Evaluation of a Carer Support Scheme for Elderly People: the Importance of 'Coping'

Correspondence to Dr Derek Milne, District Psychology Service, St George's Hospital, Morpeth, Northumberland NE61 2NU. Summary One year's consecutive referrals to an Age Concern carer supportscheme entered an evaluation of the carers' stress, coping andstrain. Unlike a comparison group who did not use the scheme,these carers of elderly dependants had significantly poorerpersonal coping strategies, which were bolstered by the scheme.Stress and strain were high for both groups of carers, indicatingthat the critical variable in their continued role as carerswas coping. Implications for the formal services are discussed.     

The Significance of the Early Stage of Illness as a Focus for Social Work Help

Summary This paper considers the experience of illness as a series ofinterrelated phases, in which the beginning phase which is thetransition from health to illness is shown to have special significance.The common responses to this stage of illness are denial, welcomeor inertia, each of which may give some forewarning of problemsthat may be encountered later in the illness. Traditionallysocial work help has focused onto the acute or convalescentstages, but it is suggested here that the beginning phase ofillness offers a rewarding point for intervention, not onlywhen opening new cases, but also among clients who are alreadyknown and where health problems may interact with other problems.The implications of this are explored both for agency policyas well as an added dimension of diagnostic understanding ofindividual clients no matter what the agency     

A Combined Approach to Parental Coping

Summary The development of coping strategies by a combination of behaviourmodification, casework and milieu therapy is discussed withreference to the case of a nine-year-old boy admitted to a childpsychiatric in-patient unit. Admission had been precipitatedby his violent and uncontrollable behaviour at home. The plannedreturn of the child to his family is stressed as an importantpart of the treatment.     

Stress factors and mental health of carers with relatives suffering from schizophrenia in Hong Kong: implications for culturally sensitive practices

Summary Based on Spaniol and Jung's stress and coping framework (1993),this study examined the difficulties and stresses experiencedby carers with relatives suffering from schizophrenia in HongKong. The impact of these difficulties and stresses and of masteryas a coping resource on carers' mental health was also explored.Results show that carers experience most difficulties and stressesrelated to the management of negative symptoms such as refusalto perform household duties and neglect of personal hygiene,and less to handling positive symptoms such as bizarre behavioursand thoughts. It is also revealed that perceptions of stressassociated with difficulties in the care of relatives with schizophreniaaccounts for poorer mental health among carers. Lastly, carerswith a strong sense of mastery have better mental health. Culturalissues such as 'family shame and face saving', 'family obligationsand reciprocal expectations', 'external orientation to personalcontrol' and the 'the Confucian work ethics' are put forwardas explanations for these findings. Suggestions on culturallysensitive practices are made.     

Guide-lines for Social Workers in Coping with Violent Clients

Correspondence to Sally Johnson, 66, Church Street, Fordingbridge, Hants SP6 2BE Summary How does it happen that the well-intentioned efforts of localauthority social services departments to offer guidance to theirsocial worker employees in coping with violent clients actuallyresult in declarations that violence is inevitable and in theexpectation that the social worker on the ground will manageit? This paper discusses the problem of violence against socialworkers and the response of four local authority social servicesdepartments as expressed in guide-lines issued to staff. Thefirst part of the paper examines the background of news eventsand theories of aggression against which the guide-lines wereproduced. The second part discusses the response of the localauthority social services departments as employers to the problemsof assessing risk and coping with violence and its aftermath.     

Split in Two: Experiences of the Children of Schizophrenic Mothers

Correspondence to Jeni Webster, Lecturer in Psychiatric Social Work, University of Manchester, Department of Psychiatry, Williamson Building, Oxford Road, Manchester M13 9PL. Summary The children and families of 28 schizophrenic women were interviewedto assess the amount of burden they experienced in the formof disruptions and problems as a consequence of the schizophrenia.Different styles of coping emerged within the family patternsthat related to behaviours associated with schizophrenia, therole of the fathers, the stages of development of the children,and the adverse effects on the family and the children.     

The Multirole Practitioner in the Generic Orientation to Social Work Practice

Summary Generic Social Work practice theory is at a promising stageof development. Utilizing concepts from systems theory a numberof new holistic practice models are now available which canbe applied in any setting. A further frame of reference is requiredthat captures the wide range of social work activity. The aim of this paper is to propose eight tasks and thirteencommon roles of practice which are presented in the form ofa model designed to delineate the role and task matrix of thegeneric practitioner. Practice experience suggests that these tasks and roles constantlymerge into, or follow one another. Some of the roles and tasksseem better understood and theoretically developed than others. The formulation that is offered is currently being empiricallytested. Practitioners, educators and practice researchers areinvited to specify the roles and tasks they regard as centralto practice, to check these against the model offered here,and to present any fundamental differences in forms that lendthemselves to empirical research.     

