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The role of health and social care workers in supporting health

Updated: 30 september 2022.

Tips and information

• Everyone should be able to access health and social services and afford to use them
• It is the job of health workers and social care workers to provide health and social services to all people
• There are different types of care such as: to promote health, prevent or treat illness; rehabilitative care to help people after illness or injury; care for people who are terminally ill and their families 
• Health workers and social care workers can help people to get information and medicines they need
• Health workers and social care workers can work with leaders to bring attention to problems people have, such as in accessing health services

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WJEC Level 3 Health and Social Care: Principles and Contexts: Referencing help

• Other Sources
• Tips for finding information
• Referencing help

Introduction to Referencing

• What is referencing?
• Why reference?
• Avoiding plagiarism
• Academic integrity
• What to reference?
• Good academic practice
• Referencing styles

shows what you have read and allows others to identify the sources you have used

demonstrates that you have read widely and understood the topic

gives supporting evidence for your ideas, opinions and arguments

acknowledges the work of others

avoids plagiarism by making it clear which are your own ideas and which are someone else’s

• copying and pasting text or images from the internet without acknowledging (citing) the original source
• passing off someone else’s work as your own
• not putting a quote in quotation marks
• quoting, summarising or paraphrasing other people’s work without citing the original source
• changing words or phrases but copying the sentence structure without citing the original source
• citing sources you did not use

The intention of this guide is to present referencing to you in the context of understanding good academic practice and academic integrity. We want to equip you with the skills necessary to produce honest written work, and avoid plagiarism. Understanding how to use the work of others is a skill that you will learn in college and take with you into Higher Education or the workplace. With good academic habits and referencing skills, plagiarism will not be an issue for you to worry about.

It is worth noting that n ot all ideas are considered to belong to others, and these are usually facts, dates and events that are generally known by someone studying in a particular subject. This is common knowledge and you do not need to reference it.

• Keep a record of all the sources you read as you go along, (author, title, date).
• If using material from the internet, note the URL and date you accessed the site.
• When note taking, make sure you can identify your own thoughts and words, where you are recording direct quotations (and remember to note the page number), and where you are paraphrasing.
• If in doubt, include a reference! 

This guide lists the sources that you will use most frequently when writing your assignments. It does not include all possible sources that you may want to use.

Ask a Librarian  for help with anything you are unsure about or c ontact us by emailing  [email protected]  .

You should receive a library workshop session on referencing in your first year of college. You can also attend drop in sessions in the library or book a one-to-one session with an experienced Library Advisor. Further information is available on the  Libraries Moodle page . 

A  referencing system  or  style   is a set of guidelines to show you what information is needed in a reference and how you should format it, both within your text and in your reference list at the end of the document.  NPTC Group mainly uses the Harvard referencing system:

Author-Date (e.g. Harvard): Author surnames and year of publication are given in the text and an alphabetical reference list/bibliography is given at the end.

Some departments use different systems:

Numerical (e.g. Vancouver for Computing and IT):  A superscript number in the text refers to a numerical reference list at the end.

Footnote-Bibliography (e.g. MHRA for History ): A superscript number in the text refers to footnotes found at the bottom of each page and an alphabetised reference list/bibliography is given at the end. 

Your lecturers will confirm which system you should use.

How to reference in Harvard style

• Books & E-books
• Journal article
• Photographs
• Reference list

Check the NPTC Referencing Guide for more examples.

If an e-book is identical to its print version, with publication details, edition and page numbers, then you reference it in the same way as a printed book. It is not necessary to distinguish between the print or online version.

Check the NPTC Referencing Guide for more examples.

If you include an image in your work, you should include a citation underneath the item and a reference at the end of your work.

Check the NPTC Referencing Guide for more examples.

Recommended reading

How referencing works

• In-text citations
• Paraphrasing
• Summarising
• Secondary referencing
• Reference list/Bibliography

When you are referring to someone else’s work or ideas within your assignment you must show where it came from. This is an in-text citation, and gives the brief details of the work you are referring to.

The Harvard Referencing style includes

• Author(s)/editor’s surname
• Year of publication 
• Page numbers (always required for a direct quotation or an idea from a specific page) e.g. (Pears and Shield, 2019, p. 7).
• Remember that in-text citations are included in your final word count.

