Finding a voice: the fee-for-service social work experience: insights from practitioners

Abstract

Fee-for-service social work is an expanding field in Australia, however current knowledge and understanding of its nature and characteristics draws primarily from studies of the purely clinical practices in overseas settings such as the United States and New Zealand. There is little research about fee-for-service from the perspective of Australian fee-for-service practitioners regarding its nature and characteristics, or how practitioners understand and apply the core social work values of respect for persons, professional integrity and social justice. Fee-for-service social work has been the subject of much debate. The past criticisms centre on concerns regarding the pursuit of profit, lack of accountability and practice standards and neglect of social justice. Contextually, much about the nature and characteristics of Australian fee-for-service is unknown. There is limited research about how Australian fee-for-service respondents experience values and inclusion and/or marginalization within the social work profession.This qualitative study of 11 South-East Queensland fee-for-service respondents seeks to understand the experience of fee-for-service practice as distinct from agency-based practice, in relation to these issues. The central research question is: “How do fee-for-service respondents experience fee-for-service social work in relation to its nature and characteristics and core social work values?” This thesis provides a contemporary portrait of a small sample of fee-for-service social work respondents. It provides information on respondents’ experiences and perceptions about the nature and characteristics of fee-for-service practice, distinctions between fee-for-service and agency-based social work, how core social work values are utilized and respondent’s experiences of inclusion or marginalization within the social work profession. To gain insight into the rich detail of the respondents’ experiences and perceptions, a semi–structured questionnaire is used in the interviews. The computer program Nvivo is used to manage the data. Social Constructionism provides the conceptual framework and informs the thematic analysis of the data.The findings reveal that many of the traditional critiques around fee-for-service are challenged due to the unique nature and characteristics of Australian fee-for-service business models. This study has identified three fee-for-service practice models which have evolved in a context that has limited third party payments, government rebates and limited welfare community referrals. These contextual issues are only a part of the challenges facing fee-for-service respondents.A major challenge for fee-for-service respondents is the need to generate a sustainable income whilst remaining responsive and flexible to client needs. These challenges by their nature encourage diversity, flexibility and advanced practice knowledge and skills in respondents. Fee-for-service provides challenges to respondents in relation to the actualization of core social work values.The findings suggest that respondents incorporate core social work values of “respect for persons, professional integrity and social justice” in their work (AASW, 2010, p.12/13). The client is central in fee-for-service practice but earning a sustainable income is the organizing principle and is a pragmatic reality. Social justice still offers some challenges in clinical practice whilst respondents reject that notion that social justice is neglected. Respondents perceive that social justice is addressed through management stream strategies and voluntary contributions of time and expertise. These activities have not been widely recognized in earlier research into fee-for-service practice. Respondents expressed an interest in the pursuit of social justice, but perceive a lack of support, training and opportunity to do so within their own work spheres. Respondents perceived that the strengths of fee-for-service are under-utilized i.e. Professional autonomy.In general, respondents perceive that fee-for-service social work is misunderstood by the wider social work profession. Further, that some misunderstandings may be due to previous research on the purely clinical practice and the application of research conclusions to fee-for-service. Misunderstandings around fee-for-service appear to be exacerbated by the dichotomous thinking that surrounds fee-for-service verse agency-based social work and the impact of the economic and political context; such as new public management, and a lack of agency referrals, with insufficient educational and support resources to overcome identified barriers.The findings of this small sample of respondents cannot be generalized to all Australian fee-for-service practitioners; however it does provide a basis to review current understandings about fee-for-service practitioners and their practice. The study identifies that misunderstandings and barriers that appear to confound the profession’s capacity to recognize the evolution of both fee-for-service and agency-based social work. An unfortunate by-product is an under-estimation of the potential for fee-for-service and agency-based social work to work collaboratively. Furthermore, these forces potentially maintain an unnecessary schism within the social work profession. It would seem timely for fee-for-service practitioners, the professional association, the wider social work community and educational institutions to work collaboratively to overcome the limitations presented in this study, to establish practice standards, competencies and ethics in service of both the free market and agency-based client.