For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Exploring drivers of demand for child protection services in an English local authority

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year. The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n = 25) from statutory services and Early Help. The findings identified a combination of long‐term and short‐term drivers of demand. Long‐term factors emphasized the impact of rising levels of deprivation combined with cuts to community‐based services for children and young people. Short‐term factors ranged from a more proactive approach to child neglect to more effective multi‐agency partnerships and joint decision making. The interaction between these factors was found to be accentuating an underlying shift to “late intervention” across the sector. The findings are contextualized in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection.     

Disadvantage and Discrimination Compounded: the experience of Pakistani and Bangladeshi parents of disabled children in the UK

This paper discusses a qualitative and quantitative study of the circumstances of 20 Pakistani and Bangladeshi families with one or more severely disabled children living in Birmingham, England. Parents and other adult carers were interviewed using a combination of structured questionnaires and a semi-structured interview schedule focusing on the families' material circumstances, their use of formal services, informal care arrangements, and aspects of the parents' social and psychological well-being. The study suggests that previous national surveys of disabled families may have under-estimated the extent of material disadvantage, while it confirms that health and social care professionals should not assume that Pakistani and Bangladeshi parents have recourse to high levels of extended family support. The combination of disadvantaged circumstances and difficulties in securing access to appropriate services, which are found for the majority of families with a disabled child, was particularly acute for these ethnic minority families, suggesting the additional dimension of institutional racism.     

Social work,poverty, and child welfare interventions

The relationship between children's material circumstances and child abuse and neglect raises a series of questions for policy, practice, and practitioners. Children and families in poverty are significantly more likely to be the subject of state intervention. This article, based on a unique mixed‐methods study of social work interventions and the influence of poverty, highlights a narrative from practitioners that argues that, as many poor families do not harm their children, it is stigmatizing to discuss a link between poverty and child abuse and neglect. The data reveal that poverty has become invisible in practice, in part justified by avoiding stigma but also because of a lack of up‐to‐date research knowledge and investment by some social workers in an “underclass” discourse. We argue, in light of the evidence that poverty is a contributory factor in the risk of harm, that it is vital that social work engages with the evidence and in critical reflection about intervening in the context of poverty. We identify the need for fresh approaches to the harms children and families face in order to support practices that engage confidently with the consequences of poverty and deprivation.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

Disability, Ethnicity and Childhood: a critical review of research

Whilst there is an increasing body of literature on the perspectives of carers of disabled children, there is little research giving the disabled child's perspective from either majority or minority populations. Indeed, the voices of black and Asian children in disability research have been almost silent. This literature review collates and analyses existing knowledge about the perceptions held by disabled and non-disabled children, and young people from black and Asian families concerning issues of disability and impairment. The Disability Movement has long proclaimed its belief in the full participation and self-representation of all disabled people. However, despite this laudable objective, the Disability Movement in Britain has mirrored society in general and for the most part been led by white, middle-class, heterosexual, articulate males. This review discusses the simultaneous oppression faced by black and Asian disabled children, and concludes that their experience is unique and different from that of white disabled children. Accordingly, it emphasises the need for further research about the subjective experience of black and Asian disabled children in order to meet their particular needs.     

Inequalities in English child protection practice under austerity: A universal challenge?

The role that area deprivation, family poverty, and austerity policies play in the demand for and supply of children's services has been a contested issue in England in recent years. These relationships have begun to be explored through the concept of inequalities in child welfare, in parallel to the established fields of inequalities in education and health. This article focuses on the relationship between economic inequality and out‐of‐home care and child protection interventions. The work scales up a pilot study in the West Midlands to an all‐England sample, representative of English regions and different levels of deprivation at a local authority (LA) level. The analysis evidences a strong relationship between deprivation and intervention rates and large inequalities between ethnic categories. There is further evidence of the inverse intervention law (Bywaters et al., 2015): For any given level of neighbourhood deprivation, higher rates of child welfare interventions are found in LAs that are less deprived overall. These patterns are taking place in the context of cuts in spending on English children's services between 2010–2011 and 2014–2015 that have been greatest in more deprived LAs. Implications for policy and practice to reduce such inequalities are suggested.     

A review of the relationship between poverty and child abuse and neglect: Insights from scoping reviews,systematic reviews and meta-analyses

An up-to-date and accurate picture of the evidence on the impact of poverty is a necessary element of the debate about the future direction of children's social care services internationally. The purpose of this paper is to update evidence about the relationship between poverty and child abuse and neglect (CAN) published since a previous report in 2016 (Bywaters et al., 2016). A systematic search was conducted, identifying seven reviews. Poverty was found to be consistently and strongly associated with maltreatment, be that in terms of familial or community-level poverty, or in terms of economic security. Findings demonstrated that both the type and the quantity of economic insecurities impacted child maltreatment. Certain economic insecurities – income losses, cumulative material hardship and housing hardship – reliably predicted future child maltreatment. Likewise, as families experienced more material hardship, the risk for maltreatment intensified. In some studies, the relationship between poverty and maltreatment differed by abuse type. Future reviews need to investigate individual papers and their findings across different CAN measures, definitions, samples, abuse types and conceptualisations of poverty to provide a comprehensive understanding of the current research base and the directions which need to be taken to further understand and prevent CAN.     

The Impact of New Labour Health Policy on Social Services: A New Deal for Service Users' Health?

Summary The health policies of the Labour Government of 1997–2001included an increased emphasis on social services departments'(SSDs) contribution to promoting health. Three dimensions ofthis policy shift are discussed: first, the drive towards organisationalfusion between elements of the NHS and SSDs; second, the newmechanisms for conjoint funding of health and social services;and, finally, the new policy focus on tackling health inequalitiesby combating social inequalities on a national and localitybasis. In each case, the touchstone of our analysis is the consequencesfor the health and well-being of SSD service users as membersof socially disadvantaged groups. We conclude that New Labourhas taken some steps, particularly reducing child poverty, whichwill have long lasting health and social benefits for actualand potential service users. However, inadequate funding ofSSDs undermines their effectiveness as a partner in integratedhealth and social care. As signalled by service user initiatives,SSDs potential for promoting more equal chances of health andwell-being in ill-health will also not be realised without substantialchanges to current SSD policy and practice.