The Need for Social Work Intervention: A Discussion Paper for the Scottish 21st Century Social Work Review

EXECUTIVE SUMMARY

1 - DEFINING TERMS

1.1 - In June 2004, the Scottish Minister for Education and Young People announced a fundamental review of social work in the 21 ^st Century. The aim was 'to be clear with the profession what we expect of them and allow them to strengthen their contribution in the modern era'. The Deputy Minister subsequently defined three key issues for the Review. 'What is the core purpose of social work in modern Scotland? …….How can we best deliver services?………Essential services must have clear lines of accountability'. As part of the Review, the Scottish Executive commissioned a discussion paper on 'the need for social work intervention'.

NEED

1.2 - This apparently simple remit contains a variety of strands, and the paper cannot do justice to them all. To consider 'need', it is necessary to define some criteria. As the Deputy Minister said of social work's core purpose, 'Is it care and welfare of individuals? Is it protection of vulnerable people, whatever their vulnerability? Is it promotion of social inclusion? Is it about enabling people to fulfil their potential and make the most of their talents? I think that social work might be about some or all of those things, but we have to set out our priorities.' Accounts from people using services, discussions with a range of stakeholders and examination of policy documents reveal a variety of perspectives on when and why there might be a need for social work. Sometimes these perspectives differ or even conflict.

1.3 - There are questions about whose need is met by social work intervention. Is it a person's or family's need for support, protection or access to a service? Is it the state's need for acceptable ways of safeguarding vulnerable people and rationing scarce resources? Is it the public's need for a welfare system which is also a means of exercising social control? These and the other considerations below also influence another aspect of need, the questions of volume, supply and demand. How many social workers will be required to meet the emerging and changing patterns of need in the 21 ^st Century?

SOCIAL WORK

1.4 - There are also different views on how 'social work' is and should be defined. Observing that the Scottish social work legislation dates back to the 60s, the Minister commented: 'Expectations are very different in the 21 ^st Century'. The Executive commissioned a literature review and established a sub-group to examine and report on the social work role, and this paper has tried to avoid duplicating that work. It is necessary however to take a view about what social work is and what contribution it can make to improving people's quality of life and delivering policies for their well-being and the public good. The remit for the discussion paper made reference to the perspectives of different user groups, and the paper examines the need for social work in the context of children and families' services and services for adults including those of working age and older people.

1.5 - Key source documents include the standards for the new social work degree, the codes of practice issued by the Scottish Social Services Council and its counterparts elsewhere in the UK, and recent Scottish legislation and policy statements . Discussion with practitioners and stakeholders indicates a significant mismatch between the models implied by the codes, standards and policies, and the ways in which social work practice has been shaped by policies, procedures and service structures over the past ten to fifteen years. There are further gaps between practitioners' and managers' accounts of what social work offers, and service users' experiences and expectations.

1.6 - Another theme running through the work on the discussion paper has been the relationship between social work and the work of other professions and other groups within social care. When do people need a social worker as distinct from another professional? Is everything currently done by social workers something that only a social worker can do? Discussions revealed a lot of concern about how far the work of other professionals was encroaching into what had traditionally been social work's territory. Views are mixed about whether this represents a threat to social work in the longer term, a natural degree of overlap between professional roles in increasingly multi-professional settings, or a modest success for social work principles and values in influencing the roles and attitudes of other professions. The discussion paper suggests an approach to defining the circumstances in which social work intervention is needed because of its particular contribution, and the requirements for effective social work in such situations.

INTERVENTION

1.7 - Finally, the remit refers not just to social work but to 'social work intervention'. Assuming that this wording is significant, the discussion paper concentrates on the need for social work which takes place within a framework of government policy and statute. In practice and at present, this refers largely to local authority social work services which have powers and responsibilities to intervene in the lives of individuals and families, generally with their consent but compulsorily in specified circumstances. It is in these areas of social work that many of the tensions and conflicts arise, not only for social workers but for people using their services and for the public. Some may be deterred from seeking social work help by fears that it could result in judgements about their ability to cope independently or care adequately for their children.

