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five social work tasks or roles with adults

Responsibilities of a Social Worker

While breaking down the role of a social worker into one of the five major responsibilities below seems to simplify the work at hand, they are richly different activities for each client and every social worker. There is no “one size fits all” plan for therapy — no two treatment plans or clients are the same. These steps in mental health care each serve a critical purpose, and only a social worker with the right qualifications and a degree in mental health care can provide them.

1. Assess Your Client

Assessment involves getting to know your client on a multidimensional level to determine the most effective way to work towards positive change. In this stage, you’ll gather information about the client’s situation within their individual, organizational, and societal systems, allowing you to learn the details of their family and medical histories, friendships, schools, jobs, and issues they’ve had in each system. Assessment allows you to understand how your client sees their situation, which areas they wish to address, and what strengths they bring to therapy. When the assessment is complete, you’ll have a stronger idea of how to develop an effective treatment plan with your client.

Personality Traits — You’re: Perceptive, Objective, Analytical

2. Create and Implement A Treatment Plan

Once you’ve assessed your client, it’s time to work on a treatment plan that will empower them to overcome, recover from, or adjust to their situation. At this stage, one of your primary duties will be to listen to your client to jointly define the goals and criteria that establish wellness for your client. Treatment plans generally include continued one-on-one individual therapy sessions to help your client move towards their desired goal and could include group or family sessions geared toward a specific challenge they’re dealing with. Flexibility in treatment plans is necessary. As goals are met, new problems become known, or crises erupt. Your duties can also include referring clients to other resources and professionals with diverse qualifications, such as support group services and medical professionals.

Personality Traits — You’re: Patient, Empathic, Flexible

3. Secure and Refer Needed Resources

Creating and implementing a treatment plan involves more than just “talk therapy.” Clients often benefit when connected to community resources and government agencies such as food banks, health care and unemployment services, and benefits programs such as food stamp programs. Social workers may also refer clients to medical professionals for further treatment, support groups specifically geared to their client’s issue, job-placement recruiters, and child-care resources to help them successfully meet their wellness initiatives.

Personality Traits — You’re: Organized, Connected, A Strong Advocate

4. Evaluate and Monitor Improvement

Once treatment is underway, you’ll continuously evaluate whether your client is moving towards their goals according to the criteria established when you created their treatment plan. The objectives are to determine how you can continue supporting your client and if your current methods effectively serve their purpose. For instance, sometimes the treatment plan needs to be changed according to new problems or information presented during treatment, if goals have been met, or if a crisis erupted along the way. The key is to remain flexible in helping your clients move towards their goals in the most effective way.

Personality Traits — You’re: Perceptive, Flexible, Analytical

5. Serve as a Client’s Advocate

Being a client’s advocate often beckons social workers to make this work their life’s purpose. Whether they think of advocacy on a micro, mezzo, or macro level — being an advocate for an individual, advocating within organizations and communities, or engaging in advocacy at the policy/research level — they have a strong calling to make the world a better place by representing those who cannot effectively represent themselves. Social workers stand for another person on an individual level, often in complex situations. For instance, their duties may include providing necessary interventions when a child is in an abusive home and working with the family, police, and DCFS to provide immediate and continued safety for the child. On the mezzo and macro levels, social workers function within groups, within community organizations, and amongst policymakers to develop or improve programs, services, policies, and social conditions that will benefit individuals and the field of social work at local, state, and national levels.

Personality Traits — You’re: Courageous, Impactful, Persistent

An Overview of the Social Work Profession

Social work is a gratifying profession that allows you to say at the end of each day, “I made a difference in someone’s life.” Though it’s demanding work, over 600,000 people chose to dedicate their lives and careers to this field, and its rapid 12% growth rate between 2020 and 2030 means many more will do so. 1 On a daily basis as a social worker, you’ll be challenged as you help people navigate a wide range of positive and negative stressors, such as supporting parents with the emotional challenges of adopting a child, helping a professional navigate a new career, or working with someone who’s trying to exit an abusive relationship, overcome an addiction, or contemplating divorce. For each client, the tasks you’ll complete in the course of your work with them will fall into most, if not all, of the five categories — assessment, treatment, securing resources, monitoring improvement, and being an advocate — though their experience within those tasks, and yours, will be completely individualized.

Make More Than a Difference

Gain the qualifications to find success as an effective clinical social worker. Learn more about Widener University’s online Master of Social Work (MSW) program, call 844-386-7321 or complete the request more information form and a program manager will contact you right away.

1 Bureau of Labor Statistics: https://www.bls.gov/ooh/community-and-social-service/social-workers.htm .

2 https://www.onetonline.org/link/details/21-1022.00 .

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What Does a Social Worker Do?

Social work attracts energetic, empathetic people who want a career dedicated to helping others lead better lives. They work with individuals, families, and groups by helping people solve problems in their everyday lives, connecting them to needed services, and responding in a crisis.

People experiencing the most vulnerable time in their lives rely on social workers to help them find solutions to complex problems. Social workers use their skills and expertise to promote good mental health, strengthen relationships, and end generational cycles of trauma and substance use, ultimately creating healthier families and communities.

A social worker’s career can lead to many places. Social workers work in a wide range of medical facilities, including hospitals, mental health clinics, school health offices, and private practices. No matter where they work, social workers spend their workdays helping people overcome difficulties and challenges in their lives.

The answer to the question, “What does a social worker do?” depends on the type of social worker. A degree in social work prepares graduates to enter a range of different occupations. They include the following, according to the National Association of Social Workers:

  • Administration and management : Taking leadership roles in private and public agencies that provide services to clients.
  • Advocacy and community organization : Championing the rights of communities and individuals to support social justice.
  • Aging : Working exclusively with older clients.
  • Child welfare : Focusing on providing care to vulnerable children.
  • Developmental disabilities : Advocating for parents of the disabled and ensuring they know their rights.
  • Health care : Working with people on social and personal issues that impact health.
  • Justice and corrections : Working in courts, rape crisis centers, police departments, and correctional facilities
  • Public welfare : Creating programs, training and supervising staff, and setting and evaluating standards and criteria for service delivery.

In whatever role they work, social workers focus on making a difference for communities and individuals.

What Are the Job Duties of Social Workers?

Social workers bring a combination of compassion, knowledge, and skills to their work. No matter where they work, certain tasks are part of the job. These tasks include:

  • Identifying the people and communities who need help
  • Assessing clients’ needs, situations, and strengths
  • Responding to crisis situations
  • Caring for in-need children
  • Maintaining case files and records
  • Developing and evaluating programs and services to ensure basic needs

Social workers often do not work a typical eight-hour workday. Rather than sit in an office, social workers spend most of their work hours in the community. A typical day might include attending a court hearing, supervising visits, advocating for client needs, and meeting with clients.

In addition to making many decisions regarding their clients, social workers also provide most mental health services in the United States, according to KVC Health Systems.

Skills of Social Workers

To complement what they learn about social work in college, social workers require other “ soft skills .” For example, they must hone their communication skills, providing support and listening carefully to patients’ issues. The job also requires a great deal of patience and the ability to help calm people. Having empathy is key to the job.

Social workers must also practice self-care. It’s a “nice to have” for many people but a necessity for people working in social work. Work fatigue is a common issue in social work. It’s important to those in the field to reduce stress and do what they can to reduce the risk of burnout.

What You’ll Learn in a Master of Social Work Program

Earning a bachelor’s degree in social work prepares graduates with the skills they need to take on entry-level positions in this important field. They will graduate into a world that values their skills. The U.S. Bureau of Labor Statistics (BLS) projects a 9 percent increase in social workers between 2021 and 2031. That translates to more than 64,000 new jobs.

The Touro University Worldwide online Bachelor of Arts in Social Work prepares graduates as a generalist in social work. The program emphasizes students gaining the knowledge needed to promote their clients’ well-being. Learning experiences include fieldwork in schools, counseling centers for families, senior centers, and social service charitable organizations.

The program also encourages graduates to enter the working world as advocates for social change and a more just, equitable society. Many graduates move on to earn a master’s degree from Touro University Worldwide, expanding their knowledge and making them better prepared to use their skills to make positive changes in the world.

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What does a social worker do?

Would you make a good social worker? Take our career test and find your match with over 800 careers.

What is a Social Worker?

Social workers are dedicated to helping people overcome personal and societal obstacles by providing support, resources, and advocacy. They play a vital role in addressing issues related to mental health, poverty, family dynamics, healthcare access, substance abuse, and more. Social workers work across diverse settings, including hospitals, schools, social service agencies, community organizations, and government institutions.

Social workers collaborate with clients to set goals, navigate complex systems, and develop coping strategies. They also work to address systemic issues by advocating for policy changes and social justice initiatives that aim to create a more equitable and inclusive society. Their compassionate and empathetic approach, combined with their knowledge of human behavior and social systems, allows them to make a meaningful impact on the lives of individuals and communities in need.

What does a Social Worker do?

A social worker talking to an elderly client.

Social workers promote social justice and improve the lives of individuals and communities. They help a wide range of individuals, families, and communities who are facing various social, emotional, and economic challenges. They work with people from diverse backgrounds and cultures, including children, youth, adults, older adults, and individuals with disabilities.

Duties and Responsibilities Here are some of the duties and responsibilities of a social worker:

  • Assessing clients' needs: Social workers need to be able to identify the needs of their clients by listening to them, observing their behavior, and conducting assessments. They may use a variety of tools such as interviews, questionnaires, and diagnostic tests to evaluate a client's mental, emotional, and social well-being.
  • Developing care plans: Based on their assessment, social workers develop care plans to address the client's specific needs. This may include recommending services such as counseling, therapy, or medical treatment. They may also refer clients to community resources such as job training programs or housing assistance.
  • Providing counseling and support: Social workers provide emotional support to their clients and help them to develop coping strategies to deal with life's challenges. They may also provide counseling for issues such as depression, anxiety, and substance abuse.
  • Advocating for clients: Social workers advocate for their clients' rights and interests, especially when it comes to accessing services and resources. They may help clients navigate complex systems such as government benefits, healthcare, or legal procedures.
  • Promoting social justice: Social workers strive to promote social justice and address systemic inequalities. They may work to change policies or advocate for reforms that address issues such as poverty, racism, and discrimination.
  • Collaborating with other professionals: Social workers often work with other professionals such as psychologists, healthcare providers, and educators to provide comprehensive care to clients. They may also work with community organizations and government agencies to develop programs and policies that benefit their clients.
  • Keeping accurate records: Social workers must maintain accurate and confidential records of their clients' assessments, treatment plans, and progress. This helps to ensure that clients receive appropriate care and that the social worker is meeting ethical and legal requirements.
  • Continuing education: Social workers must stay up-to-date on the latest research and best practices in their field. They may attend workshops, seminars, and conferences to improve their knowledge and skills.

Types of Social Workers To best serve the needs of their clients, social workers often specialize in a particular area of practice. Specializations provide social workers with the knowledge and skills they need to address the unique challenges and issues facing specific populations or in specific practice settings. Specializations also allow social workers to develop expertise in a particular area of practice and to become leaders in their field.

  • Family Social Workers : Family social workers provide support and interventions to families facing various challenges, such as financial difficulties, housing issues, substance abuse, domestic violence, or mental health concerns. They aim to enhance family functioning and strengthen relationships among family members.
  • Healthcare Social Workers : Healthcare social workers work in hospitals, clinics, and other healthcare settings. They help patients and their families navigate the healthcare system, provide emotional support, and connect patients with resources like financial assistance, home healthcare, and rehabilitation services.
  • Substance Abuse Social Workers : Substance abuse social workers work with individuals and families affected by addiction to drugs or alcohol. They provide counseling and support to help individuals overcome their addiction, manage the underlying issues that contribute to substance abuse, and develop strategies for recovery. They also work with community organizations and government agencies to develop and implement prevention and treatment programs that help address substance abuse at a larger scale.
  • Mental Health Social Workers: Mental health social workers provide support and assistance to individuals who are experiencing mental health issues or illnesses. They help clients develop coping strategies, access resources, and navigate the healthcare system. Mental health social workers may work in a variety of settings, including hospitals, clinics, schools, and community organizations.
  • School Social Workers: School social workers work in schools to support the social, emotional, and academic well-being of students. They provide counseling and crisis intervention, help students connect with resources, and work with teachers and administrators to create a safe and supportive learning environment.
  • Community Social Workers: Community social workers work in communities to identify and address social problems like poverty, homelessness, and inequality. They collaborate with community organizations and government agencies to develop and implement programs and services that help improve people's lives.
  • Criminal Justice Social Workers: Criminal justice social workers work in the criminal justice system, helping individuals and families affected by crime and incarceration. They provide counseling and support to victims of crime, help ex-offenders reintegrate into society, and advocate for policies that promote fairness and justice.
  • Geriatric Social Workers: Geriatric social workers work with older adults and their families to provide support and resources as they navigate the challenges of aging. They help seniors access healthcare, manage chronic conditions, and find housing and other services that promote their independence and quality of life.
  • Military social workers: Military social workers provide support to members of the military and their families, addressing issues such as deployment, trauma, and PTSD. They may work on military bases or with organizations that support military families.
  • Policy and Advocacy Social Workers: Policy and advocacy social workers work to advocate for social justice and change at the policy level. They may work for government agencies, non-profit organizations, or advocacy groups to develop and implement policies that address social and economic issues.
  • Research Social Workers: Research social workers conduct research on social issues and work to develop evidence-based practices and interventions to address social problems. They may work in academic settings or research organizations.
  • International Social Workers: International social workers work with individuals and communities in different countries to address social, economic, and cultural issues. They may work to provide humanitarian aid, promote social justice, and advocate for human rights, and work on issues such as poverty, human trafficking, refugee resettlement, and disaster relief.
  • Forensic Social Workers: Forensic social workers work within the criminal justice system to support individuals who have been involved in or affected by crime. They may work in prisons, courts, or with law enforcement agencies to provide services such as mental health assessments, therapy, and case management.

Are you suited to be a social worker?

Social workers have distinct personalities . They tend to be artistic individuals, which means they’re creative, intuitive, sensitive, articulate, and expressive. They are unstructured, original, nonconforming, and innovative. Some of them are also social, meaning they’re kind, generous, cooperative, patient, caring, helpful, empathetic, tactful, and friendly.

Does this sound like you? Take our free career test to find out if social worker is one of your top career matches.

What is the workplace of a Social Worker like?

Social workers can work in a variety of settings, including government agencies, hospitals, schools, non-profit organizations, and private practices. Their work can involve interacting with clients, collaborating with colleagues, and performing administrative tasks.

Here are some examples of workplace settings for social workers:

  • Government agencies: Social workers may work for federal, state, or local government agencies, such as the Department of Social Services or Child Protective Services. They may help clients access government programs and resources, provide counseling and support services, and advocate for clients' rights.
  • Hospitals and healthcare facilities: Social workers may work in hospitals, clinics, and other healthcare facilities to provide emotional support and counseling to patients and their families, help patients access community resources, and coordinate care with other healthcare providers.
  • Schools: Social workers may work in schools to provide counseling and support services to students, families, and staff. They may also help students with disabilities or special needs access support services and accommodations.
  • Non-profit organizations: Social workers may work for non-profit organizations that provide social services, such as homeless shelters, food banks, and community centers. They may help clients access services and resources, provide counseling and support services, and advocate for social justice.
  • Private practices: Social workers may work in private practices, either independently or as part of a group practice. They may provide counseling and therapy services to clients with a variety of needs, such as mental health issues, substance abuse, or relationship problems.

Frequently Asked Questions

Pros and cons of being a social worker.

Social work is a noble profession that involves helping individuals, families, and communities improve their lives and overcome challenging situations. However, like any other profession, social work has pros and cons that are important to consider before pursuing a career in this field.

  • Making a positive impact: One of the biggest advantages of being a social worker is the satisfaction of making a positive impact on people's lives. Social workers have the opportunity to help individuals and families overcome challenges and lead fulfilling lives.
  • Job Diversity: Social work is a broad field that offers many different career paths. Social workers can work in a variety of settings, including schools, hospitals, community organizations, and government agencies. This diversity provides opportunities for social workers to find a career path that aligns with their interests and passions.
  • Emotional reward: Social work can be emotionally rewarding as social workers have the opportunity to make meaningful connections with their clients. Helping others and seeing the progress of their clients can be a powerful motivator and a source of personal fulfillment.
  • Emotional strain: Social work can be emotionally draining and stressful as social workers often deal with challenging and complex cases. Supporting clients through difficult situations can be emotionally taxing, and social workers must take care of their mental health and well-being to avoid burnout.
  • Low pay: Despite the importance of their work, social workers are often paid lower wages compared to other professions with similar education requirements. This can make it challenging for social workers to make ends meet and can impact their job satisfaction.
  • High caseloads: Social workers often have high caseloads, which means they have to manage a large number of clients simultaneously. This can be challenging and may affect the quality of care that social workers can provide to their clients.

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Cover of Social work with adults experiencing complex needs

Social work with adults experiencing complex needs

NICE Guideline, No. 216

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This guideline covers the planning, delivery and review of social work interventions for adults who have complex needs. It promotes ways for social work professionals, other care staff and people with complex needs to work together to make decisions about care and support.

Who is it for?

  • Social workers, their supervisors and managers, and the organisations they work for
  • Healthcare, social care staff and allied health professionals who support people with complex needs
  • Social work academics, educators and practice educators
  • Adults with complex needs (including self-funders), their families or carers, and the public
  • People aged 16 to 18 with complex needs who have completed the transition from children’s to adults’ services

‘Adults with complex needs’ is not a defined clinical group but encompasses any adult needing a high level of support with many aspects of their daily life who relies on a range of health and social care services. These needs for support may result from illness, disability, broader life circumstances or any combination of these. Complex needs may be present from birth or may develop over the course of a person’s life and may fluctuate. The nature of these needs, and the way society is organised to respond to them, means adults with complex needs often face multiple challenges to living as they would wish and accessing support when it is needed. They are consequently vulnerable to preventable secondary conditions and premature mortality.

Social workers are one of the main professional groups who support adults with complex needs. They do this in a range of settings, on a long- or short-term basis. Their responsibilities include facilitating the local authority’s duty to conduct needs assessments under the Care Act 2014 . They also work with individuals and families to address identified needs, effect change and organise support. Social workers can help people with practical, social and interpersonal difficulties, and promote human rights and wellbeing .

There are about 100,000 social workers registered in England in 2021, according to the Social work in England: emerging themes report by Social Work England . Most commonly they are employed in local authority social care settings, but also in health and voluntary sector services. As well as providing care directly, social workers have a key role in organising support from the wider social care sector and other agencies. They work in a challenging context. The King’s Fund Social care 360 report in 2021 describes a rising demand for social care, but a reduction in how many people are receiving care, and that social care funding levels have only just returned to 2010 to 2011 levels, after a decade of lower real-terms investment. The Care Quality Commission State of Care report for 2019/20 reports that the quality of social care received by most people was good overall. However, it noted regional variation in access to and quality of care, the need for better integration and joined-up care between services, and that the COVID-19 pandemic is ‘having a disproportionate effect on some groups of people, and is shining a light on existing inequality in the health and social care system’.

In this context, it is vital that the organisation and delivery of social work is informed by the best available evidence about effective ways of working. The Chief Social Worker for Adults’ annual report: 2018 to 2019 acknowledges evidence gaps for social work, setting as priorities knowing what works and developing a better evidence base for social work practice.

This guideline was commissioned by the Department of Health and Social Care to meet this need and develop evidence-based recommendations for social work for adults with complex needs. The guideline was developed by a guideline committee following a detailed review of the evidence. It covers assessment and care management or support which is delivered by or led by social workers. It seeks to provide recommendations which are generalisable to the whole population of adults with complex needs. This guideline is for social workers, and organisations which employ social workers or commission social work services. It is also relevant for adults with complex needs and their involved family and informal carers, and for other professionals who work with social workers in supporting adults with complex needs.

Definition of adults with complex needs for the purpose of this guideline

Adults with complex needs are defined as people aged 18 or over who need a high level of support with many aspects of their daily life, and relying on a range of health and social care services. This may be because of illness, disability, broader life circumstances or a combination of these. Complex needs may be present from birth or develop over the course of a person’s life, and may fluctuate. Unless otherwise specified, when a recommendation refers to ‘people’ or ‘the person’, this is the adult with complex needs.

How does the guideline relate to legal duties, standards and other guidance?

  • Care Act 2014 and associated guidance
  • Equality Act 2010
  • Mental Capacity Act 2005
  • Accessible Information Standard
  • Human Rights Act 1998
  • Social Work England’s professional standards .

This guideline aims to complement legislation and guidance by providing evidence-based recommendations about how social work interventions including assessment, care management and support for adults with complex needs could be improved. Actions already required by law, or recommended in statutory guidance, are not replicated here unless there was evidence to suggest that these are not implemented consistently in practice, or there was a need to emphasise specific points relevant to social work interventions including assessment, care management and support for adults with complex needs. NICE guidelines cover health and care in England and therefore focus on English legislation. Other UK countries have to follow legislation from the Welsh Government , Scottish Government , and Northern Ireland Executive .

  • Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE’s information on making decisions about your care .

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1. Principles of social work for adults with complex needs

For social workers.

  • show understanding of people’s and their family’s circumstances, and be non-judgemental
  • respect the validity of the person’s lived experience
  • value their first-hand knowledge of their own needs to inform care planning
  • use professional curiosity and professional judgement
  • understand the power imbalance between the person and social workers.

When first contacting someone, and throughout provision of support, the social worker should establish with the person or with their family, carers or people important to them whether there are any advocacy, sensory or communication needs or impairments, in line with recommendation 1.1.5 in the NICE guideline on people’s experience in adult social care services (see also the NICE guideline on advocacy services for adults with health and social care needs ).

  • the reasons for the activity or process (for example, an assessment, or care management and support)
  • the aims of the activity or process, and how this relates to them
  • the key processes that will be followed, ensuring the person knows these at the planning stage for the process or activity
  • what will happen at each new stage in the process (for example, by giving the person information about any upcoming review meetings).
  • whether the person has any familiarity or previous experience with statutory processes and support agencies
  • whether the person might be reluctant to ask for help or raise issues because of personal, societal or other factors, such as stigma or mistrust of services
  • the person’s expectations and emotional state
  • the person’s wishes and needs for both family support, and for culturally specific support services.
  • history and life story
  • family and community networks
  • experience of disadvantage, discrimination or abuse
  • wishes and aspirations
  • past experiences of services.
  • avoid making assumptions about the individual’s circumstances
  • recognise that some people’s prior positive or negative views and experiences of social work may impact on the relationship with the social worker and services.
  • their experiences of society and accessing services and
  • the potential impact of intersectionality .

