Early Recognition of and Responses to Dementia: Health Professionals' Views of Social Services' Role and Performance

Correspondence to Jill Manthorpe, Social Care Workforce Research Unit, King’s College London, 150 Stamford Street, London SE1 9NN, UK. E-mail: jill.manthorpe{at}kcl.ac.uk. Summary Increasing calls for early diagnosis of dementia look set toimpact on social services. This article explores some of theissues, drawing on a series of multi-professional dementia workshopsheld in the UK. The workshops identified a series of questionsthat need to be addressed by social services in the areas ofthe drivers for early assessment, ensuing expectations, problemsand advantages in involving social services, and the benefitsof early diagnosis for individuals and their families. The articlediscusses the implications for social services in light of thedata and notes a possible move to specialist services, withinor without the social services sector. Tensions between currentresource shortages and anticipated demands for services areidentified. The difficulty of meeting low level needs whileservices are targeted on those with high levels of need presentsa further challenge to service delivery.     

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.     

Yes Minister: Reviewing the 'Looking After Children' Experience and Identifying the Messages for Social Work Research

Correspondence to Paul Michael Garrett, Centre for Social Work, School of Sociology and Social Policy, University Park, Nottingham NG7 2RD, UK. E-mail: paul.garrett{at}nottingham.ac.uk Summary The heavily promoted Looking After Children: Good Parenting,Good Outcomes (LAC) project continues to exert a powerful influenceon social work in the UK and elsewhere. Despite the repeatedassertions that the documentation associated with LAC is embeddedin ‘objective’ research, this not sustainable onaccount of the failure of the researchers to interrogate theirown normative assumptions and judgements. Specific criticismscan also be levelled at the ‘community study’ connectedto the evolution of the Action and Assessment Records (AARs)which are the key part of the scheme. The system should alsobe viewed in the context of wider pre-occupations about ‘outcomes’.In addition, the project needs to be politically situated andthe researchers' relationship with the Department of Healthshould be more fully explored. In conclusion, it is suggestedthat the LAC experience contains important ‘messages’for the future of social work research.     

Service Users and Practitioners Reunited: The Key Component for Social Work Reform

Correspondence to Professor Peter Beresford, Centre for Citizen Participation, Brunel University, Osterley Campus, Borough Road, Osterley, Middlesex, TW7 5DU, UK. E-mail: peter.beresford{at}brunel.ac.uk or Suzy Croft, Senior Social Worker, St John's Hospice, 60 Grove End Road, London, NW8 9NH, UK. E-mail: suzy.croft{at}hje.org.uk Summary This article explores the pressures towards both regulatoryand liberatory social work. It identifies a range of factorsoperating to push social work in each direction. It discussesthe key significance for more liberatory social work of theroles and engagement of social work practitioners and serviceusers. Highlighting four key characteristics in the currentpolitical and policy context of social work: ambiguity, uncertainty,complexity and contradiction, it argues that social work isunlikely to develop a more emancipatory role, unless socialwork practitioners gain more support to play a central rolein its construction and develop much closer links and allianceswith service users and their organizations and movements.     

Returning to Normality: Substance Users' Work Histories and Perceptions of Work During and After Recovery

Correspondence to Andreas Cebulla, National Centre for Social Research, 35 Northampton Square, London EC1V 0AX, UK. E-mail: a.cebulla{at}natcen.ac.uk Summary New service provisions designed to improve the employment prospectsof former substance users will enhance the roles and responsibilitiesof Drug Action Teams (DATs), Jobcentre Plus offices and otherproviders and co-ordinators of support services for substanceusers. This paper discusses the findings of a study of 30 currentand former drug and alcohol users, exploring past substanceuse histories and current employment aspirations. The researchinforms new policy initiatives designed to assist substanceusers’ entry or return to work. Differences in presentperceptions of work-readiness were observed, which reflectedusers’ perceptions of the nature of their addiction. Theattribution of blame for the substance dependency to either‘the drug’ or the individual’s psychologywas a critical influence on users’ work-readiness assessments.Work was perceived to benefit recovery from substance dependency.The evidence suggests that substance users’ return towork might be helped by their staged (re-) introduction to thelabour market as well as encouraging the primary labour marketto employ (more) recovering substance users. The research highlightedthe need for joint working between employment services and DATsto help substance users into work and to support their recovery.It also highlighted the need for mutual understanding and recognitionof each collaborator’s expertise.     

