The Probable Extent of Minor Mental Illness in the Adult Clients of Social Workers: A Research Note

Summary A small scale pilot study was conducted in two area teams andfour part-time GP attachment schemes to test the use of a psychiatricscreening instrument (GHQ28) and social assessments. The instrumentswere administered at case allocation and again at three months.Few clinical and social changes were observed in the short term.It was found that 27 out of 40 cases (68%) were identified bythe psychiatric screening instruments as probable cases of minordisorder, on both occasions, and that a further seven clientscould have had a transient disturbance. On the basis of theseresults it was felt that a larger two-stage enquiry was warranted,and necessary, before definite conclusions could be drawn.     

Social Work as an Aspect of Primary Health Care: The Social Workers' View

Summary This study is based on an analysis of social workers' viewsof their work with 168 clients referred over a six month periodin 1977 in a health centre setting. A wide range of referralswas made and there was close collaboration with other primaryhealth care professionals as well as outside agencies. Far morepsycho-social problems were encountered by the social workersin the course of their intervention than were apparent on referral,although most of the work was short term. Social work with theindividual predominated and a variety of traditional socialwork skills were employed, although the elderly received relativelylittle help with emotional problems and were offered mainlypractical help. Social workers' perceptions of their clientsare discussed in relation to their choice of methods of interventionand feelings of efficacy. The attachment scheme emerges as generallyfruitful both in terms of social workers' job satisfaction andclients benefitting from a multi-disciplinary approach; howeverthe need for closer inter-professional collaboration in meetingthe needs of the elderly is highlighted.     

Important Yet Ignored: Problems of 'Expertise' in Emergency Duty Social Work

Summary This paper deals with the important role that emergency dutyworkers play in respect of the variety of situations that arereferred to them outside of the normal working hours of socialservices departments. The first section presents some interimoutcomes of ongoing research suggesting that the variabilityof priorities and assessments made by such workers is even greaterthan might be intuitively expected. The paper questions whetherconventional expectations of social work assessment are applicablein circumstances that are radically different from day-timework. In the second section, the paper explores the evidentmoral dilemmas contained in these circumstances, highlightingthe need for workers to have internalized as ‘expert’as broad a grasp as possible of the diversity of values andmethods of social assessment, decision-making and intervention.The paper continues by considering the nature of expert methodssuitable for the demands of emergency duty work, the need forguidelines for professional judgement, and an appropriate genericframework.     

The Limits of Radical Social Work

Summary Doubts raised by research evaluation of traditional caseworkhave been increased by the perception by radical social workersthat some clients' difficulties derive from their involvementwith state machinery rather than personal capacity or circumstances,and that many can be helped by working collectively with othersin their community rather than striving alone in a dependentrelationship with a caseworker. Radical aspirations, however,assume that all clients have the capacity to overcome theirdifficulties and that none are so damaged as to be able realisticallybarely to cope with them. The radicals' doubts about the usefulnessof individual support and emphasis on collective self help raisethe danger of neglecting those who are unable to participateeffectively and gain from such efforts.     

'Don't shake the baby': towards a prevention strategy

Summary This paper reports on the findings of a study on the extentto which carers felt like shaking, and shook, their babies andyoung children and the circumstances surrounding the feelingsand/or actions of shaking. The research was designed to informa 'Don't Shake Your Baby' campaign planned by the preventionsub-committee of the London Borough of Newham's Area Child ProtectionCommittee. The main findings from interviews with 83 mothers,and self-completion questionnaires completed by 152 secondaryschool students, are discussed. Recommendations for a preventionprogramme are suggested in light of the findings.     

Tracing the Causes of Stress in Families with Handicapped Children

Summary Variations in the level of stress in mothers with very severelydisabled children do not appear to be associated with the characteristicsof the disabled child or the social and economic circumstancesof the family. The level of stress in a sample of mothers didnot change after they had received help from the Family Fund.     

Delinquency and the Family

Summary A standardized procedure based upon current social work practicewas used to assess the family circumstances of a randomly drawnsample of Tower Hamlets families with son/s between 11 and 14years of age. These families were compared to those of localboys of the same age before the Courts for a first time. Two-thirdsof the officially delinquent boys came from ordinary families,intact and without serious problems. However, compared to theofficially non-delinquents in the random sample they were significantlymore likely to come from broken homes or unbroken (intact) butwith serious and persistent problems. The differences are notdue to neighbourhood or school factors that appear to a considerableextent to operate independently of family factors. Few firstCourt appearances in Tower Hamlets are explained by boys reactingto serious family stress. Follow up over two years of the delinquentsshowed that just under one-quarter of the boys from ordinaryfamilies became persistent offenders. Just over one-third ofthose from difficult family circumstances reappeared. These findings are discussed in the light of other researchand current social work practice.     

