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

SECTION THREE: SOCIAL WORK WITH ADULTS OF WORKING AGE AND OLDER PEOPLE

3.1 POLICY CONTEXT

A good deal of work has gone on in Scotland in recent years to review and develop policy for social work services to the adult client groups. Following 'Aiming for Excellence - Modernising Social Work Services in Scotland' (Scottish Office 1999), there has been a focus on policies to promote empowerment and inclusion (Scottish Executive 2003b, 2004d), strengthen safeguards for vulnerable adults and those lacking capacity (Scottish Law Commission 1997, Scottish Executive 2002c, Atkinson et al 2002, Scottish Parliament 2000, Scottish Executive 2002a), develop more integrated approaches to assessment and service delivery (Scottish Executive 2001c, Scottish Parliament 2001, Scottish Executive 2002b), and build the capacity of communities to support individuals and families and promote well-being (Scottish Development Centre for Mental Health 2003).

The thrust of these policies is generally consistent with evidence from research and policy-making elsewhere in the UK on adult protection (Department of Health and Home Office 2000, House of Commons Health Committee 2004), social and community inclusion (Nuffield Institute for Health 2003, Gorman and Postle 2003, Joseph Rowntree Foundation 2004), personalisation (Leadbeater 2004), empowerment (Neville 2004) and evidence-based practice (Aviram 2002, Gambrill 2004). The Scottish Social Services Council and other Scottish institutions have worked alongside their counterparts in the rest of the UK on the workforce, education and training implications of these policies, particularly as they affect social work and social workers ( ADSW and CoSLA 2000; SWSI 2002; COSLA, QAA and SSSC 2003; Christie 2003; Topss England, Care Council for Wales, NI Social Care Council 2002; Scottish Executive 2004d; Topss England 2004).

3.2 LIMITATIONS OF THE CLIENT GROUP APPROACH

This section of the paper looks at ways to understand and anticipate the future need for social work intervention in the lives of adults of working age and older people. Much legislation and policy, both pre- and post-devolution, uses traditional definitions of client-groups - children and young people, disabled people, people with learning disabilities, with mental health problems, with problems of alcohol and drug misuse, and older people. It is questionable, for several reasons, how useful these groupings will be as the 21 ^st century proceeds.

Many people in the adult groups have a range and variety of physical, sensory, mental health, substance misuse and/ or learning difficulties, in different mixes, which interact with each other and with acute and chronic health conditions including HIV/ AIDS to produce a wide diversity of obstacles to ordinary living, social inclusion and the exercise of their human and civil rights. The same conditions and combinations affect the lives of children, young people and their families, and of people over 60 or 65. Children in need or at risk are often living in families, or with other adults, where effective parenting is impaired by the adults' problems of mental health, substance misuse, intellectual or social impairment, or chronic ill-health (Kearney, Levin and Rosen 2000) So-called 'young carers' are affected in different ways by the support they need to give to parents with the various impairments (Leeson 2004), and in some instances parents' uncontrolled substance misuse or acute mental illness may pose a serious threat to the children's safety and well-being.

The term 'older people' can encompass two complete generations, as retirement takes place between 50 and 70 or more, and the numbers living into their 90s and beyond grow rapidly (Joseph Rowntree Foundation 2004). Ageing makes people increasingly prone to the effects of physical and sensory impairments, medical conditions associated with physical deterioration, falls and other accidents, depression, functional mental illness and various forms of dementia. Adults with learning difficulties, including some with multiple impairments, are increasingly living into old age. Occasional or chronic substance misuse is also likely to be a growing problem amongst older people.

Various terms and sub-divisions are in use, such as 3 ^rd Age and 4 ^th Age, 'sundowners' and 'frail elderly people', to distinguish the relatively active, unimpaired and independent from those with often multiple physical, sensory, mental health and psychological problems who require treatment and support from a variety of agencies and other sources. In reality the line between relative independence and complete dependency is a spectrum with a multitude of stages, and people move along it in different and highly individual patterns. Many 'older people' are contributing to the community in various ways as carers and minding grandchildren, in paid employment, as volunteers and in voluntary organisations, as councillors at different levels of local government. The loss of a spouse, onset or discovery of severe illness, a fall and loss of confidence, or being victim of a burglary, can all produce an abrupt shift towards greater dependency. Conversely, successful treatment or effective aids to alleviate a mobility or sensory problem, moving to manageable accommodation, gaining a valued role or establishing a new relationship, can all restore confidence and self-esteem and enable people to regain different degrees of independence.