1.8 - There have long been debates about the relationship between the supportive, caring and enabling elements of social work and the need at times to exercise powers of removal or control for the protection of the individual, other family members or the public at large. This is a particular feature of local authority social work, and currently much less of an issue for most social workers employed in voluntary organisations or working independently. Patterns of employment are changing, however, with more social work posts located in multi-disciplinary and joint agency settings, and policy initiatives which could see more functions undertaken by voluntary and community organisations on behalf of the statutory sector. Many of the considerations analysed in the paper could apply to social workers deployed in voluntary organisations.

1.9 - Current policy direction and changing public expectations could also lead to a more fundamental shift away from a focus on statutory intervention and towards a culture where people positively seek social work support as part of their own problem-solving strategies. This would be consistent with policies to encourage independence and social inclusion, to help prevent problems arising or becoming worse by offering earlier support, and to enable people to take maximum responsibility for managing their own lives and playing their part as active citizens. It could also lead to social work becoming a mainstream, universally available service to which people turn, as they turn to their GP, for advice and assistance with complex problems and concerns.

2 - THE CONTEXT

2.1 - It might be expected that the profession would have a major say in defining the need for its particular set of knowledge and skills. In fact, social work has for some time shown all the signs of being a depressed and anxious profession, often on the defensive and slow to assert the value of its work. It has been bogged down in the same sterile debates about whether or not it is truly a profession, whether it is simply an arm of the state, whether it has a proper evidence base for its work, and why it does not enjoy greater public esteem. It is particularly sensitive to what it regards as unfair media criticism, often sparked by an incident involving allegations of serious child abuse, where the social workers feel 'We're damned if we do and damned if we don't'. Although social workers are acting on behalf of the public, there is a view that the public does not back them or recognise the difficult judgements they sometimes have to make about whether to intervene or not. At the same time, working alongside other professionals like nurses and teachers who enjoy greater public support, social workers say they feel uncertain about what their role should be, and concerned that they may be left with just the areas of work other professions don't want or regard as lower status.

2.2 - Perceptions of social work's relatively weak professional status are also reflected in ambivalent relationships with employers and government. It is argued that the social worker's job is too narrowly defined by the local authority, with an over-emphasis on prescribed responses to child and adult protection concerns and on acting as gatekeeper to ration scarce resources. Social workers feel hemmed in by procedures and bureaucratic requirements imposed by government guidance and local authority rationing and accountability requirements, severely limiting their contact time with people and their scope for professional discretion. The gap between people's needs, as presented to them on a daily basis, and the levels of resource available in response can lead to cynicism and a feeling that senior managers and politicians are out of touch. Here again, the generally better resource settlements received by education, the NHS and the police tend to underline the less favoured position of social work services.

2.3- Discussions suggest that a number of features characterise social work as it has developed over the past ten to fifteen years:

• workload priorities have been increasingly dominated by child and adult protection procedures.
• assessment of people's needs, particularly in services for older people and working age adults, has been largely determined by resource-led and sometimes very restrictive eligibility criteria.
• joint and shared assessment procedures in children's and adults' services, intended to avoid multiple assessment by different professionals and provide more integrated responses, have become excessively complex and burdensome for people and practitioners.
• there is a perceived discrepancy between the elaborate assessment processes and the relatively narrow range of services available to respond.
• specialist teams and segregated services, intended to focus on the particular needs of different client groups and facilitate inter-disciplinary working, have the disadvantage of requiring people to adapt their individual circumstances and needs to rigid service structures.

3 - PRINCIPLES OF A NEW APPROACH FOR THE 21 ^st CENTURY

3.1 - Social work is a profession practised all over the world, and its fundamental principles are well established. If there are changes of emphasis over time, they reflect the shifting political and social context within which social work takes place, changing expectations on the part of the people using social work services and the public, growing understanding of the professional task and developments in the knowledge base for practice. Recent policy documents from the Scottish Executive bring together a number of these changes, and provide the framework for an up-to-date statement of core principles.

3.2 - The following list sets out some key principles informing modern social work practice:

• The focus should be, and remain, centred on the needs, interests and well-being of the child, adult or family.
• The social worker should aim to work with people to define together the outcomes they are seeking and their preferred means to achieve them.
• Part of the social worker's contribution is to maintain a view of the person in the round, recognising the physical, intellectual, psychological and spiritual dimensions of their well-being, and the importance of their family, neighbourhood and community relationships.
• In line with the principles of the social model, social workers will work with people to identify the barriers and obstacles in the way of achieving their desired outcomes, and to find ways of removing, avoiding or overcoming the obstacles.
• As part of increasing children's and adults' access to life-chances, personal development, choice and independence, social workers aim to share with people a recognition of risk to themselves and others, and understanding of how it can be managed.
• Social workers seek to help people find their own solutions to problems, build on their strengths, draw on and develop their personal and social assets, and avoid becoming over-dependent on formal support structures.
• Social workers seek in their practice to safeguard and maximise people's human and civil rights, promote their social inclusion and enable them to exercise their responsibilities as citizens.

