Personalised risk: new risk encounters facing migrant care workers

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people’s choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept ‘personalised risk’. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of ‘informality’ of employment conditions experienced by directly employed care workers, the ‘emotional’ content of care worker-employer relationships, and ‘intimacy’ of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world.     

Realizing policy aspirations of voluntary sector involvement in integrated care provision: Insights from the English National Health Service

Integrating voluntary sector organizations (VSOs) into complex health and social care provision is a priority in global healthcare policy. However, realization of these policy aspirations in practice is limited, as VSOs struggle to collaborate with health and social care professionals, or influence the wider healthcare system, undermining their potential involvement in care provision. This paper aims to increase understandings of how the policy implementation gap could be addressed, by asking: how do new workforce roles support VSO involvement in delivering integrated care? Drawing on 40 interviews with VSO workers, healthcare commissioners, and healthcare professionals, conducted over 18 months in the English NHS, we outline how workforce capacity development through the introduction of coordinating roles, coupled with increasing regulatory control of VSO involvement, resulted in enhanced VSO integration in service provision. However, we also warn against the potential for exploitation of VSOs whereby they become replacements for health and social care provision, rather than a complementary service within an integrated team, resulting in patient harm. Our findings have important implications for policy makers, practitioners, VSO leaders and healthcare commissioners. We conclude that policy realization is dependent on the development of coordinating roles, coupled with levels of regulation which protect against exploitation without becoming normatively restrictive, thereby losing the important flexibility of VSOs.     

Community Care in Practice

SUMMARY

This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.     

Beautiful stranger: Voices from the front lines of community practice in Israel

Over the past few decades, economic, political and cultural forces have altered the development of social policies and affected the life circumstances of oppressed communities in many countries. In response, calls for greater understanding and awareness of macro practice skills and interventions have been increasing within many of the social care professions. These calls have been particularly strong within the social work profession. A major field in macro social work is community practice, which aims to help people organise, plan and act for change. To date, there has been a dearth of studies examining social workers’ involvement in community practice at the ground level. Drawing on in-depth interviews with 26 community social workers in public social services in Israel, this qualitative study examines community social workers’ everyday experiences of community practice and the meanings they attribute to it. Findings highlight three main themes: (a) the elusive and unbounded nature of community practice; (b) the tense relations that community social workers maintain with various actors within the profession; and (c) the complex relations they maintain with the communities in which they work. We discuss these findings in light of Georg Simmel's concept of ‘the stranger’. Implications to community practice are outlined.     

Drivers of change: Learning from the lived experiences of nursing home social workers

In response to the growing attention to integrated health care and the cultural change movement in nursing homes, this study examines the lived experiences of nursing home social workers to better understand their role perceptions, job satisfaction, and relationship with other staff members. Hermeneutic phenomenology was used in order to understand the lived experience of being a nursing home social worker. Ten nursing home social workers were recruited from a southern state and individual interviews were conducted. From the interviews, four themes emerged: challenge, coping, mattering, and rewarding. Guided by identity negotiation theory and social identity theory, these findings are discussed. Also, implications for social work education, nursing home administration, and policy is discussed.     

A collaborative exploration of the reasons for lower satisfaction with services among Bangladeshi and Pakistani social care users

This study explored underlying reasons for the expression of dissatisfaction with services among Bangladeshi and Pakistani social care users in England and investigated, using a collaborative approach, how these could be addressed. In‐depth interviews were conducted in Birmingham, Leeds and London during 2012–2013 with 63 Bangladeshi, Pakistani and white British service users and 24 social care managers, social workers and care workers. A further 34 cognitive interviews were conducted within the same study. Following data analysis, three collaborative workshops involving service users and providers were held to validate the findings and to draw out policy and practice recommendations. Analysis of the cognitive interviews showed that higher dissatisfaction among Bangladeshi and Pakistani service users reported in social care surveys was not due to questionnaire design. Instead in‐depth interviews showed that dissatisfaction across all three groups was expressed along the social care journey, including accessing care, communication with social workers and the nature of care received. While many issues were common to all three groups, cultural differences also emerged as affecting experiences of social care. These included misunderstandings about family roles in care; gender issues, especially relating to women; language and communication barriers, alongside the need for a more nuanced approach to ethnic ‘matching’; and continuing limited cultural understanding among care workers. The collaborative workshops identified practical actions that could address some of the issues identified. These covered raising awareness of services within communities; improving support for informal carers; service user input to assessments; consistent and ongoing sharing of information; improving access; and more efforts to diversify and appropriately train the social care workforce. In conclusion, the paper presents the reality of dissatisfaction among these groups and argues for more action involving communities and service providers to address these persistent issues collaboratively.     

