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

SECTION ONE: THE NEED FOR SOCIAL WORK INTERVENTION

1.1 DEFINING THE NEED FOR SOCIAL WORK INTERVENTIONS

Social policy literature on defining need is vast. This discussion paper uses an outcomes-based framework: that is, the need for social work intervention arises when the resources available to an individual, family or community are insufficient for them to achieve preferred or required outcomes. Our reasons for this approach are threefold:

1. reviews of the literature defining need in social policy already exist;
2. there is agreement between policy makers and people using services that an outcomes approach is a basis on which user centred services and practice can be developed; and
3. an outcomes approach is consistent with social work values, the Codes of Practice and standards of service and practice.

This discussion paper focuses on the need for social work intervention with individuals, families, groups and communities.

1.2 THE ROLE OF SOCIAL WORK AND NEED

It is impossible to separate the need for social work intervention from the role of social work in Scotland. This is integral to deciding social work's contribution to tackling social and personal problems and promoting well-being. The Role of Social Work is the subject of another project, but this discussion paper has had to make assumptions about its role. These assumptions set out in Appendix One are that:

1. Claiming exclusive territory is not appropriate for social work because:

• the whole of the person's life situation and social context is its focus
• the implementation of its values and the process are what give social work its quality - 'there are no good outcomes without good processes' (Shaping Our Lives, p56 in Turner and Evans 2004)

This creates difficulties for social work because professions usually define their territory through an exclusive claim to specific knowledge and skill. This lack of exclusive territory leads to the regular prediction of the demise of social work.

2. Social work's role is carried out through:

• direct practice, of various types and techniques, with individuals, families, groups and communities and with provider organisations
• the management and development of:
• • practice, including work based learning for students and staff
  • service provision, including commissioning
  • policy and strategy within, and outside the organisation
• working with a range of organisations to contribute to the promotion of social and personal well-being
• research and development.

3. The organisational context in which social workers operate is significant in determining:

• whether good practice is in spite of, or because of its support
• whether the management of practice is fit for purpose in a particular context
• the nature of the teams within which social workers are operating
• whether there is a learning environment that supports good practice so that social workers are confident about their knowledge and skills.

4. Knowledge and skill shifts occur over time

• particularly when there are significant changes in social policy
• both within and between professions and occupational groups
• because people using services build up their own expertise and this becomes incorporated into the knowledge used by professionals
• when new groupings of knowledge and skill emerge in response to new needs and policy directions
• as solutions become more standardised or there are technological developments skills move from professionals to members of the public.

1.3 THE NEED FOR SOCIAL WORK INTERVENTION

Most social workers are currently expected to cover a huge span of approaches. This may not be appropriate in the future. Different strands can be identified, which, while not exclusive of each other, form the primary focus individual social workers' interventions. We have identified three:

1.3.1 Intervening between the state and the citizen

This occurs when:

This is the predominant approach to social work based in local authorities. Its strength is that it combines a commitment to personalised support through accessing a wide range of support and balances the needs of the individual with those of others. There are five significant dangers:

• a limited range of social work skills is used. Social work becomes equated with assessment and determining eligibility to access scarce resources. Negotiation with people using services about what they want to achieve can be transformed into consultation, a lower level of power sharing (Elder-Woodward, 2002)
• social workers' capacity building through community development is minimised (Elder-Woodward, 2002)
• resources (time and expertise as well as money) are diverted towards children and families away from older people, disabled people and people with learning disabilities
• workers can become institutionalised and accept 'the way it is done here' uncritically (Marsh and Fisher, 1992), in effect abandoning professional judgement. When reinforced by a command and control management, they protect themselves against criticism by retreating into description rather than make professional judgements.
• statutory work operates a significant pull on resources (staff time and expertise as well as finances) to cover risks to the organisation as opposed to the citizen whether child or adult. Bureaucratisation of decision can means that it can take months before clearance is given for a foster child to stay overnight with friends, go on trips or have their ears pierced (Sinclair et al, 2005). This level of caution (which denies young people the 'normal life' they want and is expensive in organisational time) contrasts with the expectation that many young people will begin to live independently at 16 years old.

1.3.2 A distinct service that aims to maximise the capacity of people using services

The objective is that individuals, as far as possible, are, or become, 'expert clients' or 'informed clients'. For children and young people the aim is:

• to achieve permanent and stable emotional and social relationships
• to assist them to cope with impediments, in their past or present, to minimise or remove their impact on life options
• to secure supplementary support for their educational, health, social and emotional development
• to move as smoothly as possible through the usual developmental and transition stages of growing up.

For adults it offers an opportunity to think through with a social worker the obstacles to their well-being, or to have a social care check, similar to a health check. Social work intervention enables citizens to think through how to build on their expertise and experience by:

• working with people to navigate through the maze of information, organisations and options so that they can create a personalised plan.
• providing help lines and desks for individuals, community and user led groups, other professionals and organisations
• connecting people with similar experiences with each other and with user led organisations or community organisations
• providing information and contacts to build capacity
• providing therapeutic support
• challenging attitudes, behaviour and services that block people's capacity to take as much control over their lives as possible
• mediating between state organisations and citizens
• advocating directly or linking people to advocacy
• spotting and supporting effective innovations.

There is no reason that this form of intervention should not be a universal service on a similar basis to the General Practitioner. Such a development may require the separation of assessment from the provision of services. It would not promise unrealistic access to services, or create the expectation of statutory intervention except in clearly defined circumstances with high thresholds. Citizens who can afford to pay for services already access this support through independent social workers or counsellors, many of whom are social work qualified. There is no known research on the range of work undertaken by independent social workers, but anecdotal evidence indicates that such support is focused on:

For children:

• managing transitions for children such as the ending of a family unit and reconstituting new family groups
• building confidence and self esteem
• survival strategies for children and young people bullied in school
• reaching decisions about whether to move to independent living
• coping with family conflicts
• coping with death, loss and change

For adults:

• loss, separations and bereavements
• relationships with partners
• life options
• coping with trauma, such as sudden illness or impairment
• parenting problems and behavioural management

Strengths and weaknesses of the model

The strengths of this form of intervention are that:

• power is shared more equally and people retain control over their lives or specific areas of them
• the main resources are people's own expertise and experience, their capacity to learn, and the resources that exist in their social networks
• the individual has sought the intervention by the social worker.

