Enabling Adults with Learning Disabilities to Articulate their Housing Needs

Correspondence to Dr Alex McGlaughlin, Department of Social Sciences, The Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK. E-mail: alex.mcglaughlin{at} ntu.ac.uk Summary This study is about involving adults with learning disabilitiesin service planning by asking them to articulate their own needsin relation to housing. It also identifies some of the barriersto meeting the housing needs of this group. The views expressedindicate that ordinary housing with small numbers is the preference,and that appropriate support is highly valued. This suggestsa need for housing of a supported living model or similar. Theservice users in this study were clearly able to verbalize theirpreferences as well as to think through potential options. However,there is also clear evidence that they feel powerless in makingchoices, with decisions being taken on their behalf by professionalsand carers. This demonstrates the need for a cultural shiftwhereby the voices of adults with learning disabilities areheard and acted upon.     

Evaluating Social Work and Medical Practice with Black and Ethnic Minority Groups Using the Clinical Audit Model

Correspondence to Kish Bhatti-Sinclair, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Summary This paper is based on the External Audit-Ethnically SensitivePractice (EA-ESP) project which was undertaken within six primaryand secondary health care settings. This project is used asan example of how the clinical audit model can be used to monitorand review health and social work practice in the UK. The paperexamines quality, compares approaches to evaluation, and suggeststhat audit can be a useful tool for agencies in obtaining userand staff views on many areas of practice but in particularon equal opportunities, anti-racism and anti-oppression. Attentionis drawn to audit within broader evaluative and review approachesalready employed by social work academics and practitioners.The issue of quality and how it can be measured is consideredthrough an analytical comparison with approaches which employaction research and other evaluative means in the process ofreview. Audit is explored in the context of a growing need for the developmentof monitoring and review systems which provide evidence to supportand develop professionalism within social work. External auditis explored and compared to internal audit. Finally, the needfor the development of quality services in anti-racist and anti-oppressivework is highlighted and it is suggested that audit can be acost-effective and efficient way of achieving this.     

Entry into Residential Care

Summary This paper examines the interaction between the organizationalstructure of social services departments and procedures foradmission into residential care. By drawing on research experiencea 'placements table' is proposed which contains the key operationaldecisionstaken by the department when the client becomes a resident.It is argued that, in accordance with the structure of the department,it is possible to suggest appropriate staff to make each keydecision in order that departmental criteria for admissionsmay be met.     

Aspects of Social Work on a Cancer Research and Treatment Unit in a London Teaching Hospital

Summary With the rapid growth of technology and science in society today,an increasingly large number of people are becoming patientsin specialized research and treatment units. The reorganizationof social work support to the health service is upon us, andgreat care must be taken to ensure that this important groupof clients will receive the social work help it needs. The paper is based on work in a cancer unit in a London teachinghospital and seeks to illustrate ways in which the work is specialized     

Working in the Social Services: Job Satisfaction, Stress and Violence

Correspondence to Professor Jan Pahl, Department of Social and Public Policy and Social Work, Darwin College, University of Kent at Canterbury, Canterbury CT2 7NY. Summary A major survey of the social services workforce (Balloch etal., forthcoming), carried out in the Research Unit at the NationalInstitute for Social Work, has produced new data about sourcesof job satisfaction and about the incidence of stress and violence.The survey took place in five different local authorities inEngland, and interviews were carried out with 1276 individuals,selected from four groups of staff: managers, social work staff,home care workers and residential staff. The results suggestedthat those who work in the statutory, social services do experiencemore stress and violence than workers in other parts of thehealth and welfare services. However, different jobs presenteddifferent hazards. In general, home care workers were the mostsatisfied with their jobs, and were also the group least likelyto be stressed or to experience violence in the course of theirwork. By contrast, residential workers, especially those withmanagement responsibilities, were most at risk of both violenceand stress. Men were more likely than women to experience violence,while other groups with a higher than average risk of stressincluded younger members of staff, and managers and social workstaff responsible for elderly people.     

Feelings and Emotions in Residential Settings: the Individual Experience

Summary This paper examines the impact of admission to residential care,makes a distinction between feelings and emotions, and suggestsways in which emotional habits are formed. Some of the feelingssurrounding primary needs are considered and examples are givenof the powerful emotional drives which result from the dailyinteractions of staff and residents. The need to acknowledgeparallel feelings and emotions in both the cared-for and thecare-givers is underlined together with the importance of constructinga framework of care which allows for the growth of the individualemotional lifestyles of residents.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

Assessment and Action Records: Will they Promote Good Parenting?

