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

APPENDIX ONE: THE ROLE OF SOCIAL WORK

Social work operates in an environment of competing professions and there has been a longstanding difficulty in defining and expressing its unique contribution and expertise. The reasons for this vary from a reluctance to claim its own slice of professional territory and the authority derived from special knowledge not available to the lay person that often goes with that claim. In part the concern has been that asserting its professional authority could further dis-empower people requiring its services.

Skill and knowledge shifts within and between professions routinely take place over time. A characteristic of social work is that it's knowledge base is multi disciplinary and social workers have the capacity to move into territories of skill and knowledge that 'belong' to other professions and occupations. At times this is part of assessing the need for specialist expertise, at other times it is part of journeying (Care Journeys) with the person using services.

In a world where professionalism is seen territorially, this capacity to travel into and out of other people's territory is not seen as flexibility, but as social work 'being a Jill of all trades but mistress of none' (Williams 2004). At the same time social work feels threatened by claims from nurses, police and other professions to be able to do what social work does. This paper starts with the assumption that social work takes a holistic view of a person's life and situation whether this is in assessment of need, in direct work with them, or through accessing support from social care staff, other organisations, professionals and other workers in related fields.

The key characteristics of social work are:

• the focus on the whole of the person's life, their social context, and environment
• the capacity, in circumstances that are often difficult:
• • to engage quickly with people to establish trust,
  • to persist in efforts to engage even when this has proved difficult and others have given up
• consciously to move into situations that would be avoided by most people because they are complex and high risk
• the relationship established between the social worker and the service users involved is integral to achieving quality
• the capacity to manage situations where risks are very finely balanced so that 'you are damned if you do and damned if you don't'

We have assumed that there is a generic base for social work and that this means that newly qualified workers 'enter the social work world with the core knowledge and skills necessary to begin professional practice across the required range of settings' (Williams, 2004). Earlier specialisation can lead to tunnel vision that hinders social worker being able to keep an holistic perspective on their work and to 'indefensible divisions of responsibility' (Williams, 2004). This is particularly important given the structural divisions such as those between services and within for adults and children. If the key feature of social work is its holistic approach, retaining a generic foundation is essential. Specialist areas of practice will emerge because existing knowledge and skills have to be transferred and built on for the social worker to function effectively in a specific set of circumstances. These include the legal, organisational and inter-professional and inter-organisational arrangements involved. The stage at which these specialist areas of practice are introduced is debatable. In the view of the authors at least at post qualification levels they are likely to include the following:

• direct practice, of various types and techniques
• management and development:
• • of practice, including work based learning for students and staff
  • of service provision and development, including commissioning
  • policy and strategic developments within the organisation or the field
• working within a range of organisations to contribute to promoting policies and practice that support social and personal well-being
• research and development.

We are not suggesting an exclusive focus, but that the majority of the social worker's time will be spent on one of these areas. All will be operating in a multi-organisational and multi-professional context whether in the statutory, private or voluntary and community sector.

The term 'social work intervention' usually describes work undertaken with individuals, families, groups and communities. In looking to the future we have also used the term to cover the use of social work knowledge and skills when using any of these methods of intervening:

1. within a social care organisation to facilitate the provision of services and practice consistent with the Codes of Practice and with standards of service and practice
2. to promote the social inclusion and life opportunities of people using services
3. between organisations, where the objective is to promote partnerships that are required on a short, medium or longer term basis to provide integrated services, or to personalise a particular package of support e.g. when working with dual diagnosis in mental health and alcohol abuse, or learning disabilities and sensory impairment
4. as part of a multi-professional or multi-disciplinary team to promote effective integrated working with people with dementia and their carers, rehabilitation following strokes or brain injury, or neighbourhood and community development
5. in organisations such as businesses and industry, corporate governance, the media, and the political arena, to bring the social work perspectives and skills into organisational development and management.

