Ends and Means in Social Work

The Development and Outcome of a Case Review System for Social Workers

E. Matilda Goldberg, R. William Warburton

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000456585
• Edition: 1
• Topic: Medicine
• Subtopic: Social Work

Originally published in 1979, Ends and Means in Social Work was the first book to provide research-based evidence on what social workers actually do, what they were aiming to achieve, and what sense their activities made, both in terms of their own subjective perspectives and those of their clients.

The authors describe and analyse a series of surveys and action studies based on a year's referrals and the long-term clientele of an area office. They aimed first to find out what the clients thought of and expected from the newly reorganised social services, and how social workers saw the changes and their new responsibilities. The second aim was to discover how social work skills and other resources were being used to meet different client needs. Third, the research was designed to enable social workers, by developing a new monitoring tool, the Case Review System, to become more explicit about both the ends and means of their activities.

Widespread interest had been aroused by the Case Review System. It had raised intriguing questions about who gets what and why. On an individual level, the Case Review System can enable social workers to evaluate their practice by comparing plan with achievement; as an educational tool it can assist supervision; as a management tool it can provide aggregated data on client characteristics, the use of resources, and outcomes; as a research tool it can answer questions on the relationships between client characteristics, problems and social work practice, and provide longitudinal data on client careers.

It is in response to insistent demands for a rounded account of this research project and its results that this book has been written. It endeavours to bring together all the aspects of the specific research studies and to discuss their wider implications for the organisation of the personal social services. Particularly valuable for students and practitioners alike will be the concluding discussion in which the evidence which emerged about the use of social work resources is subjected to critical review. Questions are raised about the current deployment of social work skills, and suggestions are made about how these skills might be redeployed, tasks defined more realistically, and how statutory functions could mesh more easily with voluntary activities.

Chapter 1 SOCIAL WORK IN THE 1970s – THE NEED FOR ACCOUNTABILITY

In the 1960s most professional social work was casework directed towards the amelioration of psycho-social problems of individuals and families. Moreover, social work was a relatively small-scale enterprise, and specialised social workers were dealing with the social needs of fairly well-defined client groups. Since the reorganisation of the social services in 1971 following the Seebohm Report (1968), social work has become big business. The boundaries are ever extending. They range from psychotherapy to social planning.

Although evidence is difficult to come by, it is fairly certain that the volume of referrals in the integrated social services departments is greater than the sum of referrals to the three separate Health, Welfare, and Children’s Departments before reorganisation. Evidence does exist that in many local authority social services departments the number of referrals has substantially increased since integration. With these demands goes a growing investment of resources, both absolute and proportional, in the personal social services. While public expenditure has risen in constant prices by 5 per cent between 1972 and 1977 (from £51,577 million to £54,320 million), the expenditure on the personal social services has risen by 33 per cent (from £836 million to £1,110 million) (HM Treasury, 1978). However, we need to remember that this expenditure started from a very small base constituting only 1-6 per cent of all public expenditure in 1973, rising to 2 per cent in 1977. Compared with other social services, for every £1 spent on the personal social services, £5 was spent on health, and £6-50 on education in 1975 (Central Statistical Office, 1976).

The rise in money expenditure is mirrored in an increase in provision of services. Nearly 50 per cent more people - most of them elderly -received home help services in 1976 compared with the early 1970s, and 60 per cent more received meals-on-wheels. The number of children received into care had risen by 14 per cent, and the number of those registered as physically handicapped had more than doubled. The number of places in residential homes provided by local authorities had increased by 9 per cent.

This expansion in provision has been accompanied by an increase in staff which has been most marked in those facilities which started from very low base lines, such as day care and hostels for the mentally handicapped. The social work staff, with whom we shall be mostly concerned, increased by 11 percent, from 21,680 in 1974 to 23,971 in 1976 (DHSS, 1977).

Yet with the increasing expenditure and the widening demands made on the services, ranging from simple requests for information to the most intractable problems our society is capable of producing, there has been a growing scepticism about the effectiveness of these services. This scepticism arises from three main sources: research, scandals and sociopolitical ideologies.

