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The classification and recording of “Social problems”
Soc. Sci. & Med., Vol. 12, pp. 255 to 263.
0037-7856/78/0701-0255502.(X)/0
© Pergamon Press Ltd. 1978. Printed in Great Britain.
THE CLASSIFICATION A N D RECORDING OF "SOCIAL PROBLEMS" ROSEMARY F I T Z G E R A L D
Institute of Psychiatry, London Abstraet--A national survey of local authority social services departments was carried out to investigate methods of classifying and recording the presenting social problems of clients referred to social workers. The results of the survey revealed major inadequacies in present methods of recording information. These results are discussed in terms of the general principles underlying case recording procedures. A reappraisal of recording procedures would represent a major advance towards compiling reliable statistical information. The development of a problem classification for use in research is described as an illustration of some of the difficulties encountered in attempting to systematize data collection in this area. However, if assessment and measurement of needs, demands, resources and activities in the social work field is to be achieved social work practitioners, planners and administrators must recognize the value of systematic data collection carried out at the level of the case record.
!. I N T R O D U C T I O N :
THE NEED FOR RECORD-KEEPING
The general problem of record~keeping in social services and welfare agencies is not new and has been recognized for some long time. As early as 1937, Margaret Bristol [1] pronounced: "If I were to judge a case-record on its merits, I would consider its readability, that is, the ease with which one could read it and grasp the essential points. I would judge it partly on its visibility, that is, the ease with which a person could refer to various elements in the record and locate what was wanted. I would want it to contain a clear, concise, accurate and objective presentation of the material. It should be well-organized and not too long or too full to be usable or too short to be complete .... If I were using a number of different records I would want a certain degree of uniformity and standardization as to form and the use of abbreviation as well as in the general organization of the documents and history sheets, so that I would not need to waste a good deal of time in using the different records." Over 30 years later, in 1968, the Seebohm Report [2] voiced the same concern with reference, not simply to the case record, but to the general problem of recording information: "The personal social services are large-scale experiments in ways of helping where there is a need. It is both wasteful and irresponsible to set experiments in motion and omit to record and analyse what happens. It makes no sense in terms of administrative efficiency and however little intended, it indicates a careless attitude towards human welfare." (Para. 456). These two quotations, widely spaced in time, indicate the continuing recognition of the need for adequate recording and statistics in the area of welfare provision. This need has been accentuated particularly by three developments:
1. The increasing involvement of both central and local government in the provision of services to the community Throughout the post-war period State responsibility for welfare has been increased by extensive 255
legislation. This development has been accompanied by extensive changes in the structure of those organisations established to deliver social services. The amalgamation of departments providing personal social services under the Local Authorities Social Services' Act, 1970, and the reorganisation of Local Government in 1974 and 1975 have resulted in departments with greatly increased size, status, numbers of staff, areas of responsibility and demand on resources. Today large-scale organisations are involved in the provision of a wide range of services. A degree of accountability is required in order to monitor the deployment of the publicly provided resources that finance these activities. Record-keeping is basic to the process of controlling and accounting for the expenditure of public funds. In addition to monitoring existing policies statistical information derived from records can make an important contribution to policy formulation and decision-making concerning the actual allocation and apportionment of resources both nationally and locally. A realistic and appropriate distribution of resources and ordering of priorities will depend on adequate information for both long-term and short-term planning. This will be all the more important in the face of threatened economies in public spending in the welfare field. The Final Report of the Advisory Council on Social Work (Scotland) Committee on Social Work Statistics (1975) [3] includes the following comment: "Social work is in national competition for resources with other sectors of public services. It is becoming increasingly necessary to back up arguments for resources with detailed statistical information." (Vol. 2. Appendix 3, para. 5.) Centrally and locally there is an increasing awareness of the need for accurate and up-to-date information on the activities and resources of social services departments. This greater interest and involvement in the collection and utilization of information, particularly in relation to attempts to base management and planning on such information, is reflected in the creation of many research and development posts in social services departments since 1970.
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2. The increased complexity of the organizational structure of welfare agencies The wide range of social services available to the community and the vast numbers of personnel involved in their delivery have necessitated the development of complex administrative structures. The significance of reliable record-keeping increases in the context of social welfare provision where there is the possibility of discontinuity of care due to high staff turnover and the mobility of the population to which services are directed. Records are needed to facilitate internal communication between the different activities of a social services department and communications between social services departments and other agencies. Routine standardised record-keeping practices are of central importance if communication is to be feasible and meaningful. As Edmonds [4] has pointed out, this is a problematical area. "At a time when different Local Authority social work departments are coming together in the new social services departments, one of the areas of uneasy alliance may prove to be the combining of different methods of recording both case material and statistics." Intra- and inter-departmental liaison will depend on adequate recording techniques.
3. The growing awareness of social work as a profession Increased professionalisation has engendered a concomitant need to demonstrate that social work practitioners have a specific body of knowledge and skills to offer. In order to emerge as a stronger profession social work will need to justify its activities and demonstrative effectiveness. There is increasing recognit i o n that in this respect records and statistics can be of inherent interest and use to the social work profession, It is already generally acknowledged that adequate records can assist the worker in case management and serve to protect the interests of clients, workers and agencies. Chea [5] examining the implications of research on recording for social work administration and practice concludes: "Research on recording issues helps to systematize a worker's tasks by organizing his perceptions of his personal actions and enables the worker better to understand his professional responsibilities and their relationship to his agency's goals". In the report of the Advisory Council on Social Work (Scotland) Committee on Social Work Statistics (1975) [3"1 the direct value of "sensible statistics" to the practice of social work is underlined: "From the social worker's point of view, a standardised record and summarizing system make regular case-load reviews easier. Assessment of length and frequency of contact with client as well as attainment of established goals are thus encouraged. In a service where staff turnover is considerable it also ensures that another social worker taking up the case has at least basic information". (Vol. 1. Para. 1.16). Moreover, a number of workers have come to appreciate that research based on accurate data can make a contribution to the growing theoretical basis of social work activity. In the literature, several writers have commented on this development: "Perhaps as well as working towards the improvement
of administrative and planning skills in social work, we might concentrate our attention upon methods of recording the data from which our body of professional knowledge should be expected to develop" [6]. "One of the reasons for research into social work must increasingly be to evaluate the validity of social work methods, its selection of tasks and its success or failure ...(in this) recording will be a vital component. It is certain that social work will come under increasing scrutiny and it is right that it should do so. It will need to be demonstrated that social work does help clients, how much, and in what ways and arising from this, evaluation of the success or failure of different methods of social work help will be attempted" [4]. At the same time the motivation of social workers in this direction should not be over-estimated. Although suspicion towards research and statistics is possibly not so great as in the past, at the fieldwork level where pressure of work is demanding in the extreme the collection and recording of data constitute a relatively low priority for many workers. Often within a single agency or even within the work of one practitioner there is a great variation in the quality and quantity of recorded data. Writing of the American experience Kane 1-7] reports: "Social work students learn to recite the litany of recordkeeping. They know that one records data to insure and improve service, to provide administrative accountability, to facilitate supervision and teaching, and to permit research. For these reasons record-keeping is regarded as a necessary evil by most responsible social workers. Unfortunately, their mishty labours with the dictaphone have not, in~act,-pr0ducedrecbrds~--that actually mirror practice or lend themselves either to review or research". In order to overcome antipathy towards investing time and effort in record-keeping this area of activity has to be assigned a high value at all levels in the organization. Social workers need to be convinced that systematized data collection is relevant in making an important contribution to both social work theory and practice. C o m m o n patterns of recording would, as Stockbridge[6-] has indicated, lead to "great economy of time for students who currently have to relearn recording methods in each agency, for research workers who would know where to look for the material they need and for social workers in general when they move from one agency to another or when they inherit cases...". At the same time the knowledge base of social work would be strengthened by the stimulation given to research. Ultimately, these comments on the need for improved statistical information on the activities of social services departments culminate in the recognition of the importance of standard and comparable information based on reliable, up-to-date and easily retrievable data. These requirements have frequently been acknowledged but all too infrequently translated into practice. 11. NATIONAL STATISTICS AND RECORD-KEEPING
