Operation B: Risk analysis and harm reduction (operations 5, risk 1)

Social work is about change. It is either actively inducing change to improve one’s life or striving to contain the imminent change, i.e. conserving the person’s assets and benefits in coming perturbations (e.g. old age, illness). The change brings risks – with its benefits and dangers.

We live in a changing and risk society (Beck 1992) and we have to deal with it. Furthermore, macro-social risks, like pollution, natural catastrophes, climate change, political and military conflicts, economic crises and others strike the most the poorer, marginal and powerless segments of the society. Social work is the profession, which deals with “vulnerable groups”, i.e. the people who are exposed to societal stress to a greater degree or who, on the account of their life-situation, find themselves facing intense challenges that can result in massive distress.

Notwithstanding exposure to societal risk, ones produced by the “society”, there is a number of other instances where our life changes and presents risks to be taken. Various life events, passages, identity crises or even quite banal unexpected and unprecedented happening, no matter whether they are mishaps or just ‘haps’, occur in the life-course, affect daily routines.

Life events

Life events are highly stressful events that fundamentally change our Life-World. These events not only heighten the energy levels of functioning but also turn our notions of everyday life upside down, change the meanings, roles and alliances. This happens not only in adverse, undesired events like loss of a dear person, loss of employment, eviction, illness but also in the events that we deem positively, which we desire – like getting married, getting a child, a new job, new home etc. The research has shown that if few such events happen in a certain period (e.g. 6 months) some consequences to mental and physical well-being are very likely to happen (Holmes & Rahe 1967, Nastran Ule 1993, Gallagher 1995: 329–333, Lamovec 1998: 215–220).

Social work is very often (habitually) placed in a statutory position of a guardian whose role is to deal with hazards of people’s lives and to secure the best possible outcomes. It is an instance, to which people can turn to, when they see their own social, personal or financial capacities as insufficient to deal with the risk situation.  The task of social work is to assess the degree of risk and to provide response, provision that would diminish the risk to an acceptable measure. Risk is therefore often a measure of the entitlement to social or other provision. The assessment may be a rather simple one as in testing the means in the case of financial benefits or quite a complex one as in case of family violence and similar.

The risk taking is, however, constituent of person’s identity and self in the contemporary, capitalist society (and probably in post-capitalist too). People should be enabled to take risks (not just avoid them). The finality, the purpose of risk analysis is harm reduction, or better – the security of venture – being able to do things without exposing oneself to exaggerated, unnecessary or unwanted risks.

This is why the risk should be analysed and not just assessed. The main analytical tool is to distinguish in the risk situation the hazards, the dangers (harm) and the benefits (or even profits) of risk taking, and simultaneously consider the measures that would reduce the harm.

Distinguishing these elements of risk is necessary, since the circumstances that make a situation risky or hazardous, are in everyday life often confounded with the actual events that are dangerous. If one is psychotic, he or she is not necessarily dangerous. Statistically speaking on average not any more than any sane person, but psychotic behaviour introduces certain unpredictability of action. Hence, the assessment of the intensity (seriousness of the hazard) and the quality of psychotic situation must be done separately from assessment of the probability of a dangerous event (and combined into a risk formula only subsequently).

Moreover, the favourable events, the benefit of risk taking, and their probability must be taken into account, and be weighed against the odds of the situation. Benefits are the rationale of the risk taking behaviour. Finally, it would be unethical (and even stupid) to assess only the risks without considering the means of reducing the possible harm. It is not only the way of finding out the least harmful way of securing the benefits, but also about using the least constrictive measures to avoid harm.

These should be foreseen on various points of intervention: as means of preventing risk (not driving when drunk), as ways of accommodating the dangerous events (wearing a helmet) and modes of repairing the harm (insurance, making up). Various means of the harm reduction may be used: technical (smoke detectors, helmets, electronic devices), educational (informing, awareness raising, learning skills etc.), social (escorting, containing, mediating …), legal (written agreements, advance directives, court induced restrictions …).

In risk analysis we therefore: analyse the situation, pronounce the intensity of the risk, its acceptability and plan the risk reducing intervention. It is about securing the life situation and providing support in risk taking. 

Social work is producing change.

Social work is not needed to maintain what there is. Where routines are established, where forms have to be filled, where procedures are set and to be followed, Bill Jordan (1987) says, there is no need for social work. Social work is needed where change is necessary, where distress is so great that people cannot cope with it anymore, where change is happening and assistance is needed to fare better through the process, where a change has happened and we have to learn to live with it, or when there is a substantial possibility for a change to occur and we want to get ready for it; or prevent it. 

References:

Ulrich Beck (1992) Risk Society: Towards a New Modernity. New Delhi: Sage. (Translated from the German Risikogesellschaft) 1986.

