Ethical And Effective Practice With Service Users Social Work Essay
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Selecting an appropriate method of intervention is central to ethical and effective practice with service users. The aim of this essay is to define what is meant my method of intervention, explore the main factors which influence the worker when selecting a method and critically consider the role of partnership working and empowerment.
'Intervention is rarely defined. It originates from the Latin inter (between) and venire (to come) and means 'coming between' (Trevithick, 2005: 66). Interventions are at the heart of everyday social interactions and make 'inevitably make up a substantial majority of human behaviour and are made by those who desire and intend to influence some part of the world and the beings within it' (Kennard et al. 1993:3). Social work interventions are purposeful actions we undertake as workers which are based on knowledge and understanding acquired, skills learnt and values adopted. Therefore, interventions are knowledge, skills, understanding and values in action. Intervention may focus on individuals, families, communities, or groups and be in different forms depending on their purpose and whether directive or non-directive.
Generally, interventions that are directive aim to purposefully change the course of events and can be highly influenced by agency policy and practice or by the practitioner's perspective on how to move events forward. This may involve offering advice, providing information and suggestions about what to do, or how to behave and can be important and a professional requirement where immediate danger or risk is involved.
In non-directive interventions 'the worker does not attempt to decide for people, or to lead, guide or persuade them to accept his/her specific conclusions' (Coulshed and Orme, 1998: 216). Work is done in a way to enable individuals to decide for themselves and involves helping people to problem solve or talk about their thoughts, feelings and the different courses of action they may take (Lishman, 1994). Counselling skills can be beneficial or important in this regard (Thompson 2000b).
Work with service users can therefore involve both directive and non-directive elements and both types have advantages and disadvantages (Mayo, 1994). Behaviourist, cognitive and psychosocial approaches tend to be directive but this depends on perspective adopted and the practitioner's character. In contrast, community work is generally non-directive and person-centred.
Interventions have different time periods and levels of intensity which are dependent on several factors such as setting where the work is located, problem presented, individuals involved and agency policy and practice. Several practice approaches have a time limited factor such as task-centred work, crisis intervention and some behavioural approaches and are often preferred by agencies for this reason. In addition, practice approaches that are designed to be used for a considerable time such as psychosocial are often geared towards more planned short-term, time limited and focused work (Fanger 1995).
Although negotiation should take place with service users to ensure their needs and expectations are taken into account, it is not common practice for practitioners to offer choice on whether they would prefer a directive or non-directive approach or the practice approach adopted (Lishman, 1994). However, this lack of choice is now being recognised and addressed with the involvement of service users and others in the decision-making process in relation to agency policy, practice and service delivery (Barton, 2002; Croft and Beresford, 2000).
The purpose and use of different interventions is contentious. Payne (1996: 43) argues that 'the term intervention is oppressive as it indicates the moral and political authority of the social worker'. This concern is also shared by others with Langan and Lee (1989:83) describing the potentially 'invasive' nature of interventions and how they can be used to control others. Jones suggests that in relation to power differences and the attitude of social workers especially with regards to people living in poverty: 'the working class poor have been generally antagonistic toward social work intervention and have rejected social work's downward gaze and highly interventionist and moralistic approach to their poverty and associated difficulties' (Jones, 2002a: 12). It is recognised that intervention can be oppressive, delivered with no clear purpose or in-depth experience however, some seek and find interventions that are empathic, caring and non-judgemental due to practitioners demonstrating 'relevant experience and show appropriate knowledge' (Lishman, 1994:14). For many practitioners, these attributes are essential in any intervention and are demonstrated through commitment, concern and respect for others which are qualities that are valued by service users (Cheetham et al. 1992; Wilson, 2000).
Dependent on the nature of help sought there are different opinions on whether interventions should be targeted on personal change or wider societal, environmental or political change. Some may want assistance in accessing a particular service or other forms of help and not embrace interventions that may take them in a particular direction i.e. social action (Payne et al. 2002). In contrast, problems may recur or become worse if no collective action is taken.
Importance has reduced in relation to methods of intervention over recent years as social work agencies have given more focus to assessment and immediate or short-term solutions (Howe, 1996; Lymbery 2001). This is strengthened by the reactive nature of service provision which is more concerned with practical results than with theories and principles. This has a reduced effect on workers knowledge of a range of methods resulting in workers using a preferred method which is not evidenced in their practice (Thompson, 2000). Methods of intervention should be the basis of ongoing intervention with service users, but often lacks structured planning and is reactive to crisis. This reactive response with emphasis on assessment frameworks is concerning, as workers are still managing high caseloads and if not supervised and supported appropriately, workers are at risk of stress and eventual burn-out (Jones, 2001; Charles and Butler, 2004).
