Recently in Social work Category

Support, not coercion, is the route to moral responsibility

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Cameron Social responsibility poster 1.jpgAccess to welfare is increasingly dependent on people's behaviour, on the grounds that this promotes responsibility. However, in this guest post, Viv Ashley, from Essex University, argues that this penalises people for factors beyond their control and erodes responsibility.

As austerity cuts bite ever deeper, there are indications that society's tolerance of people receiving welfare is wearing increasingly thin - even towards those traditionally considered to be deserving of support, like disabled people. 

This is causing policymakers to raise more and more questions over whether the state can afford to support people who are seen as creating their own welfare need through choices perceived as reckless. 

They argue unconditional welfare support only encourages irresponsible behaviour and that withdrawing support is a cost-effective way of rationalising scarce resources. However, the feedback we received from social workers and other practitioners who attended our workshop on autonomy and responsibility in social welfare last week shows that this approach might be mistaken and even counter-productive - possibly damaging the life-chances of extremely vulnerable people and their children. Practitioners felt that extra support might be needed, not less.

Those attending the workshop explained how the principle of 'welfare conditionality' is becoming increasingly dominant in social welfare policy. This principle presumes that the claimant could have made a prudent decision, and should therefore bear the costs of their choice - for example, those found to have caused their own homelessness are excluded from re-housing.

But, practitioners say there are fatal flaws in such a presumption. They pointed out people often fall foul of welfare conditionality because of troubled childhoods, social exclusion or personal crises that undermine their ability to make choices which effectively promote their wellbeing. 

I would argue that such people could be said to fall into the 'grey area' between 'capacitous moral failure' and 'psychopathological incapacity' - where someone lacks mental capacity due to mental impairment. Laws such as the Mental Capacity Act aim to catch those who fall into the latter category, whilst welfare claimants capable of making wise decisions are caught by the first 

But, policymakers need to be more aware that there is a significant group of individuals whose ability to make 'good' decisions is hindered by circumstances beyond their control. 

Demonstrating the value of social work with adults

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You may well have spotted this already but Research in Practice with Adults' (Ripfa) today launched a manifesto on demonstrating the value of adult social work.

Its view appears to be that social work is of value to service users and carers, but that much more work needs to be done to demonstrate that - the 10-point manifesto seems to be a route map for demonstrating this value.

Here are some of the points:- 
  • Value cannot be demonstrated without considering the difference made to service users and carers;
  • There is an obligation to demonstrate value from money spent on social care;
  • Evidencing value is the responsibility of people doing practice as well as those undertaking research;
  • Value and impact should be captured by front-line social workers who know what is happening with individual service users and carers, as well as at a population level;
  • Demonstration of value should include experience [of users and carers] as well as the outcomes themselves.
It's very much a starting point for a wider debate on how adult social work can prove its worth, that Ripfa will take forward on Twitter (#socialworkvalue), through online contributions and face-to-face events.

Have a look if you have a moment.

What does Paul Burstow think about social work?

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This is care minister Paul Burstow at last week's Community Care Live on the government's vision for the future of social work with adults. It fleshes out some of the comments made in his speech to the conference, which we covered on the site last week.

Should promoting volunteering be key part of social work role?

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Older people who volunteer (such as John Ross in the video above) are happier, less depressed or socially isolated and have a better quality of life, finds research published today by charity WRVS. And the effect is greater, the more frequently you volunteer, the more organisations you volunteer with and the longer the period over which you volunteer.

While older people who are healthier and wealthier are more likely to volunteer than their less fortunate peers, the positive impact of volunteering on older people holds even when differences in the characteristics of volunteering are taken into account, according to the study by Manchester University.

There are some caveats in the study but it seems relatively robust. All of which begs the question of how the social care system can promote volunteering among older people who need support or who may need support in future, and what is the role of social workers in doing this.

It feeds straight into the discussions around the revival of community social work (which the government is apparently interested in and may promote in its forthcoming White Paper) and the growing interest in local area co-ordination - an approach that focuses on helping people build community networks and make the most of their assets and strengths.

It would be good to hear about any good practice in this regard.

Home care medication visits cut by pill dispenser

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automated pill dispenser image.jpgSignificant savings can be made by giving people with cognitive impairments automated medication dispensers, thus cutting down the need for home care visits to remind people to take their pills. That's the finding from an evaluation of a pilot conducted in the West Midlands. Some £431,000 was saved over six months from health and social care spending on 251 people who used the dispenser, which is set to make a sound and dispense the required pills when the person needs to take them (here's a video demo). As well as reducing the need for medication reminder home care visits, it's also cut hospital admissions. Reported user and carer satisfaction levels are high too, seemingly.

Social care's ups and downs in one blog

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Sorry for the lack of a post yesterday - I was on training and also feeling a little chastened from my big blooper earlier in the week. Anyway, here's another apology: you may have seen this but for the last few months, Walsall Council has been running a blog telling real stories about what it's social care teams are doing. It's called Who Cares? and its aim is to provide an insight into what local authority social workers and social care staff do as well as dispel myths.
It's the sort of thing Community Care and others have been calling out for ages and is well worth a look. The word cloud above illustrates the most popular words from the posts loaded so far.

The future of social work and personalisation under one roof

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CC Live 2011 pic.jpgI do hope you've all booked your free place at this year's Community Care Live, on 16 and 17 May. If not, here's a rundown of what the event offers professionals working in adult services:

Day 1 (16 May)

The role of social workers in adult social care

Social work's role in adult social work continues to be questioned as cuts bite and responsibilities shift under the impact of personalisation. This session will provide the latest thinking on what social workers bring to adult social care. For a taster, read the thoughts of one of our speakers, academic and service user leader Peter Beresford, on what clients want in a social worker.

