A Brave New World of Personalized Care? Historical Perspectives on Social Care and Older People in England

Social care policy for older people in England continues to generate extensive discussion around the need to break with the past and to deliver a personalized response to need. This article explores the extent to which this represents a complete break with the past by looking at four key reports from the past, namely the Rucker Report (1946 ) on the break up of the Poor Law, the Seebohm Report (1968 ) on the personal social services, the Griffiths Report (1988 ) on community care and The Royal Commission on Long Term Care ( Sutherland Report, 1999 ). Each is interrogated in terms of how social care is defined, how services are to be delivered, how quality is understood and the assumptions made about who will be able to access services. This analysis is used to draw out key continuities in policy assumptions such as the primacy of family and the ongoing debate about ‘What is social care?’ and how it can be distinguished from health care. The article also argues that the voluntary sector has always been seen as a ‘key player’ in social care. Finally, the analysis of the four reports is used to trace the ever changing role of local authorities in the planning, purchase and provision of social care services for older people.     

Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

The school to work transition for young people in state care: perspectives from young people,carers and professionals

Workforce participation has many positive effects on quality of life. However, as young people in care have generally below‐average levels of educational participation and attainment, they may be ill‐equipped for the transition to further education and work. A mixed‐method study conducted in Australia about career development for young people in care investigated how this population develops ideas about future work: the social and cognitive variables that influence career decision‐making; practices for preparing young people in care for the transition to work or further education; and factors that support or impede the transition. Findings from the qualitative study are reported in this paper. Interview data were obtained from the multiple perspectives of young people in care, foster carers, caseworkers and school personnel. The overall picture was one of young people in care lacking the encouragement, resources and capacity to realistically plan for the job they want. Specific interventions are required to enhance career development and employment outcomes for this population.     

Integrating Health and Social Care at the Micro Level: Health Care Professionals as Care Managers for Older People

A common problem in the provision of coordinated long‐term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user‐centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.     

‘Disability is not a word we use’: Social workers' professional judgements about support for disabled young people leaving care

Disabled young people leaving care often experience a more complex transition to adulthood than other youths. Still, policy and services can fail to recognize the intersection between a young person's care experiences and disability. Drawing on data from a qualitative interview study with 14 social workers who work with aftercare in the Norwegian child welfare services, we investigate social workers' professional judgements about support for this subgroup of the leaving care population. Our analysis uses the theoretical construct of institutional logics and shows that social workers did not include concepts of disability in their judgements about support for these young people. Instead, the social workers' considerations were guided by three other organizing principles: a ‘medical logic’, an ‘activation logic’ and an ‘aftercare logic’. We discuss these findings in light of critical disability studies and argue for a more nuanced understanding of disability in social work practice with care leavers. Highlighting disability rights and going beyond diagnosis and categorisations of disabled people can challenge a medical model approach to service provision.     

‘Undeserving’ mothers? Practitioners’ experiences working with young mothers in/from care

Although teen pregnancy is on the rise in Canada, and while adolescent mothering in general has received considerable recent attention from researchers, there is a paucity of information about the particular experiences of young women who become mothers while in government care. Emerging out of a study guided by a grounded theory methodology to address this knowledge gap, this paper examines the experiences and perspectives of government‐based social workers who work with young mothers in/from care. Our findings indicated that social workers reflect prevailing middle class values, including norms about ‘good’ and ‘bad’ parenting, and centred around the belief that adolescent pregnancy is, in and of itself, bad. One of the most significant ramifications of workers’ values was their belief about the inevitability of ‘the cycle’: of children in care begetting children who ultimately came into care. Ironically, though workers and young mothers were both preoccupied by the concept of ‘the cycle’, and each were determined to break it, the two groups had very different ideas about what the cycle was all about and what perpetuated it. Unfortunately, this disjunction in perspectives, along with major recent shifts in the direction of child welfare policy and practice and related constraints in the resources at workers’ disposal, conjoined to create significant barriers to what workers and young women both recognized as supportive practice with youth in care.     

Growing up in foster care: providing a secure base through adolescence

As the UK Government White Paper, Care Matters: Time for Change , suggested, foster children need the care system to provide them with good quality foster family care that will help them through childhood to success and fulfilment of their potential in adult life.
This paper draws on the third phase of Growing Up in Foster Care , a longitudinal study of 52 children in planned, long-term foster care (1997–2006). It aims to increase our understanding of the transformational power of foster family relationships over time and particularly in adolescence. It shows how a secure base parenting model, using concepts from attachment and resilience, can be applied to foster care of adolescents. The paper uses case material to demonstrate each dimension of this secure base model and to emphasise how, even when adolescents have had stable and effective placements, they are likely to need support through into adulthood.     

Do public services influence patterns of informal care? Informal networks and public home care in three Swedish municipalities

Whether an individual receives home care services depends on two factors: the functional disability of the care recipient and the caregiver's gender, when the living arrangements of the care recipient are controlled. Data from this longitudinal study of social networks and home care organization in 3 municipalities in Sweden show that care recipients with a severe disability received more home care services than others. In cases where the main caregiver lives together with the care recipient, the public services are adjusted to the family situation and are independent of the functional disability of the care recipient. Care recipients who live with the primary caregiver receive less formal help than do care recipients who live alone. When the primary caregiver does not live together with the care recipient, the public services are adjusted to the functional disability of the care recipient and are independent of the primary caregiver's gender. Care recipients supported by a male helper received more formal help than care recipients supported by a female helper. Those supported by a female helper received more informal help. Various models of relationships, supplementation and complementation between informal care and public services are discussed. The dependence on public home services is high. Assistance with basic activities of daily living is the first area requiring complementary contributions from the public services. A special type of kin independene was found, related to the function of public services in a modern and gender-equal society. The results provoke a discussion on research design as well as comments on welfare policy and gender equality in the transformation of the welfare state.     