Take these into account when planning care (for example, by liaising with appropriate support organisations).

  • must consider whether reasonable adjustments can be made to protect against, or help the person deal with, discrimination arising from a person’s protected characteristics as defined by the Equality Act 2010 , or from other life circumstances and experiences (see box 1) and
  • record the rationale for the decision made.

Box 1 Characteristics, life circumstances or life experiences relating to inequalities

  • gender reassignment
  • marriage and civil partnership
  • pregnancy and maternity
  • religion or belief
  • sexual orientation.
  • modern slavery
  • coercive control
  • domestic abuse
  • trafficking
  • refugee status
  • asylum seeking
  • being a migrant
  • being from a traveller community
  • being a prisoner
  • being an offender
  • homelessness
  • poor literacy
  • learning difficulties
  • learning disabilities
  • cognitive impairment
  • acquired brain injury
  • communication impairment
  • leaving care
  • transitioning from children’s to adults’ care services
  • sensory impairment
  • substance misuse
  • living in rural and isolated areas
  • long-term conditions
  • English not being a first language
  • socio-economic status
  • addictions.

The social worker must inform the person, in accordance with the UK General Data Protection Regulation (GDPR) and the Data Protection Act 2018 , about the extent and content of information sharing across agencies and within multidisciplinary teams, and their rights in relation to this.

  • autism spectrum disorder in adults
  • challenging behaviour and learning disabilities
  • cystic fibrosis
  • depression in adults
  • multiple sclerosis in adults
  • psychosis and schizophrenia in adults .

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on principles of social work for adults with complex needs (for social workers) .

  • evidence review A: needs assessment
  • evidence review B: risk assessment
  • evidence review C: supporting changing needs
  • evidence review E: integrated working .

For organisations

Box 2 organisations that employ social workers, what is an ‘organisation’.

In the context of this guideline, organisations are bodies that employ social workers in a professional capacity. This can include local authority social care departments, health services, the criminal justice system, higher and further education and voluntary and community services.

Organisations (see box 2) should consider making time allowances for social workers in caseloads so they can build relationships with people with complex needs. Recognise that building relationships may take longer with people who may have had negative experiences with services, or people concerned about stigma from being in contact with services.

  • asking all people they support about their personal and social identity as well as circumstances or experiences that may lead to inequalities or discrimination (for example, related to characteristics listed in box 1 ) and
  • understanding how their personal and social identity as well as circumstances or experiences may affect their lives, care needs and preferences.
  • Mental Health Act 2007
  • Care Act 2014
  • Children Act 1989
  • relevant case law
  • inherent jurisdiction of the High Court.
  • recognise that people with complex needs may experience the impact of intersectionality , resulting in increased inequalities in access to and outcomes of health and social care and
  • take this into account when planning and delivering services so they are accessible and responsive to the whole range of people’s needs (for example, if a person has multiple health and social care needs this could be addressed by multidisciplinary working between health and social care services – see the section on social workers and multidisciplinary teams: communication, support and collaboration ).
  • discuss and share best practice to promote the rights, strength and wellbeing of people, families and communities
  • reflect on their own practice and that of their colleagues
  • share experiences and learn from each other about how to balance the rights of the individual with the risks to self and others.

For other principles of improving people’s experience in adult health and social care services, including the principles of care and communication, see the NICE guidelines on people’s experience in adult social care services , patient experience in adult NHS services and service user experience in adult mental health . For guidance on how to make information accessible, see the NHS Accessible Information Standard .

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on principles of social work for adults with complex needs (for organisations) .

  • evidence review F: individual or family casework
  • evidence review G: helping people connect with local communities .

1.2. Assessment

Needs assessment, providing information.

The social worker should give the person information about their upcoming needs assessment in a format that is in line with their needs and preferences, and is accessible to them. Ensure they have enough notice and time to review documents, and prepare for the assessment.

In line with regulation 10 of the Care Act 2014 , the social worker must inform carers of people with complex needs about their right to a carer’s assessment (for more information, see the NICE guideline on supporting adult carers ).

The social worker should inform the person being assessed about where and how they can access information about their rights under relevant legislation, such as the Care Act 2014 , the Human Rights Act 1998 or the Mental Capacity Act 2005 (for example, providing written or oral information or signposting to relevant online resources or agencies – see also the section on principles of social work for adults with complex needs for relevant links related to meeting communication needs).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on assessment – needs assessment (providing information) .

Full details of the evidence and the committee’s discussion are in evidence review A: needs assessment .

Planning the assessment

  • using a flexible approach to tailor the assessment to the person’s needs (for example, by amending the order of assessment questions)
  • helping the person to understand assessment documentation when appropriate (for example, explaining complex concepts in a simple, clear way).
  • the urgency of the person’s support need
  • whether the person wants a preparatory initial contact, and if so whether they would prefer this as a home visit, virtual contact or a phone call
  • whether the person would have substantial difficulty in being involved in the assessment and if so, whether an independent advocate should be provided for the assessment.
  • the time and place of the assessment
  • remote or in-person assessment
  • whether they would like a supported self-assessment
  • whether they would like anyone to be present to support them, for example a family member, carer or an independent advocate.

The social worker should take into account that when there is a concern about potential safeguarding issues, an in-person assessment is likely to be needed.

If the person chooses supported self-assessment, the social worker should discuss the advantages and disadvantages of this option with them, taking into account the complexities of their needs.

  • ensuring that they have complete information about what it involves, including the list of areas and questions which it covers
  • involving advocacy services
  • providing details of who to contact if they want to clarify or discuss any areas of the assessment
  • giving reassurance that they can ask for an in-person assessment if their preference changes.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on assessment – needs assessment (planning the assessment) .

Conducting the assessment

The social workers must ensure that the information provided by supported self-assessment is an accurate reflection of the person’s circumstances (in accordance with section 6.44 of the Care and support statutory guidance , 2021). This can be done by cross referencing it with information from other sources (this should typically include involved family and carers or the multidisciplinary team).

  • whether the person’s needs arise from or are related to a physical or mental impairment or illness
  • whether the person would have difficulties in achieving 2 or more of the 10 listed outcomes; see regulation 2(2) of the Care Act 2014
  • whether there is a significant impact on wellbeing
  • whether there are any unmet needs that may relate to a condition or difficulty that may need input from other specialist services, for example from speech and language services or mental health services.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on assessment – needs assessment (conducting the assessment) .

Recording and reviewing the assessment

The social worker should give the person a draft copy of their assessment and reviews, and the opportunity to identify any inaccuracies, omissions or differences of perspective, before the assessment is finalised.

The social worker should acknowledge and record in formal case notes and the care and support plan any differences of opinion about the needs assessment.

The social worker should give people with complex needs, their families and carers and other people important to them information about the complaints procedure, including how to access it and how to lodge a complaint if they wish to about the process or the outcome of the assessment.

If the person chooses a self-assessment, the organisation must provide them with relevant information that they hold about them and their carer’s assessment if applicable, taking into account legal requirements related to consent (in line with sections 2[5] and 2[6] of the Care and Support [Assessment] Regulations 2014 ).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on needs assessment (recording and reviewing the assessment) .

  • evidence review B: risk assessment .

Risk assessment

Planning the risk assessment.

Social workers should assess risks as part of a holistic process of assessing the person’s strengths, needs and wishes.

The social worker should discuss and record the person’s views on involving family, carers, and other people important to them in the risk assessment in the formal case file. Let the person know that it has been recorded and share this information across relevant agencies and with other social workers when appropriate and necessary (in line with the UK GDPR and the Data Protection Act 2018 ).

  • there is an opportunity for rapport to develop between the social worker and person being assessed
  • the person’s perspective on risks, their strengths, needs and wishes, and their health, environment and support networks are understood.

When planning a risk assessment, take into account the urgency of any situation that may need a risk assessment within a short timeframe (for example, in a single visit; see also the section on responding to an escalation of need, including urgent support ).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on risk assessment (planning the risk assessment) .

Full details of the evidence and the committee’s discussion are in evidence review B: risk assessment .

Conducting the risk assessment

  • planning to cover their wishes in the event of any future loss of capacity (see the section on advance care planning in the NICE guideline on decision making and mental capacity )
  • developing a risk management plan.

Where a social worker has reasonable cause to suspect a person has experienced, is experiencing or is at risk of abuse or neglect, they must follow local safeguarding policies. If a need for action is established, the social worker must follow statutory safeguarding processes as set out in regulation 42 of the Care Act 2014 .

  • risks to the person from their own behaviour (including accidents, self-neglect and suicide or self-harm)
  • risks from others (including physical or sexual violence, psychological harm, neglect or exploitation)
  • risks of harm to others
  • risks of loss of independence or breakdown of caring arrangements.

When assessing mental capacity, social workers must take account of section 1(4) of the Mental Capacity Act 2005 , and not assume that the person lacks capacity because they have made a decision that the practitioner perceives as risky or unwise. See also the section on assessment of mental capacity in the NICE guideline on decision making and mental capacity , including recommendation 1.4.19 on the difficulty in assessing capacity in people with executive dysfunction .

If a person lacks the mental capacity to make decisions related to risk, the social worker must seek and take into consideration their current wishes (and any relevant past wishes expressed at a time when they were believed to have capacity) about any decisions, in line with section 4(6) of the Mental Capacity Act 2005 . For further details, see the NICE guideline on decision making and mental capacity .

  • previous decisions and choices and
  • the perspectives of involved family members, carers and multidisciplinary team members.

Social workers should use plain language and terminology that is understandable and acceptable to the person. For example, talking about ‘safety’ or ‘being careful’, rather than ‘risk’ or ‘self-neglect’.

In discussions between the person and the social worker about risk, consider the use of a structured risk checklist.

  • include discussion of what has caused previous problems and unplanned escalation of needs
  • identify what interventions have worked previously to manage and reduce risks.
  • think about how any assumptions or personal biases may have influenced their assessment (for example, assuming that frail people would not want to participate in physical activities)
  • be reflective about their own values, and challenge the impact they have on their practice (for example, how they personally feel about tidiness when working with a person who is hoarding).

Social workers should respect people’s rights to make decisions that they (the social worker) perceive as risky or unwise when the person has capacity to do so. Do not use such decisions as a reason to refuse care.

If a person with capacity declines an intervention aimed at reducing risk (see recommendation 1.2.22 for the types of risk that may need to be reduced), social workers should continue to work with them to find ways to minimise risks.

  • ascertain the person’s best interests (using the best interests checklist in line with section 4 of the Mental Capacity Act 2005 ), including identifying whether there is a Lasting Power of Attorney or court-appointed deputy with appropriate decision-making powers to make best interests decisions
  • ensure any restrictions or supervision in their care are proportionate to the risk of harm to the person
  • take into account any less restrictive ways of meeting the person’s needs and managing risks and use these where appropriate.

Social workers should avoid over-reliance on risk prediction (such as ‘high’ or ‘low’ risk) during assessments and when recording risks, and instead specify strategies on how to respond to factors contributing to increased risk and reduce potential harms.

  • must balance the rights of the person with complex needs under the Human Rights Act 1998, Article 8 (right to respect for private and family life) against the effect on children or individuals at risk if they do not share the information and
  • should record all information-sharing decisions, and the reasons for those decisions, in line with the organisation’s procedures and requirements.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on risk assessment (conducting the risk assessment) .

  • evidence review C: supporting changing needs .

Recording and reviewing the risk assessment

  • share information (in line with the UK GDPR and the Data Protection Act 2018 ) and
  • develop a coordinated risk management plan.
  • would present a risk to (or cause an escalation of risk for) the person or
  • would present a risk to any of the other parties involved (social workers, other care staff, or the person’s advocate, family or carers).

The social worker should ensure that relevant information on significant concerns about risks is shared and discussed with all necessary agencies (taking into account the legal requirements under the UK GDPR and the Data Protection Act 2018 ).

  • give the person a draft copy of their risk assessment, and the opportunity to identify any inaccuracies, omissions or differences of perspectives, before the risk assessment is finalised
  • acknowledge and record any differences of opinion about the assessment of risk in the risk assessment document and formal case notes.
  • at least annually and
  • if needed, in response to an identified change in the person’s circumstances or change in risks.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on risk assessment (recording and reviewing the risk assessment) .

Organisational support

  • provide de-escalation training to staff to support their safety
  • have systems for formally recording incidents of aggression, threats or abuse against staff.
  • debriefing them
  • providing peer support
  • providing counselling following serious incidents.

Organisations should provide access to advice for social workers whenever they are working, including outside normal office hours, about immediate concerns related to the risk to the person with complex needs or others.

  • training, including multi-agency training, to support staff in assessing risks thoroughly
  • supervision structures to support staff and encourage reflective and inclusive practice (for example, a multidisciplinary team discussion about individual situations).

Organisations should have a written strategy promoting a culture that supports staff in helping people with complex needs balance the benefits and harms relating to risk taking. This could include, for example, training and governance systems to support social workers with assessing complex and high-risk situations.

For further principles of decision making in situations where people may lack capacity, see the NICE guideline on decision making and mental capacity .

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on risk assessment (organisational support) .

1.3. Individual or family casework

Social workers should take account of the principles of social work for adults with complex needs when conducting individual or family casework.

Social workers should help people with complex needs to identify personal goals and desired outcomes (for example, through task-focused approaches ).

  • Care Act 2014’s requirement for advocacy
  • Mental Capacity Act 2005 requirements on deprivation of liberty safeguards and the Mental Capacity (Amendment) Act 2019 requirements on liberty protection safeguards
  • Safeguarding Vulnerable Groups Act 2006
  • Protection of Freedoms Act 2012 .

Organisations should consider training and support for social workers to promote the rights, strength and wellbeing of people and families (in line with Social Work England’s professional standards ) to gain specialised and advanced skills in family interventions (for example, behavioural family interventions, family group conferences and restorative approaches).

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on individual or family casework .

Full details of the evidence and the committee’s discussion are in evidence review F: individual or family casework .

1.4. Helping people to connect with local communities and reduce isolation

To help people with complex needs develop social connections, social workers should talk to them about their social networks, strengths (using strengths and asset-based approaches ), and preferences for activities and social contact.

  • identifying local community groups and networks, and resources (for example, social clubs, community gardens, faith and cultural groups, user-led social groups)
  • finding out about these resources and whether they may meet the person’s needs and preferences
  • helping the person make contact with these groups and activities (for example, by arranging IT and digital training, using familiar and accessible places).

Social workers should think creatively about the types of community resources and networks that they can put in place or support people to develop (for example, by active involvement in commissioning discussions and flexible use of personal budgets, including direct payments).

The social worker should check with the person whether any new community connection is meaningful, beneficial to wellbeing and enjoyable, and if not support the person to find a more suitable alternative.

  • creating lists of resources and updating them regularly
  • allocating workers to identify resources
  • liaising with community groups
  • commissioning voluntary organisations to keep up-to-date resource lists.
  • catchment area, and people’s right to access services outside of their catchment area
  • eligibility criteria
  • referral processes.

For information on community engagement approaches that seek to improve health and wellbeing and reduce health inequalities, see the NICE guideline on community engagement: improving health and wellbeing and reducing health inequalities . For information aimed at engaging people over 65 years in activities to improve mental wellbeing, see the NICE guideline on mental wellbeing in over 65s: occupational therapy and physical activity interventions .

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on helping people to connect with local communities and reduce isolation .

1.5. Supporting people to plan for the future, including considering changing needs, wishes and capabilities

The social worker should provide information to support the health and wellbeing of carers in their caring role, and on how the carer can help support the person with complex needs. See also the recommendations on providing information and support to carers in the NICE guideline on supporting adult carers .

Social workers should ensure that care planning meetings take place in the person’s preferred location whenever possible and practical.

  • promoting people’s dignity and wellbeing
  • respecting people’s right to self-determination
  • promoting and supporting participation
  • taking a holistic approach
  • focusing on people’s strengths and not solely on their needs.
  • be in collaboration with the person, and with their consent
  • include paid and unpaid support networks (for example, family, carers and other people important to them).
  • developing a plan that is flexible and responsive
  • reviewing and revising the care plan in response to fluctuating, evolving or rapid changes
  • developing and identifying options according to the person’s needs, wishes and preferences (for example, by helping people connect with local communities as described in the section on helping people to connect with local communities and reduce isolation )
  • ensuring consistency of care by integrating working across the range of health and social care services involved (see the section on the social worker’s role in multidisciplinary teams ).
  • take account of the person’s wishes and preferences
  • state how the person’s eligible and non-eligible needs would be best met
  • identify how arrangements will be made to meet eligible needs
  • record any eligible needs which are unlikely to be met or only partially met, the reasons they cannot be met or only partially met and any potential actions that would allow them to be met in future.

The social worker should ensure that the person has their work contact details so they can get in touch if their needs or circumstances change. Document this information in the person’s care plan.

  • the person’s needs escalate or reduce, and circumstances change (for example, after transfer from hospital)
  • the person, or their carer, a family member, advocate or another person important to them requests it.
  • use supervision and feedback to critically reflect on their own practice, including how research and evidence has informed practice
  • keep their practice up to date, and record how research, theories and frameworks inform practice and professional judgement
  • contribute to an open, creative, learning culture in the workplace to discuss, reflect on and share best practice.

Where possible, organisations should provide people who receive social work support with a named social worker.

  • continuity of named social workers or a clear handover if the social worker has to change
  • adequate time to monitor and review cases
  • responsiveness to unexpected change
  • the ability to be flexible, when appropriate, to the needs of the person.
  • transition between inpatient hospital settings and community or care home settings for adults with social care needs (in particular, section 1.5 on discharge planning)
  • transition between inpatient mental health settings and community or care home settings (in particular, section 1.5 on discharge planning)
  • transition from children’s to adults’ services for young people using health or social care services (in particular, section 1.2 on transition planning)
  • intermediate care including reablement (in particular, section 1.7 on transition from intermediate care).

To support people growing older with learning disabilities to plan for the future, see recommendations 1.4.5 to 1.4.7 in the NICE guideline on care and support for people growing older with learning disabilities .

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on supporting people to plan for the future including considering changing needs, wishes and capabilities .

  • evidence review F: individual or family casework .

1.6. Responding to an escalation of need, including urgent support

When responding to an unplanned escalation of need, social workers should take into account the person’s wishes, preferences, social circumstances and cultural background (for example, if someone expresses a strong desire to stay at home, even if necessary care may more easily be provided in a residential or inpatient setting).

  • assess the escalated need jointly with colleagues who have the most knowledge about the person’s care, wherever practical (for example, requesting a community Care and Treatment Review or a case conference)

other involved practitioners and community organisations

relevant family and social networks.

  • explore the least restrictive alternatives to address the need (in accordance with section 1(6) of the Mental Capacity Act 2005 )
  • seek provision of interventions that will have the least detrimental impact on the person’s rights and living situation.

Social workers should establish whether a person with complex needs has any advance statement of their wishes or crisis planning, and must take these into account when planning care during a crisis. Document in the person’s records how this has informed decision making and review the plan after an escalation of need.

  • the person’s wishes and preferences
  • the views of others (for example, family, carers, and other people important to them) concerned for the person’s welfare.

Organisations should ensure that social workers have access to prompt support and opportunities to be debriefed during and after their work with someone experiencing a crisis. This should include the opportunity for social workers to reflect on practice and the potential risk to themselves and the person.

  • are available 24 hours, so decisions on applications for detention under the Mental Health Act (in line with section 14.35 of the Mental Health Act 1983: Code of Practice ) can be made at any time
  • can respond promptly to a person’s escalating need
  • communicate any out-of-hours responses to escalating need quickly and clearly to daytime services.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on responding to an escalation of need, including urgent support .

Full details of the evidence and the committee’s discussion are in evidence review D: support during an escalation of need .

1.7. Social workers and multidisciplinary teams: communication, support and collaboration

Organisations should ensure that multidisciplinary teams develop a shared statement of values, core purposes and activities, and have clear objectives and aims to jointly work towards.

Organisations should consider the routine sharing of information (in line with the UK GDPR and the Data Protection Act 2018 ), and of professional expertise and perspectives, within the multidisciplinary team (for example, with joint working, forums or team meetings, themed discussions, or by championing a particular multidisciplinary approach).

  • holding multidisciplinary team meetings, including case discussions
  • having mutual access to diaries when possible
  • providing virtual means to stay in touch even when team members are working from different locations
  • making use of informal opportunities to communicate (for example, staff networking events).
  • be provided across health and social care including other relevant settings as needed
  • be co-produced with people with lived experience
  • be followed up with clear plans for implementing any best practice and lessons learnt from the training sessions.
  • providing professional social work supervision, in particular when the team manager is not a social worker
  • providing opportunities for peer supervision
  • making joint training available that provides clarity about the role of the social worker within a multidisciplinary team
  • providing bespoke, continuing professional development for social workers
  • recognising and addressing differences in organisational culture between professionals involved in the team.

To improve the efficiency of referral within multidisciplinary teams, health and social care organisations should simplify referral processes and referral pathways, for example by having clear and simple eligibility criteria.

Organisations should think about co-location to support more efficient responses and opportunities for discussion within multidisciplinary teams where feasible.

Organisations should develop shared formal agreements (including budgets and information sharing) early in the process of establishing integrated working to underpin accountability and decision making.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on social workers and multidisciplinary teams: communication, support and collaboration .

Full details of the evidence and the committee’s discussion are in evidence review E: integrated working .

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions, see the NICE glossary and the Think Local, Act Personal Care and Support Jargon Buster .

Debriefing after a distressing or safety-related incident involves the social worker having an opportunity to speak to a manager or senior colleague as soon as possible after the incident. This can be used, for example, to acknowledge the difficult situation and look into any support the social worker needs, including psychological support or counselling. This could start a reflective process to identify any lessons or ways to improve practice in future.

The term describes the interconnected nature of social categorisations such as age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual orientation and other characteristics or experiences listed in box 1 , regarded as creating overlapping and interdependent systems of discrimination or disadvantage.

Professional curiosity is to explore and understand what is happening with an individual or family; enquiring deeper and using skilled, proactive questioning and investigation. It is about comparing what the person is saying with what is observed and any other available information, questioning any incongruity, rather than making assumptions or taking things at face value, to provide appropriate and tailored support.

A rights-based approach ensures that both the standards and the principles of human rights are integrated into policy making, as well as the day-to-day running of organisations and social work practice.