The social worker's skills in forming and using relationships in problem solving, negotiation and conflict resolution are used within a social model. There is a high level of coherence between the value base of social work and the Codes of Practice for Social Care and the work.

The dangers are that social workers can become isolated from professional support or have to fit into a model of professional support that is not fit for purpose. A range of approaches will need to be developed in addition to the traditional social work supervision at fixed times, for example, 'hovering supervision' or supervision 'at the end of a phone' that gives rapid access to the worker.

1.3.3 Contributing to promoting policies and practice that support social and personal well-being

Although all social work requires the capacity to work with and through others, in this approach this is the social worker's primary role. The aim is to contribute to building the 'platforms' from which personalised services can be developed and through which citizens can promote their own well-being or manage long term conditions (Leadbeater 2004). Policy development roles could include promoting Direct Payments within health, education and housing. Elder-Woodward argues that the social workers' role in community development should include capacity building for user-led support systems as a way 'to empower people not only to control their own lives but to be in some way accountable to and for their own support systems'. The worker can be located in a wide variety of organisations in the statutory, voluntary or private sectors, in user-led organisations, community groups, schools, health, the police, businesses, local or national government. Skills include:

• the capacity to spot and manage conflicts
• working within different power structures
• negotiation within a framework of equality and empowerment
• navigation through the maze of organisations, programmes, initiatives, issues and options
• promoting social inclusion of marginalized groups in partnerships
• communicating how social care contributes to health, education, community capacity building, community safety, productivity
• building and maintaining networks or teams.

Strengths and weaknesses of the approach

The strengths are that the social work knowledge and expertise in promoting social inclusion is incorporated into new arenas. It provides a 'social well-being impact statement' as an integral part of social, economic and environmental change. The weaknesses are that the social worker can become isolated from professional support and developments, fail to identify where compromises have been made without considering the consequences or using evidence about the implications this may have in the short, medium and longer term.

Summary

Social work intervention takes a number of forms and:

• provides an access point to services needed to remove blocks to outcomes
• keeps people safe from harm and danger within statutory powers
• builds on the capacity of people using services to take as much control over their lives as possible and to manage long term social and health conditions
• contributes through a range of organisations within and outside social care to policies and practice that promote well-being.

1.3.4 The benefits of social work intervention to local communities and the wider society

The arguments for social work intervention are most often put in terms of benefits to an individual, family or group. Our views are that there are public benefits such as:

• building on the capacity of individuals and network to increase their independence and use of mainstream rather than specialist services
• maximising parents' and their children's life opportunities
• reducing community tensions through promoting mutual understanding
• using innovative approaches to reducing socially disruptive behaviour.

1.4 OUTCOMES AND THE ACHIEVEMENT OF WELL-BEING

An outcomes approach to need can be used in all these forms of intervention. In the vast majority of instances the obstacles to people achieving the outcomes they want are related to their economic poverty. The result of this is that they are likely:

• to be living in poor housing,
• to have lower educational attainment
• to have poorer health and for their children to have a higher incidence of accidents requiring hospital admission
• to have a lower life expectancy
• to be unemployed
• to have reduced chances of living in a decent and safe environment or access to leisure, recreation and transport.

Although poverty and its consequences affect the majority of people using services, the resources to address these issues are outwith the control of social work and care. For some people problems arise because of a combination of economic, relationship, health and emotional factors. Social work may be drawn on in any of these situations.

Social work is a collective activity because it works with and through other people, through partnership with other organisations. To be effective social work partnerships have to include people using services or at least their agreement to participate. Without this the task is limited to monitoring behaviour or activities.

1.4.1 Three main three main categories of need for social work intervention

We have identified three main categories where a need for social work intervention may arise. These are:

1. When people know they face obstacles to achieving the outcomes they want to achieve and seek intervention because:

• they, their families, their support networks or communities cannot overcome them, or
• the costs (physical, emotional, social and financial) to them are too high in the short, medium or longer term, or
• the resources needed are so specialised that they are only available through a social work, educational, medical or housing assessment.

2. When people do not seek, or necessarily welcome, intervention because they are not aware of ways of overcoming the obstacles they face, or lack the information, knowledge and/skills to do this either partially or completely.

3. The small minority of situations where people seek, or their behaviour creates, outcomes that are contrary to legislation and regulation, or are a serious risk to their well-being or that of others, and where compulsory intervention may become necessary.

Conflicts at all levels (the service user, the professionals, the public and the media) about the outcomes are most likely to be contested in this latter group. However, they are likely to exist in all interventions and conflicts of opinion and judgement should be recorded and monitored in the intervention plans (Nichols, Quereshi and Bamford, 2003).

Summary

An outcomes approach identifies the obstacles to people using services achieving the outcomes they want, ways of tackling those obstacles, how children, young people and adults, others in their social network and relevant organisations will contribute and work to find creative, personalised solutions. In a small minority of cases where there is a risk to themselves and others, the outcomes approach's focus is on keeping the individuals safe from harm and danger. Where there are conflicts of opinion these should be recognised and a false consensus avoided.

1.5 AREAS OF SOCIAL WORK INTERVENTION

A long-standing conundrum is 'what level of need should have attention from the state?' Statements on values refer to the rights of individuals ( BASW 2003, IASW and IFSSW, 2001), and there is a move to try and establish a 'right to independent living' (Morris, 1993). In practice, provision and intervention are limited by:

• resources (expertise, provision, time, money).
• priorities of the organisation, those of others contributing to integrated services, national and local policies.
• different conceptions of the role of social welfare.
• the role social work plays outside the boundaries of social welfare.

