On the Client’s Turf
HOME VISITS IN FINNISH SOCIAL WORK PRACTICE
Tanja Ollilainen Pro Gradu –tutkielma Sosiaalityö
Itä-Suomen Yliopisto
Yhteiskuntatieteiden ja kauppatieteiden tiedekunta
Marraskuu 2018
Itä-Suomen yliopisto Tiedekunta
Yhteiskuntatieteiden ja kauppatieteiden tiedekunta Laitos
Yhteiskuntatieteiden laitos Tekijä
Tanja Ollilainen Työn nimi
On the Client’s Turf - Home Visits in Finnish Social Work Practice Oppiaine
Sosiaalityö
Työn laji Pro-Gradu Tutkielman ohjaaja/ohjaajat
Taru Kekoni, Kaarina Mönkkönen Aika
Marraskuu 2018 Sivumäärä
114 Tiivistelmä
Tutkimuksen tarkoitus on selvittää miten kotikäyntejä käytetään suomalaisessa sosiaalityön käytännössä ja mikä kotikäyntien tarkoitus on?
Kotikäynnit nähdään sosiaalityössä tärkeänä työvälineenä, jota käytettiin monipuolisesti eri sosiaalityön prosessien vaiheissa palvelutarpeen selvityksistä alkaen, vaikka suurin osa sosiaalityöntekijöistä käyttää työajastaan alle 25 prosenttia kotikäyntien tekemiseen, Kotikäynnit osoittautuivat tärkeäksi asiakassuhteen rakentamisen ja neuvottelun
paikaksi, missä roolit sosiaalityöntekijän ja asiakkaan välillä vaihtelivat vallankäytön suhteen. Usein sosiaalityöntekijä käytti kontrollivaltaa asiakkaaseen nähden, mutta kotikäynneillä näkyi myös asiakkaiden vallan käyttö, sekä tasa-arvoiseen ja arvostavaan kohtaamiseen tähtäävä työskentely.
Vastaajat korostivat kotikäyntien vapaaehtoisuutta ja tarvetta kunnioittaa asiakkaan omaa tilaa, mutta asiakkaiden kanssa käytiin myös neuvotteluja kotikäyntien
tarpeellisuudesta. Kotikäynneillä sosiaalityöntekijät havainnoivat elämänhallintaan liittyviä seikkoja ja perheenjäsenten välisiä suhteita.
Kotikäynteihin liittyy myös työturvallisuuden aspekti missä vastaajat kokivat olevan puutteita. Kolmasosa vastaajista oli kotikäynnillä kokenut joko henkistä tai fyysistä väkivaltaa ja suuri osa oli joskus kokenut olonsa turvattomaksi.
Kotikäynnit nähtiin yleensä positiivisena ja arkisena sosiaalityön välineenä, johon linkittyi asiakkaan kanssa neuvottelu ja rentous, mutta myös riskit, negatiiviset kokemukset ja asiakkaan elämäntilanteen kaoottisuuden ja vaikeuksien välittyminen työntekijälle aistillisesti.
Asiasanat
sosiaalityö, valta, asiakastyö, kotikäynnit, sosiaalityön käytäntö Säilytyspaikka Itä-Suomen yliopiston kirjasto Muita tietoja
University of Eastern Finland Faculty
Faculty of Social Sciences and Business Studies Department of Social Sciences Author
Tanja Ollilainen Title
Home Visits in Finnish Social Work Department
Social work
Master’s Thesis
Advisors
Taru Kekoni, Kaarina Mönkkönen
November 2018 Page Count 114
Abstract
The aim of the thesis was to find out how home visits are used in Finnish social work, when and for what reason are they used?
Most of the social worker used less than 25 percent of their working time conducting home visits, but home visits were seen as an important tool for social work. Home visits were used for varied reasons all throughout the social work process.
Home visits appeared as important places where the client relationship was built and negotiated and where the power dynamics shifted between the client and the social worker. Often the social worker used controlling power over the client, but home visits also showed how the client used their own power. Home visits also enabled the social worker to posit themselves in a more equal relationship with the client.
Participants emphasized the voluntary nature of home visits and the need to respect the client’s own space, but social workers also had to negotiate about the usefulness of the home visits with the client. During the home visits, social workers observed aspects of life control functions as well as relationships between the inhabitants.
Work safety issues were present during home visits. Participants felt their workplaces did not have enough guidelines about work safety. Third of the participants had faced violence during a home visit and most had felt unsafe during a home visit.
Home visits were generally seen as a positive and routine social work tool, which was tied to negotiations with the client and a more relaxed atmosphere, but also risks, negative experiences and facing the client's chaotic life situation through immediate sensory feedback.
Keywords
social work, home visit, power, social work practice
Archived in University of Eastern Finland library Additional information
Sisällys
1. Introduction ... 1
2. The context for home visits in Finnish social work ... 5
2.1 Social work framework in Finland ... 5
2.2 Client positions in social work ... 8
2.3 Home visits in Finland ...14
3. Theory and methods ...19
3.1 Adapting Foucault’s thinking to social work context ...19
3.2 Power in social work ...22
3.3 Why use a survey as data collection method? ...24
3.4 Ethical considerations ...27
3.5 My own research position ...29
4. The survey participants ...32
5. The importance and utilization of home visits ...39
5.1 What makes home visits special? ...39
5.2 The importance of home visits ...43
5.3 Importance of home visits for Child protection and family social work ...46
5.4 The importance of home visits in social work with working-aged clients ...49
5.5 The importance of home visits for Social work in the health care, gerontological social work and social work with disabled clients ...51
5.6 Prioritization and the employer’s role in home visits ...52
6. When are home visits used in social work? ...55
6.1 Child protection and family social work ...55
6.2 home visits in social work with Working-aged clients ...57
6.3 social workers in the health care, gerontological social work and social work with disabled clients ...60
6.4 Negotiations and justification of home visits ...62
7. Home visits as a form of control ...66
7.1 Justification of home visits ...66
7.2 Observations - neutral part of assessment or a form of control? ...68
7.3 How are concerns about the client’s home brought up with the client?...72
7.4 Hospitality as an indicator of the type of client-social worker relationship ...76
8. Clients on their home turf - threat of violence during home visits ...79
8.1 Home visits alone or with a partner ...79
8.2 Work safety measures ...82
8.3 Experiences of threat and violence in the workplace ...86
9. Conclusion ...92
9.1 Home visits in social work ...93
9.2 Is there a need for further research? ...100
Sources: ...102
Attachment 1 ...108
1. Introduction
Social work practice, the social work that happens every day in social work offices and other types of work environments, has not been the topic of much social work research and even less research has been done about the face-to-face interactions between social workers and clients (Ferguson 2014, 283-284). There is a general lack of literature about home visits in social work (Winter & Cree 2016, 1175), even though home visits are a routinely utilized part of the social work process. In many countries most of the everyday social work happens in the client’s home. However, even though the importance of home visits is not in doubt it has not been of great interest for social work research.
