The Referral Process: A Study of Working Relationships between Antenatal Clinic Nursing Staff and Hospital Social Workers and their impact on Asian Women

P. A. lles. Open Business School, Open University School of Management, Walton Hall, Milton Keynes MK7 6AA. Summary A Study of an intervention in a Bradford hospital antenatalclinic designed to improve working relationships between nursingstaff and hospital social workers is described. A statisticalanalysis indicated that referral rates from the antenatal clinicwere rather low, especially for women of Asian origin. Questionnaireand interview survey data established the importance of nursingstaff perceptions of both the social work role and of Asianwomen clinic users as important determinants of whether nursesmade a social work referral. Survey feedback to social workstaff led to the physical placement of a social worker at theclinic booking-in sessions, in order to improve working relationshipsbetween nurses and social workers and thereby hopefully improvereferral rates. This intervention was relatively unsuccessful,and this relative failure is related to the literature on interorganizationaldevelopment and inter-agency team building in order to identifyfactors which might make for success in inter-agency collaborativeprojects.     

Service users' knowledges and social work theory: conflict or collaboration?

Summary So far, service users have not been systematically involvedin social work theorizing. However, disabled peoples's movements,mental health service users/survivors and other service usershave developed their own knowledges based on direct experienceand they have generated their own conceptual frameworks andbodies of theory. There are fundamental problems in social workseeking to interpret service user knowledges. Their developmentsand interpretation require the direct involvement of serviceusers and their organization in social work theorizing. Thereare strong practical, philosophical and political argumentsfor involving the knowledges and theories of service users andtheir organizations in the process of social work theory-building.This paper considers an inclusive approach to social work theorizing.While highlighting the importance of service users and theirorganizations being effectively included in social work theorizing,it also argues the need for them to have support and opportunitiesto develop their own prior and separate discussions about theory,including social work theory.     

'Anti-oppressive practice': emancipation or appropriation?

Summary This article offers an initial critical discussion of the conceptof anti-oppressive practice - AOP - from the perspectives ofservice users. Whilst acknowledging the emancipatory aspirationsof anti-oppressive practice, it also considers its regressivepotential. AOP has become central in social work theory andpractice and indeed is sometimes presented as a key approachand theory of social work. This discussion highlights the failureso far significantly to involve service users and their organizationsin the development of anti-oppressive theory and practice. Itconsiders how the ideology and structures of anti-oppressivesocial work impact upon service users; the problems raised by'expert' appropriation of users' knowledges and experiencesand the issues raised by the failure so far to address the useof social work and social care services as an area of differenceand category of social division. Finally, the article examinesalternatives to existing notions of anti-oppressive practicebased on the equal involvement of service users.     

The mentor/monitor debate in criminal justice: 'what works' for offenders

Summary There is a move - which originated in England and Wales butis now infiltrating Scottish criminal justice policy and practice- towards increased managerialism and auditing within criminaljustice social work supervision and towards more formalizedand tenuous relationships between worker and service user. Itis suggested that this runs contrary to the needs and expectationsof offenders themselves, who rarely have the opportunity tocontribute their views on criminal justice social work or on'what works'. This article looks at the views of probationersand ex-prisoners about social work supervision both in Englandand Wales and Scotland. It describes one Scottish study, whereprobationers and parolees considered their 'ideal model' ofthe social worker to be someone who was proactive and constructive,offering encouragement and emotional support and acting, intheir eyes, more like a mentor than a monitor. The researchfindings demonstrate the need for offenders' views to be givenmore prominence in both policy and practice, not least in recognizingthe significance of factors other than behaviour in determiningeffective longer-term outcomes; in so doing, it also arguesfor a more balanced view of the role of criminal justice supervisionthat incorporates elements of both justice and welfare.     

Area Teams in Social Work Practice: A Programme for Research

Summary This paper critically examines assumptions underlying the beliefthat the organization of service delivery through a system ofarea teams has major advantages in the field of social work.It is generally felt that area teams are accompanied: (1) byimproved client access to service provision, (2) by a closeridentification with the local area on the part of social workers,(3) by decentralized organizational decision-making, and (4)by an increased sense of colleague support amongst professionalstaff. A review of some relevant literature casts doubt on thevalidity of these assumptions and reveals that the operationalacceptance of the area team principle has not been complementedby thorough investigations of organizational and other influenceson service delivery. In outline a programme of further researchis proposed. The paper attempts to broaden discussion on thissubject and place the basic philosophy of area teams for comparisonagainst a body of empirical research material.     