Following the publication of the Seebohm Report the National Institute of Social Work convened, a meeting in April 1972 to consider the desirability of setting-up a national working party to co-ordinate,
Classification and recording of "social problems" study and make recommendations on local records and statistics in social services departments. The major issues identified at this meeting were: 1. The immediate need for standard and commonly agreed core-definitions for use in social services departments' records. 2. The need for clarification of information about cases at the local level. 3. The need for improved recording of intake activities. 4. The need to make more explicit, in a verifiable fashion, social work plans, activities and results. 5. The influence of both content and form of recording upon actual social work practices. Following this meeting the Social Work Service Development G r o u p of the Department of Health and Social Security was approached and established a working party on local records and statistics in social services departments. Local Authorities, central government, academic institutions and other interested parties were represented. The original intention to survey records and record-keeping practices of all kinds in social services departments was however eventually restricted to an investigation of current intake documentation and practice in a select number of local authorities. The report produced by the working party concluded: "The experience of the project showed little similarity between one local authority and another in the methods by which information about clients was collected or processed and there was wide variation in the information required on forms currently in use. The argument that local needs should be reflected in local documentation was not substantiated by the evidence collected. In addition there is no standardised terminology and it is, therefore, not possible to make valid comparisons" [8]. The report continued: "At the present time it would be difficult for many directors of social services departments to state how many people each year have asked their departments for help, who referred them, the reason for referral and even what their basic demographic features were. Even where such information is collected a director cannot compare his situation with other Local Authorities since information other than national statistics is not generally assembled in comparable form either between local authorities or even sometimes within parts of the same Local Authority". The D.H.S.S. report on Intake Documentation gave a preliminary indication of the state of record-keeping at the local level. In terms of deriving standard, comparable and reliable information as a routine pro-
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cedure from the record-keeping systems of local authorities, the outlook appeared poor. However, local authorities are required to make an annual statistical return to central government and it might be expected that this could provide a source of valuable information. At present, the statistics required by the D.H.S.S. are the only nationally available statistics provided by all Local Authorities [9]. Table 1 outlines in summary form the categories for which statistics are collected in the annual return to the D.H.S.S. Unfortunately, although the D.H.S.S. system of collecting data does provide the only regular and uniform basis for national statistics there are disadvantages in the method employed. The principal drawback lies in the fact that the returns are aggregate statistics collected in terms of client categories with reference to the statutory obligations of local authorities*. While it is obviously both necessary and valuable to monitor the implementation of statutory powers and to collect statistics on specific client groups, if data collection is restricted in these terms much social work activity is left unaccounted for or accounted for in only a very limited manner. The use of categories based on pre-Secbohm divisions in social work result in statistics that do not adequately reflect the comprehensive and generic nature of current welfare practice. Furthermore, the aggregate returns in their present form prove to be relatively unweildy, inflexible and insensitive for information needs other than those of the most general type. Consequently, at the local level the use of these statistics is often seen as of little operational value by social work practitioners, planners, administrators and managers. Although national statistics collected by the D.H.S.S. serve the limited purpose for which they are designed they cannot focus on many of the areas of interest which were outlined in the introduction to this paper and which are now attracting increasing attention. Hence, each Local Authority has tended to evolve its own system for the collection, storage and retrieval of data. In the absence of any overall direction of these activities no uniformity has been imposed and the present diversity of information systems has developed. As a result the co-ordination of data collected from different sources has proved to be an immensely difficult undertaking. The G.P.R.U.t inquiry into record keeping practices in social services departments illustrated this state of affairs. IIL THE G.P.R.U. INQUIRY
* As from March 1976 certain amendments were made to the statistical returns of the D.H.S.S. For England and Wales statistics for children in care are collected on the basis of client unit returns rather than as aggregate returns for this group. Following the recommendations of the Final Report of the Advisory Council on Social Work Committee on Social Work Statistics (1975) [3], the Scottish Office has accepted a wholesale radical change to unit returns in place of classified aggregate returns implemented as from March 1976. Unit returns are superior in that they provide separate listings of the characteristics of each client, member of staff, or establishment and yet still allow aggregation when required. t The General Practice Research Unit, Institute of Psychiatry.
The interest of the G.P.R.U. in systems of recordkeeping and the statistical collection of data in social services departments grew out of the need to formulate a classification of the social problems of clients referred to social workers in an experimental attachment in general practice. In the development of a classification to be used for research purposes it appeared necessary to investigate those systems which might already be in general use. 1. M e t h o d
At the beginning of 1974 all social service depart-" ments in England, Scotland and Wales were requested
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RO6EMARYFITZGERALD Table 1. Statistical returns relating to the activities of Local Authority Social Services Departments at 31st March 1975 Return group
Title
Residential
Persons in residential accommodation (homes for the elderly and physically disabled and homes for elderly mentally infirm) Elderly and physically disabled Homes opened and closed Registration of private and voluntary homes Children and Young Persons in Care: Residential Accomodation Section 18--ChronicaUy Sick and Disabled Persons Act (1970) Mother and baby homes Residential accommodation for mentally ill and the mentally handicapped Homes and Hostels for the mentally ill and mentally handicapped and Day Centres for the mentally ill opened and closed Supportive services Meals services Home help services Certain kinds of Assistance provided to Households Day care (centre based) services Adult Training centres Day centres for the mentally ill, elderly and physically handicapped Children's day care facilities Mental health (general) Number of persons admitted to local authority guardianship and under guardianship General Registers of handicapped persons Registration of blind and partially sighted persons Children and young persons in care Source: Department of Health and Social Security Statistics and Research, Division 6.
to provide details of any classificatory schema operating to describe the problems referred to social workers. At that time there were 226 Local Authorities in existence. In response to this initial inquiry 150 departments replied. Follow-up of the 76 non-responders at a later date produced a further 41 replies. The total response was therefore 191 (84.5~o). Of these 191, 29 replied that they used only the classification system required by the D.H.S.S., 21 provided too few details to be of use in the analysis, the 14 indicated that due to local authority re-organization we should refer to systems in use in other departments with whom they would or had combined. The remaining 127 replies were analysed. 2. Results
An examination of the remaining 127 replies to the survey revealed that there is no generally accepted typology of social problems that is widely in use. The immense variation in the classificatory systems devised by social service departments posed difficult problems in terms of analysis and presentation of the results of the survey. Classificatory systems vary widely in the items upon which information is collected, the amount of data required and the dimensions upon which data are organised and presented. All too often it was impossible to consider the problem classification in isolation because it did not exist as a distinct, identifiable element in the case record. Most systems are composed of a mixture of indicators of needs, demands, resources and provision. There is generally no clear distinction between these different levels of information. Therefore, in order to facilitate presentation of the results it has been necessary to adopt a basic framework (to be discussed later in the paper) which differentiates levels and types of information.
