A Comparative Study of Central and Eastern European Social Policy Concernig Mental Disability

The main goal of this project was to identity whether an imported system of social policy can be suitable for a host country, and if not why not. Romanian social policy concerning the mentally disabled represents a paradoxical situation in that while social policy is designed to ensure both an institutional structure and a juridical environment, in practice it is far from successful. The central question which Ms. Ciumageanu asked therefore was whether this failure was due to systemic factors, or whether the problem lay in reworking an imported social policy system to meet local needs. She took a comparative approach, also considering both the Scandinavian model of social policy, particularly the Danish model which has been adopted in Romania, and the Hungarian system, which has inherited a similar universal welfare system and perpetuated it to some extent. In order to verify her hypothesis, she also studied the transformation of the welfare system in Great Britain, which meant a shift from state responsibility towards community care. In all these she concentrated on two major aspects: the structural design within the different countries and, at a micro level, the societal response. Following her analyses of the various in the other countries concerned, Ms. Ciumageanu concluded that the major differences lie first in the difference between the stages of policy design. Here Denmark is the most advanced and Romania the most backwards. Denmark has a fairly elaborate infrastructure, Britain a system with may gaps to bridge, and Hungary and Romania are struggling with severe difficulties owing both to the inherited structure and the limits imposed by an inadequate GDP. While in Denmark and Britain, mental patients are integrated into an elaborate system of care, designed and administered by the state (in Denmark) or communities (in Britain), in Hungary and Romania, the state designs and fails to implement the policy and community support is minimal, partly due to the lack of a fully developed civil society. At the micro level the differences are similar. While in Denmark and Britain there is a consensus about the roles of the state and of civil societies (although at different levels in the two countries, with the state being more supportive in Denmark), in Romania and to a considerable extent in Hungary, civil society tends to expect too much from the state, which in its turn is withdrawing faster from its social roles than from its economic ones, generating a gap between the welfare state and the market economy and disadvantaging the expected transition from a welfare state to a welfare society and, implicitly, the societal response towards those mentally disabled persons in it. On an intermediate level, the factors influencing social policy as a whole were much the same for Hungary and Romania. Economic factors include the accumulated economic resources of both state and citizens, and the inherited pattern of redistribution, as well as the infrastructure; institutional resources include the role of the state and the efficiency of the state bureaucracy, the strength and efficiency of the state apparatus, political stability and the complexity of political democratisation, the introduction of market institutions, the strength of civil society and civic sector institutions. From the standpoint of the societal response, some factors were common to all countries, particularly the historical context, the collective and institutional memories and established patterns of behaviour. In the specific case of Romania, general structural and environmental factors - industrialisation and forced urbanisation - have had a definite influence on family structure, values and behavioural patterns. The analysis of Romanian social policy revealed several causes for failure to date. The first was the instability of the policy and the failure to consider the structural network involved in developing it, rather than just the results obtained. The second was the failure to take into account the relationship between the individual and the group in all its aspects, followed by the lack of active assistance for prevention, re-socialisation or professional integration of persons with mental disabilities. Finally, the state fails to recognise its inability to support an expensive psychiatric enterprise and does not provide any incentive to the private sector. This creates tremendous social costs for both the state and the individual. NGOs working in the field in Romania have been somewhat more successful but are still limited by their lack of funding and personnel and the idea of a combined system is as yet utopian in the circumstances in the country.

"It was hard to come to mutual understanding..." - Multidimensionality of social learning processes in natural resource use in India, Africa and Latin America

Sustainable natural resource use requires that multiple actors reassess their situation in a systemic perspective. This can be conceptualised as a social learning process between actors from rural communities and the experts from outside organisations. A specifically designed workshop oriented towards a systemic view of natural resource use and the enhancement of mutual learning between local and external actors, provided the background for evaluating the potentials and constraints of intensified social learning processes. Case studies in rural communities in India, Bolivia, Peru and Mali showed that changes in the narratives of the participants of the workshop followed a similar temporal sequence relatively independently from their specific contexts. Social learning processes were found to be more likely to be successful if they 1) opened new space for communicative action, allowing for an intersubjective re-definition of the present situation, 2) contributed to rebalance the relationships between social capital and social, emotional and cognitive competencies within and between local and external actors.

Engaged Learning: Enabling Self-Authorship and Effective Practice

There is now broad consensus that higher education must extend beyond content-based knowledge to encompass intellectual and practical skills, personal and social responsibility, and integrative learning. The college learning outcomes needed for success in 21st century life include critical thinking, a coherent sense of self, intercultural maturity, civic engagement, and the capacity for mutual relationships. Yet, research suggests that college students are struggling to achieve these outcomes in part because skills needed to succeed in college are not those needed to succeed upon graduation. One reason for this gap is that these college learning outcomes require complex developmental capacities or “self-authorship” that higher education is not currently designed to promote.

Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations

PURPOSE: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. DESIGN AND METHODS: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries. Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation. RESULTS: Among all three samples, the LSNS-6 and two subscales (Family and Friends) demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables. The proposed clinical cut-points showed good convergent validity, and classified 20% of the respondents in Hamburg, 11% of those in Solothurn (Switzerland), and 15% of those in London as at risk for social isolation. IMPLICATIONS: We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people

BACKGROUND: Social isolation is associated with poorer health, and is seen by the World Health Organisation (WHO) as one of the major issues facing the industrialised world. AIM: To explore the significance of social isolation in the older population for GPs and for service commissioners. DESIGN OF STUDY: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. SETTING: A total of 2641 community-dwelling, non-disabled people aged 65 years and over in suburban London. METHOD: Demographic details, social network and risk for social isolation based on the 6-item Lubben Social Network Scale, measures of depressed mood, memory problems, numbers of chronic conditions, medication use, functional ability, self-reported use of medical services. RESULTS: More than 15% of the older age group were at risk of social isolation, and this risk increased with advancing age. In bivariate analyses risk of social isolation was associated with older age, education up to 16 years only, depressed mood and impaired memory, perceived fair or poor health, perceived difficulty with both basic and instrumental activities of daily living, diminishing functional ability, and fear of falling. Despite poorer health status, those at risk of social isolation did not appear to make greater use of medical services, nor were they at greater risk of hospital admission. Half of those who scored as at risk of social isolation lived with others. Multivariate analysis showed significant independent associations between risk of social isolation and depressed mood and living alone, and weak associations with male sex, impaired memory and perceived poor health. CONCLUSION: The risk of social isolation is elevated in older men, older persons who live alone, persons with mood or cognitive problems, but is not associated with greater use of services. These findings would not support population screening for individuals at risk of social isolation with a view to averting service use by timely intervention. Awareness of social isolation should trigger further assessment, and consideration of interventions to alleviate social isolation, treat depression or ameliorate cognitive impairment.

Between Equity and Empathy: Social Professions and the New Accountability

This article explores the practical and ethical implications of the ‘new accountability’ (working to procedures, targets and standards) based on interviews with British social professionals. Although similar tendencies are present in other European countries, in Britain the rule-bound nature of social work is more intense. Practitioners who regard the ‘new accountability’ positively justify their views with reference to utilitarian and rights-based arguments relating to the promotion of good outcomes, the achievement of equity, respecting the consumer rights of service users and the rights of other stakeholders to information and value for money. Those practitioners who view the new accountability requirements negatively seem to speak in a different ‘moral voice’, which can be linked to more personal and situated approaches to ethics, stressing the importance of particular relationships in context, trust, sensitivity and a sense of ‘vocation’. Both ‘voices’ are part of professional practice, but the new accountability stresses the former at the expense of the latter. For social work to play the critical role identified by Walter Lorenz, maintaining a creative balance between equity and empathy will be important.

Social Work, Political Violence and Historical Change:

In this paper the author outlines the background to the history of the conflict in Northern Ireland which led to the current ‘Troubles’. In this discussion a range of key ideas are highlighted, including the nature of sectarianism and patterns of violence which have profoundly affected the society. The second part of the paper reviews a number of issues which face social workers when they try to deal with the effects of such violence as well as highlighting new challenges which have emerged as the society moves towards the resolution of conflict. It concludes with the argument that, wherever there is such conflict in the world, social workers need critically to understand the way in which political and social structures impinge upon their everyday practice.

The Postmodern ‘Turn’ in Social Work: The Challenges of Identity and Equality

Diversity and demands for equality have challenged fixed notions of identity amongst the diverse populations of Europe. This development has prompted discourses about the significance of fluidity and multiplicity in identities that have given prominence to postmodern theories in the profession of social work. A number of social work educators have contributed to the ensuing debates. Walter Lorenz’s work has contributed substantially to developments on this front by:highlighting the dangers of essentialising fixed identities in professional practice, referring to the failure of social workers to live up to professional values and ideals in the Nazi attack on Jews and others who were different from the Aryan norms that Hitler’s regime sought to impose; arguing for racial equality in multicultural Europe; and ensuring that social work theories and practice engaged with innovations in the social sciences more generally to improve the profession’s research, theoretical and practice bases. In this article, I engage with crucial debates that have shaped the profession during the post-war period, honouring Walter Lorenz’s contributions to them in the process.

