Social group work: building a professional collective of hospital social workers

Deconstruction of traditional social work departments can isolate social workers from their primary source of professional affiliation, leaving them without the support to take stands on controversial patient care issues. This paper describes an alternative: the building of a powerful social work collective based on social group work theory that potentiates professional practice while transcending management forms. The model includes group supervision, but moves beyond it to utilize the social work group as a central organizing principle. At the heart of the collective are the elements of professional accountability, support, autonomy, and collaborative decision- making within democratic peer group structures. The authors highlight current management theory, distinctions that create an authentic social work value-based practice, and outcomes for social workers, their clients, and colleagues.     

Social Group Work

Abstract

Deconstruction of traditional social work departments can isolate social workers from their primary source of professional affiliation, leaving them without the support to take stands on controversial patient care issues. This paper describes an alternative: the building of a powerful social work collective based on social group work theory that potentiates professional practice while transcending management forms. The model includes group supervision, but moves beyond it to utilize the social work group as a central organizing principle. At the heart of the collective are the elements of professional accountability, support, autonomy, and collaborative decision-making within democratic peer group structures. The authors highlight current management theory, distinctions that create an authentic social work value-based practice, and outcomes for social workers, their clients, and colleagues.     

Technical rationality in Schön's reflective practice: dichotomous or non-dualistic epistemological position

Abstract  Donald Schön's theory of reflective practice has received unprecedented attention as an approach to professional development in nursing and other health and social care professions. This paper examines technical rationality in Schön's theory of reflective practice and argues that its critique is a broad and often overlooked epistemological underpinning in this work. This paper suggests that the popularity of Schön's theory is tied in part to his critique of technical rationality, and to his acknowledgement of the significance of practitioner experience and indeterminate zones of practice in the development of expertise. Schön tapped into a growing disillusionment with technical rationality that coincided with a crisis of knowledge across a range of disciplines. The question is raised as to whether Schön's critique sets up a dichotomy between technical rationality and experience, or overcomes it. The conclusions suggest that Schön is not discarding research-based professional knowledge, but rather challenging conflated views of its practical significance. In this way, it is proposed that his critique of technical rationality can be interpreted as an attempt to overcome dualistic thinking as it pertains to professional knowledge.     

Exclusive, idiosyncratic and collective expertise in the interprofessional arena: the case of optometry and eye care in The Netherlands

This paper addresses expertise as the foundation of professional boundaries and domains through a comparative study of four eye care occupations in the Netherlands. Claims of expertise are explored with an analysis of whether practitioners believe that expertise is exclusive to their profession. Results show that (a) established professions display a stronger sense of the 'exclusiveness' of expertise; (b) idiosyncratic expertise is more common among encroaching professions than among established ones. These findings substantiate trends towards professionalism, as jurisdictional disputes on professional domains and boundaries usually occur between more established medical professions seeking to protect their knowledge area, and encroaching ones trying to expand theirs. The study next addresses the ways in which claims to expertise influence practitioners' attitudes towards professional status and professional practice. Attitudes to expertise are influenced by age, and affect professional work in the workplace. Practitioners who considered expertise as a collective characteristic were younger, undertook more examinations, more diagnoses, gave more treatments, referred less, and perceived more problems regarding inter-professional recognition of their professional status.     

Chronic illness in the director's office: a pragmatic approach to decision making

This management article is based upon a real life experience and suggests various steps that need to be taken to deal with a chronic illness in the leadership of the professional social work program in a hospital. The organizational support of upper management; the departmental structure; personnel decisions and employee benefits; the program history and current dynamics; and the expertise of the restructured directorship each play a crucial role in shaping the outcome.     