Ethnicity and Caring for a Disabled Child: The Case of Children with Sickle Cell or Thalassaemia

Correspondence to Waqar Ahmad or Karl Atkin, Ethnicity and Social Policy Research Unit, University of Bradford, Bradford, BD7 1DP, UK Summary Services for haemoglobinopathies have been a major site of strugglesfor the black communities, yet the social research literatureon haemoglobinopathies remains patchy and fragmented. We providean overview of the literature on sickle cell disorders and thalassaemiamajor in the broader context of debates on childhood disabilityand chronic illness, and on ethnicity, racism and health care.     

Social Work and General Medical Practice: Personal Accounts of Three-year Attachment

Summary In the area of social worker-general practitioner collaborationmuch has been written about conflict of roles, differing functions,avenues of accountability, and problems of distributing scarceresources. This paper suggests that if the two professions areto work more comfortably with one another, then it is imperativethat both also share the despair, hopelessness, anxiety andanger that are the occupational hazards of each. Ways are suggestedin which doctor and social worker can look at the pain theirpatients are suffering to the benefit of the patient and theiro working relationship.     

Stress and Coping in Social Workers: A Preliminary Investigation

Correspondence to Dr Paul Bennett, School of Psychology, University of Wales College of Cardiff, P.O. Box 901, Cardiff CF1 3YG. Summary Three groups of social workers (child, adult mental health orhandicap, elderly or physical handicap) completed a questionnaireexamining sources of stress, coping strategies, and stress outcomes(e.g. anxiety, depression). All respondents reported high levelsof stress, although stress resulting from factors intrinsicto the job, relationships with other people, and from the organizationalstructure were greatest among childcare workers. In addition,these workers reported greater emotional involvement with theirclients and higher levels of general anxiety and depression,as well as job related mental distress. The implications ofthese findings are discussed in relation to training, job designand support of social workers.     

Marginalized Children as Social Actors for Social Justice in South Asia

Correspondence to: Claire O'Kane, C/o Save the Children Norway, GPO Box 3394, Jawalakhel, Kathmandu, Nepal. Summary This contribution highlights the role that marginalized girlsand boys are themselves playing in varied contexts in SouthAsia to challenge inequalities and discrimination to ensurethat the rights of all children are realized. Notions of rightsare inextricably linked to the concept of social justice whichis concerned with equality, needs and entitlements. Whilst highlightingthe role of children and young people as social actors and activecitizens, this paper also explores broader contextual and discourseissues concerning social work practice, social justice and childrights in South Asia. Case examples and ethnographic materialfrom South Asia are shared. Furthermore, the changing natureand roles of social workers and development workers when enablingchildren's own protagonism are reflected upon, and lessons drawnfor social and community work practice and policy developmentin different parts of the world.     

The Determinants of Expenditure on Children's Personal Social Services

¹ Peter C. Smith, Centre for Health Economics, University of York, York YO1 5DD, UK. E-mail: pcsl{at}york.ac.ukAbstract Summary This paper reports the results of a statistical study of thedeterminants of expenditure on children's social services intwenty-five local authorities in England. The study was commissionedas part of the Government's review of Standard Spending Assessmentsfor Personal Social Services. The study combined data from avariety of sources, including local authority registers, toinfer the distribution of expenditure between 1,036 small areaswith populations of about 10,000. Multilevel statistical techniqueswere used, and suggested that the principal determinants ofexpenditure are children in lone parent families, children infamilies of income support claimants, children living in flats,children with limiting long-standing illness, and populationdensity. As well as these results, the study yielded importantinsights into potential improvements for Standard Spending Assessmentmethodology.     

Families and Serious Mental Illness: Working with Loss and Ambivalence

Correspondence to Dr David W. Jones, School of Social Science, University of East London, Barking Campus, Longbridge Road, Dagenham RM8 2AS, UK. E-mail: D.Jones{at}uel.ac.uk Summary This paper examines, in terms of a complex loss, the experiencesof people who have a family member who suffers from seriousmental illness. Whilst partnership between professionals andfamily carers is clearly being encouraged and is doubtless laudablein the whole area of health and social care, there seem to beserious obstacles to successful collaboration between familiesand professionals involved in serious mental illness. Part ofthe reason for this is that the emotional experiences of relativesare not well understood. This paper uses interview materialfrom a larger qualitative study of an ethnically diverse sampleto argue that the families of people with serious mental healthproblems need to be understood as having experienced a complexloss. The loss is complicated by (i) the continuing presenceof the person who is felt to have been lost; (ii) feelings ofanger (and subsequent guilt); and (iii) feelings of shame. Professionalswho work with families need to be aware of the uncomfortablefeelings that they are often struggling with. Professionalsare in a good position to provide support in allowing thosefeelings to be acknowledged and to take their place in the dialoguethat families need to have if they are to move on from the frustrationsof the chronic grief that others have observed (MacGregor, 1994;Wasow, 1995).     