Fundamentally this rests on four basic dimensions-systems categorising by client type, social problem presented, resource/service provided, or legislation under which provision is made. The breakdown of the results of the survey are presented in terms of this framework in Table 2. It can be seen that in 41 cases classification is made solely in terms of one of the four broad dimensions. In the majority of cases (96) permutations of some or all of the dimensions exist either in the form of complete admixtures (78), or as combinations with some dimensions subsumed under others (11), or as coexistent, distinct categories ( 7 ) I n only one case was information collected and presented in terms of each of the four dimensions treated separately. The wide variety of classification schemes in use indicates the extent to which social services departments' records fall lamentably short in providing standard, comparable data bases. Focusing on the question of social problem typologies not only are numerous different problem classifications in use, but in many instances the difficulties are magnified by procedures which either confuse quite distinct areas of information or omit some areas altogether. Very frequently items relating to the categorization of client problem were found to be inextricably enmeshed with other aspects of the case record. Alternatively, classification by social problem was sometimes omitted altogether and substituted by classification according to items belonging to other dimensions. For example, records are in some cases kept principally in terms of resources provided by the department, e.g. Aids and Adaptations, Home Help, Residential Care. Where no tangible resource can be indicated legislative terminology may be resorted to, e.g. preventive work under the Children's Act, 1963. In these circumstances there is no information regarding
Classification and recording of "social problems"
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Table 2. Analysis of Social Services Departments' classification systems No. of systems
Classifications according to: One dimension only
(a) (b) (c) (d)
Client category Social problem Resources/services provided Legislative grouping
One dimension subdivided by items from other dimensions Two dimensions, one of which is sub-divided by items from further dimensions
32 3 4 2
41
8 3
11
More than one dimension, each treated separately
Mixture of two dimensions
Mixture of three or four dimensions Total number of systems analysed*
7 a+b a+c a + d d+c d+b
9 20 11 4 I
45
a+b+c a + c + d a+b+c+d
24 8 1
33 137
* It should be noted that the number of cases analysed (137) is greater than the number of social services departments (127) from which these classification systems derive. A small number of departments used more than one classificatory system. the reason for a particular deployment of resources. What is being done in terms of provision of services is known but there is no indication of why. A linkage system between the various facets of the case record, as for example between clients' problems and social services' provision would facilitate closer investigation of social work intervention processes and their efficacy. A further example of how departments omit information of an important nature or translate it into inappropriate classifications is seen in the frequent practice of dividing clients into broad aggregate groupings according to characteristics closely akin to the pre-Seebohm social work divisions. However, if data are collected simply along such lines as Elderly, Physically Handicapped, Child Care, Family Care, Mentally Ill, Homeless, much information is lost. N o data are availab,, answer questions on the characteristic'difficulties experienced by these groups per se, whether problems are specific to certain client groups or over-lapping or common between groups or subsets of groups. The wide range and variety of classificatory schemes and the confusion even within most of the systems in operation were recognised by many of the Directors who in their replies acknowledged their dissatisfaction with existing methods. Although the G.P,R.U. inquiry intended to focus on one particular aspect of the case record--the problem classification--examination of this section of recording has necessarily involved considering the rationale behind case-recording as a whole and the general problems of information gathering within the social services. DISCUSSION: OBSTACLES TO A SCHEME OF CLASSIFICATION
IV.
From the information presented above it is apparent that an assessment and measurement of needs,
demands and resources in the social work field would involve at least two considerations. These comprise (a) definition of terms and (b) classification of data.
1. Definition of terms Definition of basic terms such as "case", "client", "referral" and "closure" are at present imprecise and are not standardized between or even within departments. Currently many concepts are used in widely varying circumstances and carry differing implications. The use of the term "case" and "referral" provide a good example. Stevenson [10] illustrates the point: "Cheshire Research and Information Section in their report 'Cases and Referrals 1972/3' say 'if statistics are to be comparable similar definitions must be used'.... The interpretation of both 'case' and 'referral', they suggest, has varied both between areas and over time". The D.H.S.S. Records Project (1974) [8] also noted the wide range of meanings given to the term "referral", stating that: "It is used amongst other meanings to denote (a) the first or initial contact or approach to a social services department; (b) the acceptance of this initial contact for further action; (c) a number of on-going activities involving the social services department (not necessarily the same as (b)". Discussing the problem of terminology, Stevenson [10] suggests that it might be helpful to resolve the tangle if the following definitions were considered. She proposes that an applicant be considered as "any person who makes or has made on his behalf an approach, i.e. an application for help/information to a social services department". This is contrasted with a referral, defined as "any individual or family becoming known to the Department, provided that the application requires a social work decision as to whether or not it shall be investigated". Stevenson continues
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social problems that could be subsumed under this general heading. Regulations for the collection and transcription of information will also be required to ensure uniformity of recording practices. The need for systematic approach towards recordkeeping does not imply that a multi-dimensional clas"The term Unscreened Bombardment (is used) to encompass the gross total of applications (i.e. the total impact) sification system can substitute for case files in all coming to a Department or Area Office in person, by tele- the richness of detail that does justice to the complexphone or in writing. Screened Bombardment is the net total ity of human problems and life situations. It is sugof applications 'proper for the Department to consider'". gested only that the introduction of such a system might be the means of crystallizing out the major The need for concensus on core definitions opens areas of focus useful to planner, administrator, and a wide area of debate which has obvious implications social worker. The value of classification lies in distilnot only for screening procedures but for social work ling vital information from detailed case notes. practice in general [12, 13]. These problems have a bearing on the record-keeping process in that until V. A FRAMEWORK FOR A CLASSIFICATION standard definitions exist and are applied consistently FOR RESEARCH A N D SERVICES there can be no guarantee that data from different sources refer to comparable populations or carry the From the analysis of the problem classification same meaning. schemes of the local authorities replying to the "it follows that an application must pass through an investigatory and decision-making process before acquiring referral status". The concept of screening as used in the Brunel study [11] is cited by Stevenson as of use in this context:
G.P.R.U. survey a general framework emerged as a 2. Classification of data possible basis for the collection and organization of The sheer volume of data which accumulates in data. Such a framework attempts firstly to reflect dissocial services departments' files is extensive. The tinct types of information which occupy different ordering of this data will depend on the application dimensions or facets of interest, and, secondly, to of an agreed system of categorizing information on order such information systematically and coherently. The suggested dimensions are as follows: meaningful dimensions. It is logically necessary to dis1. Basic identifying data. tinguish the various facets upon which data are 2. Categories of client*. already or could be ideally collected. Currently, areas 3. Social problem. of information such as demographic data, presenting 4. Service/Resource provided. problems, services requested and resources provided, 5. Legislation under which social work intervention all of which are logically separate and distinct, are very frequently confused. It is difficult to discern any is provided. In use each dimension can be linked one to another clear rationale behind the presentation of much of the data collected by social services departments. As for an individual case giving a profile of that particuhas been stated this problem has been compounded lar client. At the same time all the data pertaining by the fact that each department has been left to to one dimension can be referred to in order to give, for example, the basic demographic features of all devise its own methods of classification. The construction of a framework which could pro- cases referred to a social service department or the vide the structural basis for ordering items of infor- distribution of social problems over a specific period mation is not an easy matter. Firstly, it is necessary of time for all clients in an area. As previously indito delineate the distinct areas or dimensions into cated once the basic dimensions upon which data is which the data can be reasonably and practicably to be collected: have been agreed a series of categories divided. Secondly, given that the dimensions of a for each dimension is required. The dimension o f framework can be agreed, it is necessary to provide social problem may be taken as an illustration of the a detailed itemization of a series of categories within difficulties involved in this task. A problem classificaeach dimension. For example, having decided that tion for use in the research attachment of social social problems constitute an area of information sep- workers in general practice was developed by the arate from other data such as demographic features, G.P.R.U. This problem classification is sub-divided it is necessary to itemize the various categories of into three areas--problems associated with social factors, with personal and social relations, and with * Although several social services departments pointed health. A list of the items contained in the classificaout that they were dissatisfied with recording statistics in tion is set out in Table 3, The instrument was conterms of client typologies, there was a strong impression structed for use in a specific context and contains from the replies to the survey that many departments still more emphasis on medical factors than would be perceived client categorization according to Elderly, Physi- necessary or feasible to obtain in other settings. Howcally Handicapped, Children, Mentally-ill, etc. as a useful ever, the general points it raises are of universal appliand meaningful way of making broad divisions between cability to all attempts to develop problem classificathose seeking help. These broad categories largely reflect tions. the previous traditional specialities of pre-Seebohm social 1. The basis upon which the problem classification work. Although alien to the generic philosophy of contemis ordered should be clear and comprehensible to porary social work client typologies based on such distinctions persist and may well be encouraged by the fact that those who use it. Differing elements such as descripthe present design of the D.H.S.S. statistical returns make tion of client category, action taken and/or required, it difficult to avoid collecting statistics relating to separate legislative heading under which provisions are made client groups. For this reason client typology has been in- should not be confused with items within the problem cluded in the framework. classification. These disparate elements are logically