The perceptions of the personal and professional factors influencing social workers in Saudi hospitals: a qualitative analysis

The perceptions of 10 social workers regarding the personal and professional characteristics influencing their practice at Saudi hospitals were examined using semi-structured interviews. A qualitative analysis employing a thematic approach informed by grounded theory was undertaken and produced three broad interrelated themes: "skills upgrading," "departmental support," and "personal experience in the workplace," which subsequently informed the development of the overarching theme of "personal and professional factors." The discussion illustrates social work practitioners are inhibited from effectively performing their roles. These include: (a) Deficiencies related to job training and professional skills updating where there is a lack of efficient and accessible inservice training programs, especially in relation to practical issues. Further, these perceptions relate to a lack of long-term educational opportunities that impact on individual practitioner's currency of skills, techniques and pedagogy enabling/disenabling him/her to excel at his/her job, (b) Obvious bureaucracy within the controlling hierarchy and difficulty with the dissemination of information between the social workers were perceived to detrimentally impact on a practitioner's ability to attend to one's work demands, and (c) Personal day to day work experiences, including counterproductive emotional feelings (high stress), increased dissatisfaction with the job, and ineffective communication within the workplace were seen as limiting the social workers' professional potential. This article will focus on how these themes were addressed in terms of qualitative interview data.     

Chronic Illness in the Director's Office

This management article is based upon a real li9fe experience and suggests various steps that need to be taken to deal with a chronic illness in the leadership of the professional social work program in a hospital. The organizational support of upper management; the departmental structure; personnel decisions and employee benefits; the program history and current dynamics; and the expertise of the restructured directorship each play a crucial role in shaping the outcome.     

Ethical conflicts over access to services: patient effects and worker influence in home health

A survey of home health social workers (N = 51) explored the effects on patients of ethical conflicts over access to services. The findings suggest that patients were as likely to be discharged or not receive services as they were to receive the services without paying a fee. Social workers rated themselves as moderately influential in the resolution of the conflict. Their influence was significantly correlated with patients more often receiving services and less often being discharged. Social work influence was enhanced by recognition of professional expertise and/or through informal networking within the agency. Implications for practice and education are discussed.     

The Perceptions of the Personal and Professional Factors Influencing Social Workers in Saudi Hospitals: A Qualitative Analysis

The perceptions of 10 social workers regarding the personal and professional characteristics influencing their practice at Saudi hospitals were examined using semi-structured interviews. A qualitative analysis employing a thematic approach informed by grounded theory was undertaken and produced three broad interrelated themes: “skills upgrading,” “departmental support,” and “personal experience in the workplace,” which subsequently informed the development of the overarching theme of “personal and professional factors.” The discussion illustrates social work practitioners are inhibited from effectively performing their roles. These include: (a) Deficiencies related to job training and professional skills updating where there is a lack of efficient and accessible inservice training programs, especially in relation to practical issues. Further, these perceptions relate to a lack of long-term educational opportunities that impact on individual practitioner's currency of skills, techniques and pedagogy enabling/disenabling him/her to excel at his/her job, (b) Obvious bureaucracy within the controlling hierarchy and difficulty with the dissemination of information between the social workers were perceived to detrimentally impact on a practitioner's ability to attend to one's work demands, and (c) Personal day to day work experiences, including counterproductive emotional feelings (high stress), increased dissatisfaction with the job, and ineffective communication within the workplace were seen as limiting the social workers' professional potential. This article will focus on how these themes were addressed in terms of qualitative interview data.     

Occupations,social vulnerability and HIV/STI risk: The case of bisexual Latino men in the New York City metropolitan area

This article examines the relationship between the work environment, type of occupation and sexual risk-taking among behaviourally bisexual Latino men, in which data were analysed from a mixed-methods study of 148 behaviourally bisexual Latino men, aged 18–60. The authors draw on both sex market theory and the literature on structural violence and labour to situate sexual risk-taking within broader dimensions of social inequalities and organisation. Manual labour, hospitality and retail/professional fields are examined and compared. Major findings include (1) a high incidence of unprotected anal intercourse among manual labourers (2) a high incidence of unprotected vaginal intercourse with alcohol use and concurrent sex with females among hospitality workers (3) less sexual risk behaviour, sexual risk behaviour with alcohol and fewer concurrent sex partners among those in the retail/professional fields. Findings are discussed in relation to global economic forces, masculinity and social and symbolic capital.     