The need for social work intervention through state supported organisations is always politically shaped, but there are a growing number of employment opportunities for social workers that are extending the funding sources beyond the welfare budget. For example, as independent social workers, in education, health, employment services, industry, government and the media.

When asking questions about the need for social work intervention, it is essential first to know what political decisions have been made about the function of social welfare systems in meeting need. Hardiker et al. (2002) discuss five levels of intervention she identified in 1997 and the nature of need they address in children, young people and their families. The model could be adapted to apply to adults. The levels are:

• Base level: needs in the general population for whom universal services are provided.
• First levels: vulnerable groups which may be enabled to use universal services and are targeted through initiatives such as Sure Start.
• Second levels: early stresses and families in temporary crisis assisted by short-term interventions and resources. Hardiker locates 'children in need here.
• Third levels: serious stresses including risks of serious harm and family breakdown which need intervention to restore family functioning.
• Fourth levels: covers a diverse group of issues: social breakdown, children looked after, children abused within the care system; methods include therapy, damage limitation and permanency planning'.

Using a grid she demonstrates how different models of welfare and the levels of intervention interact. If the state takes a minimal approach, its services will not come into play until the third level is reached. If the state is committed to combating social disadvantage, interventions will be apparent at the first level. In this framework it is our view that social work is most usually needed, to varying degrees, from the second to the fourth levels.

Summary

Who has access to services that are dependent on national or local government funding is a political decision and from it flows the social work's statutory function within a specific social welfare system. The range of resources available to people using social work is increasingly wider than this. These include services supported through charitable funds and independent social workers provide alternative resource for people with their own funding. In addition, the diversification of employment bases for social workers is extending the range of social work interventions outside the social welfare system.

1.6 DECISIONS ABOUT THE NEED FOR SOCIAL WORK INTERVENTION

The social policy objective of social work intervention is that it should be tailored to a specific situation and that each person is unique. Social work is a collective activity and is consequently dependent on partnerships; not least because many of the resources required are outwith social work. While some partnerships are very successful, they are in general notoriously difficult to set up and maintain without one partner becoming dominant. There is also little evidence that co-locating different professionals will in itself lead to improved outcomes for people using services, although it can improve the effectiveness of systems. Partnerships between different organisations and local people are difficult enough (Balloch and Taylor, 2001), but they also require agreements about the function of social work within neighbourhood renewal and community capacity building. In the main this does not exist in spite of the inclusion of community development in the responsibilities of Social Work Departments. This is unsatisfactory because community development is effective in facilitating the building of the community's capacity to address both collective and individual problems.

1.6.1 Decisions about social work intervention

Social work intervention should take place only when the situation is not 'straight forward'. Routine social care responses should be through self assessment or by using social care, education, housing or health care workers with a lower level of training and skill.

The requirement for social work intervention is triggered by a number of factors such as:

1. Differences of opinion about what constitutes a social problem.

This changes over time. For example,

• until relatively recently domestic violence was accepted within marriage and other personal relationships between men and women. Evidence that domestic violence indicates a risk of violence towards children and witnessing abuse is emotionally and psychologically damaging to children and young people has moved domestic violence from a private event, to a child protection concern (Mullender and Morley,1994)
• drug and alcohol abuse is now a significant social problem. It impacts on the next generation of children through a failure to parent adequately and the likelihood of birth impairments
• child prostitution is now defined as child abuse rather than the consequence of the immoral behaviour of a young person.
• racial abuse and homophobic behaviour was endemic in our communities and institutions, but policies state that intervention is necessary.

At points of change social work intervention is necessary to innovate or spread examples of good practice that have existed in isolated pockets.

2. Service user groups where there are contentious issues

For a number of groups the imperative to promote people's rights has to be balanced with other considerations. For example:

• when a criminal offence is likely to be, or has been, committed
• when behaviour is disruptive of the life of a community, harasses or is dangerous for others
• when the child or adult needs to be kept safe from harm.

Although this represents a minority of people who need social work interventions, they are high profile. Social workers and their managers are often required to justify their action or inaction to the public, politicians and the media.

Intervention is usually multi-organisational and multi-professional. A battlefield often exists between support, rehabilitation, retribution and punishment. Professional judgements about risks and the possibility of change and public views may be in conflict with each other, even though prison is not a good predictor of changed behaviour on discharge.

To operate effectively in these areas, social workers need skills:

• in working with the bounds of confidentiality at the same time as explaining to the media and the public what they are doing in ways that are neither mysterious nor patronising,
• demonstrating that they are accountable for what they are doing in accessible language as part of social care governance (Cunningham, 2004).

3. The answer to the question: Who is the client?

Most referrals to social work services are made by other professionals, organisations, relatives, neighbours and friends, and not the individual who is the subject of concern. Social workers, and the organisations within which they work are subject to multiple systems of accountability. A clear understanding of who see themselves, and who are seen, as the potential beneficiaries of a particular social work intervention is essential. Without this the intervention can be seen to have failed, even if the service users themselves are satisfied.

4. Thresholds of need

These vary between service user groups and according to:

• the availability of resources (money, staff time and expertise),
• guidance and procedures about the assessment of need and risk
• judgements exercised by social workers and their managers and other professionals based on organisational priorities
• the support available to the service user within their own social network or their community
• different thresholds existing in voluntary or private organisation or between statutory organisations
• political priorities and the funding that flows from these.

The variability of thresholds means that there are significant gaps in coverage for groups of people with similar needs that cannot be explained by the support available through their family or social network. Although disabled children are defined as children in need, a substantial number are not known to social services. People with similar levels of Alzheimer's Disease to those in residential provision are living in the community. Their family carers may or may not receive services.

