The social worker in community mental health teams: Findings from a national survey

BMichele Abendstem, Mark Wilberforce, Jane Hughes, Andelijia Arandelovic, Saqba Batool, Jennifer Boland, Rosa Pitts and David Challis.

Journal of Social Work

Review written by Dr David Wilkins

What question does this study focus on? 

Social workers have long been part of community mental health teams (CMHTs), yet in recent years and in some areas, the make-up of these teams has been changing. This study explored the current position and role of social workers within English CMHTs, and how this might be changing.  

How did they study it? 

In 2018, the authors undertook a national survey of CMHT managers in England. They did this by obtaining a list of NHS mental health trusts in England (n=54) and finding contact details for their CMHTs. In total, they located 421 teams from 50 of the Trusts (they were unable to contact two, and two withdrew). Surveys were distributed to the team managers. In total, 188 surveys were completed (a 44% response rate), spanning all 50 Trusts and nine English regions.  

What did they find? 

The average size of a CMHT was just over 25 people. All of them included a team manager, nurses and at least one consultant psychiatrist. Four-fifths also included a social worker, while nearly 90% had an occupational therapist. More than half of the team managers said that social workers made a ‘good’ or ‘very good’ contribution to the team. Most of those who were more negative also described losing social work staff from their teams in the previous 12 months. The more social workers there were in the team, the more likely their contribution was to be rated positively. Social workers acted as care coordinators, or enhanced CPA (Care Programme Approach) coordinators, and in most teams conducted initial assessments. In a very small number of teams, social workers prescribed or administer medication. Social workers were also the largest professional group involved with making funding decisions and acting as Approved Mental Health Professionals.  

More than half of the managers described major changes for their teams in the previous 12-months. These involved restructurings, more integrated working between health and social care professionals, the loss of staff, including social workers, and changing roles. Where social workers had been lost from the team, managers often described a loss of experience and knowledge, increased workloads for other staff, and a negative impact on people using services.  

What are the implications? 

These findings point to the important role that social workers have within many CMHTs, but also their changing roles and in some cases, their absence. Team managers expressed concerns about losing social workers from their teams, and in particular how this could limit or reverse attempts to integrate health and social care service provision.  

Review written by

A photo of Dr David Wilkins, the author of this article review

Dr David Wilkins

How Does the Well-Being of Children in Foster Care in Wales Compare with that of other Welsh Children?

Well-being is meant to be at the heart of services for children and adults in Wales – yet there is little research on the wellbeing of children in care. How happy and satisfied are children in care in Wales – particularly compared to other children?

This seminar reports on research comparing children in care with a much larger group of other children in Wales to answer questions about how satisfied they are with life and what factors influence whether they are happy. It compares the wellbeing of 22 children in foster care aged 10-13 with a large national sample of 2627 other children.

This is as far as we are aware the first research able to make such a comparison, and the large sample allows us to explore not just care but also the impact of other factors such as deprivation. The findings were interesting and unexpected. This seminar will present initial findings and then open up a discussion about how we might help improve the wellbeing of children in care and the importance of considering subjective wellbeing alongside more “objective” measures such as educational achievement.

Presenters: Dr Jen Hampton (WISERD), Professor Colette McAuley (CASCADE)  Professor Donald Forrester (CASCADE Director) Cardiff University.

Date & Time: September 15th, 12pm

What difference does local authority care make to the lives of vulnerable children? Longitudinal analyses of a retrospective electronic cohort

The proposed research aims to examine, over time, education and health outcomes of children who are looked after (CLA) by the local authority (i.e. in care). Existing studies that use only one point in time have shown that CLA have poorer educational and health outcomes than the general population. Pre-care experiences, such as physical abuse, parental mental health illness and parental alcohol misuse, are common reasons for becoming looked after. These experiences also predict poorer health, education and social outcomes in young people who are not in care. For these reasons, it is difficult to understand whether poorer health and educational outcomes for CLA are because of differences in pre-care experiences, or of care itself. 

