Working in Social Care

A Systemic Approach

Dave Evans, Jeremy Kearney

• Publisher: Routledge
• Year: 2017
• eBook ISBN:
  9781351871006
• Topic: Sciences sociales
• Subtopic: Travail social

This book is designed to aid the practitioner in all social care and social work settings. It explores approaches to practice which are based upon systemic ideas and an awareness of the impact of power in practice contexts. Following the introduction of the main ideas of the book, the authors examine the systemic approach from three perspectives: ¢ key principles - to help guide practice and practice teaching; ¢ the central triangular process - between service user, worker and agency ¢ the work process - examining the triangular relationship over time. The authors address practitioners directly, not only by drawing on their own practice experience, but also by highlighting key practical questions for the reader to consider.

1 Introduction

Over recent years, a wide range of central government policy initiatives directed at the National Health Service, the personal social services and the criminal justice system have had a fundamental impact on the nature of service provision. Moreover, it is difficult to predict how these services will develop. We take the view that whatever the changes ahead, there will continue to be a wide range of workers in many different settings who will be committed to alleviating the social need experienced by others. Our own commitment to this aim as practitioners, trainers, supervisors and consultants working within a range of voluntary and statutory settings has led us to espouse a systemic approach as a framework for effective practice.

We have taken three steps to make this approach amenable and useful to the reader. First and foremost, we have attempted to orientate the ideas directly towards practice: by addressing the concrete issues of practice; by asking questions about the reader's practice, and by giving examples of our own and other people's practice. Second, we have tried to indicate ways in which a systemic approach, which focuses on interrelationships, contrasts with a currently dominant approach which focuses on separate people or units. Third, we have indicated some major disadvantages which may have been troubling the reader about two other major systems approaches - family therapy and the unitary model.

Key concepts

The title we have chosen includes four terms which take the reader to the heart of this book: 'systemic', 'approach', 'working' and 'social care'.

‘Systemic’

Systems approaches to helping people in social need were particularly popular in the 1970s, following the development and dissemination of general systems theory (Von Bertalanffy, 1968). Several writers (Pincus and Minahan, 1973; Goldstein, 1973; Specht and Vickery, 1977) employed systems ideas in unitary or integrated models which had the subtext of integrating and unifying the differing methods and settings of the growing profession of social work. Some indicated the value of systems theory as a basis for therapy with families rather than individuals (Walrond-Skinner, 1976) or for work with the other relationships supporting people in need (Davies, 1977). Rubin (1973) simply celebrated these new ideas without fully exploring their implications for practice.

However, the context which saw the growth of these ideas also constrained their development. For example, the notion of integrated models for practice which can be adopted for all service user groups in generic social work teams has given way to the rediscovery of specialisms with particular legislative frameworks and knowledge requirements.

A central constraint of that period was the tendency to minimise the conflict and power differentials inherent in social systems, with some notable exceptions (Bailey and Brake, 1975). The systemic approach we propose in this book therefore seeks to recognise the context of oppression and discrimination which gives rise to and perpetuates much of the need experienced by the consumers of social care agencies.

The main concepts of this systemic approach are outlined in detail in Chapter 2. Of these, one central idea is that of mutual interaction: person A does not simply act towards a passive person B; person B will also attempt to influence person A. In a residential home for older people, for example, a care assistant may seek to persuade an older resident on to their feet in order to get ready for their bath. The older person may have other ideas, however: to watch a favourite TV programme or to await the visit of a relative. The resolution of these conflicting interests will depend upon a number of variables, including: the value base and practice skills of the worker; the frailty of the older person, and the degree of service user involvement in the management of the home. It will certainly be the case that the two participants in this two-way interaction will not have equal power.

'Resistant' is one adjective often used by workers to describe such a resident. It clearly reveals the workers' fundamental misapprehension that service users should simply comply with workers' wishes and not exercise whatever power they have at their disposal to pursue their own wishes.

'Manipulative' is another similarly blinkered description of service users' actions. In this case, workers often find themselves at the receiving end of some effective use of power by the service user - for example, having sought the support of the officer in charge. Workers are thus hindered in using their power to pursue their own wishes, or perhaps even prevented from doing so.