Watch this short video on how to create a citation within your assignment.

A direct quotation is using someone else’s exact wording in your assignment, and should be relevant to your argument. Too many quotations can disrupt the flow and style of your own writing; your tutor would prefer you to interpret the information in your own words as it shows you have understood the evidence. 

When you paraphrase, you are taking someone else’s writing and putting it in your own words. This is another way of referring to an author’s ideas or arguments without using direct quotations. Your assignment will read more naturally and in your own style of writing, and shows that you understand what the author is saying. You must still cite and reference your source of information

When you summarise you are providing an overview or brief statement of the main points of an article, chapter, book or web page. You always write a summary in your own words and include the author’s main concept. It is different from paraphrasing as you are leaving out detailed information. If you are summarising the main idea you do not need to include a page number in your in-text citation, only the author’s name and year of publication.

Some author’s quote or refer to the work of others and this is secondary referencing. If you wish to use this information, you should try to find the original (primary) source and cite from the original author’s work. If this original research is difficult to find or access, and you are confident that the secondary source is reliable then your in-text citation will include both the primary source and the document in which you found it.  But, when compiling your reference list, you will only include the book or article that you actually read, NOT the primary source.  

At the end of your assignment, you will need to provide a complete list of all the citations used in your work. This is a reference list or bibliography , and the citations link to the full details of the information you have used at the end of your work. The list is arranged alphabetically by author’s surname, or by title if there is no author. A reference list allows the reader to locate your original source of information.

A reference list includes all the information you cited in your assignment.

A bibliography includes all the information you cited in your assignment and any additional background sources you may have read but not used in your assignment.

Most tutors require a reference list but if you are not sure which is required, ask them to clarify:

• if there are two or three authors, include all their last names and initials
• if there are four or more authors, use the abbreviation et al. after the first author’s name
• if you use multiple works by the same author, your references will be arranged in chronological order (by year of publication, beginning with the oldest)
• if you cite two or more publications by an author in the same year, you will need to distinguish between them in the text and reference list. You can do this by adding letters after the publication date e.g. (Mullins, 2017a) and (Mullins, 2017b)

Watch this video on how to create a reference list at the end of your assignment.

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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington (DC): National Academies Press (US); 2019 Sep 25.

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health.

• Hardcopy Version at National Academies Press

2 Five Health Care Sector Activities to Better Integrate Social Care

Health care sector leaders often make decisions about improving-social care through care integration and investment in the absence of information about different strategies ( Alderwick et al., 2018 ; Bickerdike et al., 2017 ; De Milto and Nakashian, 2016 ; Gottlieb et al., 2017b ; Institute for Alternative Futures, 2012 ). An evidence-informed taxonomy of health care–based strategies that can be used to support and strengthen integration may help guide activities in this area.

Based on the existing literature and other sources, as described in Chapter 1 , the committee identified five mutually complementary categories of activities that health systems can adopt to strengthen integration (see Figure 2-1 ). While all of the categories will ultimately benefit patients, two of these ( adjustment and assistance ) focus on improving care delivery provided specifically to individual patients based on information about their social risks and protective factors (conditions or attributes that may mitigate or eliminate risk). Two others ( alignment and advocacy ) relate to roles that the health care sector can play in influencing and investing in social care resources at the community level. All of these delivery and community-level activities are informed by efforts that increase awareness (the fifth category) of individual or community-level socioeconomic risks and assets relevant to a health system's geographic region or served population. Health care stakeholders—including providers, care delivery organizations, health plans, and government payers—that are exploring opportunities to launch or strengthen integration should understand the challenges of and interplay among these different strategies as well as the range of activities possible within each category. Each of the five categories (awareness, adjustment, assistance, alignment, and advocacy) depends on systems-level changes to implement and sustain integration—including a defined and well-trained workforce, data and digital tool innovations, and new financing models. These systems-level elements are the focus of subsequent chapters of this report.

Health care system activities that strengthen social care integration.

