RN22_10: Risk, Healthcare and Professional Work
Personalising Risk: Social Workers' Perspectives On The 'Making Safeguarding Personal' Approach To Adult Protection.
University of Bath, United Kingdom
Safeguarding adults forms a core part of adult social work and involves workers making efforts to assess risk and protect adults from abuse. In England and Wales, social workers have been encouraged to adopt a ‘Making Safeguarding Personal’ approach. This involves prioritising the needs and wishes of the person at risk when considering how such risks should be managed.
Drawing on ethnographic research data in three local authorities in England, this paper considers safeguarding practice using governmentality theory. The findings draw on observations of and interviews with social workers involved in safeguarding assessments.
Social workers were positive about the idea of involving people in their own assessments of risk. However, several dilemmas were raised. First, initial assessments were conducted by telephone. This made it hard for workers to assess whether individuals had the mental capacity to make informed decisions or whether the person assessed was subject to coercion. Second, social workers identified that some individuals were unwilling to engage in risk discussions, making personalised practice challenging. Third, several social workers were reluctant to be explicit about safeguarding procedures when meeting with individuals, due to concerns about the person becoming alarmed or upset.
Several benefits were identified by social workers in adopting ‘Making Safeguarding Personal’. The approach was presented as ‘empowering’ to the person being assessed, through discouraging paternalism. It was also seen to reduce unreasonable demands for risk reduction amongst other agencies such as the police or ambulance service. In addition, adopting the approach enabled social workers to engage with individuals over a prolonged period, in the context of managerial pressure to close cases quickly.
Political Representation as Social Work: Unearthing the Risk Work of Constituency Members of Parliament in the UK
University of Kent, United Kingdom
The relationship between politicians and social workers in the UK is complex and has been prone to continuous cycles of crisis and reform that can be traced back to the 1970s. Each crisis is precipitated by media, public and political reaction to a significant event or scandal. Hostile media coverage of social workers, combined with unrealistic expectations about their capacity to assess and manage risk, have had a deeply negative impact on frontline practice; made worse by increased demands and reduced resources under austerity.
In analysing the role of the politician in relation to social work, attention to-date has largely focused on their position as outsiders - either as policy-makers and legislators who react to adverse events and create the problematic conditions for the risk work that is undertaken in practice, or as commentators on a media story as it unfolds. This role can be conceptualised in terms of the politics 'of' social work. In contrast, this paper explores a conceptualisation of politics 'as' social work.
The paper draws on semi-structured interviews with British Members of Parliament, where the focus is their experience of formal state social work through activities of political representation in their constituencies. The MP accounts show how they are faced with a complex and often contradictory set of demands in relation to risk, trust and uncertainty. When risk work is understood as emotional, moral and value-laden rather than simply rational-technical in character, the boundaries between politicians and social workers as actors in state-society relations are disrupted.
Developing A Post-Formal Approach To Analysing Risk Work: A Case Study Of Tensions Experienced Amid A Public Health Intervention In A Dutch City
1University of Amsterdam, Netherlands, The; 2University of Leiden, Netherlands, The; 3University of Birmingham, UK
Decision-making amid uncertainty is inherent to healthcare work and it is
common to recognise risk as a defining mode through which uncertainty
is handled in late-modern organisations. Risk, as abstract knowledge,
seems straightforward to apply across populations but results in various
paradoxes and tensions when applied to individuals by client-facing
(para)professionals. Recent research into ‘risk work’, especially in public
health interventions, has noted such tensions but has not focused on
them as a central feature of analysis. Drawing on a quasi-ethnographic
study of a parent-focused public health intervention in a large Dutch city,
we develop a post-formal analysis which emphasises tensions and
incoherencies as important to grasping (para)professional practices and
identities. These tensions – for example around risk categories, as
abstract knowledge is reinserted into concrete social contexts – also
illuminate wider paradoxes and developments in knowledge frameworks,
organisational dynamics and (para)priofessional authority. Using
Bechky’s work on workplace artefacts as a starting point, we analyse risk
as one such organisational technology. Yet while these artefacts are
usually politicised and contested, we understand the lack of explicit
contestation of this technology in terms of the sacred nature of the
central risk object (children), and related ritual processes which impede
Foreign-trained Professionals’ Integration: Are Institutional Disjunctions Endemic?
Université TÉLUQ, Canada
As numerous authors analysing professions from a social science perspective have shown (Freidson, 2001; Champy, 2012; Ruhs, 2013; Saks, 2015), every society regulates some professions to frame an equilibrium between the State, the market and the economy. In that respect, every jurisdiction has its own history and ultimately, culture that structures and defines regulation of these professions. Furthermore, entry of foreign-trained professionals into professional practice involves a complex process through immigration, recognition and complementary training. Neo-institutionalist framework (Riza, 2008) helps to analyze how institutions and actors cooperate (or not) towards this integration. Building on analysis of Quebec’s evolving professional system, institutions and actors, this presentation looks at how actors are shedding criticisms, mainly pointing at corporate self-interest, by invoking protection of the public and complications due to institutional disjunctions, to which they sometimes contribute. Based on data from a literature review, open-ended interviews and grey documentary analysis, I describe how actors and institutions are putting in place adaptations and measures opening to a smoother integration of regulated professionals, despite their deep history of conservatism. This is further complicated by a complex set of rules and by-laws, in addition to Charters of Rights, which acts sometimes as institutional obstacles justifying delays, and as moral devices to which everyone agrees and abides. Finally, our analysis leads to propositions as to how “institutions think” (Douglas, 1985) in a web of interactions between multiples levels of institutions and actors.