Risk and professional artistry in social work practice: between the contingencies of street- level operations and regimes of formal accountability

Transcription

1 Risk and professional artistry in social work practice: between the contingencies of street- level operations and regimes of formal accountability Tom Horlick-Jones and Colin Young Cardiff University School of Social Sciences

2 Introduction Risk as an all-purpose language of administration, regulation and standard- setting. How has the adoption of a framework of risk-based practice shaped professional practice in social work? To what extent are contemporary theories of risk useful in capturing features of the real world of social work?

3 1. The nature of social work

4 What is Social Work? Different definitions: Barclay Report (1982) Griffiths Report (1988) International Association of Social Workers General Social Care Council (GSCC) statement of social work roles and tasks (2008)

5 An informal definition The tasks of social work makes the tasks the Israelites had to make bricks without straw look easy! Griffiths Report [1988] Community Care: An Agenda for Action (report which lead to the National Health Service and Community Care Act 1990)

6 The international definition, adopted in 2001 a a profession which 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 (emphasis added) Care Council for Wales [2003] p.4

7 Payne (2006) All social work contains elements of: Maintaining social order. Therapeutic reflexiveness interaction between service users and social workers, aimed at greater self-fulfillment. fulfillment. Transformationist changing society.

8 Social Work in the 21 st Century Admin and ICT skills (ECDL) Inter-personal skills Ability to think and act creatively across theoretical boundaries Multi-disciplinary Listening and responding to the service users / carer voice

9 General Social Care Council, 2008 Social work makes a particular contribution in situations where there are high levels of: Complexity, uncertainty, stress, conflicts of interest, and risk (GSCC [2008]:4)

10 Social work and risk Exposed to greater challenges (e.g. from the media) than other professions: Victoria Climbie Baby P Shipman Adult deaths as well, but less press coverage. Failures: Inadequate risk assessments Poor collaboration with other professionals

11 Climbie Lord Laming the legislative framework is fundamentally sound. Not to the often hapless front-line staff that direct most criticism,. Greatest failure rests with senior managers and members of organisations whose responsibility is to ensure services properly financed and staffed (Laming[2003]:5)

12 Climbie Lord Laming 108 recommendations, inc: Training of social workers must equip them with confidence to challenge other professionals Assessing child without carer s s consent Document concerns, record visits Recorded discussions of differences in medical opinions (esp. physical vs. non-accidental) No child with protection concerns discharged from hospital without permission of consultant (responsibility rests with consultant) Those with child protection concerns not discharged without a plan, or a GP! Check on previous concerns following admission

13 Professor Richard Baker quoted in Shipman report (p.69) Since beginning to investigate Shipman in 2000 I have been trying to understand how it was that he could kill so many without detection. There were of course system failures, but it has been impossible to avoid the question as to why these were tolerated to the extent that Shipman could murder over 200 patients. The conclusion I have come to is that all doctors share responsibility

14 Risk and professional practice Criminal justice and the new penology. Whither the welfare state? Assessing risk in child protection. Probation practice. Mental health and dangerous people. Health governance. and now. Risk management in social care.

15 2. How is risk-based practice shaping the character of social work?

16 Generating a dialogue between theory and practice Experience, gained over a number of years, of teaching risk theory to in-service social workers, studying on the post- qualification course. Practice-orientation, interactive. Opportunity for informal discussions of specific examples of practical experience. Around 100 PQ students in total.

17 Five notable topics a. The use of risk ideas in documentation. b. Risk and professional expertise. c. Use of formal techniques for risk assessment. d. The jigsaw effect. e. Risk and accountability.

18 a. Risk ideas in documentation Example: In safe hands: Implementing adult protection procedures in Wales (2000). The presence of ambiguities and confusions Risk: to the vulnerable to others to informants (to social care agencies, staff) Risk: Perceived and danger assessment (but how?) unacceptable (but criteria?) management strategy, where deemed appropriate (but criteria?)

19 b. The risk-based framing of social work practice Professional Regime Practice Basis for action Who is at risk? Pre-risk risk Professional autonomy Professional Expertise Service user Risk-based Prescribed Actions Risk Assessment Service user, carers, professionals, other stakeholders

20 c. Approaches to assessing risk A A range of practices, co-existing across geographically-close close administrative areas. Formal techniques: Check lists Risk matrix Risk scores Hazard or risk management, or a hybrid of these?