People with sensory impairments can become housebound, and consequently more susceptible to depression, because they cannot cope with the environment or be sure that buses stop near enough the pavement for them to feel confident in using them, they are vulnerable to falls and accidents. This knowledge could contribute to health, social and environmental policies on prevention and reducing social exclusion.

5. Risks to the safety of the individual, their family or the public

The nation and local state has a clear responsibility to protect children and young people. A similar responsibility holds in relation to those committing offences. In both these cases there are clear procedures that involve a combination of professional assessments with the ultimate decisions made by the courts.

Where adults present a risk to themselves this is more problematic. There are human rights issues when the individual is legally competent to make decisions about their lives. These groups include those who threaten to take their own lives, have a mental illness or learning disabilities and do not want social work or health interventions in their lives. Some may refuse treatment, or, have been treated but fail to take medication. They may be concerned about side effects or have a chaotic life style.

There are many individuals abusing illegal drugs who are not prosecuted. Often no social work intervention occurs either because there are insufficient resources or expertise and/or because there is recognition the behaviour is chronic and not likely to change. Insufficient attention is given to the fact that many people using social work services have multiple impairments that interact with each other. The drug abusers may have been abused as children, be parents, be homeless, have a mental health difficulty or face all of these difficulties at the same or at different points in their lives. Although there are multi professional forums and procedures it is often social workers or the criminal justice system that copes with chronic difficulties arising from abuse.

6. Concerns about the capacity of individuals to have control over their lives or to keep themselves or their child/ren safe

Judgements about whether individuals can keep themselves safe from harm and live independently are often very fine. Rightly there is an emphasis on their human rights and respect for people's wishes. Examples include:

• people with chronic mental health conditions, people abusing drugs and alcohol, people with Alzheimer's Disease.
• sensory impairment which increase with age and is often combined with depression or other mental health problems
• people with learning disabilities can find that their capacity to live independently is reducing as their life expectancy increases. The level of social care - as opposed to housing - support they need because of physical impairments increases at an earlier age than for the general population. We are in relatively uncharted waters in planning services that are appropriate for this group of people. Social work intervention, combined with health and housing assessments, is required to monitor the effectiveness of the personalised package of support in keeping the person safe from harm and to respond to often quite subtle changes that indicate a higher level of support is necessary.

7. The evidence about outcomes

Evidence about which social work interventions work in what situations is always likely to be tentative because there are so many variables. As in parts of medicine there are numerous circumstances in which random controlled trials are not possible. Many health predictions are for whole patient populations, rather than certainty about the effect of a specific treatment on a particular patient. Success is defined within time limits rather than for cure of an illness or condition. A growing amount of information is available about outcomes of social work and social care interventions that can assist workers and managers in reaching decisions about what responses are most likely to succeed, (MacDonald and Sheldon, 1992, Cochrane Collaboration, 2003). These include such soft data as the personality of the worker and their attention to the process (Turner and Evans, 2004).

Summary

Decisions about the need for social work intervention are determined by a number of factors. Accountability is often multiple and there are frequently conflicts that have to be managed between the perceptions and judgements of people, organisations and the public. In some areas such as child protection and mental health multidisciplinary forums manage decision making when there are serious levels of conflict and risk or the limitation of human rights. While knowledge and skill are essential to positive outcomes, high importance is given by people using services to the personality of the worker and attention to the process.

1.7 PERSPECTIVES ON THE NEED FOR SOCIAL WORK INTERVENTION

1.7.1 Introduction

The way social work interventions are implemented is not neutral or value free. There have been huge changes within social work of attitudes towards people using services. A leading social worker in the United States 1930s depression commented:

We as social workers saw for the first time was that people like ourselves in backgrounds social status, education and mores… were suddenly subject to circumstances that despite our lip service to the contrary we had reserved for people who were not like us. (Perlman, 1965)

Subsequently women, people from black and minority ethnic groups, gays and lesbians complained social work was deeply paternalistic, racist and homophobic (Dominelli & Statham 1978, Ahmad,1990). By the 1980s disabled people challenged the way the application of social work theory dis-empowered them (Oliver, 1983, Campbell,1996,) and argued for citizen participation (Beresford and Croft, 1993). These positions were then regarded as anything from dangerous to misguided by many. Just as it is impossible to shift the whole NHS overnight to regard patients as partners (Scottish Executive, 2004) so it is equally difficult to suddenly shift services and methods to be consistent with new policies.

We have identified four perspectives on the need for social work intervention for this stage of the discussion paper.

Our reason for taking this approach is that clarity about differences in perspectives, recording conflicts and uncertainties is essential to using an outcomes approach (Nichols, Quereshi and Bamford, 2003). Conflicts and uncertainty are endemic in social work and can arise from:

• the level of complexity involved
• different views about what has happened, what is needed to achieve a good outcome
• who is, or thinks they should be, the beneficiary of any intervention
• conflicts of interest
• uncertainty about the risks involved and the outcomes that can be achieved
• moral and ethical dilemmas

1.7.2 Perspective One: service user and carers

This section uses evidence from either research undertaken by people using services, or based on the views of people using services. In the context of user involvement in matching needs and services for children and young people, Tunnard (2002) (pp119-20) reported:

[Users] have clear views about the social work task they want to see preserved and promoted: early attention to problems to avoid more intrusive action later on; continued advocacy from social workers over health, housing, social security and education problems; and respite measures so that parents and children can get a break from one another or children can get temporary relief from neglectful parents or impoverished surroundings.

Aldgate (p164) notes, 'the importance of social casework as the foundation for [Children Act 1989] section 17 services was stressed by the studies, as exemplified in this view from Tunstill and Aldgate (2000),

It was clear that families in the study viewed social workers very positively and valued social work skills in responding to family distress by means of a casework approach. Casework, contrary to common misperception, includes highly developed skills of assessment, purposeful counselling and acting the role of facilitator and advocate. Without this social work intervention, many families were clear that their circumstance would have deteriorated to the point of family breakdown.' (p156)

In social work with children and families, the most contentious area is where control functions are used because the abilities of a parent/s to care for their children are deemed to have fallen below acceptable levels, or where interventions arise from concerns about an individual's safety or the risk they pose to others. This has become the best-known form of social work intervention, and colours the public's view of seeking or accepting involvement with social workers.

