Do social workers avoid the dilemmas of work with clients?

This article is devoted to Lipsky's suggestion that the purpose of street-level policies is to establish and justify patterns of behaviour that enable street-level bureaucrats to avoid the dilemmas provoked by uncertain working conditions. Based on a review of relevant literature as well as on case studies in the culture of social work service organisations by the authors, the article suggests that two kinds of street-level policies are described by the research. The first one is consistent with the aforementioned idea by Lipsky and follows the wish of social service workers to avoid the dilemmas of their work with clients without trying to change those uncertain conditions that provoke these dilemmas. The actors of the second kind of street-level policy try to negotiate with relevant partners and to change uncertain working conditions that are at the roots of their dilemmas. Both kinds of street-level policy are described by means of empirical examples and their substantive features are summarised.     

An Exploratory Needs Analysis of Parents Diagnosed with Cancer

The purpose of this study was to explore the experiences of parents and co-parents where one parent was diagnosed with cancer with specific interest in the impact of the disease on their role as a parent and the supports that were found to be useful in managing the ongoing care of their children. A qualitative research method using semi-structured interviews and thematic network analysis techniques was used. Participants included adult English-speaking parents receiving treatment for a new diagnosis of cancer at a major tertiary oncology research and treatment centre, with prior social work involvement. Participants reported multiple, complex layers of need. Four salient themes were evident: (a) emotional impact of a cancer diagnosis on the patient, (b) accessing professional supports, (c) children’s understanding, and (d) meeting children’s needs. Parents described difficulties in managing emotionally, physically, and existentially. Accessing supports within the healthcare service and community was paramount, as was guidance around communicating with children. Receiving a proactive service from a social worker was highly regarded. The results demonstrate that it is essential to respond to the needs of parents with cancer in order to minimise prolonged emotional distress.     

Mental Health Difficulties and the Support Needs of Social Work Students: Dilemmas,Tensions and Contradictions

There are a growing number of students in higher education who experience mental health difficulties and have support needs. The behaviour of small numbers of students on social work programmes indicates also a need to examine the mental health difficulties and needs of social work students. There is only limited factual information on this topic. It is rarely discussed or written about. There is a danger of discriminating against those experiencing such difficulties, especially black or female students. Yet, at the same time, undertaking a social work programme is a demanding experience, as is doing social work itself. Furthermore, on courses leading to a professional qualification, such as social work, there is an obligation to protect the rights of, and assess possible risks to users, as well as to support students. Programmes should give particular attention both to the mental health difficulties and support needs of social work students at selection, during the programme itself and upon conclusion of the programme at a wide range of levels, both within the higher education system and outside that system.     

Minimising Coerciveness in Coercion: A Case Study of Social Work Powers under the Victorian Mental Health Act

The balance between care and control in mental health social work is one of constant tension. In the State of Victoria, Australia, the Mental Health Act 2014 gives coercive powers to social workers employed by public mental health services. These include the power to decide if a person needs to be assessed by a psychiatrist, to “take” a person using bodily restraint, to enter premises, and to search and seize a person’s belongings. This paper applies a doctrinal analysis to examine the law, then argues that the use of these powers by social workers, where safe, may be less restrictive than when they are used by police or paramedics. The exercise of these powers may be less traumatic and stigmatising to the people who are subject to them, and social workers may be both legally and ethically obligated to use coercion when appropriate.

IMPLICATIONS

• More social work literature on the coercive powers under mental health legislation is needed as well as more guidance on using these powers for social workers in practice.

• In some circumstances, these coercive powers may be better exercised by social workers than by other professionals.

• Social workers should carefully consider their legal and ethical obligations to use these powers in some circumstances.

