What is social work? With this fundamental question, many of us start the journey with a new group of social work students, and the core and boundaries of social work tend to be a recurring theme throughout both undergraduate and postgraduate studies. With The compassionate bureaucrat: processing cases, facilitating change, being human Emanuel Hort and Hildur Kalman start off the current issue of Nordic Social Work Research by asking what characterises good social work and how it can be attained. Drawing on social work students’ narrated experience from social work practice, the authors identify knowledge use and premises for knowledge use in social work practice, and sketch a model for illuminating variations in the professional role of a social worker. Drawing on a discussion of the three broad occupational positions of social work casework, counselling, and social assistance, Hort and Kalman argues the case for a ‘compassionate bureaucrat’ who integrates relational aspects, facilitation of change and legal aspects in professional practice.
A key tension in debates about the nature of social work is the one between normative conceptions – what social work should be – and empirical ones – what social work is. As a comment to the latter we could summarise empirical work on social work as a field of education, knowledge and practice by paraphrasing Brown and argue that despite the almost unavoidable tendency to speak of social work as an ‘it’ the domain we call social work is a significantly unbounded terrain of power and techniques, an ensemble of discourses, rules and practices, cohabiting in limited, tension-ridden, often contradictory relation with one another (see Brown Citation1992, 12 on the state). A more middle way answer to the question of what constitutes social work could perhaps be that it depends, for example on the problem or type of social and/or human needs at hand, the historical as well as societal context, and on the perspectives among us who ask the question.
The flip side of the coin is ‘what is not social work?’ When does professional and voluntary practice with people’s struggles become something else? What troubles and needs are the responsibility of someone else than a social worker? Also here, the answer could be normative as well as empirical of course. The contributions to this issue of Nordic Social Work Research all engage with the issue of the core and boundaries of social work, and the current issue highlights relationships between social work, health and health care. Should health and social welfare be regarded as separate phenomena, or are they inevitably intertwined? What should the relationship between the social work profession and professions within the health care system be? What is the position of social work in relation to health care today? The articles bring to the fore the need to reflect upon such questions.
Through a historical perspective, Sveinbjörg Júlía Svavarsdóttir, Rafael Lindqvist, Ingólfur Ásgeir Jóhannesson and Sigrún Júlíusdóttir discuss the changing boundaries for social work in the field of mental health. In their article From patients to users of services: the discourse on mental health issues in Iceland, 1960–1985 the authors discuss how a medical model of mental illness was challenged by a psychosocial model of mental health problems during this period. The case of Iceland illustrates how social work gained ground in the field of mental health, and how several professions – including social workers – strengthened their position in relation to physicians/psychiatrists. Svavarsdóttir et al. argue that the field evolved towards more holistic approaches, which attempted to understand mental illness as a result of the complex interactions of biological, psychological and social factors. Furthermore, that a perspective of treatment was combined with one of prevention and promotion. In addition, that this period was strongly influenced by new organisational models which emphasised case management, collaborative models of care and participation of users and families in care delivery. A question raised by this exposition is what the result would be if the development until the present day in the all of Nordic countries was scrutinised.
Shifting focus to present day social work with older adults, Eeva Rossi, Marjaana Seppänen and Marjo Outila in Assessment, support and care-taking: gerontological social work practices and knowledge illustrate the importance of the organisational context, and challenges associated with the interface between social work and health care. The authors show how the practices of gerontological social workers are set in a range of social and organisational contexts that include long term care and rehabilitation. For social workers, working in rehabilitation means working in multi-professional work settings, where social workers receive and to some extent build their work on the knowledge of other professionals, they argue. Especially in this multi-professional context, the practices and knowledge of gerontological social work become visible, according to Rossi et al. However, and as illustrated in the article, there may also be challenges for social work in such contexts by organisations that favour the idea of gerontological rehabilitation as physical or medical, over a holistic model of rehabilitation. Another issue brought to the fore by the results from the study of Rossi et al. is how social work education prepares social work students for multi- and inter-professional work – and the challenges to social work that may follow from that – as many social workers will find themselves in a multi-professional work settings after graduating from the programmes.
Why do we let nurses do social work? Maria Söderberg asks in A part of social work and apart from social work: hospital nurses in hospital discharges of older people in Sweden. The author explicitly engages with the question about the core and boundaries of social work and calls into question a too narrow focus on administration, assessment and decision-making, at the expense of relationship based practice and service user advocacy. Söderberg shows how there are ideological differences between hospital nurses and social workers – municipal care managers – where the hospital nurses merit a universal welfare system and the social workers responsible for the older adults merit a more selective distributive system in which they are the active agents as gatekeepers. Why are we as professional social workers passively watching how our prerequisites to carry out social work with hospitalised older people are diminishing? is one of several challenging questions asked in this article. Söderberg outlines how the hospital based social workers are primarily called for family support in emergency cases, and how the municipal care managers have limited possibilities to obtain a holistic view of the patients at the hospital, as they as social workers responsible for the case, are located elsewhere and only visit the hospital temporarily. When social workers accept and adapt to the role of being administrators and gatekeepers of resources rather than social workers allied with older people in need of support, we are, as social workers, contributing to a situation where qualified social work with older people remains a neglected area in Sweden, the author argues. Furthermore, that as long as social work with older people is framed as ‘social care’, it is not considered to be at the core of social work practice and is considerably undervalued compared with social work practice with other citizens.