Successful social work includes the capacity to work effectively within organisations and across organisational boundaries. In the vast majority of instances social work intervention is a collective activity not an individual activity whether as an employee or an independent social worker. This aspect of social work intervention should be given the status of an intervention rather than as an adjunct to direct work with people using services. The Framework for Social Work Education in Scotland emphasises:

The significance of interrelationships with other social services, especially education, housing, health, criminal justice, income maintenance, and other services provided by partners (p32)

and the competence to:

Develop, maintain and review effective working relationships within and across agency boundaries (p42).

The most common forms of methods of social work intervention are:

1.Community development

Where problems such as environmental poverty, high unemployment rates and poor housing, are affecting a community, social work intervention at the individual, family or group level will not address the problems and a community development approach is necessary. Social work intervention with individuals and families may, however, assist people to survive coping with the impossible, foster resilience or enable them to begin to build platforms of support that could improve their lives.

Social workers were key in the UK in undertaking community development in the early 1970s, and the values, skills and expertise recommended in neighbourhood renewal programmes are consistent with those of social work. However, the documentation on social exclusion in England is singularly and deliberately silent on the role of social workers. In Scotland the role of social services in community development is embedded in legislation and pioneered much of the work underpinning the development of community social work (Smale and Bennet 1989).

2. Group work is an appropriate form of intervention where people share difficulties and want, or are required, to find ways of resolving them.

The most common forms of group work are with people who abuse alcohol and drugs, with mental health difficulties, young carers, children and young people who are accommodated, teenage mothers, children who are unaccompanied asylum seekers, and offenders. They use the collective experience and expertise to share effective solutions, provide mutual support, promote self esteem, confidence and identity. They are a powerful resource in facilitating the empowerment of people using services and in reducing isolation for example of disabled young people from black and minority ethnic groups and women who have survived domestic violence. Many of these groups take place outwith social work departments in the voluntary and community sector, in hospitals, in youth work or the health service. The workers may or may not be social work trained. The generic expertise and skills are those required for setting up, running and ending groups, understanding and using group dynamics. Specialist skills relate to understanding the needs and issues facing the particular group of services users and how these may impact on group process and dynamics.

In recent years there has been a growing number of groups and organisations run by people using services. They are based on structuring the experience and expertise of a particular service user group to form a resource for others facing similar issues. The philosophy that shared personal experience is a valuable and essential resource in achieving change is in direct contradiction to the ethos in the organisations in which most of social work is practised. Here staff are fearful of managers knowing about personal difficulties as this is deemed likely to affect views about their competence as a worker and their potential for promotion (Turner and Evans 2004). Similarly, the expertise of the 25% of staff with responsibilities for caring for an adult family member is not seen as a resource for the organisation, but often an impediment to its operation (Balloch, McLean and Fisher, 1999).

Traditionally residential care has been thought of as 24 hours a day and 365 days a year, but in supported living support can range from intensive to minimal. A different conception of residential care that recognises the diversity of 'collective', 'group living' or 'communal living' arrangements should be developed (Residential Forum, 2004). Similarly, extra care and Direct Payments can offer intensive support in people's homes as part of community based support. Group work and communal living arrangements are likely to involve individual or family casework or therapy where a personalised programme is combined with other sources of support. In a minority of cases the communal living itself is used as a continuous therapeutic experience rather than being a periodic event within it. The main interventions are likely to be undertaken by social care staff and managers, with support from a range of professionals including psychologist, psychiatrists. Social workers may be involved on a regular or ad hoc basis or as external or internal managers.

3. Individual or family casework

Here social work is the intervention. It supports the individual or family to identify, and use, their own and their social network's experience and expertise as a resource for:

• releasing potential that has been blocked by past experiences
• problem solving where there are current relationship or parenting difficulties
• devising the service user's/s' preferred way of coping with intractable problems or difficulties
• promoting self esteem and confidence to adopt different approaches to existing problems
• surviving living with high risks or uncertainty
• learning new approaches to existing, new or emerging difficulties
• accessing and using information, new skills and knowledge
• devising ways of influencing organisations, groups or individuals that are blocking the achievements of preferred outcomes.