Strengths and asset-based approaches in social care focus on what individuals and communities have, and how they can work together, rather than on what individuals or communities cannot do or do not have. The terms ‘strengths’ and ‘assets’ are often used interchangeably to apply to either individuals or communities. Personal strengths and assets can include relationships, experience, skills and aspirations. Community strengths and assets can include knowledge, people, spaces, networks and services.

  • defining a target area to work on together
  • agreeing specific goals and actions for both the social worker and the person they are supporting to help achieve these goals
  • discussion and support about progress with, and impact of, agreed actions
  • reviewing and deciding whether a further process of task-centred goal setting is needed or the process has been successfully completed.

Task-focused work is typically relatively brief but can be applied flexibly across a range of social work contexts as stand-alone support or within a broader package of care.

In the context of the guideline, wellbeing is defined in accordance to regulation 1(2) of Care Act 2014 , which states:

  • personal dignity (including treatment of the individual with respect)
  • physical and mental health and emotional wellbeing
  • protection from abuse and neglect
  • control by the individual over day-to-day life (including over care and support, or support, provided to the individual and the way in which it is provided)
  • participation in work, education, training or recreation
  • social and economic wellbeing
  • domestic, family and personal relationships
  • suitability of living accommodation
  • the individual’s contribution to society.
  • Recommendations for research

The guideline committee has made the following recommendations for research.

Key recommendations for research

1. needs assessment.

From the perspective of everyone involved, what is the acceptability of strengths and rights-based approaches to social work assessment and what are the barriers and facilitators to delivering these?

For a short explanation of why the committee made this recommendation for research, see the rationale section on needs assessment .

2. Risk assessment

From the perspective of everyone involved, what works well and could be improved about the use of tools and checklists to support social work risk assessment for people with complex needs?

For a short explanation of why the committee made this recommendation for research, see the rationale section on risk assessment .

3. Supporting people to plan for the future

What is the effectiveness and cost-effectiveness of early, preventative support for people with complex needs?

For a short explanation of why the committee made this recommendation for research, see the rationale section on supporting people to plan for the future .

Full details of the evidence and the committee’s discussion are in evidence review C: supporting changing needs .

4. Responding to an escalation of need

What is the effectiveness and acceptability of social work interventions to support people with complex needs during an escalation of need?

For a short explanation of why the committee made this recommendation for research, see the rationale section on responding to an escalation of need .

5. Helping people to connect with local communities and reduce isolation

What social and community support approaches are effective in promoting social inclusion of people with complex needs?

For a short explanation of why the committee made this recommendation for research, see the rationale section on helping people connect with local communities and reduce isolation .

Full details of the evidence and the committee’s discussion are in evidence review G: helping people connect with local communities .

  • Rationale and impact

These sections briefly explain why the committee made the recommendations and how they might affect practice or services.

Principles of social work for adults with complex needs

Recommendations 1.1.1 to 1.1.10

Why the committee made the recommendations

The committee looked at a range of evidence to inform the recommendations, which are intended to underpin all social work with adults with complex needs. They also took the Human Rights Act 1998 , the Equality Act 2010 , the Care Act 2014 and the UK General Data Protection Regulation (GDPR) and the Data Protection Act 2018 into account to address potential inequalities and data protection issues (for example, in access to services or in the services that people with complex needs receive). They also drew on the professional standards from Social Work England , the Professional Capabilities Framework from the British Association for Social Workers (BASW) and the Code of Ethics from BASW .

The committee discussed qualitative evidence related to supporting people to plan for the future that highlighted some of the barriers that could influence people’s access to and participation with services (for example, poverty, which is associated with inadequate housing and limited access to support). Such barriers could, in turn, result in people who use services feeling shame about their health conditions or living circumstances. This could further isolate them and make it more challenging for providers to support them. The committee therefore made a recommendation to emphasise that social workers need to treat people with respect and dignity to prevent barriers developing, and to understand and take into account the different circumstances of people with complex needs and any of their past experiences of services. This is also in line with the Human Rights Act 1998 and the Equality Act 2010.

There was some qualitative evidence related to approaches to needs assessments that showed people were not always aware of what to expect from an assessment, and that language could be a barrier to communicating with social workers during the assessment. The committee agreed that meeting these needs are important principles that would apply to all aspects of social work, so they decided to broaden the recommendation beyond just the assessment process. They recommended that the social worker find out whether an advocate is needed to support the person and help with communication, information and understanding the legal framework. The committee discussed that some people (for example, people with learning disabilities) may also have particular sensory needs or impairments (for example noise level or brightness of light) and therefore added that this should also be taken into account. Based on the same evidence, the committee also emphasised the importance of ensuring that all the person’s communication needs and preferences are addressed, to help them to actively participate in discussions. They noted that this was already covered in the section on overarching principles in the NICE guideline on people’s experience in adult social care services so they included a cross reference to this.

There was also some qualitative evidence showing that people did not always understand the purpose of the needs assessment and what it would entail. The committee used this evidence to recommend that sufficient information is provided for all activities and processes so that the person can understand what is going to happen and why. This will mean they can make informed choices and actively participate in the assessment.

  • qualitative evidence showed that cultural differences created challenges for practitioners
  • qualitative evidence showed that not having family support can be detrimental to the person’s wellbeing
  • quantitative evidence showed that differences in perspective because of culture lead to care needs not being raised or recognised by social workers
  • in the committee’s own experience, people’s life experiences, expectations and emotional state can have an impact on their care experiences, and consequently lead to inequalities and poorer outcomes.

The committee made recommendations to address these problems. They also highlighted the positive impact of family support (if needed and wanted) which can help the person to be actively involved.

The committee drew on both quantitative and qualitative evidence from the review of individual and family casework. They discussed the qualitative evidence that suggested people’s cultural experiences and perspectives can differ from those of the practitioner, and that this may result in the practitioner making assumptions. Based on experience and expertise, the committee emphasised that the starting point would be relationship building to identify a person’s characteristics that might predispose them to inequality in healthcare provision, by actively listening to the person. They highlighted that forming trusting relationships is the cornerstone of social work and that looking at all aspects of the person’s life would ensure that the social work approach has the person with complex needs at its centre, and that any reasonable adjustments are being made in relation to those needs. They discussed that a record of reasonable adjustment decisions should be made to ensure that this was given due consideration. The committee noted that there was only a small amount of evidence, but acknowledged that this was a key area of social work that could lead to inequalities in access to care and care provision, if not addressed. In the absence of evidence for other experiences and circumstances that may lead to inequalities and discrimination, which may be multiple (see the definition of intersectionality ), the committee applied the evidence about the challenges of cultural differences and assumption as well as their knowledge from the Equality Act to cover the protected characteristics as well as other life circumstances and experiences (see box 1 ).

The committee noted that a lot of qualitative evidence on the social worker’s role in multidisciplinary teams referred to information sharing as a potential facilitator to integrated working, as it provides continuity (and conversely, acts as a barrier if not present). They discussed, based on their experience, that information gets shared more about people with complex needs and between more agencies. There were concerns about the extent of information sharing, however. In the committee’s experience, people with complex needs value continuity and consistency and generally think that it is a positive idea to share information, but they want to be informed when and what information is shared and with whom (whenever this is possible and appropriate, in line with UK GDPR and the Data Protection Act 2018 ). The committee decided that this is a principle that should not be restricted to multidisciplinary team working but applies to all social work practice. The committee agreed that people need to be reassured that there are legal limits on information sharing and that their data is protected, but also that sharing where possible would mean that they would not have to repeatedly tell their life stories.

The committee discussed that there are a wide range of conditions, impairments or fluctuating health conditions that lead to complex needs. They discussed that the guideline should be viewed in the context of such needs and that social workers when meeting a person with a particular condition should be aware of the relevant condition-specific guidance associated with this. The committee decided to give some examples of the range of conditions that may be applicable.

How the recommendations might affect practice

The committee noted that most of these recommendations would standardise practice, as they are actions that are mandated by legislation (particularly the Equality Act 2010, the Care Act 2014), and supported by Social Work England’s professional standards or BASW’s Professional Capabilities Framework. This is particularly in relation to information sharing, and active listening and relationship building.

Return to recommendations

Recommendations 1.1.11 to 1.1.16

The committee looked at a range of evidence to inform the recommendations, which are intended to underpin all social work with adults with complex needs. They also took into account the Human Rights Act 1998 , the Equality Act 2010 (for example, to address inequalities in access to services or in the services that people with complex needs receive), the Care Act 2014 , the UK GDPR and the Data Protection Act 2018 and the professional standards from Social Work England .

The committee used qualitative evidence from the reviews on individual and family casework, and helping people to connect with local communities and reduce isolation. This showed that the social work approach that people received was not sufficiently long or in-depth enough to address their complex needs. Based on this evidence, the committee recommended organisations provide sufficient time to social workers to build relationships in order to reduce inequalities.

The committee discussed that people’s life experiences may have an impact on their care experiences, and consequently lead to inequalities in access to care and care provision and poorer outcomes. They recommended organisations support and train social workers to discuss people’s personal and social identities, and life experiences. This is in line with professional standard 1.6 from Social Work England that outlines the role of the social worker to promote social justice, helping to confront and resolve issues of equality and inclusion. This would enable social workers to feel confident that they are providing an environment where people feel that they are free of discrimination, and emotional or physical harm, and feel safe in discussing the complex needs that they have. The committee highlighted that this would also improve wellbeing of people, but they discussed that the term wellbeing is sometimes interpreted only in physical health terms. They therefore decided to adopt the definition of wellbeing provided within regulation 1(2) of Care Act 2014.

There was qualitative evidence that social workers value support, supervision and training. The committee discussed that being up to date with relevant legal frameworks was particularly important to their work. They recommended that organisations should support this with continuous professional development so that social workers continue to develop legal knowledge and therefore act in accordance to the law when carrying out their duties.

Qualitative evidence showed that people felt existing services and interventions did not sufficiently address all their needs. This was also consistent with the committee’s experience of current practice, and they emphasised that planning of services (commissioning and configuring) should take this into account to address potential inequalities in access to care and care provision.

The committee discussed evidence related to responding to an escalation of need, and concluded as a general principle that organisations should ensure social workers be given appropriate training and support during and after response to an escalation of need. However, the committee also agreed this would benefit all areas of their work, so expanded the recommendation to be one for development of an overall framework for an open learning culture. The committee discussed that this was in line with Social Work England’s professional standards which also emphasise that families and communities should be taken into consideration. This will support social workers in learning from each other, and make them better able to appraise situations generally, but also specifically assess appropriate levels of risks that can be taken.

The committee noted that most of these recommendations would standardise practice. The recommendation that organisations should consider making time allowances to build relationships may lead to longer contact times than currently, but this would be balanced against better, individualised services and this was supported by the economic analysis. The recommendation on continuous professional development would address a current variation in practice in getting access and time for such training opportunities.

Assessment – needs assessment

Recommendations 1.2.1 to 1.2.3

As there was no quantitative evidence on the effectiveness of different approaches to social work needs assessments, the committee used the qualitative evidence supported by their own knowledge and experience to make recommendations. They also took into account the legal framework underpinning social work assessments (particularly the Care Act 2014 ) and standards of practice (according to Social Work England’s professional standards or BASW’s Professional Capabilities Framework ).

There was some evidence showing that people did not always understand the purpose of the needs assessment and what it would involve, so the committee recommended giving people accessible information on why it is needed, the objectives, and how it will be done so that they have time to prepare. This also included raising awareness with carers about their right to have a carer’s assessment in line with regulation 10 of the Care Act 2014.

They also discussed that better understanding and knowledge (including of statutory rights) about social work assessments, both in terms of what is involved and the likely outcome, would reduce anxiety and stress for the person with complex needs. They noted that the social work can play an important part in addressing this by signposting to relevant resources.

Most of the recommendations will standardise rather than change practice, as they are actions that are mandated by the Care Act (such as giving sufficient information).

Recommendations 1.2.4 to 1.2.9

Based on their experience, the committee emphasised that social workers should conduct assessments in a way that would minimise stress for the person noting that this would lead to better relationships and engagement and would therefore impact positively on outcomes.

The committee discussed the review findings which suggested people were not always able to express their preferences during assessment. Based on this the committee recommended that there could, in some circumstances, be a preparatory initial contact before the assessment as a way of overcoming these issues. The committee agreed that this can be particularly important if the person may have difficulties being actively involved in the assessment. To address such difficulties, support may be needed from an independent advocate in the assessment. A preparatory meeting could provide the opportunity to assess whether there are any adjustments that can be made or family members who can get involved and could help and support the person with complex needs throughout the process. However, regardless of whether a preparatory meeting is held or not, the committee highlighted that the practical arrangements for the assessments always need to be established before the assessment takes place. They discussed the benefits and challenges of remote (for example virtual) compared to in-person assessments. While there are some advantages of remote assessment (such as when an urgent assessment is needed) there are also disadvantages (such as not being able to get cues from the person’s environment). While they could not categorically recommend 1 over the other, they highlighted that in cases of potential safeguarding concerns an in-person assessment would most likely be needed because missing any needs in these circumstances could have serious consequences.

The committee discussed qualitative evidence of possible challenges with self-assessment; for example, participants in a study reported that the self-assessment format was not always adequate or appropriate for people with multiple needs. Based on this, the committee emphasised that discussions should take place with the person about the advantages and disadvantages of this option so that they can make an informed choice, and that the person should be reassured that they will be supported and can change their mind and have an in-person assessment instead.

Most of the recommendations will standardise rather than change practice, as they are actions that are mandated by legislation such as the Care Act or based on Social Work England’s professional standards or BASW’s Professional Capabilities Framework . The recommendation for a preparatory initial contact is a change to current practice since this is not uniformly done across the country. This may lead to an increase in the number of contacts, which may cause a potential resource impact and increase demands on social worker time. However, the committee noted that a preparatory visit is an option rather than a mandatory requirement and could be a virtual contact or a phone call. The additional resources needed to have some such preparatory visits may be offset by improved outcomes from the person-centred approach, potentially improving quality of life and preventing expensive interventions later on, such as hospitalisation. Also, as it is only an option that services could use rather than something that should be implemented for everyone, the impact may be limited.

Recommendations 1.2.10 and 1.2.11

The committee used the Care and support statutory guidance and regulation 2(1) of the Care Act 2014 to make these recommendations.

The committee noted that if self-assessment is chosen, the Care Act 2014 requires social workers to check that the information that is provided in the assessment is accurate, so they emphasised this in a recommendation. This could be achieved by gathering information from multidisciplinary team members or family and carers, where appropriate.

Based on the committee’s experience and expertise of the statutory guidance in relation to needs assessment, they discussed the content of the assessment and the related eligibility criteria. They agreed that it is important to highlight the questions that the social worker should take into account when deciding on the level of support that is needed in compliance with statutory guidance ( eligibility outcomes of regulation 2(2) of the Care Act 2014 ). The committee discussed that some of the person’s needs may be outside of the expertise of the social worker, for example communication or mental health needs, and it is important that specialist input is sought to address these needs.

Most of the recommendations will standardise rather than change practice, as they are actions that are mandated by either the Care and Support Statutory Guidance or the Care Act.

Recommendations 1.2.12 to 1.2.15

Evidence showed that people were not always given the opportunity to review their assessment details, so the committee made a recommendation to ensure that people have the opportunity to check the draft documents are accurate.

The evidence also suggested that needs can be interpreted differently by the person with complex needs and the social worker, which can lead to misunderstandings about the support that is expected. The committee acknowledged that differences of opinion could arise between a range of individuals, such as professionals and family members or others involved. They therefore recommended that a record of such differences should be kept in case any future issues arise. The committee noted that this could lead to tensions between the person with complex needs and the social worker, and could sometimes lead to complaints being made. They therefore emphasised that not only is good record keeping important when differences arise, but also that people should be given information about the complaints procedure, so they know what to do if they feel the correct processes have not been followed or they disagree with the outcome of the assessment.

In the context of self-assessment, the committee noted, based on their knowledge of legislation, that organisations have an obligation to provide the person who self-assesses with relevant information that they hold to help them in the process. The committee agreed that this was not always known by social workers and made a recommendation that this must be done to comply with legislation.

There is a lack of quantitative evidence addressing approaches to needs assessment and their potential impact on wellbeing. Because of this, the committee prioritised this topic for a research recommendation on needs assessment .

Most of the recommendations will standardise rather than change practice, as they are actions that are either mandated by the Care Act (such as giving sufficient information and support, or issues related to self-assessment) or extrapolated from it (such as preferences when arranging the assessment). The recommendation for a preparatory initial contact is a change to current practice, since this is not uniformly done across the country. This may lead to an increase in the number of contacts, with a potential resource impact and increasing demands on social worker time. However, the committee noted that it would not be routinely done and could be a virtual contact or a phone call. This may be offset by improved outcomes from the person-centred approach, potentially improving quality of life and preventing expensive interventions later on, such as hospitalisation. Also, as it is only an option that services could use rather than something that should be implemented for everyone, the impact may be limited.

Assessment – risk assessment

Recommendations 1.2.16 to 1.2.19

The committee acknowledged the limitations of the evidence, including the lack of quantitative evidence on this topic, and the limitations of the included qualitative evidence (in relation to both the low number of studies and low quality of findings). They agreed to use the qualitative evidence, supported by their own experience, when making the recommendations. They also took into account relevant legislation, including the Mental Capacity Act 2005 and the Mental Health Act 2007 as well as the Human Rights Act 1998 and the UK GDPR and the Data Protection Act 2018 . The committee were also aware that decisions around risk can be influenced by culture, personal beliefs, and coping strategies. They therefore also took into consideration the Equality Act 2010 .

The evidence highlighted that when people with complex needs, and their families and other people important to them were actively involved in the risk assessment process, it facilitated discussions with social workers around risks and helped them make decisions about care and support needs. The committee agreed that this was an essential component of social work and consistent with the legal framework. The committee agreed that for people with complex needs, and their families and other people important to them to be actively involved the process, it needs to be relevant to the person and therefore holistic, looking at the person’s abilities and needs and taking their preferences into account.

The committee noted that the evidence suggested that people found it useful when family members supported them. However, they cautioned against being prescriptive about this because not every person would want their families involved in the process. Therefore, the committee recommended that social workers discuss the person’s views and preferences and that these be recorded and shared (in line with the UK GDPR and the Data Protection Act 2018) so that families are not inadvertently included in discussions if this would go against the wishes of the person with complex needs.

The committee discussed the evidence relating to contextual risk assessment that showed that people found the risk assessment approach worked better when their individual circumstances were fully understood. The recommendations emphasise the need for social workers to develop a rapport with, and engage with, the person at risk. When possible and practical, the committee recommended that ideally this should be done over several contacts so that the person’s circumstances and environment is fully understood. While the committee wanted to emphasise the need to build relationships and understand the person’s circumstances and environment, they also acknowledged that in some situations when a person is at urgent risk, immediate action needs to be taken which may not allow time for several contacts.

The recommendations reinforce current legislation and usual practice. While conducting risk assessments over several contacts (which could be a virtual contact or a phone call) is not consistently done across the country, and would add time to the assessment, this would improve outcomes through a better understanding of the person’s situation and environment. However, rather than this being implemented for everyone the committee thought that this could be one of the considerations around the assessment and would therefore not significantly change practice.

Recommendations 1.2.20 to 1.2.34

The committee acknowledged the limitations of the evidence, including the lack of quantitative evidence on this topic, and the limitations of the included qualitative evidence (in relation to both the small number of studies and low quality of findings). They agreed to use the qualitative evidence, supported by their own experience, when making the recommendations. They also took into account relevant legislation, including the Mental Capacity Act 2005 and the Mental Health Act 2007 as well as the Human Rights Act 1998 . The committee were also aware that decisions around risk can be influenced by culture, personal beliefs, and coping strategies. They therefore also took into consideration the Equality Act 2010 .

The committee noted the evidence related to assessing risk when a person lacks capacity, and so highlighted that risk assessments would also involve planning for the future so that the person’s wishes are known in advance and a plan is in place to manage risk. They agreed that this would lead to better outcomes, since any risky situation can be managed in line with the person’s preferences even if they later lack capacity to make decisions.

The committee discussed that safeguarding issues can be noticed in the risk assessment process and that it is therefore a legal duty in line with the Care Act 2014 that the social worker adheres to local policies to keep the person safe.

There was a lack of evidence about what works well and what could be improved in relation to the content of risk assessments, but despite this the committee agreed that it was important to provide guidance about what should be taken into account when conducting a risk assessment. They also discussed a guide about risk assessments from the Social Care Institute of Excellence and took this into account. In line with this, the committee recommended that to be effective the social worker should individualise the risk assessment and consider not only harmful outcomes but also where there are low risks and potential for good outcomes (for example, if the risks of harm from others and harm to others is low, it could mean that there is a good support network that the social worker could get involved to help with other potential risks that are high). The committee agreed to highlight categories of risks that would affect the person’s safety and the safety of other people, as well as risks to their independence and the independence of others who may depend on them so that plans can be made to minimise them.

The committee discussed their concerns that any risky decisions could lead the social worker to conclude that the person lacks capacity, and they therefore highlighted the legislation of the Mental Capacity Act 2005 which states that assessments of mental capacity should not be based on such assumptions. They discussed that such decisions can be challenging with some cognitive impairments, such as executive dysfunction, and therefore highlighted this in a cross reference to recommendation 1.4.19 of the NICE guideline on decision making and mental capacity.

The committee were aware that people who lack capacity to make decisions related to risk were particularly vulnerable, and that therefore the legislation in section 4(6) of the Mental Capacity Act 2005 needs to be followed so that their current wishes can be established if possible. Even though an assumption should not be made that someone is lacking capacity, the committee did not want to leave someone vulnerable to risk if they do lack capacity, so they recommended that a person who makes a decision that would put themselves at significant risk should be considered for an assessment of capacity. Getting the views of people close to the person and members of the multidisciplinary team may be helpful to determine whether an assessment may be necessary. This is to ensure their safety, and potentially the safety of their family members or carers.

The committee noted the qualitative evidence showing that people agreed that risk assessments work better when discussions take into account the words a person uses to describe risk and their understanding of risk. There was some evidence that checklists can help with this, but the committee was cautious to recommend these as a routine form of assessment as there are only a small number of validated checklists available, and so they would not address the range or complexities of risks for people with complex needs. They were also concerned that this could also be seen by the person as a tick box exercise, and so recommended that checklists be used as a starting point for a wider discussion including previous causes of an escalation of needs and what worked well before to minimise risk. Because of uncertainties with the evidence on the use of checklists and it being restricted to people with complex mental health needs, the committee also made a research recommendation on risk assessment .

