Case Example

The social worker approaches the situation using all three perspectives – rational/technical, moral/ethical, structural/rights-based. You will see 6 examples. For each, can you identify how each approach informas practice at key points?

1. The doctor’s referral leads the social worker to visit Lech and Maria to discuss their needs and identify what support can be provided. Which approach is she likely to be using?

Rational/Technical Approach

The rational/technical approach might lead the social worker to

  • identify Maria as a person who may be in need of community care services, and is therefore eligible for an assessment
  • recognise Lech as a carer, with entitlement to assessment of his needs, and possibly community care needs of his own
  • consider whether either Lech or Maria meet the legal definition of a disabled person
  • recognise they may have mental health needs

But applying the law to practice cannot be done without also considering values and rights.

Assessment duties

  • There is a duty to assess Maria and possibly Lech also for community care services under s.47 NHS and Community Care Act 1990
  • If either Lech or Maria meet the definition of ‘disabled’ under s.29, National Assistance Act 1948, then assessment is also needed under s.4, Disabled Persons (Services, Consultation and Representation) Act 1986
  • There is a duty to assess Lech’s needs as a carer under the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004

Moral/Ethical Approach

The moral/ethical approach might lead the social worker to

  • focus on both Lech and Maria’s perception of their situation
  • draw on her professional value base in approaching them with respect
  • ensure their participation in her assessment
  • recognise that their views, needs and interests may differ, and that there may well be no one obvious way forward

But applying social work values in this situation cannot be done in isolation – there are legal powers and duties, as well as broader issues of rights to be considered.

Structural/Rights based Approach

The structural/rights-based approach might lead the social worker to

  • recognise Lech and Maria’s position in their environment and community – the broader context of their lives
  • assess how their environment might be presenting barriers to their inclusion and well-being
  • be alert to the dynamics within their relationship, the extent to which each is able to exercise autonomy
  • consider the possibility that abuse is taking place

But these issues cannot be resolved without recourse to legal frameworks, or in isolation from professional values.

2. Once the assessment has taken place, the social worker offers Lech and Maria a range of services designed to meet the needs that have come to light during the assessment.

Which perspective is dominant?

Rational/Technical Approach

The rational/technical approach might lead the social worker to

  • put together a care package that draws on a range of legal mandates
  • provide primarily for services to meet needs for personal care and support for both residential and domiciliary provision.

But applying the law to practice cannot be done without also considering values and rights

Service provision powers and duties

  • Residential care under Part 3 of the National Assistance Act 1948 if either Lech or Maria is in need of care and attention that is not otherwise available to them
  • Services (such as meals, social work advice, home help and adaptations, rehabilitation support) to promote Lech and Maria’s welfare as older people under s.45 of the Health and Public Services Act 1968
  • Services (such as meals, social work advice, home help and laundry, rehabilitation support, recreation and occupation) that Lech and Maria might need in order to prevent illness or support the care or aftercare of illness, under s.21 and schedule 8 of the NHS Act 1977
  • Services (such as practical assistance at home, equipment, recreation, home adaptations, holidays, meals, telephones) to Lech and Maria under s.2 of the Chronically Sick and Disabled Persons Act 1970, provided they meet the definition of ‘disabled’

Moral/Ethical Approach

The moral/ethical approach might lead the social worker to

  • consider how Lech’s and Maria’s needs and interests might conflict, and how she can balance these within the provision that is offered
  • address such dilemmas by recognising that the ‘right thing to do’ will be a finely-tuned balance achieved through reference to moral codes that help prioritise competing interests

But applying social work values in this situation cannot be done in isolation – there are legal powers and duties, as well as broader issues of rights to be considered.

Structural/Rights based Approach

The structural/rights-based approach might lead the social worker to

  • explore ways in which Lech’s and Maria’s social exclusion can be addressed, through perhaps language, finance, housing, community support facilities
  • consider whether they are experiencing discrimination from, or require help to access, other agencies, with which the social worker can intervene

But these issues cannot be resolved without recourse to legal frameworks, or in isolation from professional values.

3. The social worker also discusses with Lech and Maria whether they wish to have direct payments so they can organise their own services.

Which perspective is dominant?

Rational/Technical Approach

The rational/technical approach might lead the social worker to

  • be aware that service users can receive direct payments instead of services, in order to regulate the pattern of service delivery themselves
  • ensure that she offers this option and considers whether Lech and Maria would be able to use direct payments

However, a critical perspective on technical knowledge of the legislation, and an appreciation of its constraints will also be important.

Direct payments

Direct payments under the Community Care (Direct Payments) Act 1996 might be an appropriate way of giving Lech and Maria more control over how their services are provided. Using money provided, they can purchase their own care and services.

Moral/Ethical Approach

The moral/ethical approach might lead the social worker to

  • be aware that direct payments are only available for services to meet needs that have emerged from a professional assessment
  • recognise that Lech and Maria may have different priorities, and that decision-making between them may be difficult.

But recognising how values can help to work through practice dilemmas is not the whole picture – technical knowledge of direct payments is also important, as is an appreciation their contribution to promoting rights of autonomy and decision-making.