Effective use of methods of intervention allows work to be planned, structured and prioritised depending on service users' needs. Methods can be complicated as they are underpinned by a wide range of skills and influenced by the approach of the worker. Most methods tend to follow similar processes of application: assessment, planning of goals, implementation, termination, evaluation and review. Although the process of some methods is completed in three/four interactions others take longer. This difference shows how some methods place more or less importance on factors such as personality or society, which then informs the type of intervention required to resolve issues in the service user's situation (Watson and West, 2006).
More than one method can be used in conjunction with another, depending on how comprehensive work with service users needs to be (Milner and O'Byrne, 1998). However, each method has different assessment and an implementation process which looks for different types of information about the service user's situation for example, task centred looks for causes and solutions in the present situation and psychosocial explores past experiences. Additionally, the method of assessment may require that at least two assessments be undertaken: the first to explore the necessity of involvement and secondly, to negotiate the method of intervention with the service user.
An effective assessment framework that is flexible and has various options is beneficial but should not awkward or time consuming to either the worker or the service user. As Dalrymple and Burke (1995) suggest, a biography framework is an ideal way as it enables service users to locate present issues in the context of their life both past and present.
Workers should aim to practice in a way which is empowering and the process of information gathering should attempt to fit into the exchange model of assessment, irrespective of the method of intervention and should be the basis of a working relationship which moves towards partnership (Watson and West, 2006). As part of the engagement and assessment process, the worker needs to negotiate with the service user to understand the issue(s) that need to be addressed and method(s) employed and take into account not only the nature of the problem but also the urgency and potential consequences of not intervening (Doel and Marsh, 1992).
Importance should be placed on presenting and underlying issues early in the assessment process as it enables the worker to look at an assessment framework and approach that assists short or long-term methods of intervention. An inclusive and holistic assessment enables the service user to have a direct influence on the method of intervention selected and be at the heart of the process. The process of assessment must be shared with and understood by the service user for any method of intervention to be successful (Watson and West, 2006).
The worker's approach also has an influence on method selection as this will affect how they perceive and adapt to specific situations. The implementation of methods is affected by both the values of the method and value base of the individual worker. The worker will also influence how the method is applied in practice through implementation, evaluation, perceived expertise and attitude to empowerment and partnership.
Methods such as task centred are seen to be empowering with ethnic minority and other oppressed groups as service users are seen to be able to define their own problems (Ahmad, 1990). However, when an approach is used which is worker or agency focused the service user may not be fully enabled to define the problem and results in informing but not engaging them in determining priorities.
Empowerment and partnership involves sharing and involving service users in method selection, application of the method, allocation of tasks, responsibilities, evaluation and review and is crucial in enabling facing challenges in their situations and lives. However, service users can have difficulty with this level of information-sharing and may prefer that the worker take the lead role rather than negotiating something different and not wish to acquire new skills to have full advantage of the partnership offered.
Selecting a method of intervention should not be a technical process of information gathering and a tick box process to achieve a desired outcome. Milner and O'Byrne (2002) suggest it requires combining various components such as analysis and understanding of the service user, worker and the mandate of the agency providing the service otherwise intervention could be is restrictive and limit available options. However, negotiation and the competing demands of all involved parties must be considered and the basis of anti-oppresive practice established.
Methods of intervention can be a complex and demanding activity especially in terms of time and energy and therefore, short-term term methods are seen as less intensive and demanding of the worker as well as more successful in practice. However, Watson and West (2006: 62) see this as 'a misconception, as the popular more short-term methods often make extensive demands on the workers' time and energy'.
Workers are often dealing with uncertainty as each service user have different capabilities, levels of confidence and support networks. Therefore, there is no one ideal method for any given situation but a range of methods that have both advantages and disadvantages and as Trethivick (2005: 1) suggests workers need to have 'a toolkit to begin to understand people' and need to widen the range of options available in order for them to respond flexibly and appropriately to each new situation (Parker and Bradley, 2003).
When using methods of intervention, workers have to be organised to ensure that the task is proactively carried out and often attempt to prioritise involvement with service users against both local and national contexts and provide an appropriate level of service within managerial constraints. This prioritisation means in practice that, given the extensive demands, work using methods can only be with four or five service users at any one time and with the additional pressure of monitoring and supervising service users and reports, risk response is often responsive and crisis driven (Watson and West, 2006).
