Service User and Carer Participation in Social Work

Identify, using examples, how a professional social worker should work in such a way as to ensure user and carer participation.

Consider the practice issues for working anti-oppressively with users or carer’s who are either a frail elderly person and their carer.

A professional social worker must approach the elderly person as an individual and ensure that individual as opposed to generic needs are assessed. In practical terms this means that the approach taken is built upon a mix of professional pragmatism and textbook rules. This manner of approach also ensures that the social worker can approach the practice issues identified in an anti-oppressive and professional manner which promotes both user and carer participation. Certainly in terms of personal reflection, and from the writer’s perspective; as a white, middle class person, integrating the theory of how one is required to engage oneself anti-oppressively, in the capacity of social worker with the pragmatics of good social skills and an ability to put a user, such as a frail elderly person and their carer at ease is all the more important where there are differences between the practitioner and the service user in terms of age, race, religion and sex to name just a few examples. Therefore promoting user and carer participation and working anti oppressively with frail elderly users is by no means an easy task. Such a task requires an understanding of models of oppression. Models of oppression mainly relate to the ‘isms’ within society such as ageism, sexism, classism, racism and many others (Williams, (2002) 1), and in the context of this question perhaps ageism and its avoidance within a user/practitioner setting is the most relevant. The professional social worker must be aware that models of oppression must be understood and applied within carer/user settings in order to promote an ethical, participatory relationship between the two (Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) 14). This is because as Beckett and Maynard ((2005) 46) observe, the social worker often deals with those groups within society who are the ‘least powerful’.

One classic example of this for the social worker in a practice situation could be at a juncture where a frail elderly person reaches a stage where their needs cannot be accommodated at home, and supported accommodation options for the elderly person may need to be discussed. In this instance ‘alone time’ spent between carer and the social worker and the user and the social worker can allow both to discuss the issues at hand frankly, and decide what the best way forward might be. This ensures that there is holistic user participation, as it is important that the needs of a frail elderly person are not entirely overshadowed by the input of the carer. This by no means implies that the carer should be ignored during a home visit, or should be excluded in any manner, but there will be times when it is appropriate for the frail elderly person (provided they are compos mentis) to express their viewpoint independently of those close to them (for example if they express a wish to have arrangements made for a will). This will also give the social worker an opportunity to have some time alone with the carer, which gives the carer an opportunity to raise concerns or to discuss issues which they would perhaps not feel comfortable raising in the presence of the person who they take care of. Of course, the user participation will be important once these discussions have taken place, because a frail elderly person cannot be placed into supported accommodation without their co-operation and consent. However, it is often beneficial, where a sensitive issue should as a move between home and supported accommodation is to be broached, that a carer and a professional social worker have an opportunity to discuss the needs of the ‘user’ of the services in a setting where these issues can be spoken of frankly. This does not mean that issues should be concealed from a user or from a carer, but often in terms of facilitating anti-oppressive practice issues it is appropriate to relate to both user and carer in different ways, and therefore it may be necessary to communicate with one or another (user and carer) separately.

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In this context the issue of power within society and how it relates to social inequalities must be understood. The social worker is in quite a powerful position compared to an elderly and frail service user, and therefore a professional social worker is required to appreciate how their language must be employed as a strategy to engage the service user, and carer anti oppressively, and at the same time promoting participation.

To take stock of another example to illustrate this point, let us look at a scenario whereby an elderly person who is frail is hostile to interventions from a social worker. Here, the requirements for anti-oppressive techniques of care become all the more important. Difficult questions become apparent in this context. Some examples are as follows: What should one do whereby a frail elderly person has a carer who looks after their needs on a part time basis, and the social worker feels that there are issues of self neglect during episodes where the carer is not present? To take this example a little further, a scenario could arise where a frail elderly person, whose carer is not present, is being visited by a social worker. Let us imagine that the social worker wishes to gain entry to the house of the elderly frail person in order to assess their needs and the elderly person is suspicious and does not wish to allow the person in. How can language be employed in this setting to promote an ethical relationship based on anti-oppressive techniques in this scenario? A simple answer would be for the social worker firstly to explain who they are and why they wish to pay a visit to the elderly person, and secondly another strategy which could be employed would be to say to the service user (the elderly frail person); Can I come in for a Chat/some Tea?, rather then an overly formal explanation of why they are there for example ‘I have to speak to you to assess whether you are capable of looking after yourself’. This approach also empowers the service user, since they may feel more in control of the interaction, and they might also be more inclined to perceive the social worker on friendly terms.