Social work management in emerging health care systems

An overview of the health care industry's trend toward multihealth systems is presented and specific adaptive strategies for social work managers in health care are suggested. The challenges to social work leaders during this transition from largely free-standing, privately owned health care institutions to corporately owned, horizontally and vertically integrated delivery systems are discussed in terms of identity, style, and substance. Directors of social work departments in multihealth corporations will need to resolve issues of institutional versus corporate identity as well as those of corporate versus professional identity. A multioptional management style that incorporates networking and political expertise should be cultivated. Substantive demands in the areas of management information systems, productivity, quality assurance, and budgeting also must be addressed. The emergence of multihealth systems poses major challenges and unique opportunities to the social work profession. Awareness of managerial strategies and critical content areas can help social work leaders enhance the role and contribution of social work in these exciting and complex health care delivery systems.     

Social work information and accountability systems in a hospital setting.

Information and accountability systems for departments of social work are a major concern for the profession, particularly within the health care sector. This paper describes the development of such a system within a large university hospital, the forces that led to its development, and the multiple expectations for its usefulness in planning and implementing social work services most effectively, within the lowest cost. It includes potential for building research projects and is utilized as a communication mechanism for recording. Collaboration within the profession is essential for implementing objective standards to be utilized in reviewing delivery of professional social work services.     

The effect of gender on medical students' aspirations: a qualitative study

Objective  This study aimed to explore the effect of gender on medical students' aspirations.
Methods  The study design included purposive sampling and interim data interpretation to guide recruitment of medical students with a wide spectrum of opinions. Data were collected through audio-recorded, semi-structured, in-depth exploratory interviews, which were transcribed verbatim. Qualitative analysis was carried out by a female medical student researcher. Her evolving interpretation was constantly compared against the original data by male (doctor) and female (pharmacist) staff researchers in a systematic search for internal corroboration or disconfirmation. Causal associations consistently present in the data are reported.
Results  Six male and six female medical students in Years 3 and 4 shared a wish to achieve a work−life balance that allowed them to devote time to bringing up children while contributing usefully to society as doctors. However, women were readier to compromise professional attainment within their personal work−life balances. Their readiness derived from gendered stereotypes of women's social and professional roles, a lack of female professional role models, womens' greater awareness of the tensions between career and family, various other informal social influences, and a lack of positive career advice to counterbalance these influences.
Conclusions  Better career advice and more flexible work opportunities are needed if the two-thirds of medical students who are women are to contribute specialist as well as generalist expertise to the medical workforce.     

Applying Ideas from Learning and Teaching in Higher Education to Develop Professional Identity: The Case of the M.Sc. in Advanced Residential Child Care

Residential child care in Scotland is located, professionally, within social work. However, the very specific expertise required to work in the field is rarely accommodated in social work training or within wider social work discourses. The literature on learning and teaching in higher education helps illuminate some of the differences between the two disciplines. Within this literature, expertise is located in the practice experience of those who work in a particular field. Accordingly, the role of the M.Sc. could not be, merely, to transmit existing “formal” knowledge. Rather, it needed to contest much of this as that formal knowledge had not served residential child care well. It had to draw out the situated knowledge of students on the course and to synthesise this with understandings from the child and youth care tradition so that the course might begin to generate a discourse for residential child care that reflected and resonated with the experiences of practitioners.     

Taint: an examination of the lived experiences of stigma and its lingering effects for eight sex industry experts

As part of a larger study examining the effects of the design of the off-street sex industry on sex worker’s health and safety practices, eight sex work experts who had experience as sex workers and as advocates and service providers were interviewed to garner their community engagement expertise in shaping the research. During narrative interviews, these experts discussed how stigma influenced their personal lives and their social justice work among sex workers. Their insights into stigma are unique to the literature because our experts simultaneously confronted direct instances of stigma that were a part of their personal and professional lives, sometimes concealing their sex work histories during the course of their professional support and advocacy work. As a result of this concealment, and because of how sex workers are sometimes mistreated, experts experienced stigma vicariously (indirectly) when their own sex work histories were not apparent. As a result of these experiences, participants became proficient at managing discrediting information about themselves when in the presence of those they mistrusted. They supported sex workers through stigmatising ordeals by using knowledge gained from these intersecting direct and vicarious experiences stigma, continuously building capacity within themselves and among other sex workers to resist stigma.     

