Bridging the gap

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Sarah Galvani has spent much of her career promoting awareness of substance issues among social workers. She talks to David Gilliver about bringing the fields together.

 ‘Social workers are not expected to be specialists in substance use in the same way alcohol and drug specialists are not expected to be social workers,’ said Dr Sarah Galvani when she launched the British Association of Social Workers (BASW) special interest group on alcohol and other drugs’ pocket guides on substance issues (DDN, January, page 5). ‘But we do still need to know enough to confidently ask about substance use and its effects on our clients and families.’

She set up that group and remains its chair, as well as being assistant director of the University of Bedfordshire’s Tilda Goldberg Centre for Social Work and
 principal research fellow at its Institute of Applied Social Research. Her determination to improve knowledge and understanding of substance issues in her profession also led her to develop the Social work, alcohol and drugs website (www.swalcdrugs.com), where it explains how working with substance use is still often not seen as the social worker’s remit. Is that beginning to change?

‘I think currently – and probably since Hidden harm – there’s a sense that parental substance use needs addressing,’ she says. ‘But I think social work as a profession has been very slow on the uptake. There are more moves within children’s social care than adult social care to recognise that it’s an issue we need to be involved with, but I don’t think we’ve got to the point yet of thinking that it’s our job. It’s very much still “yes, we see it all the time,” but from what I hear from social workers they don’t feel confident or competent in how to identify it, what questions to ask, how to respond.’

People need support to ask the right sort of questions, she stresses. ‘They need the knowledge, so they know what to ask and what the answers might mean, and they need the supervision and leadership. I don’t think we’re there at all yet – we’re a long way off having all social workers trained in even the basics of substance use.’ 

 

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Joint working has long been a mantra in public services, but the reality usually falls short of the ideal. How good is collaboration between drug and alcohol services and social work departments? ‘There is good practice – I’d hate to tar everyone with the same brush,’ she says. ‘There’s some good joint working in some places, but it’s very much at a local level and it’s usually about having dynamic and creative leadership and commissioners who can see the benefits of funding particular services. But generally joint working suffers because of a lack of resources.’

If social workers and treatment professionals were really to ‘joint-assess, joint-visit and joint-manage’ everyone with overlapping issues there wouldn’t be enough resources on either side, she states. However, a survey by her special interest group found that when social workers do approach a substance use service they find it ‘hugely helpful’.

‘Certainly, they feel they’ve shared a burden. The other side is a minority of social workers who find that substance use services are unhelpful if service users don’t fit the right boxes – if people have learning difficulties or particular disabilities that prohibit access in some way, if they’re an older person who’s going to feel embarrassed about going to a service or a parent who wants help but there’s no crèche facilities or outreach. So there’s certainly very positive feedback about joint working when it happens, but we also hear that services can be restrictive in terms of who they’ll see.’

Is she hopeful that things might improve with the increased focus on localism? ‘It could – if we’re looking from a glass-half-full point of view – present some real opportunities for better joint working, joint service delivery and a much more holistic approach to dealing with the complex needs that people often present with. But again it’s about local leadership and commitment to what are often marginalised services, ensuring that the commissioners are able to secure that funding. If you have a health and social care group that works closely together and agrees those kinds of priorities and funding arrangements, and is creative in its leadership, then I think there are huge opportunities.’

The flipside, of course, is that where those things don’t exist it will be a case of ‘traditional one-to-one services based in community offices – if you’re lucky there’s a community detox, there won’t be much conversation between the two, and there’ll just be a postcode lottery,’ she says. ‘Only time will tell.’

 

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Her interest in substance issues started when she was doing voluntary work for Crisis at Christmas in the late ’80s, at the same time as temping for the Financial Times. ‘I saw a lot of people who had alcohol and drug problems as part of the reasons that they were homeless. I used to go from work to the shelter and do a night shift and then go back to work, and every other night I’d go home and sleep. I did that for a couple of months and realised I was getting much more out of my voluntary work than my day job.’

When the Bruce House hostel in Covent Garden opened soon after she took a full-time job as a project worker – ‘I was in social care and homelessness and substance use, and it seemed the right place to be’ – before choosing to do her social work training at the University of Hull because it had specialist substance use modules. Seven years ago she made the move from social work and social care practice to full-time research, becoming director of the Tilda Goldberg Centre in 2009.

She’s still a registered social worker, however, a profession that can be a favourite target for some newspapers. Can that affect morale? ‘It’s probably more frustrating and irritating than anything else. Negative media profiles never reflect the reality of a social worker’s role and decision making, and of course social workers aren’t allowed to stand up and say, “actually that’s wrong – this is how it works.” But I think the morale issues really come from the amount of cuts that everyone’s experiencing – jobs are being frozen, people aren’t being replaced, redundancies are being made and yet we hear “you need to do better and you need to do more.” Well, give us the resources. And then of course people like me turn around and say, “and you need to know more about substance use and be asking about it and responding to it,”’ she laughs. 

Her other specialist area is the overlapping issues of substance use and domestic violence. While alcohol plays a role in around half of all domestic violence incidents, as her website points out ‘alcohol and drugs do not cause domestic violence’ or ‘delete our understanding of right and wrong’, and she stresses the need for treatment services to challenge people when they blame substance use for their actions. Are they doing that?

‘Some do, but I think most don’t,’ she says. ‘It’s a bit like social workers asking about substance use – there’s a recognition that there’s an issue, but people need to feel confident to ask the right questions in the right way. Part of that can be very easily resolved because there’s lots of good practice guidance out there, for example from the Stella Project. The important thing to remember is that these people are already in your service – they’re not a new service user group that have yet to come through the door. These are the people who sit in front of us – clients who are behaving in an abusive and violent way and who may or may not be disclosing it.’

A key part for workers is simply learning to recognise disclosure, she stresses. ‘Simple references like, “oh, you know, sometimes I have a bit of a short fuse”. It’s about picking up on things that may indicate perpetration of violence or abuse and just exploring that, because it may be that person testing the water and seeing how you react. If that’s met with an inappropriate or dismissive response – “oh, so do I” – the person either will feel it’s nothing for them to worry about or that they’re not going to go any further with talking about it.’ Crucially it’s also about the worker picking up on the safety of the partner and children, she states – ‘seeing not just the person in front of them but the whole family as part of their concern.’ 

Another key issue, of course, is that of domestic violence victims using alcohol or drugs to cope with abuse – or deal with abuse issues from the past – which can make them even more vulnerable. As she pointed out before in DDN (16 November 2009, page 6), the majority of women in treatment will have suffered domestic abuse at some point. ‘You’re looking at two thirds, if not more, depending on how you define abuse and violence,’ she says. ‘So again these are people who are already in treatment – they’re not new people. 

‘It’s ensuring that the substance use specialists and professionals feel equipped to ask about it and are prepared to ask again later on, because sometimes people won’t disclose the first time. There are those myths around “I don’t want to pry, or ruin the relationship, or put them off coming to the service,” but you ask about all sorts of personal things so something about their own safety may be just what they need. You don’t know unless you ask.’  DDN

The BASW special interest group is holding a child protection and substance use event in Durham on 30 April. Details at www.basw.co.uk/event/?id=107 The group is building a database of social workers in the substance field and is keen to hear about events or resources people would like to see – email s.richards@basw.co.uk