According to Ferguson, the reason for the lack of research may be that there is an assumption that social workers only move their organization, its policies and processes from the office setting into the client’s home (Ferguson, 2018, 66-67) and that the actual interaction with the client does not change much despite the different environment. The client-social worker relationship has been studied and theories about different types of relationships that occur between social workers and their clients have been made and the relationship is seen as fluid and able to change and evolve according to different situations in the client’s life (Juhila 2006, 11). The reason for why the relationship is seen to shift and evolve has not often be credited to the physical environment and how changes in it can effect the social worker – client relationship.
As I was looking for previous research about home visits, almost all the studies I found were done in the field of child protection social work. This raised questions about how home visits are used in other social work fields and if they use home visits the same way, for the same purposes. In this thesis, I set out to find out what is the purpose and role of home visits in Finnish social work. I used a quantitative online survey to gather responses from social workers in different social work settings from family social work to gerontological social work. My aim was to collect responses from all across the social work fields to see if the reasons why home visits are done differs from one social work specialty to another and how they are used. In my survey, I wanted to know how common home visits are in Finnish social work and how the frequency differs between different types of social work.
I was interested in looking at home visits from the institutional angle, what kind of instructions there are about home visits, if home visits are regulated somehow, who says when home visits are done?
From the social worker’s perspective, I was interested in how we see home visits when it comes of our personal security and assessing risks to our person.
Home visits have been studied in the Finnish social work context before, only on the thesis level and often the scope of the research was qualitative, and the responses, though illuminating, did not offer answers to the wider question of how universal these experiences with home visits were. My own survey data consists of 98 responses, which is not a large enough sample size to draw generalizing conclusions, but it is still somewhat illuminating in showing the variety and commonality in responses concerning social work home visits. I did not find previous research looking into social work home visits in Finland where the different social work specialities were compared to each other or looked at as a whole. The previous research I found was focused on one particular group of social workers.
For me it was just as important to see the differences between social work specialities as well as the similarities in how home visits are used and why. This way it is possible to get a clearer picture about the role of home visits in Finnish social work practice.
My thesis structure is set up so that in chapter two the social work context is explained to some extent, about how the social work structure was formed on the basis of strong institutions and how social work in Finland has been based on systems. The chapters shortly describes the societal, political and economic changes that have happened since the 1990’s and which have had a profound impact on the social work institutions. The chapter touches on the topic of what is seen as the function of social services and social work in particular. After looking at the system view of social work, the aim changes from the macro view to a closer look at social work practice, with the emphasis on the client.
The client position is examined, from the reasons why people become social work clients and what different types of client-social worker relationships exits, and how those different relationships serve the client in different ways depending on the client’s situation. The client’s position is also looked from the view of what the subject-object position the client has and how the client is able to affect or influence the social work process. The third part of the chapter looks at an even more micro aspect of the social work whole, the home visit itself and what has been said about them in social work literature and what their function might be.
In the third chapter, I am looking at the theoretical underpinnings of my thesis as well as the methodological and ethical choices that were made. I was using the thinking of the French sociologist Foucault to examine and make visible the different power and control relationships found within the
social work context. I was interested in seeing how social workers see their own position as someone who wields power in relation to the client and how the social worker exercises this power when it comes to home visits. Looking at the different kinds of power dynamics and how they affect social situations within social work is the main theoretical viewpoint in this chapter. Foucauldian theories about how power dynamics are present in all social interactions in different ways is a fruit ful way of looking at relationships between social workers and their clients. The important notion of Foucault’s theory about power and control was that power is not a zero-sum game, where one person or entity has all the power and the other person or entity has none. Power is always in flux and in different situations and in different times, the power dynamics can shift. The method of a qualitative survey and how the participants were recruited and what type of selection methods were used, as well as, the different ethical considerations are examined in this chapter.
Chapter four is the first chapter where the findings from my data is analysed. This chapter explains what type of people my participants were, their gender, where they work, what type of social work they do, how many clients they had and so on. I wanted to separate this information into its own chapter to help the reader get an idea about what type of social workers participated in the survey. I felt it was important to show the variables about the participants at the beginning of the study, so it is easier to keep in mind in later chapters, where I have done comparisons between different groups of participants, for example comparing child protection social workers and social workers with working- aged clients.
Chapter five looks at the factors that make home visits special as tools for social work, how important they are to different social workers depending on the type of social work they do. I compared social workers from different social work fields to each other to see if there were differences on how important they saw home visits as and if they felt, they were able to do enough home visits. I also looked at how many home visits social workers did in general and what type of influence their employer or their workplace had on when or how often home visits were used.
Chapter six is focused on when home visits are used, what is their function in different social work fields and, what the differences were, for example how were home visits used in social work with disabled clients, or in child protection social work.
In chapter seven I’m looking at the power and control aspects of home visits, is the client able to say no to home visits, what social workers notice and observe during home visits and generally how the power relationship is negotiated during the home visit, where the social worker knows they are in the client’s home territory as a professional visitor, where the line is between that and being a guest, how does the social worker respect the client’s right to privacy and how the actual environment of the client’s home affects the interaction between the social worker and the client.