Applying a community needs profiling approach to tackling service user poverty

Summary Poverty across the United Kingdom is a growing phenomenon. Itsimpact on the users of social work services is well documented.This paper puts forward the argument that poverty is a legitimatepart of the social work agenda rather than being seen as a complexproblem which is somehow outside the scope of social work agenciesand best left to politicians and policy makers. Social workpractitioners and managers must not only begin to accept andacknowledge that poverty is a social work issue but also tobegin confronting this challenge in a changing society whereexclusion, social inequality, racism and oppression deny peopletheir citizenship. The community needs profiling approach is proposed as a usefultool in addressing service user poverty whereby practitionersand their agencies can become more aware of the needs of usersand the communities in which they live. It is argued that, armedwith this knowledge, social workers have the potential to becomepart of the solution rather than remaining on the margins ofthe lives of poor people. Using evidence and ideas drawn froma range of community needs profiling research studies and texts,the author offers working suggestions for applying the approach.     

Differing Conceptions of a Child's Needs: Some Implications for Social Work with West African Children and their Parents

Summary The 1975 Children Act implies an increased statutory involvementof local authority social workers with West African childrenwho are fostered, and with their parents. The Act gives a newurgency to the need for a greater understanding of West Africanculture if effective social work help is to be given and suchwork should help to prevent legal disputes concerning the custodyof these foster children. A general discussion of variablesthat influence child-training is followed by a more specificconsideration of West African and British approaches. Importantdifferences are noted and areas of possible misunderstandingindicated. The mediating role that the social worker could playin this cross-cultural fostering is emphasized. Attention isdrawn to limitations in our present knowledge and the need forfurther research is stressed. Not only would this have practicalvalue but, it is suggested, it could increase our knowledgeof socialization processes in general.     

Constructivism in Social Work: Towards a Participative Practice Viability

Summary Social work has traditionally drawn upon an expansive rangeof social science research and theorizing as its claim upona ‘knowledge base’. Recent debates have exploredthe need for the profession to develop its own theory of socialwork knowledge arising from practice. This paper seeks to extendthe boundaries of these ideas through an operational and epistemologicalelaboration and critique of Sheppard's (1995a; 1998) notionof a practice paradigm. In an examination of the contributionof constructivism and the seminal work of George Kelly's (1955)Psychology of Personal Constructs, arguments are put forwardfor social work practice to focus upon the co-construction ofviable working relationships with service users as the basisfor an anti-oppressive and participative professionalism. Itargues that the sterile philosophical dichotomies between objectivism/realism-subjectivism/interpretivismand the equally unhelpful social work division between practice-theoryshould be integrated within a situated, participatory, constructivistapproach to knowledge creation in social work practice and continuingprofessional development.     

Risk and Supervision: Social Work Responses to Referred User Problems

Correspondence to Peter Burke, Department of Social Work, University of Hull, Hull HU6 7RX Summary This study examines social work responses to users followingcase allocation of the initial referral. The aim of the studyis to demonstrate the need for supervision of social workersdealing with cases which have in common an inherent quality,described as ‘risk’. The study also links referralsto other practice responses identified as ‘service delivery’and ‘advisory’ work. The relationship between theseparticular responses is tested against the outcome decisionreached on case closure. All referrals were allocated betweentwo fieldwork teams over a one-year period and a total of 312referred cases was allocated within the categories mentioned.Findings are indicative that more ‘risk’ type referrals,however defined, are resolved with additional supervisory inputthan without, and that lower status workers favoured ‘middleground’ decisions of outcome when compared to their seniorcolleagues. A consideration resulting from this research isthat agency definitions of risk are different to the type ofrisk which requires crisis intervention. The question of riskto the user or to the agency requires the workers concernedto be able to discriminate between such cases. The implicationfor team training is that supervisory input should clarify thenature of risk, if any, and the task required of the workerfollowing case referral. The matching of skills which wouldultimately be the objective of this type of research cannotbe finally determined until a more comprehensive set of parametersfor practice is identified. This study shows that the responsecategories used demonstrate some basic supervisory needs ofthe worker.     

