Social Work Case Research Articles

Professional Relationships and Power Dynamics Between Urban Community-Based Nurses and Social Work Case Managers

The purpose of this study was to explore how community-based case managers interface with their clients' healthcare providers and other community organizations as a function within their advocacy efforts. Case managers previously defined advocacy as occurring at individual, organizational, and community levels. The relationships they attempt to develop and maintain are consistent with case management ideology, yet this is a complex process to ensure care for vulnerable populations with many medical and socioeconomic needs. Community-based case management settings. In-depth qualitative interviews with a total of 20 nurse and social work case managers working in public housing, university-affiliated community nursing centers, local parishes, and community ministry. The case managers in this study reflected on how they interface with their clients, other healthcare providers, and community organizations on behalf of their clients. They reflect on the importance of trust and communication to facilitate this process. The advocacy work of case managers is influenced by the setting, others' perceptions of their knowledge and expertise, and power dynamics. Their ability to effectively advocate is greatly influenced by the strength of the relationships they forge. Advocacy for vulnerable clients is influenced by the existing relationship between case managers and their clients' healthcare providers. Case managers need to be persistent in their interactions with other providers to ensure that their clients have access to valuable community resources. Clear lines of communication should be established between case managers so that there is clarity around roles and expectations in service provision. Case managers should also participate in the mentoring of future health professions students so they may learn the application of advocacy work in community settings.

Cross-national social work case analysis: learning from international experience within an electronic environment

This article presents the results of a pilot of a cross-national learning process within the context of social work education. The pilot was carried out in the electronic environment by students from four European universities (Hogeschool Utrecht, Sheffield, Tartu and Vilnius). The analysis of the social work case of a disabled person was aimed at developing students’ abilities to make sensitive cross-national comparisons, to communicate within a different language and cultural context and to demonstrate understanding between practice and policy in a different country. Students’ reflections revealed the relevance of cross-cultural social work case analysis for developing future social workers’ professional and personal competencies. The study offered new insights into the social reality of the students’ own countries, into social work education and practice, and provided a broader understanding of international social work trends. The evaluation of the piloted e-learning programme indicated the advantages and limitations of long distance, cross-national learning. Straipsnyje pristatomi socialinio darbo studentams skirtos elektroninio mokymosi programos bandymo tarptautiniu lygiu rezultatai. Programos bandyme dalyvavo keturiu Europos aukštuju mokyklu studentai (Šefildo, Tartu, Vilniaus universitetu ir Utrechto Hogeschool). Elektronineje erdveje jiems buvo pateiktas neigalaus asmens problemiškos socialines adaptacijos atvejis, kuri, vadovaujant destytojams, jie turejo sinchroniškai išanalizuoti programoje nurodytomis pakopomis. Mokymo programos tikslas – ugdyti studentu tarpkulturine kompetencija, gebejimus atlikti lyginamaja analize, padeti jiems giliau suprasti ryši tarp skirtingu šaliu socialines politikos ir socialinio darbo praktikos. Studentu refleksijos bei atvejo sprendimo proceso analize parode, kad tokia programa yra tinkama ugdyti busimu socialiniu darbuotoju profesine ir asmenine kompetencija tarptautiniu lygiu. Vertindami elektroninio mokymosi programa, studentai konstatavo, kad ji leido jiems naujai pazvelgti i savo šaliu socialine situacija, geriau suprasti tarptautinio socialinio darbo tendencijas ir suteike lyginamuju tyrimu patirties. Programos bandymas padejo identifikuoti ir distancinio mokymo trukumus, i kuriuos butina atsizvelgti taikant ja ateityje. In dit artikel worden de resultaten van de pilot van een e-learning programma gepresenteerd waaraan Social Work opleidingen van verschillende Europese universiteiten en hogescholen hebben deelgenomen (Hogeschool Utrecht, Vilnius University, Sheffield Hallam University Sheffield en University of Tartu). Een Nederlandse casus over de begeleiding van de werksituatie van een verstandelijk gehandicapte cliënt vormde het uitgangspunt. Gedurende een periode van 10 weken, maakte van elk land een groep van 4 studenten een analyse en interventieplan. De resultaten van digitaal verstrekte opdrachten werden met elkaar vergeleken. De bedoeling was dat studenten op deze wijze inzicht verwerven in diversiteit van benaderingen binnen Social Work in Europa. Het resultaat van de pilot is dat minstens zoveel overeenkomsten als verschillen in de Social Work praktijk en het onderwijs zichtbaar werden. Internationale trends konden worden onderscheiden. In een evaluatie van het e-learning programma worden de mogelijkheden en beperkingen van grensoverschrijdend afstandsonderwijs besproken.