Classification and recording of "social problems" Table 3. General practice research unit problem classifications I. SOCIAL FACTORS I. Housing: a. Homelessness b. Tenancy problems c. Physically unsuitable for needs d. Overcrowding e. Poor conditions f. Other (specify) 2. Finance: a. Low income b. Poor management c. Indebtedness d. Other (specify) 3. Occupation : a, Unemployment: i) extrinsic ii) intrinsic b. Occupational difficulties, e.g. job dissatisfaction need for sheltered work c. Other (specify) 4. Problems with formal institutions: e.g.D.H.S.S., legal system, Police, Race Relations Board. Specify: 5. Problems of cultural adaptation: a. Religion b. Language c. Social behaviour d. Other (specify) 6. Education: a. Problems at school/college b. School refusal c. Inadequate or inappropriate educational provision d. Other (specify) 7. Problems with home management: a. Personal care of self b. Domestic care of family c. Other (specify) II. P E R S O N A L A N D SOCIAL RELATIONS 1. Relationship problems a. Marital b. Parent/child c. lntra-familial d. Problems with extended family e. Problems with close personal relationships outside the family, e.g. boy-friends f. Problems with neighbours g. Problems with workmates h. Other (specify) III. HEALTH I. Physical health a. Minor physical ill-health b. Major physical ill-health 2. Mental health a. Minor psychiatric/emotional disturbance b. Major psychiatric/emotional disturbance 3. Problems associated with reproduction a. Contraception b. Pregnancy c. Infertility d. Infant behaviour problems (infants under 12 months e. Other (specify) MAJOR SOCIAL P R O B L E M :
8. Environmental Factors: a. Neighbourhood/Environmental factors, e.g. noise, smell, traffic. b. Other (specify) 9. Problems associated with delinquency/ crime: a. Juvenile b. Adult
2. Lack of relationships a. Social isolation b. Bereavement c. Absence from home of parent/spouse d. Other (specify)
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distinct and belong to other dimensions in the framework. 2. The problem classification itself should be composed of mutually exclusive and unambiguous categories in order to minimise error and ensure uniformity in completion of data. 3. Social problems are not discrete, easily identifiable entities which appear singly or in isolation. As Marshall and Munro [14] have stated: "as a profession we are too new to the field to have formulated any ideas about the cluster of problems tending to occur together which might make a syndrome worthy of a label". Clients will generally exhibit a constellation of problems. Therefore a system which allows for the inclusion of more than one problem per client is more realistic than single category stipulations. An indication of major problem(s) as against subsidiary or related difficulties might be worth consideration. 4. The perception of the problem might be expected by vary according to whether the problem is defined by the client or the social worker. It is necessary to strictly define the way in which problems should be identified so that the maximum degree of consistency is achieved. In recording data such as name, address and date of birth the subjective judgement of the recorder does not enter into the process in the same way as it does in defining areas such as the presenting problem. This is an unavoidable problem which exists in compiling case records in all forms of medicosocial enquiry. Therefore it is necessary to be aware of this difficulty and to make clear to those using the system that it is the social worker's and/or the client's definition of the problem that is recorded. Although it would be theoretically possible to distinguish and record problem areas as perceived by both client and social worker, in the G.P.R.U. classification the social worker's assessment of presenting the problem was taken. An addition of another column could provide for the client's definition of his situation but in this case it was not included as it was not an item of focus in the research. 5. Social problems are not static. Problems existent at one point in time may change or shift in relation to one another so that problems may be resolved, created or changed in their predominance of one over others. Just as it is vital to know whose definition of the problem is recorded it is also important to know the point in time to which the data refer. In the G.P.R.U. system the social problems presented at time of referral were taken as a base-line. It would also be useful in case management as well as in research to monitor changes in social problems at specific review points. A regular review system could enable case categorization to be kept up-to-date. Additional data such as this would require amendments in the design of the documentation and are not precluded by the conceptual basis of the classification. 6. In the G.P.R.U. classification system there was provision for indicating whether the identified presenting problem(s) was (a) manifested by the client himself or involved the client and other family member(s)/significant other(s), or (b) manifested by other family member(s)/significant other(s) not directly involving the client but the client reported this as part of his social situation and problem constellation. This refinement was felt to be of some importance in the
setting of general praction referral. In other contexts it might not be so feasible to make these distinctions as a matter of routine procedure. However, this point raises once again the question of stricter definitions of terms such as "client" and "case" and the issue of the unit of analysis to which the data should apply---e.g, the individual client, the family or the household. 7. Notes for guidance accompanied the social problem classification in order to increase accuracy of recording and minimise errors of interpretation. The skeleton basic framework and the itemization of one dimension outlined here are offered only as suggestions for future discussion. Further dimensions may be added either for routine recording purposes or for special intensive investigations. For example, the addition of an assessment of service/resource required as against that provided might give a crude indication of shortfall in provision of services. Obviously, before any detailed recommendations could be made in relation to content and form, different systems would need to be piloted and assessed. Finally, it should be clear that flexibility in recording techniques is warranted where there are actual differences in, for example, agency functions, client populations, or social work services. In advocating uniform and standard recording practices the demand is only that within and between the same agencies the same activities should find reflection in comparable records.
CONCLUSION
The results of the survey of records relating to problem classification support the conclusion that the mass of data contained in the case files of social services departments is not susceptible to systematic review or research. It has been suggested that social services departments' statistics could be greatly clarified if standard uniformly agreed procedures for collecting and presenting data operated. A basic framework for such a system has been outlined and one aspect of this--the problem classification--has been discussed to illustrate both the problems and possibilities. This examination of record-keeping has focused on the state of affairs at the local level. Reference was made to the statistical requirements of central government since all departments are obliged to submit an annual return. However, national statistics are of limited value and fail to compensate for the deficiencies found at the local level. In recommending revision of record-keeping practices at the local level it would be advisable to bear in mind how both local and central statistical needs could be considered in relation to one another. At present the extraction of data for central government poses serious problems with consequences for accuracy and reliability. Ideally, it would be more economical if there existed some linkage between local and central informationgathering so that returns to government represented a condensation of data already collected routinely at local level. Finally, it should be emphasized that adequate record-keeping practices justify themselves not only
Classification and recording of "social problems" by their contribution to planning, m a n a g e m e n t a n d research but also as an aid to practical, day-to-day case-managonent. In support of the view that attention should be drawn to this neglected area it is fitting to conclude with an extract from a report by a working party of Principal Social Workers: "It goes without saying that any improvement in the confidence and morale of social workers in the department is reflected in an increased standard of service to the community. It is our intention that, far from being an irksome aspect of the district administration, which unfortunately tends to be the case, statistical data should and could be a valuable support to morale". (City of Liverpool Social Services Department, 1973) [15].
Acknowledgements--This study was carried out at the General Practice Research Unit, Instutute of Psychiatry under the direction of Professor Michael Shepherd and supported by the Department of Health and Social Security. I am most grateful for the co-operation of all those Directors of Social Services Departments and their staff who responded to the survey. REFERENCES
1, Bristol M. Handbook of Social Case-Recording. Social Services Monograph No. 4, University of Chicago Press, 1937. 2. Report o f the Committee on Local Authority and Allied Personal Social Services (The Seebohm Report). H.M.S.O., London, 1968.
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3. Final Report of the Advisory Council on Social Work Committee on Social Work Statistics. Social Work Services Group, Edinburgh, 1975. 4. Edmonds J. The case record: a basic framework to meet need for standardisation. Social Work Today 2, 4, 1971. 5. Chea M. W. Research on recording. Social Casework 53, 3, 1972. 6. Stockbridge H. E. Social case-recording. Case Conf. 15, 8, 1968. 7. Kane R. Look to the record. Social Work 19, 4, 1974. 8. D.H.S.S. Social Work Service Development Group 0974). Records Project: An Intake Document for Social Services. 9. D.H.S.S. A Guide to Health and Social Services Statistics, 1974. 10. Stevenson J. Referral statistics: potentialities and implications. In Referral and Statistics Day Conference: A Summary of Proceedings. North-west Social Services Research Group and University of Manchester, Department of Extra-Mural Studies, 1974. 1 I. Brunel University Social Services Organization Research Unit, Institute of Organization and Social Studies (BIOSS), Social Services Departments. Heinemann, 1974. 12. Hall A. S. Client reception in a children's department. Publ. Admin. Spring, 1971. 13. Loewenstein C. An intake team in action in a social services department. Br. J. soc. Wk 4, 2, 1974. 14. Marshall M. and Munro J. Can we classify social work? Social Work Today 5, 8, 1972. 15. City of Liverpool Social Services Dept. Statistics: A Suggestion for Improvement of the Present System. 1973.