The Supervision of Child Protection Work

Correspondence to Alan Rushton, Course Director, M.Sc. in Mental Health Social Work, Social Work Department, The Maudsley Hospital, 101 Denmark Hill, London, SE5 8AZ, UK Summary It has frequently been recommended that statutory child protectionservices in Great Britain need greater provision of specialistsupervision to support front line social workers. This qualitativestudy, based in social services departments in London, usedthe focus group method to explore the provision of supervisionby team managers in a very pressurized work environment. Thestudy highlights the difficulty of protecting adequate supervisiontime but shows how supervisors can use their skills to conductcase related discussion concerned with developing professionalskills. ‘Inquisitorial’ and ‘empathic-containing’functions are identified and an approach is proposed for combiningthem in training courses for child protection supervisors. Thepaper recommends that supervision training needs to be expanded,to be more precisely targeted, and that outcomes need to berigorously and appropriately assessed.     

Language and Practice: Minority Language Provision within the Guardian ad litem Service

Correspondence to Richard Pugh, North East Wales Institute of Higher Education, Plas Coch, Mold, Road, Wrexham, LL11 2AW, Wales. Summary This article contends that language should be seen as an importantelement of social difference and not simply subsumed under ‘race’.While it acknowledges the complex role of language as perhapsthe most significant means by which power is exercised, theprimary focus is upon understanding language as an importantaspect of differentiation that social service agencies needto consider. The results of a survey into Welsh language provisionwithin the guardian ad litem service in Wales are describedand used to develop a discussion on language policies, linguisticawareness, and anti-discriminatory practice more generally.The article contextualizes the Welsh results within the UK andoffers suggestions as to how services might be improved. Finally,it restates the broader relevance of the study of language asa necessary element in the analysis of discrimination.     

Social Work, Liberty and Law

Correspondence to Professor John Williams, Department of Law, University of Wales, Aberystwyth, SY23 3DY, UK. E-mail: jow{at}aber.ac.uk Summary The relationship between law and social work is complex. Doeslaw assist practitioners to promote rights, or is it confinedto ensuring accountability and regulating practice? This articleexplores law's role, and its limitations, in promoting liberty,or more accurately ‘constitutional liberty’. Doeslaw provide practitioners with liberty-based values capable,if necessary, of legal enforcement? The paper argues that thereis no simple answer; law impacts on social work in differentways and there is little consistency across and within clientgroups. However, it concludes that law is one of the tools thatsocial workers can use to promote liberty.     

Is Gender Inequality in Social Work Management Relevant to Social Work Students?

Correspondence to Ms C. Taylor, Research Fellow, Social Work Research Centre, University of Stirling, Stirling FK9 4LA. Summary This paper reports on a study carried out in 1991 based on questionnaireswhich asked 169 female and male social work students about theiraspirations and expectations in respect of promotion in theirfuture career. Underlying the study is a concern about the unequalrepresentation of male and female workers at management levelsin social services in the UK, there being at present a predominanceof male managers. The phenomenon is not regarded as unique tosocial services, but as part of the pattern of gender inequalityin the workforce as a whole. The view that women contribute to the phenomenon by a fundamentallack of interest in, or unwillingness to apply for, promotionwill be challenged. It will be argued that the differences inthe aspirations and expectations of male and female employees,which previous research studies have reported, may be an effectof the experience of the organization rather than a cause ofthe scarcity of female employees in promoted posts. The paper will focus on some of the findings, including students'aspirations and expectations, their opinions about the unequalrepresentation of men and women in social work management, theimplications of this for their own career and whether they considerthis issue is, or should be, a significant component of socialwork training.     

