Service users and carers’ involvement in social work education: lessons from an English case study

Within the larger context of the search to improve social work practice in Europe, this article presents a case study of a UK innovation in social work education with the potential to radically change social work practice. Following governmental requirements, Anglia Ruskin University has introduced systematic involvement of service users and carers in the training of a new undergraduate degree since September 2003. The conceptual and value base, the structure, staffing, and main activities are outlined; the main achievements and obstacles are highlighted. Mindful of the danger of slipping into tokenistic involvement, the project has included an action research evaluation component exploring the views of all the project's stakeholders thus establishing the project as an evidence-based educational innovation. The findings highlight the value of service users and carers’ involvement on the qualifying social work degree, of the action research design of the evaluation, and the steps needed for the cultural change required for such an involvement to become more comprehensive and embedded in the degree.     

City of One: A Qualitative Study Examining the Participation of Young People in Care in a Theatre and Music Initiative

Young people's engagement with the arts can facilitate skills development, improve mental health and strengthen resilience. This article reports on a qualitative study exploring the experiences and involvement of ten young people in care in the development of a musical play exploring life in the care system. The project was viewed as successful in a number of ways: involving young people who had not previously taken part in drama; developing skills, confidence and resilience, and improving feelings of social connectedness. Extending work on participatory arts approaches, this study identifies factors that influence young people's ability to maintain involvement and the implications for carers and professionals supporting them.     

Caring at a distance: Learning and practice issues

Emphasis on support for informal carers focuses on those who provide, in the words of the Carers (Recognition and Services) Act 1995, 'substantial' and 'regular' care. Following research and policy, professional education has also developed interest in those who live with the people they support, such as co-resident spouses and children of all ages. This article considers those who probably do not define themselves as carers and are usually referred to as 'relatives' or 'family', living at a distance from an older relative. It explores their possible need for support as well as the form and level of their involvement in relation to care managed services. It describes key areas or events to draw out practice issues and concludes with a discussion of the extent to which care management can work with such relatives. In many ways caring at a distance forces an examination of what is meant by 'care' and who can legitimately claim this as an emotion or status. The rationale for such interest is therefore three-fold. If social workers and social work educators restrict the meaning and their definitions of carers to those who provide 'hands on' services, as part of the care package, they risk alienating relatives from the learning experience of students. In doing so they may neglect these highly valued supports of older people and may leave relatives distressed and disempowered by anxiety over their contract with social work agencies.     

Hospital social work in Sweden and the UK: Access to chances of physical health and well-being

In Swedish and UK practice, interest is developing in social work's contribution to tackling service users' unequal chances and experience of physical health. This is through alleviating disadvantaged social conditions such as relative poverty which service users face and which are associated with health inequalities. Ready access to social work services is an essential preliminary if service users are to gain the material and social resources services can provide, to alleviate their adverse social circumstances and thereby improve their health prospects. However, despite hospital social work's well-established position, its significance as an access point for services has tended to be marginalized. Drawing on a comparative account of Swedish and UK practice featuring two action research projects, we explore how hospital social work is a key point of access to services for service users experiencing profound disadvantage. We analyse major barriers to such access, notably the underfunded nature of hospital social work, discriminatory procedures, and unequal professional service user power relations. Nevertheless, the action research projects show how these barriers may be breached to some degree, enabling service users as patients and carers to access resources which contribute to more equal chances of health and well-being in ill-health.     

Developing Responsive Preventative Practices: Key Messages from Children's and Families’ Experiences of the Children's Fund

As part of the prevention and social inclusion agenda, the Children's Fund, set up in 2000, has developed preventative services for children at risk of social exclusion. Drawing on a large qualitative dataset of interviews conducted in 2004/05 with children, young people and their parents/carers who accessed Children Fund services, this article analyses key practices and approaches valued by children and parents. These included: specialist support tailored to individual support needs, family‐oriented approaches, trusting relationships with service providers, multi‐agency approaches and sustainability of services. Finally, the article draws out key lessons for the future development of preventative services.     

Carer perspectives of factors affecting placement trajectories of children in out-of-home care

Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.     