Chapter eight, the last chapter where my survey data is analysed focuses on the risk, danger and safety issues inherent in the home visit. The importance of work partner’s presence during home visits is analysed, by looking at the numbers when social workers do home visits alone or with a partner and how paired work is seen as the most important work safety factor during home visits. The chapter shows the power the client holds over the social worker, how work safety issues are dealt with in social work workplaces and how common the presence or risk and danger are for social workers during home visits. Chapter nine draws conclusion from my data and I reflect on what the survey data showed about home visits in Finnish social work as well as suggesting interesting avenues for further research on the topic.
2. The context for home visits in Finnish social work
2.1 Social work framework in Finland
The social service sector can be divided into two: 1) providing social services, which are meant for everyone and where the aim is to help the individual manage in their everyday life more easily. These services are voluntary and there is not stigma attached to them. 2) Social work, which is aimed at making interventions that should create change in some specific problem the client has and the process is more intensive and does not touch all citizens. Compared to general social services, clients don’t usually become clients voluntarily, there is sometimes a negative stigma attached to being a client of social work and there are interventions in social work that the client can be subjected to without their consent. (Pohjola 1998, 47) The aim of social work is to create the type of change where the client’s life becomes more “normal” and the aim is that once the change has happened the need for social work ends and the client relationship ends (Raunio 2011, 59).
The history of social work in Finland is based on social reformism, where reforms aimed at fixing social inequality were the function of the state and organized through different kind of public and universal programs and laws. The way social work is organized is based on system centric institutions, which ensures the same services for everyone in the country. The laws related to social work safeguard the client’s rights and their right to receive aid. (Raunio 2011, 18-20) The effectiveness of social work in Finland is measured by what kind of services social work can offer clients and the client has historically had very little say in what type of services they were able to get. As the Finnish social work model has historically been very system and institutions based, it has led to the view where the client is often in the position of a cog in the social work process instead of an active and independent actor (Pohjola 2010, 26). The assumption was that if a client has access to services that will automatically increase their wellbeing. Unfortunately, this can lead to thinking where no matter the nature of the service provided the service itself will have a positive effect on the client and often eliminates the need to assess the effectiveness of our interventions (Paasio 2017. 403). At the same time, the scrutiny of social services and their effectiveness is often tied more to the neoliberal needs to cut public spending as they are in ensuring the best services for the client.
After the recession of the 1990’s many aspects of the welfare state have been diminished to cut costs on public spending. The three most obvious changes to modern welfare state are 1) privatization and the dismantling of the monopoly on different aspects of society from healthcare to banks, 2) the creation of the active citizenship ideal, especially boosting the idea that people should be self-reliant and responsible for their own actions, and 3) localization, where power has been shifted from the central government to more local institutions and private businesses (Ewijk 2010, 22-28). In Finland social services have been the responsibility of municipalities for a long time already and the trend now is to move from a municipality level to a larger province system where all the cities and municipalities of the province will share the cost and responsibility of providing social services to its citizens.
As neoliberal market economy thinking is applied more and more into the public sector one of the ways it is done is the distancing the personal from the professional. It can manifest in social work where the client and social worker have clearly defined roles in their interactions. More distance can be also created by guiding service users to digital services, where social interaction is not necessary and where the client is reduced to cost-benefit calculations and risk assessments, instead of embracing the idea that each client must be met and understood in a holistic way where their whole life experience and life situation are taken into account and appreciated. (Ikäheimo 2008, 18-19) One recent development of this is the way basic social assistance, which is a type of financial aid meant for people who cannot live on other types of income or benefits, was moved away from the working- aged social work in municipalities where the client lived and to KELA, which is the Finnish social insurance institution, where clients are more and more guided to fill in their benefit application online, without being able to talk to a social worker or some other professional. There has been discussion about how this change has taken out the human element of assessment and people have been reduced to numbers and there is a feeling that it is harder for people to receive the social assistance than it was before the change. (Yle, Helsingin sanomat). There has also been worry about the client’s who rely on social assistance getting more excluded from society as it is more easy now for the client’s situation to worsen drastically before anyone notices if they only use online services and there has been discussion about how there are problems with KELA about guiding clients into social work services when a worker processing the social assistance application notices something might not be alright in the client’s life (THL Blogi 2018). Even though the type of neoliberal thinking where people are supposed to manage on their own and where getting public services is made harder and the client’s forced to “prove” they deserve benefits, for example how unemployed people have to show they have
been active in applying for jobs or getting education that will help them get jobs (Social and Health Ministry 2018) there is still a more holistic view of the client used in social work, where at least the aim is not to reduce the client into numbers and cost-benefit analysis, but to try to offer them services that would help them solve their social problems.
When we consider the implications of offering services as the solution to people’s social problems we have to pay even greater attention to how we decide which services will aid the client the most.
Which leads us to the importance of the assessment process. When we are talking about social work practice as a process, it usually includes steps like defining and describing the problem, assessing the situation, planning and executing interventions or other actions, and monitoring and assessing the progress or the outcome of the intervention (Karvinen 1993, p.163-164). When the social work process is viewed in this way, it makes visible the need for assessment in all parts of the process and requires that the problem has been defined clearly and both the social worker and the client know what they are working with. (Kananoja 2017, 179) In her article, Aulikki Kananoja lists and mentions many social work tools and assessment methods, which social workers use in making assessments and getting information for defining the client’s problem but she does not mention home visits at all.
To me this may indicate that home visits exist in many ways as part of the invisible work done on the micro level in different social work institutions and which is seem as something routine and self- evident in its purpose.
In Aulikki Kananoja’s view, laws and guidelines have defined social work practice more than the holistic survey of the client's situation and that the framework of existing benefits and services has defined the way social work is done in Finland more than evidence-based research. (Kananoja 2017, p.179.) Even though Finnish social work process may be strictly guided by different laws and regulation our social work model allows individual social workers freedom to decide how they wish to conduct assessment, apply social work interventions and lead the social work process with each client. While laws, regulation and municipal bureaucracy set the boundaries of social work on the macro level, the everyday social work practice is still largely up to each social worker’s own choices.
While this type of personal freedom is possible, we have to regularly review the methods of every day social work to see what purpose they serve and how different social work methods affect both the clients and the social workers themselves.