4 - CRITERIA INDICATING THE NEED FOR SOCIAL WORK INTERVENTION

4.1 - Social work departments employ a variety of fieldwork staff, by no means all of them social workers. Social work intervention is most likely to be triggered when the combination of social work values, knowledge, skills and personal qualities best matches the needs and circumstances of the child, adult or family. This includes when:

• the child's, adult's, family's or social situation is unusually complex with a number of interacting factors affecting assessment and decision-making.
• the child or adult is at risk of serious harm from others or themselves and requires skilled risk assessment and safeguards.
• the child or adult is likely to put others at risk of harm, distress or loss and a response needs to take account of the individual's interests and others' welfare.
• the child's or adult's circumstances, including their health, finances, living conditions or social situation, are likely to cause them or others serious harm, social exclusion, reduction of life-chances or well-being.
• the situation requires assessment of, and intervention in, unpredictable emotional, psychological, intra-family or social factors and responses.
• relationships, rapport and trust need to be established and maintained with a child, adult or family who find trusting relationships difficult.
• there is a high level of uncertainty about the best form of intervention and/or its likely outcome.
• the circumstances are such that there are significant risks in both intervening and not intervening, and a fine judgement is required.
• the person is facing obstacles, challenges, choices and/or life-changes which they do not have the resources (personal, intellectual, emotional, psychological) to manage without skilled support.
• prescribed or standard service responses are inadequate, and sensitive, creative and skilled work is needed to find and monitor personalised solutions.
• the child's or adult's situation is getting worse, either chronically or unpredictably, and is likely to need additions or changes to interventions.

4.2 - Social workers are not the only professionals likely to be working with individuals and families in these circumstances. Indeed, in the nature of the complexities, interactions and risks involved, many people will also be dealing with other professional groups from the health, education, housing, employment and justice services. Seeing people's situations in the round includes recognising the effects on them of having to engage with a variety of agencies, and assessing where action or change on the part of other agencies may open up opportunities for people or remove barriers to achieving the outcomes they seek. Social work skills are often deployed to good effect in collaborative work with other professionals, either in on-going multi-disciplinary teams or in ad hoc joint work around the needs of an individual or family. The distinctive social work contribution combines a developing body of knowledge and skills, a set of core values and priorities, and a range of personal qualities.

5 - PERSONAL REQUIREMENTS FOR SOCIAL WORK PRACTICE

5.1 - Practicing social work effectively in these situations is a demanding task. It requires the social worker to develop and maintain high levels of knowledge and skill, and to possess a number of personal qualities. These include:

• the ability to apply core social work values as a basis for decision-making in situations of complexity, uncertainty and competing or conflicting interests.
• the capacity to tolerate uncertainty and anxiety and not to close down options prematurely.
• a mature, unthreatened sense of their own identity.
• good emotional intelligence and an ability to establish relationships in situations of challenge and risk.
• clarity in assessing and responding to situations involving complex relationships and risks.
• flexibility in analysing human situations and developing creative solutions.
• the intellectual curiosity to stay up-to-date and develop a broad understanding of people and their circumstances.
• acceptance of multiple, sometimes competing accountabilities.

6 - SOCIAL WORK WITH CHILDREN, ADULTS AND THEIR FAMILIES

6.1 - Local authority social workers are often organised in specialist teams. In one department, there are teams with titles including children in need, child protection, people with learning disabilities. disabled people, mental health, drugs and alcohol, older people, youth and adult offenders. There are various rationales for these structures. It is said that social workers need to limit the range of people they work with because of the levels of specialised practice knowledge and skill required; that the team definitions relate to structures in other services and systems such as the NHS and the justice system, and make for better joint working across professional and agency boundaries; and that the specialist focus ensures a fair allocation of attention and resource to different groups of people needing services and support.