Qualitative accounts of young-people,parents and staff involved with a purpose-designed,pilot short-break service for 18–24 year olds with life-limiting conditions

PurposeTransition to adult health and social-care services is a time of great uncertainty for young adults with life-limiting conditions; due to improved management, many who would have previously died before they were 18 years old are now surviving into early adulthood. Nevertheless, few services exist to meet their specific needs for specialist short breaks away from home. The purpose of this research was to determine the views and perspectives of young adults' parents/carers and staff engaged with a purpose-designed, pilot short-break service for 18–24 year olds with life-limiting conditions. Data were gathered through qualitative individual or focus group interviews involving two young adults, four mothers and fifteen health or social-care staff associated with the service. Data were analysed using Framework Analysis.Principal resultsEmergent themes: (i) The need for a specialist short-break service; (ii) Decision making when using or delivering the service; (iii) Challenges of staffing and financing the service (iv) Meeting young adults' complex needs and preferences (v) Suggestions for how to improve the service.The young adults described how they benefitted from access to specialist, age-appropriate, on-site clinical skills facilities and opportunities to socialise with peers. Mothers said they benefitted from time alone or with other family members in the knowledge that the specialist short break service met the needs and preferences of their child as they made the transition to adult services. However, all participating mothers and staff expressed concern about the future well-being of young adults when they left the service at 24 years old.Major conclusionsThis study provides new information to inform ongoing development of short-break services for the increasing number of young adults with life-limiting conditions who are surviving longer than they would previously have done. This will help to ensure that UK services are responsive to users' needs and preferences.     

Promises and Pitfalls: Involving Service Users and Carers in Social Work Manager Education

Partnership working occupies an increasing amount of social work managers' time and budget, requiring skills and abilities not always developed previously within social work programmes. Much discussion around partnership working centres on building collaborative inter-agency and inter-professional relationships with less emphasis on the need to ensure good working relationships with service users and carers, despite their being the ultimate recipients of the process. This article explores efforts to develop a focus on service users and carers within a module for social work managers as part of post-qualifying (PQ) social work education. It documents a process where, initially, service users and carers provided personal testimonies of being recipients of services and then subsequently occupied more authoritative roles within teaching, to the current position when they are again less actively involved.

In describing these developments it explores possible reasons why involving service users and carers within this module has proved challenging. The article acknowledges that there is relatively limited literature about the involvement of service users and carers in PQ education. It suggests that lessons learned from involving service users and carers in qualifying social work training cannot directly be transposed to the post-qualifying context.     

The intersection of employment and care: evidence from a UK case study

Working carers are a key focus of UK policies on health and social care and employment. Complementing national and European evidence, this paper presents a local case study of working carers. It draws on data from a county-wide survey containing a module on caring. Data were primarily categorical and were analysed using SPSS. Three quarters of all carers who responded to the survey were of working age: two thirds were employed and one third had been employed previously. The majority of working carers were mid-life extra-resident women. Over half of cared for relatives were elderly parents/in law; ‘physical illness’ was the primary cause of dependency. A tenth provided intensive care and half reported that caring adversely affected their health. Both were triggers for leaving employment. Two thirds of households received input from services and/or friends/family; being a co-resident carer appeared to mitigate against service allocation. Four issues were identified as pivotal to facilitating employment: access to advice and information, the availability of a matrix of affordable good-quality social-care services, ‘joined up’ needs assessment of the carer and cared for person, and employers identifying carers in their workforce. Europe's ageing profile underscores the study's timeliness.     

Health of Carers of Young People with Early Psychosis: A Biopsychosocial Approach

Despite widespread recognition of the usefulness of a biopsychosocial approach in social work, there are limited studies exploring how social workers can use this approach to support the health and wellbeing of carers of young people with first episode psychosis (FEP). Validated questionnaires and anthropometric measures were used to assess the physical health and wellbeing of 42 carers of young people with FEP. Carers had moderate levels of negative caregiving consequences, quality of life, and health status. More than half (52.4%) of carers were experiencing social isolation. Many carers were overweight (78.6%), had a high risk for type 2 diabetes (39.0%), and had hypertension (33.3%). Practical implications of a biopsychosocial approach to social work that supports both clients and their carers are discussed.     