As established earlier, the aim of social work is to create change in the client’s life, in aspects of the client’s life, which are considered negative from the view of our society. Some of the core principles of social work are to alleviate or remove social exclusion, deprivation and exploitation. The aims for social work increase the client’s ability to participate in society and to manage independently without the need of social work interventions or support (Raunio 2011, 87). These are not simple tasks and it is useful now to move from the more macro level of looking at the social work context and framework into how the client is seen in the social work process.
2.2 Client positions in social work
Kirsi Juhila has written about the different kinds of client - social worker relationships that can appear in the social work context. She has identified four different kind of possible client relationships. They are 1) social work relationship as normalizing and controlling the client 2) relationship as a partnership with the client, 3) relationship as caring for or taking care of the client and 4) relationship built during interaction with the client. (Juhila 2006) In my thesis, I am mostly interested in the first category, which is ‘social work relationship as normalizing and controlling the client’. In this type of client relationship, the social worker’s aim is to normalize the client into mainstream culture and if necessary control those clients who do not want to be normalized. The client’s role is to be the subject of these normalizing interventions. (Juhila, 2006. p.49)
The view of society is that most people are included in the “normal” population, while a small portion of citizens have been excluded or have excluded themselves from the “normal society”. This can happen because of unemployment, poverty, divorce (exclusion from a family group), substance abuse problems, mental health problems and so on. Usually poverty is the common thread among different groups of people who have been excluded from “normal” society. (Juhila 2006, 54). Things that a person needs to be included into normal society are: paid work, safe living environment, housing, local communal services (like access to healthcare, schools etc) and social security network that enables people to live independently. When a person does not fit into this mould and they are excluded from one or more of these aspects they might need social work interventions. (Juhila 2006, 51) Social exclusion is tied to the idea that there is such a thing as “normal life” and social work is there to
enable everyone to participate in this normal society, its normal quality of life, normal way of life and normal control of one’s own life. In a normative perspective an individual is not allowed to choose to exclude themselves from society, but all citizens are obliged to participate in the “normal society”
(Raunio 2006, 13)
As we talk about social exclusion in the Finnish context, it is important to look at how the term has gained popularity and become universally accepted and seen as useful when talking about social problems. Social exclusion as an accepted term in social politics and social policy became common and popular in Finland after the recession of the 1990’s. It moved from an academic interest into to political programs and became to be seen as one of the most important social problems on an European level and the European Union encouraged its member states to form social policy programs to combat social exclusion (Sandberg 2015, 36). It is interesting to note how many different types of social problems are included under the umbrella term of social exclusion and ask why these different aspects are seen as a part of a larger whole. (Sandberg 2015, 44) Social exclusion is mostly agreed to include poverty, which is often tied to unemployment (Sandberg 2015, 82). Researchers are not unanimous in their definition of who is socially excluded as the numbers of how many Finns should be included in this group vary from year to year and depending on what study we are looking at. For example, the figures from the social and health ministry estimate that around 30,000 Finnish people are excluded from society, compared to the figures from the social barometer, which indicated that 70,000 Finns have very poor welfare (Sandberg 2015, 91).
In the client - social worker relationship, power, control and support are intertwined. In social work ethic the values placed on social work include the importance of meeting clients in a way that is ethically sound, but the social worker doesn’t meet the client in a vacuum where you are able to interact as any two people would meet, but the laws governing social work, the institutional and societal structures and the roles both social worker and the client have color and influence how the interacting goes and can even challenge the ethics of care (Laitinen & Pohjola 2010, 11)
Figure 1. Themes relating to the position of social work client (Laitinen & Pohjola 2010, 11)
humanity me/you, us/them
ethics and values client is valued
dimensions of power empowered/controlled client
professional skills client feels heard/helped, given subject position multiprofessional aspects client met together, client met separately legality and rights laws protect the clients rights
services client given services /client as partner organizations institutionalized client
society client as a political entity
As different client positions are shown in the above figure, we can see how in social work practice the client usually occupies different positions simultaneously and these categories fit well with Juhila’s theory of the four different client - social workers relationships as many of these aspects are present in all of Juhila’s categories, with different emphasis on what is considered to be the most important positions. For example, the relationship as partnership category would place more value on the ‘ethics and values’ and ‘professional skills’ categories. Whereas in the social work relationship as normalizing and controlling the client the emphasis would be in the ‘dimensions of power’ and
‘services’ categories. In all of the categories defined above, the most important function for social work is to prevent or stop social exclusion and work to include the client back into a productive member of society. (Juhila 2006, 52)
As shown above, social worker - client relationships can be built on different types of relationships and these relationships are not static, but can evolve and change depending on the client’s situation and where in the social work process the client and social worker are at any given point. The type of relationship between the client and social workers often differs between different types of social work, as the client faces different types of social problems in each category and may then benefit from a different type of approach than another client with a different type of social problem or life situation.
In the Finnish social work context, people who become clients of social work can be divided into different groups, which I have defined below:
1) Work-aged clients. The aim and goal for social work with working age clients is often to aid clients who live in poverty and who are often unemployed and usually have some other difficulties managing their life. The aim is often to enable the client to seek employment, as unemployment is considered the most likely cause for social exclusion (Juhila 2006, 57).
2) Disabled clients. These services are geared more to making sure the disabled person has access to services that enable them to have a productive life, where they are able to participate in society equally with everyone else. However, social work also functions as gatekeeper by assessing who really needs services or what kind of aid, assistance or services a client receives.
3) Gerontological social work, where the aim is to ensure elderly people are able to live independently as long as possible with the help of welfare services and to ensure the clients know which services they are entitled to.
4) Social work done in health care setting. The goal of social work is to ensure people have access to services they need to live independently and are able to get access to rehabilitation if they need it.
Social work done in the health care setting can also be more therapeutic as social workers work in mental health wards and rehab facilities. I am including social work done with clients with substance abuse problems in this category, even though it could also be included into the ‘working-aged client’
group.
5) Social work done with families and children, the aim is to work with families before they need to become clients of child protection services. Usually social work is done in schools, or family centres, or within the organization where child protective services are, but these days, it is common for the organization to have its own team for family social work. The aim is to guide the clients to right services to prevent the need of child protection.
