SS4115 integrated Social Work Practice

OutlineOutline

Definition Historical and rationale of integration Model of integration

- profession oriented integration

- method oriented integration

- agencies oriented integration

- locality oriented integration

- client oriented integration Difficulties and solution of integration Discussion Others

What is integration?What is integration?

It is to change the different parts into a new whole.

During the integrating process, each of the different parts will have to have some adjustments in order to cope with the change.

The quality of the new whole is totally different from the quality of the original parts.

( 譯自 : 阮曾媛琪 , 1992; 社會服務整合化的意義及展望 . 香港社會工作學報 , 第二十六卷第一期 )

Why do we Integrate?Why do we Integrate?

Respond to the changing needs of clients and society.

Repair the difficulty in Service Centre, e.g. overloaded and overstretched.

Solve the problem on service delivery. Prevent duplication on service.

Allow centre to allocate the recourse flexibly.

Reduce the high expenses in social welfare agencies, e.g. the salary of senior worker.

Social Workers are suggested to be generalist in all fields.

The development of integrationThe development of integration

Social welfare in the 1990s & beyond, the social welfare Department purposed on integrated approach. (See White paper Description 1991)

It aims at solving the difficulties brought by fragmented services provided by various department or agencies.

By adopting the integrated approach, service users can more easily get access to the service, and related departments.

Agencies can provide service with existing resources more vividly and economically.

The rationale of Integration The rationale of Integration approach:approach:

1. Coordination and Integration of the Service Delivery:

Provide clients with more convenient access to a wide range of services (e.g. One-stop service) and enable more flexible and cost-effective use of available resources. Different service units join together to work for the betterment of the clients.

2. Holistic and Person-oriented approach The coverage of the service should include all

groups in society and no group is being left out. (Comprehensive coverage)The services provided by agencies should base on the needs of clients and society. Clients can get comprehensive care. It allows the worker uses multi-content and multi-level approach to meet the needs of clients.

Profession-oriented integration

Definition: different professions joint together

AdvantagesAdvantages

1. Multi-context intervention and assessment Since social workers may not be competent

enough to cope with different problems of the service users, profession-integration helps to gather professional knowledge from different fields to provide comprehensive service to service users and assess clients’ needs in broader and diverse context.

Example: school social workers can obtain information from teachers about the student’s behaviour problem in classroom in order to provide in-depth assessments. Teachers may also assist social workers to monitor the change of client in classroom.

2. Convenient to service users Service users do not need to go to other

agencies to obtain service, but can obtain different services in an integrated centre, so it is more convenient and less time-consuming to seek for services.

Example: parents can obtain family service in I.T. centre, the PHAB Association.

3. Able to access resources quickly Profession-integration enhances the

communication and co-operation among different professions, so social workers may help to identify these professions and related resources quickly.

4. Support different professions With communication and discussion between

professions, it helps to support different professions in providing service or designing intervention plan.

Example: School social workers support teachers in handling students’ emotional problem so that teachers can teach the class effectively.

DisadvantagesDisadvantages

1. Time consuming

Takes more time to communicate and cooperate with different departments and centres, so more time is consumed in administrative procedures.

2. Difference in vision, mission and work practice among different professions

With co-operation, the workers may have to meet the demands and expectation of other professions, which service users may sacrifice in obtaining some of the services. It is also difficult for different professions to come up with a consensus.

Example: The police of Yuen Long adopted the social work notion of “zero tolerance to family violence” and co-operated with Yuen Long IFSC, they arrest abusers without trying to remedy the situation and keep them over night, so as to protect the victims and other family members. Yet police may not understand the rationale behind, they may mislead or deprive clients during execution.

3. Higher the cost of service Having more professions to deal with a

case, it accelerates the cost of service. The agency may need to employ different professionals, so the service users may not be able to afford the cost.

Method orientated integration

Models of integrationModels of integration

Use all three social work practice methods to deal with the different levels of client’s problem. E.g. Case, Group, Community Work. The rationale of the integration is to provide preventive, supportive and remedial services to the clients.

For example: IFSC is integrated as family resources unit (preventive and educational), family support unit (supportive and empowerment) and family counseling unit (intensive counseling). Within these service units, it includes the practice of case, group and community work to intervene with client’s needs.

AdvantagesAdvantages

1. Actively respond to clients’ needs The model could provide initiative to client’s needs. For

example: FSC used to specialize in doing the case. The case was received passively. The center could not put the first aid and assess potential risk of the family. The support network is rather weak for those families in need. After integration, more preventive and supportive work would be done as to response to the needs of the client. Worker would go outreaching to identify potential clients.

2. Easy to assessable Before the integration, client needed to face

geographic inconvenient. Different government departments would respond to their work individually. Case department and group department were different units that located in different areas. Client needed to refer to different departments when they undertook case or group intervention. Method integration which provides all three levels of practice would be undertaken in one single unit. Client no longer needed to refer to different departments to undertake different services.