Amongst the adult groups, the clearest account of how service users define needs comes from the disability movement and its development of the social model (Oliver, 1993, Campbell and Oliver, 1996).

Key to this perspective is the understanding that needs for support and assistance come not so much from people's impairments, but mainly as a result of the obstacles society and the environment place in the way of their leading the lives they choose. These barriers limit or prevent them from taking charge of their lives, exercising choice and participating fully in the educational, employment, family and social activities non-disabled people take for granted.

Advocates of the social model argue that social work assessment should shift from focusing on what people cannot do, their degree of dependency and their eligibility for services, to addressing how the barriers to independence can be removed and what support will give people better access to mainstream activities and ability to manage their own lives (Oliver 1993, Campbell and Oliver, 1996). Social work intervention may include enabling people to access information, direct payments and other funding, communication, assistive technology, personal assistance, and mainstream educational, employment, housing and health services. It may also involve support to challenge discrimination and stigma, to enforce legal and civil rights such as those relating to disabled people's access to jobs, goods and services, and to promote their rights to privacy, family life and participation in civic society.

Initially established in the disability field, approaches reflecting the social model have been applied in mental health (Maria Duggan, 2004 Social Perspectives Network, MINDWorks) and in learning disabilities. The Scottish learning disability review The same as you? (2000) identified clear and consistent messages from users and carers that people wanted 'to be included - in community life, in education, in leisure and recreation, in day opportunities and particularly in employment', to have greater access to mainstream services, to have their own homes in the community, to have better information on which to base choices and decisions, and an advocate to support them if they weren't being heard.

These comments are mirrored to a large extend by carers who often do not receive a separate assessment of their needs and who are supporting children and adults who are as frail and vulnerable as those in hospital or in residential homes. The failure to provide them with sufficient support adds a potential strain on the social work services.

There are close links between the social model, the holistic model and a Leadbeater's personalisation agenda (2004). All emphasise:

• using the strengths of individuals, families and communities
• capacity building to increase independence and choice
• skill in promoting skills learning
• reducing blocks that exist in systems and organisations that are based in prejudice against groups of people
• the importance of demonstrating respect for people and their human rights.

It is often carers, whether family, friends and neighbours, or staff in social work services and primary health care, who initiate social work intervention in relation to people with learning disabilities, older people and young people with disabilities or mental health problems. For individuals and their carers the main considerations will tend to be need for:

• information, advice and support at times of transition - when young people move from children's to adults' services, when older people are no longer able to cope at home without assistance, when parents of learning disabled adults look ahead to the time when they will no longer be able to provide care and support
• assistance in finding their way round complex multi-agency structures of assessment, prioritising, resource allocation, service provision and purchase, in order to put together flexible packages of support or get access to scarce or specialist services
• assistance where there may be conflicts of interest between service users and their carers - whether different opinions about the best way forward, competing needs in areas like respite and risk, family and relationship stress and tension, or potential or actual abuse of one or more vulnerable people.

1.7.3 Perspective Two: the front line

Front line social workers often complain that they do not use the skills for which they were trained. The emphasis on assessment to determine eligibility and dealing with high risk diverts attention from preventative and therapeutic work. The front line is the point of interaction between social workers and people using services and whatever the policy statements say, this is where the words either become a reality in the lives of people using services or remain words on paper. Using an outcomes approach, social workers can define whether they and the service users are working towards:

• maintaining the current level of a person's, group's or community's quality of life and social and emotional well-being, or to try to slow down deterioration in it. This maintenance work will be a continuing task - throughout assessment, care planning, therapeutic interventions, monitoring and review to enable adjustment to changing needs
• to achieve a change in the quality of their lives
• to evaluate the impact of the process of the service, that is how it is delivered rather than what is provided (adapted from Nichols, Quereshi and Bamford 2003).

1.7.4 Perspective Three: national policy on well-being and regeneration

The context within which social work operates and the agenda for the foreseeable future is broadly set within a public health or well-being agenda. This strategic approach focuses on improving the economy and social life through investment in individuals, families groups and communities. Based on evidence from a range of disciplines, effective intervention involves an integrated multi organisational and multi-professional response. A key focus is reducing or removing blocks to life- long education and training, health, community development and neighbourhood renewal. The principles, methods of promoting involvement and participation and social inclusion overlap with those of social work. Both share an emphasis on facilitating empowerment, people taking control over their own lives, building commitment to and ownership of the process of change. Social work could add skills to these interventions particularly for socially excluded groups who are often seen as a part of the problem rather than part of the solution. The evidence is that local people experience being marginalized or excluded entirely from decision making (Balloch and Taylor 2004).

6

Work such as Charles Leadbeater's Personalisation through participation: a new script for public services (2004) has modernised the language of the public health agenda. Leadbeater points out that in the past improvement was often achieved through the state providing services - clean water, health and safety, sewage - but that in the 21 ^st century governments also have a responsibility to provide 'platforms' or 'environments' that enable citizens to take as much control as possible over the management of problem solving in their lives. Drawing heavily on social care research and development, he argues:

The key is to build up the knowledge and the confidence of the users to take action themselves, to self manage their health without turning to professionals. (p 18)

Social work has the skills to promote the participation of socially excluded groups, to manage change, negotiate conflicts and build on capacity. However, this has to be seen as a significant function and not one than is residual to be undertaken in the spaces between rationing scarce resources through assessment and managing risk. A shift is required in the conception social work among politicians and the public. The framework of social work education in Scotland provides a sound base for developing the workforce in this direction as opposed to it being the individual choice of career option for some social workers.

