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This paper argues that day centres for older people are often assumed to be outdated or too expensive, particularly given the Care Act 2014’s focus on choice, control and person-centredness.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

What do service users want from mental health social workers? A best-worst scaling analysis

By Mark Wilberforce, Michele Abendstern, Saqba Batool, Jennifer Boland, David Challis, John Christian, Jane Hughes, Phil Kinder, Paul Lake-Jones, Manoj Mistry, Rosa Pitts and Doreen Roberts. (2020)

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 explores what service users most and least value about mental health social workers. 

How did they study it?

The study involved participants (n=144 from five different English regions) reading a series of case studies and selecting their most and least preferred outcomes for each one. The study was co-produced by a mixed team of academics, people with experience of mental health services and carers. Through a process of discussion, shortlisting and piloting, these case studies were designed to invoke ten social work attributes, as follows:

The social worker…

  1. Thinks about my whole life, not just my illness
  2. Protects my rights and entitlements
  3. Is non-judgemental
  4. Arranges access to other services
  5. Looks carefully for signs of abuse and neglect
  6. Understands why people become vulnerable
  7. Suggests different ways of helping me, and does not concentrate on medication alone
  8. Is a reliable and continuous point of contact
  9. Understands how people’s difficulties can vary from time-to-time
  10. Is compassionate

Each time one of these attributes was selected as ‘best’, it scored one point. Each time it was selected as ‘worst’, it scored one minus point. As each attribute appeared six times in the case studies, this means for each participant the attributes could score between -6 (chosen as the worst attribute every time) and +6 (chose as the best attribute every time). 

 What did they find?

The overall results indicated that participants ranked attribute 8 most positively, and attribute 4 least positively (see table for the full ranking). Some of the attributes, such as numbers 2 and 5, appeared to divide opinion, with some participants viewing them very positively, and others very negatively. 

Overall rankingAttribute
1Is a reliable and continuous point of contact
2Thinks about my whole life, not just my illness
3Suggests different ways of helping me, and does not concentrate on medication alone
4Understands how people’s difficulties can vary from time-to-time
5Looks carefully for signs of abuse and neglect
6Protects my rights and entitlements
= 7Is non-judgemental
Understands why people become vulnerable
8Is compassionate
9Arranges access to other services

What are the implications?

As noted in the article, the overring concern of participants was for social workers to be a reliable and continuous point of contact, and this was true irrespective of the individual characteristics and experiences of the service user. This suggests that services as a whole need to pay close attention to the importance of maintaining relationship-continuity, and not expect service users to form and re-form relationships with different workers unnecessarily. The second most important attribute was paying attention to the service user’s whole life, not just their illness. This highlights the continuing significance of the social model of mental health – seeing and understanding people in context, not as a set of symptoms. It also reflects the important contribution that social workers can make for people with mental health difficulties, not simply as care coordinators, but as reliable people with whom they can form an holistic relationship.  

Review written by

Dr David Wilkins

Cascade Talks: Understanding the social care landscape in Carmarthenshire

CASCADE Centre Director, Donald Forrester is joined by Jake Morgan, Director of Communities and Deputy Chief Executive and Stefan Smith, Head of Children’s Services in Carmarthenshire County Council. They speak about their journey into social work, integrating social work models into their work amongst a range of topics.

Music: The Right Direction by Shane Ivers

Cascade Talks: Social care leaders and reducing care rates in Neath Port Talbot

CASCADE Research Centre Director, Donald Forrester, is joined by Andrew Jarrett, Director of Social Services, Health and Housing in Neath Port Talbot County Borough Council. Andrew talks about his journey and experience in social work and discusses, amongst many issues, the rates of children in care in Neath Port Talbot.

Music: The Right Direction by Shane Ivers

Rethinking how we view gang members

By Sarah Frisby-Osman and Jane L. Wood (2020) 

Youth Justice, 20(1-2) 93–112 

Summary of article by Nina Maxwell

What question does this study focus on? 

This article focuses on the question of whether young people involved with gangs have higher levels of affective, behavioural, and mental health needs than young people who are not involved with gangs. Both groups were compared in relation to their levels of (1) anxiety and depression, (2) emotional distress and proneness to guilt, (3) conduct problems, (4) exposure to violence as victims, and (5) socio-cognitive processes, including moral disengagement and rumination (where anger-provoking thoughts are constantly replayed).  

How did they study it? 

The authors used a cross-sectional, between-participants design. Young people were invited to take part from three coeducational schools in areas of England that have identified as having high levels of gang activity by the UK government. The schools included one mainstream secondary school, one further education college and one Pupil Referral Unit. Ninety-one young people took part in the study with a mean age of 14.93. Of these, 56 (62%) young people were identified as nongang-involved, 32 (35%) as gang-involved and 3 (3%) were unspecified based on findings from a robust screening tool.  Their affective, behavioural, and mental health needs were measured using a range of scales including the Beck Depression Inventory, the Moral Disengagement Scale and the Strengths and Difficulties Questionnaire.   

What did they find? 

Young people involved in gangs were more likely than those not involved with gangs to report anxiety and depression, conduct problems, exposure to violence as victims, moral disengagement and rumination. There was no difference between the two groups regarding emotional distress and proneness to guilt. To explore which level of need was more likely to be associated with gang involvement, discriminant function analysis were undertaken. This analysis found that conduct problems, moral disengagement and angry rumination were more likely to account for gang involvement followed by anxiety, depression and violence exposure. Emotional distress and guilt-proneness were not related to gang involvement.  

