9789144125008

THEORY FOR SOCIAL WORK PRACTICE

BJÖRN BLOM STEFAN MORÉN

This volume is a translation of Teori för socialt arbete, published in Swedish 2015 by Studentlitteratur

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Art. No 39884 ISBN 978-91-44-12500-8 First edition 1:1 © The authors and Studentlitteratur 2019 studentlitteratur.se Studentlitteratur AB, Lund Translation chapter 4, 5, 6, 8, 11 and 12: Amanda Larsson och David Ordoubadian, Accent Språkservice AB Cover design: Jens Martin Cover illustration: BABAROGA/Shutterstock Printed by GraphyCems, Spain 2019

CONTENTS

Preface 7

Part I Theory and method – CAIMeR as a framework of concepts

1 Why theory in social work? 11 Background and aim of the book – the need for theory 12 What is theory? 13 Theory and meta-theory 14 Different types of theory 16 Generalization and the range of theories 17 What is social-work theory about? 20 The link between theory and method 20 The difference between ‘theory’ and to ‘theorize’ 21 The contents and structure of the book 22 2 Explaining practice – Critical realist theory 27 What is a ‘cause’? From evidence to explanative knowledge 28 Critical realist theory 29 A stratified world with different domains 31 Causality in terms of generative mechanisms 33 CAIMeR as a theory-based structure 40 Finally 40

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3 CAIMeR as a conceptual framework and model 43 CAIMeR – from conceptual structure to theoretical model 43 Lastly 53

Part II Content and conditions of client work

4 Theory of actors and interventions 57 Actors 57 Interventions 60 Methodology and intervention pattern 61 Mechanisms in social work 63 Basic elements and patterns of mechanisms – what must be included? 66 Conclusion 71 5 Theory of professions in social work 73 Social work as a mission 74 The concept of professions – a few different views 74 From occupational professionalism to organizational professionalism 78 Implications for social work 81 Conclusion 83 6 Results theory 85 Some common ways to look at results 85 Results based on CAIMeR 87 Conclusion 94 7 Perspectives on quality 95 Different perspectives on quality 95 The issue of quality – from the manufacturing industry to social-work practice 98 Quality of service and quality of life 100 4

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The importance of distinguishing quality of service from quality of life 103 The problem with regarding diverse quality of results as quality of life for clients 104 Quality from the stakeholders’ perspectives 106 Judging quality of services with regard to the different stakeholders’ interests 108 Conclusion 110 8 Programme theory in social work 113 Programme theory – definitions, areas of use and examples 113 Reconstructing programme theory – a general introduction 120 Conclusion 126 9 Domain theory for social work 129 Background 129 Politics, administration and professional practice – like threads in a web 130 Towards a domain theory of social-work organizations 131 Neo-liberal governance 141 Conclusion 143

Part III Explaining social-work practice

10 Analysis of generative mechanisms 149 How can mechanisms be identified, described and conceptualized? 149 Response mechanisms – from A to Z 158 Lastly 160

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11 CAIMeR in practice I: Opening the black box 163 Intervention documentation – a link between concept and empirical data 163 The CAIMeR configuration 166 CAIMeR in practice – how do the parts fit together? 171 Conclusion 175 12 CAIMeR in practice II: Reconstructing programme theory 177 Reconstruction of programme theory as a response to the knowledge needs of social workers 177 Design and implementation of the project 178 Analysis of the empirical material 180 The results – the organization’s programme theory in brief 184 Interventions 187 Mechanisms 189 Results 190 A CAIMeR configuration of the organization’s programme theory 191 Theory for social-work practice 191 Appendix 195 Index 199

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CHAPTER 3

CAIMeR as a conceptual framework and model

This chapter provides an overall presentation of CAIMeR as a conceptual framework and theoretical model.1 Initially we describe and exemplify the basic concepts: contexts, actors, interventions, mechanisms and results. Then we show how these concepts can be put together into a theoretical model. The purpose of this chapter is to present the theoretical basis which is necessary for readers to establish before going on to the book’s remaining chapters, and to offer a theoretical starting-point that can be used when carrying out social work and evaluating or doing research in social work.