The National Framework, the National Occupational Standards that underpin the qualification for Social Work in England, Northern Ireland and Wales, and the Codes of Practice for Social Care Staff provide the boundaries for the values, knowledge and skills for social workers in Scotland.

Legislation on the responsibilities of Social Work Departments and the roles of social workers in the delivery of these responsibilities identify which needs must be responded to. Broadly, these concern the safety of the individual and that of others. These are the control functions of social work: that is where social work interventions are required because:

• minimum expectations of parenting capacity have not been met
• the individual belongs to a group defined as vulnerable and needing protection
• the behaviour of the individual is creating a risk to themselves or to others or seems to pose a threat to the life of the community.

Whilst this remit is national, thresholds differ and acceptable risks will depend both on formal and informal support systems in local communities. For example, in a rural area, a person with learning disabilities or mental health problems may be seen to present less of a threat, or none at all, because they are known as an individual. The same behaviour may be seen very differently in an inner city area where the person is not known. Social work has to be able to recognise, and act according to, the distinctions between these different contexts.

For over forty years it has been recognised that social work intervention cannot be seen in isolation and that it is dependent on the infrastructure provided through income and employment, health, housing, education, transport and the local environment (Killbrandon, 1966, Seebohm 1968, Barclay 1982 etc). These resources are also the priorities for people using services (Beresford and Turner 1997).

It is essential that social work does not over promise and under deliver. Social work suffers from a history of either not stating what an intervention is intended to achieve (drift) or of presenting itself as 'the solution' to a social problem. A more cautious approach exists in health where definitions of success are circumscribed by the evidence about its effectiveness for general populations rather than outcomes for individual patients. Estimations of success in social work must be measured against the level of damage that a person has to overcome whether this is the result of emotional or sexual abuse, serious relationship problems, poor parenting. In many cases statutory agencies are not in a position to say 'no' when change is impossible. There should be greater emphasis in future of identifying where the outcome is likely to be at best stabilisation or the alleviation of the effects on the individual and the family. This is similar to health where it is impossible to treat serious conditions and efforts are made to alleviate pain and distress or to slow down deterioration.

Evidence based practice should provide a sounder basis for identifying achievable outcomes from social work interventions and therefore assist in focusing expectations and input. It is equally important to hold on to the capacity for hope because confidence, self-esteem and positive attitudes in both people using services and workers can achieve outcomes against evidence of what it was reasonable to expect. The capacity to convey hope and belief in a person are components that resist measurement. A frequently omitted element in satisfaction of people using services is the personality of the social worker or care worker involved (Turner and Evans 2004, Health and Social Care Occupational Standards, 2005) - something that is difficult to educate or train a person in, though existing characteristics can be enhanced.

The implementation of policies to the extent that their impact is noticed by people using services and by social workers requires the management of change in organisations and people. The management of change is usefully divided into:

• First order change: this is incremental change within the rule of the existing system
• Second order change: is when there is a change in the rules that requires a change in the nature of the system itself.

Current policies require second order change, with impacts on multiple systems and on the skills and expertise valued. What at an earlier point was a highly valued skill can become a block to implementation. Over the past 30 years Social Work Departments have undergone substantial change as have the expectations and training of the workers within them. There remain remnants of the past in systems and in the minds of workers from each generation. Some will welcome innovation because it allows them to do the work they always wanted to do. Others will resist because their power or professional identity is threatened, or because they lack the confidence or the capacity to meet the new demands (Smale, Tuson and Statham 2000). There is a multiplicity of organisational and professional stages and positions that have to be worked with, rather than a monolithic unity that has to be managed. Part of this is a persistent strand of resources and approaches that are service rather than needs led. Some time lags relate to the lengthy process of shifting resources, including buildings and staffing, into new areas. Others concern the time taken to embed innovations: years rather than months. Direct Payments is a very good example of second order change. Implementation has been slower than hoped. Growth has been in the 'safer' areas such work with disabled people who led the demand for and developed the expertise in using Direct Payments. It has been less successful in reaching people with learning disabilities, sensory impairments or older people. In part, the explanation is lack of information among first line and middle management who act as gate keepers to innovations and also to a failure to connect Direct Payments with a new conception of the rights of people using services (Evans and Carmichael 2002).

1.7.5 Perspective Four: International

A third framework is the international definition of social work agreed between the Schools of Social Work and the International Federation of Social Workers:

Social work is a profession which promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at points where people interact with their environments. Principles of human rights and social justice are fundamental to social work. (2001)

This takes a very broad perspective on the role of social work. Conceptions of social work's role in promoting human rights and social justice

• differ between countries and at different times in the same country,
• whether it is a legitimate activity when people have been trained often with financial support from, and subsequently employed by, state institutions.

The Scottish policy emphasis on human rights and social justice for people who are disadvantaged potentially offers coherence between policy objectives and international definitions of social work. However, achieving these changes at the front line when there is a limited view of social work's primary activity is much more difficult. There is an incongruity between a conception of social work as concerned with human rights and social justice and its current primary task: rationing scarce resources and assessment.

All the above perspectives view social work intervention as more than an administrative task. Quality and effectiveness are achieved through how that service or support is provided: the process and the relationship are integral to the service and sometimes a service in itself.

They must also be responsive to the people who use them and must treat them with respect. The more people feel valued within their community, the more likely it is that they community itself will develop the capacity to thrive. (Chisholm and Mulligan 2003)

Personalisation is just as simple (as privatisation) by putting users at the heart of services, enabling them to become participants in the design and delivery, services will be more effective by mobilising millions of people as co-producers of the public goods they value. (Leadbeater, 2004, p19; writer 's addition in brackets)

Summary

Service users organisations and national government use the social model to look at the outcomes they want to achieve. Within this there are different priorities for social work intervention. Where national or local government funding is used and where statutory responsibilities exist, these are the dominant force. The weakest force is the international perspective. Service users and carers priorities tend to be to find solutions that are as close as possible to living as 'normal a life' as possible in their own homes or with their families.