3. Person-centered Person centered approach is likely

applied as client could get comprehensive case within three aspects of intervention. Clients can obtain different intervention methods according to their needs.

4. Simpler administration One case file is used within the agency

for each client when getting different services.

DisadvantagesDisadvantages

1. The quality of work Dealing with all different methods may introduce

much more workload and pressure to workers. Different methods may require skills to handle the tasks; the worker may not familiar with all the methods and thus have pressure when they are requested to provide services that they are not good at.

2. Use of the resources The resources may be reduced after method integration. One service

center is used to capture the work of case, group and community work. However, the resources may not be enough to provide all three aspects. Center has to balance the resources and provide a fixed amount of group work and community work project. The resources may not be flexible enough in response to client’s needs.

For example: some of the family service centers such as single parent center would be incorporated in the IFSC. The original resources to run those family centers would not be given to IFSC. There are insufficient resources to provide service to those clients and the quality of service would be lower.

3. The quality of worker The worker used to specialize in doing one

field unit, however, after integration; worker would require being skillful in both group work, case work and community work. Workers may not be able to master the demands of all the methods .They would not handle the work properly as lack of skill training.

4. Complicated administrative procedures Different methods may associate with different

administration procedures, providing all these methods by a single agency may make the overall administration complicated. Even though having the same case file, different services may still be provided by different workers

Agencies oriented integration

Example:Example:

DECC (district elderly community center) Integration of Social Welfare Department,

DECC, NEC, Non-Governmental Organization elderly centres, home services, care & attention home, nursing home, the leisure and cultural service department and Hospital Authority.

Advantages Advantages

1. Re-deploying existing resources:Different agencies join in the service can manipulate the resource more efficiency. The flexibility of the service can be increase due to the more resources in used. Service become more faultless which is benefit to our service users.

2. Injection of new resources:Different kind of service provided wide range of resource. It solved the problem which is lack of resources, knowledge and professional. It expand the function to provide a wide range services to the services users.

3. Increase agencies communication and cooperation:

Agencies oriented integration highlight the issue about cooperating between different agencies. The information, knowledge were interchange within agencies. Due to the cooperation increase, service become diversely and gives more choice to service users. Resources saving with integration that reduce the repetition expenditure on the same resources.

4. Save some NGO’s life and retain them in the community Resources, manpower supported by different agencies

save some NGO’s life. They can had more chance to provided service and maintain there competitiveness in the community.

5. Joining professional workers together:such as social worker, psychologist, elderly assessment workers, doctors…etc. therefore, they could provide one stop-service to service users.

Disadvantages Disadvantages

1. More complicated cooperation that may take a long time to work with other departments.

2. Takes more time to communicate and cooperate with all the departments and centres.

3. More difficult to allocate resources because there may lack of manpower to proceed the service render provided by the different departments.

Locality-oriented Integration

DefinitionDefinition

Within one locality, different agencies or workers join together. e.g. agencies join together to respond to hot issues like indecent assault. (Lo, 2006)

Examples of locality-oriented integration:

Example 1:Example 1:

The anti-family-violence road-show of Thye Hua Kwan Moral Society, Family Service Centre (Bedok North) in Singapore.

Background: Family Service Centre (Bedok North) located in old, poor district

where a lot of women suffer from family violence. Family violence doesn’t only happen to those low-educated women,

but also to the high-education one. Victims often did not like to disclose themselves. “Reporting family violence is the only way to stop violence.” Fidzah

(The Social worker) told us. The goal of the road show is to arouse the awareness of local

people about the issue and encourage them to report it to The FSC. Therefore, different centre cooperated to achieve these goals.

Details of the road-show: Road show titled “Break the Silence, Seek

Help to End Family Violence” held on Sunday (July, 2006).

The road combined a myriad of elements of music, drama, games, pictures to convert anti-violent message.

Example 2: Example 2:

朗日計劃 of Yuen Long (West) Integrated Family Service Centre

Programme Details: This is a programme jointly held by an Inte

grated Family Service Centre of Social Welfare Department, an Integrated Family Service Centre of a NGO and a Youth Centre of a NGO.

Objective: The programme aimed at building commu

nity and social network between CSSA recipients and single-parent families in two targeted public housing estates. The programme made use of the client data from the Social Security Field Unit to screen out targeting clients.

Example 3:Example 3:

元朗區福利辦事處—元朗西「服務區域為本」協作網絡會議

Programme Details: This cooperate-network meeting is organized by the Social Welfare

Department. Members of the meeting included staff from Social Welfare Department, Social Security Field Unit, Family and Child Protective Service Unit, Integrated Family Service Centres of Social Welfare Department, Integrated Family Service Centres of Non-governmental Organizations, children and youth centres, secondary schools, primary schools, kindergartens. The rationale of the meeting is to create a communication platform to enhance the cooperation between various agencies and departments within the district. The meeting also served provided a platform for promotion of services. The meeting is held every half year.