Experiences of Young People with Harmful Sexual Behaviors in Services: A Qualitative Study

ABSTRACT

Young people are responsible for a significant number of the sexual offenses that are committed every year. These young people are generally referred to specialist services for treatment. This article explores the health characteristics and service experiences of 117 young people with sexual behavior problems, and the issues that services face when working with them. The study is based on analysis of 117 case files, identified from nine specialist services in the UK. The case files were thematically analyzed. Case files provided information on the following topics: the reasons why the young people were referred to harmful sexual behavior services; the young people’s personal characteristics; their medical and mental health problems; the young people’s interests and aspirations; their attitudes toward services and interventions; continued problematic sexual incidents in services; progress in services; and post-service experiences. Overall, the findings of the study indicate that these young people have a number of strengths, but often have problems across a range of personal and health domains. A number of them continue to remain sexually and generally violent in services, particularly in residential settings, which has risk management implications for staff.     

It's Good to Talk! A Multidimensional Qualitative Study of the Effectiveness of Emotional Literacy Work in Schools

This paper reports on a small‐scale research study evaluating the work of an emotional literacy project in the North West of England. The purpose of the evaluation was threefold: to assess the degree of success of the emotional literacy project in achieving its aims; to capture and disseminate learning of what works, with whom and in which context, when promoting emotional literacy; and to provide policy makers and practitioners within the LEA, and beyond, with research evidence upon which best practice can be delivered to children, young people and their families. A multi‐dimensional qualitative study was designed to explore the views of children, young people, parents/carers, headteachers, teachers, project workers and allied professionals regarding the emotional literacy project from their own perspective. The findings contribute to the growing body of research evidence on, and models of best practice in, promoting the emotional well being of children and young people. © 2006 The Authors(s).Journal compilation © 2006 National Children's Bureau     

Early multiple intervention: a view from On Track

On Track started life in 2000 as part of the Crime Reduction Programme in the Home Office, but was shifted to the Children and Young People's Unit less than a year later. This paper describes tensions that emerged during the first phase of the evaluation of this innovative programme, designed to provide interventions for four to twelve year olds at risk of becoming involved in crime. Analysis of interventions and multiple intervention is presented, together with reflections on the need for a different kind of evaluation and a more positive approach to services for children and young people.     

Leaving Special School: the next step and future aspirations

One of the most important changes within the life-course is the movement from 'childhood' to 'adulthood'. This takes place through many different dimensions of experience, for example, biological, legal, social, cultural, emotional and attitudinal. It is also important to recognise that the concepts, 'childhood' and 'adulthood' are ambiguous and hard to define [Jones, G. &; Wallace, C. (1992) Youth, Family and Citizenship (Buckingham, Open University Press); Coles, B. (1995) Youth and Social Policy: youth, citizenship and young carers (London, UCL Press)]. This is partly due to the fact that they are not static concepts, but are historically and culturally fluid, open to interpretation and change [Ward et al. (1991) The Transition to Adulthood of Young People with Recorded Special Education Needs, final report to The Scottish Office Education Department (Department of Education at the Universities of Edinburgh and Stirling); France, A. (1996) Youth and citizenship in the 1990s, Youth and Policy, 53, pp. 28-43]. Despite this conceptual ambiguity, the transition from 'child' to 'adult' status is viewed as an important achievement within society. However, it is a complex, involved process, which evolves over a period of time. Of course, not all-young people undertake the transition in a similar manner or at the same pace. Social ideas and prejudices, whether these are class, gender, race or disability based, can and do effect the transition experiences of different groups of young people. This paper focuses upon the transition experiences of disabled young people, a group frequently forgotten or hidden within discussions of 'youth'. In particular, it explores and evaluates traditional models of transition with the aid of data drawn from a study of disabled young people leaving special schools [Mitchell, W. (1998) Leaving School - transition experiences and routes taken by disabled young people, D.Phil. thesis, University of York]. The paper initially focuses upon young people's next educational/vocational step after school leaving in relation to the traditional ideal of a school to work transition. Taking a broader approach the paper then explores and begin to unpack the complex concept of a more independent 'adult' status from the perspective of the study's young people and their parents/carers. Have the young people taken steps towards a more 'adult' independent life and, if so, in 'what' areas and 'how'?     

Young people's views of children's rights and advocacy services: a case for ‘caring’ advocacy?

