Social Work with Disabled People

Michael Oliver, Bob Sapey, Pam Thomas

• Publisher: Bloomsbury Academic
• Year: 2012
• ISBN:
  9781350313279
• Edition: 4
• Topic: Social Sciences
• Subtopic: Disabilities in Sociology
• Index: Social Sciences

Having gone through 30 years of development, the new edition of this highly-regarded classic is the most trusted companion for understanding and promoting the potential for social work with disabled people. It offers readers a clear introduction to the core issues of disability alongside discussion and assessment of the social worker's role. Written by an experienced and highly respected team of authors, the book reflects:
- The latest updates, developments and policy changes
- The broad range of areas needing to be understood for informed practice
- Recent changes to the focus of social work education and practice
- The Social Model of Disability, encouraging debate about its role in social work
- Developments for independent living
- The heightened importance of safeguarding issues, giving attention to the topical issue of disabilist hate crime Accessible to a broad readership and respected by disabled people themselves, this text is the foundation for effective practice.

CHAPTER 1

Social work and disability: old and new directions

Old directions

The social work role and tasks

Prior to 1970 help for disabled people and their families was really only available through the health service or voluntary organisations. The Seebohm Report (Department of Health and Social Security, 1968), local government reorganisation and the Chronically Sick and Disabled Persons Act 1970 led to services for disabled people being established as a social services responsibility. The National Health Service and Community Care Act 1990 led to the reorganisation of adult social services, while the Children Act 1989 brought in separate provisions for disabled children.

By the mid 1980s social services were under pressure from disabled people who were dissatisfied with the inequitable distribution of services (Feidler, 1988) and their lack of autonomy as service users (Shearer, 1984). The government was concerned with the spiralling costs of welfare services for adults (Audit Commission, 1986). The Disabled Persons (Services, Consultation and Representation) Act 1986 attempted to ensure a voice for disabled people in the assessment of their needs, but was superseded by the 1990 Act which sought to control expenditure through the introduction of a quasi-market into the social welfare sector. This reinforced the role of local authorities as the assessors of need so the disabled people’s movement continued to argue its case for greater control of personal assistance (Oliver and Zarb, 1992; Morris, 1993a; Zarb and Nadash, 1994). One of the results was the Community Care (Direct Payments) Act, 1996 which allowed money to be given directly to clients. Direct payments and putting the users of social services in control became a cornerstone of social care policies: ‘the guiding principle of adult social services should be that they provide the support needed by someone to make the most of their capacity and potential’ (Department of Health, 1998: para. 2.5).

The government (Department of Health, 1998, para. 2.11) also aimed to take action to reduce the use of institutional care through:

• better preventative services and a stronger focus on rehabilitation,
• extension of direct payments schemes,
• better support for service users who are able to work,
• improved review and follow-up to take account of people’s changing needs,
• improved support for people with mental health problems, and
• more support for carers

The publication of A Quality Strategy for Social Care (Department of Health, 2000) and the Requirements for Social Work Training (Department of Health, 2002) both emphasised the need for social workers to be skilled in working in partnership with service users. The Department of Health made funds available to help universities pay service users to be involved in social work education and bringing disabled people into the classroom as teachers. This respect for the expertise of disabled people reflects a major shift from seeing social workers as the experts.

The role of social workers may be affected by organisational developments, but in essence little has changed. Although in theory their role has over time been envisaged as quite broad including the provision of personal social work help to individuals and families, the assessment of needs, the provision of support and rehabilitation, support and training of social care staff and co-ordination of care packages (CCETSW, 1974; Stevens, 1991), in practice social workers have had a much more limited role.

There have been a number of studies which have discussed social work in relation to disabled people, but few have been complementary. Social workers have often failed to recognise the potential of working with disabled people. Priestley (2004) criticises the core role of social work as being structured to enforce dependency:

The practice of care assessment and management is not simply a technical ‘gate-keeping’ mechanism – it defines disabled people’s needs in a very particular way. Value-laden purchasing decisions can perpetuate the myth of ‘care’ over independent living by focussing resources on personal care and limited domestic chores at the expense of support for social integration. Thus, care assessments all too frequently consolidate the social segregation of disabled people in their own homes, rather than challenging their enforced dependency. (Priestley, 2004: 259)

The managerialisation of welfare during the 1990s saw the conversion of many social work managers to the creed of quality assurance. This doctrine claims that it is of no importance as to who delivers or arranges a service so long as it is provided, but it contradicts much of the evidence from consumers of welfare (Howe, 1987; Morris, 1993a; 1993b; Willis, 1995) that the way in which social workers undertake their duties is important. Not only does this doctrine ignore the wisdom of experience of the Poor Laws, that it was necessary for the administrators of welfare to ‘humanise the relationship between the poor and authority’ (Albert Evans MP quoted in Silburn, 1983) if they were to overcome the stigma attached to receiving assistance from the state, it also contradicts evidence from practice. For example, Dawson (2000) found that the take up of direct payments was most affected by the attitude of social workers, a clear indication of both the positive and negative effects that approaches to professional practice can have on the lives of disabled people. The topic of direct payments is returned to in Chapter 3.