Let us examine these three sources of scepticism in turn. There has been serious criticism of social casework, which began in Britain with the almost forgotten onslaught by Barbara Wootton in the late 1950s (Wootton, 1959). Some of her indictments - deeply resented and contested by the social work profession at the time - seem prophetic in view of very recent developments towards more modest and down-to-earth goals in social work. For example, she attacked the social worker’s conviction that ‘she can understand other people better than they understand themselves’ (p. 293), and the social worker’s duty to penetrate below what is called the presenting problem. ‘So we pass out of the frying pan of charitable condescension into the no-less condescending fire - or rather cool detachment - of superior psychological insight’ (p. 293). ‘If she uses a request for practical help as an opportunity to intrude into other aspects of her client’s life, she does so, or should do so, at her peril’ (p. 295).

However, the notions which most affronted caseworkers in the late 1950s were that of the social worker as an expert ‘middle man’ helping to mobilise facilities within the complex network of state and voluntary services to suit the requirements of particular individuals, and that of the poor man’s secretary who could provide acceptable substitutes for those services which the rich can afford to buy. In our concluding chapter we shall discuss recent developments which approximate both these roles.

Research studies carried out in the 1960s mainly in the USA (Meyer, Borgatta and Jones, 1965; Brown [ed.], 1968; Mullen, Chazin and Feldstein, 1970; Fischer, 1973) have cast much doubt on the effectiveness and appropriateness of casework as the main method of intervention, particularly in situations of basic social and economic deprivation which require practical assistance, social reform and social action for their resolution. The widely accepted conclusion is that social work with individuals and families, however good and caring, cannot hope to achieve substantial improvements in social functioning in the absence of basic social provision, such as sufficient money, housing, education, employment opportunities, and so on. A number of investigations, and especially Reid and Shyne’s experimental study into brief and extended casework (1969), have called into question the belief in the invariable superiority of long-term intensive casework in dealing with problems of family relationships. In this country the melancholy results of the probation experiment in long-term intensive casework with young delinquents point in a similar direction (Folkard, Smith and Smith, 1976).

Other studies (Brown [ed.], 1968; Davies, M., 1969; National Institute for Social Work, unpublished) suggest that social workers are most successful with those clients who apparently need least help. That is to say, greatest improvement tends to occur in the low-risk groups receiving a limited amount of help, and deterioration is most likely among those clients with the severest problems despite a massive amount of social work input. The issues raised by these findings are:

1. that social workers take on, or are forced to take on, situations which are not amenable to the social work methods employed;
2. that there might be in operation a law of diminishing returns, and that by continuing social work over long periods of time in an open-ended, non-specific way, certain behaviour patterns may be unwittingly reinforced, dependencies induced, and a greater awareness of underlying problems encouraged for which there do not appear to be any solutions (Reid and Shyne, 1969);
3. that, by concentrating their efforts on ‘moderately severe’ problems, social workers could possibly use their skills to the greater benefit of their clients.

We will return to these issues in the concluding discussion after we have considered some of the evidence arising from our consumer studies and the monitoring exercise in one area office.

A few tentative positive findings have also emerged, namely that training and resulting skills of social workers are associated with more successful outcomes in work with the elderly in both the material and non-material spheres, compared with the intervention by untrained social workers (Goldberg, Mortimer and Williams, 1970). A recent field experiment of social work in prison (Shaw, 1974; Sinclair, Shaw and Troop, 1974) indicates that clients with a high degree of introversion benefit more from counselling than extrovert types of clients. In addition, research in the field of behaviour modification suggests that personality variables such as introversion/extroversion (Eysenck, 1957) influence the response to some forms of intervention.

Finally, suggestions are arising, both from the residential and social casework field (Reid, 1967; Mullen, 1969; Sinclair, 1971) that the personality and style of the key worker, be it the warden of a hostel or the fieldworker, is a very important and relatively unchanging ingredient which is not adapted as much as had been supposed to the differing needs of different types of clients. Thus careful matching of clients and caregivers warrants more attention and systematic exploration.

All the findings quoted so far are bedevilled by the fact that much of the evaluative experimental research on the effectiveness of social work has been carried out in a specific situation; hardly any of these studies have been replicated, which is particularly important in experiments that show positive outcomes (Reid, 1974). Operational definitions of inputs and outcomes are as yet too general so that we are still very uncertain about the association - let alone any causal relationships - between type of problem situation, type of social work input and specific outcome. Furthermore, no generally accepted terms and categories exist to describe different problem situations and different components of the social-intervention process which social workers could adopt to provide more systematic evidence about their inputs in different problem situations and their outcomes.