Social care as first work experience in England: a secondary analysis of the profile of a national sample of migrant workers

Migrant workers are increasingly important to the care sector in England as well as in other developed countries. The profile of migrants is likely to continue changing due to reforms in immigration policy and legislation limiting the range of jobs open to migrants from non-EU countries while facilitating migration from the new European Union accession countries. This article reports on detailed secondary analysis of newly available data on the characteristics of migrants working in the care sector as their first job. The analysis was undertaken in 2009 as part of research investigating the contribution made by migrant care workers in England. The sample was identified from the new National Minimum Data Set for Social Care (NMDSSC), which is completed by social care employers in England. Workers whose ethnicity was identified as not White British and who had their previous job abroad were used as a proxy of recent migrants. The analysis shows that this group of workers has a significantly different profile compared with other workers. Recent migrants in the care sector were significantly younger and held higher qualifications relevant to social care; however, there were no significant gender differences. They were also significantly concentrated in the private and voluntary sectors and in direct care work. There were variations between recent migrants' ethnicity and their job roles, with Asian workers more prevalent in senior care positions. These findings have a number of possible implications for social care workforce and providers, particularly within the current context of changing migration rules and social care reforms.     

Quality assurance in mental health-care: a case study from social work

The quality of health and social care is now a high priority for government, professionals, and the public. This is particularly true of mental health, where explicit standards lie at the centre of current policy, demanding the development of reliable means for quality assurance. These need to allow for the multiplicity of stakeholders in mental health-care, and their different constructions of "quality". The challenges presented are illustrated by this account of an action research programme, which was developed to improve social work practice in a multidisciplinary mental health service, and evaluated using a case study design. An action research approach was chosen in preference to an "off-the-shelf" quality assurance system, because it possessed features that appeared to match the context of the work. It involved feeding back the findings of a baseline assessment of service quality to four teams of social workers, who used the information to select priority areas for improvement. An action plan was developed with them, and its implementation and impact were examined. Substantial improvements were observed in only one of the chosen target areas--the quality of case recording. For the other--securing the clients' full involvement in their care plan--very limited improvements occurred. Interview data suggested that this was due to the presence of extensive organisational support for the first objective, but not the second. These findings suggest that while some features of action research can contribute to quality improvement, these must be incorporated into a more comprehensive programme of change, which commands the support of all the stakeholders involved.     

Conjoint Multi-Disciplinary Assessment in a Community Mental Health Team

ABSTRACT

Community Mental Health Teams (CMHTs) offer the opportunity to integrate social workers and health professionals to provide multi-disciplinary assessment and care. This potential for joint working is frequently not fully realised, with the various professions operating independently. Social work staff in CMHTs are reported to experience high levels of role confusion. This study of the introduction of a system of conjoint multi-disciplinary assessment in a Scottish CMHT describes the positive impact on the social work role in terms of greater involvement in front-line assessments to the CMHT and more fully integrated teamwork.     

Social workers and unemployment: Factors associated with using employment‐promoting practices in Israeli Municipal Departments of Social Services

Unemployment is a harsh social phenomenon with far reaching negative implications. Unemployed individuals often seek assistance from social workers working in Municipal Departments of Social Services around the world. However, little to no research exists on the factors involved in social workers’ choice to engage in employment‐promoting practices (EPP). The current study aimed to tackle this gap of knowledge, providing initial conclusions about the relationship between social workers’ attitudes towards unemployment, their knowledge regarding EPP, the extent to which they perceive their organisations as endorsing EPP and their actual implementation. The main research question dealt with the extent to which each of the examined factors, in itself or in combination with others, would be the best predictor of social workers’ utilisation of EPP. The study sample consisted of 163 social workers in Israel with varied experience in working with the unemployed, all working in public sector social services. Structural equation modelling performed on the attained data revealed that knowledge, skills and perceived organisational endorsement of EPP were positively associated with implementation of EPP. Contrary to the hypothesised, attitudes towards unemployment were not associated with the implementation of such practices. At the same time, professional training and seniority were associated with EPP only through the mediation of perceived organisational endorsement. Ultimately, perceived organisational endorsement of EPP emerged as the most influential factor involved in social workers’ decision to carry out EPP with their service‐users. Consequences of these findings for social work education, supervision, research and policy making are discussed, referring to the local Israeli context as well as its possible international inferences.     