6) Child protections clients where the aim is to safeguard the child’s right to a safe childhood, the aim is to offer families services that intervene as little as possible into their private lives, while also helping the family resolve the problems they have. Child protection social work is the only type of social work in Finland where the social worker has the right and power to enact interventions into the client’s life without their consent.
7) Prisoners. Social work in prison setting is aimed at rehabilitating the inmates back into “normal”
society in a way that prevents them from repeating offences and ending up back in prison. Usually social work is interested in helping prisoners prepare for the time when they are released, by making sure they have somewhere to live, they apply for the benefits they are entitled to and link them back to category one (work-aged clients) where they will pursue work, if they aren’t already employed.
These types of groupings illustrate how in Finnish society exclusion from society does not happen randomly, or touch everyone the same way. Certain groups of people are seen as more vulnerable to social exclusion and social work efforts are aimed at groups viewed to be in risk of exclusion (Juhila 2006, p.56). As mentioned before poverty is a connecting factor between these groups and many clients who need one type of social services need multiple different kinds. Most often the connection is between social work with working-aged clients and some other type of social work, for example family social work, or social work in the health care setting. Social work with working-aged clients deals with problems the client has being able to live financially independently on their own means, instead of needing financial aid from social services.
In our modern society the aim is for people to start working as young as possible and then to stay working and active as long as possible as not to strain the welfare state and the taxpayers. Most if not all alternative lifestyle choices are seen as deviant and something that society has to intervene in, and social work is the tool for how these interventions are carried out. It is based around an idea that, for example, Finnish society has a dominant form, hegemonic form, which is seen as the only right way of living and something everyone should strive for. The problem is often that the “normal” is not easy to define, so only the parts that are considered “deviant” are defined and interfered with (Helne 2002, 3-8).
When on one hand we see social work clients as part of a group of people who are at risk of social exclusion, or who have already been excluded, it is easy to lose sight of the individual client and not see that their life story and lived experience are unique. On the other hand, economic thinking and neoliberalism enables us to think that the individual is totally free to make choices and as such is then responsible for the consequences of those choices. So for example: a client with substance abuse problems is seen as an individual who made wrong choices in their life, which in turn makes it possible to forget the macro level systems that may have led to the persons problems, such as growing up in a poor family where one parent had substance abuse problems, growing up in a small city and a poor neighbourhood, not getting support in school as a child, not having access to secondary education and so on. Even this view is too limiting as it places much of the blame on the family, when we could look at the situation from a system level of global economic changes, which causes recessions, layoffs as industries move away, migration inside a country, which leaves certain areas worse off than others, which leads to more unemployment, schools being shut down, the welfare state
being pulled back and reduced, which creates holes in the safety net, through which more and more people fall. (Juhila 2006, 67-68). So the aim for a social worker is to be able to meet the client as an unique individual with their own life story and experiences, while also not ignoring the underlying issues, which have affected what kind of choices the client has been able to make.
The client’s position can be viewed from different perspectives, either from the systems view of welfare services or from the point of view of the client’s own individual experiences of their own life.
From the system perspective, the agency and needs of the client are put into perspective and compared to the average service user, or the average person who does not need social services. Every client is an object of social work, a case among others and who sets challenged and demands on the system and social work, whereas the client is interested in managing and coping in their living situation and making their everyday life easier (Pohjola 2010, 29).
In these cases, I feel that it is important that the assessment process is transparent enough for the client to understand. In social work it is important for the client to know what the social worker wants from the assessment of the client's situation and what the goal of social work is. Alternatively, why the family/person is considered to be a client of social work. It is often the case that the social worker and the person/family have different views of the situation or social problem, so clear communication is important for the process to proceed in the direction both parties want. As Eskola puts it: in social work, action does not start before there is a reason for it. A client has to have some type of social problem that they cannot solve by themselves. Social work starts when such a client comes into the knowledge of social work. The aim of social work is to remove the social problem from the client’s life, but there may be different opinions about what the problem actually is, how the intervention should be enacted, and where the intervention is needed; on the personal level, community level or the society level. What the interests of the person making these decisions is dictates the level of action, where it is aimed at and the way in which the intervention is executed. (Eskola 2003, 110)
In theory, each aspect of social work should serve a purpose and that purpose should be the alleviation of or removal of a social problem the client has. This purpose is enacted by first defining and assessing the problem and then by using different interventions trying to enact change in the client’s life. If we look at social work from this view, the role allotted for the client is a rather passive one, where the existing welfare services available define the type of help/guidance/control offered to the client who then only has two options. 1) To accept the offered services and accept the assessment that they have
a social problem, or 2) to refuse the offered services and withdraw from the position as a social work client. If they choose the second option, there are usually negative consequences for the client. They may lose monetary benefits, are branded as difficult clients or as people who are excluded from society. In child protection, the client may also be subjected to interventions that are done against their will. At the same time, the role of the client does not have to be seen in such a negative light.
The client has become a client of social work because they need help with something in their life and they would not need to be a client if they could resolve the problem themselves. Therefore, even though our current system emphasizes the role of the client as active and equal partner or as a passive recipient of social work interventions we can look at it from the view that too much responsibility placed on a client when they are in a difficult life situation can be detrimental to their wellbeing and asking too much. (Pohjola 2010, 30)
2.3 Home visits in Finland
The roots of the social work home visit can be traced back to the origins of social work, in Finland to the charity organized and enacted by wealthy women, often through churches. The aim then was to educate poor families about how to live in a better way, for example talk about hygiene or how to feed or take care of babies. There are still similar aims for social work, where education or guidance is still a part of the social work process. From a Foucauldian perspective the aim was to expand the reach of social control during this period (end of 19th century and the beginning of the 20th century) and the aim was to create ‘docile subjects’, people who could be subjected to, used, transformed and improved through training, correction, normalisation and surveillance (Winter & Cree 2016, 1179).
Home visits became an established part of social work, which was cemented by the work done by Mary Richmond, who created the case work model for social work, where home visits were seen as having an important function in providing information about the client and their problems. (Winter
& Cree 2016, 1182).
