Casework with carers: what works and why?: a longitudinal realist evaluation

Victor, Elizabeth (2017) Casework with carers: what works and why?: a longitudinal realist evaluation. PhD thesis, University of Nottingham.

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Abstract

Carers who look after family members on an unpaid basis often experience negative impacts from their caring role due to the lack of value placed upon care more widely in society. Casework with carers, ‘the individualised support work undertaken by a practitioner with a newly identified carer’, offers a means to support carers. This thesis considers the research question ‘Casework with carers: what works and why?’. The study places an original focus upon the work of third sector carer organisations upon which there has been very little other research. A comparative perspective is taken to consider this together with the casework with carers undertaken by third sector condition specialist organisations and through statutory carer assessment. The study uses the realist evaluation framework, grounded in critical realism, to identify the outcomes of casework, the mechanisms explaining these and the contextual factors influencing this. A longitudinal research design involving thirty seven qualitative case studies of individual carers’ experiences enabled original findings about change in outcomes over time to be identified and provided a unique insight into the long term impacts of casework. Separate carer and practitioner interviews at timed intervals, supported by audio-recording of the first main contact of casework, provided a comprehensive insight into casework.

The findings have been used to develop a new and original model of casework with carers. This identifies how outcomes can be achieved through a number of different types of mechanisms consisting of: psychological support to recognise the value of caring and carer needs; expression of feelings; development of knowledge and skills about caring and about resources and how to access these; and carer action including to access secondary services. It also identifies how a range of contextual factors, including carer characteristics and practitioners’ characteristics and approach to casework, influence outcomes. The study illustrated that third sector carer and condition specialist organisations were potentially well placed as relatively accessible and visible services to achieve varied positive outcomes with carers. However, the findings also showed that casework was of limited help to some carers who continued to have serious unmet needs principally because of barriers in terms of the availability of appropriate secondary services or the reluctance of the person receiving care to use such services.

Interpreting the findings through the theoretical frameworks of the ethic of care and carer empowerment highlighted how the nature of the casework practised constrained its potential to support carers. The lack of integrated and ongoing support limited the ethic of care achieved, but perhaps the personalisation of services might help towards overcoming this. The mainly administrative approach of casework (rather than a therapeutic or empowerment based approach) limited the achievement of carer empowerment. Substantial changes in casework practice would be required to address this.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Becker, Saul
Laird, Siobhan
Keywords: Caregivers, Services for, Great Britain.
Subjects: R Medicine > RA Public aspects of medicine
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Sociology and Social Policy
Item ID: 43484
Depositing User: Victor, Elizabeth
Date Deposited: 14 Jul 2017 04:40
Last Modified: 15 Jul 2017 17:11
URI: http://eprints.nottingham.ac.uk/id/eprint/43484

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