The Beckford Report: A Critical Appraisal

Correspondence to Nigel Parton, Department of Behavioural Sciences, The Polytechnic, Queensgate Huddersfield HDI 3DH. Summary This paper provides a critical analysis of the Beckford Reportand its implications for social work and the personal socialservices. Four interrelated themes are explored: the relationshipbetween social work practice, statutory responsibilities andthe law; the attitudes of social workers towards children andfamilies; the social work skills required; and the assumptionsthat are made about child abuse and the role of social workers.This is then related to recent research findings in the areaof policies and decision making in child care. It concludesby arguing that the report is in great danger of misdirectingour attentions from the major issues concerned with social workwith children at risk.     

The nature and culture of social work with children and families in long‐term casework: Findings from a qualitative longitudinal study

Social work in the United Kingdom is preoccupied with what social workers cannot do due to having limited time to spend with service users. Yet remarkably little research has examined what social workers actually do, especially in long‐term relationships. This paper draws from an ethnographic study of two social work departments in England that spent 15 months observing practice and organizational life. Our findings show that social work some of the time has a significant amount of involvement with some service users and the dominant view that relationship‐based practice is rarely achieved is in need of some revision. However, families at one research site received a much more substantial, reliable overall service due to the additional input of family support workers and having a stable workforce who had their own desks and were co‐located with managers in small team offices. This generated a much more supportive, reflective culture for social workers and service users than at the second site, a large open plan “hot‐desking” office. Drawing on relational, systemic, and complexity theories, the paper shows how the nature of what social workers do and culture of practice are shaped by the interaction between available services, office designs, and practitioners', managers', and service users' experiences of relating together.     

Abortion: With Particular Reference to the Developing Role of Counselling

Summary This paper suggests that counselling is a rapidly expandingfield in which professional and para-professional workers mightcombine to produce an effective service, given appropriate selectionand training procedures. Initially these are seen as being providedby professionally qualified social workers with relevant experience.The author has used her own social work experience in abortioncounselling to exemplify the article and to discuss some ofthe existing problems for workers and clients alike.     

No-one else could understand': Women's Experiences of a Support Group run by and for Mothers of Sexually Abused Children

Summary Previous studies have shown that when a woman finds out aboutthe sexual abuse of her children the consequences for her areserious and can represent a major life crisis. Women in thisposition frequently report a lack of professional understandingand support. The current study explores the experiences of women attendinga busy peer support group at the NSPCC in York. It demonstratesthe vital role that peer support can play. It traces a varietyof factors which mean that family, friends and social workersare not well placed to help. At the heart of these difficultiesare the powerful feelings of guilt and failure in their roleas mothers which the women experienced as a result of the sexualabuse of their children. For these women it was impossible toshare with social workers their doubts about their own abilitiesas mothers, particularly in a context in which those workerswere making judgements about their ‘ability to protect’.On the other hand the support group provided a safe and non-judgementalforum in which these powerful emotions could be expressed anddealt with. The study explores the role that social workerscan play in relation to such groups.     

Stress and Pressures in Mental Health Social Work: The Worker Speaks

Two-thirds of councils with social services responsibilities(CSSRs) took part in a UK survey of mental health social workers.A one in five sample of front line workers was drawn, and 237respondents completed a questionnaire and diary about theirwork context and content, and their attitudes to their work,their employer, mental health policy and the place of mentalhealth social work in modernized mental health services. Thequestions, that called for free-text responses, were completedin detail and at length. This paper reports the results of aqualitative analysis of these responses using NVIVO software.The paper is structured around the themes emerging from theanalysis: pressure of work; staffing matters; job satisfactionand well-being; recruitment and retention issues; and beingvalued. The conclusions are that the social workers value faceto face contact with service users, and that their commitmentto service users is an important factor in staff retention.The most unsatisfactory aspects of their work context arisefrom not feeling valued by their employers and wider society,and some of the most satisfactory from the support of colleaguesand supervisors. Without attention to these factors, recruitmentand retention problems will remain an unresolved issue.     