When reviewing evidence indicating that risk assessments worked better if social workers fully understand the person’s perspectives of risk (when they have capacity to do so), the committee noted that this was consistent with their own experience. They therefore wanted to ensure that this was taken into account when assessing risk, but also that this should not stop social workers from providing necessary support if needed. The committee noted that this was in line with Social Work England’s professional standards which advise social workers not to prejudge the person’s state and also reflect on their own interpretations (which can be based on their own values), so as to avoid their own feelings around risk influencing their assessment.

The committee discussed evidence highlighting that a risk assessment works well for people who have capacity when it balances a person’s risk with their autonomy, and other evidence that showed understanding the person’s perception of risk facilitates the process. They therefore highlighted that people can make their own decisions about risks or decline interventions (for example, keeping many personal belongings if they are hoarding items even if it makes it difficult to move around their home). However, such choices should not be a reason to stop working with them or providing care even if the social worker perceives these decisions to be risky or unwise.

There was evidence related to detention under the Mental Capacity Act for people assessed as lacking capacity, and the committee used the principles of the Mental Capacity Act to highlight that the circumstances where potential risks for people who lack capacity could occur need to be carefully considered, including ascertaining the person’s best interests, so that any restrictions made are proportionate and justified.

There was evidence highlighting that it is difficult to define the seriousness of risk, which was consistent with the committee’s experience that risk would vary from person to person. The committee discussed that in the absence of such definitions, risk assessments can potentially place too much emphasis on the use of generic risk categories such as ‘high’ and ‘low’ risk – these do not distinguish the severity of potential harms from their likelihood, and do not take into account the different circumstances and choices of the person at risk. Based on these discussions, the committee made recommendations which emphasised that when recording risks social workers need to assess the severity and likelihood of identified potential harms to inform a risk management plan. This should weigh potential harms against potential benefits of risk taking, and a person’s needs and wishes.

The committee acknowledged that the person at risk may not always give consent for their information to be shared. The committee identified the Human Rights Act 1998 underpins such decisions, and this was stated in the recommendations.

The recommendations reinforce current legislation and usual practice. For advance decision making, while this is not a mandatory part of risk assessment it is commonly done, so the recommendation is likely to lead to standardised practice.

Recommendations 1.2.35 to 1.2.39

The committee acknowledged the limitations of the evidence, including the lack of quantitative evidence on this topic, and the limitations of the included qualitative evidence (in relation to both the limited number of studies and low quality of findings). They agreed to use the qualitative evidence, supported by their own experience, when making the recommendations. They also took into account legislation, under the UK GDPR and the Data Protection Act 2018 .

Based on their experience, the committee were keen to emphasise the need to balance any competing demands and perspectives of different organisations, and for different practitioners to be able to exercise their professional judgement. To achieve this, they recommended that, in complex situations involving potential risks of serious harm (for example these could be situations where there are many different opinions in the multidisciplinary team, potentially different complex harms or where 1 action to avoid 1 risk might bring about a further risk), social workers coordinate a case conference. Usually this would include the person and their family or carers but the committee decided that there are situations where a case conference could be a cause of distress for the person or may put a family member at risk. They therefore made a recommendation to highlight both that the person’s and their family’s involvement is important as well as situations when this may not be advisable.

Also based on their experience, the committee discussed that, when there are significant concerns about risks, information ought to be shared between agencies to ensure the safety of the person with complex needs. However, they emphasised that this can only be done within the constraints of the legal framework within the UK GDPR and the Data Protection Act 2018.

Evidence showed that people were not always given the opportunity to review their risk assessment, so the committee made a recommendation to ensure that people have the opportunity to check the draft documents are accurate.

The evidence also suggested that disagreements could arise across different organisations and among different practitioners because of the varying ways in which risk is conceptualised and decisions on managing risk are made. The committee also noted that differences of opinion could arise among professionals, the person with complex needs, family members or others involved. They therefore recommended that a record of such differences should be kept in case any future issues arise from disagreements.

The committee also noted that risk assessments need to be relevant, up to date and responsive to change and therefore, based on their experience, recommended that they are reviewed at least annually, or when circumstances change and a new review is needed.

The recommendations reinforce current legislation and usual practice.

Recommendations 1.2.40 to 1.2.45

The committee acknowledged the limitations of the evidence, including the lack of quantitative evidence on this topic, and the limitations of the included qualitative evidence (in relation to both the limited number of studies and low quality of findings). They agreed to use the qualitative evidence, supported by their own experience, when making the recommendations.

The evidence showed that social workers valued support, particularly when they have experienced abuse, and ongoing training (including legal literacy). Based on the evidence and potential for high-risk situations, advice for social workers should be available whenever they are working, including outside normal office hours. The evidence showed that positive organisational cultures give social workers confidence in making risk assessments, and the committee drew on this to recommend a written strategy for training and support.

The recommendations reinforce current legislation and usual practice. The availability of training on risk assessment for social workers varies, so there may be a resource impact where it is currently not available. However, this would lead to better outcomes by improving the knowledge and awareness of processes and approaches to assess risks. Having out-of-hours access to advice in relation to risk for social workers who do not work during office hours is common practice (such as using an on-call system), so should not be an additional resource impact in most cases.

Individual or family casework

Recommendations 1.3.1 to 1.3.4

The committee drew on both quantitative and qualitative evidence to make recommendations.

The committee discussed the quantitative evidence, which showed mixed results for social work approaches to individual and family casework. They discussed the evidence that showed that a stepped care intervention had an important benefit in terms of morbidity outcomes. This intervention had a number of components including guided self-help and problem solving. The qualitative evidence suggested that social work approaches, in particular goal setting, helped people to identify their priorities and think about ways to achieve these goals. Based on experience, the committee discussed the benefits of such approaches – in particular, those with components that seek solutions to defined areas and working to agreed goals to solve problems. They decided that they could not recommend the specific stepped care approach described in the study, as it was done in a different health and social care setting (Belgium and the Netherlands) and had many components that would make it difficult to implement. However, they noted that some of the components would fall into the category of task-focused approaches which are already used by social workers in the UK. Although the evidence showed benefit for a specific group, the committee agreed that the importance of identifying goals and outcomes (as is done in task-focused approaches) could be extrapolated to the wider population of adults with complex needs and recommended that people should be supported in this process.

The committee highlighted legal frameworks that were in place to support the rights of the person as well as the rights of the family. They agreed that by doing this, social workers would better understand that their role is not necessarily to resolve conflict, but to uphold the rights of the person being supported.

The committee looked at evidence around the challenges of involving family members in social work approaches to casework, and potential conflicts which may exist between family members and how safeguarding concerns may arise in some situations. They discussed the difficulties, as highlighted in the evidence, of ensuring family members participate and engage in interventions. However, they noted that there was little quantitative evidence on the effectiveness of any particular family intervention that had been carried out specifically by social workers to address these challenges. The committee was aware that there is a benefit from family interventions (for example, improving communication between family members), but that the evidence originates from other disciplines (for example, research in clinical psychology) and it is therefore unclear what the role of these interventions is in social work. However, to promote the rights and wellbeing of people and families (in line with Social Work England’s professional standards ) they felt such interventions could be considered with sufficient training, because the benefits of positive family relations and the social support that this could provide to the person with complex needs could lead to positive outcomes.

The recommendations aim to standardise practice rather than change it.

Helping people to connect with local communities and reduce isolation

Recommendations 1.4.1 to 1.4.7

The committee discussed the quantitative evidence, which showed benefits for some outcomes but no differences for other outcomes. However, because of methodological biases, as well as uncertainty around the magnitude of the findings, the committee were less confident in relying completely on the quantitative evidence to support recommendations. There were some themes of the qualitative evidence that supplemented or provided an explanation for the lack of clear results in the quantitative evidence. This combination of quantitative outcomes and qualitative themes suggested that the relative lack of improvement in the quantitative outcomes could be explained by the qualitative evidence that social workers place importance on taking an individualised approach to achieve positive outcomes. The committee agreed that this was a reflection of their experience of practice and was therefore important to take into account.

The committee made a recommendation based on the quantitative evidence that showed social work approaches to social inclusion had an important benefit over usual practice that mainly focused on the person’s existing networks, as there was an improvement in perceived social support. The qualitative findings also highlighted the importance of thinking about the different levels of support a person may need. Based on the combination of the quantitative and qualitative evidence and drawing on their experience, the committee were confident to make a recommendation for the social worker to use a strengths-based, person-centred approach to help the person to develop connections with their local communities. The committee emphasised that approaches that do not solely focus on the person’s needs would improve their confidence and contribute to their overall wellbeing by helping them to take steps to reduce isolation.

The committee also made a recommendation for social workers to support access to a range of activities in the community. A number of qualitative themes supported this recommendation, including the benefits of taking an individualised approach to social inclusion activities (as people’s preferences and needs will vary greatly). The findings also highlighted that participants felt community-based groups and resources could be more beneficial in matching people’s needs than those provided by health and care services.

The committee discussed the qualitative evidence around practitioners’ views of social work approaches to social inclusion, which highlighted that the range of available groups and resources for people were not always adequate. As reducing isolation is beneficial to the person, the committee recommended social workers use creative approaches to see whether new resources could be developed. This also include the flexible use of personal budgets to support an activity. Support should also be given at an organisational level to help social workers find activities and groups that might match a person’s interests. This relies on information being up to date, so the committee gave some examples of how this could be achieved.

The committee discussed evidence that highlighted that it was important to take into account that the level of support needed varied depending on peoples’ needs. They agreed that the support of the social worker should not end once a person has made contact with a group, but that this should be followed up with the person after they have joined a group to ensure that they benefitted from it.

Based on experience, the committee agreed that it was important for organisations to provide information that is up to date about available community resources, as this would minimise barriers to accessing services (such as frustrations around contact details no longer being active, or activities no longer being available).

The committee discussed the evidence around the barriers to connecting with communities or groups, that showed that an NHS trust’s catchment area could be a barrier to this because it is assumed by practitioners and the person that people do not have the right to access groups that are outside the catchment area. The committee recognised that it was not within the scope of the guideline to make a recommendation about local authority catchment areas, but agreed to recommend that people are informed about their rights to receive services outside of their catchment areas to help address this. Based on their experience and knowledge, they expanded on this to alleviate other barriers to access, such as eligibility criteria and referral processes.

Even though there was both quantitative and qualitative evidence to draw on, the committee felt that further evidence to clarify the best approach that social workers could take to help people connect with their local community is needed and so made a research recommendation on social and community support approaches to address this.

There is variation in practice in how much time is spent by social workers helping people connect to local communities. The recommendations will increase the time social workers spend researching, supporting and helping people to make connections in their communities. However, this potential change in practice could lead to improved outcomes by reducing the detrimental effects that loneliness can have on the person’s health and wellbeing.

Supporting people to plan for the future, including considering changing needs, wishes and capabilities

Recommendations 1.5.1 to 1.5.13

The committee discussed both quantitative and qualitative evidence. The quantitative evidence was of limited value because of the quality of the studies and applicability, as most of the included studies were not conducted in the UK so the care provision and legislation were different. They therefore focused on the qualitative evidence as it was of better quality, with themes that the committee agreed were more generalisable to the wider population (with more UK evidence and a wider range of complex needs included).

The evidence suggested that when people have information and support in advance and understand the care planning process, this helps them to participate in planning for the future with their social worker. The committee highlighted the key role social workers play in communicating relevant information to people with complex needs, as well as to their support network, in a timely manner throughout the whole process. The committee emphasised that this would also include information and support for carers, which would have a positive impact on their own wellbeing as well as that of the person that they are providing care for.

There was evidence that highlighted that the environment and service location can be an important facilitator to help the person feel safe and relaxed, and there was also benefit in having a location that provides easy access to case management services (this included visits to the person’s home). The committee drew on this to recommend that care planning take place in the person’s preferred location whenever possible.

There was some limited evidence about the importance of building relationships and trust. This was consistent with the committee’s experience that good relationships that include meaningful conversations to engage individuals are an important aspect of case management and care planning. Drawing on their own expertise, the committee recommended a rights-based approach to case management and care planning, focusing on the individual’s rights according to the principles of the Human Rights Act 1998 . This would improve people’s outcomes by promoting their dignity and wellbeing, building on their strengths and supporting both their participation in the community and engagement with services.

The committee discussed the qualitative evidence that highlighted the importance of existing relationships between adults with complex needs and their family members and carers, and also the wider community. Promoting such relationships may enhance the support networks available to adults with complex needs, which may in turn help minimise the potential for isolation. They discussed the importance of both paid and unpaid support networks (for example, family and personal assistants), and agreed that their input should be reflected in the care plan where appropriate.

Based on evidence that highlighted that a barrier to successful planning for the future was not recognising quickly enough when needs change, the committee highlighted the benefits of a flexible and responsive approach. This should include regular reviews so that plans can be adjusted to ensure the person’s safety and wellbeing.

Based on the evidence about the challenges of planning and addressing all the person’s needs, and supported by their own knowledge and experience, the committee were aware that services may not always successfully address the whole range of identified, eligible needs. The committee therefore agreed to acknowledge this in a recommendation, stating that the agreed care plan should be delivered while also highlighting any eligible needs which appear unlikely to be met or only partially met, with the aim of exploring why some needs have not been met through review and looking to meet these needs in future.

In relation to this, the committee cited section 13.13 of the Care and support statutory guidance which describes the routes to reviewing care and support plans. While, based on their experience, a review should be planned with the person and take place at least once a year, the statutory guidance highlights that there can be situations where an unplanned review is necessary (for example, if needs change or if it is requested by the person or other people important to them).

The committee discussed findings around working arrangements which identified certain conditions that enabled social workers to fulfil their roles more successfully, including autonomy, training, support and supervision. However, the evidence suggested that most social workers reported a lack of support from managers from their own organisations. The committee were keen to emphasise the importance of supporting social workers in their role so that in turn, adults with complex needs would be effectively supported. This was reflected in the committee’s recommendation that organisations provide social workers with regular, practice-based supervision and support so they can be responsive to people’s complex and fluctuating needs, and keep their knowledge and practice up to date.

The committee discussed the evidence showing that continuity was valued in care planning, particularly because people with complex needs felt frustrated about having to tell their stories repeatedly. The committee noted that this was consistent with their experience that offering people access to a named social worker would benefit them in terms of providing such continuity of care, which would in turn enhance their health and wellbeing (where there are changes in social workers, continuity could be maintained by having clear handover processes in place).

The committee made a research recommendation on supporting people to plan for the future to inform future guidelines that would address the gap in the effectiveness evidence relating to the evaluation of specific models of social work case management.

The recommendations will mainly standardise practice. There is some variation nationally in provision of a ‘named’ social worker so increased provision may have some resource impact, but this is already common practice for many services so this may be limited.

Responding to an escalation of need, including urgent support

Recommendations 1.6.1 to 1.6.7

While some quantitative evidence was available, the committee decided not to make use of it when making recommendations, as only 1 small observational study with methodological limitations (such as lack of comparison group) was identified and the population was restricted to the specific needs of people with mental health conditions. Therefore, it was difficult to generalise to the wider population of people with complex needs. The committee drew on the more substantial qualitative evidence (from 8 studies) and supplemented this with their experience and knowledge to make advice applicable to the wider population of adults with complex needs.

The committee used their expertise and knowledge of BASW’s Professional Capabilities Framework – which sets out the ethical principles and critical reflection practices that a social worker must apply to guide their decision making – to recommend social workers consider a person’s wishes, preferences, social circumstances and cultural background when planning during an escalation of need. This would help ensure that any decisions that are made are not based on the social worker’s assumptions.

The committee discussed the evidence that suggested practitioners who used the wider support network of friends and family to help with decision making during a Mental Health Act assessment facilitated the social worker’s response to an escalation of needs. Based on this evidence and their experience, and statutory requirements, they decided to generalise this to the whole population for all situations of unplanned escalation of needs. They agreed that gathering information about the situation not only from the person’s family and social networks, but also relevant practitioners would create a clearer picture of the situation (and any previous, similar situations) and would therefore likely lead to better solutions. The committee noted that usually this information could be gathered by phone or using virtual meetings (for example, virtual case conferences or Care and Treatment Reviews).

The evidence that showed there was a lack of time and resources for social workers to look at alternative options to detention under the Mental Health Act in response to an escalation of need. However, in accordance with the Mental Capacity Act 2005 other less restrictive options need to be considered which can take time. They discussed that social workers in such circumstances can feel under pressure and may make rushed decisions. They drew on 1 of the principles of the Mental Capacity Act that highlights that whenever possible, options must be explored that are less restrictive of the person’s rights and freedom of action. To ensure that this principle is upheld and to ensure that people with complex needs can maintain their independence and autonomy as much as possible in the event of an unplanned escalation of need, the committee made a recommendation to reinforce this legislative requirement.

The committee used their knowledge, supported by legislation, to make recommendations on the use of a person’s advance statements during decision making to ensure a personalised approach to care is taken. The committee noted that an advance statement could be any statement of a person’s wishes and preferences which is not to be confused with a formal written document like an advanced directive related to medical treatment decisions. An advance statement should lead to better outcomes and satisfaction with services, as a person’s wishes and preferences may have been informed by what has worked previously. However, the committee noted that individualised approaches are always needed, even if no advance statement has been made, to provide support in accordance with the person’s wishes and preferences.

The committee discussed the review finding that showed there was dissatisfaction that out-of-hours services were not always available. The committee were aware of legislation that supports 24-hour services and made a recommendation in favour of them so that prompt support can be provided in situations of an unplanned escalation of need in the context of Mental Health Act assessments in accordance with legislation ( section 14.35 of the Mental Health Act Code of Practice ). They noted that availability of services out of hours may prevent some hospital admissions or presentations to accident and emergency departments. They noted that, in their experience, use of out-of-hours services was not always well communicated with daytime services, so recommended that timely and clear communication take place between services to enable better continuity of support.

To address the identified evidence being restricted to a narrow population, the committee made a research recommendation on responding to an escalation of need .

Most of the recommendations aim to standardise current practice and are supported by legislation. The recommendation for a joint assessment in some crisis situations would not have a significant resource impact or cause a change of practice, because this would usually be done by phone or virtually. The current availability of out-of-hours services is varied in the context of Mental Health Act assessments, but according to legislation (section 14.35 of the Mental Health Act Code of Practice) decisions on applications for the detention under the Mental Health Act should be covered over 24 hours so services should have such arrangement in place already.

Social workers and multidisciplinary teams: communication, support and collaboration

Recommendations 1.7.1 to 1.7.8

The committee agreed that the features of the integrated services covered in the quantitative evidence were not directly applicable to the whole population of people with complex needs. They also noted other limitations in the evidence, such as concerns about the way the studies were conducted and had mixed or contradictory findings, with uncertainties about the size of effects that decreased the confidence in this evidence. Therefore, the committee made recommendations using the qualitative evidence together with their experience and expertise and legislation (the UK GDPR and the Data Protection Act 2018 ) as well as drawing on BASW’s Professional Capabilities Framework and BASW’s Charter for integrated working . They agreed that the qualitative evidence highlighted specific aspects that were key to successful integrated working.

There was evidence indicating that having shared visions and aims helped to promote integrated working, because it led to an increased understanding between organisations and disciplines. The committee discussed the importance of this to help everyone in the team understand the context in which they work, even if they come from different disciplines. Having a clear strategy should improve team working because overall purposes and objectives can be defined, and everyone knows the part they play.

Most of the available evidence related to organisational matters that can help or hinder multidisciplinary team working, rather than focusing on actions taken by individual social workers. This was consistent with the committee’s experience of team members’ willingness to work together, that they felt could be better supported by the organisations members work for. Supporting information sharing (in line with the UK GDPR and the Data Protection Act 2018) and providing opportunities for clear communication should lead to better teamwork, because members would understand each other’s expertise and roles and have opportunities to share knowledge and learn from each other. It would also help team members define what role they can play in providing support to the person with complex needs. The committee also decided that information sharing relies on clear communication within the multidisciplinary team and suggested some measures to increase efficiency.

The committee agreed that joint training opportunities would enable the sharing of skills and knowledge between professionals and help them understand each other’s roles and responsibilities across different health and social care roles (as well as other relevant settings, for example voluntary sector organisations). This would enable team members to direct the person with complex needs to the practitioner who can provide the most relevant support. Based on the committee’s experience, it was noted that training would need to include the views and perspectives of people with lived experience to give team members greater confidence in understanding the role that each of them can play in providing individualised care (as outlined in BASW’s Professional Capabilities Framework). This would address addressing people’s needs more effectively and in turn lead to improved outcomes. The committee agreed training should not only be about the theory, but also contain practical information with examples of best practice or lessons that have been learnt. This would mean training can be followed up and implemented to improve team working and to benefit people with lived experience (for example, using case studies that show how the principles of best practice of multidisciplinary team working could be applied).

There was evidence on barriers to integrated working related to a lack of clarity of roles within integrated teams. Using the evidence on facilitators of integrated working, and drawing on BASW’s Charter for integrated working, the committee made recommendations to support social workers in retaining their professional identity when working in an integrated team. This can lead to better outcomes, as the person with complex needs knows what to expect and from which person, so that they are aware which needs can be specifically addressed by a social worker.

There was evidence that bureaucracy was often viewed as a barrier to effective integrated working within multidisciplinary teams, negatively impacting efficiency of referral within the team and causing delays. Simplifying referral processes and pathways (for example, with clear eligibility criteria) was seen as a solution for this and would likely improve outcomes by improving the speed and accuracy (in terms of going to the person most able to help) of referral.

The committee discussed the evidence related to potential benefits of co-location which was assessed as high-quality thematic evidence and was also supported by the mixed method analysis of qualitative and quantitative evidence. They acknowledged that this could have a positive impact on services but would not always be feasible, practical and could be costly (particularly if it involves new premises), and therefore cannot be routinely implemented. However, the committee recommended that organisations should think about whether this could be a beneficial and achievable option for their particular service (for example, having a social work team in a hospital co-located with healthcare staff may improve joined-up services and could have practical benefits).

The committee discussed evidence suggesting shared formal agreements help integrated working. This was in line with their experience, so they recommended such agreements should be used to support integrated teams, particularly in terms of shared decision making and accountability. The committee agreed this should also cover budgets, as the evidence showed that a lack of access to pooled budgets could create barriers to integrated working.