6.2 - People and their circumstances and needs however rarely fall into such neat categories. Parents of children in need and children at risk often have physical, social, economic or health problems of various kinds. Adults of working age may have more than one disabling condition, exacerbated by obstacles reflecting stigma, poverty, exclusion and discrimination. Amongst older people, ageing presents an increasing range of physical, sensory, intellectual, emotional and psychological challenges, coupled often with environmental and economic limitations. Specialist social work team structures can militate against seeing people's situation in the round, and add to the barriers which need to be overcome if they are to achieve the outcomes they are seeking. The paper therefore addresses social work intervention in two broad areas: work with children and families, and work with adults of working age and older people.

CHILDREN AND FAMILIES

6.3 - A number of key considerations for social work with children and families flow from the preceding analysis:

• The prime focus for work with children and families is the well-being of the children. 'For Scotland's Children' indicates that by the end of the journey to adulthood each child should have reached his/her potential in terms of emotional and social maturity, be in good health, and have attained a level of academic achievement and other skills. Children should be assisted to overcome barriers that create inequality.
• Local authorities are required to promote and safeguard the welfare of children in need in their area and so far as consistent with that duty, promote the upbringing of children by their families. Parents' well-being is thus crucial. Social work skills, knowledge and persistence may be needed to establish working relationships of trust, find the key to engaging the family's cooperation and interest, identify the issues with the family, lead them through the process of assessment, help them participate in determining the direction of change and ensure their aims, capacities and plans are identified and developed. Social workers may also help children and parents to maintain any changes made. Continued support of this kind may attract criticism as encouraging dependency, but practice experience shows that failing to provide such support may reduce the return on substantial investment of social work resources.
• In families it is the children to whom social workers owe the greater duty of care. Children can be clear about what they need. There may be tensions between children's needs and wishes, parents' needs and wishes, the views and wishes of the wider family, of the community, other professionals, and with the requirements of the law, regulation and procedure. Even where the decision is to remove a child the way social workers conduct their business can make a difference. Thus social work has to respond to parental needs for the sake of the children, but may need to abandon them to maintain the primacy of the child's welfare. The consequences of getting the balance wrong in either direction expose both children and parents to suffering and pain. Social work requires controlled, emotional commitment, readily discernible as present or lacking to most users. Sometimes the nature of the issue will demand decisions that appear to undermine that commitment. Social workers have to take the decision and maintain the commitment.
• The social worker works as therapist and advocate or broker. While the change to greater teamwork and integrated assessments places more equal responsibilities on the range of professions and agencies, at least for the time being, social work needs to champion those who cannot speak up for themselves or who alienate others through disruptive behaviour or poor social skills.
• Social workers also work with people who want change, results and improvement and for whom none comes. Supporting and being alongside people whose lives are painful, is more controversial in certain aspects of children and families work, where the obstacles to meeting the objectives for the child appear to emanate from the parents' inability or unwillingness to provide the desired environment and care. Removal may be the societal response, but there is no guarantee that alternative care, in the wider family, or in family or residential placement, will meet the needs of the child. Social work is needed to point out the difficulties, weigh up the choices, and stay with the situation, listening and supporting, preventing deterioration where possible, organising compensatory experiences for the child, being alert to the signals of possibilities for positive and negative change, and keeping alert to the whole picture, while other professionals address more discrete needs.
• Social work with children and families is s not confined to the statutory sector, and takes place in a variety of voluntary and independent organisations. It is highly regulated and increasingly all sectors are brought within the statutory frame. This may result in an approach that legitimises only that work which is in line with objectives and targets. The state wants children to flourish; so do parents. Parents and children are individuals; some may not have the capacity to meet targets. Social work bears the burden of working with the individual within the context of a framework for the many. Social work is required to help to prevent tragedies, to give confidence to families to flourish and to the state to be safe. It is needed to hold these balances and tensions on behalf of children and families and on behalf of the wider community.
• Were social work to be seen as non-threatening, available to all at the behest of the user and to meet the requirements of the user, social work by invitation rather than social work intervention, parents and children might also value social work's 'whole person/whole situation' approach.