Problems or difficulties may have resulted from the effects of social exclusion, lack of skills or knowledge, or, self- defeating or self-damaging behaviour that achieves the very result that the individual or family most dreads.

The purpose of the intervention is diverse and ranges from:

• increasing life skills or changing behaviour to increase life options
• promoting independence and inter-dependence
• working with conflicts of interest or in relationships
• stabilising or slowing down deterioration and loss of independence
• coping with changed life situations and transitions
• learning new skills, for example in parenting or as a family carer
• loss, bereavement and trauma,
• balancing expectations, needs and responsibilities that involve ethical and moral dilemmas
• supporting individuals' development to enable them to participate in groups, use local community resources or to move to mainstream services.

A key factor is decisions about whether the social worker should:

• use direct, intensive therapeutic or social work. This often requires to the social worker:
• • to develop relationships in often complex and emotionally loaded situations at the same time as retaining some measure of neutrality
  • to convey the personal qualities of warmth, trustworthiness, confidentiality, and the capacity to listen and respond appropriately
  • to cope with pain and distress, anger, frustration and fear
• monitor situations where there is a significant element of risk or uncertainty that has to be managed or where it is not possible to establish a working relationship
• support others to provide direct support, that ranges from therapeutic interventions to providing intimate personal care
• work within and between organisations to facilitate the planning, implementation or monitoring of personalised plans
• plan a short, medium or long term intervention
• work to create a team whose membership is determined by the agreed preferred outcome. The definition of a team here is whoever is required to have the best chance of achieving the task. It is likely to include the individual using services and family carers or parents as well as workers and professionals within and outwith the workers own organisation (Smale, Tuson and Statham, 2000).

Trends in views about the effectiveness of social work

Over the past thirty years there has been a tendency to constrain social work within narrow boundaries because it was regarded as 'too liberal', 'too soft' and or created rather than reduced dependency. There have been numerous predictions of its total demise. Yet social work has survived often with a grudging sense that there is nothing else that covers its ground. A consequence of this ambivalence is that a failure of an individual or a social work organisation is taken as a failure of social work itself. In this it is unlike education that is not confused with the failure of a school, or medicine is not condemned as a whole as a result of the Shipman Inquiry. The calls here are for improvements rather than elimination of the discipline or the activity. Appalling though deaths are in social work, the figure of some 2000 avoidable deaths in our hospitals each year fail to raise headlines.

Evidence is growing about the effectiveness of social work and its limitations, including from people using services whether as adults or children and young people. A view of social work as specialising in working with uncertainty and complex ethical and moral problems means that new systems may be necessary to work through ethnical and human rights and public safety dilemmas, to improve accountability and public understanding. These already exist in child protection and mental health for example.

There is no one method or model of social work intervention that is fit for all purposes. The limitations placed on the range of interventions will depend on:

• social policy and resources
• the distribution or re-distribution of knowledge and skills between:
• • different professions and occupational groups,
  • levels of worker in social care, health, education. In March 2005 an English Minister proposed a Degree in Social Care that is separate from the Social Work Degree to match higher levels of skill required in social care
  • the degree to which adults, children and young people are empowered to use and build on their own expertise and experience
  • the support provided by the infra-structure necessary to promote well-being (income, housing, transport, environment)

Social work is a demanding professional discipline based on a body of values, knowledge, skills and personal attributes, and requiring a commitment by the social worker to continuing professional and personal development. It has a sound and consolidating knowledge base that can be deployed, and contributes in a growing variety of organisational and informal contexts.

