprocity and reliability. We also identified five clear ideas about what characterizes an ideal supportive service; supported opportunities for getting out, genuine and reciprocal relationships, reliability, visitor characteristics, and connecting people to their culture. Befriending adds to social networks, and enhances connectedness to the community. Loneliness is alleviated when mutually beneficial and genuinely reciprocal relationships develop. However, group interventions or connections to community groups may be more appropriate for some.     

Is ‘Candidacy’ a Useful Concept for Understanding Journeys through Public Services? A Critical Interpretive Literature Synthesis

Across the public sector there is concern that service uptake is inequitably distributed by socio‐economic circumstances and that public provision exacerbates the existence of inequalities either because services are not allocated by need or because of differential patterns of uptake between the most and least affluent groups. A concept that offers potential to understand access and utilization is ‘candidacy’ which has been used to explain access to, and utilization of, healthcare. The concept suggests that an individual's identification of his or her ‘candidacy’ for health services is structurally, culturally, organizationally and professionally constructed, and helps to explain why those in deprived circumstances make less use of services than the more affluent. In this article we assess the fit of candidacy to other public services using a Critical Interpretive Synthesis of three case studies literatures relating to: domestic abuse, higher education and environmental services. We find high levels of congruence between ‘candidacy’ and the sampled literatures on access/utilization of services. We find, however, that the concept needs to be refined. In particular, we distinguish between micro, meso and macro factors that play into the identification, sustaining and resolution of candidacy, and demonstrate the plural nature of candidacies. We argue that this refined model of candidacy should be tested empirically beyond and within health. More specifically, in the current economic context, we suggest that it becomes imperative to better understand how access to public services is influenced by multiple factors including changing discourses of deservedness and fairness, and by stringent reductions in the public purse.     

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.     

Making Markets in the English National Health Service

Many commentators point to the rise of markets in public services such as healthcare. However, the conventional ‘similarity’ thesis has been challenged by the ‘difference’ thesis. This article critiques and extends the analysis of a recent contribution by Jane Gingrich to the ‘difference thesis’ with a more detailed case study of the English National Health Service (NHS). It argues that the text tends to ignore earlier models and other associated variables; provides a rather crude monolithic characterization of ‘left’ and ‘right’; and assumes rather than demonstrates strategic choice. It modifies some of her major conclusions: markets in public services matter (correct); markets vary in profound and important ways (correct, but perhaps in other ways); and partisan politics are central to explaining and shaping markets (perhaps over‐stated). While Gingrich's ‘breadth’ account is persuasive at the macro‐level, some questions arise from a more detailed account of the English NHS. First, it is not certain that Gingrich's typology is based on the most important dimensions. Second, her account tends to under‐state the importance of issues such as the nature of contracts, price competition, regulation and policies such as Private Finance Initiative. Third, it is not clear that the Conservative healthcare market can be characterized as an Austerity Market, and the Labour market as a Consumer‐Controlled Market. Fourth, this static characterization under‐states the degree of change between and within governments. Lastly, it is not clear what type of market the coalition government has introduced, but this hybrid type may be marked more by policy learning than ideology.     

Middle‐Class Political Activism and Middle‐Class Advantage in Relation to Public Services: A Realist Synthesis of the Evidence Base

Since the late 1960s social policy scholarship has been concerned with the distribution of the resources or benefits across social gradients. This article presents a review of the literature on one mechanism by which inequity might be produced – activism by middle‐class service‐users enabling them to capture a disproportionate share of resources. The review used the methodology of realist synthesis to bring together evidence from the UK, the USA and Scandinavian countries over the past 30 years. The aim was to construct a ‘middle‐theory’ to understand how and in which contexts collective and individual activity by middle‐class service‐users might produce inequitable resource allocation or rationing decisions that disproportionately benefit middle‐class service‐users. The article identifies four causal theories which nuance the view that it is the ‘sharp elbows’ of the middle‐classes which confer advantage on this group. It shows how advantage accrues via the interplay between service‐users, providers and the broader policy and social context.     

Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations

Cortis N. Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations Social service providers strive to meet the needs of those most marginalised from society and from service systems. Yet many people who might benefit from available help consistently miss out. Using qualitative data, this study developed a repertoire of actions that organisations and service personnel can employ to improve participation and outcomes for groups who may be eligible for and may benefit from services, but whom service providers find difficult to identify, reach and engage. Semi‐structured interviews with service managers and coordinators of child, family and youth services in Australia attest to the diversity and context specificity of those who are deemed to be ‘hard‐to‐reach’. The research data highlight ways to improve reach and engagement in a managerialist context by refining organisational action in four strategic domains: overcoming access barriers, building client relationships, utilising networks and partnerships, and ensuring staff capacity and sustainability.     

A Triumph of Hope over Experience? Modernizing Accountability: The Case of Complaints Procedures in Community Care

Complaints procedures are one component of maintaining and improving the quality of community care services. However, how effective are they in providing a means of redress for service users? This article presents the findings from four research projects, which included complaints procedures in their survey of service users’ experiences of community care provision. These findings are compared with the outcomes of similar research projects. The article concludes by evaluating the Department of Health’s consultation proposals on complaints procedures, and other policy documents, in the light of the research findings.     

‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

In the context of rising need for long‐term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self‐completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub‐sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short‐term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly‐funded services for disabled and older people who are looked after by unpaid carers.     

Accepting and Negotiating Service Users' Choices in Mental Health Transition Meetings

Across Western welfare regimes, policies emphasize that service users should have more choices regarding their services. This article examines how service choices are presented, responded to and decided in interactions between service users and professionals in mental health transition meetings. Choice is often associated with consumerist user involvement ideas, but in mental health choice also relates to the democratic user involvement approach and to shared decision making between professionals and service users. The results of the study show that professionals construct service users as consumers by offering service options in choice making sequences, expecting users to make appropriate choices. Service users mostly act like consumers by responding to these choice options. However, the study also demonstrates that the professionals do not always accept the user's first choice but respond to them as non‐preferred. Sometimes, they also suggest choices on behalf of the users. In these ‘non‐accepting’ sequences, choices are negotiated in interaction between the parties, rather than users acting as autonomous choice makers. The sequences are based on two kinds of professional reasoning: first, the professional‐led needs assessment and, second, the structure of the service package that the user is being offered. This negotiation has elements of shared decision making and the ‘logic of care’. But it also has elements of paternalist control which challenge both consumerist and democratic service user involvement and suggests consideration of more collectively oriented service user actions.     

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.     

Activation Reform and Inter‐Agency Co‐operation – Local Consequences of Mixed Modes of Governance in Sweden

Organizational reform has become a recurring solution to problems of social exclusion and unemployment. In Europe, and other parts of the world, there is a trend towards policies of ‘activation’ in employment and social policy. The idea of flexible, individualized and tailor‐made services is coupled with managerial and market‐based reforms as well as collaborative governance. In these complex structures of service provision, coordination and inter‐agency co‐operation have become key concerns. Based on a study of a recent reform of programmes for newly arrived refugees in Sweden (Etableringsreformen), this article seeks to contribute to the literature on governance of ‘activation’ by examining the consequences of mixed modes of governance (market and collaborative) on local inter‐agency co‐operation. Drawing on data from in‐depth case studies in two municipalities, it is demonstrated how the coupling of managerial practices and quasi‐markets with existing collaborative arrangements has created barriers for inter‐agency co‐operation. The results indicate that institutional tensions between governance forms represent an important factor for explaining governance failure in this policy area.     

Putting the ‘public’ into public service delivery for social welfare in South Africa

Mubangizi BC, Gray M. Putting the ‘public’ into public service delivery for social welfare in South Africa Int J Soc Welfare 2011: 20: 212–219 © 2010 The Author(s), International Journal of Social Welfare © 2010 Blackwell Publishing Ltd and the International Journal of SocialWelfare. The privatisation of some essential services in South Africa has raised severe difficulties for those for whom the idea of fees for services is quite foreign and who, in any case, cannot afford to pay for services. The government has developed several initiatives to educate people about the need to pay for services provided by local government, the largest of which was the Masakhane fees‐for‐services campaign. This article describes two recent initiatives that seek to engage local citizen participation, namely, Integrated Development Plans and izimbizo (or traditional forums). These are examined along with the challenges faced by local government in promoting citizenship participation in service delivery within a decentralised system of governance. The article concludes with some recommendations on how citizen participation can be enhanced so as to make the ‘public’ visible in public service delivery and thus improve social welfare services.     