ADULTS OF WORKING AGE AND OLDER PEOPLE

6.4 - From the adult's point of view, the need for social work intervention is likely to arise if they are unable, without it, to achieve outcomes they are seeking for themselves and their families. Social work with adults of working age and older people entails:

• encouraging all professionals involved to take and keep taking an all-round view from the person's perspective.
• working together with the person and others on strategies for their empowerment, independence and control of their own lives.
• identifying the person's abilities, assets and potential for capacity-building, and enabling them to develop to the full.
• assisting the person to explore and access alternative living situations, including those with the benefits of smart housing and housing-based support schemes.
• assisting the person with their assessment of their support needs and preferred solutions, and with securing satisfactory arrangements.
• where the person wishes, helping them to access direct payments and establish and manage support arrangements to their specifications.
• assisting the person and their family through the transition to higher levels of support needs, whether through increased disability, ill-health or bereavement, or in order to access opportunities for independence and participation.
• helping to resolve charging and payment issues in the user's interests.
• supporting the person to access help with financial planning, budgeting, raising income and securing credit without being exploited.
• supporting the person in exercising their human and civil rights, including rights to privacy, family life, freedom from enforced constraints.
• intervening in complex partnership or family situations to resolve relationship problems, conflicts of interest and damaging interaction affecting physical and mental health.
• ensuring, with maximum input from the individual, safeguards against exploitation, unnecessary constraint, neglect, domestic violence and abuse.
• with the person, their family and others they trust, helping them avoid being or becoming an unacceptable risk to themselves or others.
• within statutory frameworks, intervening to prevent the person becoming an unacceptable threat to others or themselves.
• helping carers to maintain their support role in line with the person's preferences and their own wishes, without the carers suffering exploitation, damage to health, isolation or social exclusion, and avoiding over-protection or undue pressure on the person.
• helping people with restricted capacity to protect their interests in relation to family members, neighbours and others who could take advantage of them.

6.5 - Additional elements in work with adults below retirement age (itself an increasingly flexible concept) would include:

• assisting the person and their family in the transitions from services for children and young people to those for adults, and the natural process of becoming fully adult and less dependent on parental care.
• supporting the person to access remedial, further and higher education to maximise their level of achievement and qualification.
• supporting the person to access and benefit from professional and vocational training opportunities to equip them for jobs, including self-employment, appropriate to their skills and abilities.
• supporting the person to enter and maintain employment suitable to their abilities and expectations, and to develop satisfying and challenging careers in their chosen fields.

7 - IMPLICATIONS AND ISSUES FOR CONSIDERATION

7.1 - The issues for social workers and their managers and employers highlighted in this paper include:

• managing the relationship between user preferences and society's expectation for control and protection.
• the differences in social work with groups who are included, tolerable and tolerated by society, and those who are excluded or regarded as intolerable.
• how far the social worker's role includes being the advocates and champions of outsiders and groups defined as 'too difficult'.
• the social worker's remit for mediating between the whole person and the full range of supports and services which may enable them to achieve the outcomes they seek.
• the implications of dealing with the whole person in relation to their family, community and society, particularly where this involves competing or conflicting interests.
• the tensions in working as professionals accountable to the people using their services, their regulatory body, employers allocating resources and setting targets, and government determining policy.
• conflicts in the social worker's role when rationing scarce resources and applying eligibility criteria to exclude some with assessed needs.
• how the social worker's focus on empowerment and enabling people to manage their own lives can be balanced with assessing and helping people to manage risk, and with responsibilities for adult and child protection.
• identifying and extending 'the best available evidence' as a basis for social work practice.
• recognising the human element in social work, in its dealings with weaknesses, mistakes and uncertainty.

7.2 - The Social Work Review may also wish to consider a wider set of issues with implications for some of the key stakeholders:

• Should social work become a mainstream, universal service available on request?
• What is the scope for developing existing and new staff roles and support systems to make the most effective use of the scarce and skilled resource social workers represent?
• Does social work require its own distinctive form of professionalism to support a person-centred, outcome-oriented social model of practice?
• What liabilities do employers carry for actively supporting the continuing learning and professional development of their social work staff?
• What routes are available to strengthen the engagement of education and research academics with the complex world of social work practice?
• What mechanisms would support a shared responsibility for developing and continuously updating the knowledge base for social work?
• Are there ways to avoid specialist team structures, geared to facilitate inter-agency working, creating additional boundaries and obstacles for people to overcome?
• How far is it possible to promote coherent government policies, integrated across departmental boundaries, which take account of the whole person in their family and social situation?