• HEALTH CARE ACTIVITIES TO STRENGTHEN SOCIAL CARE AND HEALTH CARE INTEGRATION

The five complementary types of integration activities correspond to different roles that health systems can play to strengthen the delivery of social care in health care settings. These activities build on the community-informed and patient-centered care 1 recommendations from a previous National Academies of Sciences, Engineering, and Medicine (the National Academies) report, Systems Practices for the Care of Socially At-Risk Populations ( NASEM, 2016 ) (see Figure 2-2 ), by illustrating how these two approaches can most efficiently interact to enable high-quality care, whether to keep people healthy or reduce the burden of disease.

Promising systems practices to improve care for socially at-risk populations. SOURCE: NASEM, 2016.

In developing its overall strategy to social care integration, the committee drew on this report's overarching theme—moving upstream to improve the nation's health—and recognized that there are both “near” and “far” upstream activities for strengthening integration. Near-upstream activities are targeted toward interactions that individuals have with health care clinical providers or clinical systems, whether for primary prevention or treatment of acute and chronic illness. They include ensuring that health care providers adjust traditional medical care decision making based on social risk and assets data and that patients with social risk factors then receive assistance connecting with and securing available government and community resources related to identified social needs. Far-upstream activities are more community-oriented. They involve aligning health care resources and investments to facilitate collaborations with community and government sectors as well as bringing health care assets into broader advocacy activities that augment and strengthen social care resources. As an example of how this could work in practice, Table 2-1 describes ways in which individuals' access to transportation might be improved using the five categories of activities.

The five broad categories are not part of a sequential process; they instead complement one another, and health care stakeholders might engage in multiple strategies simultaneously. These categories provide multiple pathways to achieving integration based on the evidence considered by the committee. Therefore, it would be a disservice to the field to suggest rules, guidelines, or a one-size-fits-all approach because one size does not fit all. Any of these categories is an umbrella for many specific activities that may take different forms, including similar activities that involve different levels of intensity. For example, assistance programs can range from light touch (e.g., providing patient handouts with basic information about social resources) to high touch (offering intensive case management to patients who need more help obtaining resources). These activities are described in more detail below, accompanied by relevant examples.

Awareness: Strategies to Increase the Health Care Sector's Awareness of Social Risks

Both national and local health sector activities seeking to increase social and health care integration frequently begin with elevating and sustaining awareness about the influence of social risk and protective factors on health outcomes. Across both social and health sectors, the general awareness of the relevance of social factors on health is increasing rapidly. The committee documented an exponential increase in medical literature published over the past 18 years that (1) refers to the social determinants of health (SDOH); and (2) links those determinants with health care delivery (see Figure 2-3 ).

PubMed search results for “social determinants of health” overall and in the context of health care, 2000–2018. NOTES: Number of results of PubMed searches for “social determinants of health” (SDH) and for “social (more...)

TABLE 2-1 Transportation-Related Examples Highlighting Different Categories of Social and Health Care Integration Activities

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The committee defined awareness as those activities that identify the social risks and assets of defined patients and populations. Awareness strategies are not limited to sector-level awareness of the intersection of social risks and health outcomes. Instead, the committee recognized that building stakeholders' investments in social care also involves a more active, immediate awareness of a specific population's social risks and assets. Though the committee acknowledged that awareness is an important component of both individual- and community-level activities aimed at improving care integration, no consensus exists regarding the most effective or efficient strategies to increase awareness in ways that can facilitate subsequent actions. The strategies that health care systems already invest in to increase awareness vary across settings. The Kaiser Permanente Social Needs Network for Evaluation and Translation (SONNET) has highlighted five different pathways through which information about social risks and assets can be brought to the attention of health care systems (see Figure 2-4 ): clinical care, screening large populations, screening high-risk groups, hotspotting, and identifying vulnerable communities.

Pathways to identify basic resource needs. NOTE: EHR = electronic health record SOURCE: Steiner JF, Adams JL, Clausen D, Clift KM, Millan A, Nau CL, Roblin D, Schmittdiel JA, Schroeder EB. Predictive Models for Social Determinants of Health in KP Members (more...)