CAIMeR – from conceptual structure to theoretical model Before the presentation of the conceptual scheme, we should mention something about the background to the development of CAIMeR. Firstly, we identified a number of limitations in a critical realist evaluation model developed by the researchers Ray Pawson and Nic Tilley (1997). Their model is interesting and helped us to move our thinking forward. From our perspective, however, the main problem is that that model does not explicitly consider the actors and interventions, which is problematic when social-work practice is in focus. Moreover, CAIMeR is a result of our participation in several developmental projects together with social workers in different types of organization (Andersson-Långdahl et al., 2013; Blom & Morén, 2007). In sum, we experienced that the shortcomings in Pawson and Tilley’s evaluation 1 This chapter partly builds on an article by Blom and Morén (2010) previously published in the Journal of Social Work. Permission for partial reproduction is granted by the journal (2016-12-16).

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model, as well as experiences from the projects we have participated in, revealed a need to develop concepts and theories that could better respond to the complexity of social-work practice. The theoretical concepts presented below are therefore rooted in empirical experiences and observations.

CAIMeR as a scheme of concepts The basic concepts of the scheme (Contexts, Actors, Interventions, Mechanisms and Results), which form the acronym CAIMeR, are placed in the left-hand column (Figure 3.1). With the purpose of specifying the basic CAIMeR concepts (numbered 1–5) we have divided them into a number of subconcepts that are also placed in the left-hand column. The concepts are marked with different fonts and numbered in up to four levels (for example 5.2.2.1) to show how subdivisions are created. In the right-hand column, there are a number of examples illustrating what each concept includes. The following description is structured according to the basic concepts of CAIMeR.

Contexts We distinguish between three different types of context: two relatively narrow ones that are ‘close’ to clients and social workers (Intervention context respectively Client’s lifeworld), and a broader one (Societal context and Cultural context) in which the other two are embedded. Intervention context and the client’s lifeworld contexts2 refer to conditioning ‘local’ circumstances for social work respectively the client’s ‘private sphere’. By way of example, the intervention context comprises organizational aspects, norm systems, goals and resources. Examples of the client’s lifeworld are: private relations, living conditions and problem situations.

Moreover, there is a distinction between primary and secondary relations and lifeworld conditions. We believe it is analytically beneficial to separate relations to family members from relations to acquaintances/friends, because they often have different meanings. Furthermore, we have divided the intervention context into two sub-categories; direct and indirect (but 2 The concept of lifeworld is inspired by the sociologist Jürgen Habermas (1987/1981), who in turn borrowed it from the phenomenologist Edmund Husserl.

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local) intervention conditions. Direct conditions, comprise, for instance, the organization and working-climate within an agency, while indirect conditions include aspects such as local political decisions, administrative governing systems and resource allocation. However, laws and political decisions on the national level – as well as other non-local intervention conditions – are parts of the societal and cultural context. Regarding social context mechanisms, we make a distinction between the macro-, the mezzoand the micro-social mechanisms.

Societal and cultural context refers to the national and global conditions for clients, social workers and other intervention actors, etc. It may involve, for example, disabling (problem-generating) as well as enabling (promoting) cultural, political, economic and social aspects.

Within the framework of direct and indirect intervention conditions, there are various programme theories (Leeuw, 2003; Weiss, 1998). Often, but not always, there are official ‘theories’ concerning what an organization is supposed to accomplish and how the objectives should be achieved, sometimes these are even manifested in brochures or policy documents etc.

Within an agency it is also possible that one or more unofficial programme theories exists. This refers to such assumptions that an agency/organization does not want to provide information about, due to the risk of conveying a negative picture, and/or assumptions that it is not possible to inform others about because they are unconscious and taken-for-granted.

Actors The actor concept (heading 2) refers to the actors who are involved in the intervention process, and their formal qualities (e.g. education, position and gender). Moreover, this concept involves the individual’s more general assumptions about humans, society and social work, namely: their outlook on humanity (e.g. if human beings are determined by external powers or are free to choose their lives), their outlook on society (e.g. whether society by nature is unjust and filled with conflicts or if society’s natural state is consensus and equality), their outlook on social work (e.g. if social work aims to adapt people to the current society or society to people’s needs). Thus, it is not a question of the actors’ situation-specific conceptions, connected to work with particular clients. © T h e au t h ors and S t u d e ntlitt e rat u r

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Main and sub-concepts

Examples

1 CONTEXTS 1.1 Societal and cultural context 1.1.1 Enabling factors 1.1.2 Disabling factors

Surrounding world, neighbourhood, other organizations. Enabling vs disabling structures etc.