This research, for the first time, linked an existing Wales-wide dataset on education and health with routinely collected data on young people’s support from social services. The research is exploring three objectives. First, addresses the lack of large-scale studies in the UK that statistically examine the role of CLA status in predicting educational outcomes and health over time. Second, it will reduce uncertainty over the extent to which poor outcomes among CLA are because of pre-care experiences, or experiences of being in care. This will be achieved through comparison between CLA, and children who receive help from social services but are not CLA (Children In Need, but Not Looked After – NLA). There are likely to be differences between these two groups that predict why one group becomes CLA and the other does not, but NLA are likely to be more similar to CLA than children not known to services. To take account of some further differences between groups, we will adjust for physical abuse, parental mental health illness, parental alcohol misuse and domestic violence. Third, whilst CLA status is often based on the assumption that removing young people from adversity will move them toward better life trajectories, this study will be the first to examine over time the role of care in reducing the effects of pre-care experiences on education and health care outcomes. 

The research is funded by the Economic and Social Research Council (ESRC).

Presenter: Dr Sara Long, DECIPHer, Cardiff University.

Date & Time: 14th September, 11am

New safeguarding resource for working with children and young people developed from Cardiff University research, brings together resources and materials created from research and partnership work with young people, as well as foster carers, and social care and allied professionals. It builds on the outcomes of research led by Dr Sophie Hallett in the Keeping Safe? report which used case records to track a cohort of 205 children involved with social services in one Welsh local authority, alongside involvement from young people, social workers, foster carers and residential workers.

The resources are for use by all those working with and caring for young people. They are designed as reflective tools to help people ‘check their thinking’ about key issues in safeguarding young people from exploitation, harms and other abuses. They can be used by individuals to help support them in their work, by providing the opportunity to reflect on their own understandings and practices. Or they can be used as a way of facilitating discussion and sharing of views within and across teams.  The website, launched on 1st July 2021, premieres a new animated film developed in partnership with young people from Voices from Care and is a way of letting young people know that they have been heard, that their voices have contributed to new policy and that support is available. This work was commissioned by Welsh Government, the original research was funded by the Welsh Government through Health and Care Research Wales.

Choice, control and person-centredness in day centres for older people

By Katharine Orellana, Jill Manthorpe and Anthea Tinker

Journal of Social Work

Review written by Dr David Wilkins

What question does this study focus on?

This paper argues that day centres for older people are often assumed to be outdated or too expensive, particularly given the Care Act 2014’s focus on choice, control and person-centredness. The authors explore what professionals and older people think about these services, and the extent to which person-centred support can be enacted at day centres. 

How did they study it?

The study ran for three years in total, with a focus on four generalist day centres. The centres were chosen purposefully, so that they spanned the local authority, housing association and voluntary / not-for-profit sectors. Two of the centres were in highly urban areas, one in a small town and one in a rural area. 

The lead author for the paper undertook weekly visits to the centres between September 2015 and December 2016. During this time, interviews were conducted with 13 local authority staff, including social workers, commissioners and those making referrals, 23 older people, 10 family carers and 23 day centre staff, including managers, volunteers and carers. 

What did they find?

The paper presents its findings across three themes – professionals’ views of day centres, the enactment of person-centred care, and older people’s views of day centres. 

– Professionals’ views

Practitioners viewed day centres as relevant to their work, on the whole more so than local authority commissioners. Practitioners noted the importance of having a range of services available in the area, including day centres, so that older people can make meaningful choices about what they want. However, some commissioners thought that within day centres themselves, choices would be limited by the availability of activities, meal options and impersonal staff rotas. 

– Enactment of person-centred approaches

Practitioners talked about the importance of matching people to the right centre for them, which meant knowing about the centre, and its activities, as well as the individual. Day centre managers also noted the importance of taking a personalised approach. Older people attending day centres talked about being able to choose where to sit, what drinks and meals to have, and what activities they wanted to do. On the other hand, some older people had not been offered the choice of other centres or services, and individual needs and preferences were not always provided for. Sometimes the choice available was to do an activity or not, rather than choosing between different activities, and in one centre, there was no choice of meals. Some commissioners and practitioners felt that the use of day centres was largely needs-driven. 