Hospice social workers’ perception of being valued by the interdisciplinary team and the association with job satisfaction

ABSTRACT

Being valued and respected by colleagues is an important contributor to job satisfaction in hospice and other health care settings. The purpose of this study was to examine how the perception of feeling valued by different members of the interdisciplinary team and interdependence of team members are related to hospice social workers’ job satisfaction. The study aims were to examine: (1) the degree to which hospice social workers feel valued by other members of the interdisciplinary team; and 2) whether this is associated with job satisfaction. A nonprobability sample of 203 hospice social workers completed an online survey assessing job satisfaction, perception of feeling valued by each of the professionals on the interdisciplinary hospice team, interdependence of team members, and professional and personal characteristics. The final regression model for intrinsic job satisfaction included feeling valued by doctors and by other social workers, and interdisciplinary interdependence. The final model for extrinsic job satisfaction did not include any of the perception of feeling valued by others on the interdisciplinary team, although interdependence and the number of social workers at the hospice were significant in this model. Reasons for the difference in these models and the practice and policy implications are discussed.     

Social welfare reform in Israel: Social workers’ views on change,participation and professional values

In recent years, many western welfare states have undergone reforms in their social services. These reforms are intended to influence the work of social workers in the public sector, and depend largely upon workers’ ability and willingness to implement them. The research presented in this article addresses the reform in Israeli Departments of Social Services through the perspective of the social workers tasked with its implementation. Drawing on recent developments of the Knowledge‐Power‐Politics Triad model, the relationship between aspects of social workers’ support for the reform and their perceived and actual involvement in reform policy making, general attitude towards change, and professional inclinations was examined. Our sample consisted of 180 social workers employed in departments currently implementing the reform. The study's results emphasise the vital role employee participation plays in forming support for reforms' goals, and at the same time expose the complex interplay between developing a ‘sense’ of participation and participation's actual realisation. They offer several insights into the way social workers’ support for reform is constructed, and not less so, regarding aspects of examining such support.     

Assessing the effectiveness of policy interventions to reduce the use of agency or temporary social workers in England

There has been growing concern that English local authorities are over reliant on temporary staff to meet the shortage of social workers. This has been criticised as inefficient and costly while leading to problems of continuity and consistency for people using social work services. Focussing on recent policy and the implementation of new administrative procedures for the procurement and management of temporary or agency staff, this article explores progress being made towards achieving the previous government’s policy goal that by 2020 local authorities will no longer need to rely on agency workers to carry out tasks that would normally be carried out by a permanent social worker. The article draws on the findings of an exploratory study (2007–2010) commissioned by the Department of Health which comprised of the following: a survey of local councils in England with adult social services responsibilities; case studies in three different localities; and qualitative interviews with stakeholders (n = 93). The findings suggest that while local authorities have reduced the costs of employing temporary staff through the setting up of intermediary control mechanisms, agency social workers continue to play important roles in teams and services.     

The role of social work in discharge planning

Changing social policy and scarce resources affect the delivery of health and social services. Higher costs mean shorter stays in hospitals. People are being discharged ‘quicker and sicker’. This paper considers discharge planning policies and practices in America, in relation to a recent study on hospital social work in Madison, Wisconsin. It supports the view that discharge planning is a highly skilled activity, integral to social work and best done by qualified, trained workers. Such findings have relevance for Britain, where demands for cost effectiveness in the managemennt of care has raised the profile of discharge planning. In processing these changes, social workers are having to redefine their role in health care.     

Health care decision making in southern county

We combine two standard approaches to analyze power and influence in health policy formulation within a moderately large county in the south. Intrinsic methodologic weaknesses are discussed and several conclusions are drawn regarding power in the health care sector of that community. The most significant finding is the shift in power over time, away from the individuals to committees and health care organizations. The ignorance of most physicians about the broader health care issues that affect the community was reflected in their lack of recognition by others in the community as influential decision makers. The insular relationship of the university to the rest of the community was also noted. Past racial politics had a continuing effect on later health policy formulation. These findings are discussed in light of current and past issues. Because we had promised confidentiality to the persons we interviewed, fictitious names were given to the county, the institutions, and the interviewees.     

Healthy by Association: The relationship between social participation and self-rated physical and psychological health

This paper investigates the relationship between social participation and subjective health. Using individual-level data from the British Household Panel Survey, we show that being an active member of a social or sport organisation increases self-rated physical and psychological health. For men, the benefits of social interaction work primarily via physical pathways, while women report a more psychosocial channel. We separate the main results by occupation and document some heterogeneity. Manual workers find more physical and psychological relief via social involvement, whereas non-manual workers are more likely to take relief from sport participation. Interestingly, as the number of associations in which the individual is active increases, the incremental increase in social benefits diminishes. Our findings point to the importance of promoting social and sport activities in health communication and policy making.     

The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.