The next source of growing unease about social work is the accelerating number of scandals mainly related to injury and deaths of children caused by battering parents as manifested in the Colwell Report (1974) and followed since by a number of similar inquiries. Such scandals notoriously arise in extreme situations, and although they can highlight gross deficiencies and lead to significant reforms (for example, the Curtis Report, 1946, and the Children Act of 1948), they are hardly ever representative of the wide variations in current practice. However, the recent spate of public inquiries raises questions whether current practices and their monitoring devices need a thorough overhaul, or whether the community’s expectations of social workers have become unrealistic in terms of the problems they are supposed to solve having regard to the skills, knowledge and resources that are at their disposal.

The scepticism with which certain political and sociological ideologies view social work is important, if only to remind us that much social work effort is directed towards problems to which it can make at best only a marginal contribution and which may be more capable of solution by collective action on a much broader scale (Heraud, 1973; Leonard, 1975). On the other hand, even in a more compassionate society, enjoying a more equitable distribution of economic resources and political power, such phenomena as severe mental and physical handicap, difficulties in interpersonal relationships, frailty in old age, and so on, are likely to persist for the foreseeable future and call for some kind of personalised social intervention. It is surely the height of naivety to postulate that ‘in the absence of oppression, human beings will, due to their basic nature or soul, which is preservative of themselves and their species, live in harmony with each other’ (Steiner, 1974).

The conclusion we draw from this discussion is that both trends - the growing demands on the personal social services and the lack of evidence of their differential effects - point to the need for social workers to develop more accurate and informative ways of accounting for their efforts in their ordinary day-to-day activities. In addition, the constant demands for more resources make accountability as to how the present resources are being used all the more urgent.

Chapter 2 THE VASTNESS AND VAGUENESS OF THE SOCIAL WORK TASK

A general haziness and indeterminateness surround the whole concept of social work and social services, so that even now in the late 1970s, some fifty years after the introduction of systematic training for social workers, colleagues in related professions - doctors, nurses, teachers - often ask in exasperation: ‘But what do they do?’ Since the span of social work activities is so broad and since many problems landing in the huge final dustbin of the social services departments are well nigh insoluble at present, this blurred image of social work is explicable. Recently the British Association of Social Workers (BASW, 1977) has made an attempt to delineate the ‘social work task’ by trying to distinguish those roles which require professional social work expertise from social service and administrative roles by using such criteria as client vulnerability, complexity of case situation and the weightiness of the decisions to be made. However useful such a theoretical exercise may be, it does not remove the need for operationally based descriptions of tasks to be performed and skills needed. Neill’s social worker studies in Seatown and Stevenson’s more extensive studies in thirty-one area offices are building up a picture of social work tasks as perceived and described by the social workers (Neill et al., 1973; Neill, Warburton and McGuinness, 1976; Stevenson and Parsloe, 1978); there are also some studies (Mayer and Timms, 1970; McKay, Goldberg and Fruin, 1973; Rees, 1974; Glampson and Goldberg, 1976) of the clients’ perceptions. But what we lack so far is documentation of what actually happens in d...

Table of contents

• Cover
• Half-Title Page
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Acknowledgements
• Introduction
• 1 Social Work in the 1970s – the Need for Accountability
• 2 The Vastness and Vagueness of the Social Work Task
• 3 Social Worker and Consumer Perspectives
• 4 The Development of the Case Review System
• 5 The Exercise of Feedback
• 6 ‘Needs’ and Demands on Social Services in the Area
• 7 A Year’s Intake to an Area Office
• 8 Short-Term Social Work in an Intake Team
• 9 The Long-Term Teams and Their Clients
• 10 Long-Term Social Work with the Elderly and Disabled
• 11 Long-Term Social Work with Child and Family Problems
• 12 Environmental Problems
• 13 Problems of Mental and Emotional Disorder
• 14 The Social Worker’s Evaluation of the Case Review System
• 15 Conclusions and Reflections
• References
• Appendix 1 Case Review System
• Appendix 2 How the System Works
• Index