Risk in social work: tips for managers

Therefore, structural social workers aim to help service users connect with existing groups, connect with one another within agencies or service settings, and amplify the voice of consumer advocacy groups within organizations. This analysis highlights examples of structural influences at three levels: While researchers are still exploring the reasons for this, some possible explanations for the association between unstable housing and HIV risk include the difficulty injection drug users have in accessing clean syringes while staying on the street or in shelters, the pressure to exchange sex for rent money or a place to sleep, and the pervasive feelings of hopelessness that many homeless people experience Dickson-Gomez et al.

Homelessness may present particular risks for women, who are generally not well-served by emergency shelters, often designed primarily to accommodate homeless men Wechsberg et al. Additionally, housing is a critical resource for improving the health and well-being of HIV positive people. Understanding these associations, structural social workers should help service users who are homeless or unstably housed to access housing.

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This includes applying for housing subsidies if service users cannot afford housing on their own, with attention to the limitations and conditions inherent in accepting different types of subsidies. Structural social workers can also engage in advocacy to make housing a more accessible and equitable resource in the U. An important prerequisite for this work may be consciousness raising around the structural causes of homelessness, as service providers and service users alike tend to blame individuals for becoming homeless, rather than examining the economic and political factors that contribute to the problem of homelessness Lyon-Callo, Having access to health care and prevention services is essential for people who are HIV positive or at high risk of contracting HIV.

In the United States, being able to access competent health care is inextricably linked with poverty, racism, and homophobia. Several factors contribute to this situation, including employment discrimination against people of color and sexual minorities, and the fact that gay and lesbian people are unable to access partner benefits through marriage in most states. In addition, policies on pre-existing conditions make it difficult for HIV positive people to independently purchase private insurance under the current structure of the U.

Having access to care does not guarantee that it will be competent. At a basic level, structural social work, like all social work, must start with helping people meet their immediate needs, including health care. Thus, structural social workers should use their advocacy skills to help uninsured people obtain insurance when feasible, such as by providing assistance in navigating the complex bureaucratic maze of applying for Medicaid and prescription drug assistance programs.

In addition, social workers should help service users overcome barriers such as transportation and language to access the most competent care possible. This may include assisting service users in advocating for themselves with health care providers who demonstrate discriminatory attitudes or behaviors. Additionally, structural social workers and service users should advocate to reform the U. Thus, both concepts are rooted in the stigmatizing of sexual minorities lesbian and bisexual women are also affected by homophobia and heterosexism in manifold ways, but are at a much lower HIV risk than MSM due to different risk behavior profiles.

A related concept is transphobia, which is negative attitudes and hostility toward people whose gender identity or presentation differs from their sex as assigned at birth Lombardi, In many countries and in some U. Texas , some sexual acts between men are or recently were illegal Herek et al. Criminalizing sex between men forces MSM into secrecy, making it difficult for men to access prevention and HIV testing services, or to disclose their HIV status for fear of harassment, blackmail, and arrest Beyrer, Other effects of stigma are less obvious, but still impactful.

Some advocates have linked the struggle for gay marriage in the U. Furthermore, homophobia and heterosexism are tied with racism in complex ways. From this perspective, the fact that sexual minorities are systemically denied social, economic, and political rights influences hope and decision-making in the context of HIV risk. Therefore, working to change these oppressive structures stands to positively impact the HIV risk environment at multiple levels. Within dialogical relationships with service users, social workers can facilitate critical consciousness through the use of critical questioning, political education, and social empathy.

This may help service users connect their health and risk behaviors to the heterosexism inherent in dominant ideologies, such as the idea that gay men might as well be promiscuous since traditional marriage and family life are not available to them, or the sense of hopelessness that some gay men of color may feel in the face of homophobia, racism, and gendered ideologies about what constitutes a masculine identity and role. In this instance, collectivism and connecting gay and transgender service users with one another and with activist groups is a potentially powerful strategy, both in terms of facilitating critical consciousness and working to achieve social and political change.

A case study helps to illustrate the structural factors influencing HIV risk and health, and the approaches structural social workers can use to address them. William is a 22 year-old African American man living in an impoverished community in a large Midwestern city. He was asked to leave his home three years ago after coming out as gay to his parents. Since then, he has bounced between different living situations, sometimes staying with friends, renting rooms at transitory hotels, or living on the street.