3.3 SOCIO-ECONOMIC FACTORS

All the groups for whom social work intervention is likely to be needed are also more subject than most to a range of social and economic problems and barriers. A major factor is chronic poverty, often associated with unemployment or enforced retirement, long-term dependence on social security benefits, being the adult or a child in single parent families, and living in old age with inadequate pension provision. Poverty often goes hand in hand with other disadvantages and obstacles such as poor educational and employment opportunities, inadequate housing, living in deprived and run-down neighbourhoods, limited transport facilities, and lack of access to public services and commercial opportunities.

People's problems are exacerbated by the interaction between these socio-economic factors and their individual impairments and family situations. Many forms of disability generate additional costs to the individual for elements of everyday living. Unemployment levels are very high among disabled people and those with long-term mental health problems, who are also subject to stigma and prejudice on the part of employers. People without jobs and dependent on benefits find it hard to access credit. Poor children, those growing up in one-parent families and children in the public care suffer serious educational disadvantage, which in turn impairs their job prospects in later life. Ill-adapted and hard-to-heat housing has an adverse effect on older people's health and well-being, and social isolation made worse by mobility and transport problems can undermine their mental health.

3.4 NEED FOR SOCIAL WORK INTERVENTION WITH ADULTS

From the individual'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. For adults of working age and older people, these outcomes may be in one or more of the following areas:

• Exercise of Choice and Control ï¾' fully exercising human and civil rights and equal opportunities, maintaining or regaining maximum independence, managing risks inherent in ordinary life, being able to access information and choose and control support arrangements, being free from discrimination, harassment, neglect, exploitation or abuse.
• Economic Well-being - access to income and resources, from employment, pension, benefits and other sources, sufficient for a good diet, accommodation, heating, communications, participation in family and community life, and to meet costs arising from specific individual needs.
• Improved Quality of Life ï¾' suitable and convenient accommodation, safety and security at home and outside, access to transport, leisure, social activities, life long learning and universal, public and commercial services, ability to secure appropriate levels and preferred forms of support and personal care when required
• Making a Positive Contribution ï¾' engaging in education and training to reach full potential, having access to work appropriate to individual's abilities, active participant in the community through employment, voluntary and public service opportunities, involvement in local activities including participation in developing support service policy, decision making, provision and practice.
• Improved Health - Maintaining good physical, emotional and mental health, personal dignity and respect, with opportunities for physical activity and access to appropriate treatment and to support in managing long term conditions independently, keeping clean and comfortable in a chosen environment.

In response to these desired outcomes, the specific contribution of social work is to adopt a holistic approach to understanding the needs and difficulties of individuals and families in their social context, and to help them develop the solutions and achieve the outcomes that best fit their strengths, aspirations and preferences. This requires skills in working with and across a range of agencies and disciplines, adherence to a strong value base in a range of situations where solutions are not prescribed, the capacity to address conflicts of interest between individuals and between an individual or family and wider society, and the ability to exercise control when required within legal and professional frameworks with the minimum of damage to the individual's integrity. It also requires a range of personal qualities:

• 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

These requirements are common to working with children, adults and families, and reflect the reality that most children live with one or more parents or other adults, and that both the children and/or the adults involved are more likely than most families to experience difficulties stemming from the health or social problems listed. They support the model found in a number of other professions, where initial training and qualification is common and specialisation in training and practice takes place at the post-qualifying stage.

Most of the outcomes sought through social work intervention are common to work with adults of working age and with older people. Social work with adults 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

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 educational 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
• support the person to enter and maintain employment suitable to their abilities and expectations, and to develop satisfying and challenging careers in their chosen fields