Care, control and change in child care proceedings: dilemmas for social workers, managers and lawyers

This paper draws on findings from an interview‐based study of the ways that local authority social workers, social services managers and lawyers work together in child care cases in England. The study shows how stressful social workers can find care proceedings, and how much they look to the lawyers for support. It also shows how the lawyers’ involvement can bring new stresses and dilemmas. The managers are especially likely to resent ‘over‐involvement’ (as they see it) from lawyers, but lawyers are quick to defend their role and responsibilities. The paper shows how the complex, multifaceted dimensions of care, control and change interweave with professional differences in care proceedings: care for children, parents and social workers; struggles for control against the court, the other parties and sometimes the other professionals on one's own side; and responsiveness to change set against wariness about ‘lawyers’ deals’ and undue risk to children. The paper concludes that the valuing of difference, rather than its avoidance or suppression, is at the heart of effective inter‐professional work. It calls for greater recognition of this in current initiatives to promote interdisciplinary working in children's services in England.     

'Polyphonic' welfare: Luhmann's systems theory applied to modern social work

This article applies a series of concepts from Niklas Luhmann's systems theory in an analysis of modern welfare organisations. The point of departure is that social help in late modern welfare states has become 'polycentric' in that 'help' is today being defined by various different agents: public, voluntary and private care providers. Empirically, this article investigates re-housing work with homeless people, a kind of social work which involves several different welfare organisations. The case study shows how these organisations define themselves by making internal constructions of their surroundings, and how their self-enclosed nature creates a certain 'insensitivity' towards one another. How to coordinate and translate within this 'polyphony' of incomparable observations and values represents a major managerial challenge for present-day social workers.     

A Caring Profession? The Ethics of Care and Social Work with Older People

The feminist ethics of care present a challenge to social workersto re-assess not only the place of care within professionalsocial work practice but also the way in which concepts of justice,autonomy and rights are conceptualized and ageing is understood.In this article, the arguments for an ethics of care are consideredin relation to social work practice with older people. It isargued that the feminist ethics of care offer useful insightsthat are relevant to the practice of social work, particularlywithin contemporary demographic, economic, political and organizationalcontexts, all of which have made the task more complex and confusing.     

Defender, spokesperson, therapist: representing the true interest of the client in therapeutic law

The aim of this article is to analyse the role of the legal representative in therapeutic law, specifically in Swedish administrative court hearings relating to compulsory care. Data are collected from three types of cases where a health or social welfare authority argues that it is necessary to apply coercion to a citizen: the Care of Young Persons (Special Provisions) Act, the Care of Alcohol and Drug Abusers (Special Provisions) Act and the Compulsory Psychiatric Care Act. The data consist of audio-recordings from 39 hearings, supplemented by 28 interviews with participants in these hearings, and court documents. Three primary roles of the legal representatives are identified: defender, spokesperson and therapist. We show how the primary role of the attorney becomes that of the spokesperson, but also that the role of the therapist takes precedence over that of the defender.     

Prisoners of Love? Job Satisfaction in Care Work

Previous research has established that paid care work is typically undertaken by women and that this work is often poorly rewarded in terms of pay and promotion opportunities. Much less is known about the reasons why women enter these jobs or their experiences of this work. This paper examines the motivations and experiences of two groups of care workers: childcare workers and dental assistants in Queensland in 2009 (N=1,767). We examine intrinsic, extrinsic and overall job satisfaction and the effects of job characteristics, work experience and demographic characteristics on job satisfaction. We find that childcare workers are less satisfied with their jobs than dental assistants on all three measures, despite a greater proportion nominating intrinsic reasons for entering the occupation. The most important factors predicting job satisfaction for both groups are day‐to‐day work experiences such as control over weekly rosters and entitlements that enable work‐family balance. We conclude that although love of the job may be a strong drawcard into care occupations for some women, experiences may not live up to expectations. Moreover, there is considerable diversity across these groups in motivations and outcomes indicating that it is impossible to view all care occupations as similar in terms rewards, outcomes and experiences.     

What social workers talk about when they talk about child care proceedings in the District Court in Ireland

Court proceedings are a fundamental and increasingly time‐consuming aspect of social work practice. However, to date, there is a relatively modest body of literature considering the experiences of social workers in instituting child care proceedings and giving evidence in court. This paper draws on data gathered as part of an in‐depth qualitative study of professional experiences of District Court child care proceedings in Ireland and presents findings regarding the experiences of social workers in bringing court applications for child protection orders. It seeks to answer 2 key questions: First, how do child protection and welfare social workers experience the adversarial nature of child care proceedings in the District Court? Second, what are the views of child protection and welfare social workers on the strengths and weaknesses of child care proceedings as a decision‐making model for children and young people? The main findings are that social workers expressed significant reservations about the predominantly adversarial model that currently operates in Irish child care proceedings and about the level of respect that social workers are afforded within the operation of the system.     

Professional Social Work Education in End-of-Life Care

Abstract

Social work education in both BSW and MSW level courses is missing vital content about end-of-life care, palliative care, and bereavement. End-of-life care training opportunities through continuing education programs have also been limited. This deficit is significant because a vast number of social workers are already confronted with end-of-life issues on a daily basis in a variety of practice settings. Through the Project on Death in America, Social Work Leadership Development Awards initiative, many programs and models for professional social work education and training in end-of-life care have been developed and are presented in this article. These include: end-of-life care courses, symposia, training manuals, certificate programs and fellowships. Although the curricula continue to be refined, many of these programs are available to practitioners to advance their knowledge and skills and their curricular models are available to social work educators for possible replication.