Professional knowledge and the epistemology of reflective practice

Reflective practice is one of the most popular theories of professional knowledge in the last 20 years and has been widely adopted by nursing, health, and social care professions. The term was coined by Donald Schön in his influential books The Reflective Practitioner, and Educating the Reflective Practitioner, and has garnered the unprecedented attention of theorists and practitioners of professional education and practice. Reflective practice has been integrated into professional preparatory programmes, continuing education programmes, and by the regulatory bodies of a wide range of health and social care professions. Yet, despite its popularity and widespread adoption, a problem frequently raised in the literature concerns the lack of conceptual clarity surrounding the term reflective practice. This paper seeks to respond to this problem by offering an analysis of the epistemology of reflective practice as revealed through a critical examination of philosophical influences within the theory. The aim is to discern philosophical underpinnings of reflective practice in order to advance increasingly coherent interpretations, and to consider the implications for conceptions of professional knowledge in professional life. The paper briefly examines major philosophical underpinnings in reflective practice to explicate central themes that inform the epistemological assumptions of the theory. The study draws on the work of Donald Schön, and on texts from four philosophers: John Dewey, Nelson Goodman, Michael Polanyi, and Gilbert Ryle. Five central epistemological themes in reflective practice are illuminated: (1) a broad critique of technical rationality; (2) professional practice knowledge as artistry; (3) constructivist assumptions in the theory; (4) the significance of tacit knowledge for professional practice knowledge; and (5) overcoming mind body dualism to recognize the knowledge revealed in intelligent action. The paper reveals that the theory of reflective practice is concerned with deep epistemological questions of significance to conceptions of knowledge in health and social care professions.     

Defining the 'social': towards an understanding of scientific and medical discourses on the social aspects of the new human genetics

The way in which 'the social' is treated in discourses about the new human genetics is an important marker of the interests and relative power of the groups it concerns. Scientists and clinicians are powerful players in such discussions and seem to be able to direct attention towards the social implications of genetics, often viewed as beneficial, rather than to the science and technology itself. This can serve to protect their cognitive authority by promoting the benefits of their work and marginalising more critical commentaries. Here, three aspects of some written accounts of the social aspects of genetics are considered: the social use and abuse of genetics; eugenics and genetic determinism; and professional responsibilities and expertise. We consider the dominant and minority discourses within these accounts and reflect on the stances taken by clinical and molecular geneticists and public health specialists. We argue that these discourses create strategic boundaries between science and society which protect scientists' cognitive authority, but that critical leverage can nevertheless be garnered when these boundaries become blurred. This might be usefully combined with social scientists' empirical and theoretical analyses of the new human genetics, in order to facilitate more sophisticated and inclusive policy discussions and decisions.     

A framework for systematically improving occupational therapy expert opinions on work capacity

Aim:  To present an evidence-based framework to improve the quality of occupational therapy expert opinions on work capacity for litigation, compensation and insurance purposes.
Methods:  Grounded theory methodology was used to collect and analyse data from a sample of 31 participants, comprising 19 occupational therapists, 6 medical specialists and 6 lawyers. A focused semistructured interview was completed with each participant. In addition, 20 participants verified the key findings.
Results:  The framework is contextualised within a medicolegal system requiring increasing expertise. The framework consists of (i) broad professional development strategies and principles, and (ii) specific strategies and principles for improving opinions through reporting and assessment practices.
Conclusions:  The synthesis of the participants' recommendations provides systematic guidelines for improving occupational therapy expert opinion on work capacity.     

Autonomy,Accountability, and Professionalism

Social work lacks a major, if not the major, criterion or attribute of professionalism, autonomy in practice. Further, this lack of autonomy has been fostered by frequently lifelong close supervision of social work practitioners, a model which is taught in degree programs (bachelor's and master's levels), and fostered and encouraged in subsequent practice in the field. Lack of autonomy and self-control in practice has led to a de-emphasis on accountability and performance outcome evaluation and assessment which, in turn, has led to a diminution of social work's ability to generate its own knowledge base and, hence, to have knowledge, specific and unique expertise which only it can exercise, and professional power.