This paper looks at some preliminary findings from research with young people in foster and residential care in the UK who have received advocacy services from a range of local authority and voluntary agencies. The study also includes the views of professionals, from both children's rights and social services. The initial findings highlight the importance to young people of their relationship with rights professionals. They speak about the value to them of care and respect, aspects not always seen as fundamental to rights work. Caring, in its various guises is seen by young people as a vital component of their relationship with children's rights workers. They also see this as important within advocacy work itself since caring about the outcome is often key. A pure individual rights focus with an emphasis on challenge and ‘being heard’ may not take account of the complexity of their situation and may pose difficult dilemmas for young people, especially in dealings with their carers. This ‘caring’ advocacy is not the paternalistic approach of a professional who ‘knows what's best for you’ but is a model based on a strong awareness of ways that young people are excluded and oppressed. It is also about placing a positive value on their contribution as citizens and links to a view of society that gives importance to an ethic of inter‐relationship and care as well as an ethic of individual rights. Copyright © 2007 John Wiley & Sons, Ltd.     

Young Carers: Conventional or Exaggerated Levels of Involvement in Domestic and Caring Tasks?

Historically, research about young carers has focused on defining the tasks and responsibilities undertaken by children caring for ill or disabled family members and the impacts of such care, without reference to the domestic and caring work undertaken by children and young people in families where there are only non‐disabled or well members. This study presents new evidence of what children and young people generally do to assist in the home and examines how the lives of young carers differ from children and young people who are not carers. It concludes by examining the implications of these research findings for evidence‐informed policy and practice. Copyright © 2006 The Author(s). Journal compilation © 2006 National Children's Bureau.     

ADAPTING THE MODEL: THERAPEUTIC WORK WITH CHILDREN FROM ARMY FAMILIES

This paper describes the development of a specialised therapeutic service for parents and their young children in an inner city social services family centre. The Under five's counselling service, based on the Tavistock Model, offers brief psychoanalytic interventions to parents who are worried about their young child's development e.g. crying, eating, persistent crying etc. The premise behind setting up such a service was to provide therapeutic intervention to the parent-child relationship at the earliest possible stage, preventing further ongoing difficulties. The paper draws upon observations and interventions with families I have seen in the first year the service was opened. Particular themes which emerged in the work with these families will be highlighted. In particular a link is made between early childhood difficulties and unresolved loss in the mother's lives. Furthermore, the impact of the service upon the rest of the social services family support services is commented upon.     

A menu for learning: a World Café approach for user involvement and inter-professional learning on mental health

Inter-professional learning (IPL) initiatives and service user involvement are well established in professional education programmes, but are seldom incorporated in the same teaching and learning project. In order to accomplish a combination of these approaches, an interactive learning format, styled as a World Café on mental health, was chosen to bring social work and mental health nursing students together with service users and carers. The project aimed to be participatory and inclusive from the outset, establishing a steering group with staff, students and user/carer volunteers to plan the day-long event. The event enabled all participants to engage in round table conversations to learn from each other's outlooks and roles, and for students to reflect on their future inter-professional practice and engagement with service users. Findings from this project indicate that the World Café as a teaching and learning method may have much to offer students engaged in IPL activities. We believe that the findings from this project can contribute to the advancement of existing knowledge regarding IPL and user involvement, and that a World Café approach may serve as a template for replication for other education providers, as part of a wider repertoire of inter-professional and service user involvement initiatives.     

Children with disabilities in out-of-home care: Perspectives on organisational collaborations

Many contemporary support services for children and young people (CYP) in out-of-home-care have adopted a collaborative approach to service provision in order to best meet the complex needs of clients. The purpose of this study was to gain a better understanding of the perceptions of Evolve Behaviour Support Services (EBSS) frontline and managerial staff delivering services to CYP in out-of-home-care with disability and complex behaviours regarding interagency/stakeholder collaboration. Views about the number and nature of collaborative partnerships, factors which facilitate or hinder effective relationships and advantages (including unintended benefits) of collaboration were sought. Qualitative interviews with 21 participants highlighted issues around: (1) general and agency/stakeholder specific issues and barriers, and (2) benefits of collaboration. The collaborative approach to service provision was seen as greatly enhancing the effectiveness of EBSS' response and ability to meet the range of CYP's complex needs, as well as having benefits for carers and service providers. Nevertheless, difficulties with collaboration were also encountered. Frequently identified challenges included reduced stakeholder engagement, differences in professional backgrounds and practice frameworks, unequal initiation of contact and follow-up, organisational disparities, communication and information sharing problems, frequent stakeholder turnover and geographical barriers in rural/remote areas.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.