The recommendations largely reinforce current regulation and usual practice. There may be some short-term costs if office accommodation needs to be reconfigured to allow for co-location, although there should be no difference in costs once this has been achieved and potential cost savings through working efficiencies and economies of scale. If physical co-location is not feasible, measures to allow virtual co-location (such as diary sharing and virtual meetings) should involve negligible costs, if any, while allowing potential savings from more efficient and integrated working.

  • Finding more information and committee details

To find NICE guidance on related topics, including guidance in development, see the NICE webpage on adult’s social care .

For full details of the evidence and the guideline committee’s discussions, see the evidence reviews . You can also find information about how the guideline was developed , including details of the committee .

NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice .

Your responsibility : The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • Cite this Page Social work with adults experiencing complex needs. London: National Institute for Health and Care Excellence (NICE); 2022 May 26. (NICE Guideline, No. 216.)
  • PDF version of this title (393K)

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Other titles in this collection.

  • National Institute for Health and Care Excellence: Guidelines

Related NICE guidance and evidence

  • Social work with adults experiencing complex needs [A] Needs assessment: Evidence review A
  • Social work with adults experiencing complex needs [B] Risk assessment: Evidence review B
  • Social work with adults experiencing complex needs [C] Supporting changing needs: Evidence review C
  • Social work with adults experiencing complex needs [D] Support during an escalation of need: Evidence review D
  • Social work with adults experiencing complex needs [E] Integrated working: Evidence review E
  • Social work with adults experiencing complex needs [F] Individual or family casework: Evidence review F
  • Social work with adults experiencing complex needs [G] Helping people connect with local communities: Evidence review G

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Social workers have expertise in mental health support

  • What social workers do

Social workers aim to improve people’s lives by helping with social and interpersonal difficulties, promoting human rights and wellbeing. 

Social workers protect children and adults with support needs from harm. 

From helping keep a family under pressure together to supporting someone with mental health problems, social work is a varied, demanding, often emotional and very rewarding career.

Read the International Federation of Social Work’s global definition of social work .

Social workers recognise the bigger picture affecting people’s lives and work for a more equal and just society where human rights are respected and protected.

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What does the day-to-day of a social worker look like?

Social workers work with a number of people at any one time. This is often referred to as a caseload. Day-to-day work involves assessing people’s needs, strengths and wishes, working with individuals and families directly to help them make changes and solve problems, organising support, making recommendations or referrals to other services and agencies, and keeping detailed records.

The problems social workers deal with are often rooted in social or emotional disadvantage, discrimination, poverty or trauma. Social workers recognise the bigger picture affecting people’s lives and work for a more equal and just society where human rights are respected and protected.

In all roles, you will be trained and skilled to bring about change. You will also be skilled in using relevant legal powers to protect people’s rights (and sometime balance the rights of everyone involved). This combination of skills is unique to the social work profession.

What are the specialisations in social work?

Social workers work with adults, children and families and often specialise in a specific field of work – such as support for children and families, or working with adults with physical disability or mental health related needs. We help people make changes and access their rights as people and citizens. We often work with social networks, families or communities, as well as individuals, and help develop supportive relationships.

What does a children's social worker do?

If you are working in children and family services, you may work with children in care (also known as ‘looked-after children’), young offenders, children who have experienced or are at risk of abuse, children with health and mental health needs - and with their families. This may include helping families experiencing difficulties to resolve their problems. You may work specifically to assess and intervene where there are child protection concerns within a family or from elsewhere. You may also manage the adoption and fostering processes, and support children with a disability.

What is the role of a social worker with older people?

If you are working in adults’ services you may work with older people, people with learning or physical disabilities. If you work with people with mental health problems, you’ll focus on promoting independence, wellbeing and having control over their lives, including accessing their entitlements to welfare support and/or to be in employment. You may also support adults who have substance abuse problems, have offended, are living with HIV or Aids, or are involved with the criminal justice system.

How much do social workers get paid?

Social work salaries vary according to location, experience and area of work. Newly-qualified social workers can expect to earn around £25,000 a year, rising to over £40,000 a year as you gain experience and responsibility.

Social workers work for local authorities, health organisations including the NHS,  voluntary organisations and charities, and for private businesses. Some social workers work independently, setting up their own companies to contract for work, often using considerable experience and specialised expertise. (When applying for jobs, it’s worth checking with the employer for the range of benefits included in your salary, such as pensions and annual leave pay.)

Many employers across different industries are keen to employ social workers because of their expertise and training. A social work qualification can lead to diverse work opportunities working with people and also in policy, education, research, management and leadership.

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Social Care Online from SCIE

The UK’s largest database of information and research on all aspects of social care and social work

Role and responsibilities: Adult Principal Social Worker

This guidance sets out the role, function and purpose of a Principal Social Worker (PSW) in adult services. It includes a person specification which indicates essential and desirable experience, skills, and personal attributes of the role. ​ It will help inform job descriptions support employers when recruiting to the role. It also clarifies what social workers and other practitioners can expect from the PSW in their organisation. Information on delegating social work functions to Mental Health Trusts is also included. The guidance should be read alongside the capability statement for PSWs in adults services. (Edited publisher abstract)

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Social Work Toolbox: 37 Questions, Assessments, & Resources

Social Worker Toolbox

This may be because of its unlikely position, balanced between “the individual and society, the powerful and the excluded” (Davies, 2013, p. 3).

Social work is a unique profession because of its breadth and depth of engagement and the many governmental and private organizations with which it engages.

Not only does it help individuals and groups solve problems in psychosocial functioning, but it also attempts to support them in their life-enhancing goals and ultimately create a just society (Suppes & Wells, 2017).

This article provides a toolbox for social workers, with a selection of assessments and resources to support them in their role and career.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

6 best resources for social workers, top 17 questions to ask your clients, 2 assessments for your sessions, social work & domestic violence: 5 helpful resources, our 3 favorite podcasts on the topic, resources from positivepsychology.com, a take-home message.

Demanding professions require dedicated and supportive resources that transform social work theory into practice. The following worksheets and tools target some of the most challenging and essential areas of social work (Rogers, Whitaker, Edmondson, & Peach, 2020; Davies, 2013):

Emotional intelligence

“Understanding emotion arises from the combined consciousness of how we perceive emotions and use our intellect to make sense of them” (Rogers et al., 2020, p. 47).

For social workers, emotional intelligence is invaluable. They must develop and maintain awareness of both their own and their client’s feelings and use the insights to select appropriate interventions and communication strategies without becoming overwhelmed.

The Reflecting on Emotions in Social Work worksheet encourages social workers to stop and consider their feelings following an initial client visit.

In the worksheet, the social worker is guided to find some quiet time and space to reflect on:

  • How do I feel about my initial visit?
  • What are my thoughts regarding the purpose of the visit?
  • How do I think I can proceed with developing a relationship with the client?
  • How do I think the client feels about my visit?

Being self-aware is a crucial aspect of social work and will inform the ongoing relationship with the client.

Fostering empathy

Mirror neurons fire when we watch others performing an action or experiencing an emotion. They play a significant role in learning new skills and developing empathy for others’ experiences (Thomson, 2010).

Social workers must become more aware of service users’ experiences, as they can influence and affect the interaction with them.

Use the Fostering Empathy Reflectively worksheet to improve the understanding of your own and others’ emotions and increase the degree of empathy.

Observing others can make social workers more aware of human behavior and the emotions and thoughts underneath to increase their capacity for empathy.

Reflective cycle

Reflecting on situations encountered on the job can help social workers fully consider their own and their clients’ thoughts and feelings before drawing conclusions. Indeed, “successful reflection emphasizes the centrality of self-awareness and the capacity for analysis” (Rogers et al., 2020, p. 64).

Use the Reflective Cycle for Social Work to reflect on events, incidents, and behaviors in a structured and systematic way (modified from Gibbs, 1988).

Challenging social interactions

Good communication skills and confidence in social interactions are essential for social work. There will be times when you need assertiveness to challenge others to ensure the client’s needs are met (Rogers et al., 2020).

However, like all skills, social skills can be learned and maintained through education and practice.

The Preparing for Difficult Social Interactions worksheet considers how a situation or event may unfold through focusing on the essential issues.

Practice and role-play can help social workers prepare for a more successful social interaction and gain confidence in their coping abilities.

Motivational Interviewing in Social Work

“Change can become difficult for service users when they are ambivalent about the extent to which the change will be beneficial” (Davies, 2013, p. 451).

One method used by social workers to explore their clients’ intrinsic values and ambivalence is through motivational interviewing (MI). MI has four basic principles (modified from Davies, 2013):

  • Expressing empathy Displaying a clear and genuine interest in the client’s needs, feelings, and perspective.
  • Developing discrepancy Watching and listening for discrepancies between a client’s present behavior and values and future goals.
  • Rolling with resistance Avoiding getting into arguments or pushing for change.
  • Supporting self-efficacy Believing in the client’s capacity to change.

The Motivational Interviewing in Social Work worksheet uses the five stages of change to consider the client’s readiness for change and as input for selecting an appropriate intervention (Prochaska & DiClemente, 1986; Davies, 2013).

The client should be encouraged to create and implement a plan, including goals and details of the specific tasks required.

Respectful practices

Rogers et al. (2020) identified several fundamental values that social workers should be aware of and practice with their service users, families, and other organizations with which they engage. These include:

  • Individuality
  • Honesty and integrity

The Respectful Practices in Social Work worksheet encourages reflection on whether a social worker remains in touch with their values and the principles expected in their work.

Social workers should frequently think of recent examples of interactions with clients, families, and other organizations, and ask themselves (modified from Rogers et al., 2020):

  • Were you polite, courteous, warm, and approachable?
  • How well did you accept people with different beliefs and values from your own?
  • Did you attempt to understand the person and their history?
  • Were you professional, open, honest, and trustworthy?
  • Did you treat each person equally, providing fair access to your time and resources?

A regular check-in to ensure high standards are being maintained and values remain clear will ensure the continued professionalism expected from a social worker.

Social work questions to ask

The following questions provide practical examples; practitioners should tailor them according to timing and context and remain sensitive to the needs of all involved (Rogers et al., 2020; Suppes & Wells, 2017; Davies, 2013).

Open questions

Open questions encourage the respondent to reflect and respond with their feelings, thoughts, and personal experiences. For example:

  • What is your view of what happened?
  • What has it been like living with this issue?
  • How could we work together to find a good solution?
  • What are your greatest fears?

Closed questions

Typically, closed questions are used to find out personal details such as name and address, but they can also provide focus and clarity to confirm information. Closed questions are especially important when dealing with someone with cognitive impairment or who finds it difficult to speak up, and can lead to follow-up, open questions.

For example:

  • How old are you?
  • Are you in trouble?
  • Are you scared?
  • Do you need help?

Hypothetical questions

Hypothetical questions can be helpful when we need the service user to consider a potentially different future, one in which their problems have been resolved. Such questions can build hope and set goals. For example:

  • Can you imagine how things would be if you did not live with the fear of violence?
  • Where would you like to be in a few years after you leave school?
  • Can you imagine what you would do if a similar situation were to happen again?

Strengths-based questions

“Focusing on strengths helps to move away from a preoccupation with risk and risk management” and builds strengths for a better future (Rogers et al., 2020, p. 243). Strengths-based questions in social work can be powerful tools for identifying the positives and adopting a solution-focused approach.

Examples include:

  • Survival – How did you cope in the past?
  • Support – Who helps you and gives you support and guidance?
  • Esteem – How do you feel when you receive compliments?
  • Perspective – What are your thoughts about the situation, issue, or problem?
  • Change – What would you like to change, and how can I help?
  • Meaning – What gives your life meaning?

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Interventions in social work are often described as having four stages: engagement, assessment, intervention, and evaluation (Suppes & Wells, 2017).

The assessment stage typically involves:

  • Collecting, organizing, and interpreting data
  • Assessing a client’s strengths and limitations
  • Developing and agreeing on goals and objectives for interventions
  • Selecting strategies appropriate to the intervention

Assessment is an ongoing process that typically focuses on risk. It begins with the referral and only ends when the intervention is complete or the case closed.

Assessment will need to be specific to the situation and the individuals involved, but it is likely to consider the following kinds of risks (Rogers et al., 2020; Bath and North East Somerset Council, 2017):

General risk assessment

Risk management does not remove risk, but rather reduces the likelihood or impact of problematic behavior. Risk assessments are performed to identify factors that may cause risky behavior or events (Davies, 2013).

Questions include:

  • What has been happening?
  • What is happening right now?
  • What could happen?
  • How likely is it that it will happen?
  • How serious could it be?

The wording and detail of each will depend on the situation, client, and environment, guided by the social worker’s training and experience.

Assessment of risk to children

A child’s safety is of the utmost importance. As part of the assessment process, a complete understanding of actual or potential harm is vital, including (modified from Bath and North East Somerset Council, 2017):

  • Has the child been harmed? Are they likely to be harmed?
  • Is the child at immediate risk of harm and is their safety threatened?
  • If harmed previously, to what extent or degree? Is there likely to be harm in the future?
  • Has there been a detrimental impact on the child’s wellbeing? Is there likely to be in the future?
  • Is there a parent or guardian able and motivated to protect the child from harm?

Social workers must use professional judgment to assess the level of risk and assure the child’s ongoing safety.

Assessment process – Oregon Department of Human Services

Social Work & Domestic Violence

The figures related to domestic violence are shocking. There are 1.3 million women and 835,000 men in the United States alone who are physically assaulted by a close partner each year (NASW, n.d.).

The NASW offers valuable resources to help social workers recognize the signs of existing domestic violence, prevent future violence, and help victims, including:

  • We can help end domestic violence – information on how the White Ribbon Day Campaign is raising awareness of domestic violence

SocialWorkersToolBox.com is another website with a vast range of free social work tools and resources. This UK-based website has a range of videos and educational toolkits, including:

  • Exploring Healthy Relationships: Resource Pack for 14–16-Year-Olds
  • Parents’ Guide: Youth Violence, Knife Crime, and Gangs
  • Family Meetings: Parents’ Guide and Templates
  • Preventing Bullying: A Guide for Parents

Many of the worksheets are helpful for sharing with parents, carers, and organizations.

Here are three insightful podcasts that discuss many of the issues facing social workers and social policymakers:

  • NASW Social Work Talks Podcast The NASW podcast explores topics social workers care about and hosts experts in both theory and practice. The podcast covers broad subjects including racism, child welfare, burnout, and facing grief.
  • The Social Work Podcast This fascinating podcast is another great place to hear from social workers and other experts in the field. The host and founder is Jonathan Singer, while Allan Barsky – a lecturer and researcher – is a frequent guest. Along with other guests, various issues affecting social workers and policymakers are discussed.
  • Social Work Stories Podcast hosts and social workers Lis Murphy, Mim Fox, and Justin Stech guide listeners through  all aspects of social work and social welfare.

five social work tasks or roles with adults

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Social workers should be well versed in a variety of theories, tools, and skills. We have plenty of resources to support experienced social workers and those new to the profession.

One valuable point of focus for social workers involves building strengths and its role in solution-focused therapy . Why not download our free strengths exercise pack and try out the powerful exercises contained within? Here are some examples:

  • Strength Regulation By learning how to regulate their strengths, clients can be taught to use them more effectively.
  • You at Your Best Strengths finding is a powerful way for social workers to increase service users’ awareness of their strengths.

Other free helpful resources for social workers include:

  • Conflict Resolution Checklist Remove issues and factors causing or increasing conflict with this practical checklist .
  • Assertive Communication Practicing assertive communication can be equally valuable for social workers and service users.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

  • Self-Contract

Commitment and self-belief can increase the likelihood of successful future behavioral change.

The idea is to commit yourself to making a positive and effective change by signing a statement of what you will do and when. For example:

I will do [goal] by [date].

  • Cognitive Restructuring

While negative thoughts may not accurately reflect reality, they can increase the risk of unwelcome and harmful behavior.

This cognitive psychology tool helps people identify distorted and unhelpful thinking and find other ways of thinking:

  • Step one – Identify automatic unhelpful thoughts that are causing distress.
  • Step two – Evaluate the accuracy of these thoughts.
  • Step three – Substitute them with fair, rational, and balanced thoughts.

Individuals can then reflect on how this more balanced and realistic style of thinking makes them feel.

If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

Society and policymakers increasingly rely on social workers to help solve individual and group issues involving psychosocial functioning. But beyond helping people survive when society lets them down, social workers support them through positive change toward meaningful goals.

Social workers must be well equipped with social, goal-setting, and communication skills underpinned by positive psychology theory and developed through practice to be successful.

Reflection is crucial. Professionals must analyze their own and others’ emotions, thinking, and behavior while continuously monitoring risk, particularly when vulnerable populations are involved.

The nature of social work is to engage with populations often at the edge of society, where support is either not provided or under-represented.

This article includes tools, worksheets, and other resources that support social workers as they engage with and help their clients. Try them out and tailor them as needed to help deliver positive and lasting change and a more just society.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

  • Bath and North East Somerset Council. (2017, June). Risk assessment guidance . Retrieved November 17, 2021, from https://bathnes.proceduresonline.com/chapters/p_risk_assess.html
  • Davies, M. (2013). The Blackwell companion to social work . Wiley Blackwell.
  • Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods . Oxford Further Education Unit.
  • National Association of Social Workers. (n.d.). Domestic violence media toolkit . Retrieved November 17, 2021, from https://www.socialworkers.org/News/1000-Experts/Media-Toolkits/Domestic-Violence
  • Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. R. Miller & N. Heather (Eds.) Treating addictive behaviors: Processes of chang e. Springer.
  • Rogers, M., Whitaker, D., Edmondson, D., & Peach, D. (2020). Developing skills & knowledge for social work practice . SAGE.
  • Suppes, M. A., & Wells, M. A. (2017). The social work experience: An introduction to social work and social welfare . Pearson.
  • Thomson, H. (2010, April 14). Empathetic mirror neurons found in humans at last . New Scientist. Retrieved November 16, 2021, from https://www.newscientist.com/article/mg20627565-600-empathetic-mirror-neurons-found-in-humans-at-last/

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Jonathan Singer

Thanks so much for including the Social Work Podcast in this article. One correction: Allan Barsky is a frequent guest, but Jonathan Singer is the founder and host.

Caroline Rou

Hi there Jonathan,

Thank you so much for bringing this to our attention! We are delighted that you are reading the blog as we are fans of your podcast as well.

We will adjust this right away so we can give credit where credit is due 🙂

Thanks for all that you do!

Kind regards, -Caroline | Community Manager

Carla

Petra, it does not hurt to see this information again. Some social workers are new at their jobs and can always benefit from hearing this info repeated. If you want to hear from social workers only, then encourage your peers and or colleagues to write this stuff from their perspective.

Petra van Vliet

This article is demeaning and patronsing! As social workers – we have done our (at least) 4 years at uni and this stuff is social work 101. As psychologists – I find you often think you know best and can “tell” other professionals how to do their jobs. So – if you want to write something to social workers – get a social worker to write it! Petra van Vliet – proud and loud social worker

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Effective Social Work with Older People

This report is part of the review of the role of the social worker commissioned by the Scottish Executive to inform the work of the 21st Century Social Work Review group. Their prime focus is the role of the social worker across different service systems and national contexts.

CHAPTER FIVE ROLES, TASKS AND SKILLS FOR EFFECTIVE SOCIAL WORK WITH OLDER PEOPLE

Introduction

5.1 Evidence abut effective social work with older people arises from a number of sources - through the evaluation of policy implementation, research into social work and other related activity, and through what is written to enable a student or qualified practitioner audience develop social work skills and understanding. This chapter will start by looking at interpretations of the social work role within some standard social work texts. It will then consider the care management cycle of assessment, care planning and review before going on to look at direct work with older people. Earlier chapters have suggested that a key area for older people is that of loss and change, of managing life events such as bereavement and loss of home, health and status. The role of the social worker in the context of these changes is considered: we then examine the work required in situations where vulnerable older adults may need protection. Finally, social work in health and group care settings is discussed.

5.2 As described in Chapter 4, the social work task is supported and prescribed by legislation - in its broadest sense by the Social Work (Scotland) 1968 Act and more specifically by a range of legislation such as the NHS and Community Care Act 1990, the Community Care and Health (Scotland) Act 2002, the Mental Health (Scotland) Act 1984, and the Adults with Incapacity (Scotland) Act 2000. The relevance of this legislation to the various tasks is discussed in each section below.

What is the social work role?

5.3 To provide a framework, this section takes a brief look at some standard texts, written for social workers and students, which address the role of the social worker with older people. Strikingly less has been written on this topic compared with the number of publications about social work with other service user groups, such as children and families. At the same time, there are arguments against categorising older people separately from other adults (as if older people were not 'adults') (Midwinter 1990), and, as we have seen in the previous chapter, older people do not form a homogenous group with a single set of needs. Nevertheless, there appear to be some distinctive, if overlapping, aspects to the social work role with older people, which are summarised below.

5.4 Marshall's text, Social work with old people (1990) is one of the few dedicated to this field. She suggests that the social work role lies in:

  • communication, including sensitive listening and awareness of non-verbal communication
  • taking time to assess needs, starting where the older person is
  • supporting people with managing crises that arise through loss and change, e.g. bereavement, changing physical and mental health
  • supporting people whose lives are constrained by illness and disability
  • practical help
  • generating and organising resources
  • Working with other professionals
  • Helping the helpers, including carers and colleagues
  • Combating ageism.

5.5 In Quality Work with Older People , Mary Winner (1992) provides a similar list, adding 'ability to work in an ethnically sensitive way, and combat individual and institutional racism towards older people' and 'capacity to work effectively as a member of a multidisciplinary team, consult with a member of another discipline, and represent the interests of an older person in the multidisciplinary context'. In a different section she writes:

"It is possible that the complexity of some social work with older people is sometimes not fully understood. The work can require fine judgements regarding:

  • acceptable risk taking
  • the limits of self determination;
  • family or carers conflicts;
  • exploitation;
  • challenging poor practices" (Winner 1992)

5.6 Fourteen years later, these themes are still very much to the fore in a text written to support social work students with the new Degree in Social Work (Crawford and Walker, 2004). Community care reforms have resulted in an emphasis on the care management role, but not to the exclusion of engaging with individual service users to try to develop an understanding of their lives and needs. Crawford and Walker focus on the importance of :

  • effective communication
  • core tasks of assessment, planning, intervention, and review
  • understanding of individual experiences and the importance of biography
  • empowering and anti-discriminatory practice
  • identifying and working with vulnerability and abuse
  • partnership working with older people, carers and agencies.