To work in an empowering and anti-oppressive perspective is to ensure that intervention focuses clearly on the needs of the service user, is appropriate to the situation than the needs of the service. An understanding of these competing demands and the worker's ability to influence decision-making processes does impact on method selection however, this should not mean that the service is diluted and methods be partially implemented as this is not conducive to managerial or professional agendas on good practice. Thompson (2000:43) sees this as 'the set of common patterns, assumptions, values and norms that become established within an organisation over time' and a concern of workers is competitive workplace cultures where ability is based on the number of cases managed rather than the quality that is provided to service users which may result in use of less time-consuming methods.
For work to be effective, an ethical and a professional not just a bureaucratic response to pressures faced is required and is not about the service user fitting into the worker or agency's preferred way of working but looking at what is best for the service user and finding creative ways to make this happen.
Workers need to be careful not to seen as the 'expert' who will resolve the situation as even the most established and experienced practitioners have skills gaps and often develop skills when working with the service users. This process of learning in practice requires good support and supervision, enabling the worker to reflect on assumptions about service users and their capabilities especially in relation to gender, race, age or disability to prevent internalised bias to impact on what the service user requires to work on to change the situation (Watson and West, 2006).
It is crucial to appreciate the situation from the service user's perspective and see them as unique individuals as Taylor and Devine (1993: 4) state 'the client's perception of the situation has to be the basis of effective social work'. This concern is also shared by Howe (1987:3) describing 'the client's perception is an integral part of the practice of social work'. Service users often have their own assumptions about what social work is and what workers are able to provide which is generally based on past relationships and experiences for example, black service users experience may reflect a service which in the past was not appropriate to their needs (Milner and Byrne, 1998: 23) but to alleviate this practitioners need to work in an open, honest and empowering manner and recognise that although service users may be in negative situations they also have strengths and skills that need to be utilised in the social work relationship.
Workers should ensure that written agreements are developed that acknowledge all participants roles and responsibilities and avoid assumptions or issues (Lishman, 1994), this avoids breakdown in trust and encourages honesty and open shared responsibility between service user and worker. This involves negotiation on what should be achieved, by whom, including agency input. Agreements can provide the potential for empowering practice that involves partnership. However, cognisance has to be taken to ensure that the agreement does not become a set of non-negotiated tasks that service users have no possibility of achieving, combined with no reciprocal commitment or obligations by the worker as this does not address the issue of empowerment or oppression and can reinforce the power difference (Rojek and Collins, 1988).
The final stage of the process is termination which should be planned and allow both parties time and opportunity to prepare for the future however, it has to be carefully and sensitively constructed and is much easier to achieve if the work has been methodical with clear goals as it demonstrates what has been achieved. Evaluation is beneficial as it enables the service user and worker to be reminded of timescales and can acknowledge the service user's increasing skills, empowerment, confidence and self-esteem which can be utilised after the intervention has ended. Endings can however, be difficult for both the worker and service user resulting from various factors such as complexity of service user's situation, issues of dependency and lack of clarity about purpose and intervention. This lack of clarity can result in a situation of uncertainty for both worker and service user (Watson and West, 2006). Finally, termination as part of the change process creates opportunities but also fear, anxiety and loss (Coulshed and Orme, 1998).
It is important for workers to take a step back and reflect on their practice and review their experiences to ensure that they are providing the best possible service in the most ethical and effective manner. Reflective practice provides support and enables workers to not just meet the needs of the organisation but also develop their own knowledge and skills and increased understanding of their own approach and the situation experienced by service users. A good tool to facilitate this is the use of reflective diaries. Reflecting in action and on action both influences and enhances current and future practice. The use of effective supervision is another process where workload management, forum for learning and problem-solving should take place which should be supportive and enabling to the worker (Kadushin and Harkness, 2002). However, the worker's role in supervision is often viewed as passive as the supervisor sets the agenda. This can lead to disempowerment of the worker in relation to the agency and is potentially oppressive and discriminatory and provides a poor role model for work with service users and therefore consideration must be given on how they can create a positive and empowering relationship (Thompson, 2002).
In conclusion, good practice requires workers to have knowledge to understand the 'person in situation,' (Hollis, 1972) understanding both sociological (society and community) and psychological (personality and life span) and the interrelation and impact on the service user (Howe, 1987). A critical skill for effective and ethical practice is empowerment which is based on knowledge and values and is the difference between informing and genuine partnership and the importance of active participation of service users throughout the process.
Social work is a value based activity and workers through reflection and supervision can all learn from experiences, adapt and enhance these to develop practice and gain self-awareness to understand how they themselves and their approach impacts on service users.
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