The meeting focused on monitoring and improving the welfare services of the Yuen Long District. Some foci of the meeting were prevention of family violence, enhance residents’ sense of belonging, improve communication platform between agencies and between agencies and residents.

AdvantagesAdvantages

To clients: As different types of welfare organizations will join and h

old function together to target the hot issue, citizens could know more about hot issue and types of services they needed at the same time.

Locality-oriented integration responds to the hot issues which usually reflect the needs of people.

Easier to access as there are more than one agency involved.

It enhances local people’s sense of belonging to the community.

To Social Worker: Multi-level intervention Bring in more views and alternatives in tackling the issue

s Enhance workers’ sense of belonging to the locality Enhance the cooperation of workers in different agencies. Self improvement by learning from other social worker o

n handling the case, group, or community work.

To centre: It facilitates the mutual cooperation process

among agencies within the locality Different agencies may have different netwo

rk and user groups, they can greatly increase the work effectiveness and efficiency by working together.

Agencies can assess clients’ needs in broader and diverse context.

It may simplify administration and communication procedures after discussion and compromises over communication platform like meetings

It allows multi-context intervention. It prevents service duplication. Better use of resources through centralized

management For the more public advertisement of welfare

organizations to the citizens. Provide different service creatively and flexibly .

To community: By involving many agencies within the locality, it is easier to

create an atmosphere in the locality concerning the issue, which lead to better effect

Better use of resources through centralized management Prevents crime Division of work depends on the characteristics of the agency,

result in higher efficiency in responding to local issue The community work shows compassion to the citizens and it

enhance the social cohesion in long term. it broadens the social network of the residents in the same loc

ality

DisadvantagesDisadvantages

To clients: Clients may not know clearly about the

detail work division between the agencies, and may get confused of which agencies provide the service

To worker: The cooperation involved a lot of shared resource (time, material,

manpower, money...), it may result in conflict when there is unfair events.

Communication between workers from different agencies may not be as feasible and effective from workers in the same agency; this may lower the work efficiency

As it involves many agencies and professionals, it is not easy to communicate all the information accurately if not over a communication platform like meetings

It is time consuming to create the platform as it involves many agencies and professionals within the locality

To centre: Different centre have different missions,

vision and work practices, these may result in misunderstanding and conflicts

Agencies have different work focus; it is difficult to gather different agencies and departments to focus on one specific issue of the locality

To community Locality is very large and complex; target

at all hot issues may not be possible

Client-oriented Integration

DefinitionDefinition

It provides the service in order to meet the individual or family needs, it is different from placing the clients into the existing services, thus, the planning of integration services develop in community and clients’ needs. Clients obtain the services which they need in the same agency, even the same worker.

Two styles of client-oriented integration:

1. Same clients but different needs.

2. Different clients but same needs.

Examples:Examples:

1. The Jockey Club Centre for Positive Ageing It is specially designed for the care of elderly with demen

tia, and for training carers working in the field as well as informal carers, (e.g. family members, domestic helpers). Quality services are assured with the professional involvement, a team of specialists comprising a medical doctor, nurses, occupational therapist, physiotherapist, social workers and personal care workers operate the Centre. It provides one-stop services to the elderly with dementia.

2. Integrated Family Service Centre IFSC as a whole, it includes Family

Counseling Unit, Family Support Unit and Family Resources Unit. People come from different needs, for instance: financial needs, housing needs, needs for job and emotional needs, etc.

AdvantagesAdvantages

The services were not divided into different departments, we can understand the individual, family and community needs in all-round, therefore we can provide appropriate service for their needs.

Multi-level assessment of different clients: different perspectives from different professions to assess the same case. Effective - comprehensive care to satisfy the client’s need.

Clients can obtain different services in the same agency, it can save their time and it is convenient to them. they can also obtain different services from different workers

Person-centered: clients get comprehensive care, it respects individual and start from client’s needs.

Make a good use of allocation of manpower, places, facilities and other resources with good flexibility. Clients may have a larger space in centre for activities.

Apply diversification and multi-level of social work intervention with good flexibility.

Simpler administration: one case file within the agency for each client while getting diverse services In IFSC, every client just has one case file, no matter what servic

es they got. (financial and counseling service )

DisadvantagesDisadvantages

Cooperation with different workers The quality of service depends on the

cooperation of different workers and their communication style.

Different methods may associate with different administration procedures, providing all these methods by a single agency may make the overall administration complicated.

Different methods require different skills, knowledge and experiences from workers, workers may not be able to master the demands of different professional knowledge and intervention methods. In the JCCPA, they run a case management

intervention method to deal with every client, however, their case managers are come form nurses, occupational therapist, physiotherapist and social workers, so they may not acquire professional knowledge from other fields.