William graduated from high school but has had difficulty finding stable employment. When he needs money or a place to stay, William sometimes has sex with other men in exchange for money or housing. He reports that he does not always use a condom when having sex. What do I have to live for? When he last visited the local public health clinic, he says he experienced negative attitudes from staff after he told them he was having sex with men, so he does not want to return there.

William does not know his HIV status. At the community level, the neighborhood public health clinic is a potential resource for William, but his access to it may be limited both by his lack of insurance and discrimination by the service providers there. Macro-level structural inequalities are interlaced with these factors.

Structural approach to practice. Like all social work, structural social work begins with relationships. In this case, a social worker in virtually any medical or social service setting will have access to power and resources that William does not have.

The Unheard Gender: The Neglect of Men as Social Work Clients

The structural social worker should be mindful of this power and acknowledge the skills, experiences, and strengths that William brings to the relationship as they work together. For example, the social worker might help William apply for Medicaid, food stamps, or subsidized housing, but should make sure William is aware of the implications of applying for and receiving such types of aid, such as if a religiously based housing program would be accepting of his sexuality.

While the social worker might help William get an HIV test or drug treatment if he wishes, these should not be preconditions for William receiving other assistance. Structural social work is more than a theory or practice approach. Being HIV positive is a stigmatizing condition, and the groups most at risk for contracting HIV are already oppressed and marginalized in other ways.

However, structural social work does not end in the clinic, hospital, or office. Living this commitment may involve policy work, advocacy, engagement in electoral politics, and the creative resistance of both social workers and services users. Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9 3 , Theorising critical social work.

An introduction to theories and practices pp.


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Practising critical social work. Structural barriers and human rights related to HIV prevention and treatment in Zimbabwe. Global Public Health, 4 6 , Global prevention of HIV infection for neglected populations: Men who have sex with men. Clinical Infectious Diseases, 50, Challenging the stigmatization of female sex workers through a community-led structural intervention: Learning from a case study of a female sex worker intervention in Andhra Pradesh, India.

AIDS Care, 22, The dynamics of family policy. An examination of the persistence of the residual child welfare system in the United States: Addressing charges of radical theoretical myopia with implications for social work practice. Journal of Progressive Human Services, 20 1 , Creating contexts for effective community mobilisation.

Centers for Disease Control and Prevention. HIV prevention in the third decade. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Retrieved from Centers for Disease Control and Prevention website: The relationship between housing status and HIV risk among active drug users: Anti-racist social work 3rd ed.


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  7. Managing risk is at the heart of social work - here's how to do it effectively.

A theory of practice. National Transgender Discrimination Survey report on health and health care. Putting sexual minority health issues in context. Human rights and social work: The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. Public health and trans-people: Barriers to care and strategies to improve treatment. The production of self-blame and self-governing within homeless shelters. Medical Anthropology Quarterly, 14 3 , Historical development of critical social work practice.

Delivering HIV services to vulnerable populations: A review of CARE act-funded research. Public Health Reports, 2 , Selecting appropriate practice models. A structural approach to social work practice. Qualitative Health Research, 20 11 , Canadian Journal of Social Work Education, 5 1 , The new structural social work 3rd ed. Denver MSM sociostructural factors: Preliminary findings of perceived HIV risk. Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care, 16 6 , Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse.

Research on Social Work Practice, 16 1 , Conspicuous by their absence? These describe programmes and interventions with divorced fathers e. Perel and Peled, , fathers of children removed from home e. Indeed, empirical studies in England Roskill et al. Moreover, much of the literature on fathers has an agenda: Scholars contend that the inclusion of fathers in social work will contribute to the well-being and development of their children, by fostering their involvement in their children's lives, encouraging them to meet their financial obligations to the family, and helping to maintain and improve the spousal relationship e.

They also argue that involving fathers in social work interventions will provide a necessary corrective for the finger pointing at mothers in cases of child maltreatment and make clear the responsibility that fathers have for the care of their children e. Policy changes aimed at including fathers in the welfare system have been made in England, continental Europe and North America e. Risley-Curtiss and Heffernan, ; Scourfield, Numerous programmes have been established to help social workers include and better relate to fathers in their practice for comprehensive reviews, see Maxwell et al.

