High hurdles

“The evidence base for social care is becoming increasingly
important for social work practice. But practitioners rarely have
an opportunity to contribute to this through high quality research.
My experience as a researcher and practitioner suggests that this
is because there are too many obstacles to overcome.

First, it takes a sympathetic supervisor to encourage a
practitioner to develop research questions. The priorities of
casework and risk management often override opportunities to
consider social care needs or evaluate practice on a larger scale.
Research opportunities can easily be missed in busy fieldwork teams
and social workers are often ignored in multi-disciplinary research
projects.

Even if enterprising social workers find opportunities for
research, resources are scarce. Funding for social care research,
especially for small scale projects, is meagre in comparison with
that available to our medical colleagues.

I came across the Association of Directors of Social Services
Research Group awards scheme, which aims to address this need. The
Research Group offered a limited number of awards of up to
£2,000 to help social services practitioners undertake
research projects. Funded by the private sector, the three-year
scheme has shown what can be achieved when time and money is
invested in practitioner research.

Mine was one of six projects funded in the final year of this
scheme in 2001. Curious about a connection between the use of
section four of the Mental Health Act 1983, known as the “emergency
section”, and social deprivation in London,¹ I designed
a study to investigate whether section four admissions were the
result of social exclusion.

Obtaining funding was the key to the success of this project. With
the backing of the ADSS Research Group I had both the impetus to
undertake the study and the guaranteed support of my local
authority – Kingston in south west London.

Before starting the project I needed the approval of the South West
London & St George’s Mental Health NHS Trust research and
development committee and the local research ethics committee.
These bodies are more used to scrutinising proposals for drug
trials than evaluations of social policy. No social workers sat on
these committees and they betrayed a lack of knowledge of the
concept of social exclusion. Service user researchers report
similar difficulties and their perspectives often appear alien to
committee members.²

My proposal was initially rejected by the R&D committee as I
had not included a power calculation for the sample size. Although
I now realise that this is a basic statistical requirement of
research proposals, my post-graduate social work training had not
prepared me for it. My proposal was extensively modified by a
statistician and re-submitted to the R&D committee. The changes
that were made improved the empirical validity of the study and,
more importantly, ensured that it met the R&D committee’s
criteria for acceptance.

The local area research ethics committee expressed some concerns
about confidentiality and the methodology of the study. This body
of more than 12 people from different medical backgrounds had
little understanding of the work of the approved social worker and
were dubious about a non-medical research proposal. It was only
after extensive questioning and subjecting the proposal to minute
scrutiny that the committee chairperson agreed the project.

Having funding and ethical approval for the study obliged my local
authority to support me with the research. However, there were no
additional resources available to help with my caseload. I had to
complete the research while managing case work of up to 30 people
with severe or enduring mental health problems.

I planned to take 12 months to complete the project. The
three-month delay from the R&D and ethics committees meant Ihad
to achieve more in less time. I asked my manager for half a day a
week to do the work for the project. The only time that could be
spared was during the weekly team meetings to ensure that the
office would be appropriately staffed at other times. This meant
that I was unable to attend important team meetings for a number of
months while I collected the data.

The study was a case file analysis of 300 Mental Health Act
assessments in two London local authorities. I collected data on
socio-demographic variables and perceived risk factors. In general,
I found access to the records was relatively easy.

Access to resources for the literature review was more problematic,
however. I was able to gain access to the medical library of St
George’s Hospital, after a senior manager confirmed that I was a
bona fide member of the mental health trust. This was of limited
use because of the lack of relevant social policy journals. I had
to return to Royal Holloway College, where I did my social work
training, to view its wider collection of journals. However, I
could only gain access to sociology and social policy bibliographic
databases through my partner, who was undertaking social work
training at the time.

I was fortunate to gain support with the quantitative analysis of
data required in the study. The research funding paid for a short
course in statistics and purchased a copy of the statistical
software package SPSS. With the support of the trust statistician,
and the supervision of professor Peter Huxley of the Institute of
Psychiatry, I drew some conclusions about the patterns that
emerged. But this kind of support is not widely available to social
services practitioners.

Many evenings and weekends were taken up completing the literature
review, data analysis and final report. This enabled me to present
my findings to the ADSS Research Group on time in February
2002.

The research revealed that the most significant factors in
predicting section four admissions were the risks of suicide or
harm to others presented by people being assessed under the Mental
Health Act. The social exclusion of individuals was not
significantly associated with the use of section four. ASWs and
psychiatrists alike were interested in these findings and my
presentations to the two groups led to much discussion about our
practice and the potential for multi-disciplinary research in
community mental health.

Social workers are reluctant to become involved in research as
teams lack the structure or resources to support them.
Practitioners need training and support to become more
research-minded and to develop the skills and confidence to
undertake studies. This needs to be backed by funding and the
commitment of employers to allow some caseload relief. The support
doctors or clinical psychologists receive to undertake research
stands in stark contrast to that available to social workers.

With more research opportunities, supported by adequate resources
of time and expertise, social workers will be able to bring their
valuable insights to the social care agenda.

Martin Webber is social science fellow at the Institute
of Psychiatry, Kings College, University of London.
m.webber@iop.kcl.ac.uk

References

¹ PJ Huxley and M Kerfoot,
“Variation in requests to social services departments for
assessment for compulsory psychiatric admission”, Social
Psychiatry and Psychiatric Epidemiology, 28 (2), 71-76,
1993

² V Lindow, “Being ethical,
having influence”, Openmind, 116, 18-19, 2002

Recommendations:

• Include research training in new social work degree
  course.
• Increase research competence of social workers on
  post-qualification training courses.
• Ethics and research and development committees to include
  social workers as members.
• Ring-fenced funding for social care research, accessible to
  practitioners.
• Resources to be found to provide caseload relief for
  practitioners undertaking research.
• Free access to social science journals and libraries for local
  authority employees.