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.     

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.     

Show Me the Way to go Home: A Narrative Review of the Literature on Delayed Hospital Discharges and Older People

Correspondence to Jon Glasby, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Edgbaston, Birmingham B15 2RT, UK. E-mail J.Glasby{at}bham.ac.uk Summary This Research Note reports findings from a narrative reviewof the literature on the rate and cause of delayed hospitaldischarge in the UK. In addition to summarizing our knowledgeto date in this important area, the Research Note raises a seriesof questions about aspects of current hospital discharge policyand practice (and in particular, the recent reimbursement policyto charge social services departments for delayed discharges).     

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.     

Social Work and Child-centred Family Court Mediation

Correspondence to Dr Greg Mantle, APU, Ashby House, Floor 2, Brook Street, Chelmsford CM1 1UH, UK. E-mail G.J.Mantle{at}apu.ac.uk Summary In April 2001, the Children and Family Court Advisory SupportService (CAFCASS) became responsible for family court work,including the provision of mediation services. Family courtmediation offers a gateway for social work with children andfamilies whose needs are largely left untouched by current services,and could thereby play an important part within the broaderextension of prevention, early intervention, parenting and supportservices recommended by government. Over the past two decades,mediation has become a popular approach to reducing conflictand resolving disputes in a wide range of inter-personal, communityand organizational settings. Given the professional interestthat social workers have in helping their clients achieve moreharmonious lives, the space for mediation would appear considerableand yet the connections between mediation and social work are,as yet, insufficiently mapped and analysed, in terms of boththeory and practice. This paper draws on literature and recentresearch to review the relationship between family court mediationand social work.     

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.     

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.     

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.     

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).     

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.     

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.     

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.     

Interaction Between Field and Residential Social Workers

Summary This paper is based upon collaborative project work with a socialservices department aimed at improving interaction and collaborationbetween field and residential social workers. It describes theprinciples upon which it was agreed that interaction shoulddevelop. These include notions of case-accountable staff, acollateral model of interaction between staff and the idea ofone party being identified as a prime care agent. Based on theseprinciples it sets out a model arrangement for clients enteringresidential care which recognizes the need for precision aboutthe nature of key decisions that need to be taken with clientsand the way these decisions should be taken.     

Sponsored Places: The Use of Independent Day-Care Services to Support Children in Need

Correspondence to: Dr June Statham, Project Director, Thomas Coram Research Unit, 27-28 Woburn Square, London WC1H OAA Summary The implementation of the Children Act 1989, with its emphasison family support through the provision of non-stigmatizinglocal services and on local authorities working in partnershipwith voluntary and private service providers, has given a newfocus to the use of independent day-care services to supportchildren in need and their families. This article uses datafrom research in England and Wales on the implementation ofthe Children Act as it affects early years services, to considerthe extent of sponsored day-care, the circumstances in whichit is used, and the issues it raises for local authorities,independent day-care providers and the children themselves.     

Hidden Gems: Systematically Searching Electronic Databases for Research Publications for Social Work and Social Care

Correspondence to Brian Taylor, Queen's University Belfast, Department of Epidemiology and Public Health, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland. E-mail: b.j.taylor{at}qub.ac.uk Summary Context: Electronic bibliographic databases are an importantsource for professional publications about social work and communitycare more generally. This article describes and evaluates amethod of identifying relevant articles as part of a systematicreview of research evidence. Decision making about institutionaland home care services for older people is used as an example.Method: Four databases (Social Science Citation Index, Medline,CINAHL and Caredata), which abstract publications relevant tohealth and social services, were searched systematically toidentify relevant research studies. The items retrieved wereappraised independently using a standard form developed forthe purpose. The searches were compared in terms of sensitivity,precision, overlap between databases and inter-rater reliability.Results: The search retrieved 525 articles, of which 276 wererelevant. The four databases retrieved 55 per cent, 41 per cent,19 per cent and 1 per cent of the relevant articles respectively,achieving these sensitivities with precision levels of 54 percent, 48 per cent, 84 per cent and 94 per cent. The databasesretrieved 116, 73, 24 and 15 unique relevant articles respectively,showing the need to use a range of databases. Discussion: Ageneral approach to creating a search to retrieve relevant researchhas been developed. The development of an international, indexeddatabase dedicated to literature relevant to social servicesis a priority to enable progress in evidence-based policy andpractice in social work. Editors and researchers should considerusing structured abstracts in order to improve the retrievaland dissemination of research.     

Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

Summary The delivery of health and social care has undergone massivechange in the UK in the 1990s. A key factor in the drive forreform was the failure of joint working arrangements betweenhealth and social services and the need to provide integratedcare for people who have overlapping health and social careneeds. This article draws on a research study investigatingthe community care provided to people with Parkinson's diseasein the wake of the 1990 National Health Service and CommunityCare Act. As a chronic progressive disease predominantly affectingolder people, the management of Parkinson's provides an exemplarof some of the key features of supporting people with continuingcare needs. This study found serious deficits in the assessmentand meeting of need, arising from weaknesses at the health andsocial care interface. The article concludes by consideringan approach which resources and supports the service user/carerin managing their own care pathway.     

Slovenian Social Work: A Case Study of Unexpected Developments in the post-1990 Period

Correspondence to Dr Shulamit Ramon, London School of Economics, Department of Social Policy and Administration, Houghton Street, London WC2A 2AE. Summary The paper contextualizes Slovenian social work in terms of thepolitical, social, economic and cultural changes which Sloveniahas gone through recently. The frame-work of social work educationand services is then outlined. Two major examples of unexpectedinnovative social work projects are outlined and analysed. Theimplications of these examples to Slovenian social work practiceand theory are looked at in the conclusions.