Gallagher, B.,J. (1995) The Sociology of Mental Illness. Engelwood Cliffs: Prentice Hall.

Holmes, T. H., and Rahe, R. H. "The Social Readjustment Rating Scale." Journal of Psychosomatic Research 11 (1967): 315–328.

Jordan, B. (1987), Counselling, Advocacy and Negotiation. British Journal of Social Work Vol. 17, N. 2 (April 1987): 135-146.

Lamovec T. (1998), Psihosocialna pomoč v duševni stiski, Ljubljana: Visoka šola za socialno delo.

Nastran-Ule, M. (1993), Psihologija vsakdanjega življenja. Ljubljana: Znanstveno in publicistično središče.

Operation A: Needs, claims and entitlement (operations 3, Life-World 2)

Needs

This kind of mapping and in the context of accessing the resources is often termed needs assessment.

Needs are a paramount term in social work and social policy, as well as in general discourse. It not only lacks clarity but is also problematic because of its normative nature. Based on the biological proposition of homeostasis, it presupposes a lack, a deficit, which can easily be ascribed to an individual person, group or community rather than to a situation, social relationships or the system. In doing this, it is a devaluating mechanism and a misleading tool of action. Besides, it is normative in sense of prescribing the nature of what people need and the quantity of what they are entitled to. However, they implicitly express rights for some kind of welfare provision. In fact, the term of ‘needs’ mask the rights into a socio-biological given.

Illich (1992) historically deconstructs needs into desires or wishes on one hand and the necessities on the other. Desires meaning what somebody wants or wishes to do, to happen, while necessities are about social or material contingencies of what ought to be done, to happen. Rather than using concept of “needs” in order to integrate this dialectical double, “goals” can be used as a such integrative term in alternation with desire; thus stressing the volition and accumulation rather than predetermined state and the lack. The “needs”, however, will remain in use, for time being, albeit just as a technical term. 

The goals and desires might be directly placed on the map or deduced from its intricacies – contradictions, gradients etc. of the everyday life. Once identified and articulated they will be transformed into claims (applications, requests), which are to be placed in the system and eventually brought back to the claimer as entitlements or eligibility. However, the claims have to be evaluated, assessed, usually by experts and according to some rules. Once claim is granted, the claimer transforms from a claimer to a beneficiary, a recipient. The resource is to be integrated into his or her Life-World.

When this operation is about mobilisation of the (dormant) resources in one’s own Life-World it may still be about putting claims on others that share this Life-World, but it is also about participation, membership, and person’s contribution to a group, network or community. It is also about recovering the ground and instigating doing something in common good.

Claiming should not be seen as a selfish, egotistic action, just for one’s personal benefit. When it is about claiming from the public resources it is an act of “redistribution” and “re-appropriation” of a public goods into the common good, based on rights rather than needs. When claim is placed on the others in the community, it must be seen a creation of something that works for a common good.

When the claim is approved, sometimes formally sometimes informally, delivery is to be performed. In the case of simple matters, such as simple financial benefit, the delivery is simple as well. In the case of complex provision of services and benefits, the delivery entails besides the direct provision, coordination, care for continuity and monitoring of the effects. When it is about informal provision the attention must be given to the stability of newly mobilised resources, e.g. by giving needed support to participants, also coordination and common interest. Attention must be given also to the interface of the Life-World with “other worlds” in a way that the latter do not overrun the former, that the “colonialization” impact of the abstract scheme is reduced to a minimum.

The best example of this basic operation is person centred care (personal planning and coordinating care). It is based on the personal plan, which presents and analyses person’s life situation, establishes personal goals and operatively sets them in motion by listing the providers, the needed means and resources, sets the deadlines and, in case of direct funding, calculates the costs. It begins with an individual person, consults with other actors involved and is usually approved on a team conference. After that, it is beginning to be delivered with a support of the care coordinator. (Further reading:  Brandon, 1994; Glasby, 2002; Rafaelič, Nagode, Flaker, 2013).  

References:

Brandon, D., Brandon, A. (1994), Yin and Yang of Care Planning. Cambridge: Anglia University.

Glasby, J., Littlechild, R. (2002), Social Work and Direct Payments. Bristol: Policy Press.

Illich, I. (1992), Needs. V: Sachs W., (ed.) The Development Dictionary. London: Zed Books: 88-101.

Rafaelič, A., Nagode, M. & Flaker, V. (2013) ‘Direct payments as a means of long-term care provision and a vehicle of resettlement from total institutions’, Dialogue in praxis, Volume 2 (15), Issue 1—2 (24—25), 2013, pp. 93—109. [Online] available at: http://dialogueinpraxis.fsd.uni-lj.si/index.php?id=5&a=article&aid=30