Social Work in an Ethnically Diverse Europe: The Shifting Challenges of Difference

This article addresses the inherently politicised context of social work practice located within the contested logics and values of national social policy and professional values and identities. Noting the key role of social work in delivering the state’s promise of social citizenship, it is argued that the increasing neo-nationalist sentiments and politics in European states generate significant pressures upon the universalist, inclusive, values of social work in a multiethnic Europe. The academic and policy debate around social cohesion is explored to illustrate how an assimilationist drift in multicultural state policies undermines the capacity of social work services to deliver appropriate, ethnically sensitive, services. It is further argued that the pervasive spread of populist counter-narratives to multiculturalism erode support for anti-racist and transcultural social work practice. In this context it is argued that social work must acknowledge its compromised situation and explicitly develop a political agenda committed to guaranteeing substantive equality in service delivery.

The Diverse Impacts of the Neo-liberal Social Policies on Children’s Welfare and Social Work with Young People: The Finnish Perspective

This article discusses the impacts of globalization, neo-liberal social policies and the Finnish economic recession of the 1990s on children's and young people's welfare. It summarises some of the impacts of Finnish social policies on the everyday lives of families with children and highlights some of the features of the recent and current debates surrounding youth delinquency and the societal reactions to young generations. All this contributes to a contradictory and conflicting societal context which challenges experts in the field of child welfare social work experts to operate - as expected - at the right moment, legally and effectively. Instead of being overly-defensive for the ‘good old’ ways of practicing social work with children, the authors invite social work scholars and practitioners to reconceptualise both the concept of children's citizenship and its position both in child welfare theory and practice in the context of children's global rights.

Quality Management and Formalization in Social Service Organizations - A Survey on Home-Based Family Intervention Services

Although the effects of quality management on social work are still widely unexplored, critics suspect that it will lead to a negative standardization of working conditions, whereas supporters of quality management hope for a greater transparency and effectiveness of service delivery. This article reports on a survey of 30 managers, 261 professionals, and 435 families in 30 family intervention service organizations. It uses cluster analysis to explore the relationship between quality management and different forms of work formalization. Results showed that working conditions generally are enabling for professional practice, but differences exist between what is called here a managerialist machine bureaucracy, an atomistic professional organization, and a collegiate professional organization.

International social work education at the crossroads

Social work has been a player in the international arena since 1928 when the International Association of Schools of Social Work (IASSW) was founded alongside its sister organisations, the International Federation of Social Workers (IFSW) and the International Council for Social Welfare (ICSW). These divided their remit into education, practice and policy respectively. Their development has been an interesting one, but the details of it need not detain us here. I only want to lay aside the argument that having an interest in the international domain is a new phenomenon in social work. At the same time, I want to emphasise how impressive it is that a profession that has been so tied into modernity, linked to the modern nation-state (Lorenz, 1994) and rooted in local legislation and traditions has such a long-standing history of involvements that have crossed borders to promote understanding and knowledge-building. In these encounters, social work educators and practitioners have engaged with others who were different from them while struggling to make their interactions egalitarian and respectful ones.

The Concept of Developmental-Tasks and its Significance for Education and Social Work

The term "developmental-task" was introduced by Robert Havighurst in the 1950's. According to R. Harvighurst, the term refers to tasks which arise in a social context during an individual lifetime. Since the 1950's the concept of developmental-tasks has become an important theoretical approach in educational science and in theories of growth and development - but not in social work and social pedagogy. In the following article I aim to show that this approach is very important to theory and practice of social pedagogy and social work.

Social Workers Involvement in Taiwan's 1999 Earthquake Disaster Aid: Implications for Social Work Education

On September 21, 1999, a strong earthquake devastated Taiwan's central areas and claimed more than two thousand casualties. Social work roles in the disaster aid were surveyed with standardized questionnaires six months after the earthquake; in addition, interviews of the key informants, documental research, focus groups and open-ended questionnaires were utilized to collect qualitative data. The study found that social workers had significant roles and functions in both rescue and recovery stages especially in linking the victims' needs with resources. Social workers, including from public and private sectors as well as from campuses including the faculties and students of social work departments, have been deeply involved in helping the victims. Regrettably, most Taiwanese social workers participated in the rescue aid with limited training in disaster aid; social work practice in disaster aid is not included in current curriculums of college level. This means that social work roles and functions in the disaster aid process have not been fully realized by Taiwan's society and professional education.