Training courses have been established to help social workers engage fathers in child protection work and to encourage non-custodial fathers to become more involved with their children e. Some guidelines have been formulated for practice with fathers e. These initiatives are indicative of a changing trend.

However, as scholars point out, fathers are still largely outside social workers' field of vision e. A study conducted in Sweden found that social workers there regard single fathers as less deserving of support than single mothers Kullberg, Fathers are not perceived as a parental resource that can be mobilised in problematic family situations e. Moreover, even when they are not completely left out, they are viewed almost exclusively in terms of their paternal functioning, which is regarded as less relevant than maternal functioning e. This narrow perspective not only affects how social workers treat fathers.

It also conveys a negative message to all family members e. The perspective is harmful to all concerned. Where children are maltreated, the mother is usually automatically blamed. Fathers who have difficulties are not helped. Fathers who might be able to give needed support to the mother or become the primary parent are not identified or given assistance. With fathers viewed almost exclusively in terms of their function, their emotions and needs have tended to go unrecognised and unacknowledged in social work literature and practice e.

Thus, with rare exceptions Baum, , the literature on divorce pays scant attention to fathers' feelings of loss, grief and pain when they are distanced from their children. The literature on court-ordered removal of a child has similarly focused mainly on mothers e. Freymond, and largely ignored fathers' feelings. Baum and Negbi's study of fathers in Israel is the only study I found that focused solely on fathers. It found that all those interviewed reported experiencing the removal as a traumatic event, which utterly devalued them and annihilated their paternal identity.

The loss and pain revealed to the researchers do not seem to meet with a listening ear from social workers in the field. The import of such testimony may be easy to minimise, as coming from only one father in a moment of exceptional pain. However, the paucity of testimony does not necessarily indicate any rarity of the occurrence, but rather the very small number of fathers studied. As scholars have noted, all the parties involved contribute to the neglect of men in social work. Fathers often create barriers to engagement with social workers e.


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Some mothers do not want their partner to engage with social workers e. The professional discourse on fathers in child protection work paints them variously as useless, irrelevant, absent and a threat e. Various factors contribute to social workers' neglect of men. One is that most social workers are women and find it easier to work with women, whose outlook and language are usually closer to their own. Another, ironically, is the commitment of the social work profession to help the weak, powerless, oppressed and discriminated.

For all the social changes in the last decades, men as a group are still socially dominant and more powerful than women. A third factor is social work training. In few if any social work courses are men—their needs, their gender-related ways of manifesting and coping with distress, and interventions specifically geared to them—an inherent part of the curriculum. A review of thirty-two undergraduate social work programmes in Canada found that fewer than 5 per cent of the courses relating to social work with children and families mentioned fathers or fathering in any way Brown et al.

One outcome of such gaps in training may be seen in Ryan et al. The first phase of the study was conducted when the respondents were social work students, the second phase three years after graduation. The findings showed that, irrespective of gender, most participants did not want to engage in a therapeutic relationship with men and that some even refused to do so. Various explanations may be provided for the fact that, even when they do work with men, many social workers have difficulty providing them with the emotional support that they much more readily provide to female clients e.

One is that social workers believe that men are less receptive of emotional support than women. Another is anchored in differences in how and when men and women manifest their distress e. Whereas women tend to manifest sorrow and pain in words and gestures e. Some professionals fail to identify the latent distress that lies behind such manifestations, and do not recognise such behaviours as overwork, drinking and engagement in sports as means men employ to diffuse their distress Martin and Doka, The one notable exception is the extensive social work intervention with men defined as deviant: Baynes and Holland, , disengaged fathers e.

Kruk, and fathers in prison e. Social workers' apparent readiness to work with such men may be accounted for by social work's dual commitment to the well-being of the individual and the well-being of society. Work with these men addresses major social problems, even where interventions are individual. Men have received limited attention not only in social work practice, but also in social work research. The psychology and sociology literatures deal extensively with men's experience both of normative life transitions e.

These literatures show that men, no less than women, face difficult challenges as they move from one life phase to another and underscore the many stresses and emotional difficulties men encounter. The social work literature has barely touched on these matters. The above-noted survey yielded very few articles specifically on men.

Leung and Chan's paper on the impact of unemployment on men in China and Winnett et al.