5.7 The importance of anti-ageist practice, and the need to promote the strengths and resilience of older people are also strongly emphasised by recent writers for a social work audience (Thompson 2002, Phillipson 2002).

5.8 It is worth looking at some of these 'core tasks' in more detail, as they are required in work with older people.

ASSESSING THE NEEDS OF OLDER PEOPLE

5.9 One of the most important features of the NHS and Community Care Act 1990 was the introduction of the right to community care assessment. The intention was to ensure that any services or assistance offered to someone in need were tailor-made to those needs, because they were based on a comprehensive assessment. Services were to be 'needs led', not 'service driven'. Anyone presenting themselves to a social services department appearing vulnerable or in need had a right to be offered an assessment, although not necessarily a right to whatever services the assessment recommended (Scottish Office, Circulars, 11/91 and 10/98).

5.10 As community care services developed and as skills and understanding of the need for, and importance of, eligibility criteria developed, assessment developed a secondary and perhaps implicit function of creating the basis for prioritisation of allocation of resources or services - in short, a rationing device. Assessments are carried out by social workers primarily to establish the individual needs of older people before creating a package of care services designed to meet those individual needs. However, the expectation that social workers would record unmet need, when decisions were made about what services could be arranged in response to the assessment, underlines the fact that assessment has a dual function.

5.11 Social work texts emphasise the importance of holistic assessment practice which takes account of a wide range of factors and steers away from routine matching of services to needs (e.g. Thompson 2001). Richards (2000), drawing on case materials in an ethnographic study of assessment of older people's needs, suggests that where older people's perceptions are not given due weight, the risks of unwelcome or inappropriate interventions increase. The researcher proposes a user-centred approach to ensure that information-gathering and service provision are meaningful to the older person and sensitive to their own efforts to analyse and manage their situation. It is suggested that these perspectives may emerge most clearly as older people tell their own story but this can be overlooked in more agency-centred assessment processes.

ASSESSMENT AND INTEGRATED WORKING

5.12 The introduction of single shared assessment was intended to 'broaden the range of assessors to include professionals from health and housing and where relevant, other agencies and groups' (Scottish Executive, 2001). More recent guidance has distinguished between care management and care co-ordination and states that care management is 'a complex activity that should be carried out by professionally qualified staff, suitably trained, who have appropriate skills, competencies, and experience' (Scottish Executive, 2004: 9). The majority of staff undertaking care management are professionally qualified social workers in local authorities and, whilst it is anticipated that there will be an increase in the participation of other key health and social care professionals, social workers are likely to continue to play the major care management role (Scottish Executive, 2004).

5.13 Although there is an increasing emphasis on the importance of effective joint working, we have uncovered surprisingly little research into the assessment approaches of different professions in community settings. However, a qualitative study carried out in Scotland in 1998 explored assessments of 18 frail older people, undertaken by social workers and district nurses (Worth, 2002). An ethnographic approach was taken to analysing the process, involving interviews with practitioners and observation of assessment practice. Similarities and differences of approach between district nurses and social workers were explored, with a view to identifying particular areas of expertise in this crucial area of practice. The study findings suggest that there are a number of similarities but that the focus of their assessment differed in important respects. It appeared that social workers and district nurses had different, but complementary, areas of expertise which brought together the components of a holistic needs assessment. The two groups covered similar areas of enquiry in their assessments apart from the financial assessments which only social workers were required to carry out. As might be expected, social workers tended to put greater emphasis on social, and nurses on health needs. Closer working relationships between district nurses and social workers within a care management team were found to support a more holistic assessment of service user need.

MONITORING AND REVIEWING CARE

5.14 The 21 st Century Social Work Review user and carer panel emphasised 'the need for regular reviews of support to determine whether the service offered is still working or if it needs to change.' It is interesting to note the priority it gives to the review process. The original guidance introducing community care assessment was also clear about the importance of reviews, and this is reinforced in recent guidance relating to care management: 'Monitoring and reviewing are essential parts of care management if services are to respond to changing needs and resources are to be used to best effect' (Scottish Executive, 2005:11). Assessing the impact of the 1993 community care reforms, Warburton and McCracken (1999) suggest that social service departments did not pay sufficient attention to monitoring and reviewing care of older people. Often social workers are unable to maintain an active involvement in individual care management once needs are assessed and services provided, with routine monitoring and review being undertaken by care providers such as care homes (Lymbery, 1998). Although monitoring and review is clearly an important role for social work, and one that has the potential for ensuring that older people receive quality care services responsive to their changing needs, there is little other formal research evidence of the effectiveness of reviewing and monitoring, or of the outcomes of different approaches to these processes.

5.15 For some older people who are at risk (or find themselves unable to cope in their own homes), a move to a care home can be part of the solution. In 2002, nearly 35, 000 older Scottish people were living in care homes (Scottish Executive, 2002). However, as the reports of the Care Commission show , good standards of care are not always achieved. The social worker is needed to empower the older person and their relatives to raise any concerns or to advocate on behalf of an older person where the standard of care is inadequate, where it is not centred on the individual and when there is concern about neglect or even abuse. The social worker needs to ensure that the initial contract made with the home accurately specifies the services required by each older person - in other words, translates the needs identified during assessment into a comprehensive and personalised care plan, setting out how those needs will be met. Then, along with the resident and family, the social worker should regularly review the implementation of the care plan, ensuring that it is updated to meet changing needs. This may involve challenge to the managers of the home, particularly around best value and resource constraints.

CARE MANAGEMENT FOR PEOPLE WITH COMPLEX NEEDS

5.16 The process of assessment, care planning and review is encompassed within the term 'care management'. While this term is most often associated with community care services, the concept is not markedly different from other models of social work, such as casework or the care programme approach in mental health. Social workers with older people will often have to commission services such as home care or day care from providers in the independent sector, involving contractual arrangements and costings, and this too is included within the term 'care management'.

5.17 A comprehensive evaluation of care management in Scotland, based on telephone interviews with staff in all Scottish local authorities and a number of case study visits, considered the definitions and models of care management in use (Stalker and Campbell, 2002). Although the question of effectiveness was not a major part of the research brief, the study found that in most instances social workers were most likely to carry out the care management role.

5.18 The research also reinforces the notion of complexity in a way which is helpful to this review. Care management, it suggested, was not a task required by all clients, or even all those who share the same condition - dementia, for example. Rather, where there was a variety of needs, and perhaps competing concerns of the service user and carer, where there was likely to be frequent change, unpredictability or vulnerability, then care management skills were needed. This leads to the conclusion that the skills required for care management are not only those relating to contracting and purchasing, but are more akin to those generally associated with social work, including assessment skills, based on an holistic approach to all the person's needs, and an ability to balance or mediate between competing interests. Given our earlier point about evaluative research which does not distinguish the effectiveness of social work from the social care/social service impact, this distinction around complexity is a valuable insight.

5.19 This is given further weight by Statham et al. (2005). Considering situations where the social worker may be 'the professional of choice', these authors suggest that social workers have a particular role in complex and uncertain circumstances, thus:

  • where no one knows what the right answer is - social workers are better than other professions at handling uncertainty and complexity
  • where relationships are complex - for example, where there are tensions, disagreements or conflicts of interest within a family
  • where there is a high degree of risk - social workers' approach to managing risk is at the core of their distinctiveness. Arguably, most other professions primarily focus on removing or minimising risk. Social workers frequently work with situations where there is a degree of risk, but where intervening could actually make situations worse.

The issue of risk in effective social work with older people is our next topic.

BALANCING RIGHTS, RISKS AND NEEDS

5.20 This aspect of social work is most often associated with child protection, following a number of enquiries, investigations and government reports over the last 30 years. Sadly, recent events in Scotland have also focused attention on adult groups. In April 2004, the Scottish Executive published a report of an inspection of services for people with learning disabilities in Scottish Borders (Mental Welfare Commission/ Social Work Services Inspectorate, 2004). This followed confirmation of the 'extreme' levels of abuse suffered by a woman who had been using social and health services for a number of years.

5.21 The MWC / SWSI report made 28 recommendations for improvements, 6 of which are directed specifically at the future practice of social workers. Many of the recommendations echo similar proposals from child care enquiries, requiring improved communication and coordination, minimum standards for records, case conferences and reviews, and specific actions to be taken on home visits.

5.22 That report also argues that social work with vulnerable adults 'is a constant balance between promoting independence and self determination, and providing appropriate levels of protection.' This balance is articulated clearly in the Scottish Social Services Council Code of Practice for social service workers, which refers to: 'recognising that service users have the right to take risks, and helping them to identify and manage potential and actual risks to themselves and others' (Scottish Executive Social Work Inspectorate, 2004: 11). The emphasis here is on managing the delicate balance between independence and protection for all vulnerable adults, including some older people. This gives further weight to the complexity of successfully managing risk as a key issue in effective social work practice with older people.

5.23 The risk of abuse of older people is not a new phenomenon but it is only in the last twenty years that it has begun to be addressed in the U.K (Penhale, 2002). The major focus has been the abuse of elders by their carers in domestic settings but there is increasing awareness of abuse in institutional settings (Glendinning and Kingston, 1999). Abuse may include physical, emotional, sexual and material (both funds and property) abuse and shades into both active and passive forms of neglect. Pritchard's (2001) study of the abuse of older women in the north of England found that it is often perpetrated by partners in the domestic setting, and frequently continues a pattern begun in earlier life. Pritchard found that women often remained in abusive situations because they did not know how or where to access practical advice and information. They also needed supportive discussion and appropriate housing.

5.24 Older people may put themselves at risk of a different kind, knowingly or otherwise. People with dementia may not realize that they have left a pan on a stove, turned the gas on and not lit it, or be eating food that is unfit to eat. They may go out to look for parents or partners who are long dead. They may have lost awareness of the risk of crossing a busy road. Above all they may agree to various arrangements to protect them against these risks, and then forget completely what has been agreed. The prospect of moving, or being moved to a safer environment such as a care home will cause considerable anxiety and fear, and is likely to exacerbate confusion and forgetfulness, which in itself will be increased by an unfamiliar environment. Such issues are not limited to older people with dementia. Older people whose capacity to sustain an independent lifestyle is reducing may exaggerate their abilities and downplay the risks, so as to remain in their own home and avoid what they fear will be an enforced move to an unfamiliar, and perhaps institutional environment.

5.25 The social work role is complex in these potential risk situations, raising difficult questions about how to balance empowerment with protection. Preston-Shoot (2001) argues that the value of self-determination is highly influential in social work practice but should not absolve practitioners from finding ways to protect vulnerable users. He finds that the literature on elder abuse emphasizes the importance of social workers:

  • using communication skills e.g. building trust and support
  • assessing, especially the vulnerability of the service user and circumstances of the abuse
  • providing information about services and consideration of different options
  • protection planning, monitoring and review
  • understanding the legal mandate relating to welfare provision, incapacity, common law and criminal justice. (Preston-Shoot, 2001:12)

5.26 We look in detail below at the 'legal mandate' for social workers in Scotland working with older people at risk. The common themes of communication, assessment, planning, monitoring and review again emerge, although this time from a different starting point.

5.27 Pritchard's (2001) study of older abused women highlighted the importance they attach to being able to talk to somebody about their experiences. She underlines the importance of all social workers being trained not only to identify abuse but also to understand and be equipped to work with survivors to address longer term as well as short-term practical needs. Research conducted to determine older women's understandings of elder abuse has also emphasized the importance of looking at the quality of care-giving relationships, rather than simply analysing action or behaviour when assessing risk and vulnerability (Morbey, 2002).

The duty to protect

5.28 Social workers have a statutory responsibility to intervene when action is required to protect older adults from dangerous situations, including abuse. It was noted in chapter four that older people can experience difficulties created by the onset or continuation of mental health problems. A number of specific duties are imposed on local authorities by the Mental Health (Scotland) Act 1984, including the appointment of Mental Health Officers ( MHO s) (s.25(1)). Guidance states that MHO s should have a professional qualification in social work and have completed an approved training course (Scottish Office, 1996). The main functions of MHO s under the Act relate to their involvement in considering consent to compulsory detention, and the provision of social circumstance reports ( SCR s) for the Responsible Medical Officer and the Mental Welfare Commission. The number of older people subject to detention under current legislation is broadly in the same proportion as for all adults (Grant, 2004).

5.29 In October 2005, the existing Mental Health Act will be replaced by the Mental Health (Care and Treatment) (Scotland) Act 2003. The Millan Review of the Mental Health (Scotland) Act 1984 took the view that social work was the only profession to combine independence from the health service with training and experience in working within a statutory framework. Accordingly, MHO s 'play a significant role' in many parts of the new Act:

"similar to the role they play under the 1984 Act, but greatly extended. Local authorities will be able to appoint as MHO s only those individuals who are officers of the local authority and who meet certain requirements on qualifications, training and experience." (Scottish Executive, 2003)

Whilst the Act does not specifically refer to older people, its principles include a respect for diversity, including age, and non-discriminatory practice.

5.30 The Adults with Incapacity (Scotland) Act ( 2000) introduced measures to safeguard the interests of adults who are unable to make all or some decisions or to communicate those decisions about their welfare and/ or finances. This includes adults with dementia and learning disabilities as well as people who have lost communication skills, for example, as a result of a stroke. Local authorities also have a duty to investigate any circumstances made known to them in which the personal welfare of an adult appears to be at risk.

5.31 Part 6 of the Act introduces welfare and financial intervention and guardianship orders. Local authorities are under a duty to apply for intervention/guardianship orders where it appears that such an order is necessary. Local authorities discharge these responsibilities through their social work departments or equivalents; such is the complexity of issues likely to arise that qualified social workers (although not necessarily MHO s) are most likely to be required. Whilst the Act does not specifically refer to the needs of older people, figures from the Office of the Public Guardian show most applications for guardianship and intervention orders are for people over 60 (70 to 80%) and female (Grant 2004).

5.32 Research into the first two years of operation of the Adults with Incapacity (Scotland) Act 2000 suggested a dynamic situation with patterns of usage changing over time (Killeen et al., 2004). The research into the operation of Part 6 of the Act (Grant 2004) found that MHO s were most knowledgeable about the Act and had a key role in promoting awareness of it to service users, carers and other professionals. MHO s also played an important role in seeking alternatives to statutory intervention.

5.33 Interpretation and use of Part 6 has not been straightforward. The Mental Welfare Commission reported:

"Early in the implementation of Part 6 of the Adults with Incapacity Act, it became obvious that there was considerable uncertainty about the appropriate circumstances in which to use Part 6 applications for welfare interventions. It was not clear whether a significant intervention (such as a change of residence) should always require the authority of a guardianship or intervention order." (Mental Welfare Commission, 2004)

5.34 As a result, the Commission commissioned Hilary Patrick, from the School of Law at Edinburgh University, to prepare a discussion paper on the use of Part 6 (Mental Welfare Commission 2004). She concluded that, whenever a local authority deals with a person lacking capacity, it should do so within the framework of the Act. This does not, however, mean applying for a Part 6 order for every case in which a significant intervention is proposed. An assessment for an order should be carried out, in accordance with the principles of the Act. (The implication is that such an assessment, which will include the needs of the client, as well as their capacity to understand and agree to what is proposed for them, will be carried out by a social worker).

5.35 In such circumstances, and faced with these needs, the effective social worker must be able to evaluate the risks, balance the individual's rights (as a citizen and under the European Convention of Human Rights) with the need to protect and promote the welfare of people in need, and to mediate between the concerns of relatives and carers and the wishes of the older person, much as described in the extracts from the SSSC code of practice and discussed by Statham (quoted above).

5.36 A vivid practice example of the potential for effective use of Part 6 of the Act also makes clear the complexity of issues that face social work staff in work with older people:

"An older man with long-standing mental health problems, and subject to a section 18 detention at the time, was determined to return to his house despite growing concern for his safety. The chronic delusional beliefs he held led to his conviction that he could not leave the property. He had become increasingly isolated, had refused to accept the support package arranged for him, and had become increasingly vulnerable to the unpredictable behaviour of a relative. Powers were sought to decide where he should live, and ensure that a range of services/professionals were able to enter his new home to provide the care he was assessed as needing. Although initially reluctant to move, he accepted that he was required to do so as part of the guardianship order. With the benefit of an improved environment, very supportive staff, and a confidently designed support package, he quickly became more confident and independent in all his activities for daily living. Staff (health and social work) who had known him for years felt that the change in the quality of his life was dramatic. The situation became so settled that it was decided that the welfare powers were no longer required." (Scottish Executive, 2004:3)

Loss, change and transition

5.36 One potential outcome of the introduction of the current community care model is that health and social care practitioners' role could be limited to a technical and administrative one of assessing need and arranging services provided by others (Hughes, 1995). Indeed, it has been suggested that an administrative model holds sway, so that 'paradoxically, community care, as defined, evidences a migration away from direct contact between elders and practitioners' (Biggs, 1993). Hughes instead argues for a 'professional' model of community care which is 'exploratory, holistic, integrative, and therapeutic and is based on an understanding of the complex interconnected nature of needs for many older people' (1995: 144).

5.37 Later life is a time when many people will experience multiple losses - of health, status, close friends, relations and spouses. Phillipson (2002) suggests that social work with older people in these circumstances is often inseparable from supporting older people with bereavement, helping individuals to rebuild confidence, self-esteem and social networks to manage loss. Whilst this work is clearly not exclusive to working with older people, experience of death tends to be 'clustered towards the end of the life course' (Phillipson, 2002:59). The notion of 'the life course' for work with both children and adults is significant in social work education. The life course involves a series of transitions, including the 'developmental crises' associated with the work of Erikson (1977). Thompson (2002: 297) suggests that 'an understanding of the significance and impact of such transitions should be a basic part of the social worker's repertoire of competence'.

5.38 A life course approach emphasises the importance of seeing older people in the context of their life history. Biographical approaches to work with older people stress the importance of individual life stories and include activities such as reminiscence, storytelling and life review work. This approach also takes account of people's environment and the impact of wider social issues including gender, class and race (Crawford and Walker 2004). Two studies, neither directly about social work practice, provide evidence of the effectiveness of biographical activities. McKee et al. (2002) looked at the impact of reminiscence activities on the quality of life of 142 older people living in care settings. Residents who participated in activities over a period of a month appeared to have an improved quality of life compared to those who did not take part. Reminiscing seemed to help older people convey their identities and life events to care staff and appeared to enhance inter-generational family relationships. However, care staff expressed concern that social care (talking, listening, sharing) with older people is not recognised as 'real work' within care organisations. Another study, exploring use of biographical approaches in a nursing home and NHS Hospital Unit, found that life story work helped practitioners understand the needs of service users better and form closer relationships with them and their families (Clarke et al., 2003).

Social work with people who are dying

5.39 Social workers have made a significant contribution to the development and delivery of palliative care (Clausen 2005). In a review of the literature, Small (2001) suggests four main contributions

  • helping people respond to loss
  • a whole system view, putting individual experience into a social context
  • helping to ameliorate the practical impact of change
  • education and support of other members of the multidisciplinary team and mainstream social work.

5.40 These contributions resonate with four key elements of the social work role in palliative care as identified by Sheldon (2000)

  • a family focus
  • influencing the environment, e.g. through advice, information giving, organising finance, liaising with colleagues
  • being a team member;
  • managing anxiety in the family, the professional team and oneself.

5.41 Lloyd, in a study of hospital social workers working with bereaved and dying people, found that 'social workers have the integrated approach and necessary skills to incorporate both the individual and social meanings of death'. Picking up an earlier theme in this review, Worth (1998) found that social workers are currently concerned that current care management arrangements limit their opportunities for counselling and case work, echoing Clausen et al's argument that resources and structures do not enable social workers to meet the needs of people who are dying. He speaks of the 'disadvantaging' of members of the community who most need 'the compassion, knowledge and unique intervention of a skilled social worker':

" The patients in our study had clearly expressed needs which could potentially be met by social workers, yet few if any had social work involvement. Sheldon (2000) stresses the need for a whole person approach, looking at the individual in the social context, linking past, present and future. Social workers may best be able to conduct holistic needs assessments and be case managers, with medical support, providing continuity of care, journeying with the patient and acting as a guide into the unknown." (Clausen et al., 2005: 283-4)

THE SOCIAL WORK ROLE IN HEALTH CARE SETTINGS

5.42 Thus far, most of this review has focused on social work in community care settings or integrated specialist teams for older people. We now review briefly effective social work in other settings, beginning with health care.

5.43 Social workers in hospitals and other health care settings are often particularly well placed to identify the needs of older people and carers for support and intervention at times of crisis and change. Marshall (1990) emphasises the application of crisis intervention theory to these situations in which people may, for a short period, be more receptive than usual to support and assistance. This area of social work practice seems to have generated more research than some others. Three examples of research into social work's role in health settings are described below.

5.44 The policy of diverting older people from admission to acute hospital care on social grounds has, in some areas, resulted in the placement of social workers in Accident and Emergency teams. McLeod et al. (2003) undertook research into the outcomes for 28 people using one such scheme in a Midlands hospital. The findings suggest that Accident and Emergency based social work can be of great benefit to service users, including assistance in negotiating the hospital environment, information about issues crucial to managing their health and help with the complexities of planning future care. Social workers in this study had the role of identifying social care needs, reducing inappropriate hospital admission and minimizing hospital stays on social grounds. They also had fast track access to social care services and had their own budget for incidental services. However, these services were not always sustained in the longer term due to service user/ service provider power imbalances and lack of resources.

5.45 A study of post-discharge needs among 456 older patients (over 75) stressed the particular importance of effective assessment for older people, because a stay in hospital often represented a 'turning point' (Healy et al., 1999). They found that multi-disciplinary assessment was associated with superior care assessment and that formalising assessment procedures improved communication between different professional groups. The authors concluded that teams led by social workers tended to produce more fine-tuning in matching patient needs to available services, including a wider range of services. The study has implications for health and social care professionals, since it demonstrates that the post discharge services received by older patients are influenced by the kind of professionals who assess them.

5.46 Finally, a study conducted in the U.S. suggests that the psychosocial recovery of patients (aged 40-80) after cardio-vascular surgery may be promoted by the involvement of social work in health and home care (Ai et al., 1998).

GROUP CARE SETTINGS

5.47 Social workers also work alongside social care staff within a range of group care settings, including day care facilities and care homes. Most of the research in this area relates to the perceived quality of these services rather than the social work role within the setting. Some recent research with relevance to the role of social work in residential settings is summarised below.