0037-7856/78/0701-0255502.(X)/0
© Pergamon Press Ltd. 1978. Printed in Great Britain.
THE CLASSIFICATION A N D RECORDING OF "SOCIAL PROBLEMS" ROSEMARY F I T Z G E R A L D
Institute of Psychiatry, London Abstraet--A national survey of local authority social services departments was carried out to investigate methods of classifying and recording the presenting social problems of clients referred to social workers. The results of the survey revealed major inadequacies in present methods of recording information. These results are discussed in terms of the general principles underlying case recording procedures. A reappraisal of recording procedures would represent a major advance towards compiling reliable statistical information. The development of a problem classification for use in research is described as an illustration of some of the difficulties encountered in attempting to systematize data collection in this area. However, if assessment and measurement of needs, demands, resources and activities in the social work field is to be achieved social work practitioners, planners and administrators must recognize the value of systematic data collection carried out at the level of the case record.
!. I N T R O D U C T I O N :
THE NEED FOR RECORD-KEEPING
The general problem of record~keeping in social services and welfare agencies is not new and has been recognized for some long time. As early as 1937, Margaret Bristol [1] pronounced: "If I were to judge a case-record on its merits, I would consider its readability, that is, the ease with which one could read it and grasp the essential points. I would judge it partly on its visibility, that is, the ease with which a person could refer to various elements in the record and locate what was wanted. I would want it to contain a clear, concise, accurate and objective presentation of the material. It should be well-organized and not too long or too full to be usable or too short to be complete .... If I were using a number of different records I would want a certain degree of uniformity and standardization as to form and the use of abbreviation as well as in the general organization of the documents and history sheets, so that I would not need to waste a good deal of time in using the different records." Over 30 years later, in 1968, the Seebohm Report [2] voiced the same concern with reference, not simply to the case record, but to the general problem of recording information: "The personal social services are large-scale experiments in ways of helping where there is a need. It is both wasteful and irresponsible to set experiments in motion and omit to record and analyse what happens. It makes no sense in terms of administrative efficiency and however little intended, it indicates a careless attitude towards human welfare." (Para. 456). These two quotations, widely spaced in time, indicate the continuing recognition of the need for adequate recording and statistics in the area of welfare provision. This need has been accentuated particularly by three developments:
1. The increasing involvement of both central and local government in the provision of services to the community Throughout the post-war period State responsibility for welfare has been increased by extensive 255
legislation. This development has been accompanied by extensive changes in the structure of those organisations established to deliver social services. The amalgamation of departments providing personal social services under the Local Authorities Social Services' Act, 1970, and the reorganisation of Local Government in 1974 and 1975 have resulted in departments with greatly increased size, status, numbers of staff, areas of responsibility and demand on resources. Today large-scale organisations are involved in the provision of a wide range of services. A degree of accountability is required in order to monitor the deployment of the publicly provided resources that finance these activities. Record-keeping is basic to the process of controlling and accounting for the expenditure of public funds. In addition to monitoring existing policies statistical information derived from records can make an important contribution to policy formulation and decision-making concerning the actual allocation and apportionment of resources both nationally and locally. A realistic and appropriate distribution of resources and ordering of priorities will depend on adequate information for both long-term and short-term planning. This will be all the more important in the face of threatened economies in public spending in the welfare field. The Final Report of the Advisory Council on Social Work (Scotland) Committee on Social Work Statistics (1975) [3] includes the following comment: "Social work is in national competition for resources with other sectors of public services. It is becoming increasingly necessary to back up arguments for resources with detailed statistical information." (Vol. 2. Appendix 3, para. 5.) Centrally and locally there is an increasing awareness of the need for accurate and up-to-date information on the activities and resources of social services departments. This greater interest and involvement in the collection and utilization of information, particularly in relation to attempts to base management and planning on such information, is reflected in the creation of many research and development posts in social services departments since 1970.
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2. The increased complexity of the organizational structure of welfare agencies The wide range of social services available to the community and the vast numbers of personnel involved in their delivery have necessitated the development of complex administrative structures. The significance of reliable record-keeping increases in the context of social welfare provision where there is the possibility of discontinuity of care due to high staff turnover and the mobility of the population to which services are directed. Records are needed to facilitate internal communication between the different activities of a social services department and communications between social services departments and other agencies. Routine standardised record-keeping practices are of central importance if communication is to be feasible and meaningful. As Edmonds [4] has pointed out, this is a problematical area. "At a time when different Local Authority social work departments are coming together in the new social services departments, one of the areas of uneasy alliance may prove to be the combining of different methods of recording both case material and statistics." Intra- and inter-departmental liaison will depend on adequate recording techniques.
3. The growing awareness of social work as a profession Increased professionalisation has engendered a concomitant need to demonstrate that social work practitioners have a specific body of knowledge and skills to offer. In order to emerge as a stronger profession social work will need to justify its activities and demonstrative effectiveness. There is increasing recognit i o n that in this respect records and statistics can be of inherent interest and use to the social work profession, It is already generally acknowledged that adequate records can assist the worker in case management and serve to protect the interests of clients, workers and agencies. Chea [5] examining the implications of research on recording for social work administration and practice concludes: "Research on recording issues helps to systematize a worker's tasks by organizing his perceptions of his personal actions and enables the worker better to understand his professional responsibilities and their relationship to his agency's goals". In the report of the Advisory Council on Social Work (Scotland) Committee on Social Work Statistics (1975) [3"1 the direct value of "sensible statistics" to the practice of social work is underlined: "From the social worker's point of view, a standardised record and summarizing system make regular case-load reviews easier. Assessment of length and frequency of contact with client as well as attainment of established goals are thus encouraged. In a service where staff turnover is considerable it also ensures that another social worker taking up the case has at least basic information". (Vol. 1. Para. 1.16). Moreover, a number of workers have come to appreciate that research based on accurate data can make a contribution to the growing theoretical basis of social work activity. In the literature, several writers have commented on this development: "Perhaps as well as working towards the improvement
of administrative and planning skills in social work, we might concentrate our attention upon methods of recording the data from which our body of professional knowledge should be expected to develop" [6]. "One of the reasons for research into social work must increasingly be to evaluate the validity of social work methods, its selection of tasks and its success or failure ...(in this) recording will be a vital component. It is certain that social work will come under increasing scrutiny and it is right that it should do so. It will need to be demonstrated that social work does help clients, how much, and in what ways and arising from this, evaluation of the success or failure of different methods of social work help will be attempted" [4]. At the same time the motivation of social workers in this direction should not be over-estimated. Although suspicion towards research and statistics is possibly not so great as in the past, at the fieldwork level where pressure of work is demanding in the extreme the collection and recording of data constitute a relatively low priority for many workers. Often within a single agency or even within the work of one practitioner there is a great variation in the quality and quantity of recorded data. Writing of the American experience Kane 1-7] reports: "Social work students learn to recite the litany of recordkeeping. They know that one records data to insure and improve service, to provide administrative accountability, to facilitate supervision and teaching, and to permit research. For these reasons record-keeping is regarded as a necessary evil by most responsible social workers. Unfortunately, their mishty labours with the dictaphone have not, in~act,-pr0ducedrecbrds~--that actually mirror practice or lend themselves either to review or research". In order to overcome antipathy towards investing time and effort in record-keeping this area of activity has to be assigned a high value at all levels in the organization. Social workers need to be convinced that systematized data collection is relevant in making an important contribution to both social work theory and practice. C o m m o n patterns of recording would, as Stockbridge[6-] has indicated, lead to "great economy of time for students who currently have to relearn recording methods in each agency, for research workers who would know where to look for the material they need and for social workers in general when they move from one agency to another or when they inherit cases...". At the same time the knowledge base of social work would be strengthened by the stimulation given to research. Ultimately, these comments on the need for improved statistical information on the activities of social services departments culminate in the recognition of the importance of standard and comparable information based on reliable, up-to-date and easily retrievable data. These requirements have frequently been acknowledged but all too infrequently translated into practice. 11. NATIONAL STATISTICS AND RECORD-KEEPING