And check out the following pieces for some useful background reading:

Social workers still have big role, says new Adass chief
Adult social workers pessimistic but proud, finds College
How social workers can be liberated from shackles of care management
What future for adult social work?

Adult safeguarding: lessons from Winterbourne View

The Winterbourne View scandal has sparked calls for fundamental improvements in safeguarding and the care of people with learning disabilities and complex needs, with calls for an end to institutionalisation and much more personalised support. This session will give us the Department of Health's latest thinking on this, courtesy of director of mental health, disability and equality Bruce Calderwood, and the evidence from the Care Quality Commission's inspections of 150 services, called in response to Winterbourne.

Here's some useful reading:

How service users are leading the response to Winterbourne
Preventing abuse of people with learning disabilities in the wake of Winterbourne View scandal

Effectively implementing the Mental Capacity Act

With practitioners and researchers identifying training and knowledge gaps regarding the Mental Capacity Act, our session on effectively implementing the legislation will provide much-needed advice and guidance.

Here's a ready-made reading list of 10 key articles on the Act's implementation.

Picture: John Behets

What service users want from social workers

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Just a quick one to alert you to a great piece from Peter Beresford (left) on what service users want from social workers.
He picks out four key qualities: relationship-building, social awareness, listening and providing practical as well as emotional support.
Beresford's perspective is informed by his own research - he is professor of social policy at Brunel University - and his experience of using mental health services and chairing users' network Shaping Our Lives.

The latest on local area co-ordination

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I've given the topic of local area co-ordination a rest after the spate of posts earlier in the month (on the experience from Scotland, and how far it does or does not overlap with community social work) but it's worth catching up with recent developments in the latest Local Area Co-ordination Network newsletter, produced by Inclusive Neighbourhoods, the organisation that is promoting the model in England and Wales.

Our first social work practice debate in summary

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It was so good to see (virtually!) so many of you at our first Social work dilemmas live practice debate yesterday. You can read it in full on the page linked to, but for those short of time, here's a summary:

Case study

Jackie is 64 and has been diagnosed with clinical depression. She has no living relatives. Her social worker visits her at home. Jackie seems confused and mistakes them for one of her neighbours. There is a pile of unopened mail by the front door. Some of these appear to be unpaid bills and final demands. Since the social worker's last visit Jackie seems to have noticeably lost weight. It is evident that there is very little food in the cupboards. Despite this, Jackie insists she went shopping yesterday. Jackie says she does not want to receive support with her shopping and food preparation. The social worker is concerned and asks if Jackie would see the psychiatrist for a review meeting. But Jackie says that everything is fine, and that she is "just a bit tired".

Initial thoughts

One of our panellists, social worker Victoria Hart, helped kick things off with her initial thoughts on the case.

Unanswered questions

Our expert panellists agreed that there were a number of unanswered questions that the social worker would need to probe to build a full picture of Jackie's life, for example who else is involved in her care and what contact does she have with friends or neighbours?
Victoria pointed out that there could be a physical health reason for Jackie's change in presentation, such as a urinary tract infection, and it would be worth asking her if she wanted to go to the GP to rule this out..

Should we assess capacity?

There was quite a significant consensus that we shouldn't be assessing Jackie's capacity before identifying why her presentation has changed. In line with the Mental Capacity Act 2005, Jackie should be assumed to possess capacity and supported to make decisions.
Victoria pointed out that not wishing to open mail or see a psychiatrist was not evidence of a lack of capacity.
Panellist Natalie Saunders, an independent mental capacity advocate and consultant, also stressed that capacity can only be assessed with a reference to a specific decision Jackie may need to take.

What kind of social work is required?

Many participants, including our panellists, stressed that the social worker should be focusing on building up Jackie's trust and slowly introducing the idea of her accessing support.
"This situation highlights the need for gently introduced support which is sensitive to her needs and wishes," said panellist, social worker and academic Martin Webber. He said this was something social workers were particularly good at. Fellow panellist and social worker Pete Morgan said that the point of social work involvement was to help Jackie regain control of her life. He added: "Too rapid a response will be counter-productive, though there is still a duty of care to be met."

We also had this comment from Janine Hudson: "There is no indication to adopt an assertive approach but given that there are so many unknowns including the state of her physical health I would try and visit as often as possible in order to tease out more information."

When should capacity be assessed

Jackie's capacity to decide how to respond to her symptoms should be assessed if she declined to visit her GP, a high majority of people viewing the debate said in a poll we conducted.
However, most of those who commented in the debate suggested a less conditional approach, focusing on gathering information and building a relationship with Jackie. An exception was Philip Measures who said starkly: "A GP is essential, not a suggested option." His view was that Jackie had clinical depression and was ill; what was required was a medical assessment, not social work. His view was that she had no insight into her condition.

The Mental Health Act

Philip said that a Mental Health Act assessment might be required if it appeared her life was at risk, however others disagreed.

"This poor lady... put yourself in her shoes for a moment," said Dawn LaBarre. "She is alone, she is likely lonely, she has nothing to occupy her. She may have money problems and so opening her bills just makes her feel worse. Instead of running to assessments, perhaps talking with her first will help us gain some insight."


About the Adult Care blog

   
 

The Adult Care blog looks behind the policies, practices and personalities involved in the care of older and disabled people for any hidden truths, helpful tips or humour.

It is written by Community Care’s adults’ services beat editor Mithran Samuel.

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