'Resistant' and 'manipulative' are therefore both epithets which give warning that a worker has not been sufficiently aware of (a) the two-way nature of interactions and (b) the power differentials inherent in those interactions. Seen from the perspective of the 'resistant' or 'manipulative' service user, the interaction will assume a very different complexion. Indeed, at times, the service user may well apply the mirror adjective to the worker:

service user 'resistant' = worker 'manipulative'
service user 'manipulative' = worker 'resistant'

Another idea central to a systemic approach is that of context by which we mean the relevant aspects of the environment. Context can be 'synchronic' that is, at one point in time. At the same time as writing this book, we have other roles as, for example, workers and husbands, which influence and are influenced by the writing. Context can also be 'diachronic' - that is, extended through time. Our writing on a given day will be influenced by a previous late night or the prospect of a future holiday. These two contextual axes intersect (see Figure 1.1).

Figure 1.1 Two contextual axes

The specific context which brought us together as co-writers included a growing shared awareness of the constraining and limited use to which potentially more useful systems ideas had been put. As social work students and teachers, we had been struck by the limitations of unitary models of practice, based on systems theory. As experienced family therapy practitioners and trainers, we became aware of the inappropriate constraints imposed by developing systems ideas in clinical settings. (These criticisms are discussed in Chapter 2.) A further context within which we have joined to work on this book is a growing awareness of the profound influence power plays in all human interactions. Systems theory and family therapy have both been slow to develop an analysis of power.

It is this focus on power which leads us, like other writers (Howe, 1987; Cordern and Preston-Shoot, 1987a; Lishman, 1994) to draw on the existing body of social work consumer research. In seeking to address the power imbalance in favour of professional workers and their agencies and against service users, it would seem essential to listen carefully to what those service users have to say about workers and agencies (Wallace and Rees, 1984). This is not to suggest that all policies and practices should be framed exclusively by service users, but that they should have some influence. Although it was written over a decade ago, Rees and Wallace's Verdicts on Social Work (1982) provides some seminal evidence, not only in its comprehensiveness but also in its orientation to issues of power, and is cited on several occasions throughout this book, along with other summaries of consumer studies, including Fisher (1983) and Cheetham et al. (1992).

‘Approach’

This book does not contain a new theory: it is not a highly abstract set of ideas which seeks to explain existing phenomena or to predict future events. It simply describes an approach, comprising an interrelated set of ideas which are orientated to help workers develop their practice. It is true that the approach draws from a theoretical base, as will be demonstrated in Chapter 2. However, we have been concerned more with the usefulness of ideas than their abstract coherence or status.

The value of theory in social care has been much debated. Research has consistently indicated how little overt use experienced workers in the personal social services make of theory (DHSS, 1978; Carew, 1979). Some of this underuse can perhaps be explained, as Davies (1984) suggests, by educators, writers and other brokers of theory not making sufficiently meaningful links between theory and practice. It has even been argued that people in academic settings have a vested interest in demonstrating the usefulness of theory (Pilalis, 1986; Evans, 1987b).

As might be expected from our current posts in academic institutions, our own views on theory are more sympathetic than many workers in the personal social services. Like Coulshed (1988), we see the relationship between theory and practice as an interaction, wherein the one influences the other. Although the relationship is frequently conceived of as one-way, whereby theory influences practice, it is also the case that the experiences of practice give rise to the development and refinement of theory. Our approach has arisen precisely from maintaining this mutual interaction between abstract ideas and concrete practices.

We are also in agreement with Paley (1987), who asserts that the question which most concerns workers is not 'How does theory relate to practice?' but 'What ideas can help me in my practice?' For this reason, we offer a set of helpful ideas which constitute an approach.

‘Working’

Everyone seeks to alleviate social need. Sometimes they experience it firsthand themselves or it is experienced by someone else with whom they have an ongoing relationship, such as a neighbour, friend or relative. These efforts form only a part of much wider processes in life. Indeed, if people only concentrated on alleviating social need to the exclusion of all other facets of life, they would risk living considerably unbalanced lives. This everyday relationship to social need could be called 'living with'.

However, certain people also seek to address the social need experienced by other people with whom they have no other ongoing relationship. They do so as part of their work, as a volunteer, a freelance worker or a paid employee. In this book, we refer to this particular relationship as 'working with', and consider it to be of a different nature to the more everyday relationship of 'living with' social need.