The discourse today about the role of home visits in social work differs between countries. For example in Britain there are two compering view; where one is driving for more regulation and the
need for more evidence-based measurement tools and interventions and the other, which demands the deregulation and the greater emphasis on relationship-based practice. (Winter & Cree 2016, 1185).
There is not such a clear division among the Finnish social work organizations or social workers.
There is more conversation about the effectiveness of social work interventions and the need to be able to assess different ways of doing social work, but there is still not much standardized guidelines or regulations about how social work should be done.
Home visits in social work have a special meaning compared to social work done in the social work offices or in other public places. When a social worker enters a client’s home they cross a boundary into the private sphere of the client and while the social worker is in the client’s home, the home itself influences how people act, both how does the client act at home as well as how the social worker acts in the client’s home (Ferguson 2018, 70). Home as a concept is both extremely private and personal, as well as common, in the sense that it is shared with everyone else; the home is an arena where people’s private lives and the shared cultural norms coexist (Saarikangas 1993, 38-39). Entering someone’s home includes this dichotomy where we feel a shared concept - that we all have a home, but at the same time our homes will differ from each other and it is natural that there is the automatic comparisons made, between our own home and the home we are visiting.
Home visits in social work are always an invasion of privacy. The social worker and the client do not know each other socially and it is highly unlikely that without the social work aspect that the social worker would ever be invited into the client’s home. The relationship is not reciprocal; the social worker never invites the client to visit their own home. Looking at privacy more closely it can be defined as: someone not being interfered with, having the ability to exclude others and having the moral right to “be left alone” (Bowles et al 2006, 155). The client’s basic right to privacy about the details of their personal life is also regularly violated in social work, where the client is expected to open up and explain very private matters. Privacy is also the ability to control the information about themselves and decide who has access to it and in how much detail (Bowles et al 2006,162-163)
I was interested in gaining a wider look at how home visits are seen to function in the Finnish social work context. I chose the Handbook of Social Work (Kananoja et al 2017), as it is a recent book written about the social work field in general, which dedicated chapters to most types of social work that are present in Finland. The book is written by Finnish experts on social work and the writers are well known in the academic field. I will summarize how the handbook viewed home visits in social
work, as it then gives us an access point into comparing the usage and the importance to what the survey data from my participants produced. In the Handbook of Social Work the chapter concerning the laws that govern social services the purpose of home visits is defined as a part of ´advisement and guidance´ which is a service defined in the social welfare act (sosiaalihuoltolaki §6). Home visits do not require the person to be a client of social work and they are usually conducted voluntarily with the permission of the person whose home is visited. (Kananoja et al 2017, p.75) The social welfare act states that there are situations even when the client does not allow it if:
“(1) If absolutely necessary in the interests of a person in obvious need of social welfare on the grounds of severely endangered health, development or safety, and if the need for social welfare cannot otherwise be ascertained, a social worker is entitled, on an order from a senior social welfare officeholder appointed by the organ referred to in section 6, paragraph 1, to gain entry to the dwelling or other place of residence of such person in order to determine the need for welfare. (736/1992)
(2) If entry to the dwelling or other place of residence is prevented, the social welfare authority shall ask the police authorities for executive assistance as referred to in section 22 of the Act on the Status and Rights of Social Welfare Clients. (125/2006)” (Finlex 2006)
Generally home visits are defined as an action taken when there is concern about the social risk factors in the living conditions or the life-situation of the person whose home is visited. Usually this concern is raised in some other service, for example school, workplace or healthcare. During the home visit the professional can tell the person about the support or services provided by the municipality and assess the living conditions and life situation of the person. During the home visit the professional can take into account the person and or their family’s view of their need for support services and if necessary guide them to a more thorough assessment of their service needs in. (Kananoja et al 2017, p.75) Translating this part of the chapter was interesting as it is written completely in the passive voice. I added the professional in, as the original text does not in any way define who is conducting the home visit. The need to hear the own assessment of the person being visited is also written as optional, something that can be done, but not as something that should be done, or must be done. The assessment of the invisible assessor is given prevalence. The person whose home is visited has a very limited and passive role in home visits in this definition. They are there to hear about services and possibly they get the chance to describe their own situation. The purpose of the home visit seems to be a risk assessment of the living conditions and the living situation.
In the chapter concerning advisement and guidance, home visits were mentioned twice. First in a paragraph talking about a particular area of Finland (South-Carelia, Eksote) where social services
have been arranged with the emphasis of early intervention and prevention of social problems. Here home visits were mentioned as a way of bringing services to where the people needing them live in their everyday life, as opposed to forcing people to leave their house and possibly going to several different offices in search of help for their problem. The idea was that when services go to the people instead or people going to the services that the people find this more convenient and seek help earlier (Kananoja et al 2017. p.213). The second mention defines the purpose of home visits as a part of gerontological social work where the professional assess the whole living situation of the old person with the person, their next of kin and other people who are close to the old person. They will inform the person about the service options and guide the person to the services they may require. (Kananoja et al 2017. p.215) In gerontological social work, the aim for home visits is in preventative approach where home visits are done before a concern is raised elsewhere. The purpose is to offer support or services to the elderly before their own resources are severely limited by health problems or social reasons. (Kananoja et al 2017. p.265, 268) In these mentions the client is seen as a more active participant, their wishes are taken into consideration and other people in the client's network are seen as having useful input in assessing the service needs of the client.
In the chapter talking about social work with disabled clients the home visit sits in the framework of social service needs assessment process. In the disabled client context, emphasis is placed on assessing the resources of the client and the people close to them. The need to hear the opinions of the client and the active participation of the client are mentioned. In the assessment process, the home visit is an arena where the client is interviewed and observed in their home environment. The goal is to assess the functionality of the home and environment, access to social connections and the accessibility of the home and neighbourhood and the accessibility of services. The opinion and views of the client are central to the assessment process. The UN Disabled Persons Rights Act and the Finnish Social Welfare Act obligates the social worker to respect the client's right to self-govern and to find out and respect the opinions of the client. (Kananoja et al 2017. p.284) Here when we were talking about disabled people the rights and the participation of the client themselves was raised into importance in a way that the rest of the articles have not. The client is seen as the expert on their own life situation and what kind of services or help they require.