1.2 Clients’ lifeworld 1.2.1 Primary relations and lifeworld conditions

Family, relatives, close friends etc. Also ‘troublemaking’ relations. Health, housing, provision etc. Critical/ meaningful events etc.

1.2.2 Secondary relations and lifeworld conditions

Colleagues, neighbours, acquaintances, etc. Also ‘troublemaking’ relations. Workplace, communications, recreational possibilities etc. Critical/meaningful events etc.

1.3 Intervention context 1.3.1 Direct intervention conditions

1.3.2 Indirect intervention conditions

Physical and social ‘environment’ where direct intervention takes place, An agency’s inner-working organization, localising, interior, co-operation climate etc. Official and unofficial programme theories.

Local intervention conditions and they who set them. ‘Outer’/overarching organization, organizing, politicians, heads, objectives, resource allocation etc.

Official and unofficial programme theories.

1.4 Context mechanisms (social) 1.4.1 Macro-level

Market mechanisms etc.

1.4.2 Mezzo-level

Organizational mechanisms etc.

1.4.3 Micro-level

Group mechanisms etc.

2 ACTORS 2.1 Primary intervention actors 2.2 Clients 2.3 Other intervention actors 2.3.1 Formal other intervention actors 2.3.2 Informal other intervention actors

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Social worker, therapist, etc. Outlook on humanity, society and social work Adults, youth, children. Basic outlook on humanity, society and social work Teacher, physician, police, priest etc. Basic outlook on humanity, society and social work Somebody who intervenes, without having a formal intervention role, e.g. a neighbour. Basic outlook on humanity, society and social work

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Main and sub-concepts

Examples

3 INTERVENTIONS 3.1 Social workers’ interventions 3.1.1 Formal interventions

Methods, models, techniques, relational approaches.

Introduction of ideas and resources etc.

3.1.2 Informal interventions

E.g. help, support, socializing as friends

3.2 Clients’ interventions

Efforts, relational approaches, considerations, readiness, choice etc.

3.3 Others’ interventions 3.3.1 Formal interventions 3.3.2 Informal interventions 4 MECHANISMS 4.1 Social intervention mechanisms

Methods, models, techniques, relational approaches.

Introduction of ideas and resources etc.

Compassion, practical help, expectations, social control etc.

E.g. response, challenge, role-transgressing, risk-taking mechanisms

4.2 Social psychological intervention mechanisms

Internalising the external and externalising the internal

4.3 Psychological intervention mechanisms

E.g. altruism, ‘social passion’, egoism, ‘revengefulness’, identification

5 RESULTS 5.1 Outputs

E.g. received material or emotional support

5.2 Outcomes (early, intermediate, long-term) 5.2.1 Surface aspects 5.2.1.1 General 5.2.1.2 Specific 5.2.2 Process aspects 5.2.3 Depth aspects 5.2.3.1 General 5.2.3.2 Specific

E.g. stopped abusing, satisfactory economy E.g. a new tattoo, different dress style, other friends E.g. gradually increased responsibility for one’s own change E.g. changed self-image, emotional maturity, increased social competence E.g. free from a certain type of anxiety, can feel joy over one’s children, revaluated importance of close relationships

Figure 3.1 Scheme of CAIMeR concepts – divisions and examples.

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The actor concept is divided into primary intervention actors (e.g. social workers), clients and other intervention actors, this latter category being subsequently divided into formal and informal other intervention actors.

A formal other intervention actor is someone who in his/her work entirely or partly carries out social ‘human service’ tasks, but that does not mainly conduct social work. A teacher can, for instance, be such an actor, but a hairdresser cannot. On the other hand, a hairdresser or a helpful neighbour can be an informal other intervention actor. Such persons can often provide important social assistance (e.g. emotional support or practical help) although it is not within their professional role.