Following the publication of the Seebohm Report the National Institute of Social Work convened, a meeting in April 1972 to consider the desirability of setting-up a national working party to co-ordinate,
Classification and recording of "social problems" study and make recommendations on local records and statistics in social services departments. The major issues identified at this meeting were: 1. The immediate need for standard and commonly agreed core-definitions for use in social services departments' records. 2. The need for clarification of information about cases at the local level. 3. The need for improved recording of intake activities. 4. The need to make more explicit, in a verifiable fashion, social work plans, activities and results. 5. The influence of both content and form of recording upon actual social work practices. Following this meeting the Social Work Service Development G r o u p of the Department of Health and Social Security was approached and established a working party on local records and statistics in social services departments. Local Authorities, central government, academic institutions and other interested parties were represented. The original intention to survey records and record-keeping practices of all kinds in social services departments was however eventually restricted to an investigation of current intake documentation and practice in a select number of local authorities. The report produced by the working party concluded: "The experience of the project showed little similarity between one local authority and another in the methods by which information about clients was collected or processed and there was wide variation in the information required on forms currently in use. The argument that local needs should be reflected in local documentation was not substantiated by the evidence collected. In addition there is no standardised terminology and it is, therefore, not possible to make valid comparisons" [8]. The report continued: "At the present time it would be difficult for many directors of social services departments to state how many people each year have asked their departments for help, who referred them, the reason for referral and even what their basic demographic features were. Even where such information is collected a director cannot compare his situation with other Local Authorities since information other than national statistics is not generally assembled in comparable form either between local authorities or even sometimes within parts of the same Local Authority". The D.H.S.S. report on Intake Documentation gave a preliminary indication of the state of record-keeping at the local level. In terms of deriving standard, comparable and reliable information as a routine pro-
257
cedure from the record-keeping systems of local authorities, the outlook appeared poor. However, local authorities are required to make an annual statistical return to central government and it might be expected that this could provide a source of valuable information. At present, the statistics required by the D.H.S.S. are the only nationally available statistics provided by all Local Authorities [9]. Table 1 outlines in summary form the categories for which statistics are collected in the annual return to the D.H.S.S. Unfortunately, although the D.H.S.S. system of collecting data does provide the only regular and uniform basis for national statistics there are disadvantages in the method employed. The principal drawback lies in the fact that the returns are aggregate statistics collected in terms of client categories with reference to the statutory obligations of local authorities*. While it is obviously both necessary and valuable to monitor the implementation of statutory powers and to collect statistics on specific client groups, if data collection is restricted in these terms much social work activity is left unaccounted for or accounted for in only a very limited manner. The use of categories based on pre-Secbohm divisions in social work result in statistics that do not adequately reflect the comprehensive and generic nature of current welfare practice. Furthermore, the aggregate returns in their present form prove to be relatively unweildy, inflexible and insensitive for information needs other than those of the most general type. Consequently, at the local level the use of these statistics is often seen as of little operational value by social work practitioners, planners, administrators and managers. Although national statistics collected by the D.H.S.S. serve the limited purpose for which they are designed they cannot focus on many of the areas of interest which were outlined in the introduction to this paper and which are now attracting increasing attention. Hence, each Local Authority has tended to evolve its own system for the collection, storage and retrieval of data. In the absence of any overall direction of these activities no uniformity has been imposed and the present diversity of information systems has developed. As a result the co-ordination of data collected from different sources has proved to be an immensely difficult undertaking. The G.P.R.U.t inquiry into record keeping practices in social services departments illustrated this state of affairs. IIL THE G.P.R.U. INQUIRY
* As from March 1976 certain amendments were made to the statistical returns of the D.H.S.S. For England and Wales statistics for children in care are collected on the basis of client unit returns rather than as aggregate returns for this group. Following the recommendations of the Final Report of the Advisory Council on Social Work Committee on Social Work Statistics (1975) [3], the Scottish Office has accepted a wholesale radical change to unit returns in place of classified aggregate returns implemented as from March 1976. Unit returns are superior in that they provide separate listings of the characteristics of each client, member of staff, or establishment and yet still allow aggregation when required. t The General Practice Research Unit, Institute of Psychiatry.
The interest of the G.P.R.U. in systems of recordkeeping and the statistical collection of data in social services departments grew out of the need to formulate a classification of the social problems of clients referred to social workers in an experimental attachment in general practice. In the development of a classification to be used for research purposes it appeared necessary to investigate those systems which might already be in general use. 1. M e t h o d
At the beginning of 1974 all social service depart-" ments in England, Scotland and Wales were requested
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RO6EMARYFITZGERALD Table 1. Statistical returns relating to the activities of Local Authority Social Services Departments at 31st March 1975 Return group
Title
Residential
Persons in residential accommodation (homes for the elderly and physically disabled and homes for elderly mentally infirm) Elderly and physically disabled Homes opened and closed Registration of private and voluntary homes Children and Young Persons in Care: Residential Accomodation Section 18--ChronicaUy Sick and Disabled Persons Act (1970) Mother and baby homes Residential accommodation for mentally ill and the mentally handicapped Homes and Hostels for the mentally ill and mentally handicapped and Day Centres for the mentally ill opened and closed Supportive services Meals services Home help services Certain kinds of Assistance provided to Households Day care (centre based) services Adult Training centres Day centres for the mentally ill, elderly and physically handicapped Children's day care facilities Mental health (general) Number of persons admitted to local authority guardianship and under guardianship General Registers of handicapped persons Registration of blind and partially sighted persons Children and young persons in care Source: Department of Health and Social Security Statistics and Research, Division 6.
to provide details of any classificatory schema operating to describe the problems referred to social workers. At that time there were 226 Local Authorities in existence. In response to this initial inquiry 150 departments replied. Follow-up of the 76 non-responders at a later date produced a further 41 replies. The total response was therefore 191 (84.5~o). Of these 191, 29 replied that they used only the classification system required by the D.H.S.S., 21 provided too few details to be of use in the analysis, the 14 indicated that due to local authority re-organization we should refer to systems in use in other departments with whom they would or had combined. The remaining 127 replies were analysed. 2. Results
An examination of the remaining 127 replies to the survey revealed that there is no generally accepted typology of social problems that is widely in use. The immense variation in the classificatory systems devised by social service departments posed difficult problems in terms of analysis and presentation of the results of the survey. Classificatory systems vary widely in the items upon which information is collected, the amount of data required and the dimensions upon which data are organised and presented. All too often it was impossible to consider the problem classification in isolation because it did not exist as a distinct, identifiable element in the case record. Most systems are composed of a mixture of indicators of needs, demands, resources and provision. There is generally no clear distinction between these different levels of information. Therefore, in order to facilitate presentation of the results it has been necessary to adopt a basic framework (to be discussed later in the paper) which differentiates levels and types of information.