When it comes to the chapter on children and family social work, it emphasized the need for the child or family to get services without the need to be clients of child protective services. Social worker assesses the child’s or the family’s need for services, (Hämeen-Anttila 2017, 217-218) but it is not
mentioned how this assessment is carried out in particular. However, usually the assessment is done according to the Social Welfare Act, which I mentioned previously and which states that the home visit can act as a part of the assessment process. Home visits are not mentioned specifically in the chapters concerning child and family social work, substance abuse social work, social work done with homeless people, social work done with prisoners, or social work done with work-aged adults.
I think part of the reason for this is that home visits are seen as a natural part of social work practice that does not need to be specifically mentioned, as similarly client meetings in the social work offices are not mentioned. The structure of the handbook defines social work in more abstract ways where we only talk about assessments, interventions and providing services, without mention to how there processes are done. Yet home visits are mentioned in other parts of the book when it comes to social work process and I think it is interesting to note where it is mentioned specifically and where it is omitted.
3. Theory and methods
3.1 Adapting Foucault’s thinking to social work context
Michel Foucault was a French sociologist and a post-structural theorist. In my thesis, I am mostly interested in his thinking about society and power. Foucault did not think power in itself was either bad or good. Foucault was interested in seeing how power works and influences people, what kind of relationships and practices power enables and creates (Helén 2010, 27). Foucault theorized that power was not located in any one place, for example the state, but it permeates all aspects of society and affects all individuals in different ways in different contexts. Power is always changing and never universal. As power is always evolving and being developed and organized, it also develops and organizes people. Power is apparent in the relations between active subjects. Therefore, if we look at an individual we cannot separate their personality, identity or subject position from the power relationships and the society in which they live and act in. (Kaisto & Pyykkönen 2010, 10)
The use of power is legitimized by appealing to political rationalizations, which are divided into four different forms. 1) The rationalizations are moralistic, where certain values are set as the foundation and the aim of power. Such as safeguarding society, justice, equality, and quality of life. 2) The rationalizations are based on scientific knowledge and are epistemic in nature 3) they are idiomatic and have their own vocabulary and jargon. 4) Rationalities are translatable and transferable to other contexts. (Helén 2010, 30). As we can see from this list these rationalizations are very easily transferred to how social work is legitimized, which is point four on the list. The others can be applied as: 1) Social work promotes quality of life, equality and its purpose is to safeguard society as a safety net for its citizens. 2) The ways in which social work is done is based, more and more on scientific knowledge, defining social problems and so on. 3) Social work has its own jargon and expressions that are often formally defined in laws.
Governement is calculated and consistent action that aims to guide individuals, communities, and whole populations towards goals that are considered important at that moment in that society. To be efficient governement has to be aimed at individuals individually; people have to understand their role as citizens, consumers, workers, who all have their own responsibilities. The basic idea of governement is the combination of outside power influencing the individual as well as the individual governing and controlling themselves (Kaisto & Pyykkönen 2010, 11). The ideal situation is that the
role of outside power is minimal and the individual controls themselves, so that power structures often seem invisible. Power in this sense is not positive or negative, it depends on what the aims of the power are or whether the individual agrees to the aims and controls themselves in the desired manner. Individuals are free to do as they please as long as their choices are within the accepted options. The idea that the more the individual assumes the normalized position the less they are objectivized and the more freely they are able to live. For example in today’s society the people who live “normal” lives, where they go to work, are able to control their own lives financially and socially are able to live largely without interventions from institutions that hold the subjectivating and objectivating power, like social work, police or hospitals for example (Juhila 2003, 58)
The idea of objectivating and subjectivating the client in the social work context is easy to apply into social work, even though Foucault was talking about different kind of institutions in his own writings.
The idea of objectivating and subjectivating is that the subject position of the individual is changed or adapted by objectivating them. Institutions guide individuals into assuming certain roles and behaviours or to assume a certain subject positions. In social work the aim of client work is often to enact change on the personal level, where the client changes their subject position, for example a person with substance abuse problems sobers up and as such does not fit into the subject position of
‘a person with substance abuse problems’ (Juhila 2003, 52) Often the process of objectivating and subjectivating is linked into normalizing practices where the aim is for the client to realise they are abnormal and that they need to change their behavior and move closer to what is considered the norm in society. In the 21st century the norm is the independent individual, where the aim is for all people to be self-reliant and able to act proactively and where dependency and passivity are seen as abnormal and even pathological (Juhila 2003, 55) In order to fulfil its normalizing function social work has to dominate and control its clients, but at the same time social work has to be done in a way that does not jeopardize the clients right to control their own life and their right to self-determination. In other words, in order to be efficient and effective social work has to make clients assume normative roles for themselves, but it has to be done without force, indirectly and voluntarily. Control and support are present at the same time in all social work aspects no matter which institutions social work is done (Juhila 2003, 55)
In Foucault’s views, institutions play a major role in governing and defining what is normal for a particular part of society. For example, hospitals define what is healthy or what sickness is, or how
schools educate children in how society works, or what is acceptable behaviour. In these institutions, we have experts who will define what is normal and punish the deviant. These can be doctors, teachers, police (Jones 2003, 136), but also social workers. Social workers are experts in what our society considers normal everyday life. Social workers guide and control their clients into fitting better into what our society thinks is normal in ways of living, working, raising children and so on.When social workers go to someone’s home in a professional capacity the implicit purpose of the visit is to compare the home against our preconceptions of what a normal home should be like.
Foucault was interested in how knowledge was both generated as well as generative and what types of knowledge gain hold and became truth or normal and what are the processes that enable this process. According to Foucault, power is reinforced by the production of knowledge (Winter & Cree 2016, 1176). The production of knowledge creates discourses, which refer to a shared way of thinking, understanding, writing and talking about a particular issue. These discourses produce ‘a truth or truths’ and different discourses can exist at the same time, but which one gains pre-eminence is related to broader political, economic and social considerations. Truth is not something that exists universally or as an independent object, but truth is a social construct that is formed when a dominant discourse has formed (Winter & Cree 2016, 1177).