Furthermore the failure of social workers to develop an adequate theoretical and practice base for their interventions has led to criticisms, notably by disabled people themselves, who have accused social workers of ignorance about impairment and long-term illness, benefits and rights, failing to recognise the need for practical assistance as well as verbal advice and to involve disabled people in the training process. They have also expressed resentment at being treated on a less than equal basis in the professional/client relationship (Finkelstein, 1991). In addition social workers have often been reluctant to throw themselves wholeheartedly into work with this particular group.

Adults with physical impairments make up the largest group of disabled adults of working age both in terms of those who are, and those who are not, eligible for social care. Social work support and services for working age adults with physical impairments have not had the same specialist attention as adults with learning difficulties or adults experiencing mental distress. This includes specialism in career choices for social workers. In some cases social work with adults with physical and or sensory impairments may have been treated as an ‘add on’ to support for older people.

As a measure of social workers’ disinterest, Sapey (2004) reported that in a review of papers on disability relevant to social work, only one in eight were published in social work journals while more than half were within the disability studies field which is led by disabled people.

Inappropriate teaching about disability on some training courses may mean that workers feel inadequate or incompetent when working with disabled clients. Personal fears about impairment may mean that workers are reluctant to get involved in what they perceive to be the personal and social consequences of adjusting to a human tragedy or disaster. The major criticism is, however, that social workers, like all other professionals, have largely operated with inappropriate models or theories of disability, so it is in a sense perhaps fortunate that social work intervention has been so limited. There have of course been several attempts to change this both from within and without the profession (Oliver, 1983, 1991; Holdsworth, 1991; Stevens, 1991; Middleton, 1992, 1995; Morris, 1993a; 1993b; 1997a; Swain et al., 1993; Thompson, 1993; Cavet, 1999; Oliver and Sapey, 1999, 2006; Moore et al., 2000; Read and Clements, 2001; Harris, 2004; Glasby and Littlechild, 2009), but there is little evidence that employers of social workers have made significant changes in the environments in which they practise. As Holdsworth (1991: 10) pointed out:

The practice of empowerment social work can thus be seen to entail a radical shift in attitudes on the part of the social worker, and ultimately on the part of Social Services Departments and society as a whole, if continual conflict between individual social worker and employing agency is to be avoided. However, as societal and Social Services Department views are unlikely to change sufficiently rapidly, the individual social worker is likely to experience at least periodic conflict with her employing agency as she aligns herself with her client in an attempt to fulfil a jointly agreed-upon service need.

Before going on to consider an appropriate model of social work intervention, it is necessary to discuss why the current model is inappropriate; this will be referred to as the ‘individual model’ of disability.

New directions

The social work role and tasks

More recently the social work role continues to be envisaged as quite broad:

The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work. (General Social Care Council, 2008: 9)

The specific tasks which are undertaken by social workers vary according to the situation, but according to the General Social Care Council (2008: 16) will include helping children and adults to:

• overcome the problems of disability;
• negotiate the transition to adulthood and achieve independent living;
• access direct payments, individual budgets and other funding; and
• secure personal assistance, equipment and employment adjustments

However, social workers are also expected to play a role in ensuring that welfare provision is both fair and sufficient by:

helping to ensure that public resources are allocated and any charges applied fairly, and informing commissioners of any evidence that the type, scale or quality of services is not matching needs. (General Social Care Council, 2008: 16)

Laudable as these aims may be, they will fail disabled people if social workers do not first have an understanding of disability.

Explaining disability

There are three main sources upon which to draw when considering the question ‘What is disability?’ First there is social consciousness generally or culture, then there are professional definitions of disability and third there are personal realities, as articulated by disabled people themselves.

Source one: general social consciousness or cultural views of disability

The dominant view of disability is one of personal tragedy or disaster but this is not true of all societies, and some may regard impairment as a sign of being chosen or possessed. Culture, customs and beliefs change over time, and there is not always agreement about what disability actually is within the same culture:

A class of persons grouped together under the term ‘physically handicapped’ is at best difficult to treat as ethnological data. Here for us is a category of persons with social liabilities peculiar to the conditions of our society. It represents no logical or medical class of symptoms. For example, carrot-colored hair is a physical feature and a handicap in certain social situations, but a person with this characteristic is not included in this class. Nor is the symptom itself the only criterion, for though the person afflicted with infantile paralysis may limp as a result of the disease and be deemed to be handicapped, yet the person with an ill-fitting shoe or a boil on his foot who also limps will be excluded.

When one introduces the concepts of other cultures than our own, confusion is multiplied. Even assuming the existence of such a class in other societies, its content varies. The disfiguring scar in Dallas becomes an honorific mark in Dahomey. (Hanks and Hanks, 1980: 11)

Variations in cultural views of disability are not just a random matter. Differences may occur as a result of a number of factors such as the type of social structure, for example restricted mobility is less likely to be a problem in an agricultural society than in a hunting and gathering one. And the way production ...