Social Workers' Implementation of Client Participation: What Factors Make the Difference?

ABSTRACT

Client participation is both a value and a strategy in social work, involving clients in decisions influencing their lives. Nevertheless, the factors encouraging its use by social workers in social services have received little research attention. This article reports on a study drawing on Goal Commitment Theory to examine, for the first time, four categories of variables that might predict its implementation: background variables (intervention method, age, experience, education, supervision); personal resources (self-esteem, mastery); organizational variables (superiors' support, organizational commitment); and situational factors (previous client participation, perception of client participation).

A sample of 661 Israeli social workers completed questionnaires. Hierarchical regression analysis and t-tests revealed that intervention method, mastery, superiors' support, and both situational variables contributed significantly to explaining the variance in client participation. Moreover, social workers valued client participation significantly more than they used it. The implications for researchers and professionals in social services are discussed. Proper training could increase social workers' awareness of client participation and provide tools for implementation. Policy makers should set standards for its use and evaluation, and require its inclusion in all interventions. Further research investigating clients and managers of social services could provide a broader picture of the factors impacting client participation.     

A Client Satisfaction Measure of Homecare Services for Older Adults

Client satisfaction can be used as an indicator for service quality. Without concrete feedback from clients, however, the usefulness of client satisfaction data for service improvement can be limited. This study described the development of a client satisfaction measure that can be used to provide concrete feedback for service providers. Based on a conceptual framework proposed in the literature, the Client Satisfaction: Home Care (CSAT-HC) uses a client-centered perspective to measure client satisfaction for homecare services for older adults. A survey of 200 older adults receiving homecare services provided by a social service agency in a large U.S. Midwest city was conducted to assess the psychometric properties of CSAT-HC. Results based on the 156 completed surveys show that CSAT-HC has good validity (correlation r = .62 with a popular client satisfaction measure) and test-retest reliability (r = .75). These results indicate that CSAT-HC is a valid and reliable client satisfaction measure; and therefore, providers of homecare services for older adults can use CSAT-HC to obtain client feedback for quality assurance or program evaluation purpose. Future research may use CSAT-HC to explore the potential influences of quality of homecare services on the well-being of older adult clients.     

The Social Therapeutic Club

In the mental health field, it can be said that a com- munity based social recreation program functions well as a collecti- vity. Structured as a large, open ended entity, it allows for flexibility in all facets of its organization. The client population served ac- counts for a large diversity in developmental and emotional needs. The structure of the programming accomodates this diversity, while clients' interests and specific skills are reflected by their input. In creating a supportive environment for social interaction, the pro- gram enables clients to develop group identity which reduces their isolation. Thus, this collectivity provides clients with the potential to improve their interpersonal skills and develop self-confidence.     

Professionals Assessing Clients' Needs and Eligibility for Electric Scooters in the Netherlands: Both Gatekeepers and Clients' Advocates

Independence and maintaining social contact are important factorsof elderly persons’ quality of life. An electric scootermay support people with mobility problems to achieve these goals.In the Netherlands, needs assessors have been appointed to evaluateclients’ eligibility for electric scooters. They haveto cope with a twofold job assignment: allocating services toonly those clients who are eligible according to predeterminedcriteria, but also acting in their client’s best interest,for the system of needs assessment should be client oriented.This paper examines how needs assessors apply eligibility criteriaand act in the client’s interest at the same time. A qualitativestudy was performed, observing twelve house calls of clientsrequesting an electric scooter. Interviews were held with needsassessors and a document analysis was made. We found that needsassessors used their discretionary room to create their ownpolicy regarding who deserves an electric scooter and who doesnot. They did this by concealing or emphasizing certain information.Especially when needs assessors sympathized with their clients,they did their best to sustain the case. The paper concludeswith the suggestion that needs assessors would benefit fromdiscussing their personal values, not only to agree on theirnorms as a professional group but also to avoid illegitimatearguments influence the decision. Furthermore, needs assessorshould try to influence local social policy, gearing it towardsthe needs of the local community.     