Interventions We have divided the intervention concept (heading 3) into social workers’ interventions, clients’ interventions and others’ interventions. In both the first and the last categories we differentiate between formal and informal interventions. This is partly due to the above-mentioned division between informal and informal actors. Social workers as well as other intervention actors can conduct formal interventions (what somebody is obliged to do within the professional role), along with informal interventions (what a person is not obliged to do, for instance social support and companionship similar to that between friends).

Mechanisms Intervention mechanisms (heading 4) are separated into social, socialpsychological and psychological mechanisms. The social and the psycho­ logical mechanisms exist in different strata in social reality. Examples of social mechanisms mentioned in Figure 1.1 are response, challenge, roletransgressing and risk-taking mechanisms (cp. Morén & Blom, 2003). They, in turn, can emanate from and interact with mechanisms at the psychological level, which consists of social workers’, clients’ and others’ intra-psychic dynamics. Moreover, in our studies we have observed how social interplay in the intervention process, through internalisation, sometimes becomes transformed into the psychological level (social-psychological transformation). This refers to the way in which social interaction between 48

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social workers and clients can be mentally incorporated and transformed into psychological intra-action.

We have been able to study how conversations between social workers and clients have been internalised and become a changed “inner dialogue” within the client. We have chosen to denominate this mechanism, as the internalisation of the external. Social-psychological mechanisms also work in the other direction, which implies that there is also an externalisation of psychological intra-action. This means that the client’s inner dialog is transformed and located in the ‘outside world’ as action and social interaction. We have also studied how internalised social worker–client conversations first changed the inner dialogue of the client and subsequently his och her behaviour and social interaction of the client. We call this mechanism the externalisation of the internal. Consequently, socialpsychological mechanisms work as mediating and transforming forces in the interface between ‘the inner/psychological’ and ‘the outer/social’. We want to highlight that social psychological intervention mechanisms affect not only clients but also the intervention actors with whom clients interact.

Results In the literature on interventions in social work, discussions concerning results are sometimes quite diffuse; it is not clear what kind of results are in question. Often results in social work are discussed in terms of a decreased need for help (for example, the client can manage without financial assistance) or behavioural changes (their abuse has decreased or discontinued). We devote extra space to this issue in the book’s sixth chapter. In brief, however, we mention some fundamental aspects of results in social work, below.

In Figure 3.1, the results concept (heading 5) has been divided into several different but interconnected steps. The results we primarily refer to in this context are the client effects – in other words, changes in the life situation of socially vulnerable people, which emerge as a result of the interventions. In evaluation research, these types of result are called Outcomes (Osborne, 1992). Another type of result – which in an imaginary ideal process, precedes but, in reality, often occurs in parallel with the client effects – are known as Outputs, that is, what the intervention actually © T h e au t h ors and S t u d e ntlitt e rat u r

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leads to in terms of different types of received service. The concept of client effects, in turn, can be divided into surface aspects, process aspects and depth aspects, which may be general or specific. In Chapter 6, we will return to the issue of results in social work as we move through the various results aspects in more detail.

CAIMeR as a model When we present CAIMeR here as a model, we want to emphasize that all models are simplified representations of reality. The purpose of presenting a model is to focus on the essential characteristics of a system, leaving out irrelevant details (cf. Abstraction in Chapter 1). We can compare a model with a map that gives a fair description of a geographical area, even if the details of the terrain are not included. We believe that the CAIMeR model depicts the essential qualities of ‘the system’ of social work with individuals and families under different contextual conditions. Thus, the model can be used as a basis for social work, organizational development and different types of study of social work, both evaluations and research.

Described in its basic form (Figure 3.2), the course starts in the grey field to the left in the model – the client’s lifeworld – where people live their lives and where they can be socially vulnerable. When a person establishes a contact with an agency that carries out social work, he/she will occasionally also be a client within an intervention context. This context is constituted by direct and indirect intervention conditions, which are more or less close (in time and space) to the actual situation of intervention. The intervention context, like the client’s lifeworld, is in turn embedded in and conditioned by a societal and cultural context, containing mechanisms on macro-, mezzo- and microlevels. The actual intervention process is constituted by different types of actors, making various interventions that trigger different mechanisms, all of which generates diverse types of result. Presented this way, social work may appear as an unambiguous one-way course: from social problem to result.

However, in reality there are a number of interacting processes and causal feedbacks that make the course of events far more dynamic.