Fundamentally this rests on four basic dimensions-systems categorising by client type, social problem presented, resource/service provided, or legislation under which provision is made. The breakdown of the results of the survey are presented in terms of this framework in Table 2. It can be seen that in 41 cases classification is made solely in terms of one of the four broad dimensions. In the majority of cases (96) permutations of some or all of the dimensions exist either in the form of complete admixtures (78), or as combinations with some dimensions subsumed under others (11), or as coexistent, distinct categories ( 7 ) I n only one case was information collected and presented in terms of each of the four dimensions treated separately. The wide variety of classification schemes in use indicates the extent to which social services departments' records fall lamentably short in providing standard, comparable data bases. Focusing on the question of social problem typologies not only are numerous different problem classifications in use, but in many instances the difficulties are magnified by procedures which either confuse quite distinct areas of information or omit some areas altogether. Very frequently items relating to the categorization of client problem were found to be inextricably enmeshed with other aspects of the case record. Alternatively, classification by social problem was sometimes omitted altogether and substituted by classification according to items belonging to other dimensions. For example, records are in some cases kept principally in terms of resources provided by the department, e.g. Aids and Adaptations, Home Help, Residential Care. Where no tangible resource can be indicated legislative terminology may be resorted to, e.g. preventive work under the Children's Act, 1963. In these circumstances there is no information regarding
Classification and recording of "social problems"
259
Table 2. Analysis of Social Services Departments' classification systems No. of systems
Classifications according to: One dimension only
(a) (b) (c) (d)
Client category Social problem Resources/services provided Legislative grouping
One dimension subdivided by items from other dimensions Two dimensions, one of which is sub-divided by items from further dimensions
32 3 4 2
41
8 3
11
More than one dimension, each treated separately
Mixture of two dimensions
Mixture of three or four dimensions Total number of systems analysed*
7 a+b a+c a + d d+c d+b
9 20 11 4 I
45
a+b+c a + c + d a+b+c+d
24 8 1
33 137
* It should be noted that the number of cases analysed (137) is greater than the number of social services departments (127) from which these classification systems derive. A small number of departments used more than one classificatory system. the reason for a particular deployment of resources. What is being done in terms of provision of services is known but there is no indication of why. A linkage system between the various facets of the case record, as for example between clients' problems and social services' provision would facilitate closer investigation of social work intervention processes and their efficacy. A further example of how departments omit information of an important nature or translate it into inappropriate classifications is seen in the frequent practice of dividing clients into broad aggregate groupings according to characteristics closely akin to the pre-Seebohm social work divisions. However, if data are collected simply along such lines as Elderly, Physically Handicapped, Child Care, Family Care, Mentally Ill, Homeless, much information is lost. N o data are availab,, answer questions on the characteristic'difficulties experienced by these groups per se, whether problems are specific to certain client groups or over-lapping or common between groups or subsets of groups. The wide range and variety of classificatory schemes and the confusion even within most of the systems in operation were recognised by many of the Directors who in their replies acknowledged their dissatisfaction with existing methods. Although the G.P,R.U. inquiry intended to focus on one particular aspect of the case record--the problem classification--examination of this section of recording has necessarily involved considering the rationale behind case-recording as a whole and the general problems of information gathering within the social services. DISCUSSION: OBSTACLES TO A SCHEME OF CLASSIFICATION
IV.
From the information presented above it is apparent that an assessment and measurement of needs,
demands and resources in the social work field would involve at least two considerations. These comprise (a) definition of terms and (b) classification of data.
1. Definition of terms Definition of basic terms such as "case", "client", "referral" and "closure" are at present imprecise and are not standardized between or even within departments. Currently many concepts are used in widely varying circumstances and carry differing implications. The use of the term "case" and "referral" provide a good example. Stevenson [10] illustrates the point: "Cheshire Research and Information Section in their report 'Cases and Referrals 1972/3' say 'if statistics are to be comparable similar definitions must be used'.... The interpretation of both 'case' and 'referral', they suggest, has varied both between areas and over time". The D.H.S.S. Records Project (1974) [8] also noted the wide range of meanings given to the term "referral", stating that: "It is used amongst other meanings to denote (a) the first or initial contact or approach to a social services department; (b) the acceptance of this initial contact for further action; (c) a number of on-going activities involving the social services department (not necessarily the same as (b)". Discussing the problem of terminology, Stevenson [10] suggests that it might be helpful to resolve the tangle if the following definitions were considered. She proposes that an applicant be considered as "any person who makes or has made on his behalf an approach, i.e. an application for help/information to a social services department". This is contrasted with a referral, defined as "any individual or family becoming known to the Department, provided that the application requires a social work decision as to whether or not it shall be investigated". Stevenson continues
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ROSEMARYFITZGERALD
social problems that could be subsumed under this general heading. Regulations for the collection and transcription of information will also be required to ensure uniformity of recording practices. The need for systematic approach towards recordkeeping does not imply that a multi-dimensional clas"The term Unscreened Bombardment (is used) to encompass the gross total of applications (i.e. the total impact) sification system can substitute for case files in all coming to a Department or Area Office in person, by tele- the richness of detail that does justice to the complexphone or in writing. Screened Bombardment is the net total ity of human problems and life situations. It is sugof applications 'proper for the Department to consider'". gested only that the introduction of such a system might be the means of crystallizing out the major The need for concensus on core definitions opens areas of focus useful to planner, administrator, and a wide area of debate which has obvious implications social worker. The value of classification lies in distilnot only for screening procedures but for social work ling vital information from detailed case notes. practice in general [12, 13]. These problems have a bearing on the record-keeping process in that until V. A FRAMEWORK FOR A CLASSIFICATION standard definitions exist and are applied consistently FOR RESEARCH A N D SERVICES there can be no guarantee that data from different sources refer to comparable populations or carry the From the analysis of the problem classification same meaning. schemes of the local authorities replying to the "it follows that an application must pass through an investigatory and decision-making process before acquiring referral status". The concept of screening as used in the Brunel study [11] is cited by Stevenson as of use in this context:
G.P.R.U. survey a general framework emerged as a 2. Classification of data possible basis for the collection and organization of The sheer volume of data which accumulates in data. Such a framework attempts firstly to reflect dissocial services departments' files is extensive. The tinct types of information which occupy different ordering of this data will depend on the application dimensions or facets of interest, and, secondly, to of an agreed system of categorizing information on order such information systematically and coherently. The suggested dimensions are as follows: meaningful dimensions. It is logically necessary to dis1. Basic identifying data. tinguish the various facets upon which data are 2. Categories of client*. already or could be ideally collected. Currently, areas 3. Social problem. of information such as demographic data, presenting 4. Service/Resource provided. problems, services requested and resources provided, 5. Legislation under which social work intervention all of which are logically separate and distinct, are very frequently confused. It is difficult to discern any is provided. In use each dimension can be linked one to another clear rationale behind the presentation of much of the data collected by social services departments. As for an individual case giving a profile of that particuhas been stated this problem has been compounded lar client. At the same time all the data pertaining by the fact that each department has been left to to one dimension can be referred to in order to give, for example, the basic demographic features of all devise its own methods of classification. The construction of a framework which could pro- cases referred to a social service department or the vide the structural basis for ordering items of infor- distribution of social problems over a specific period mation is not an easy matter. Firstly, it is necessary of time for all clients in an area. As previously indito delineate the distinct areas or dimensions into cated once the basic dimensions upon which data is which the data can be reasonably and practicably to be collected: have been agreed a series of categories divided. Secondly, given that the dimensions of a for each dimension is required. The dimension o f framework can be agreed, it is necessary to provide social problem may be taken as an illustration of the a detailed itemization of a series of categories within difficulties involved in this task. A problem classificaeach dimension. For example, having decided that tion for use in the research attachment of social social problems constitute an area of information sep- workers in general practice was developed by the arate from other data such as demographic features, G.P.R.U. This problem classification is sub-divided it is necessary to itemize the various categories of into three areas--problems associated with social factors, with personal and social relations, and with * Although several social services departments pointed health. A list of the items contained in the classificaout that they were dissatisfied with recording statistics in tion is set out in Table 3, The instrument was conterms of client typologies, there was a strong impression structed for use in a specific context and contains from the replies to the survey that many departments still more emphasis on medical factors than would be perceived client categorization according to Elderly, Physi- necessary or feasible to obtain in other settings. Howcally Handicapped, Children, Mentally-ill, etc. as a useful ever, the general points it raises are of universal appliand meaningful way of making broad divisions between cability to all attempts to develop problem classificathose seeking help. These broad categories largely reflect tions. the previous traditional specialities of pre-Seebohm social 1. The basis upon which the problem classification work. Although alien to the generic philosophy of contemis ordered should be clear and comprehensible to porary social work client typologies based on such distinctions persist and may well be encouraged by the fact that those who use it. Differing elements such as descripthe present design of the D.H.S.S. statistical returns make tion of client category, action taken and/or required, it difficult to avoid collecting statistics relating to separate legislative heading under which provisions are made client groups. For this reason client typology has been in- should not be confused with items within the problem cluded in the framework. classification. These disparate elements are logically