Correspondence to Theo Knight, Department of Applied Community Studies, Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 2RR. Summary In this article the authors seek to provide a critical lookat Looking After children: Good Parenting and Good Outcomes(Department of Health, 1995). They welcome the sentiments underpinningthis major contribution, which recognizes the many disadvantagesfaced by children and young people who are looked after by localauthorities, and acknowledge that local authorities have notbeen positive parents of those in their care. The writers alsoacknowledge the thoroughness which has gone into the detailof the Action and Assessment Records contained in the abovepack. What is questioned is the normative view of parentingand family life which is seen to be at the heart of these documentsand the lack of consideration of the resourcing of action plans.The checklist approach is criticized for the way in which itwill enhance the bureaucratic nature of being in public care,which in turn affects the relative power positions of parentsand children in relation to the local authority and which willimpact on the development of a partnership model of care. Thewriters conclude that children and young people in care arebut one group of young people facing disadvantage and deprivationin British society. An examination of their plight and how toaddress it need to be based within a clear framework of children'srights and a recognition of the power adults hold over them.     

Beyond Retroduction? -- Hermeneutics, Reflexivity and Social Work Practice

Correspondence to Susan White, University of Manchester, Department of Social Policy and Social Work, Williamson Building, Oxford Road, Manchester Summary Over the last three decades qualitative research methodologieshave been in the ascent within social science. Yet social workevaluation studies have tended to be quantitative in nature,conventially relying upon the generation of criteria againstwhich interventions are retrospectively judged. The generationof such criteria inevitably depends upon pre-suppositions, whichin themselves go unresearched. As a consequence the .sense makingactivities on which social work interventions depend are renderedimmune from critical analysis. This reflects a broader tendencyfor social work to cling to naive realist epistemologies, whichare arguably obsolete within the interpretive paradigm in whichits activity is properly located. By examining the debates withininterpretive social science, this paper argues for an approachto social work assessment which avoids the pitfalls of naiveobjectivism and the nihilism of anarchic relativism, whilstretaining creativity, imagination and hope.     

The Effort Involved in Finding Employment for White-Collar Offenders

Summary Ex-offenders are notoriously difficult to place into employment.However, the efforts needed to help such clients find work varyenormously and an important question to consider is whetherit is more appropriate to help a larger number of clients bylimiting the amount of placing effort for each client or tocontinue to try to assist those who prove much more difficultplacing propositions. The present study indicates some of thepotential dangers in concentrating upon short-term aid and thefindings have relevant implications for other areas of socialwork where there is a need to ration efforts made on behalfof clients. The present paper also stresses that the difficultiesof while-collar es-offenders finding work have not been fullyrecognized by other comtnentators.     

Adolescents in Care and their Social Workers: A Research Note

Summary There has recently been an increasing concern that young people,and especially those in residential care, should be encouragedto express their views, and that the views expressed shouldbe used in improving the care which they receive. The publicationof the Who Cares? booklet (Page and Clarke¹), and the emergenceof ‘Who Cares’ groups and the ‘Voice of theChild in Care’ organisation, is evidence of this concern.In sympathy with these developments has been a study of adolescents'perceptions of social workers, and a part of this research hasincluded a pilot study of the views of adolescents living intwo family group homes.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

Determinants of Substitute Child Care Practice

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford CX1 2ER Summary The first part of this paper attempts to examine the factorswhich help to define foster and residential care practices.The discussion is informed by a comparative study of fosterhomes and Children's Homes, which was reported in the previousissue of this journal (BJSW 18:1). Overall, care practices inthe foster homes compared very favourably with those observedin the Children's Homes. It is argued that this finding owesmuch to the bureaucratization of Children's Homes. The secondsection considers the implications of my work for policy andpractice in the field of substitute child care. Use is madeof the insights provided by the preceding section to suggestways by which the major shortcomings identified by empiricalresearch might be ameliorated. This statement includes an argumentin favour of a significant expansion of family placement forolder children in public care, and a proposal for a child-orientedalternative to the sorts of Children's Homes visited.     