Structural/Rights based Approach

The rational/technical approach may cause the social worker to

  • see direct payments as a means of promoting rights to autonomy of decision-making
  • recognise that the constraints attached to entitlements and expenditure impose limits to the extent of their autonomy

But she will still need technical knowledge of the direct payments system, and an appreciation of the complexities of using it in this situation.

4. The social worker considers whether Lech and Maria’s housing could be made more suitable for their needs, and whether their financial position could be improved

Which perspective is dominant?

Rational/Technical Approach

The rational/technical approach may cause the social worker to

  • Draw on technical knowledge of housing law to respond more broadly to Lech and Maria’s needs
  • Review their benefits entitlements, or refer them to a specialist service for this purpose

But this knowledge cannot be applied in isolation from moral/ethical considerations and an awareness of how rights may be promoted.

Housing

  • Adaptation of housing can be carried out under the Housing (Grants, Construction and Regeneration) Act 1996
  • Review of welfare benefits entitlements is an important way of promoting anti-poverty strategies at an individual level – it is not uncommon for older people in particular not to be claiming all the support to which they are entitled

Moral/Ethical Approach

Using the moral/ethical approach the social worker may

  • Consider the pros and cons of broadening the focus of intervention, and the impact of changes in Lech and Maria’s living environment
  • Ensure that she maintains a focus on goals that they may prioritise

But legal knowledge will also be important in achieving change, as will an understanding of how action on this broader front may promote rights.

Structural/Rights based Approach

Using the structural/rights-based approach the social worker may

  • identify broader housing issues within the community which require intervention to stimulate collective action
  • consider that review of welfare benefits entitlements is an important way of promoting anti-poverty strategies at an individual level, knowing it is not uncommon for older people in particular not to be claiming all the support to which they are entitled

However, technical legal knowledge and professional values also have a role to play in this type of intervention.

5. The social worker considers whether it is necessary to undertake an assessment of either Lech or Maria’s mental health needs, and in particular there is a need for admission to psychiatric hospital.

Which perspective is dominant?

Rational/Technical Approach

From this perspective the social worker

  • Will be alert to the possibility that either Lech or Maria, or both, have mental health needs
  • Will be concerned to identify whether duties to consider admission to psychiatric hospital are triggered

However, any consideration of using mental health legislation must be accompanied by an appreciation of the ethical issues involved in taking action that might curtail an individual’s liberty, and of the complex interplay of rights involved.

Mental health assessment

  • If admission to psychiatric hospital was deemed to be necessary on a compulsory basis, an Approved Social Worker would need to decide whether there were grounds under s.2, s.4, s.3 of the Mental Health Act 1983
  • Under s.13 of the Mental Health Act, the ASW must make arrangements for an assessment interview to take place ‘in a suitable manner’ – an important consideration here given the communication needs that can be anticipated.

Moral/Ethical Approach

From this perspective, the social worker may

  • Be aware that action to curtail liberty raises serious ethical concerns, which would need to be considered here if compulsory admission to hospital was contemplated
  • be aware of the ethical concerns raised by the power to over-ride service users’ wishes, and would seek to justify her actions by reference to ethical principles

Equally, she would be aware of issues such as rights to liberty, and would require sound technical knowledge of what action might lawfully be taken.

Structural/Rights based Approach

From this perspective, if contemplating compulsory admission to hospital, the social worker might

  • recognise that rights to liberty are in conflict with rights to protection
  • recognise that intervention must be proportionate to the sought goal – so that rights are preserved as far as possible in the circumstances

It will be necessary to balance competing imperatives, an exercise that must have recourse to professional ethics, and to careful matching of the circumstances to legal criteria.

6. The social worker is concerned to investigate the possibility that Lech and Maria are vulnerable to abuse from each other.

Which perspective is dominant?

Rational/Technical Approach

From this perspective, the social worker will

  • be aware that there is no statutory mandate to investigate abuse of adults
  • be familiar with policy guidance – 'No Secrets' (Department of Health 2000) - which provides a framework for responding to suspected or alleged abuse of vulnerable adults, and with the local procedures for inter-agency practice in such circumstances
  • be aware of the court’s power to exercise its inherent jurisdiction and make orders to protect adults who might lack capacity to protect themselves

This legal knowledge will only be useful in the context of her ethical deliberations, and her awareness of the rights that each may claim.

Moral/Ethical Approach

From this perspective the social worker

  • might feel uncertain about who could be thought to be an abuser and who might be being abused in this situation
  • would need to balance different perspectives and understandings from her contact with Lech and Maria
  • consider how the procedure for protecting vulnerable adults might assist, or not

Ethical principles will assist her in this task, but she must also have good knowledge of legal options and of the rights issues involved.

Structural/Rights based Approach

From this perspective, the social worker will

  • view potential abuse in the context of the right to protection from inhuman and degrading treatment (Article 3 of the European Convention on Human Rights)
  • consider how this right applies to the situation in which Lech and Maria are living
  • decide whether any protective intervention would be an appropriate way of preserving the rights of either

Technical legal knowledge will also be important, and the ability to weigh up options by reference to ethical principles.