Keeping Social Work Honest: Evaluating as Profession and Practice

Correspondence to Ian Shaw, School of Social and Administrative Studies, University of Wales Cardiff, 50 Park Place, Cardiff CF1 3AT Summary The central argument of this paper is that social work needsa radical alternative to existing options for evaluating practice.Social workers at present are offered three choices. They areinvited to choose between applying research, conducting researchor adopting specific forms of empirical research-based practice(for example Everitt et al., 1992; Thyer. 1993; Fuller and Petch,1995). We touch briefly on reasons why we believe none of these optionsprovides an adequate grounding for social work, referring especiallyto the growing call for social work to find new purpose throughan empirical, research-based practice. If alternative approachesare to be persuasive, they must be fashioned from the materialsof a new approach to research on social work practice—‘one that is exploratory rather than confirmatory, buildinga model of evaluation from the practitioners' own accounts ratherthan superimposing an ideal model’ (Elks and Kirkhart,1993, p. 555). The major part of this paper is taken up withevidence from research of this kind. The model of evaluatingin practice with which we conclude the paper is simultaneouslytrue to social workers' accounts of their practice, while offeringa critical starting point for evaluating and refashioning thatpractice.     

Older People and Access to Care

Correspondence to Denise Tanner, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: d.tanner{at}coventry.ac.uk Summary At the heart of a number of New Labour health and social policyinitiatives are stated concerns with supporting independence,preventing deterioration and extending access to services. Thisarticle examines the potential impact of these initiatives,including Prevention Grants (Department of Health, 2000b), theNational Service Framework for Older People (Department of Health,2001a), the Fair Access to Care Services Guidance (Departmentof Health, 2002a), and the Single Assessment Process (Departmentof Health, 2002b), on older people with ‘low level’needs who have increasingly been excluded from services targetedat those in high risk categories. Key standpoints for this analysisare research findings indicating what older people themselveswant from preventive services. Central messages, consistentwith those from other service user ‘groups’, arethe need for support services that enable older people to continueto exercise choice and control over their lives. New preventivemeasures are evaluated in the light of these findings and foundwanting. It is argued that recent policy initiatives are likelyto do little to widen access to support services for those withlow intensity needs, and, moreover, that the processes involvedin identifying those at future high risk will detract from ratherthan enhance citizenship. A more diffuse approach to preventionis advocated, based on mutuality, community development, andcapacity-building.     

'Low Key Practices' in Social Work. Towards a Socio-historical Method

Summary In this article a ‘socio-historical’ method of analysisand intervention in social work will be developed, illustratedby an example drawn from social work with families, the programknown in France as Action Educative en Milieu Ouvert. Our purposeis to support and encourage what we call ‘low key practices’,which refers to practices in which social workers within theexisting structures of so-called ‘individual social work’attempt to explain the social struggle taking place in the situationsthey are dealing with.     

Rethinking Professional Practice: The contributions of Social Constructionism and the Feminist 'Ethics of Care'

Correspondence to Professor Nigel Parton, Centre for Applied Childhood Studies, School of Human and Health Sciences, University of Huddersfield HD1 3DH, UK. E-mail: n.parton{at}hud.ac.uk Summary Drawing upon social constructionist and postmodern perspectives,together with recent feminist debates about ‘the ethicsof care’, this paper reflects upon the productive waysin which contemporary social work can be thought about, organizedand practised professionally. It argues that an emphasis on:process; plurality of both knowledge and voice; possibility;and the relational quality of knowledge are key elements intaking these issues forward. In contrast to the traditions ofabstract and instrumental reasoning where the pursuit of knowledgeis intertwined with the pursuit of control, the importance ofsensory knowledge, symbolized by the unity of hand, head andheart is underlined.     

Sleepwalking through an Epidemic--Why Social Work should Wake up to the Threat of Hepatitis C

Correspondence to Dr Ian Paylor, Department of Applied Social Science, Cartmel College, Lancaster University LA1 3HY, UK. E-mail: i.paylor1{at}lancaster.ac.uk Summary One of the many consequences of injecting drug use is the potentialrisk to infectious blood-borne viruses. There is evidence thatthe risk of contracting Hepatitis C (HCV) is greater than thatof HIV. Despite repeated warnings from a variety of sourcesand thousands of new infections among drug users each year andrising incidents of ‘'crack’ injecting, successivegovernments have failed to address a public health emergencyof immense proportions - the HCV epidemic. This article exploresthis issue and the implications it has for social work.     