– The views of older people

Older people said they valued the communal nature of the day centres, and the continuity of relationships with staff. However, some older people also said they found it difficult to live with other residents, particularly if they exhibited upsetting or disturbing behaviour. Sometimes staff were too busy helping people with physical or medical needs to organise and take part in social activities.  

What are the implications?

These findings suggest that day centres can help enact personalisation and choice for older people and can have some advantages compared with individualised support packages. However, they may not represent a genuine choice, either at the macro level (because there are no other services available) or the micro level (because choices within the centre are limited or superficial). 

Review written by

A photo of the article review's author, Dr David Wilkins

Dr David Wilkins

Influence of adoption on sibling relationships: Experiences & needs of new adoptive families

The influence of adoption on sibling relationships: Experiences and support needs of newly formed adoptive families

By Sarah Meakings, Amanda Coffey and Katherine Shelton 

British Journal of Social Work, 50(5), pp. 1324-1344
Review written by Dr David Wilkins

What question does this study focus on?

This paper looks at how sibling relationships, in their various different forms, are affected by adoption. 

How did they study it?

The case-file records of 374 children recently placed for adoption in Wales were reviewed. In addition, 96 adoptive parents completed a questionnaire, and 40 of these parents were also interviewed. The questionnaires were completed four months after the child was adopted, and the interviews took place another five months later. 

What did they find?

Analysis of the case-file records found that most of the children placed for adoption (n=325, 87%) had at least one brother or sister, and one-third (n=122, 33%) were adopted as part of a sibling group. From the questionnaire sample, nearly one-third (n=29, 30%) were placed for adoption as part of a sibling group, while the majority (n=81, 84%) had at least one sibling living elsewhere. New sibling relationships were created in nearly one-third of the families (n=28, 29%). Sibling relationships were reported to provide the child with companionship, reassurance and comfort. However, parents were also concerned about unexpected levels of sibling discord, and perceptions of harmful dynamics. Several described sibling relationships as being characterised by fierce jealousy. There were some reports of physical violence between siblings. For adopted children with birth siblings living elsewhere, parents spoke passionately about the importance of maintaining meaningful contact, although a smaller minority did not want this because of safeguarding concerns in relation to birth families more generally. All the parents who did want to promote sibling contact felt they needed help from the local authority to facilitate it. Some said they had to prompt social workers to help, while others noted a distinct lack of support. 

What are the implications?

The process of adoption does not just have the potential to sever and create child-carer relationships, it also severs and creates child-child relationships. Social workers need to recognise and value the importance of sibling relationships for adopted children, while local authorities need to think carefully about what support they offer to adoptive families to promote and facilitate sibling contact. 

Dr David Wilkins

Social Care Wales ‘Padlet’ of wellbeing resources

As part of the ExChange Wales Well-Being Conference Series 2021, Social Care Wales has created a fantastic resource called a ‘padlet’ of well-being resources for the social care workforce.  It can be found online and contains links to:

  • Helplines
  • Social Care Wales website
  • Peer support groups
  • Care First
  • Bitesize well-being sessions
  • Free well-being Apps

Just click on the links below to take you to directly to the padlet:

English version

Welsh version

For more information, please contact Social Care Wales.

The performance and improvement framework for social services

Written by Well-being and Improvement Branch at Welsh Government

The Social Services and Well-being (Wales) Act 2014 (‘the Act’) came into force in April 2016.  The Act provides the legal framework for improving the well-being of people who need care and support, and carers who need support, and for transforming social services in Wales.  

As part of the development of the Act, in 2016 the Social Services and Improvement Division within the Welsh Government established a series of performance indicators, measures and outcomes frameworks to measure the impact of the Act on the well-being outcomes of people who need care and support and carers who need support.  