Life-styles of Severely Retarded Non-communicating Adults in Hospitals and Small Residential Homes

Summary Comparisons were made of the care practices of the staff, organizationand management, physical environment and activities of the residentsof three hospital wards and three small non-hospital residentialhomes for mobile, severely or profoundly retarded adults withdisturbed behaviour. Although, overall, compared with the wards,the small homes had better staff ratios, markedly more staffautonomy, resident oriented care practices, occupations andleisure pursuits and their residents were more often engagedin simple constructive activities, there were differences amongthe individual units, especially the wards. The results showedthat, even within a rigidly run insititution, the initiativesof individuals in charge of the living unit can have an appreciablepositive effect upon the residents' life-styles.     

Communication in Care and Coercion: Institutional Interactions between Family Supervisors and Parents

Summary In this study the interaction of 51 videotaped professionalcommunications between Dutch family supervisors and parentsof children under family supervision were analysed. Family supervisionlies at the interface of care and control. This is evident inthe communication of professional child welfare workers withtheir clients for whom they have to clarify their rights. Theanalysis shows some of the strategies used by Dutch family supervisorsin cases of formal decisions and other interactions where theyanticipate confrontation with the client. In this way, familysupervisors separate their caring from their repressive functions.Nevertheless care and control were found to be successfullyintegrated in some communications.     

Identifying the Extent of Challenging Behaviour in Adult Learning Disability Services

Correspondence to Carol Hayden, ICJS, St. George’s Building, 141 High Street, Portsmouth PO1 2HY, UK. E-mail: carol.hayden{at}port.ac.uk Summary This article presents one part of the findings of an ongoingstudy that set out to investigate and explain the extent ofchallenging behaviour in twenty-one social service run day andresidential services in one large county authority in England.This part of the study reports on staff perceptions of problematicbehaviour from service users. It uses staff reports of levelsof problematic behaviour as indicative of potentially challengingbehaviour. The study uses an adapted version of an establishedinstrument, the BPI (Behaviour Problems Inventory), as a surveytool completed by staff for all service users in a one-monthperiod (January 2000). The findings of this exercise are basedon 1,390 service users, near to a census at the time of thesurvey. The study shows ‘non-compliance’ to be themost problematic and prevalent behaviour from the point of viewof staff. Overall the research illustrates a split between themajority of service users who present staff with problematicbehaviour in a relatively minor to moderate way and a smallgroup of individuals (less than 2 per cent) who present muchmore extreme behaviour. Brief reference is made to other datacollected in the study when it helps in the interpretation ofthe behaviour patterns identified by the BPI.     

Exploring the 'Need' for Family Centres: The Perceptions of Social Workers and Their Importance for Planning

Correspondence to Ms J. R. Fells, Wooster Arms, The Walk, Islip, Oxon OX5 2SD. Summary This article follows Gilbert Smith in questioning the usefulnessof some traditional ways of regarding need, which rely mainlyon surveying potential client populations in order to decidewhat provision a social services department ought to make. Itdescribes a small study which examined in detail what socialworkers meant when they said that certain families ‘needed’a Family Centre, and which also looked at the subsequent historyof the department's contact with those families in the absenceof such a resource. It is, therefore, based on looking at whathappened to families when the Centre was not provided, and onanalysing social workers' perceptions of the need they encountered. It is argued that, despite its limitations, such an approachcan give useful indications, not only of what services shouldbe provided but as to the specific way they should be offered.In view of the role played by social workers in assessment for,and allocation of, services, it is suggested that a clearerunderstanding of their perceptions is essential to achieve effectiveservice utilization.     

Tricks of the Trade: Questionable Theory and Practice in Family Therapy

Summary This paper looks at certain over-systematizing trends in familytherapy, and at a group of practices, connected with such systems-thinking,which espouse manipulation and deception. It is argued thatthese theories and methods, couched in a language of scientism,represent a questionable and cynical direction in therapeuticwork. This technocratic approach not only disfigures personaland social being, but erodes social work principles foundedmorally upon a respect for persons. An alternative view is advocatedin which the value of the person is considered as central toan adequate human science. This regards the nature of understandingas based upon the finitude of experience, and therefore offersan appreciation of the person not as an ‘object’fit for technocratic manipulation, but in terms of his subjectiveand historical being.