Social Workers in Community Care Practice: Ideologies and Interactions - Literature review Example

?Research Methods: Critique of a Qualitative Journal. This paper critiques the article by Mary Pat Sullivan en d “Social Workers in Community Care Practice: Ideologies and Interactions” (Sullivan, 2000). The author has a background in Canada but at the time of writing was based in the UK and engaged in an academic teaching role. This author’s international experience gives her the ability to see NHS developments with an outsider’s perspective, while her professional links in the UK give her access to insider information as well. The title adequately reflects this mingling of perspectives since it deliberately focuses on “Ideologies and Interactions” in the plural and sets out to look for multiple results. It is a concise title, which is free of extraneous words and or phrases. Abstract. The wide ranging approach of the article is confirmed in the abstract which stresses the “complex and multifaceted” way in which ideology affects people at various stages in their professional careers, and in different contexts. The abstract highlights the theoretical underpinning of the work by the work of Goffman on frame analysis (1974; 1981) and outlines how a grounded theory methodology was used to analyse the interactions between professionals and older people. There was some indication of the scope, the variables and the findings of the study in the abstract, but little in the way of detail. The most accurate description for the type of research that this study represents is a survey, with strong theoretical underpinning and a focus on linking ideology with practice. No direct interactions between social workers and clients were observed, and the information about such interactions was second-hand via the interviewing process. Introduction The problem that the article addresses is was very clearly defined as a need to evaluate the success of the 1990 NHS and Community Care Act in meeting the needs of older people. This is not a new issue, since the Act had been in force for almost two decades at the the time of publication of the article, but the author demonstrates that the critical literature has produced very mixed evaluations. The complexity of the environment, with its conflicting demands such as professional standards, management directives, shifting ideologies, financial constraints and different individual values has led to a proliferation of research outputs which illuminate the detail, but do not address the more fundamental question of dominant ideologies. The background to the problem is described as “a practice context that has challenged well established modes of social work intervention, … an emphasis on inter-professional working… and ethical considerations surrounding service rationing and individual rights.” (Sullivan, 2009). The problem itself is clearly formulated as a need to “explore both the manifest content and the functional properties of dominant ideology in community care practice”. (Sullivan, 2009) Literature Review Sullivan cites a number of key studies in her description of the fundamental changes in the delivery of care to older people since 1990. These include the work of Postle (1999; 2000; 2002) on the changing role of social workers, and various studies on how bureaucracy affects the delivery of care, such as Lipsky (1980) in an American context and Ellis et al. (2007) in a UK context. Stereotypes of social worker description are listed with reference to Wilmot (1995) and Dalley (1991). A great many studies on organizational policy and its effects on professionals and older people are cited. The extensive quotation of other scholars gives the literature review the quality of a meta-analysis, and at the end of this the author homes in on the issue of how ideologies impact on practice delivery. The somewhat overpowering density of references is no doubt due to the fact that the article rests on the author’s PhD research. (Sullivan, 2003). Method procedure. The study proper begins with a reiteration of Goffman’s frame theory of human social behaviour. This approach informs the use of purposeful sampling, based on a data collection through semi-structured in-depth interviews with social workers and social work assistants. Data was collected in the form of audio tapes, anonymized and transcribed. These measures give some assurance that extraneous sources of error or data loss were minimised. The method: Design  Practitioner focus groups were used to assist in the development of the interview schedule, and a decision to focus on interactions rather than beliefs was made at this stage. This was a good strategy which ensured that realistic rather than manufactured evidence would be collected and bias on the part of interviewees towards wishing to impress the interview could be avoided. By recording reported actions, and the way they were described, the researcher built in a focus on authentic data. By allowing interviewees to speak freely about their work, using their own terminology and style, the researcher could objectively observe hidden ideologies emerging. As the speakers described their actions, they forgot about the self that they were projecting, and this meant that the information on their underlying ideological framework was retained intact for the researcher to deconstruct. The method: sample  The sample size is relatively small, at 40 individuals employed in social work related roles, and located on two different sites. Efforts were made to recruit groups that were representative of the organizations in terms of age, gender, education, experience and ethnic origins. It was interesting that