The well-being needs of the people receiving support from social services are a key priority at the Welsh Government. It was with this in mind that we set about developing a more comprehensive Performance and Improvement Framework which links in to the Well-being of Future Generations (Wales) Act 2015 as well as the Social Services and Well-being (Wales) Act 2014. 

The new approach

The new approach aims to encourage a deeper understanding of experiences of individuals who use social services and the impact these services are having. Through this greater understanding, we can support improvement within the sector so that ultimately the well-being outcomes of individuals who receive care and support can be improved. 

The new approach has been developed to focus on performance and improvement equally.  It includes the development of new Quality Standards alongside a new Performance and Improvement Framework. 

The new performance and improvement framework for social services in Wales consists of the code of practice as well as a series of guidance documents. The framework and supporting guidance brings together a number of key elements into a single toolkit for local authorities to use in their understanding of how social care is delivered locally and nationally and the impact it has on the well-being of individuals in Wales. It will focus on three key areas; Measuring Activity and Performance, Understanding Experience and Outcomes and Using Evidence to Drive Improvement.

The Welsh Government have worked collaboratively with local authorities and other partners within the sector to gather high quality data and evidence so that together we can fully understand and improve how social services are delivered across Wales as well as assessing the impact that this has on the well-being of the people who live in Wales.

Experiences of unpaid carers during the pandemic and beyond

Unpaid carers are the backbone of the health and social care system in Wales and across the United Kingdom. Under the Social Services and Well-being (Wales) Act 2014, an unpaid carer is understood as an adult who provides care to another person who would not be able to cope without their support, whether due to physical illness, disability, mental illness or addiction. Unpaid carers may provide practical support, including housework, shopping and transportation, personal care, including washing, toileting and support with medical treatment (e.g., taking medication, managing dressings) and/or emotional support. People can become carers at any time in their lives and may find themselves responsible for the welfare of a partner, a parent, a disabled child, a relative, a friend or a neighbour with little or no prior preparation.  During the COVID-19 pandemic, the responsibilities of unpaid carers have increased considerably. There are more unpaid carers than ever before, and most of those who provided unpaid care before the pandemic are now spending more time on providing care for another person. Despite the vital contributions they make on a day-to-day basis, unpaid carers are poorly recognised in public discussions of health and social care and have felt overlooked during the pandemic, in contrast to professional health and social care workers, whose efforts have received greater recognition.

Our study, which was funded by Public Health Wales, aimed to explore the experiences of unpaid adult carers across Wales during the COVID-19 pandemic. We carried out in-depth interviews, via video link or telephone, with a total of 47 participants, aged from 15 to 85 years. This work has helped to highlight the extent of challenges faced by carers prior to the pandemic, the nature of carers’ experiences during the pandemic, and what their hopes and concerns are for the future. a person-centred planning and outcomes recording app is in its final phase of development involving pilots across a range of services in Wales and has won a National Welsh Government SBRI challenge called Better Lives Closer to Home. It has been piloted in learning disability, children’s services and work support.

The App supports any individual receiving targeted support to take much greater levels of control over what is important TO them, as well as for them. It also allows the people supporting them to effectively evidence the impact of their interventions. supports the individual (alongside a Mentor) to:

  • Create a strength-based profile of what is important to them and their future;
  • Identify a Circle of Support; individuals in their life who can support and encourage them;
  • Identify a set of goals and actions that will support them to achieve their desired outcomes;
  • Collect a rich story of achievement through words and pictures via a smartphone or tablet;
  • Review how far they have travelled towards each goal through regular meetings.

The support organisation is able to coordinate the whole process and record evidence of achievement against both the individual’s own goals (in their words) and against KPIs such as the National Outcomes Framework for Wales.

Activity is recorded in real time, similar to many social media platforms, and supporters are able to view progress and provide encouragement in a joined-up way.

This webinar gave an overview of the App, its current and potential use in practice, and the benefits for service users and providers.

Presented by Roger Rowett, Director of Ltd.