     

Using social support for LGBTQ clients with mental illness to be out of the closet,in treatment,and in the community

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are often faced with societal challenges that can lead to mental health or substance abuse issues. They may be misunderstood or mistreated when seeking services because of a lack of training in offering culturally sensitive treatment by service providers. A program, the Rainbow Heights Club, was developed to support LGBTQ individuals with a mental health diagnosis. All of the members are in treatment for their mental health and/or substance abuse problems, but prior to the development of the program did not have a place to feel accepted, supported, or have a sense of community. Members were surveyed determine if Rainbow Heights was helpful in maintaining themselves in the community. Results indicated that 75% of members are more consistent in following prescribed treatments, keeping them free from inpatient hospitalization, and 79% reported being clean and sober since coming to the Club.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

Making connections: Severe mental illness and closeness with other people

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.     

The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work

ABSTRACT

Peer adviser roles are becoming an increasingly common—and celebrated—aspect of agencies where social workers are located. This article reports on a qualitative research study exploring the experiences of staff within a homelessness outreach service in which three peer advisers (people with a lived experience of homelessness) commenced employment. Drawing on action research principles, the study explored the experiences of the peer advisers and the broader team following the introduction of the peer adviser roles. Themes identified include, realising the skills of peer advisers, defining the role, taking a “whole of team” approach, and reflecting on power. This study demonstrates that the introduction of peer adviser roles into human service organisations is a promising strategy for creating services that are more likely to respond effectively to the needs of service users. However, social workers need to be aware of the pitfalls of tokenism and the devaluing of experiential knowledge.

IMPLICATIONS

• Peer advisers in health and welfare agencies add significant benefits to an agency’s capacity to respond to the needs of service users.

• The introduction of the peer workforce is aligned to social work values of service user empowerment and the valuing of experiential knowledge.

• In order to avoid tokenism, the introduction of peer adviser roles should be supported by both the attitudes and actions of other staff members, as well as organisational support structures.

     

An examination of social work interventions for use with displaced Iraqi households in Jordan

The purpose of this paper is to identify and examine how models of social work intervention are being used with displaced Iraqi households in Jordan. The review of the situation of displaced Iraqis in Jordan identifies the size, characteristics and experiences of this group, Jordanian government policies towards them, and the role of IGOs and NGOs dealing with them. The literature review of social work interventions with refugees internationally identifies a range of psycho-social and community-based intervention models that are contextual, some of which include spiritual dimensions. The paper reviews social work interventions in use with Iraqi households in Jordan and concludes that these need to be focused at the individual, household and community levels using an inter-professional, holistic approach that includes spiritual dimensions, and that coordination between agencies is essential.     

Community-based psychosocial rehabilitation for schizophrenia service users in the north west province of South Africa: A formative study

Psychosocial support is recognized as important for recovery for service users with schizophrenia, in addition to provision of antipsychotic medication. This study aimed to develop a community-based psychosocial rehabilitation programme for service users with schizophrenia to be facilitated by auxiliary social workers, and to investigate acceptability and feasibility of the programme. A task-sharing approach was adopted in which auxiliary social workers were trained to facilitate psychosocial rehabilitation groups. In-depth individual qualitative interviews were conducted with six group members at baseline, midpoint, and endpoint (18 interviews in total). NVivo10 was used to store data and conduct qualitative framework analysis. Participants reported benefits of the programme, including improvements in group members’ self-esteem, social support, illness knowledge, self-care, and contribution to their households. A key barrier to acceptability was the lack of provision of income generating opportunities. Implementation challenges include difficulties in tracing and engaging service users and families, lack of an appropriate venue, and issues with supply of antipsychotic medication. This study has provided evidence for the benefits and acceptability of this contextually adapted programme. Key barriers to implementation can be addressed through the provision of the necessary resources for auxiliary social worker input in the community.     

Becoming an Ally: Breaking the Cycle of Oppression (2nd edn)

Abstract

In the present context of “get tough on crime” and “back to criminal justice” campaigns that continue to dominate political agendas throughout Australia, critics point to the inadequacy of “welfarist” or reformist criminological and sociological theories that have informed interventions in the past and reinforce the need for “retributive justice” models of penal policy. The present paper examines historical evidence on the role of the human sciences in juvenile justice administration during the 1940s, a formative time when psychiatric, psychological, and social work expertise came together in the form of the Children's Court Clinic in Victoria. It suggests that contemporary critiques about the failure of the welfare model of juvenile justice inadequately capture the historical functioning of expertise in justice administration and the real extent to which the welfare model as “actual rehabilitative intervention” was ever implemented.     