Stress in Social Services: Mental Wellbeing, Constraints and Job Satisfaction

Correspondence to Margaret Coffey, Liverpool Hope University College, Room AEW 098, Hope Park, Liverpool L16 9JD, UK. E-mail: coffeym{at}hope.ac.uk Summary The public sector is facing an impending shortage of staff,because young people no longer want to work in it and nearlya third of its workforce is over 50 years of age. Staff workingwithin the public sector report that stress is the biggest singlefactor affecting their decision to leave. This research notereports the findings of a recent study carried out in two socialservice departments in the north-west of England. The primaryaim of the research was to explore work-related stress, usinga ‘problem diagnosis tool’ to understand the stressorsexperienced by social services staff, and to inform the developmentof interventions aimed at reducing and/or eliminating them.This study used in-depth interviewing to develop a questionnaireincorporating a variety of measures to assess potential stressorsand mental well-being. The questionnaire response rate was 33per cent (n = 1234) and the results demonstrated statisticallysignificant differences between staffing grades. Staff workingwith children and families reported the highest levels of absenteeism,poorest well-being, and highest level of organizational constraints.Job satisfaction was low compared with established norms forvarious occupational groups. This grounded research baselineis a crucial step to inform specifically designed and targetedinterventions, which can be effectively evaluated from thisbaseline position.     

Non-Statutory Mental Health Social Work in Primary Care: A Chance for Renewal?

Correspondence to Malcolm T. Firth, Honorary Research Fellow & Senior Psychiatric Social Worker, 'DEAL', Department of Psychiatric Social Work, 12th Floor, Mathematics Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: malcolm.firth{at}mhsc.manchester.nhs.uk Summary The current status of evidence-based practice in the field ofmental health has led some to question the potential for innovationif social work practice is organizationally proscribed or reducedto a dogged adherence to methodological orthodoxy. Conversely,social work's value base is esteemed disproportionately to itsevidence base. Changing service contexts in the UK, particularlythe emergence of Primary Care Trusts as gatekeepers and commissionersof health and social care services, are providing opportunitiesfor social work to develop a new presence and purpose. The authorsdescribe their work in a small-scale service based in primarycare that anticipated these opportunities, by a retrospectivestudy of 120 cases. A new evidence base that derives directlyfrom practice is suggested as a way forward for social workeducation and training, as well as for service and professionaldevelopment.     

Discourses of Child Protection and Child Welfare

Correspondence to Gordon Jack, University of Exeter, Department of Social Work and Probation Studies, Amory Building, Rennes Drive, Exeter EX4 4RJ Summary The history and dominance of the discourse of child protectionand its influence over social work practice with children andfamilies is discussed in the light of recent research into theoperation of child protection systems in the UK and elsewhere.The often negative effects of current approaches on professionals,parents, and, particularly, children are highlighted. The issuesof confidentiality and empowerment appear to be of central importancefor current debates about the welfare of children and youngpeople. Three strategies for change are outlined and discussed. It isargued that a fundamental challenge to the child protectiondiscourse is required. Parallels are drawn with the changeswhich occurred in attitudes and responses towards football supporters,following the Hillsborough disaster in 1989. The dangers and shortcomings of the present reliance on a diseasemodel of ‘abuse’, with its focus on individual pathology,are analysed. Support is provided for the development of a newdiscourse, which acknowledges the social contexts within whichallegations of ‘abuse’ arise, and without whichsocial work will continue to be restricted to a procedurallydominated conservative orientation to child welfare.     

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.     

Beyond Social Constructionism: Critical Realism and Social Work

Summary Theories within the social and psychological sciences continueto shape social work practice. However, recent debates withinthese sciences on the shortcomings of ‘social constructionism’,and the attempt to overcome them through a critical realistposition, have so far failed to capture social work's attention.This paper provides a critical overview of these theoreticaldebates, highlighting the shortcomings of social constructionismfor social work. The critical realist challenge to social constructionism,as articulated by the British philosopher Roy Bhaskar, is consideredand its relevance to social work formulated in terms of a returnto ‘depth’ in practice.