5.48 The Office of Fair Trading (2005) has conducted a study of how well the care homes market serves people over 65 in the UK . It notes that the process of moving into a care home can be very distressing for the older person and sometimes their families. The findings of the study emphasise the need for good information for service users about the rights of older people and the obligations of local authorities, fair and clear contract terms, and accessible complaints procedures. These are all areas in which social workers are centrally involved.

5.49 Bland (1999) also explores the transition into residential care and examines one of the main problems for older people facing admission - fear of losing their independence. Drawing on a wide range of literature relating to the development of institutional care, Bland compares two approaches to residential care provision. A case study of one private home illustrates the 'service' approach in which residents were treated as though they were hotel guests, their movements were not restricted and the normal conventions of privacy were observed by staff and residents alike. Staff treated residents, including those with dementia, as competent adults rather than as dependents in need of protection, and residents' needs and preferences were respected. Based on her research and observations of care homes, Bland characterises the dominant 'social care' approach as more akin to the hospital than the hotel. Most care homes attach overriding importance to minimising risk, leading to residents being kept under surveillance. Bland argues that the ideology of care implicit in this approach impedes the changes necessary to allow older people to retain their dignity and independence in a care home setting.

5.50 The Accounts Commission's (1999) evaluation of residential and nursing homes involved a self-selected sample of 39 establishments. This survey included interviews with 318 residents and 47 relatives. The report concludes that quality could be improved in some homes without incurring extra cost by measures such as paying more attention to individual needs and requirements, developing better links with local communities, and integrated team working, giving residents a smaller staff group to relate to. The report also includes many illustrations of good practice in involving residents and taking account of their individual needs.

5.51 The quality of life of older people during and after transition into institutional care was explored in an ethnographic study of 52 frail older people through observation and focus groups (Tester et al., 2003). The authors concluded that in order to promote quality of life, practitioners (as well as policy makers and providers) needed to disregard their own assumptions and focus on the priorities of the older people. The role of practitioners in enabling residents to maintain their sense of self, to communicate verbally and non-verbally, to exercise rights and control, to maintain and develop relationships and to participate in meaningful activity and interaction within the care setting was stressed.

WORKING WITH FAMILIES AND CARERS

5.52 The Community Care and Health (Scotland) Act 2002 (s.8-11) introduced the entitlement for 'substantial and regular' adult carers to have an assessment of their ability to care ('carer's assessment'), independent of any assessment of the person they support. Given the numbers of older people who are also acting as carers, already noted, this development is very relevant to this essay. In this instance, there is no restriction on who can carry out such assessments, and no systematic evaluation has yet been conducted.

5.53 Pickard (2004) has undertaken a comprehensive review of the effectiveness of services for carers in the U.K., focusing particularly on studies undertaken since the implementation of community care policies in the early nineties. Positive outcomes for carers, in terms of reduction of the negative psychological effects of caring, were found to result from the use of day care, home care, institutional respite care and social work/ counselling services. She supports her evidence of the efficacy of social work intervention with data from a study of community care for 419 older people and 238 care givers in 10 local authorities in England and Wales (Davies and Fernandez 2000). This research suggested that counselling and therapeutic social work activity was effective in reducing stress on carers. The study also found that social work and counselling were highly cost-effective in reducing subjective carer 'burden' compared to other interventions. However, social work intervention was not effective in delaying moves to long term residential care and only a small proportion of carers (18%) were found to have access to a qualified social worker.

Conclusions

5.54 Social workers bring a unique mix of skills and expertise to situations of complexity, uncertainty, conflict and risk - all of which arise in their work with older people.

5.55 Effective social work with older people requires both practical skills, such as securing and co-ordinating resources, and 'people' skills, such as sensitive communication and listening skills, taking time, moving at the individual's pace, supporting families and collaborating with colleagues in a multi disciplinary setting.

5.56 It is vital for effective social work with older people that the demands of care management are not allowed to prevent social workers from engaging meaningfully with older people and developing a good understanding of their lives, needs and wishes. There is a risk of assessment becoming bureaucratic, being used primarily to ration services rather taking a holistic, user-centred approach. Care management should not be seen as an alternative to counselling and casework, where these are needed.

5.57 It is important for social workers to take a positive and proactive approach to working with older people, for example, through anti-discriminatory work, by promoting individual strengths and resilience, and by helping rebuild confidence, self-esteem and social networks following experiences of loss or change.

5.58 A key task in social work with older people is to weigh up the promotion of independence, self determination and individual rights against the need to provide sensitive protection to vulnerable adults facing risk. Achieving what is often a fine balance between these competing demands will involve building trust and support, careful assessment, opportunities to discuss different options, protection planning, monitoring and review - as well as a sound knowledge of relevant legal frameworks.

5.59 Little evidence is available about effective approaches to monitoring and review, yet these are critical in situations of rapidly changing or fluctuating need. Research on this topic would be helpful.

5.60 There is evidence about the effectiveness of social work in a range of settings, including health care, group care, care homes and in work with families and carers.

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12 Social Work with Persons with Disabilities

Emily E. Clarke, BSW and Megan R. Westmore, LMSW

Learning Objectives

In this chapter the student will be reviewing:

  • Overview of disabilities and type of disabilities.
  • Ableism and strategies for addressing its effects on clients.
  • Common issues for disability social workers.
  • Overview of American with Disability Act.

Disability and Language

Using respectful language is one of the easiest things social workers can do to build rapport with clients and help create a safer environment for services. It’s also an area that takes work! Language is constantly evolving, and throughout your career as a social worker, you will need to keep up to date with the current, best language to use with a variety of clients. When it comes to your clients with disabilities, there are several language choices to consider. Often people use a lot of euphemisms to refer to disabilities. Euphemisms are words that are substituted into conversations because they are supposedly less harsh or unpleasant. Common euphemisms for disabilities are “special needs,” “differently abled,” and “challenges.” For the most part, advocates with disabilities recommend using the term “disability” rather than any of these euphemisms. After all, “disability” is not a bad word. But even for those who use the term “disability,” there are a couple different options to choose from.

For a long time, the gold standard in the disability field was person first language . As the name implies, a person’s first language emphasizes the personhood of the individual you are talking about and suggests that disability is just one part of a person’s identity (Dwyer, 2022). For example, rather than saying “a disabled person,” you would say “a person with a disability.” Instead of talking about “the Down Syndrome woman,” you would say “the woman with Down Syndrome.” For many individuals, a person’s first language is considered the most respectful choice.

Other people with disabilities prefer identity first language . These advocates stress that disability is an important and valuable part of a person’s identity, and there is nothing disrespectful or wrong about putting disability first (Dwyer, 2022). As an example, someone who was diagnosed with autism spectrum disorder may prefer to be called “autistic” rather than “a person with autism.”

So, if some people prefer identity first language and others prefer person first language, which should you use? Ultimately, the best option is to ask your client which language they prefer. People with disabilities are the experts in their lives, bodies, and experiences, and they get to make all decisions about their care, including about what language should be used to refer to them. In this chapter, we will alternate between person first and identity first language.

One other note about language—keep in mind that some disabled people may use reclaimed terms. Reclaimed terms are words that historically have been considered offensive and have been used to speaking negatively about people with a particular identity. Individuals with these identities later reclaim the terminology that has been used against them and use it proudly as a part of their identity (Popa-Wyatt, 2020). For example, some people with physical disabilities may choose to refer to themselves as “crips,” reclaiming this word that in the past was used to oppress them. If you do not have a physical disability yourself, you should be very cautious about using this terminology. It is usually not appropriate for someone without the identity in question to use a reclaimed term.

Social workers with persons with disabilities

Social workers provide services to a variety of populations on a daily basis. One such population is people with disabilities.  Disabilities can take many forms, such as physical, cognitive, or mental illness (Centers for Disease Control and Prevention, 2016). The broad range of potential disabilities can pose many unique challenges for social workers. It is also important to note that while disabilities can be a singular occurrence for some individuals, disabilities often span across many population segments. In fact, about one in four adults in the United States (26%) have some type of disability (Centers for Disease Control and Prevention, 2020). It is common for people with disabilities to suffer from victimization, stigmatization, and segregation in our society. Therefore, all social workers, no matter what area of social work they are in, should be knowledgeable about the types of disabilities and those who live their lives with them. They must also be able to recognize and address ableism as it arises in their practice.

Below is a video for students to understand social work and disabilities:

Disabilities and their Meanings

There are many different types of disabilities. Sometimes it will be immediately apparent that your client has a disability, and other times they may have what is called an “invisible” or “hidden” disability. These are disabilities that you cannot see just by looking at someone. In fact, you may work with a client and never know that they have a disability diagnosis, so it is important to try to be as accessible as possible in all the work you do. Below is a description of six common types of disabilities: physical, cognitive, mental illness, visual, auditory, and speech. Keep in mind that some clients may also have multiple types of disabilities.

Five images representing types of disability with text reading Cognitive, Visual, Auditory, Motor, Speech

Physical Disabilities

Physical Disability: a limitation on a person’s physical functioning, mobility, dexterity, or stamina. Physical disabilities can take many forms and can occur at any time in an individual’s life. Many physical abnormalities can occur before a person is born, developing in utero. Known as congenital disorders, these impairments can take many forms. Some can be as minor as a birth mark or as severe as a missing limb or internal abnormalities (Nemours, 2017). Sometimes congenital disabilities are referred to as birth defects, but that term is often considered offensive and outdated, so the appropriate description is congenital disability. When a congenital disability proves to be severe and long lasting, it has the potential to develop into a lifelong disability. Infants born with missing limbs or improperly developed physical traits will often grow to have a physical disability. Some physical congenital disabilities can be corrected or improved with medical technology, such as surgeries to correct cleft palates; however, there are many that cannot be corrected, potentially leading to a physical disability.

There are also physical disabilities that occur after birth at any time in an individual’s life. Major accidents are the most common cause of physical disabilities after birth. Car accidents are common accidents that can cause physical disabilities at any time in life. Car accidents can lead to minor injuries, but in severe cases can cause lifelong physical disabilities such as severed limbs, brain, and spinal cord injuries (Disabled World, 2015).

Military personnel are also at substantial risk of procuring physical disabilities through outside means. War can lead to various physical disabilities due to military engagements. The most recent military conflicts have led to high numbers of physical disabilities resulting from IEDs (Intermittent Explosive Devices) which have caused loss of limbs, spinal cord injuries and traumatic brain injuries.

Physical disabilities can impact individuals in a variety of ways. Depending on the nature of the physical impairment individuals may be limited to where they can travel, and the type of employment they can procure. Social workers must be prepared to not only address the physical limitations that a physical disability can pose, but also the emotional impact that one may have on a client. Working with clients who have a physical disability can be a unique and rewarding experience. Each client will require an individualized approach, as not everyone who has a physical disability will cope in a uniformed way.

Cognitive disabilities

Cognitive disabilities, also known as intellectual disabilities, are other forms of disabilities that social workers will encounter in the field. There are many types of cognitive disabilities that can vary in impact, but all affect a person’s mental functioning and skills to some extent.

Some common types of cognitive disabilities are:

  • Down Syndrome
  • Traumatic Brain Injury (TBI)
  • Learning Disabilities

Cognitive disabilities, like physical disabilities, can be present at birth. Any disability that develops before someone reaches the age of 22 is also called a “developmental disability.” Some cognitive disabilities at birth can be almost impossible to distinguish and usually begin to be present in early childhood. Some indicators of cognitive disabilities can be present in infancy, such as the infant failing to meet certain milestones or presenting unusual symptoms such as lack of sleep and inconsolable crying. While these indicators can be present, it is often difficult for medical professionals to diagnose cognitive disabilities in infants and toddlers.

Most cognitive disabilities are diagnosed in childhood and early adolescence. There are several assessments that can be conducted to determine the presence of a cognitive disability. While many medical professionals may suspect a cognitive disability, most often patients are referred out to have the appropriate assessments completed. Once a diagnosis is made there are several forms of therapy that can be performed depending on the type of cognitive disability, and early intervention at young ages can be hugely beneficial.

Even with the advancements in medical technology, there are no “cures” for cognitive disabilities. While various therapies and some medications can help improve cognition and stall deterioration in some, there is no way to fully heal the cognitive disability. Professionals can, however, make many adaptations and accommodations to provide the most accessible services possible to people with these disabilities. Cognitive disabilities can impact individuals on many levels, from employment to personal relationships. With the proper support, people with cognitive disabilities can work, live, and play in their communities. Social workers working with this population must be prepared for the diversity within and the individual challenges faced by those with cognitive disabilities.

The chapter began with a discussion of respectful language, and there are some terms used with people with cognitive disabilities that are worth unpacking. When working with clients with cognitive disabilities, you should avoid using mental age theory. Mental age theory is when someone refers to an adult with a cognitive disability as having the mind of a child (Smith, 2017). It might sound something like, “She is 25, but has the mind of a 5-year-old.” Self-advocates with intellectual disabilities have spoken against this language, explaining that it is disrespectful and hurtful to them. If you find yourself wanting to use this language, take a minute to reflect on what it is you are trying to communicate. What do you mean when you say someone has the mind of a 5-year-old? How could you communicate what you are trying to say differently? For example, you might say something like, “She is 25, but uses pictures to communicate,” or “She is 25, and needs you to talk to her in short sentences of no more than a few words.” Likely there are many other ways you can communicate valuable information about your client without using language that is disrespectful. Never treat adult clients with cognitive disabilities like they are children.

Mental Illness

Mental Illness is considered a wide range of mental health conditions — disorders that affect mood, thinking and behavior. (Merriam-Webster’s collegiate dictionary, 1999)

While many may not consider mental illness to be a category of disability, there are several mental illnesses that impact an individual’s life in such a way that it can be classified as a disability. Mental illnesses such as Schizophrenia, Borderline Personality Disorder, and bipolar disorder can be so severe that an individual’s everyday life is impacted. When a mental illness impairs an individual’s ability to function, it can be considered a disability.

For some mental illnesses, medication can help alleviate symptoms. This is especially true regarding disorders such as Schizophrenia and Bipolar disorder. While there is no cure for these disorders, medication in combination with behavioral therapies can reduce the symptoms. However, there are some mental illnesses that even with medication and therapy can still make coping difficult.

Agoraphobia is a disorder that causes fear of places and situations that might cause panic, helplessness or embarrassment. This is  one disorder that can severely impact everyday functions, to the point where the individual may not even be able to leave their home due to anxiety.

Mental illnesses in themselves can be considered disabilities when they impact an individual’s life to the point of impairing functioning. Mental illnesses can also contribute to other health concerns and behavioral symptoms that impact lives.

Visual disabilities

Individuals with visual disabilities, also sometimes called visual impairments, have a decreased ability to see, even when using glasses or contact lenses. People who are blind may have no ability to see, or very limited usable vision (American Foundation for the Blind, 2020). Visual disabilities may be congenital or can be acquired through disease or injury. Individuals who are blind or have visual impairments may use a variety of strategies to navigate through the world, such as using a guide dog or a mobility cane. Always ask before providing assistance to someone with a visual disability. Remember, they are the experts on their bodies, and they can best decide if they even need help, and if so, how they would like to be helped.

Auditory disabilities

Auditory disabilities impact an individual’s ability to hear sounds, and hearing loss occurs on a spectrum. Deaf individuals have little to no functional hearing, while those who are hard of hearing have some degree of hearing loss and ability (Disabilities, Opportunities, Internetworking, and Technology, 2021). Other terms individuals in this community use are deafblind (for people with hearing and visual disabilities), deaf disabled (for people with hearing and other types of disabilities), or late-deafened (for people who become Deaf later in life) (National Deaf Center, n.d.). Many Deaf people use American Sign Language (ASL) to communicate. They may not identify as having a disability, but rather see deafness as a cultural group with its own language, traditions, and values.

Speech disabilities

Speech disabilities impact an individual’s ability to create the sounds needed to communicate with others (American Speech-Language-Hearing Association, 1993). Many speech disabilities are physical in nature, meaning the individual may have typical cognitive functioning. As you work with a client with a speech disability, you will likely learn more about their speech patterns and be better able to understand them. Never pretend to understand someone if you do not. It is better to ask a client to repeat themselves, or rephrase their statement, than to miss what they are trying to communicate.

While it is important for social workers to know about a variety of disabilities, what may be even more crucial in your practice is the ability to recognize and address ableism. Ableism is a system of discrimination based on the false belief that disabled people are inferior to nondisabled individuals. It is a form of discrimination in which disabled people are oppressed and nondisabled people are privileged (Conley & Nadler, 2022). Unfortunately, ableism is deeply ingrained in our society, and it can take many forms. One such form is physically inaccessible rooms. Think about the spaces where you spend time—your home/apartment, school, workplace, favorite coffee shop, etc. How accessible would those spaces be for someone who uses a wheelchair? Would they be able to easily enter the space, navigate through it, and exit? Surprisingly, the answer to these questions is often “no.” Social work agencies need to regularly review their spaces to ensure they are accessible for all clients, including those with disabilities.

Ableism also shows up in the form of assumptions and prejudices. For example, there is a false stereotype that people with disabilities are asexual. This false belief leads to many harmful practices, such as denying disabled people access to sexuality education (Shandra & Chowdhury, 2012). Discrimination can also cause employers to not hire people with disabilities, contributing to disproportionately high rates of unemployment among disabled people in the United States (Friedman & Rizzolo, 2017). Ableism also leads to people with disabilities experiencing higher rates of violence, such as sexual assault, than their nondisabled peers (McGilloway et al., 2018). These are just a few examples of the devastating consequences of ableism.

Below is a video for the student to understand ableism from a person with a disability perspective:

https://embed.ted.com/talks/lang/en/stella_young_i_m_not_your_inspiration_thank_you_very_much

Ableism can even show up in the language we use! Sometimes, when a person rapidly changes their mind, or is acting in a way that we perceive to be overly emotional, we might say things like, “Oh, he was being so bipolar.” When we say things like this, we do not stop to think about the fact that being bipolar is someone’s actual lived experience, and it is not appropriate or respectful to use someone’s disability to insult someone else. Take a look at the list of words on the right side of the figure below. How many of these words do you use on a regular basis? If you are like most people; you use many of them a lot! Ableism is so common that it creeps into our daily conversations without our conscious awareness. We can all make efforts to use language that is less ableist. In the sections to follow, we will also talk about other ways you can address ableism in your social work practice.

Image text: Say This! Not That! Unreal/insane, unbelievable/crazy, jerk/psycho, awful/stupid, bad/dumb, moody/bipolar, ridiculous/retarded, eccentric/mental case, dismantled/crippled, unruly/mad house

Models of Disability

There are several models that can be used to understand disability and ableism. Three of the most common are the medical, social, and human rights models.

Under the medical model of disability, the person is understood to be disabled by their physical or cognitive condition. Individuals who subscribe to this model believe that the problem is the disability itself, and much of the focus of funding and interventions is on seeking a cure for the disability. This model puts the responsibility on the person with a disability to “overcome” the disability and adapt to the society around them. For example, if a student with dyslexia is struggling to read on grade level with her peers, the medical model would state that the problem is the student’s cognitive abilities.

The social model of disability , on the other hand, suggests that the person is disabled not by their body or mind, but by the inaccessible world our society has created. Advocates who use this model explain that we need to make accommodations to our environments and services, so they are accessible for disabled people. Disability is seen as a normal part of humanity, and it is our collective responsibility to ensure that we create spaces and services for all people. Returning to our example of the student with dyslexia who is not reading on grade level, the social model of disability suggests the problem is not the student’s disability, but rather the strategies her teachers are using to teach her to read. Accommodations need to be made for her disability, so she is better able to learn.

One of the more recently developed approaches is the human rights model of disability . This model emphasizes that disability is a normal part of human diversity, and that disabled people must have the same rights as everyone else. While there are many overlaps between the social and human rights models of disabilities, the human rights model acknowledges that there are some difficult aspects of certain disabilities, such as chronic pain or shorter life expectancy, that will still exist even after societal barriers are removed. This model suggests that individuals should also receive support for these parts of their disability that cannot be addressed through environmental and service accommodations alone (Disability Advocacy Resource Unit, n.d.). Even after the student with dyslexia receives education tailored to her needs, it still may take her extra time to read or to “catch up” to her peers, and she may be frustrated by this process. The human rights model says that we need to advocate for her rights to be treated with respect and care as she reads in the way that works best for her.

Social workers tend to follow the social and human rights models of disabilities. We understand that we have a responsibility to provide accessible services to our clients with disabilities, and to ensure their rights are being respected. The following video provides additional information on these disability models.

The Americans with Disabilities Act (ADA)

Social workers not only have an ethical responsibility to serve individuals with disabilities, but also a legal one. The Americans with Disabilities Act (ADA) was put into place in 1990. It guarantees equal rights for those with disabilities in the United States. It prohibits discrimination against those with disabilities “in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public” (ADA National Network, 2017). The purpose of the ADA is to allow the same opportunities and rights to those with a disability as everyone else.  While this policy has created great advancements for those with disabilities, especially in education and employment, discrimination still takes place daily in our country.

Not everyone with a physical, cognitive, or mental health disability is limited in the same ways and the world has developed to allow more access for those with a physical disability. The Americans with Disabilities Act has helped individuals with disabilities not only because it prohibits discrimination in all areas of public life, but it has also opened many opportunities for individuals with disabilities to gain independence.

Accommodations

One responsibility all social workers have under the ADA is to provide reasonable accommodations for their clients with disabilities. Accommodation allows someone to do something they would not otherwise be able to do, or it makes it easier for them to do these things. All of us have used accommodations at some point in our lives. Perhaps you use spell check before turning in your homework. Or maybe you use a pill box to separate your pills by the day of the week to ensure you are taking your medication properly. Both things are accommodations! There are many different types of accommodations, but we will go over a few common ones here.