the study made no attempt to triangulate the findings from the social workers with the views of the clients themselves. This was a weakness, which the author occasionally tried to offset by surmising how a client might interpret a situation differently than a professional. The method: instrumentation  Ethical approvals for the study were obtained from all participating institutions and participants. All interviewees were professional practitioners, adults, and able to give informed consent to the study. From the raw data smaller sections were extracted which illustrated the issue of dominant ideologies most intensely. There was no attempt to quantify statements, and instead the aim was to highlight utterances that provided data on the desired topic area. The author does not mention who was conducting the interviews, but it is implied that this was the author herself, using a protocol that was consistent with all participants. The narratives which are quoted reveal that there was quite a lot of lee-way for speakers to elaborate in an anecdotal fashion, and that the interviewer encouraged this when the content matched the topic area under examination. Results As befits a qualitative study, the results are presented in the form of extended narratives. There are no tables or graphs, but there is extensive quotation from the various interviews. In a step by step process the author illustrates how Goffman’s theory of frames is enacted in daily practice. The dominant ideology turned out to be that of professional practice, although this was modified in some cases by frames such as “the deserving client” who was granted leave to opt for choices outside the managerialist provision of the organization. Instances of dominant ideologies were interpreted, for example the tendency to invervene for clients who were motivated, grateful and compliant, suggesting that individual experience modified institutional directives, with the result that some patient groups, such as those with dementia for example, might receive less intervention even though their need might be objectively greater. This dual approach of narrative with interpretation allowed a reliable basis for the formation of results which merge practical and theoretical concepts. Epithets like the social worker as “agent of the state and good citizen” or the social worker as “young, healthy and capable human being” acting in a paternalistic way towards “older clients with compromised physical and mental health” clarify the ideological points in a very helpful way for the reader. The author reports a lot of inconsistency in the interviews, and instances of contradictory beliefs and behaviours, which she interprets as “unease” on the part of the professionals. There is a suggestion, obliquely expressed, that training of social work professionals is not adequate and there may be some danger that vulnerable older people face when working with such professionals. Opinion. In my opinion the article was well represented and well organised. It was and easy to read and follow despite the fact that some heavy sociological concepts were being used. I felt that the author made some good points about the confusion of frames that can occur when professionals acquire layers of ideology from their own personal experience, from the organization they work for, from new directives and from their idea of what a professional approach should be. I could see that sometimes the professional staff were so hemmed in by time constraints and financial limitations that they adopted the easiest approach, which was to seek conformity to institutional patterns, rather than empowerment of individual clients. I also felt that the author fell into the trap of a patriarchal ideology by devising a study that looked only at the professionals’ perspective and made no attempt to give voice to the clients at all. This would have been a very useful counterbalance and validity check, and admittedly the author cites this as an area that merits more research. References Dalley, G. (1991) Beliefs and behaviour: Professionals and the policy process. J ournal of  Ageing Studies 5 (2), 163–180.  Ellis, K., Davis, A. and Rummery, K. (1999) Needs assessment, street-level bureaucracy  and the new community care. Social Policy and Administration, 33 (3), 262–280.  Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. New York: Harper and Row. Goffman, E. (1981) A Reply to Denzin and Keller. Contemporary Sociology 10 (1), 60-68. Lipsky, M. (1980) Street-Level Bureaucracy: The Dilemmas of Individuals in Public  Service. New York: Russell Sage.  National Health Service and Community Care Act. (1990). Available online at: http://www.legislation.gov.uk/ukpga/1990/19/contents Postle, K. (1999) ‘Things fall apart; the centre cannot hold”: Deconstructing and reconstructing social work with older people for the 21st century. Issues in Social Work Education 19, 23–43.  Postle, K. (2001) The social work side is disappearing: I guess it started with us being  called care managers’, Practice, 13 (1), 13–26. Postle, K. (2002) Working “between the idea and the reality”: Ambiguities and tensions  in care managers’ work. British Journal of Social Work 32 (3), 335–351.  Sullivan, M. P. (2003) Social workers and district nurses in community care care:  Framing ideologies and interactions with older people. Unpublished Ph.D. thesis,  King’s College London.  Sullivan, M. P. Social Workers in Community Care Practice: Ideologies and Interactions with Older People. (2009) British Journal of Social Work 39 (7), 1306-1325. Wilmot, S. (1995) Professional values and interprofessional dialogue. Journal of  Interprofessional Care 9 (3), 257–266.  Read More