To pose another critically important question here: how should a social worker in this above outlined scenario handle a conflict which arises between an elderly user and the state where an elderly person, who lacks capacity to make decisions for themselves is self-neglecting and will not co-operate with a social worker who encourages them to move into supported accommodation? Two models of intervention may be employed here by the social worker, to deal with the conflict. One is the state intervention model, which may involve sectioning the frail elderly person and removing them into the care of an institution, and alternatively the social worker can choose to employ more moderate interventions which involve living support from voluntary sector groups (Scottish Executive (2006) Section 1.3). Which one is best always depends upon the individual circumstances of the frail elderly person, and the judgement of the individual social worker^[1].

In this context, and to continue the reference to the particular example where a social worker wishes to gain entry to the house of a frail, elderly person for the purposes of assessing their needs, it is also important to remember that the social worker owes the frail elderly person some legal responsibilities. All social work practitioners, for example are required to adhere to the various codes of ethics which have been issued through the General Social Care Council, which was set up in 2001. Amongst other duties, each of the 84000 social workers and social worker students on the Social Care Register must submit to inspection by the Commission for Social Care Inspection, and are required to have their own copies of their codes of conduct; and also as of 2003, the Social Care Register requires that only registered social workers may describe themselves as social workers (to label oneself a social worker, and at the same time intending to deceive others in this respect is now a criminal offence) (www.gscc.org.uk). Another legal responsibility which the professional service user owes to the user and to the carer is the duty not to discriminate unnecessarily against a person on the grounds of their race, ethnicity, disability, and age to give just a few examples of areas which are protected by law by anti-discrimination legalisation. Research into what practice issues are important for services users including carers and the elderly which was carried out by the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust suggests that the combating of discrimination and how it can lead to an oppressive relationship between service user and social worker is very important in social work practice (Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) 14).

In terms of both user and carer participation, the issue of confidentiality is of the utmost importance. This builds trust between user and the social work practitioner and also may lead to a feeling of empowerment by the service user, who is in the context of this question a frail elderly person. To refer back to the first example used in this essay (where the issue of perhaps assessing the needs and views of both carer and an elderly frail person separately has been raised); where there are issues which are quite sensitive between a carer, and a frail elderly person, it is important that the confidence of both parties are respected by the social worker. It is also important to speak to each person on their terms. One classic example of this in the context of a frail elderly person, addressing the user firstly by using their formal title ‘Miss Jones’ for example or ‘Mrs Smith’, as opposed to the use of first names is potentially an important strategy to employ. It is often the case that there will be a large generational gap between the frail elderly person and the social worker, and this makes to concept of anti-oppressive techniques and participation techniques all the more important. Such a generational gap may make a frail elderly person perceive the social worker as more of a threat to them, and may perhaps convey to them the impression that the social worker has little understanding of their needs and view of the world. In this sense, also good case management and record keeping (often a legal requirement for social workers) will also facilitate user and carer participation, as well as anti-oppressive practices.

In conclusion therefore there are a plethora of practice issues which are pivotal in a scenario where a social worker is required to interact in a professional capacity with a frail elderly person and their carer. All of these issues are intersecting, related, and sometimes contingent upon each other. The requirements for user and carer participation and for an understanding of anti-oppressive techniques are therefore complex concepts which require a pragmatic approach, integrated with a theoretical approach on the part of the contemporary professional social worker. These arguments have been supported throughout the essay through a focus upon reflective and theoretical reasoning.

Bibliography

Books

Beckett, C. and Maynard, A. (2005) Values and Ethics in Social Work. Publisher: Sage Publications. Place of Publication: UK.

Articles

Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) Strategy for Social Work and Social Care. Publisher: Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. Place of Publication: UK.

Scottish Executive (2006) The Need for Social Work Intervention. Publisher: Scottish Executive. Place of Publication: UK.

Williams, C. (2002) A Rationale for an Anti-Racist Entry Point to Anti-Oppressive Social Work in Mental Health Services Critical Social Work, 2002 Vol. 3, 1.

Website

<< http://www.gscc.org.uk/News+and+events/Media+releases/Put+social+care+centre+stage+in+social+exclusion+drive.htm >>.

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Footnotes

^[1] See the Scottish Executive Publication for a more in depth account of models of intervention.