Toward a Theoretical Framework for Perinatal Bereavement

Correspondence to Dr Keith Brownlee, School of Social Work, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, P7B 5E1 CANADA. E-mail: keith.brownlee{at}lakeheadu.ca or oikonenj{at}imail.tbh.net Summary For many women a foetal or neonatal death is a significant life-alteringevent. Modern medicine has offered pregnant women an early awarenessof their developing foetus coupled with an opportunity for advancedfeelings of attachment, which, in most cases, accentuates thegrief and sense of loss. While crisis intervention serviceshave become standard practice in hospital settings and typicallymeet many clinical and short-term needs of bereaved parents,conventionally held theories of grief fall short of the realitiesdescribed by such parents. This paper critically examines theclinical and research support for current approaches to perinatalgrief and argues that theory development specific to perinatalloss is needed within the field and that social workers canplay an important role in this respect. Some emerging ideasare discussed that appear to hold promise for establishing modelsthat would be more responsive to the particular complexitiesof perinatal bereavement.     

Attachment and Child Abuse

Summary Defects in the bonds of attachment between parent and childare put forward as a precursor in cases of child abuse and neglect.It is suggested that therapeutic work with such families shouldbe focussed on the re-establishment or strengthening of thesebonds, if they are found to exist. Ways of determining theirexistence and building upon them are discussed. It is suggested that, with the safeguard of a regular and intensivecontact with the family, separation can often be avoided. Thisallows an immediate start on the basic task of strengtheningthe bond, and avoids weakening it still further as a resultof separation. A case example is given.     

The Supply of Foster Families for Children in Care

Correspondence to John Miles, Institute of Social and Applied Psychology, The University, Canterbury, Kent CT2 7LZ. Summary The family circumstances of 2694 foster homes in England arecompared with representative families from the 1985 GeneralHousehold Survey. Foster families typically include a womanin the 31–55 age group, live in homes with three or morebedrooms, are two parent families with one parent working full-timeand the other not, and they have older children only. The incidenceof families with these characteristics is used to develop anestimator of the relative supply position of local authorityareas for foster care, from which a number of conclusions aredrawn. Over the last thirty years some social changes have improvedthe supply, others decreased it, and on balance the nationalsupply position is little changed. Ironically, supply is bestin those areas which have the lowest need for fostering services.Ways in which local authorities can improve their supply positionare considered. The supply estimator reveals that the averageboarding out payments made by authorities show clear signs ofresponsiveness to the local supply position for foster families.     

The Death of a Child

Summary The death of a child is an intrinsically tragic event for theparents of that child. What might appear as abnormal grief inbereaved parents can often be understood in the context of thepreceding circumstances of their lives and that of the child.This paper examines guilt and anger as experienced by a bereavedcouple in relation to the sudden death of their mongol son;the inability of another couple to detach themselves from theirbaby who had suffered a cot death; and the effects on bereavedparents of the denial of death in modern society.     

The Significance of the Early Stage of Illness as a Focus for Social Work Help

Summary This paper considers the experience of illness as a series ofinterrelated phases, in which the beginning phase which is thetransition from health to illness is shown to have special significance.The common responses to this stage of illness are denial, welcomeor inertia, each of which may give some forewarning of problemsthat may be encountered later in the illness. Traditionallysocial work help has focused onto the acute or convalescentstages, but it is suggested here that the beginning phase ofillness offers a rewarding point for intervention, not onlywhen opening new cases, but also among clients who are alreadyknown and where health problems may interact with other problems.The implications of this are explored both for agency policyas well as an added dimension of diagnostic understanding ofindividual clients no matter what the agency     

An Examination of the Determinants of Positive Outcome in Child Guidance Social Work

Summary A sample of 50 cases carried by four Child Guidance Social Workerswere monitored over a period of three months and their outcomesassessed from the standpoint of four different assessors; practitioners;researchers; clients; and referring agents. These assessementsof outcome were compared and analyzed in an attempt to identifywhat factors contributed to those interventions evaluated ashaving a positive outcome. The study revealed high levels ofinter-rater agreement with respect to assessment of outcomeand certain factors emerged as contributing to positive outcomeincluding aspects of the problems and children referred andaspects of the interaction between worker and client. Attentionis drawn to the implications of these findings for practice.     

Organization Development: a Group Centred Approach to Improving the Effectiveness of After-care Hostels

Summary This paper describes an approach to improving the effectivenessof voluntary hostels in which (a) the target for change is theentire management group of the hostel, (b) the content of therelationship between the management group and the consultantis real work problems and (c) the method of achieving changeactively involves members of the management group in the identificationand diagnosis of problem areas and in the development of strategiesto improve the situation. The aim of this approach is to encouragethe management group to take the initiative and manage ratherthan drift along and react to new circumstances as they arise.     