The rights of the child enabling community development to contribute to a valid social work practice with children at risk

This paper presents a way of thinking about and doing child protection work using community development (CD) principles to guide practice. It suggests that a useful addition to CD can be found within the rights of the child provisions in Human Rights conventions. Using examples from the authors' three countries to illustrate the work that practitioners do in their work with children at risk, we argue that social work practice can be enhanced by the inclusion of these principles and practices which are essentially core generic social work practice. However, much of social work with the protection of children is bound by ‘risk’ perceptions which result in investigatory approaches being used as a first action, often to the exclusion of preventive approaches. This article demonstrates that in very different situations from different environments, CD in concert with the principles of the rights of the child can assist good outcomes with children at risk. A model is presented for unifying the worldview of human/children's rights with social work's core concern, the protection of children, using generic social work skills.     

Tracking residential outcomes of supported independent living programs for persons with serious mental illness

This study seeks to document patterns and reasons of leaving housing, and identify factors associated with different types of exits for a cohort of 452 residents with serious mental illness entering supported independent living (SIL) in Philadelphia, PA. The study cohort was tracked through an integrated administrative database comprised information on basic demographic and clinical characteristics, length of stay, homeless shelter use, and publicly funded behavioral health services use. A convenience sample of 46 SIL leavers and their support staff provided data on scenarios of leaving. The findings of this study suggest that departure from SIL is not a unitary phenomenon, but involving plausibly favorable as well as unfavorable circumstances. Multivariate analysis based on administrative tracking data suggests demographic and clinical factors, housing setting, and service use factors to have effects on leaving SIL and distinct types of exit examined in this study. Data procured from the convenience sample highlight the potential roles that program rules and resident–staff relationships play in affecting housing tenure. Implications of the findings for the development of permanent supportive housing for persons with serious mental illness are discussed.     

Exploring the Development of Professional Identity with Newly Qualified Social Workers

This paper discusses the experiences of newly qualified social workers as part of a research project exploring professional identity. Drawing on literature in this area and a subset of data from a larger study involving Australian practitioners, it is argued that while several studies explore experiences of identity, the phenomenon remains under-researched, especially in Australia. Seventeen people participated in three in-depth, semistructured interviews across a 12-month period. A subset of the data explores how participants were actively motivated and benefitted from reflecting on their identities through the research process. Findings indicate newly qualified social workers appreciate meaningful opportunities to critically reflect upon their social work identities. It is concluded that further research is needed, to understand the identities and needs of newly qualified social workers in Australia.     

Critical Reflection on the Ethics of Mindfulness

Mindfulness is a way to achieve mental wellbeing that has been widely adopted as part of counselling and mental health treatment. However, there is a distinct lack of critical reflection about the origins of this technique, how it is used, and the implications it has for the beliefs of clients. The purpose of this paper is to provide a carefully considered response to the use of humanistic mindfulness. Social workers need to explain why they recommend mindfulness, and explore culturally consistent and sensitive practice, so that they are abiding by the Australian Association of Social Workers Code of ethics.

IMPLICATIONS

• The use of mindfulness in social work practice requires careful consideration as to its impact and relevance to clients’ needs.

• Mindfulness originates in philosophical traditions distinct from mental health treatment.

• In choosing to use mindfulness social workers require consistent and sensitive understanding of clients’ needs, world views, and culture.