1.8 CONFLICTS BETWEEN PERSPECTIVES

Much social work intervention is concerned with managing conflicts between the different perspectives on the need for social work intervention. When social work was seen as promoting a dependency culture the consequence was that the role was deliberately circumscribed. This view was in conflict with the perception that social workers had of themselves and their purpose. Throughout the UK there has been a growing consistency between the perspectives of people using services and policy positions. It is much harder to hold to this consistency in practice. Often conflicts between policies, resources and requirements are resolved only at the front line. Some of these conflicts could and should be resolved by management and others are contradictions that have to be lived with at all levels. An outcomes approach to social work intervention and an emphasis on personalisation and person centred planning requires greater openness about conflicts and the way they are resolved.

1.8.1 Conflicts arising from interventions relating to control functions

Although a separate project is addressing offending behaviour, the control functions of social work cannot be ignored in this project, because it is a significant source of conflicts of perspective between social workers and:

• parents who are abusing drugs or alcohol in relation to decisions to remove their children,
• mental health survivors over compulsory admissions,
• people with learning disabilities where individuals have committed offences,
• members of the community who disagree with assessments that the risks to the safety of the individual and/ to others are within acceptable limits.

When the exercise of social work control functions fail this is often seen to be the result of misjudgements or interventions that were too limited, involvement too late or non-existent. The failure of social work interventions may result from a lack of skills and knowledge, or from organisational priorities including allocating sufficient time for the work, or be the result of an insufficient supply of, or inappropriate resources or expertise, a lack of evidence on which to act. It may equally be a mixture of all of these. Social work is not alone in coping with the consequences of the failure to control. This situation affects other professions, such as doctors and sheriffs and the police and there are systems in place to address these failures. However, social work probably suffers more than these professions from a tendency for condemnation to spread from the specific failure to the profession as a whole. The establishment of regulatory organisations for social work and social care may in time give the public confidence in the profession.

1.8.2 Conflicts arising from implicit or explicit disagreements about problems and outcomes

The history of social work is littered with evidence that there can be a huge gap between the judgements of social workers and those of people using services (Marsh and Fisher 1992). This is a problem that has not been resolved. A consistent finding of research led by people using services is that social workers do not listen to them even though this skill is given high priority in social work education (Harding and Beresford, 1996, Turner and Evans 2004). Nichols et al (2003) argue that identifying different perspectives on an issue or problem and having clarity about the service user's 'preferred option' is essential to addressing the noise that enters the interaction between the worker and the people using services. Some of this comes from very well intentioned standards, procedures, policies of the organisation and the profession that divert the worker away from listening to the explanations, experience and expertise of the people concerned.

1.8.3 Conflicts arising from complexity and contradictions

Social workers intervene where the issues are complex and where these contradictions are likely to be in evident.

Social workers work in complex social situations to protect individuals and groups and promote their well-being…..social work is a moral activity in the sense that social workers make and follow difficult decisions about human situations that directly benefit or harm an individual or group. They should be able to understand moral reasoning and to make decisions in difficult ethical situations, especially where there are conflicting moral obligations.

(The Framework for Social Work Education in Scotland, 2003, p19)

In much of their work social workers have to find reasoned and responsible solutions amid a maze of values:

• the profession's own values
• society's predominant values as set down in legislation
• society's conflicting values - expressed by vocal minorities and held by powerless majorities
• other professions' values - health, medicine, education
• the local community's values
• the extended family's values
• the nuclear family's values
• the individual's values.

A high level of skill is required to identify conflicts, their origins and to negotiate outcomes that are frequently a compromise between what is preferred and what is possible within available resources, the balance of the rights and expectations of the individual and those of others involved and to negotiate an agreement (including disagreements) about a viable course of action. The level of the expertise required can be missed because the immediate location is often mundane - a person's home, in a car, during an activity such as cooking, filling in a form. Similarly, it is this very ordinariness of the situation that can obscure conflicts in perspective.

Summary

Conflict and uncertainty are inherent in social work. The reasons for this are first that there are different perspectives on the role and effectiveness of social work in both in general and in specific interventions. Secondly, social workers are routinely face complex issues that often involve moral, ethical and human rights dilemmas. Thirdly, solutions are often compromises. For this reason Nichols et al (2003) talk of identifying what people using services want to achieve and then agreeing the 'preferred outcome'. Finally, in some situations there are contradictions that cannot be resolved at the level of social work intervention and which have to be lived with.

1.9 WORKING WITHIN AND BETWEEN ORGANISATIONS

Social work intervention alone is rarely sufficient. It is dependent on trying to create the conditions within which change or maintenance outcomes can be achieved. Usually this requires securing agreements and resources from within and outside the social worker's organisation and profession. For example:

Within the organisation negotiation is necessary:

• to make and implement a plan for permanence for an accommodated child
• to get support from the mental health team for a parent to continue to care for her child
• to fund support for a carer of a person with learning disabilities or Alzheimer's Disease
• for a disabled person to achieve greater independence through Direct Payments.

Outwith the organisation negotiation is necessary with:

• the police to protect a black or minority ethnic family from racial harassment
• health services to secure health care for an elderly person whose condition has deteriorated
• private and voluntary care homes to provide a home for an older person
• a housing support organisation to arrange independent living for a person with learning disabilities, or to negotiate changes in the level of support because the individuals social care needs or health needs have increased.

Negotiating for resources within or outwith the organisation, or supporting others to do this, is carried out routinely by all levels of social worker. This is often described 'working the system'. It could, and we argue should, be seen as an intervention necessary to ensure that the organisation delivers its primary objectives as often as possible. One member of our team worked in an authority where the computer system failed two or three times a week. It was not until it was framed in terms of a potential child death that the computer team understood their contribution to the safety of children.