In the model we have marked five different ‘spots’ where dialectical influence (two-way arrows) often occurs: between direct and indirect intervention conditions; between different dimensions of the client’s lifeworld; between 50

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3 CAIMeR as a conceptual framework and model Societal and cultural context Context mechanisms (macro-, mezzo-, micro-) Intervention context

Client’s lifeworld Secondary relations and lifeworld conditions

Indirect intervention conditions Direct intervention conditions Actors Intervention actors

Primary relations and lifeworld conditions

Interventions Social workers’

Clients

Others

Others

Client’s

Mechanisms Social

Results Outputs

Socialpsychological Psychological

Outcomes

Solid arrows show principal ways of influence.

Dotted one-way arrows show feedback loops.

Two-way arrows show alternating influence.

Figure 3.2 A CAIMeR model of social work.

lifeworld and intervention context; between social workers’ and clients’ interventions, and between different types of mechanism.

Furthermore, the model illustrates three different kinds of feedback (dotted one-way arrows) that can generate indirect and often unforeseen influence during the intervention process. These feedback types are illustrated below, with examples from addiction care.

1. The first feedback is between mechanisms and interventions, that is, it is not only interventions that trigger mechanisms, it can also be the other way around: mechanisms trigger interventions. However, this feedback does not go directly to the interventions, but through the actors who make them.

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3 CAIMeR as a conceptual framework and model Feedback between mechanisms and interventions For the third time Harry has been given compulsory treatment for serious polydrug use and aggressive behaviour. The social worker Charles, just as in previous stays at the treatment centre, is in charge of Harry’s treatment. Charles works with cognitive behavioural therapy and relapse prevention, as part of the treatment centre’s regular range of interventions. The treatment process does not seem to lead anywhere, when one day Harry suddenly says: “I don’t like being treated; I’m just like an object that should change. But I’m a human being just like you. Look – I have got myself a shirt similar to yours!” Charles is surprised and starts to think that Harry identifies with him; the contact has led to a role transgression. Harry’s reaction triggers a challenge mechanism that first makes Charles feel ambivalent and provoked. After a while, however, he feels encouraged to try to find other interventions that can motivate Harry to change. At their next meeting Charles suggests that they should go to a café in the city centre once a week. In addition, Charles asks what Harry would like to do to change his life situation. Harry’s initial criticism thus presents a challenge to the social worker, Charles, with the consequence that he partly changes the content of the intervention.

2. Another kind of feedback is that between results and actors. For instance, a result during a contact with the social services (e.g. a client receives an insight into his addictive behaviour) can influence a social worker to do other interventions than initially planned. However, the results do not exert influence on the actors directly but via mechanisms that consecutively influence the actors.

Feedback between results and actors Because of his drug use, Tommy has had continuous contact with both the municipal social services and a drug-dependence unit within the health care system. The contact has implied fairly strong elements of control, including mandatory follow-ups with the social worker every week, regular urine tests and substitution treatment. The social worker Maria believes that Tommy would not be able to stay free of drugs without these interventions with a high degree of control. This is mainly because Tommy does not see himself as having a problem with drugs. However, after six months of contact, Tommy has been almost completely drug-free, and in discussions with Maria, he explains that he is beginning to realize the extent of his drug use and how it affected him and his surroundings. Tommy’s insight triggers a risk-taking mechanism that affects Maria.

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She begins to think that this positive process will hopefully develop if the control of Tommy is decreased. She does not feel totally sure but is willing to take the risk.

Maria thus changes her interventions by saying to Tommy that their mandatory meetings can be held at longer intervals. She also contacts the drug-dependence unit within the health care system to discuss whether urine tests and substitution treatment are needed or could be reduced.

3. The third type of feedback occurs between results and the client’s lifeworld. By way of example, a client who has changed as a consequence of interventions might come to influence his social network positively, which in turn can imply that a formerly uninvolved network thereafter acts supportively, and so forth. This can have an unexpected and positive impact on the client, which is further enhanced thanks to changes in the lifeworld.

