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

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

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

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

Judging parental competence: A cross-country analysis of judicial decision makers’ written assessment of mothers’ parenting capacities in newborn removal cases

By Jenny Krutzinna and Marit Skivenes (University of Bergen, Norway)

Child and Family Social Work, volume 26, issue 1, pages 50 – 60

Review written by Dr David Wilkins

What question does this study focus on?

This paper reports on a study from England, Germany and Norway, in which the authors looked at how mothers’ parenting capacity was assessed, understood and justified in relation to the removal of new-born babies. 

How did they study it?

The data consists of written court judgements from the three countries, made in relation to new-born babies. In total, the paper includes 117 such cases – 27 from Germany, 76 from Norway and 14 from England. The authors looked at these written judgements and sought to analyse the information and justifications they contained relevant to the final decision. They also interviewed a small number of judges (or other court decision-makers) to help ensure that their analyses were reasonable. Using the court judgements, they i) mapped the characteristics of the cases, ii) identified discussions of parents and parenting capacity, iii) coded them for parent-related risk factors and iv) looked for discrepancies and took steps to ensure their analysis was reliable. They focused only on mothers, and not fathers, due to their “relative importance with regards to newborns and the widespread absence of fathers [from the court cases]” (p. 53). 

What did they find?

Many of the mothers were very young, with nearly-half (41%) being aged 21 or less. Nineteen of the mothers had a previous child already in care, and over one-third (36%) had a history of child protection involvement of their own. One hundred of the cases (86%) resulted in the removal of the new-born baby. A mean average of more than three ‘risk factors’ were identified in each case (3.6 in England, 3.3 in Germany, 5.6 in Norway). These included a lack of empathy for the child (in 60.7% of cases), poor parenting competency (59%), mental illness (58.1%), abuse in childhood (53%), lack of compliance (50.4%), denial of problems (47%), substance misuse (28.2%) and learning disability (28.2%). A number of ‘risk-reducing factors’ were also identified, including willingness to engage with services (58.1%), competence in some areas (24.8%) and recognition of problems (23.1%). The court judgements overall contained more information about risk factors, than risk-reducing factors, and there were clear differences between the countries in relation to which factors were most often and rarely mentioned. The judgements often lacked an attempt to balance between the risk-increasing versus the risk-reducing factors when justifying the decision. 

What are the implications?

It may be that in most, if not all, of these cases, the risk to the new-born was so high, that a balanced consideration of risk-reducing factors was impossible or irrelevant. It is also the case that because the baby was new-born, the decision was made necessarily on the basis of predicted future harm, rather than an evidenced-based assessment of actual parenting capacity. Nonetheless, the authors do invite practitioners to consider the importance of risk-reducing factors and the interplay between parenting problems and social support measures that are or could be provided. Of course, in the short-term there may be little option but to prioritise child-safety – whether the same applies to longer-term planning, or indeed when the child is older, may be less obvious.  


Review written by

Dr David Wilkins

Implementing Routine Outcome Monitoring in Statutory Children’s Services

By Thomas Mackrill and Idamarie Leth Svendsen 

Child and Adolescent Social Work Journal, doi: 10.1007/s10560-020-00734-9

Review written by Dr David Wilkins

What question does this study focus on? 

This paper reports on a study from Denmark, in which one service implemented the use of routine outcome measurement. Such measurements are often used in counselling services but are much less common in social work.  

In this case, social workers were asked to gather two types of feedback every time they met with a family member. At the beginning of each session, the worker completed an Outcome Rating Scale, to monitor well-being, and at the end of each session, a Session Rating Scale, to obtain feedback on how the meeting went. You can watch a short 1-minute video of how these scales were used in practice here (the video is in Danish but has English subtitle).   

How did they study it? 

The study ran for two years. The researchers observed training and supervision sessions and helped develop a manual for implementing the new approach. They also interviewed social workers and managers about the perceived benefits and challenges of measuring outcomes in this way.   