The definition of normal has variable meanings depending on whose home we enter into. We have a concept of what the home of a single man is like; we think we know what the home of a family with kids is like. We have a notion what the home of a “normal person” is like and then we have the notion of what our clients homes are like. This knowledge is gained with work experience, as we visit and see the homes of our clients we build a database on what the homes of our clients usually look like.
What the home of someone disabled is like, what the home of a person with substance abuse problems or mental health problems is like and so on. Sometimes the idea of what a normal home is like and what our clients home is like can be identical or very similar, but we also make parameters for the deviation from these norms. We define what is good enough and make judgement calls on what sort of deviation is still acceptable when we evaluate homes from the viewpoint of a social worker? The question being, when does a social worker have to say something about a person’s home or in some other way interfere into how a person is living? Often social workers do not have to say anything about their client’s home, as they are within our accepted perimeters for what homes look like.
3.2 Power in social work
One of my interest in home visits was in the aspect of control and power present in the interaction.
No matter what type of social work we do and how equalitarian we try to make the encounter with the client, there is always the presence of inequality in the interaction. It does not mean that the client is powerless in the situation and there are ways for the client to resist the power roles and exert power of their own. I will try to explore both of these aspects of power relationships in my thesis. There is another power relationship at work inside the organization where social workers do their work. Home visits are a part of the culture of the work place and might be seen as mandatory. How are home visits defined in the workplace in the sense of workplace safety, resources and guidelines? Who decides when home visits are done?
When Foucault’s thinking is applied to social work we can make visible certain aspects that are considered normal and become invisible. Such question can be: what kind of truth is built about social problems, the right kind of life, how social problems are defined; for example where is the line between alcohol abuse and “normal alcohol consumption” (knowledge aspect), what kind of governmentality actions are linked with social problems and the guidance towards change and
“normal life”. What are the support and control functions the client is subjected to; how are the obligated to participate in interventions and treatment (power aspect). How are people encouraged to change themselves and to control themselves; how is the client made to want to decrease their alcohol intake or to sober up completely so it becomes something they want for themselves instead it being something pushed on the client from the outside? (ethical aspect). (Juhila 2003, 50) It can be said that all social work includes aspects of control, but at the same time, all control aspects include the idea of support. Social work does not aim to control its clients just for the fun of it, but the idea behind control functions is that by social work interventions and its controlling aspects the client is able to change their life for the better (Jokinen 2008, 112).
In modern social work, we often talk about the relationship between social workers and clients or service users. The accepted wisdom being that clients and social workers should have as close to an
equal position as is possible, where the work is done in dialogue and the client is an active subject who works to change something (a social problem) about their life with the help or co-operation of the social worker. The social worker is supposed to act as an advocate for the client and offer new ideas or concrete services to the client who then can use them to enact change in their life. The ideal situation being one where the client is an active service user who is able to choose the services that work the best for them. This type of thinking has ties to the liberal ideal of the rational and active individual who is in the end responsible for their own actions and wellbeing. This type of thinking does not work well when it comes to the reality of social work in many fields. For example in child protection when a child is taken into care and even before that the family has very little choice in do they actually want to get services or what happens when the child is taken into care. (Niemi 2008, 86) To some extent, this is also accurate of other types of clients who have multiple social problems and not enough energy and resources to act independently and seek out services they need. For example, clients with substance abuse problems, homelessness, mental health, or health problems, some of the elderly and so on. I think in some aspects we might even say that one reason why we have clients in social work is that the client has a lowered ability to make rational decisions about their lives and they have less resources and energy to pursue completely independent lives.
In this context, the role of the social worker can never be that of an equal where the client is like a person shopping at the mall, picking up things they need by themselves for themselves. The social worker often works as both guardian of the clients rights and right to services, but also as the gatekeeper who decides who really needs and deserves the social services and has to think about the monetary restraints from the point of view of their employer. When it comes to power, a social worker has institutional power that comes from their workplace and depends on what the role of their workplace has in the social services sector. Social workers also have power that comes from the laws that govern social services and the social worker is a representative of their nation’s governmental power.
Niemi (2008) asks in his article why the discourse around social work these days often tries to hide or minimize this role social workers have and theorizes that it is done in an effort to build a more confidential and safe client-worker relationship. Niemi posits that usually this is done in vain, as most clients already have some idea of the power social workers have and often also have fears relating to this power. Niemi asks wouldn't it be more beneficial to bring the aspects of power to conversation and build transparent rules from the beginning so the client is aware of their role and rights from the
start. (Niemi 2008, 92) This type of open conversation about the control aspect of social work might also be beneficial as social workers themselves feel the control aspect of their work as a negative and relate it to situations where they cannot trust the client and therefore have to try to gain information
“behind the client’s back” to find the truth about the client’s situation (Jokinen 2008, 119-120).
3.3 Why use a survey as data collection method?
When I was collecting sources and doing a literature overview of what kind of research had been done about home visits I noticed a trend that in other thesis papers, the research method had been a qualitative interview or ethnographic observation of home visits with an additional interview. I did not find studies about home visits in social work, where the source material was collected by using a qualitative method. The results of these qualitative papers were complementary to the results I got from my own data and it seems that the experiences of social workers have many things in common and that because of these similarities even smaller sample sizes may give surprisingly accurate insight of the everyday experiences of social workers.
In my thesis, I hoped to collect as many responses from social workers as is possible. I did not want to limit the responses to one particular type of social work, as I noticed when I was looking into the type of research that had previously been done on the subject it appeared, that the most popular subject for examination had been child protection social work. After reading these papers, I became even more interested in seeing if the reasons for home visits differ on different social work sectors and how these differences appear.
The survey questions are available as an attachment at the end of the thesis. The question were written in Finnish and the survey was half-structured, meaning that it included both open questions and multiple-choice questions. Most multiple-choice questions often included the option of “other”, where the participant was able to add their own answer on top of the choices I had provided. The open questions where the participant was able to write their answer freely were added to enable the participants to show their own views in questions where I felt it was impossible for me to accurately know what type of things the participants would want to answer. At the end of the survey, the