Modernization and Devolution: Delivering Services for Older People in Rural Areas of England and Wales

The modernization of public services, with its emphasis on managerialism, choice, co‐production and outcome focused service delivery, has been implemented to a certain extent in both England and Wales. Indeed, the welfare states in both countries share a great deal, particularly in relation to policy objectives and the expectations of citizens. Devolution has chiefly meant that the instruments used to deliver policy have separated, although it remains unclear whether this amounts to formal divergence. What is also unclear is to what extent have the experiences of those living within the policy environment in both countries separated or diverged? This article addresses this question using qualitative data composed of interviews with policy actors in six rural areas of England and Wales. By focusing on the discourses of people involved in modernizing and providing services for older people in rural areas, we bring out the impact of modernization for older people. What we show is that modernization engages both service users and the wider population who may one day become service users. But the emphasis on these groups unfolds in different ways in England and Wales. In England, where there has been a commitment to a customer citizen, policy at the local level has emphasized re‐enablement, community development and individual responsibility. In Wales, where modernization has focused on collaboration and citizenship, local policies have focused on service users, and on engagement with the voluntary sector. In effect, the policy environment provides a different context for the experience of ageing in both countries.     

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.     

Understanding and negotiating identity: Children from cross-community families in public care in Northern Ireland

In Northern Ireland, most research on the impact upon children of living through the ‘troubles’ and in a divided society has assumed that children are from either the Catholic or Protestant community. There has been very little research with children from cross‐community families who have one parent from a Catholic background and one from a Protestant background. It is known, however, that these children are over‐represented in the public care system in Northern Ireland. The study reported in this paper addresses this gap in knowledge by exploring the experiences and views of children from cross‐community families who are in public care in Northern Ireland. The study has key messages for the development of services for looked after children from cross‐community families, if these are to be delivered in accordance with legislative duties in Northern Ireland and in an anti‐sectarian manner.     

Transforming child and family services in urban communities in South Africa: lessons from the South

Post‐apartheid, South African agencies have been required to shift their services in fundamental ways, including offering services in previously un‐resourced areas, honouring the rights of children and families, ensuring that users, staff and governing bodies are representative of the population and providing developmental social welfare services in place of child protection‐oriented interventions only. A study of urban South African child welfare agencies provides insight into the complex task of managing and leading change. In view of overloaded change agenda and resource constraints, managers focused on effecting incremental change and prioritized the most ‘rewarding’ change efforts. Transforming practice towards a developmental approach was less successful. Structural interventions were also not prioritized. Child welfare agencies internationally face demands to transform in response to the effects of local change and globalization. The study's insights might resonate with agencies working for change in other societal contexts.     

Strategic administration of nonprofit human service organizations: a model for executive success in turbulent times

Rapid and unprecedented changes in our modern society have created extremely turbulent environments for nonprofit human service organizations. These changes threaten to transform the very nature of our business in ways difficult to predict and prepare for. The author examines the collective views of 21 purposely sampled executive directors in the city of Baltimore, Maryland on the future of the nonprofit human services sector. In 1 hour face-to-face interviews, subjects were asked to respond to three questions. What major trends will impact the nonprofit sector in the near future? What potential impact do you see these trends having on the nonprofit sector? What strategies would you recommend that executive directors take today to ensure success of their organization in the future? Narrative responses to each question were aggregated, organized into dominant views, and summarized. Subjects identified a host of social, political, economic, and technological trends that will have major effects on the future of the nonprofit sector. Subjects recommend a variety of tactics for helping an agency respond successfully to these forces. These tactics emphasize three critical areas of strategic administration: planning, management, and leadership.