What are the implications? 

This study highlights the need to consider the psychological and socio-cognitive predictors of gang involvement within early intervention and prevention strategies. Specifically, findings highlighted the need to target antisocial and problem behaviours as these were the biggest predictor of gang membership. Early intervention and prevention strategies should also address youth anxiety and depression as feelings of low self-esteem or perceived lack of opportunity were associated with the perception that gang membership was a way of getting their basic needs met. Finally, early intervention and prevention strategies should address the emotional impact of exposure to violence and the socio-cognitive processes of moral disengagement and rumination.  

Review written by

Nina Maxwell

CASCADE Talks: Poverty, Practice and Social Context

The podcast discusses the relationship between poverty and contact with children’s services. Drawing on the Child Welfare Inequalities Project , Professor Brigid Featherstone, discusses potential approaches to supporting families around their material circumstances at the level of individual practice, local authorities, and national policy. 

Music from The Right Direction by Shane Ivers

Young people outside

No two gangs are alike: The digital divide in street gangs’ differential adaptations to social media.

By Andrew Whittaker, James Densley and Karin S. Moser (2020)

Computers in Human Behaviour, 110.

Review written by Dr Nina Maxwell

What question does this study focus on?

This article focuses on the question of whether there were differences in gang member use of social media at the individual level (younger members versus older members), and the group level (less established gangs versus more established gangs) in Waltham Forest, London.

How did they study it?

This was a mixed methods study that included two stages of data collection. First 

qualitative, semi-structured interviews were conducted with ex-gang members, gang-affected young people, police officers, criminal justice workers, local authority workers, including community safety, education, early help and terrorism prevention, and voluntary sector grassroots workers. Second, preliminary findings were tested with two focus groups comprising stakeholders from local government agencies, criminal justice and grassroots workers. Due to ethical issues surrounding interviewee and researcher safety, the study did not include active gang members.

What did they find?

The article found that gangs differ in their use of social media. Broadly speaking, older members with established reputations tended to avoid social media to reduce the risk of detection by the police. Younger members, with less established reputations were more likely to embrace social media to build their reputation and status. Findings showed that gangs have moved away from open platforms that could be used for police surveillance such as Facebook and towards end-to-end encrypted platforms such as WhatsApp. Applications such as Snapchat are also being used to advertise and sell drugs as these tools automatically render photographs and messages inaccessible after a set time period. For those gangs that used social media, some were using apps with GPS tracking, such as Find MyiPhone or Find My Friends to increase their monitoring and control of younger members, for example by requesting photographic and video evidence of their activities. 

What are the implications?

While gangs may differ in the extent to which they use social media, even those gangs who shun its general use were aware that it could be weaponised against them or they could use it against their competitors. The authors conclude that where police and social workers monitor social media to identify the warning signs for conflict, this can be used to effectively de-escalate situations before serious violence occurs. This article highlights that service providers should be aware that younger gang members may be subject to constant monitoring and control by older gang members using social media. Such surveillance can limit young people’s opportunities to seek help.  

Review written by

Dr Nina Maxwell

Women sitting with children

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children’s social care

By Jessica Roy

Child & Family Social Work (2020)

Review written by Dr Donald Forrester

What question is the research trying to answer?

A high proportion of child and family social work involves parents who misuse drugs or alcohol, but there is limited research examining the nature of these issues – and the biggest study to do so is almost 20 years old. Roy’s research addresses this by describing the characteristics of 299 children from 186 families referred to a single local authority in England and addressing the question – what are the sorts of parental alcohol and drug problems that get referred to children’s services?

How does it try to do it?

The study is based on social work case records. The paper provides a description of the sample, and explores whether there are any significant associations between the different variables 

What did it find?

The main referrer was the police and alcohol was far the most common substance identified – for almost three quarters of the children. There were strong associations with other parental challenges – 44% of the children lived in families where parental mental health was an issue, 43% domestic abuse and 60% had criminal justice involvement. A very high proportion had previous involvement with children’s services– almost 70% of the families had had previous referrals.

What should we make of the findings?

The most interesting element of this study will be the follow-up, which will seek to find out what happened to the children and what factors influenced their outcomes. This may help us identify risk or protective factors, and provide pointers toward how we might help families more effectively. 

Nonetheless, these findings are also interesting in their own right. I was the lead author on a similar study to this one – some twenty years ago – and perhaps the most striking finding is that the situation seems rather similar. Of course, it is just one local authority – and not a Welsh one – but the way that parental drug and alcohol problems are woven into a complex tapestry of other problems remains the same. Thus, alcohol or drug problems are associated with poverty, domestic abuse, mental health issues and myriad other complications.

What this means is that drug or alcohol misuse are rarely problems in isolation. They are  caused by and contribute to a variety of other issues. This implies two things. First, social workers need a good understanding about alcohol and drug problems. They should know what causes drug or alcohol misuse and the basics of how to help – and what is unhelpful. Second, social workers need to also recognise that this knowledge is not enough on its own – because drug and alcohol problems are rarely if ever isolated, but occur as part of a more complex picture. 

More generally, this piece of research helps remind us of why we need social work in the first place – precisely because we need to understand issues such as drug and alcohol misuse not as individual problems but as part of a wider social and psychological context.

Review written by

Dr Donald Forrester