Of course, there are many similarities between the two sets of relationships, particularly when the work takes place in informal group care settings. Indeed, there is evidence from the clients of social workers that they prefer workers who minimise the differences: who are more like friends and less like professionals (Mayer and Timms, 1970). It is our experience, as teachers, that social work students early in their careers can often fulfil this preference but are unlikely to be able to sustain it throughout their career. One of the aims of this book is to help workers maximise their potential advantages as workers and minimise the inherent disadvantages.

Social care

In using the term 'social care', we are seeking to emphasise the communalities between two sets of workers within the statutory, voluntary and private sectors of the personal social services. Social care workers and social workers are often differentiated in terms of tasks. Hugman (1991) makes the useful distinction between workers who 'care for' people, often involving direct physical care, and those who 'care about' people, involving less direct physical care. Social care workers and social workers also differ according to their work settings, training, status and, particularly, salary levels. Bamford (1990) further distinguishes between the two, albeit rather unconvincingly, in terms of, respectively, maintenance and change. With the increased emphasis on social care planning in social work (NISW, 1982; Griffiths, 1988; NHS and Community Care Act, 1990), however, and the development of a cohesive training strategy by the National Council for Vocational Qualifications, these differences are being eroded.

It is our view that the similarities between these two sets of workers outweigh the differences. Not only do they often possess similar values and attributes, they also operate within similar social situations. These situations can be described in two main ways: 'social need' or 'social problems'.

Payne (1991) argues persuasively that 'need' is a key concept in social work. A similar claim can be made in all the work performed by social care workers. As Payne suggests, the concept is a highly complex one, and its complexity stems from the differing answers to two central questions:

• What are needs?
• Who defines needs?

Maslow (1970) distinguishes between two distinct sets of need: those which ensure survival (basic physical and psychological needs) and those which promote the person's self-actualisation (intellectual and creative needs). Payne (1991, p. 29) makes an alternative dichotomy between needs which are 'internal drives' (for example, for food) and those which are 'socially defined' (for example, good health care).

What is common to both categorisations is the moral imperative implicit in the term 'need'. Once something is defined as a 'need', it becomes morally incumbent on people to seek to fulfil it. 'Need' is thus not the language of objective description but the language of moral obligation. Like other moral language ('must', 'should', 'ought to'), it is used to influence other people's behaviour, presumably to fulfil that need.

The second question, 'Who defines needs?', focuses on who is trying to influence whom. Bradshaw's (1972) taxonomy of social need gives some indications of who defines needs:

• normative need - defined by an 'expert' or professional;
• felt need - defined by the individual person experiencing it;
• expressed need - defined by the individual, and often another person, in applying for services;
• comparative need - defined, for example, by policymakers or managers in seeking equitable service delivery.

Increasingly, legislators are also attempting to define need ('children in need' in the Children Act, 1989 and 'assessment of need' in the NHS and Community Care Act, 1990).

This second question takes us to the heart of the issue of power: who has the power to determine that a certain condition must be attended to. Will vulnerable individuals be in a position to determine their circumstances as 'need' in order to elicit a response, or will powerful workers, managers and politicians determine 'need' for quite different reasons, such as the allocation of inadequate resources or the increased privatisation of social welfare? The history of the implementation of the NHS and Community Care Act (1990) suggests that the tension in defining need still remains, but that service users will not be allowed to determine need alone.

The inadequacy of resources in social welfare points to one of the deficiencies in the term 'need'. On the one hand, 'need' implies a moral imperative; on the other, inadequate resources determine that this imperative will not be fulfilled in all cases. It is clearly misleading for central government, agencies and their workers to raise an expectation that situations must be alleviated when they clearly cannot be.

A second deficiency in the term 'need' is inherent in Bradshaw's (1972) distinction between 'felt' and 'expressed' need. Much 'need' remains in the private domain and is not brought to the attention of personal social service agencies, whether statutory, voluntary or private. Indeed, many people suffering severe physical needs (for shelter or protection) may be unaware of other 'higher' needs, in Maslow's (1970) terms. Clearly, the level of need which is 'felt' and not 'expressed', or which is even 'beyond awareness', would be beyond the scope of the personal social services to assess. Personal social service agencies are already stretched by dealing with need as it is overtly expressed to them, without seeking to discover covert need.

An alternative view of these social situations construes them as 'problems'. Perlman (1957) introduced a problem-solving app...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of figures
• Acknowledgements
• 1 Introduction
• 2 The development of a systemic approach
• 3 Key principles of a systemic approach
• 4 The central triangular context
• 5 The work process
• References
• Index