What did they find? 

They found that social workers were more used to thinking of themselves as case managers, rather than considering how their interactions with the family could be an important mechanism for facilitating change. By obtaining regular feedback, workers become more aware of their practice, of their strengths and their areas for improvement. Workers also found they were having more conversations with family members about whether things were getting better for the child or not.  

Some workers worried that by asking parents directly and more often about their views, this could undermine their statutory authority. Some were also concerned that if the outcome measures showed things were not getting better for the child, this would reflect poorly on them and on the wider service. Workers also felt that the outcome measures were too simplistic to accurately measure the complexity of family life, and that they could detract from a focus on risk and on structural problems such as poverty.  

What are the implications? 

These findings show the potential benefits of implementing routine outcome monitoring in social work, and some of the challenges. The study also shows how making these kinds of ‘simple’ changes is not always straight-forward and can have unintended consequences too.  


Review written by

Dr David Wilkins

Work and resilience: Care leavers’ experiences of navigating towards employment and independence

By Rosemary Furey and Jean Harris-Evans (Sheffield Hallam University)

Child and Family Social Work, doi: 10.1111/cfs.12822 

Review written by Dr David Wilkins

What question does this study focus on?

This paper reports on the perspectives of care leavers in relation to obtaining employment and independence after leaving care. It looks in particular at a scheme in one local authority to support care leavers via the provision of an internship within various different departments of the council. 

How did they study it?

Young adults with care experience took part in interviews, and workplace supervisors of the internship programme attended a focus group. One additional supervisor was interviewed, as they were unable to attend the focus group. The interviews and focus-group were audio-recorded and transcribed. Thematic analysis was then used to explore the perspectives of the participants and identify common themes across the data. 

What did they find?

The care leavers spoke about the importance of making a genuine contribution via their internships, but also about the need for an emotionally supportive working environment. The workplace supervisors were also aware that some of the care leavers needed additional emotional support, compared with other members of staff, and most felt they could provide this – but not all, some feeling that they lacked the specialist knowledge required. Within the wider internship programme, care leavers could also access support from an education support worker, a dedicated worker as well as a supervisor to help support them and continued to have a statutory personal advisor. For some, this caused role-confusion and care leavers were not always sure who they should ask for help. 

What are the implications?

All of the care leavers in this study successfully completed the internship programme and wanted to continue in education or training afterwards. Although only small-scale, this study does show the potential for internship programmes to help facilitate future employment-related activities and promote care leaver independence. It also shows that supporting adults with care experience into work can be as much about providing emotional-support, as it is about workplace support per se.   


Review written by

Dr David Wilkins

Strengths-based practice in social work with adults

Price A, Ahuja L, Bramwell C, Briscoe S, Shaw L, Nunns M et al. (2020) Research evidence on different strengths-based approaches within adult social work: a systematic review. Southampton: NIHR Health Services and Delivery Research Topic Report. 

Review written by Professor Jonathan Scourfield

What question does this study focus on?  

This study summarises existing published research on the effectiveness and the implementation of strengths-based approaches within adult social work in the UK. These approaches are well-known in children’s services and are supported by recent legislation for adult care but little is known about their effectiveness and they are thought to be difficult to implement.

How did they study it?

They did a systematic review – that’s the most robust approach to summarising existing research. They looked in academic journals, with no restrictions on date or language, and they did some limited searching of ‘grey’ literature such as policy reports, although they acknowledge they may have missed some of these. They were only looking for studies from the UK, which is understandable given they wanted the research to be very relevant to UK services, but they will no doubt have missed some international studies that could also be relevant and important. Fifteen studies met the criteria to be included in the review, six of which were assessed as good quality.

What did they find?

There were seven studies of Making Safeguarding Personal – an outcomes-focused and personalised approach whose aim is for safeguarding to be done with, not to,

people. The other eight studies covered a range of approaches: Local Area Coordination, Solution Focused Therapy, Family Group Conferencing, Asset-based Community Development, Strengths-based with Relationship-based Approach, Asset-based approaches, and Motivational Interviewing.  None of the studies allowed the researchers to answer the question about effectiveness.