In common with other disciplines such as psychology and nursing, social work in the 21 ^st century is likely to take a variety of forms and develop new kinds of specialism. Just as psychology now forms the core of such roles as clinical, forensic, educational, occupational and industrial psychologists, so it is likely that social work will increasingly be recognised as an independent discipline applicable in a variety of jobs, teams, organisations and career patterns. Current examples include:

• the recruitment of social workers to work with young people as personal advisors for the education and employment opportunities in the Connexions service,
• the success of managers from social work backgrounds in NHS senior management
• the used of social work consultants in the NHS
• the increased number of social worker MPs and MSPs
• combining skills from other professional groups
• skill shifts between levels in SVQ, graduate social work and Post Qualification and between professional groups
• independent social workers who are selling their services to the public and to organisations
• service industries and manufacturing that have found social work skills in human relationships in the workplace economically efficient.

The implications for social work education is for a diversity of routes in post qualification training and multi professional training where there are established career pathways. It is necessary to provide signposts into other professional training, for example in health, education, youth work, personnel management. There should always be room of innovative career paths which, although at the time may seem an idiosyncratic pattern, can indicate future trends. An example is Cicely Saunders' career path that led to the establishment of the Hospice movement. Other examples include HIV/ AIDS or working with unaccompanied young people seeking asylum.

Within this pattern of diversification, we understand the term 'social work intervention' to describe social work that takes place:

• in a framework of legislation, government policy, statutory powers and responsibilities, and practice and provision funded wholly or partly from public expenditure. This includes social work services provided by local authorities, by joint bodies combining social work with health, housing and/or education services and employment
• by voluntary and not-for-profit organisations including organisation run by people using services and community groups
• by private sector providers commissioned by statutory authorities or their proxies or privately purchased by individuals, families, groups or communities.

Prediction hazardous, but current trends indicate:

• multi-organisational/multi-professional and mixed skill teams as the predominant mode of delivery that are re-defining common and specific knowledge and skills in health, social work/social care, education.
• a greater emphasis on social and relationship problem solving and learning new skills and abilities. The model proposed by Leadbeater (2004) would mean that the need for social work intervention will be with those individuals who:
• • cannot for a range of reasons learn how to successfully self manage their problem solving
  • cannot cope with innovation and challenges to their personal, family and community functioning without additional support
  • have experienced severe trauma for which they or their family could not be expected to have the knowledge or expertise to cope with
  • new areas of need where creative responses are necessary
• a continued emphasis on person centred planning, interventions and outcomes. This changes the status of people using services and the balance of power between the social worker and the people using services. Exceptions to this position is where social control exercised e.g., in the justice system, child protection and, when rehabilitation is deemed to have failed
• a move from seeing a team as a group of professionals geographically located to membership being determined by whoever is needed to accomplish the task
• methods to manage the impermanence structured into our systems and work patterns and which children and adults find constant difficult.
• a focus on practice and provision that create as near 'ordinary living' (Residential Forum, 2004) or 'normal' family life as possible (Sinclair et al 2005),
• new specialisms and structures as needs change, for example, to work with asylum seekers teams, with women abusing drugs and/alcohol to support them to mother their babies
• changes in what is specialist and what is generic. For example work with older people needs a greater understanding of sensory impairment since incidence increases dramatically in people over 75 years
• systems and process that offer professional support to workers whose main work is outside social care.

The focus for intervention will include:

• assisting people either directly or through access to other forms of support, to reach a level where they can participate more fully and independently and access support from mainstream services, voluntary and community organisations
• providing directly, or through access to other resources, support that enables people with complex needs and communication difficulties to participate in making decisions about their lives and the way they live
• safeguarding the interests of people who are unable either temporarily, or in the medium or long term to be involved in participating in making decisions about their lives
• intensive therapeutic work with children and adults who have had traumatic experiences
• the management of long term conditions
• complex social or personal problems that are long standing, resistant to mainstream and other efforts to change them.
• partnership with the growing number of organisations controlled by people using services that are now significant providers
• promoting the use of support such as Direct Payments that give people as much control over their lives as possible
• methods of keeping an holistic approach when structures and services use artificial divisions between children and young people and adults.