The fact that health issues may enter into the field of social work in many different ways is illustrated by the discussion of the practices of the so called NAV offices in Norway, in Ole Kristian Håvold’s article Opportunity talk, work talk and identity talk: Motivating strategies used by the Norwegian labour and welfare offices. What the multi-professional setting of the NAV office can mean for social workers’ understanding of their own knowledge has been discussed in a previous issue of Nordic Social Work Research (see #2 2017). Håvold’s analysis enters into the practices of NAV offices from a different angle and explores how frontline workers operationalize new institutional schema in their approach to users with health disabilities, as the data used in this article derives from a project exploring the transitions of traumatic brain injury (TBI) patients between different organisations during the rehabilitation process. The analysis identifies three different strategies employed by the frontline workers, and Håvold argues that these three strategies are part of a schema that is operationalizing ‘an asset model of activation’, and rely on a shift in the understanding of work, traditionally seen as a burden, to an understanding of work as beneficial to health and wellbeing. According to Håvold, the frontline workers in the study seem to be in the process of institutionalising an asset model of activation, and he argues that such shifts in approaches and problem-solving within organisations can be linked to changes in the institutions governing the field in which the organisation operates. Notion of work as beneficial to health seem to be a key in this process of change.
Whereas ‘activation’ seems to have been successfully integrated into social work practice in Norwegian NAV offices, the picture is more contradictory when it comes to the integration of work with intimate partner violence (IPV) in municipal personal social services in Sweden. The results from the study of Lisa Lundberg, A new area of expertise? Incorporating social work with intimate partner violence into Swedish social services organisations, indicate that IPV specialisation has to some extent been developed in a majority of the municipalities. However, the number of caseworkers assigned to work with IPV is relatively low and a considerable part of IPV social work is handled by other parts of the organisations, particularly in the larger municipalities. Lundberg argues that while there has been movement towards IPV specialisation in the social services, it has not resulted in any major organisational change. She concludes that although specialisation, even in small measure, might be seen as recognition of IPV as a specific social problem, it remains to be seen to what extent IPV will grow into an established part of the social services’ structure in Sweden. Regarding the theme for the current issue of Nordic Social Work Research of the relationship between social work and health, it can also be noted that this study indicates that social services’ collaboration with the health care sector appears to be less developed than with the women’s shelters or the police. The study indicates both that there are lower levels of formal collaboration, and that social services managers express less satisfaction with the quality of collaboration. Considering the many negative health outcomes documented in research on women subjected to violence, this is a concern.
Several other issues of concern are raised by the article by Pia Tham, Where the need is greatest: a comparison of the perceived working conditions of social workers in Swedish metropolitan low,- middle-and highincome areas in 2003 and 2014. Here questions are raised about possibilities to carry out high quality social work, particularly in areas where the need is greatest. A series of studies comparing the development of the working conditions of child welfare social workers in Sweden during the last decade shows that a deterioration of working conditions in low-income areas has taken place at the same time as there have been improvements in middle- and high-income areas. The results demonstrate what segregation and increasing social inequalities imply for social work practice, and help to explain, for example, the problems with staff turnover in parts of the personal social services in Sweden. It is also clear how the context and conditions for social work can become an issue of social workers’ health and well-being. According to Tham, social work in these low-income areas is characterised by high job demands, the occurrence of frequent emergency situations in client work and less possibility for social workers to receive support and help from supervisors and colleagues in the organisation. She also points out how staff more seldom feel well taken cared of, that they report that communication is insufficient and that more than half of the work group have expressed an intention to quit their job. Such work conditions do not offer the best opportunities for a social work of high quality. To conclude, these results demonstrate how the situation of service users and of social worker are interlinked, and Tham shows how social workers in low-income areas have less possibility than those middle- and high-income areas to give service users the recognition and help they might need. This picture of social work is far from idea(l)s of what it should be, and social change is clearly needed.
The book review included in the current issue adds another facet to the discussion about ‘what social work is’ through Marcus Hertz’ critical engagement with Transforming social work. Social Constructionist Reflections on Contemporary and Eduring Issues by Stanley L. Witkin. In the review Herz raises the question of how intellectual change and the analysis of assumptions, dominant beliefs, ideas and practices of social work, may be linked to individual and social change. He argues that the discussion of what is next for social work, and of how social work should be transformed as well as being transformative, is especially important in the current times of increased political uncertainty and social inequalities. This issue of Nordic Social Work Research may indicate how such a transformation could require inter-professional debates on how to respond to social and human needs regardless of in what professional, organisational or institutional setting they appear.
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