For Making Safeguarding Personal, the implementation issues were these:

  1. It was seen as demanding on practitioners at first but as having advantages over the longer term – e.g. improved personalisation and reduction in future referrals and burden on the range of services involved in safeguarding. Significant practice change was needed. The model needed adaptation for specific localities, which sometimes caused implementation problems.
  2. The approach required cultural changes in organisations, to move away from older practices such as being risk-averse and not engaging people in conversations about what they want from safeguarding. MSP requires a shift from process-led to user-focussed social work. More outward-facing and smaller local authorities tended to be most successful in implementing MSP.
  3. The knowledge, skills, creativity and confidence of service providers were important for delivering MSP. Practitioners’ willingness to embrace the model made a difference. 
  4. Successful implementation needed strong leadership – sound planning, engagement of staff across service boundaries and the active involvement of people receiving services.

What are the implications?

We need more evidence, which is so often the conclusion of systematic reviews! For this topic, there is a real need for comparative studies, to look at whether consciously strengths-based approaches actually result in different in the positive differences they would claim to bring, when compared with usual practice. The points about how MSP was implemented are useful for services that want to bring in practice changes.


Review written by

Professor Jonathan Scourfield

Article Reviews

At ExChange we know that busy practitioners do not have the time to find and read the latest research.  Finding interesting and relevant articles, evaluating the quality of the research and making sense of the implications for practice are all time consuming activities – and most workers are busy dealing with the challenges of working with people. 

To help you we are launching a new part of our website – regular Article Reviews. In Article Reviews academics from CASCADE will identify an important recent article, summarise its findings and provide some critical thinking about the research and its implications. 

We hope that these summaries will be useful – some may answer important questions, others may challenge your thinking or offer new ways of thinking about an issue or problem. 

We also hope that the Reviews will help you decide whether or not you want to read the article itself – we are going to pick Reports and articles that are freely accessible whenever possible and provide links. 

We hope that our Reviews will provide interesting, expert introductions to important current research that will help you find out the latest evidence in adult and children’s social care. We look forward to hearing from you whether you have found it helpful and how we might improve the service.  

Child protection social work in COVID-19: home visits and digital intimacy

By Sarah Pink, Harry Ferguson and Laura Kelly – Anthropology in Action, 27(3), 2020, pp. 27-30.  

What question does this study focus on? 

Social work is a public service, but social workers very often do their work in private (Bostock et al, 2018). In much of his most important research to date, Professor Harry Ferguson has used observational methods to explore what social workers do during home visits and how their work involves negotiated movement in intimate physical spaces. In this article, Ferguson and colleagues consider the impact of Covid-19 on this kind of work, and how social workers have adapted their practice using digital and virtual methods of communication.  

How did they study it? 

To do this, the authors spoke to social workers already involved in their studies about how their work has changed as a result of the pandemic and associated lockdowns and social distancing. As the authors note, there was no existing template for shifting social work practice online in a working-from-home context” (p. 28) and so each local authority, and to some extent each individual practitioner, had to develop their own new ways of working.  

What did they find? 

For some workers, having to work remotely from children and their families involved not being able to do the things they normally would. For example, one social worker talked about how they would engage with babies by touching them, and another described how they would use their sense of smell to help judge whether a child was being washed regularly enough. Virtual communication allows one to look and hear, but not to touch or smell. On the other hand, another worker described how some children find it easier to communicate with them digitally, either on a video-call or via text messages.  

What are the implications? 

While the disruption and ongoing harm of the pandemic could not ever be described as positive, there might nonetheless be some positive things to emerge from it. The authors of this article suggest that for some children and families, even after the pandemic, a hybrid approach combining in-person home visits with some forms of virtual communication might be more desirable and more helpful than either approach in isolation.  

Review written by Dr David Wilkins.