  • Accessible language: Have you ever signed a consent document without understanding exactly what you were signing? Many of us have! Too often the language used on intake and consent forms is so complicated that it is no longer understandable for clients. In your social work practice, you are likely to encounter countless opportunities to practice using more plain, concrete, and accessible language. This will not only help you to better communicate with clients with cognitive disabilities, but it will likely be helpful for all your clients, including those without disabilities. If you have the opportunity to design forms, handouts, and/or flyers for clients, take a moment to check the readability of your document before finalizing it. You can also try to use less technical and more accessible speech when you talk to clients. Keep in mind that the average US resident reads at a 7th grade level, and this level is likely to go down by one or two grades when someone is stressed (Taylor, 2018). Using more accessible language will help you better accommodate clients with disabilities and will also be more trauma-informed when working with any clients who have experienced stressors.
  • Physical devices: Many physical devices are also used as accommodations. For example, someone might use a wheelchair, cane, or walker to physically navigate through a space. A hearing aid might improve someone’s ability to communicate with others. Or a grabber might be used to reach items on a high shelf.
  • Changes to the environment or service: Sometimes you might make accommodations for your clients by changing the environment or service provided. If you are working with an autistic client who is sensitive to sensory inputs, you might turn off the overhead light and instead use lamps in your office, or you may seek a quieter space within your building to meet. You might look at the steps leading into your office and advocate for a ramp to be built. All of these are examples of changes made to the physical environment in order to accommodate clients with disabilities. You can also accommodate individuals by adapting your services. If you are working with someone with an intellectual disability, you might pull up pictures on one of your electronic devices to better communicate with your client. Or if you need someone with a visual disability to sign a document, you could either read the document out loud, or send it to them electronically so they can use a screen reader on their device to review the document.
  • Paid Services: Sometimes disabled people use paid services as an accommodation. For instance, your agency may need to contract with an ASL interpreter to work with a Deaf client. Or someone with a physical disability may have a paid personal care attendant who assists them with things such as using the restroom or driving to appointments.

This list of accommodations only barely scratches the surface of the many different types of accommodations you can make for clients in your practice. More often than not, accommodations are simple and low-cost. You do not need to know every possible accommodation that exists—that would be impossible! What’s most important to remember is that the disabled client is the expert in their experience. They know their body and mind best, and they can tell you what accommodations would be most helpful. Allow the client to determine what kind of accommodation you provide.

Sometimes, you may also have to advocate with and for your client for an accommodation. For example, you might ask if your agency has money in its budget for ASL interpretation. If not, why not? Or perhaps your agency does not typically allow someone to have a support person present during services, but your client needs their personal care attendant present to access your services. Part of disability allyship is being willing to advocate for your client on micro, mezzo, and macro levels. This is important for social justice reasons, but also because we are all likely to experience temporary or permanent disability at some point in our lifetimes, either due to an accident or the effects of aging (World Health Organization, 2011). Designing accessible services and environments is beneficial for all.

Competencies for the social worker with individuals with disabilities:

  • Basic to the social worker’s work with those with disabilities is the core belief that persons with disabilities are equals, and a willingness to advocate for any anti-ableist attitudes and social inclusion.
  • Such competency will certainly include the social worker’s willingness to advocate for access to needed resources and for the client’s competency in decision- making.
  • The social worker demonstrates respect for those with disabilities in their incorporation of respectful language, joining advocacy efforts, and challenging beliefs that persons must “overcome” their disabilities.
  • A social worker’s practice being person-centered as well as engaging the person in decisions impacting their life.
  • Practice from a strengths-based perspective that focuses on the person’s existing strengths and resources.
  • Attend to any situations or conditions that are challenging persons with disabilities and their family or support network.

People with disabilities face challenges in modern society that other population segments do not experience. With the various and sometimes limited resources offered, social workers must know how to navigate a system to better provide for their clients. With the rising cost of healthcare and an ever-changing political environment, social workers are tasked with advocating and serving those in the population who may need additional services navigating around the less than accessible parts of the world we live in.  People with disabilities are valuable contributing members of our world and as social workers we must stand to make a better future for all.

ADA National Network. (2017). What is the Americans with Disabilities Act (ADA)? Retrieved from https://adata.org/learn-about-ada

American Foundation for the Blind. (2020, October). Key definitions of statistical terms. https://www.afb.org/research-and-initiatives/statistics/key-definitions-statistical-terms

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. https://www.asha.org/policy/rp1993-00208/

Centers for Disease Control and Prevention (CDC). (2016). Disability overview: Impairments, activity limitations, and participation restrictions. Retrieved from https:// www.cdc.gov/ncbddd/disabilityandhealth/disability.html

Centers for Disease Control and Prevention (CDC). (2020, September 16). Disability impacts all of us. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html#:~:text=61%20million%20adults%20in%20the,is%20highest%20in%20the%20South .

Conley, K. T., & Nadler, D. R. (2022). Reducing Ableism and the Social Exclusion of People With Disabilities: Positive Impacts of Openness and Education.  Psi Chi Journal of Psychological Research ,  27 (1), 21–32. https://doi-org.ezproxy.uta.edu/10.24839/2325-7342.JN27.1.21

Disabilities, Opportunities, Internetworking, and Technology. (2021, April 9). How are the terms deaf, deafened, hard of hearing, and hearing impaired typically used? https://www.washington.edu/doit/how-are-terms-deaf-deafened-hard-hearing-and-hearing-impaired-typically-used

Disability Advocacy Resource Unit. (n.d.). How does the human rights model differ from the social model? https://www.daru.org.au/how-we-talk-about-disability-matters/how-does-the-human-rights-model-differ-from-the-social-model

Disabled World. (2015). Accidents and disability information: Conditions and statistics. Retrieved from https:// www.disabled-world.com/disability/accidents/

Dwyer, P. M. A. (2022). Stigma, incommensurability, or both? Pathology-first, person-first, and identity-first language and the challenges of discourse in divided autism communities. Journal of Developmental & Behavioral Pediatrics, 43 (2), 111-113. doi: 10.1097/DBP.0000000000001054

Friedman, C., & Rizzolo, M. C. (2017). “Get us real jobs:” Supported employment services for people with intellectual and developmental disabilities in Medicaid Home and Community Based Services Waivers.  Journal of Vocational Rehabilitation ,  46 (1), 107–116. https://doi-org.ezproxy.uta.edu/10.3233/JVR-160847

Kids Health. (2017). Birth defects. Retrieved from https://kidshealth.org/en/parents/birth-defects.html

McGilloway, C., Smith, D., & Galvin, R. (2020). Barriers faced by adults with intellectual disabilities who experience sexual assault: A systematic review and meta‐synthesis.  Journal of Applied Research in Intellectual Disabilities ,  33 (1), 51–66. https://doi-org.ezproxy.uta.edu/10.1111/jar.12445

Merriam-Webster’s collegiate dictionary (10th ed.). (1999). Springfield, MA: Merriam-Webster Incorporated.

National Deaf Center. (n.d.). Defining deaf. https://www.nationaldeafcenter.org/defining-deaf

Popa-Wyatt, M. (2020). Reclamation: Taking back control of words.  grazer philosophische studien ,  97 (1), 159-176.

Shandra, C. L., & Chowdhury, A. R. (2012). The first sexual experience among adolescent girls with and without disabilities.  Journal of Youth and Adolescence,   41 ,  515–532. https://doi.org/10.1007/s10964-011-9668-0

Smith, I. (2017, September 7). Mental age theory hurts people with intellectual disabilities . NOS Magazine. http://nosmag.org/mental-age-theory-hurts-people-with-intellectual-disabilities/?fbclid=IwAR3rIowvza–suPeczRKzMiw0CAKCtfQEc92vS6RyacqUD6zBAJ80rUB8Lk

Taylor, Z. W. (2018). Unreadable and underreported: Can college students comprehend how to report sexual violence?  Cultivating safe college campuses conference . docs.wixstatic.com/ugd/7c1e05_885eec3ce6c1425bb4c0cd6947c7638d.pdf

Workplace Fairness. (2017). Disability discrimination. Retrieved from https:// www.workplacefairness.org/disability-discrimination

World Health Organization. (2011).  World Report on Disability  (Rep.). Geneva, Switzerland.

Introduction to Social Work: A Look Across the Profession Copyright © 2022 by Emily E. Clarke, BSW and Megan R. Westmore, LMSW is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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‘I want to improve things for people’: seven social workers reveal why it’s such a rewarding career

Social work can be seen as a difficult job, but many of those working in the sector say it brings professional fulfilment and career opportunities

Ola Finch knew from the age of 14 that she wanted to be a social worker. Privately fostered to white families months at a time when her Nigerian parents returned home to study, she understood first-hand the power the profession has to help change lives. “I was being fostered in Norfolk and I think at that time in the 1980s they didn’t really know what to do with this black child,” says Finch. “There was pressure on me to return home, but my social worker advocated for me – she was the first person to listen to me in order to work out the best outcome for me. This experience fuelled my desire to be a social worker – I wanted to be able to do something like this for somebody else.”

Finch, 49, a senior services manager for learning disability services with more than 20 years’ experience in adult social services at Norfolk county council, says it is a perfect career choice if you are interested in community and society. “Using your position to develop a strategy with people who use the service and to make changes can be very empowering,” she says.

Ola Finch

That is a view shared by Vava Tampa, 36, deputy head of social work and social care at Central and North West London NHS foundation trust. “When I was growing up I saw how trauma and social issues had an impact on mental health, that’s what led me to this job – I wanted to improve things for black people and their mental health.”

The desire to change lives is what motivates people to train as a social worker, especially those who have decided to switch careers. Natalie Maxim opted to make the swap while working during Covid in adult social care recruitment and retention for Surrey county council. “I was supporting staff in care homes who were going beyond, and doing everything they could in the most extraordinary circumstances,” she says. “I was inspired by what I saw and it made me question whether I was getting enough satisfaction from the role I did.”

Today, Maxim, 44, is following a social work degree apprenticeship, which allows her to apply her learning in the workplace. “Managing the study while working is hard, but I am applying what I learn every day at work. I think my 20 years of life and work experience are worth quite a bit. I’m not fazed by much, which is probably a benefit.”

Helen Gormley, who gave up her job as a bank manager to become a social worker, says it was the opportunity for career progression that attracted her to the profession. “In my old job after four or five years you’d be expected to leave and move on. But in social work, I can do something different and still develop my career and go down different pathways,” says the 52-year-old child protection team manager for Gloucestershire county council. “Now if I wanted I could move into adoption and fostering for example – my degree isn’t wasted.”

A social work degree can open doors to new career paths across the public and voluntary sectors, such as teaching and research, management and leadership, social policy, campaigning and advocacy. Ruth Allen, chief executive officer at the British Association of Social Workers , says: “I don’t think we are overt enough about that. I think there is such a focus on the need to fill statutory roles [in children and adult services] that you can easily paint a picture that the career is a bit of a cul-de-sac rather than an opportunity.”

Catherine Andrews

Ruth Tudor-Robb, deputy team manager in adult social care at Essex county council, says knowing the degree guaranteed a definite career was a big pull when she was forced to give up her job as a peripatetic singer and instrument teacher in county primary schools because of osteoarthritis in her hands and wrists. “It took me a few years in the profession for me to realise that my music background had given me numerous transferable skills,” says 55-year-old Tudor-Robb. “As a musician I was constantly reflecting on my work and what I would do differently next time – skills which absolutely apply in social work.”

There is a tradition, says Allen, of career changers coming into social work and bringing their life and work experiences with them, which “enrich” the profession. Typically, about 40% of students on postgraduate social work degree programmes are career changers. Last year, 33% of graduates who joined the mental health social work programme Think Ahead had switched careers.

Catherine Andrews, 32, is a career changer and practice specialist at Think Ahead, where she supports trainees through the programme and their first year in practice. She gave up a job as a benefits adviser at the Department for Work and Pensions to train as a social worker. “I wanted to understand people better and be able to support them to where they wanted to head,” she says, adding: “I always say I didn’t choose social work – it chose me.”

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Five Tips for People with Vision Loss from Lighthouse Guild Social Workers

March 12, 2024

five social work tasks or roles with adults

March is National Social Work Month

NEW YORK (March 12, 2024) — Social workers are essential in helping people with vision loss manage challenges. From addressing urgent and chronic life issues, to making sure people can get to their appointments, get their medications and access needed medical equipment, social workers are on hand to offer professional guidance and smooth the way. 

“When a person receives a diagnosis of vision loss, it can initially be devastating,” says Jocelyn Tapia, LCSW-R, Clinical Social Worker at Lighthouse Guild. “Social workers coordinate care, connect people with resources, and offer a listening ear. We are licensed to assess biological, psychological, and social situations, and make mental health diagnoses.” 

Lighthouse Guild social workers offer five tips to help individuals and their families cope with vision loss: 

  • Education is crucial. Having an evaluation with an eye specialist and obtaining an understanding of your specific eye condition and any possible treatments is the first step. 
  • Include your loved ones in important conversations. Familiarizing your loved ones with your eye condition is helpful. Loves ones can be present during eye appointments and help make necessary adjustments and accommodations at home to ensure safety.
  • Seek mental health counseling. Vision loss involves an adjustment period where people may experience anxiety and depression. Counseling provides a safe space for an individual to process feelings, grieve their loss of independence and acquire coping mechanisms to adapt to their new normal. 
  • Meet with a low vision specialist. Low vision services aim to maximize remaining vision. A low vision doctor can evaluate, prescribe, and recommend visual aids, adaptive devices, and orientation and mobility training all of which can contribute to an individual maintaining a certain amount of independence. 
  • Consider joining a support group. Support groups offer individuals an opportunity to connect and relate to a larger community which often reduces feelings of loneliness and isolation. 

Social Work at Lighthouse Guild

At Lighthouse Guild, social workers serve in many different roles — from psychotherapists at the Behavioral Health Center, providing individual, couples, family and group therapy; to the Health Center, providing support groups helping patients to remove obstacles to accessing medical and vision care; to GuildCare, the Adult Day Health Care program, assessing and monitoring the bio-psycho-social needs of each client, throughout the day; to the Rehabilitation Department, providing emotional support and guidance to individuals seeking education and work, as they establish and pursue their goals. To further help in the cycle of care, many Lighthouse Guild program directors and administrators are also social workers.

Lighthouse Guild Lighthouse Guild provides exceptional services that inspire people who are visually impaired to attain their goals. Our podcast series, “ On Tech & Vision with Dr. Cal Roberts ” offers information and insights about technological innovations that are tearing down barriers for people who are blind or visually impaired. For more information, visit  Lighthouseguild.org .

Source:  Lighthouse Guild

Press Contact:  Bryan Dotson, Manners Dotson Group, 917-796-8632, [email protected]

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Lighthouse Guild is dedicated to providing exceptional services that inspire people who are visually impaired to attain their goals.

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five social work tasks or roles with adults

CDC updates Covid isolation guidelines for people who test positive

A passenger wears a mask while riding a train in Washington, D.C.

People who test positive for Covid no longer need to isolate for five days , the Centers for Disease Control and Prevention said Friday.

The CDC’s new guidance now matches public health advice for flu and other respiratory illnesses: Stay home when you’re sick, but return to school or work once you’re feeling better and you’ve been without a fever for 24 hours.

The shift reflects sustained decreases in the most severe outcomes of Covid since the beginning of the pandemic, as well as a recognition that many people aren’t testing themselves for Covid anyway.

“Folks often don’t know what virus they have when they first get sick, so this will help them know what to do, regardless,” CDC director Dr. Mandy Cohen said during a media briefing Friday.

Over the past couple of years, weekly hospital admissions for Covid have fallen by more than 75%, and deaths have decreased by more than 90%, Cohen said.

“To put that differently, in 2021, Covid was the third leading cause of death in the United States. Last year, it was the 10th,” Dr. Brendan Jackson, head of respiratory virus response within the CDC’s National Center for Immunization and Respiratory Diseases, said during the briefing.

Many doctors have been urging the CDC to lift isolation guidance for months, saying it did little to stop the spread of Covid.

The experiences of California and Oregon , which previously lifted their Covid isolation guidelines, proved that to be true.

“Recent data indicate that California and Oregon, where isolation guidance looks more like CDC’s updated recommendations, are not experiencing higher Covid-19 emergency department visits or hospitalizations,” Jackson said.

Changing the Covid isolation to mirror what’s recommended for flu and other respiratory illnesses makes sense to Dr. David Margolius, the public health director for the city of Cleveland.

“We’ve gotten to the point where we are suffering from flu at a higher rate than Covid,” he said. “What this guidance will do is help to reinforce that— regardless of what contagious respiratory viral infection you have — stay home when you’re sick, come back when you’re better.”

Dr. Kristin Englund, an infectious diseases expert at the Cleveland Clinic, said the new guidance would be beneficial in curbing the spread of all respiratory viruses.

“I think this is going to help us in the coming years to make sure that our numbers of influenza and RSV cases can also be cut down, not just Covid,” she said.

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Still, the decision was likely to draw criticism from some clinicians who point to the fact that the U.S. logged 17,310 new Covid hospitalizations in the past week alone.

“It’s something that is likely to draw a wide array of opinions and perhaps even conflicting opinions,” said Dr. Faisal Khan, Seattle’s director of public health. “But [the CDC’s] rationale is sound in that the pandemic is now in a very different phase from where it was in 2021 or 2022 or 2023.”

Though the isolation guidelines have been wiped away, the CDC still encourages people to play it safe for five days after they are feeling better. That includes masking around vulnerable people and opening windows to improve the flow of fresh air indoors.

The majority of viral spread happens when people are the sickest. “As the days go on, less virus spreads,” Cohen said.

People at higher risk for severe Covid complications, such as the elderly, people with weak immune systems and pregnant women, may need to take additional precautions.

Dr. Katie Passaretti, chief epidemiologist at Atrium Health in Charlotte, said it was a “move in the positive direction.”

“We are continuing to edge into what the world looks like after Covid, with Covid being one of many respiratory viruses that are certain that circulate,” she said.

The new guidance is for the general public only, and does not include isolation guidelines in hospital settings, which is generally 10 days.

On Wednesday, the agency said that adults 65 and older should get a booster shot of the Covid vaccine this spring. It’s anticipated that the nation will experience an uptick in the illness later this summer.

Winter and summer waves of Covid have emerged over the past four years, with cases peaking in January and August, respectively, according to the  CDC .

Another, reformulated, shot is expected to be available and recommended this fall.

CDC’s main tips for reducing Covid spread:

  • Get the Covid vaccine whenever it is available. Cohen said that 95% of people who were hospitalized with Covid this past winter had not received the latest vaccine.
  • Cover coughs and sneezes, and wash hands frequently.
  • Increase ventilation by opening windows, using air purifiers and gathering outside when possible.

five social work tasks or roles with adults

Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

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  4. What Do Social Workers Do?

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  5. What Does a Social Worker Really Do? Main Roles of a Social Worker

    The general role of a social worker includes the following types of activities: Identify people or communities in need of assistance. Conduct assessments for clients (needs, strengths, situation, and other types of assessments) Make recommendations for helping the client with the problem situation.

  6. What Does a Social Worker Do?

    This branch of social work deals with big-picture issues of policy, leadership, and applied research. Here social workers do things like design proactive social work campaigns and society-level responses to widespread community challenges like addiction, violence, and poverty. There's also a large segment of social work that's academically ...

  7. What Does a Social Worker Do?

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  8. Types of Social Work

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  9. What does a social worker do?

    Social workers are dedicated to helping people overcome personal and societal obstacles by providing support, resources, and advocacy. They play a vital role in addressing issues related to mental health, poverty, family dynamics, healthcare access, substance abuse, and more. Social workers work across diverse settings, including hospitals, schools, social service agencies, community ...

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    A social worker has special training to help people with challenging situations in their everyday lives. They can help individuals (like a child or adult) or groups of people (like families or communities). Clinical social workers can diagnose and treat mental health and behavioral conditions. They're also called licensed clinical social workers.

  11. PDF Role and responsibilities: adult principal social worker (PSW)

    Amongst other tasks the PSW role should also: Support effective social work supervision and decision making. Oversee quality assurance and improvement of social work practice. Advise the DASS and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice.

  12. Social work with adults experiencing complex needs

    Definition of adults with complex needs for the purpose of this guideline. Adults with complex needs are defined as people aged 18 or over who need a high level of support with many aspects of their daily life, and relying on a range of health and social care services. This may be because of illness, disability, broader life circumstances or a ...

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  14. Role and responsibilities: Adult Principal Social Worker

    This guidance sets out the role, function and purpose of a Principal Social Worker (PSW) in adult services. It includes a person specification which indicates essential and desirable experience, skills, and personal attributes of the role. It will help inform job descriptions support employers when recruiting to the role. It also clarifies what social workers and other practitioners can expect ...

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    Practice and role-play can help social workers prepare for a more successful social interaction and gain confidence in their coping abilities. Motivational Interviewing in Social Work "Change can become difficult for service users when they are ambivalent about the extent to which the change will be beneficial" (Davies, 2013, p. 451).

  16. What does an Adults Social Worker do? Role & Responsibilities

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    9. Leadership. Social workers must have leadership skills to help promote social change. In your role, you'll engage with stakeholders and organizations to manage strategy, advocate for positive change and maintain relationships. You may be required to have a "take charge" attitude as an advocate for your clients.

  21. Effective Social Work with Older People

    What is the social work role? 5.3 To provide a framework, this section takes a brief look at some standard texts, written for social workers and students, which address the role of the social worker with older people. ... 5.58 A key task in social work with older people is to weigh up the promotion of independence, self determination and ...

  22. Social Work with Persons with Disabilities

    A social worker's practice being person-centered as well as engaging the person in decisions impacting their life. Practice from a strengths-based perspective that focuses on the person's existing strengths and resources. ... Reducing Ableism and the Social Exclusion of People With Disabilities: Positive Impacts of Openness and Education. ...

  23. 'I want to improve things for people': seven social workers reveal why

    Ola Finch knew from the age of 14 that she wanted to be a social worker. Privately fostered to white families months at a time when her Nigerian parents returned home to study, she understood ...

  24. A day in the life of a social worker (description and FAQs)

    Social workers help people in need. This role can be quite varied and involves lots of time working with others. If you're interested in becoming a social worker, knowing what to expect from the role can help you decide if it's the right choice.In this article, we explain what a social worker is, describe a day in the life of a social worker, discuss the requirements for this role and answer ...

  25. Five Tips for People with Vision Loss from Lighthouse Guild Social

    March is National Social Work Month. NEW YORK (March 12, 2024) — Social workers are essential in helping people with vision loss manage challenges. From addressing urgent and chronic life issues, to making sure people can get to their appointments, get their medications and access needed medical equipment, social workers are on hand to offer professional guidance and smooth the way.

  26. Social Work Education on Transgender and Gender Nonconforming People

    All social workers must be prepared to work effectively with transgender and gender nonconforming (TGNC) people. This work relies on social workers' knowledge, skills, and self-awareness. Social workers who lack knowledge, skills, and self-awareness of the dimensions of gender diversity can create barriers to care for TGNC people.

  27. CDC updates Covid isolation guidelines for people who test positive

    The CDC's new guidance now matches public health advice for flu and other respiratory illnesses: Stay home when you're sick, but return to school or work once you're feeling better and you ...