Lessons Learned in OBOT: 3 Case Studies of Women who did not Succeed in Pharmacy-based Methadone Treatment

As part of a series of trials of office-based opioid treatment (OBOT) in different US settings, we explore the circumstances favoring OBOT in different community settings and patient characteristics that seem to predict different patient outcomes in OBOT. In the New Mexico trial, we found that 11 of the 14 patients (followed for 12 mo) made a good adjustment to OBOT with outcomes equal or superior to their clinic care. We focus here on the cases of 3 women who were stable in methadone maintenance treatment and transferred to OBOT, but did not do well and had to be returned to clinic care. We examine the course of their treatment for factors related to treatment noncompletion, the course of their OBOT progress, and discuss the reasons it was necessary to return them to clinic care. Case study method was used to examine the course of the treatment noncompleters for factors related to treatment noncompletion and the course of their OBOT progress. The data collected were the eligibility screening form, methadone maintenance treatment program clinic counselor referral, social work case notes, clinical case conference notes, methadone dosage, take-home schedules, and toxicology results. The problems that arose in the care of this small group represent a sampling of the issues facing many potential candidates for methadone maintenance treatment in a primary care/pharmacy OBOT model. Common themes were varied interpretation of the study criteria, suboptimal methadone dosage, stigma and ambivalence toward methadone, sensitivity to treatment change (provider leaving study and pharmacy closing), co-occurring disorders, and illicit drug use. Our experience indicates that patients who do not adapt well to OBOT will most likely display early signs that they need to return to the more familiar structure of their methadone maintenance treatment program and will readily agree to return to clinic care.

Specialized Social Work Education: The Case for Social Work with Offenders

In the past, social workers have taken a lead in working with individuals involved with justice agencies and advocating for system change. Despite the fact that offender populations continue to increase in size and need, today there appears to be minimal involvement in this system by social workers. Using a mail survey of 400 social workers belonging to one of two U.S. professional organizations, we explore the impact of social work education on the likelihood of professionals choosing to practice with criminal offenders. Results indicate that social workers exposed to offender issues through specific coursework or offender internships during education are more likely to choose to work in justice settings. Implications of these findings for social work education are addressed.

Emotional and Behavioural Difficulties of Children and Young People at Entry into Care

Emotional and behavioural difficulties of a sample of children and young people were identified at the point of entry to local authority care by analysis of social work case files. The files indicated high levels of need, including that in children aged under 5. Bedwetting was identified as an important issue related to the physical health and emotional well-being of looked-after children. There was an association between bedwetting and emotional and behavioural problems. Analysis of placement types at entry to care showed that significantly more boys than girls were first placed in residential care.

Growth in the Shadow of War: The Case of Social Workers and Nurses Working in a Shared War Reality

This study aimed to assess post-traumatic stress symptoms and vicarious traumatization (VT) versus post-traumatic growth (PTG) among Israeli practitioners who shared war-related reality with their clients during the Second Lebanon-Israel war (2006). In addition, the contribution of potency (one's personal resource) and the role of peri-traumatic dissociation (the emotional detachment activated during or immediately after a traumatic event) were examined. Two months after the war, a convenience sample of 204 practitioners (seventy-six nurses and 128 social workers), all residents and employees in the Haifa area, were administered a self-report questionnaire. Findings showed that nurses had higher post-traumatic growth (PTG) compared with social workers. Personal resource (potency) was found to contribute to the reduction of vicarious traumatization (VT), whereas peri-traumatic dissociation was found to contribute to both PTG and VT in the group of social workers.

“You Can’t Tie and Untie Love That Fast”: Family Preservation and Reunification in Midcentury Philadelphia

This article traces the advancement of modern family preservation theory and practice over years 1946–63 through an analysis of published social work literature and case records from two Philadelphia foster care agencies. It argues that, well before the policy reforms of the 1970s, developments in social scientific theory and in the social work literature combined with the experiences of foster care workers to produce a recommitment to and revisions in the family preservation paradigm. The article also explores the internal tensions generated by family preservation practices and the experiences of so‐called natural and foster parents under the midcentury family preservation model.

From Ideological to Competency-Based: The Rebranding and Maintaining of Medical Social Work's Identity