     

Understanding the needs of LGBTQ clients and their risk for commercial sexual exploitation: Training community mental health workers

Training on commercial sexual exploitation (CSE) and victimization of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youths can increase awareness among professionals who provide services to this community. This study evaluated the effectiveness of a community-based training program geared toward mental health workers in a diverse metropolitan city. The training provided information about the continuum of sexuality and gender identity, sensitivity when working with LGBTQ clients, LGBTQ clients’ risks for CSE, and ways to improve service delivery to this population. Participants’ (N?=?64) knowledge level of these areas was examined prior to the training, immediately thereafter, and in a six-month follow-up. Participants showed an increase in knowledge from pretest to posttest. Follow-up testing on a limited sample revealed scores that were lower than posttest scores, but higher than pretest scores. Overall, through this community-based training, participants gained knowledge about the continuum of sexual and gender identity, appropriate service delivery when working with LGBTQ individuals, and the risk factors for CSE for LGBTQ youths. Participants also reported feeling satisfied with the training approach and format. Implications for future training to enhance mental health workers’ competence with LGBTQ victims of sexual exploitation are explored.     

Social workers' assessments of needs and interventions for adolescents with substance misuse problems,criminal behaviour and mental health difficulties: a vignette study

The aim of the current vignette study was to examine how social workers assess adolescents with substance misuse problems, criminal behaviour and mental health difficulties, and how they make decisions about treatment interventions to reduce these problems. Earlier research has shown lack of knowledge concerning factors and processes that govern assessments and decisions in social work practice. In this anonymously administered survey, social workers in Stockholm, Sweden, were invited to assess fictitious youth issues. We found that social workers recognise the problems and needs of young people, but that they find it harder to link needs to evidence-based interventions. Also, there is a tendency to overrate alleged non-serious problems in the vignettes. We conclude that there is a need for increased knowledge about evidence-based methods and more structured procedures to broaden the basis for decisions.     

Evaluation of a system designed to link people living with HIV/AIDS with mental health services at an AIDS-service organization

This study evaluated the Rapid Response System, an initiative designed to link people living with HIV/AIDS with mental health services at an AIDS service organization. Data were extracted from agency records for 314 clients who had contact with the Rapid Response System over a 6-month period. Of the 281 clients who scheduled an appointment for an evaluation to initiate mental health services, 64% completed the evaluation. In the multivariate analysis, Latinos were significantly less likely than whites to complete the mental health evaluation. Further, there was a significant decrease in the likelihood of completing the mental health evaluation as the number of days between the Rapid Response System contact and the date of the evaluation appointment increased.Strategies that reduce the period of time between the initial referral and initiation of services may facilitate linkage with mental health treatment, particularly in the context of larger multi-service organizations.     

Financial insecurity and risk experiences of justice involved persons with severe mental illness

More information is needed about the financial experiences of justice-involved persons with severe mental illness. Qualitative and quantitative methods were used to examine the financial resources, financial risk experiences, and financial literacy of a random sample of 12 mental health court participants. Mental health court participants had limited financial resources, frequently ran out of money, and had engaged very few financial tools to manage their money. Justice-involved persons with severe mental illness need financial management interventions to help develop strategies for managing depleted resources and to develop the financial resources needed to live in community settings.     

Exploring the Educational Experience of a Social Work Student with a Disability: A Narrative

Social work educators seem to have mixed feelings about the development of open and distance learning in Britain and the USA. Open and distance learning has tended to be marginalised. It has been compared unfavourably to campus based programmes, but there has been a lack of research on this topic in the United Kingdom. However, research in the USA indicates that open and distance learning social work students have a high degree of satisfaction with teaching and learning approaches compared with those on campus based programmes, while student outcomes and level of achievement have been at least comparable to those on ‘traditional’ programmes.

Some criticisms of open and distance learning in the UK are examined. These include narrow, mass produced, ‘assembly line’, mechanistic, isolating, individualistic approaches. Advantages of open and distance learning in the UK are considered, such as well organised teaching packs, flexibility and individual choice in pace, time and place of learning with especially good learning opportunities for mature women with family commitments. Improvements are advocated, centred around developing more opportunities to rehearse and develop practice skills, encouraging more divergent, critical thinkers operating from a more pluralistic knowledge base and the empowerment of students in collectives.