An understanding of group dynamics in team working is necessary in multi-skilled/ professional teams as a means of enabling them to function effectively (Learner and Statham 2005). The more social work intervention becomes a collective, rather than an individual, activity the more these group work skills will be required:

• for building, maintaining, disbanding work based teams. These often include not only agency workers but also members whose life experience, professional training and work experience have been in a variety of countries. For this group their time in Scotland is intended to be time limited before they resume their career in their own country.
• for teams to be inclusive of service users and carers.
• to create ad hoc teams to deliver personalised services, whose membership is routinely changing so that they are fit for purpose. They are as likely to include parents and family carers as other professional groups.
• to keep the focus on the work as opposed to being diverted into conflicts between team members or relative professional status.
• to build and maintain community partnerships that are experienced as inclusive by people using services and their organisations rather than empty words (Balloch and Taylor, 2002).

These tasks are not exclusive to social work, but require seeing effective team and inter organisational working as part of the professional task.

Understanding human relationships, individual learning patterns, group dynamics and the way power operates, contributes to improving poor team performance, but also to the maintenance and development of effective teams. Scotland's expansion of social care involves a growing demand for social care skills and retaining existing and attracting new staff is a key task for organisations (Scottish Executive 2004).

Summary

The policy thrust towards integrated services to deliver personalised packages of support highlights the need for interventions that promote collaboration and partnership working with and between organisations and professionals. The skills of social workers in understanding and using group dynamics, in team development, networking and in communication with different stakeholders have the potential to contribute to this work.

1.10 USER LED ORGANISATIONS, VOLUNTARY ORGANISATIONS, COMMUNITY GROUPS AND PRIVATE COMPANIES

Organisations providing social care are diverse not only in their specific focus, but also in their governance, structures and priorities. How consistent the day to day practice is with the aspiration for user centred outcomes or personalisation will depend on the remit and purposes of the organisation. Coherence between an organisation's remit and its front line practice requires a culture that supports practice and learning, including learning from mistakes, and taking risks. The maintenance of this culture requires constant attention and in common with good practice is easily lost.

In service user organisations there is likely to be a high level of consistency between the perspectives of services users and the purposes of the organisation. Where a voluntary organisation is self funded this level of consistency may also be retained within the limits of available funds and the stated charitable purposes. This position of secure independence is relatively rare, since most voluntary organisations will be commissioned by a local authority to provide services according to contract with evidence provided that this has been achieved. A similar situation applies in private companies.

There is consistent evidence that mainstream services frequently fail to provide support that is culturally appropriate for people from black and minority ethnic groups (Butt and Box 1997, Harris and Dutt 2004). For black run organisations interventions are necessary to create the space for culturally competent practice. Interventions on the part of the manager to work with the majority population, with funders and statutory organisations were routinely required to enable front line workers to offer culturally appropriate interventions (Ejo 2004).

The pull towards statutory duties often distracts workers from their aspirations to deliver personalised services and to provide the early interventions that would make a difference to the quality of people's lives and avoid or delay the need for more intensive support. Sure Start and neighbourhood renewal projects have deliberately targeted funding outside Social Work Departments and provided new contexts within which long term goals for promoting social well-being can be pursued. Implementation of the Local Government in Scotland Act 2003 promotes a focus on the promotion of community well-being and could enable voluntary and community organisations and businesses to open up a whole range of preventative resources. The role of social workers in community development would be to support these developments and to work to ensure that the needs of minority communities are addressed.

Summary

Organisations led by people using services are a powerful source of support. They use their own expertise and experience as a resource. They have innovated approaches that empower people to take control over their own lives, resist being labelled as a 'service user' 'patient', demonstrate culturally competent practice with black and minority ethnic groups. Initiatives to promote well-being have been successful where partnerships involved statutory organisations, but have been set up outside of them. The test will be whether these can survive being mainstreamed or whether they are best left outside of statutory organisations.

1.11 THE NEED FOR CHANGE IN SOCIAL WORK INTERVENTIONS

There are four main reasons for the need to change.

1. Policy changes resulting in a change in status of people using services to citizens

Interventions have been based on assumptions that people using services were recipients. They focused on what individuals could not do as opposed to what they and their social network could do. A model based on full and equal citizenship (Elder-Woodward 2002) requires interventions in which people using services are active and equal participants.

2. Changes in the knowledge and skill base

As with any profession there are both new approaches and new understandings about the effectiveness of specific interventions. Investment in research and the dissemination of knowledge and skills in health remains vast greater than in social care. But the strengthening of these resources in social work and social care should result in more knowledge based practice and management in the medium term. The case for recognising different sources of knowledge has been made and the multiplicity of information collected in Departments needs to include that produced through the experience and expertise of people using services and front line workers as well as from research.

3. Technological and structural changes

Given rapid changes, gaps in knowledge and skills may arise because new areas of work are emerging resulting in supply falling behind the demands. Examples of this in the past have included the emergence of HIV/ AIDS, working with asylum seekers, the role of social work in disasters (Newburn 1993). New technologies and the growing familiarity of the public in using them opens up new forms of interventions particularly to assist independent living and at the lower levels of need. In areas where there is rapid development or new issues practice is of necessity in advance of theory. Strategies in these circumstances include:

• transferring existing knowledge and skills to the new area
• drawing on any international experience and expertise
• networking to share and learn from experience.
• research on needs and effective responses.

Initially these may need to be done separately to structure different a perspective before it is possible to bring experience and learning together in new ways.

4. Multi organisational, multi disciplinary teams and multi professional teams will be the norm

A consequence is that greater attention will have to be given to:

• supporting professional social work practice
• safeguarding the value base, the relationship and the process as essential to good practice
• charting new and emerging groupings of skills and expertise of social workers and related occupations and professions. Some will merit attention at post qualifying levels, some will be idiosyncratic and fit for purpose only in a very limited number of circumstances.