Despite a history rich in patient care, case management, and knowledge-building, medical social work has limped through the past decade. Although there are still the occasional success stories about true heroes who have managed to not only persevere, but also thrive, their efforts have not been easily replicated by the masses. The medical social work community might benefit from taking an honest look at itself and the challenges the future holds. Presently we remain employees of host agencies that have been besieged by increasing expenses, nursing shortages, and third-party payers who continue to strangle reimbursements. Berger et al. (2003) reported that an increasing number of social work professionals are managed and supervised by nursing and other health care practitioners. To further exacerbate this challenge, social work's surface-level values are often perceived to be in juxtaposition with that of hospitals struggling to correct declining financial status. TWENTY-FIRST CENTURY CHALLENGES The challenges facing medical social work can be differentiated into three areas: the work environment, the traditional branding of the social work profession, and a resistance toward change. The Environment Many hospital-based social workers face the challenge of professionally residing in an ecosystem that does not naturally support social work life. First, it has long been noted that the medical social work department, even in its heyday, resided in a host agency. Although this was never meant to convey second-class citizenship, the responsibility lies with social work to evolve and align with the changing face of our hosts. Second, many social work managers run into the same gender bias and glass ceilings faced by other administrators. Furthermore, the social work manager (regardless of gender) is typically outside the loop of any naturally occurring good old boys network. Perhaps not a group of which we are desirous of membership, it is still critical to note that there is a lack of institutional-based, natural mentors for social work leaders in health care. The literature often sites mentorship as an important predictor of career advancement (Goleman, 1998). For example, nursing has a well-developed career ladder and preceptorship program at most hospitals. This is not the case for social work. Typically, there are few incumbents at senior and executive levels of management who speak social work's language. Although social work interventions activities often drive patient satisfaction and cost savings, balance sheets are not set up to capture these contributions. Therefore, hearing our voice and translating our contributions are not instinctive. The Traditional Social Work Brand Typically, social workers are not inherently motivated by cookbook compliance with policy and procedure, but thrive on the ownership and ambiguity involved in the management of one's own case. As with most professions, social work candidates are likely guided toward the profession by talents, desires, and a goodness of fit (Buckingham & Coffman, 1999). However, efforts to market the profession have failed to convey an accurate image to the marketplace. From the serious media to television sit-corns, we are often portrayed as left-wing undereducated, do-gooders, lacking business and financial acuity. The profession reacts to the undereducated piece, but we seem to wear the counterculture label as a badge of honor. This is noble, but not necessarily strategic. Social work must protect against presenting itself along narrow, steadfast, ideological and political lines, with little regard for the diverse cultures and environments inhabited by its practitioners. This often results in a disconnect among academia, our host organizations, and practice realities. From a macro, organizational development prospective, we fail to align our talent, skill, and knowledge with the current needs of our employers. …

Substance Abuse and Mental Retardation: Balancing Risk Management with the “Dignity of Risk”

Substance abuse (SA) is a documented issue for many people with mental retardation/developmental disabilities (MR/DD). However, little empirical data exist regarding the appropriateness or effectiveness of prevention or treatment approaches for this population. Compounding this issue, access to SA treatment for this population is also limited, making social work case management a challenge. For social workers, the problem of SA among people with MR falls into a gray area between the facilitation of the “dignity of risk” and risk management. Discussions of Deborah Stone's commentary on balancing liberty, equality, and security in social policy are presented in light of ways to encourage the implementation of the “dignity of risk.” Linking theory to practice, a baseline framework is provided for planning individualized, self-determination-oriented case management approaches for people with SA who have MR.

Best Practice Case Management for Improved Medical Adherence

Less than optimal treatment adherence for many health conditions impedes clinical progress, leading to increased morbidity, mortality and health care costs, particularly for low-income and racial and ethnic minority patients. When properly understood as a complex phenomenon involving patient, provider, and health system interacting factors, adherence improvement is a natural target for social work's multi-system model of case management. We present five key elements for a generic “best practice” case management blueprint applicable to a range of medical settings. The theory and evidence base for the elements are discussed and illustrated with SAFe, a tested social work case management program to improve adherence following abnormal cancer screens.

Transforming family positions: a conversational analysis of a family social work case

ABSTRACTIn a discourse and conversational analysis of a Dutch family supervision order, the transformations in family positions are examined. The parents in this case consider their son's drug addiction to be an individual problem. The family guardian succeeds in convincing them that it is a problem which concerns all the family rather than merely a personal issue for their son. By combining a positive and supportive attitude towards the parents with an unrelenting emphasis on the familial character of Marco's problems, the family guardian succeeds in getting the parents to reflect on their own position in relation to their son and their share in the problems in his life.

Social Work as Management

The purpose of this study was to explore the utilization of corporate management functions, such as planning, organizing, coordinating, motivating, advocating, and monitoring and evaluating, by social work care managers. Method: The sample included 122 care managers in 13 urban hospital settings. Each care manager chose two completed cases, one judged by them to be a good and one a poor case. They then completed an open-ended questionnaire about each case. Results: Content analyses indicated that themost frequently utilized goals and interventions were traditional corporate management functions. Logistic regression analyses indicated that the presence versus absence of 5 management outcome variables (planning, organizing, coordinating the interdisciplinary team, coordinating hospital and community resources, and advocacy), taken together as a scale, correctly predicted 89.1% pre-designated good cases, and 83.8% poor cases. Conclusion: Successful social work cases required the use of corporate management functions.