Child Sexual Abuse Allegations in the Context of Divorce: Issues for Mothers

Correspondence to Catherine Humphreys, Department of Applied Social Studies, University of Warwick, Coventry, CV4 7AL Summary The investigation and assessment of allegations of child sexualabuse constitute a difficult and contentious area for practitionersinvolved in this process. When these allegations emerge in thecontext of divorce, the problems of assessment appear to becompounded. This paper argues that when mothers raise concernsabout child sexual abuse during divorce proceedings these areoften construed as vindictive or misguided. Such constructionsof mothers have significant implications for the protection,or lack of protection of children in these circumstances. Theway in which this ‘knowledge’ about mothers hasdeveloped is explored and held up against the results of empiricalstudies which show that there is little basis for this constructionof mothers. Possible explanations for this incongruity are suggestedwith a view to progressing child protection in this area. As the court cases go on I can see the hopelessness of the wholething. It's getting stronger in me to want to take the law intomy own hands. I wouldn't say it's revenge, it's not ... I meana mother protects its young. You wouldn't see a lioness lettingsomething attack its young. (A mother expressing her desperation that the Family Court ofAustralia has ordered her to send her child on visits to herex-husband who she believes sexually abused their child.)     

An Evaluation of Family-based Intervention with Schizophrenia Using Single-system Research

Correspondence to Dr K. J. Bentley, Assistant Professor, School of Social Work, Virginia Commonwealth University, 1001 West Franklin Street, Richmond, V A 23284-2027, USA. Summary The purpose of this study was to determine the effects of ashort-term model of intervention on schizophrenic out-pattentsand their relatives. The author implemented an in-home ten sessioneducational and skills training programme adapted from existingmodels. The intervention's effects on patient's clinical statusand social functioning, relative's attitudes, and family stresswere evaluated using a multiple baseline acroos four cases,as well as pre, post, and follow-up data.     

The Problems of Managing the Family Contacts of Children in Residential Care

Summary The study explores the problems of managing the family contactsof children in residential care. It focuses on the family linksexperienced by two children undergoing a two month long periodof observation and assessment. It is seen that the family linksof these children take a low priority, particularly as socialwork plans change and the informal world of the institutionbecomes pervasive. The outcomes of the two cases are charted.     

Eligibility Criteria for Cash Assistance for Older and Disabled People in Hungary: A Model for Countries in Passage from a Planned to a Market Economy

Correspondence to Ruth Landau, Paul Baerwald School of Social Work, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel. Summary The political and economic changes presently taking place inthe Central and Eastern European countries are accompanied byprofound social changes for which, in terms of personal well-being,older and disabled people pay the highest price. Having lostthe security of a minimum standard of living, many are exposedto poverty in its broadest sense. The collapse of governmentalarrangements to provide for the minimum needs of this populationled to the establishment of non-governmental voluntary socialagencies. Unfortunately, these are characterized by limitedresources on the one hand, and lack of trained and skilled socialwork staff on the other. Based on the experience of a Hungariannon-governmental social agency, a model for eligibility criteriafor cash assistance under these circumstances, taking vulnerabilityas a key concept, is suggested for the benefit and dignity ofthose most in need.     

Assessing Child Protection Risk

Correspondence to Lorraine Waterhouse, Lecturer, Edinburgh Centre for Social Welfare Research, 23 Buccleuch Place, Edinburgh EH8 9LN. Summary The article outlines a set of child protection criteria usedby social workers for the evaluation of risk in sexual abusecases. The criteria were distilled from research findings basedon a sample of 51 child sexual abuse cases drawn from ChildProtection Registers in Scotland in 1987/89. Criteria dividebetween two types: primary (child care) criteria which concentrateon assessing circumstances prevailing within the family home;and secondary (disclosure) criteria which serve to either substantiateor refute disclosure. Primary criteria include attitude of non-abusingparent to alleged perpetrator; access between referred childand alleged perpetrator; type of abuse; age of child or youngperson; attitude of alleged perpetrator to allegations; andparental attitude to social work investigation. Secondary criteriainclude belief or disbelief of child; psychological symptomsin child; physical signs of abuse; children's attitudes towardsremaining at home; and criminal or psychiatric history includingalcohol or drug abuse. In practice the criteria tend to be usedlike a set of building blocks: tall towers represent higherrisk; low towers lesser risk. Given the enormous stakes involvedin child protection decisions, front-line practitioners wereunder considerable pressure to ‘play it safe’.