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

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

Working Together to Protect Children on the Child Protection Register: Myth or Reality

Correspondence to Jan Horwath, Department of Sociological Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield S10 2TU, UK. Summary Child protection guidance at a national level has predominantlyfocused on the investigation and assessment of child abuse andneglect. Post-registration practice has received little attention,resulting in a variety of local responses. This paper describesthe findings from a national study designed to identify theimpact of the lack of national guidance on local post-registrationframeworks for practice. Data collected indicate that very fewArea Child Protection Committees (ACPCs) have developed policies,procedures or practice guidance which would provide a structurefor post-registration practice. This position is aggravatedfurther as individual professionals are confused about theirown roles and responsibilities and those of colleagues. We considerthe impact of these findings on practice and conclude by suggestinga macro level framework that can be utilized by ACPCs who wishto develop practice in this area.     

Cognitive-Behavioural Social Work with Children

Correspondence to: Dr Tammie Ronen, The Bob Shapell School of Social Work, Tel-Aviv University, Ramat-Aviv, Tel-Aviv 69978, Israel Summary The paper aims to explore the complex and important links betweeninterventions with children, cognitive therapy, and social work.Although children comprise about half of the referrals to socialwork services, they do not generally receive direct treatmentin these settings. Social workers are involved with childrenin the roles of mediator or counsellor and as the supervisorwho is concerned with the placement of the child in appropriatesettings. When the need for direct therapeutic interventionarises, children are usually referred to educational or clinicalpsychologists. Social work as a profession has been foundedupon a psychodynamic approach; however, social workers havealways been concerned with effective treatments, the definitionof clear goals, and the clarification of client needs. Thesefeatures link social work to cognitive-behavioural therapy.Cognitive therapy, although not frequently used with children,is presented in this paper as a means for conducting directinterventions with children which fulfil social work's basictargets and needs.     

Implementing Community Social Work from a Social Services Department: Some Issues

Summary The proposal in the Barclay Report on the role and tasks ofsocial workers for ‘community social work’ as astrategy for social services departments is assessed The writerargues that the voluntary sector has significant roles and prioritiesoutside the social services, that government priorities forencouraging the voluntary sector emphasise other areas of workand that involving voluntary groups in official initiativesmay be seen as going against the independence of some groups.The motivation of groups and individuals in the voluntary sectorwill be important, but various research and practice shows thatindividuals, informal groups and mutual aid groups may be difficultto involve in a substantial programme. The climate of opinionin the field of volunteering and the social background of clients'neighbours may provoke hostility. Experience of community worksuggests that official initiatives may lead to resistance andconflict rather than involvement, and there may be ethical problemswith compulsion.     

Social Work Teachers and Social Work Practice

Summary A survey was undertaken to discover the extent to which thosesocial work teachers who teach social work methods, continueto practise after they become educators. The results suggestthat not more than 25% do so, and many of these on only a tokenbasis. Most respondents however regarded such practice as animportant aide to the teaching of social work methods, althoughsome consider consultancy roles to be equally relevant. In nocases was such practice linked with research, and only exceptionallydid employers allow time explicitly for it. We outline fourdifferent bases on which teachers might practise, all of whichwere suggested by respondents, many of whom added personal notesto the questionnaire, indicating the extent to which this subjectis a matter of wide interest and concern     

The Quality of Life of the Chronically Mentally Ill: A Comparison of Public, Private, and Voluntary Residential Provisions

Correspondence to J. P. J. Oliver, Lecturer in Psychiatric Social Work, Department of Psychiatry, University of Manchester, Rm 11.11, Mathematics Tower, Oxford Road, Manchester, M13. Summary A pilot survey was undertaken as part of a long-term investigationof the needs which people with chronic mental illness have forcommunity support. The main purpose of this preliminary exercisewas to develop relevant measures of need. particularly measureswhich give due weight to the assessments which chronic patientsmake of their own quality of life. Results have particular relevancein the light of the ‘White Paper’ on community care,Caring for People and the National Health Service and CommunityCare Act, 1990 because the survey considered patients' experienceof life in three distinct types of resettlement facility: thepublic, the private and the voluntary. While differences inregimes, the personal characteristics of residents and objectivequality of life were noted, no differences in subjective qualityof life (either in general or in specific domains of life) werenoted from one type of facility to another. These results andtheir implications are discussed.     

Differences in Problems Faced by Families with a Child Coping with a Serious Emotional Disorder or an Adult Member Coping with Mental Illness

Abstract

Examination of similarities and differences in the issues families face can help determine whether models for families with a child coping with serious emotional disorder (SED/behavioral disorder (BD)) warrant inclusion in, or adaptation of, interventions for families with an adult member coping with a mental disorder. Families attending psycho-education workshops identified problems faced in managing their family member's illness. Composite lists of problems generated by 175 participants were categorized and sorted, using previously established methods for determining reliability and validity. Fourteen categories were identified for children and fifteen for adults, with ten overlapping. Family members attending the child-focused workshops more often listed mood symptoms and problem behaviors. Family members attending the adult-focused workshops more often listed family issues, denial and noncompliance, and positive symptoms of psychosis. Problems identified by families with a child coping with SED/BD may be sufficiently distinct from those of families with an adult coping with mental illness to warrant separate and distinct interventions.