Classification and recording of "social problems" Table 3. General practice research unit problem classifications I. SOCIAL FACTORS I. Housing: a. Homelessness b. Tenancy problems c. Physically unsuitable for needs d. Overcrowding e. Poor conditions f. Other (specify) 2. Finance: a. Low income b. Poor management c. Indebtedness d. Other (specify) 3. Occupation : a, Unemployment: i) extrinsic ii) intrinsic b. Occupational difficulties, e.g. job dissatisfaction need for sheltered work c. Other (specify) 4. Problems with formal institutions: e.g.D.H.S.S., legal system, Police, Race Relations Board. Specify: 5. Problems of cultural adaptation: a. Religion b. Language c. Social behaviour d. Other (specify) 6. Education: a. Problems at school/college b. School refusal c. Inadequate or inappropriate educational provision d. Other (specify) 7. Problems with home management: a. Personal care of self b. Domestic care of family c. Other (specify) II. P E R S O N A L A N D SOCIAL RELATIONS 1. Relationship problems a. Marital b. Parent/child c. lntra-familial d. Problems with extended family e. Problems with close personal relationships outside the family, e.g. boy-friends f. Problems with neighbours g. Problems with workmates h. Other (specify) III. HEALTH I. Physical health a. Minor physical ill-health b. Major physical ill-health 2. Mental health a. Minor psychiatric/emotional disturbance b. Major psychiatric/emotional disturbance 3. Problems associated with reproduction a. Contraception b. Pregnancy c. Infertility d. Infant behaviour problems (infants under 12 months e. Other (specify) MAJOR SOCIAL P R O B L E M :
8. Environmental Factors: a. Neighbourhood/Environmental factors, e.g. noise, smell, traffic. b. Other (specify) 9. Problems associated with delinquency/ crime: a. Juvenile b. Adult
2. Lack of relationships a. Social isolation b. Bereavement c. Absence from home of parent/spouse d. Other (specify)
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distinct and belong to other dimensions in the framework. 2. The problem classification itself should be composed of mutually exclusive and unambiguous categories in order to minimise error and ensure uniformity in completion of data. 3. Social problems are not discrete, easily identifiable entities which appear singly or in isolation. As Marshall and Munro [14] have stated: "as a profession we are too new to the field to have formulated any ideas about the cluster of problems tending to occur together which might make a syndrome worthy of a label". Clients will generally exhibit a constellation of problems. Therefore a system which allows for the inclusion of more than one problem per client is more realistic than single category stipulations. An indication of major problem(s) as against subsidiary or related difficulties might be worth consideration. 4. The perception of the problem might be expected by vary according to whether the problem is defined by the client or the social worker. It is necessary to strictly define the way in which problems should be identified so that the maximum degree of consistency is achieved. In recording data such as name, address and date of birth the subjective judgement of the recorder does not enter into the process in the same way as it does in defining areas such as the presenting problem. This is an unavoidable problem which exists in compiling case records in all forms of medicosocial enquiry. Therefore it is necessary to be aware of this difficulty and to make clear to those using the system that it is the social worker's and/or the client's definition of the problem that is recorded. Although it would be theoretically possible to distinguish and record problem areas as perceived by both client and social worker, in the G.P.R.U. classification the social worker's assessment of presenting the problem was taken. An addition of another column could provide for the client's definition of his situation but in this case it was not included as it was not an item of focus in the research. 5. Social problems are not static. Problems existent at one point in time may change or shift in relation to one another so that problems may be resolved, created or changed in their predominance of one over others. Just as it is vital to know whose definition of the problem is recorded it is also important to know the point in time to which the data refer. In the G.P.R.U. system the social problems presented at time of referral were taken as a base-line. It would also be useful in case management as well as in research to monitor changes in social problems at specific review points. A regular review system could enable case categorization to be kept up-to-date. Additional data such as this would require amendments in the design of the documentation and are not precluded by the conceptual basis of the classification. 6. In the G.P.R.U. classification system there was provision for indicating whether the identified presenting problem(s) was (a) manifested by the client himself or involved the client and other family member(s)/significant other(s), or (b) manifested by other family member(s)/significant other(s) not directly involving the client but the client reported this as part of his social situation and problem constellation. This refinement was felt to be of some importance in the
setting of general praction referral. In other contexts it might not be so feasible to make these distinctions as a matter of routine procedure. However, this point raises once again the question of stricter definitions of terms such as "client" and "case" and the issue of the unit of analysis to which the data should apply---e.g, the individual client, the family or the household. 7. Notes for guidance accompanied the social problem classification in order to increase accuracy of recording and minimise errors of interpretation. The skeleton basic framework and the itemization of one dimension outlined here are offered only as suggestions for future discussion. Further dimensions may be added either for routine recording purposes or for special intensive investigations. For example, the addition of an assessment of service/resource required as against that provided might give a crude indication of shortfall in provision of services. Obviously, before any detailed recommendations could be made in relation to content and form, different systems would need to be piloted and assessed. Finally, it should be clear that flexibility in recording techniques is warranted where there are actual differences in, for example, agency functions, client populations, or social work services. In advocating uniform and standard recording practices the demand is only that within and between the same agencies the same activities should find reflection in comparable records.
CONCLUSION
The results of the survey of records relating to problem classification support the conclusion that the mass of data contained in the case files of social services departments is not susceptible to systematic review or research. It has been suggested that social services departments' statistics could be greatly clarified if standard uniformly agreed procedures for collecting and presenting data operated. A basic framework for such a system has been outlined and one aspect of this--the problem classification--has been discussed to illustrate both the problems and possibilities. This examination of record-keeping has focused on the state of affairs at the local level. Reference was made to the statistical requirements of central government since all departments are obliged to submit an annual return. However, national statistics are of limited value and fail to compensate for the deficiencies found at the local level. In recommending revision of record-keeping practices at the local level it would be advisable to bear in mind how both local and central statistical needs could be considered in relation to one another. At present the extraction of data for central government poses serious problems with consequences for accuracy and reliability. Ideally, it would be more economical if there existed some linkage between local and central informationgathering so that returns to government represented a condensation of data already collected routinely at local level. Finally, it should be emphasized that adequate record-keeping practices justify themselves not only
Classification and recording of "social problems" by their contribution to planning, m a n a g e m e n t a n d research but also as an aid to practical, day-to-day case-managonent. In support of the view that attention should be drawn to this neglected area it is fitting to conclude with an extract from a report by a working party of Principal Social Workers: "It goes without saying that any improvement in the confidence and morale of social workers in the department is reflected in an increased standard of service to the community. It is our intention that, far from being an irksome aspect of the district administration, which unfortunately tends to be the case, statistical data should and could be a valuable support to morale". (City of Liverpool Social Services Department, 1973) [15].
Acknowledgements--This study was carried out at the General Practice Research Unit, Instutute of Psychiatry under the direction of Professor Michael Shepherd and supported by the Department of Health and Social Security. I am most grateful for the co-operation of all those Directors of Social Services Departments and their staff who responded to the survey. REFERENCES
1, Bristol M. Handbook of Social Case-Recording. Social Services Monograph No. 4, University of Chicago Press, 1937. 2. Report o f the Committee on Local Authority and Allied Personal Social Services (The Seebohm Report). H.M.S.O., London, 1968.
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3. Final Report of the Advisory Council on Social Work Committee on Social Work Statistics. Social Work Services Group, Edinburgh, 1975. 4. Edmonds J. The case record: a basic framework to meet need for standardisation. Social Work Today 2, 4, 1971. 5. Chea M. W. Research on recording. Social Casework 53, 3, 1972. 6. Stockbridge H. E. Social case-recording. Case Conf. 15, 8, 1968. 7. Kane R. Look to the record. Social Work 19, 4, 1974. 8. D.H.S.S. Social Work Service Development Group 0974). Records Project: An Intake Document for Social Services. 9. D.H.S.S. A Guide to Health and Social Services Statistics, 1974. 10. Stevenson J. Referral statistics: potentialities and implications. In Referral and Statistics Day Conference: A Summary of Proceedings. North-west Social Services Research Group and University of Manchester, Department of Extra-Mural Studies, 1974. 1 I. Brunel University Social Services Organization Research Unit, Institute of Organization and Social Studies (BIOSS), Social Services Departments. Heinemann, 1974. 12. Hall A. S. Client reception in a children's department. Publ. Admin. Spring, 1971. 13. Loewenstein C. An intake team in action in a social services department. Br. J. soc. Wk 4, 2, 1974. 14. Marshall M. and Munro J. Can we classify social work? Social Work Today 5, 8, 1972. 15. City of Liverpool Social Services Dept. Statistics: A Suggestion for Improvement of the Present System. 1973.