Social Work Values: The Moral Core of the Profession

Correspondence to Cynthia Bisman, Graduate School of Social Work and Social Research, Bryn Mawr, PA 19010, USA. E-mail: cbisman{at}ada.brynmawr.edu Summary This paper argues that an emphasis on the profession’sknowledge base has come at the expense of attention to socialwork's values and mission. The discussion examines the relativeimportance of knowledge, values and skills in an effort to understandthe shifting emphases of the profession within a social andhistorical context. The consequences of these shifts for theprofession and for its relationship to society are also considered.Concepts from the intellectual struggles of social work andfrom an interdisciplinary perspective suggest ways to groundthe profession’s skills and knowledge in its values ofhuman dignity, service to humanity and social justice. At itscore, social work must respond to the moral imperative of caringfor the neediest among us. This entails re-claiming and buildingon the commitment of early social workers ‘to work withforces that make for progress . . . to forward the advance ofthe . . . common people’ (Richmond, 1899, p. 151). Thepaper concludes that for social work to have a future, the professionmust take pride in its moral core, define its contemporary meaningand work for the social welfare in ways that are relevant toboth social workers and non-social workers.     

Applying for money The encounter between social workers and clients--A question of morality

Correspondence to Lars-Christer Hydén, Department of Social Work, Stockholm University, S-106 91 Stockholm, Sweden Summary The facts of household finances generally obtain their meaningfrom the moral standards of everyday life: it is in relationto these standards that we evaluate our personal finances. Personswho lack money and apply for social welfare compensation generallyhave to turn to a public social welfare bureau where their eligibilityis assessed by a professional social worker. The central questionfor the present study is how social workers and clients dealwith the morally delicate question of personal financial deficitsand how this question should be processed in a formal and institutionalsetting by formal means. This problem is discussed through ananalysis of conversations between social workers and clientsat social welfare bureaux in the municipality of Stockholm,Sweden. In pursuing a formal inquiry the social worker is conductinga moral search: the social worker has to determine the moralcharacter of the client and the circumstances around his/herhandling of his/her own financial situation. The ‘relevantcharacteristics of the citizen’ that the social workertries to match with the beneficiary rules are of a moral nature.In this respect, the social worker is not only a social workerbut also a moral worker. In order to define and defend his orher moral character the client has to pursue the financial issueas a moral issue. In the encounter, the client alludes to everydaycircumstances to account for his/her financial situation andto justify it by applying everyday moral standards.     

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.     

An Interview: Constructing Reality

Summary This paper is concerned with the relevance of interactionistperspectives in sociology to social work practice. Crucial tothese perspectives are the ‘meanings’ that peoplegive to situations and the ways they interpret actions. Basically,they are grounded on the assumption that there is no such thingas a single social reality. There are many different constructionswhich depend on the identities of the different people involvedand on the context in which they occur. The paper is based ontape recorded excerpts from an interview between a client, MrsSmith, and a social worker, from a discussion about some aspectsof that interview between the social worker and the writer,and from a discussion about the case between the team leaderand the writer. This material suggests different interpretationsof the situation, information gained in the discussion withthe social worker providing new ideas about the original interview.The views of the different people involved indicate that itis helpful to take into account the organizational context ofthe interviews. It is also suggested that conceiving of interviewsas ways of constructing reality has implications for the studyof social work practice.     

Narrating Love and Abuse in Intimate Relationships

via email: heather.fraser{at}rmit.edu.au Summary In this article, I use discourse analysis to explore the relationshipbetween love and abuse. I argue that Anglo-American social workhas been reticent to theorize love; and that when it does, theborders separating love from abuse are usually assumed to berelatively stable and readily apparent. After nominating someof the reasons for and repercussions of dichotomizing love andabuse, I suggest that knowledge about intimate abuse will expandif more attention is given to the study of love. I promote theuse of feminist discourses because they provide valuable insightsabout the operations of power in love relationships. Drawingideas from both structural feminism and post-structural feminism,I encourage social workers to move their analytical attentionback and forth between the micro-politics of intimate relationshipsto the wider cultural contexts within which they are staged.I conclude with the assertion that social workers will be betterplaced to understand the dilemmas that many ‘ordinary’women confront in their everyday lives, if they critically analysethe intersections of love and abuse.     

The Changing Nature and Context of Social Work Research

Summary Social work research is constantly diversifying and expandingand this article explores its changing nature; including changesto epistemology and practice; and the critical influence ofthe wider economic, political, theoretical and practice changesoccurring to social work itself. The author discusses a numberof issues facing social work research: the enduring conflictsof ways of knowing, doing and valuing social work research;the role of practitioners as researchers; and the challengeto empower service users as self-determining researchers.