Utilizing a Required Documentation Course to Improve the Recording Skills of Undergraduate Social Work Students

ABSTRACT

Baccalaureate social workers respond to documentation and record-keeping demands of regulatory organizations that oversee or fund social service agencies. Learning to accurately document client needs, progress, and service delivery outcomes is important in ensuring that clients are receiving effective services. Despite the importance of documentation skills, many undergraduate social work programs do not provide sufficient curriculum content on client record keeping. The authors report the results of a study that examined changes in baccalaureate social work students’ perceptions of their documentation skills after completing a required documentation course. The sample size included 101 students at pretest and 97 students completing the post-test. Statistically significant findings show students perceived an increase in knowledge in three areas of documentation: 1) formats, 2) content, and 3) writing skills. The authors discuss implications for social work education and practice.     

The effect of characteristics of human service workers on subsequent morale and turnover

The authors examine the relationship of sociopsychological characteristics of human services workers to their subsequent morale and continuance on the job. Eighty-two intensive case managers (half of them social workers) who had caseloads of clients with severe mental disorders were invited to participate in a four-wave panel study. Explored are the relationships between 16 predictors (general background, prior work experience and training, and social psychological variables) and worker outcomes (beliefs, attitudes, perceptions, and turnover). The major finding was that better personal well-being at the time of hiring was the most consistent and significant predictor of lower burnout, higher job satisfaction, and generally higher worker morale at later points in time. Those from higher social class backgrounds and those with lower starting salaries were more likely to leave the job. Those workers with more experience had a tendency to perceive greater client improvement.     

Implications of Male and Female Same-Gender Dyads

ABSTRACT

A sample of 222 Swedish social services officers were surveyed in regard to their opinions on a fictitious case addressing the needs of a same-gender client. The 49-question survey was statistically analyzed through a comparison of female and male same-gender dyads. The findings suggest that gender is an important factor in assessment, and this seems to be influenced by the gender of the client, the gender of the assessor, and how the problem area or situation of the client is “gendered.” Also, same-gender dyads tend to strengthen stereotypical expectations of men and women as clients and influence what forms of assistance are offered to the client. The male same-gender dyad tends to reduce the likelihood of assistance being offered, while the female same-gender dyad increased it. These results suggest that assessments are based upon stereotypical beliefs about men and women rather than being focused directly on individual differences and needs. Further research is recommended that incorporates a number of more refined “gendered” problem areas and situations and how these assessments can affect social work practice.     

Gerontological Social Workers' Perceived Efficacy for Influencing Client Outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure–process–outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R ² = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Academic Affiliations of Social Work Journal Article Authors from 1999–2003

Abstract

The academic affiliations of the authors of all articles published between 1999 and 2003 in six major social work journals were tabulated to produce a ranking of the colleges and universities whose faculty made the most substantive contributions to the social work literature. The results of this analysis are compared with findings of four identical, previously published studies, which cover the five-year periods of 197–1983, 1984–1988, 1989–1993, and 1994–1998. The limitations of this method of analysis are discussed, as are its merits.     

Quality function deployment for developing a customized social medical service

This article describes the use of quality function deployment in orienting clinical social medicine to a quasi-market situation. The study shows that different customers had different requirements. For example, the social welfare office asked for close investigation followed by treatment in which time was not a critical factor, whereas the social insurance office asked for rapid and superficial investigations of a client's ability to work. General needs for improving the provision of information were identified, both for clients and the type of services that could be provided. The conclusion is that quality function deployment can be used as a method of defining and developing social services. However, a strict accommodation of the demands from the quasi-market would lead to contradictions with the theories used today as the basis for sociomedical services.     