Feedback between results and the client’s lifeworld Thanks to efforts by the social services, the employment agency and the women’s shelter, Carrie has taken control of her addiction and found a job and her own apartment. This has meant that she does not need to borrow money from family and friends, drinks much less alcohol and messes less with people in her social network. The result is that irritation felt by Carrie’s children, sister and friends changed to a more positive view. One consequence of the positive result is that several people in Carrie’s lifeworld actively support her, for example by ensuring that she stays sober at weekends.

There are also mechanisms in the client’s lifeworld (i.e. the results of social work do not influence people in the lifeworld directly) but, since the focus in the CAIMeR theory is social work, we have not included such mechanisms in the model.

Lastly Above, we have described and exemplified the basic components of CAIMeR in the form of a concept scheme with a series of exemplifications. We want to emphasize that these concepts do not exclude other theoretical concepts.

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which does not cover all aspects of a study object. To tailor the theoretical framework, it may be relevant, for example, to use a complementary theory of communication (Wachsmuth et al., 2013), a theory of the exit processes (Ebaugh, 1988) or a theory of collaboration (Horwath & Morrison, 2007).

In the next chapter, we will delve more deeply into CAIMeR by discussing two of the basic elements of social work, namely actors and interventions.

References Andersson-Långdahl, G.-E., Blom, B., Ericsson, A., Gyllenberg, L., Marklund, R., Morén, S., Perlinski, M., Spång, U. & Westermark, E. (2013). Rådgivningen Oden – utveckling av programteori om hur en verksamhet för missbruksbehandling fungerar. Umeå: Umeå University, Department of social work, Research Report No. 56.

Blom, B. & Morén, S. (2007). Insatser och resultat i socialt arbete. Lund: Student­litteratur.

Blom, B. & Morén, S. (2010). Explaining social work practice – the CAIMeR theory.

Journal of Social Work, 10(1): 98–119.

Ebaugh, H. R. F. (1988). Becoming an Ex: The Process of Role Exit. Chicago: University of Chicago Press.

Habermas, J. (1987 [1981]). The Theory of Communicative Action, Volume 2, Lifeworld and System: A Critique of Functionalist Reason. Cambridge: Polity Press.

Horwath, J. & Morrison, T. (2007). Collaboration, integration and change in children’s services: critical issues and key ingredients. Child Abuse and Neglect, 31(1): 55–69.

Leeuw, F. L. (2003). Reconstructing program theories: methods available and problems to be solved. American Journal of Evaluation, 24(1): 5–20.

Morén, S. & Blom, B. (2003). Insatser och resultat. Om utvärdering i socialt arbete.

Umeå: Umeå University, Department of social work, Research Report No. 48.

Osborne, S. P. (1992). The quality dimension. Evaluating quality of service and quality of life in human services. British Journal of Social Work, 22(4): 437–453.

Pawson, R. & Tilley, N. (1997). Realistic Evaluation. Thousand Oaks, CA: Sage.

Wachsmuth, I., de Ruiter, J., Jaecks, P. & Kopp, S. (eds) (2013). Alignment In Communication: Towards a New Theory of Communication. Amsterdam: John Benjamin.

Weiss, C. H. (1998). Evaluation – Methods for Studying Programs and Policies.

Upper Saddle River, NJ: Prentice Hall (2nd edition).

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Björn Blom is professor of social work at the Department of social work, Umeå University, Sweden. His research interests include organizations, professions, knowledge-use, evaluation and addiction treatment.

Stefan Morén is professor emeritus in social work. He lives in Uppsala, Sweden.

THEORY FOR SOCIAL WORK PRACTICE This book presents a theory with the ambition of both describing and explaining the nature of social-work practice. It is the first book that presents an explanative theory developed specifically from and for social-work practice.

One of the fundamental questions is: How can we explain how results in social-work practice emanate from social worker’s and clients’ actions under certain contextual conditions?

The theory presented in this book is named CAIMeR, which means that it takes a systematic and coherent approach to the theory of Contexts, Actors, Interventions, Mechanisms and Results. The meta-theoretical basis is critical realism, where a key feature is the concept of generative mechanisms. This perspective can help us capture the often unobservable powers that explain how results in social work emerge as a consequence of interventions and contextual conditions. The book also presents a domain theory that explains how social workers’ professional practice is conditioned by politics, management and institutional conditions.

This book is essential reading for students in social work and adjoining disciplines, but also for researchers, managers and professional social workers.

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