21 d. The jigsaw effect Notion coined by Firkins and Smith (2002), prompted a strong resonance with the students. Decision-making in conditions of incomplete knowledge. Information is spread between different professionals, agencies and other members of the community. A practitioner may only possess a few pieces of the jigsaw. How to gain the other pieces? Working with an incomplete picture. The trade-off between collecting further information and the immediate welfare of the service user.

22 Unknown unknowns as we know, there are known knowns; ; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns the ones we don t t know we don t t know. Donald H. Rumsfeld, February 2002

23 e. Risk and accountability Risk-based practice and formal accountability. Slippage between everyday professional practice and what gets recorded in the paperwork. Liability issues. Back covering. Getting things done by ensuring the assessments turn out appropriately.

24 3. A little theory

25 Preamble To what extent can sociological theories of risk help understanding of the praxis through which social work is daily accomplished? The distinction between contingency and risk. Risk Society, too broadbrush? Governmentality,, the technical discourse of risk, and totalisation? Relevance of other grand theories?

26 Some different perspectives Street-level bureaucracy (Lipsky( Lipsky): a a corrupted world of service,, under-resourced resourced overload, informal techniques of practice. Keeping the peace (Bittner). Professional artistry (Sch( Schön). Good organisational reasons for bad clinical records (Garfinkel( with Bittner) Conflicting knowledges (Kemshall) Risk is decentred (Horlick-Jones): a chronic, situationally-specific, specific, ambiguity over the nature of the risk object; slippage between formal and informal practices.

27 Conclusions Social workers operate in skilled and pragmatic ways to address the practical challengers of heavy workloads, whilst maintaining an orientation towards the formal demands of risk management. Limited explanatory capacity of some grand theories of risk to capture the diversity and situational specificity of patterns of risk praxis. Implications for the development of social work practice and risk scholarship?

28 Contact details Prof. Tom Horlick-Jones Dr. Colin Young Cardiff School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT, Wales UK.

29 References 1 Bittner, E. (1967) The police on skid-row: a study in peace keeping, American Sociological Review,, 32, pp The National Occupational Standards for Social Work. Cardiff: Welsh Assembly Government. Care Council for Wales (2003) The National Occupational Standards for Social Work. Cardiff: Welsh Assembly Government. Firkins, A. and Smith, S. (2002) Judgement as a resource in child protection practice in Candlin,, C. (ed.) Research and practice in Professional Discourse, City University of Hong Kong, Hong Kong pp Garfinkel,, H. with Bittner, E. Good organizational reasons for bad clinical records in Garfinkel,, H. (1967) Studies in Ethnomethodology, Prentice-Hall, Englewood Cliffs NJ. Pp GSCC (2008) Social Work at its Best. A Statement of Roles and Tasks T for the 21 st Century. London: L GSCC. Horlick-Jones, T. (2005) On risk work : : professional discourse, accountability and everyday action, Health, Risk & Society, 7(3) pp Horlick-Jones, T. (2008) Risk, praxis and everyday life,, keynote paper delivered to a session on The Everyday Management of Risk,, International Sociological Association congress, Barcelona, September, available le from the author or via: Jones.pdf.

30 References 2 Kemshall,, H. (2000) Conflicting knowledges on risk: the case of risk knowledge in the probation service, Health, Risk & Society,, 2, pp Laming, Lord W.H. (2003) The Victoria Climbie Enquiry CM London: HMSO. Lipsky,, M. (1980) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services,, Russell Sage Foundation, New York. National Assembly for Wales (2000) ) In Safe Hands Protection of Vulnerable Adults Cardiff: National Assembly for Wales. lic ations/ /safe_hands?lang=en National Institute for Social Work (1982) Social Workers Their Role and Tasks London: National Institute for Social Work. Payne, M. (2006) What is Professional Social Work? Bristol: Policy Press Schön,, D. (1983) The Reflective Practitioner: How Professionals Think in Action, Basic Books, New York. Shipman Inquiry (2005) (Web-site: shipman-inquiry.org.uk/home.aspinquiry.org.uk/home.asp