Implementation of Active User Principle: Learning from the Czech Social Services Reform

ABSTRACT

The active user principle introduced in Czech social services by the new Act on Social Services (2007) was expected to induce change of the prevalent paternalistic nature of social service provision. This study examines the relationship between clients and social service workers in social service facilities designed for people without shelter. From 2001 to 2008, instrumental case studies were examined from three different shelter facilities using qualitative interviews (with 17 members of staff) and document analysis. The findings indicated that neither the frontline workers nor the managers could always understand how to implement this principle. Response patterns and the effect it had on recipients are examined. These findings imply that such a profound change needs to be supported with proper explanation, professional training, and practical application skills. Directions for further application and future research are suggested.     

A Comparative Study of the Management of Cases of Deliberate Self-Harm in a District General Hospital

Correspondence to Michael Bateson, Senior Psychiatric Social Worker, Lancaster Moor Hospital, Lancaster, Lanes. Summary A controlled study was undertaken of two services assessingand managing cases of deliberate self-harm admitted to a casualtydepartment. The first service featured psychiatrists only andthe second included psychiatric social workers as well as psychiatrists. A combination of standardized instruments, a structured questionnaire,a twelve month diary and medical and social work files wereused to collect information. Demographic factors, repetitionrates, types of help offered, client satisfaction, social circumstancesand general health were investigated. Few significant differences were found to have existed betweenthe client populations of the two services at initial assessment.Also, there were no apparent differences in factors interveningbetween initial assessment and follow-up. However, the analysisof outcome measures indicates that clients benefited substantiallyfrom the addition of a psychiatric social worker in the followingareas: help offered, client satisfaction, social circumstancesand general health. These results are discussed.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Community-Based Disability Prevention Programs for Elders: Predictors of Progam Completion

Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. Program completion remains an important barrier to their effectiveness. We examined the association between provider relationships and client variables, and program completion in senior centers. Our mixed methods design used secondary data for 719 clients and primary data through telephone interviews with 20 nurses, 23 social workers, and 18 site managers. Quantitative data showed that higher client baseline self-efficacy positively influenced completion and minority status negatively influenced completion. Qualitative data showed that higher focus on provider-client relationships was associated with high completion.     

Gerontological social workers' perceived efficacy for influencing client outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure-process-outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R (2) = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Reciprocity and Affection

This paper provides a view of the creation of social services to meet the needs of the elderly since the turn of the century. The framework herein reveals that the development of the social worker's role in dealing with the elderly remains historically consistent. Differentiations within the profession since 1900 have not affected services to the elderly as they have other client groups. Furthermore, social policies designed to provide services to the elderly have not met their needs.     

A comparative cost analysis of alternative models of adult day care

An analysis of the component costs of adult day care (ADC) programs in the Commonwealth of Pennsylvania indicates widely varying experiences in terms of fiscal and contractual administrative arrangements. Medical model ADC, program-funded services, and those agencies performing their own client assessments reported higher client per diems than the social model, slot-funded, and non-ADC assessed programs. For-profits displayed cost characteristics similar to their not-for-profit counterparts. Medical and slot-funded programs more frequently turned to multiple sources for budget supplementation. All program types tended to depend on voluntary client contribution methods as compared to means-tested approaches when determining fee-for-service.     

Agency-Family Partnerships

This paper describes a research and demonstration project in which partnerships are formed between agency social workers and family members of elderly clients. While the social worker retains responsibility for counseling and provision of support to the elderly client, the family member is taught by the social worker to assume responsibility for the case management of services provided to his/her elderly relative. Practice issues which have emerged during the first year of this three-year project include: the generalizability of findings in light of the special characteristics of agency clients, the definition of the agency-family partnership, confidentiality in the context of this partnership, exceptions to family involvement, clients without families, and our experiences with research-practice collaboration. Each of these issues is discussed in this paper.     

Client Experiences of Trauma-Informed Care in Social Service Agencies

This paper describes a qualitative study of individual client interviews (n?=?26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot and Harris framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n?=?4), substance abuse (n?=?8), older adults (n?=?12), and maternal/child health (n?=?2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients’ experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of trauma-informed policies on client experiences of each TIC domain.