Different professionals work together, but different people have different style to deal with the same case. We can not control their treatment method and style.

Dealing with all different methods may introduce much more workload and pressure to workers, as they may not have the knowledge in different professionals and perspectives.

Even though having the same case file, different services may still be provided by different workers

Positive comments on the practices Positive comments on the practices and Client-oriented Integrationand Client-oriented Integration We can understand more about the client

and did not divide into different parts and needs, it is easy for us to have a well recognition of the client.

It is good for us to work with different professionals and workers, we can learn from their experiences.

Negative comments on the practices Negative comments on the practices and Client-oriented Integrationand Client-oriented Integration

We need to spend more time to have some discussion, for example, different professionals share their professional views and opinions on the same case in the case conference.

It is easy to argue with different workers through discussing and sharing different points of views.

Difficulties in implementing integrated practice

Difficulties 1:

Misunderstand the concept of integration Different professions are only joining

together to provide different services without recognizing the concept of integration. They may have some misunderstanding and did not know the rationale or meaning of the integration.

Method to face or solve the difficulties: Provide training to worker in

understanding the concept of integration. To train staff such as case manager who

responsible for coordination between different professions.

Difficulties 2:

Difference in vision and practice between professions and agencies.

Not all the professions obtain the training know about integration and there is a difference between every profession. Such as social worker, teacher, occupational therapist and physiotherapist etc.

Method to face or solve the difficulties Train up professional managerial personnel to monitor

the integrated practice. Pursue further education is needed for different

professionals or workers in order to fulfill the new trend of case management.

Communication Different professions or departments should

have a good communication channel to share their knowledge, views, and intervention method with others.

Difficulties 3:

Demand both specific and generic skills of workers.

The balance of specialist and generalist, some workers are required to be skillful in group work, but some are good at case work. Except for special skill, different workers have different treatments or intervention methods.

Method to face or solve the difficulties Require social workers to attend

continuous trainings.

Difficulties 4:

Worker’s may not have enough knowledge, acceptance and initiative to adopt integration in their practice

Method to face or solve the difficultiesProvide practice guidelines and training to

social worker.

Difficulties 5:

Time Management In takes time to communication with other workers and

agenciesMethod to face and solve the difficulties

Communication Case conference is a good chance for different

professionals or workers to deal with the problems of the clients. They should make a good use of the case conference to exchange their opinions and intervention methods for professional development.

Difficulties 6:

Funding from the government is limited How to distribute the funding to different

departments and organization in a more appropriate way? How to face the demand of quantity of services provided. For example, not enough school social workers.

Discussion

Integration offers one-stop services and service users could obtain the required services within one setting. To increase the range of services and relatively, more resources is needed for the administration fee and to hire more workers for the provision of services. But it is known that government did not raise any subsidy to the integrated setting after integration. Therefore, the workload of workers become heavier and the performance of workers is going to be questioned. Integration is rather ideal to offer comprehensive services to the service users but in reality, the resource is not directly proportional to the increasing of services and so it is value to think if service users could really gain any benefits from integration.

Discussion (Cont’)

The mission of integration is to combine wide range of services for the services users. Through the interview with some social workers in the I.T. setting of The PHAB Association, they expressed that workers were responsible for the youth service in the C&Y centre in the past. But after integration, workers needed to cope with the family and outreaching services and actually they were not competent enough to handle those problems. The purpose of integration is to offer clients with better services but in the reality, worker’s ability or coping skills might not adapt to this sudden changes. Therefore, the mission of integration is going to be questioned as clients might not obtain ‘Good services’ after integration.

Others

The integration of different culture’s worker in Singapore As the Social workers in Singapore come from different

culture background (India, Malaysia, Chinese…), some of them were educated in their own country (Malaysia). However, they worked together to function well as a unit, because their clients may also come from different culture (to meet the needs of clients). They respect each other and they learn other’s language to achieve cultural Integration.

Reference:

何潔雲 , << 資源重整 --- 香港青少年綜合服務本地經驗反思 >>,“ 社會福利與社會工作本土化 --- 理念與實踐”學術研討會 ,1997, 台北

阮曾媛琪 , 1992; 社會服務整合化的意義及展望 . 香港社會工作學報 ,第二十六卷第一期

Web site: Lai Chi Fung. The budget cut of family service center. Retrieved

http://www.hkbu.edu.hk/journewsnet/news/news420.htm from 31/10/2006.

home4u.hongkong.com/education/training/skh/milestone.html http://home4u.hongkong.com/education/training/skh/model.html http://home.netvigator.com/~yipsir/newpage5D-278.htm http://swforum.socialnet.org.hk/article/001112.htm http://www.emb.gov.hk/index.aspx?nodeID=1974&langno=2

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