Suicide Among Social Workers: A Research Note

Occupations have been a relatively neglected risk factor in the etiology of suicide. Client-oriented occupations are often thought to contribute to suicide by increasing psychological stress. The present study tests this thesis for the case of social work. Data were collected from 21 reporting states in the year of 1990. Controls are introduced for possible covariates of social work including gender, race, region, age, and marital status. The results of a preliminary logistic regression analysis found that being a social worker increased the odds of death by suicide by 55.6%, compared to the rest of the working age population. However, when controls for other occupations were incorporated into the analysis, social workers were no longer at elevated odds of death by suicide relative to other professional-managerial occupations. The psychological resources and training of social workers may act as buffers against occupational stress. Being Caucasian, male, younger, and being non-married all increased the odds of death by suicide.

Accessing Social Work Case Files for Research Purposes

The use of social work case files as an important research resource is being threatened by the increasing regulation of both the research process and access to personal identifiable information. While these developments can be seen as a reaction to specific incidents of inappropriate research and the misuse of personal information, it is argued that the pendulum has swung too far the other way, and in seeking to protect the rights of vulnerable individuals, the lives of these same individuals may go unstudied with the consequence that they receive less appropriate services. Drawing upon the current research of the authors, this article explores the difficulties encountered in gaining access to social work case files for research purposes without the explicit consent of service users and highlights the uncertainty surrounding this issue. Suggestions are made for improvements in the situation.

An experience of social work case management for frail elders in Hong Kong

Eighty‐three hospital‐discharged elders were served by a social work case manager in our 18‐month case management project in July 2000. Results indicate that elderly care‐recipients utilized less hospital services without sacrificing the quality‐of‐life of their informal carers. This paper shares the experience in the process of case management interventions and suggests strategies to implement case management interventions successfully.

School Social Work Case Characteristics, Services, and Dispositions: Year One Results

This article describes the results from the first year of a longitudinal study of a school social work caseload in a large midwestern school district. The purpose of the investigation was to examine the relationship among case characteristics, types of services provided, and case dispositions. Data were collected using a management information system developed by a partnership of university and school social work staff. School social work caseload data for 911 students were analyzed using descriptive and logistic regression techniques. Referral reasons were associated with the referral source and student characteristics. The process of model building for a logistic regression analysis of positive case disposition revealed significant differences in the model of case disposition for students referred for three reasons or more compared with the full sample. Implications of the results for understanding social work practice and assessing the potential of using administrative data to capture school social work caseload information are discussed.

Therapists' Benefits from Conducting Psychotherapy: The Case of Social Workers

Objective: This study examines social workers' benefits from conducting psychotherapy Method: The Therapist's Psychological Benefit Questionnaire (TPBQ), which includes six dimensions of benefits, was administered to 114 clinical social workers. Results: Participants were found to benefit most from Vocational Benefits and Self-Improvement, followed by Narcissistic Gains and Improved Relationships. Benefits related to Object Relations were ranked third, and those related to Fulfillment of Needs were ranked last. These results are discussed in light of the various theoretical-qualitative descriptions of therapists' gains from psychotherapy. Also discussed are the rankings of specific items included in the different dimensions. Conclusions: The participants are clearly not “selfless givers,” thereby confirming the claim of many theoreticians that therapists benefit psychologically from their helping role.

Considering the Countryside: Is There a Case for Rural Social Work?

Summary Most British social work literature is written with the implicit assumption of an urban context, but large numbers of people still live in comparatively rural settings. Rural social work remains a largely unrecognized dimension of practice, receiving little atten tion beyond the reportage of individual projects or initiatives. This paper considers whether it is a sufficiently distinctive area of practice to warrant specific consideration. It concludes that it is an under-researched aspect of practice within the UK which merits particular attention and identifies some areas for future development. The aim of this paper is not to argue that rural social work is entirely distinctive from work in urban areas—for, in many respects, social work in the countryside is not essentially different from that undertaken in towns and cities—but to point up some features of rural contexts which are different and to indicate how these might impact upon people's problems and, consequently, upon how workers and agencies might need to respond to them. The conclusion of this paper is that rural social work is sufficiently different to warrant particular attention, but that our knowledge of the general features of rural environments as well as of the specifics of practice is limited. Thus, it seeks to problematize an aspect of social work provision in the UK

Our Social Work Imagination

The aim of this article is to present the case for social work, the case that the old truths and fighting spirit of an earlier day-our social work imagination-live on, even in the face of uncaring economic forces and resurrected punitiveness. Sustained by an idealism as old as humankind, members of the profession continue to advocate for the poor, the sick, and the oppressed.

A Social Work Case Management Experience in a Managed Care Setting: The Need for Effective Communication

Many systems come together to provide for the health care needs of an individual. Case management is practiced by several professional disciplines in various settings. It is in the best interest of the consumers to have case managers collaborate so that each professional specialty may be fully realized. The social work case manager in a managed care setting is a psychosocial resource in the health care continuum.