Social Workers vs Bob The (boozy) Builder: Can we do it?

Social Workers vsBob The (boozy) Builder: Can we do it? Dr Sarah Galvani BASW SIG Conference 3 May 2012

Depends what ‘it’ is.... • Identify problematic substance use? • Assess substance use? • Work with substance specialists?

We tried to find out Target participants: • Front line social work and social care practitioners with caseworker, or key worker, responsibilities working in Local Authorities across England Multiple methods were used including: • an online survey (designed to take 15 minutes to complete; 90 closed questions, 6 open questions) • individual interviews with key informants • focus groups with practitioners

Who responded? • Social work and social care practitioners from: • 8 Adult Social Care directorates • 10 Children’s Services directorates • 11 different Local Authorities in all • Directorates reflect urban and rural authorities, a geographical spread, range of deprivation index scores • Total survey population was 3164 • Response rate was just over 20% (n=646) • Removed substance use specialist responses • Final total sample = 597

Sample Characteristics • 357 (61%) worked in Children’s Services • 240 (39%) worked in Adults’ Services • 129 (22%) worked in a support role, 337 (56%) were qualified practitioners and 125 (21%) were in managerial roles • The majority of respondents were social work qualified (62%) • There was a fairly even spread of length of experience in social care sector.

What we found: Defining • The majority of practitioners provided social definitions of problematic substance use. • In particular it was defined as problematic when it was having a negative impact on their ability to fulfil roles and functions of daily living. “If it regularly affects their ability to undertake activities of daily living over and above their physical disability.” “The impact the substance use has on their ability to function daily and meet the needs of their children.”

What we found: Identifying • We asked people how easy it was to identify when a person’s substance use was problematic • Focus group data: subject was difficult, touchy, sensitive, vast, impertinent, judgemental

Identifying (cont.) • Those who found it easier to identify problematic substance use included: • Those working with YP • people experiencing mental distress • those with higher current numbers of people with SU problems on a) their caseload and b) across their social care careers. • NB. This was not the case for those working in child protection or with children in need despite these factors being present.

What we found out: Asking • Just over half the respondents do not ask their service users ‘often’ or ‘very often’, and less than a third ask about the substance use of someone close to them.

Asking (cont.) • Those who did ask were more likely to • be working in CS or MH practitioners • have higher levels of therapeutic commitment • more experience working with SU over their careers • have SW qualifications rather than other qualifications • have received more training. • Focus group data: • primary service user group determines whether and how the subject is raised • some people asking in a roundabout way or not until a relationship is established • others are direct and frank from the outset

Asking (cont.) • Limited guidance provided on how to assess and what to ask – one or two prompts on some practitioners’ forms; no sense of routine questioning; some practitioners chose not to use them. “It is a regular checklist question in a core assessment, but I only pursue it if there is an indication of difficulties - most of my current parents present as in control of their lives with no contraindications suggesting alcohol or violence.” “This used to be part of the SAP assessment, with questions about alcohol and smoking, usually asked in a conversational way, 'do you like to have a drink /like to smoke', followed by how often or how much. I do not talk about units as such. This does not appear on the new Supported Self Assessment, so can now be more difficult to introduce.”

Asking (cont.) • When people asked – used a range of open and closed qu’s Do you regularly/rarely/never use alcohol/substances? In what situations would you use? Do you feel you have a substance misuse/alcohol misuse issue? What thoughts do you have about why you use? What's your use history? When did you first use? • Differences between AS and CS responses • CS: always include the impact of SU on the children or the person’s parenting including impact it on budgets. • AS: embedded in qu’s around their service users’ health; often excluded illicit drugs, focussed on smoking/alcohol • Small no. of respondents from both AS and CS asked about the person’s interest in changing their substance use.

What we found: working with specialists • We asked practitioners who they would normally... • ...seek advice from • ...refer to • ...joint work with • Then, repeated for frequency of contact with specialist substance use service providers • Qualitative data from focus groups/open survey questions – themes around challenges and opportunities of joint working

Advice seeking • Majority (81%) stated normally seek advice from substance use specialists, but also advice from colleagues /team managers. • In practice, 38% had sought advice from specialists at least once in last 6 months, 33% had not, the remainder had sought advice monthly or more often. • Practitioner working with particular service user groups sought advice more often, eg. LAC, adults with MH problems, YP and CP or CIN roles • SW with high levels of role engagement and higher caseload proportions also sought advice more often • Qual data – info and advice very positively received

Making referrals • Majority stated normally refer to specialist SU services, followed by self help groups, CMHT , the GP. • 47% had not made a referral to specialists in last 6 months, 38% had, 15% monthly or more often. • Referrals most likely from practitioners working in CS, men, those with higher levels of role legitimacy and role engagement, and moderate numbers of people with substance use on their caseloads. • Qualitative data suggest practitioners spent a lot of time encouraging people to accept or attend referrals.

Joint visits/assessments • Half practitioners stated they would normally conduct joint visits/assessments with specialist SU colleagues, closely followed by colleagues in their team. • 17% said they wouldn’t work collaboratively or didn’t know who they’d do joint visits/assessments with. • 70% - no joint visit/assessment with specialist SU workers in last 6 months; 23% had at least once • Those most likely to conduct joint visits/assessments were those working with young people, and children and families, and had higher caseload proportions

Benefits of joint working • On a personal/professional level: • A problem shared – a sense of relief • Freed up to focus on own specialism • Increased confidence in working with the issue • For the service user: • A perception that specialist workers are able to develop more open communication with service users • An independent worker who can advocate for the service user

“None of us are specialists, well I’m not a specialist with alcohol and drug users. (Yes we come across them.) So I feel our role is more about empowering and trying to enable them, and put what support they need in place to make those changes, but we do have to work very closely with specialists of drug and alcohol support services, and liaise regularly with them. They’re the best people that are going to put the support in place for that parent, but we need to be empowering them, and if they’re saying “I can’t go to an appointment because I’ve got no childcare”, then we provide childcare so that they can. So we need to do all we can” (Senior practitioner, Intake and Assessment Team)

Can we do it? • YES WE CAN! • And most of us are to a greater or lesser degree, BUT... • Our findings suggest we can do better with: • Better knowledge and training • Increased confidence and support • Closer working with specialist partners • AND with tools and resources to support our practice

Thank you! • Sarah Galvani • Email: sarah.galvani@beds.ac.uk • Tel: 07884 007222 • www.beds.ac.uk/goldbergcentre Galvani, S. (2012) Supporting people with alcohol and drug problems. Social work in practice series. Bristol: Policy Press Galvani, S. (ed.) and McCarthy, T. (2010) Alcohol and other drugs. Essential Information for Social Workers. A BASW Pocket Guide.Luton: University of Bedfordshire

Social Workers vs Bob The (boozy) Builder: Can we do it?