On the clinical side, patients visiting health care organizations are increasingly being asked to answer social risk screening questions in the context of their care and care planning. In some places, screening is incentivized by payers. As part of the MassHealth Medicaid program, for instance, Massachusetts accountable care organizations now include social screening as a measure of care quality ( MassHealth, 2018a , b ). Similar initiatives are under way in North Carolina and Rhode Island. Clinic-based screening can be universal (everyone in a health care setting is asked about social risks, such as housing or food, either at each visit or at defined intervals; see Pathway 1 in Figure 2-4 ), or it can be more directed at specific age groups (e.g., children and seniors) or high-risk groups (e.g., people with certain diseases or who are on government insurance) (see Pathways 2 and 3 in Figure 2-4 ). As an example, Geisinger Health directs food security screening and interventions specifically at patients with diabetes ( Feinberg et al., 2017 ). It is important to note that efforts to raise awareness by collecting data (both on patient clinical history and overall community health) may be affected by unconscious or implicit biases held by program leaders and practitioners, which can create new implementation barriers and workforce training demands (detailed further in Chapters 3 and 6 ) ( Garg et al., 2005 ; Gottlieb and Alderwick, 2019 ).

A wide array of social risk screening tools has emerged to meet the demand for clinic-based social risk awareness activities ( UCSF, 2019 ). Existing screening tools vary in the social domains covered, length, language accessibility, and other characteristics ( UCSF, 2019 ) (see Table A-1 for adult screening tools; pediatric screening tools also are available). Often these tools use different measures to assess social risks even under a single domain.

Though some screening tools use items from domain-specific validated instruments (e.g., hunger vital signs) ( Hager et al., 2010 ), scant research is available on the psychometric validity of grouped items (Lewis et al., 2019). Existing studies generally indicate that a strong majority of patients find clinic-based social risk screening acceptable ( Fleegler et al., 2007 ), though the unintended consequences ( Garg et al., 2016 ) and possible opportunity costs of clinic-based screening have not been clearly articulated ( NASDOH, 2019 ).

Some health systems use neighborhood- or community-level data to help select patients for more targeted social risk screening or to help identify high-risk communities (see Pathway 5 in Figure 2-4 ). For example, Cincinnati Children's Hospital conducts particularly intensive outreach with patients from two high-poverty zip codes to identify children with social needs ( Auger et al., 2017 ). To facilitate such targeted outreach activities, the American Board of Family Medicine and the University of Missouri's Center for Applied Research and Engagement Systems have together developed the Population Health Assessment Engine (PHATE), which is provided to clinical providers enrolled in the American Board of Family Medicine's PRIME registry ( American Board of Family Medicine, 2019 ). PHATE uses patient address data to incorporate “community vital signs” into patient charts based on publicly available census-tract-level characteristics. These and other uses of PHATE are summarized in Box 2-1 . Some nonprofit hospitals, federally qualified health centers, and local public health departments also use the community-level social risk data in community health needs assessments, which are required by the Internal Revenue Service and are intended to influence community-level investments ( Alberti et al., 2014 ).

Uses of Population Health Assessment Engine.

The committee searched for indicators of the prevalence of awareness activities (e.g., social risk assessments or data linkages across social and medical sectors). Though multiple surveys targeting different health care stakeholders (e.g., payers, health systems executives, providers, and consumers) have asked about the prevalence of social screening in health care settings, there are limited data that can be synthesized across these surveys (findings from 23 surveys are summarized by SIREN) ( Cartier et al., 2019 ). The majority of the existing surveys ask whether the health care system conducts some form of social risk assessment broadly without asking further questions about the specific strategies undertaken to obtain information. For example, survey items typically fail to distinguish among universal, clinic-based social screening, targeted screening for high-risk patients, and community data integration; they do not ask respondents to report the numbers of patients who complete social risk assessments; and they do not ask about the capacity of the workforce or activities undertaken in general or by discipline to respond to any identified risks. Some research has explored the adequacy of using electronic health record (EHR) documentation (e.g., LOINC, SNOMED, International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10], Current Procedural Terminology [CPT] codes) to gauge the prevalence of individual-level social risk screening, though this would fail to capture other related activities that facilitate social needs and asset awareness. At this time, the lack of both coding standards and capacity in medical coding systems and documentation incentives makes EHRs an unreliable source of information ( Arons et al., 2018 ; DeSilvey et al., 2018 ; Lewis et al., 2016 ; Navathe et al., 2018 ; Torres et al., 2017 ). These and other technology-based opportunities to strengthen care integration are the focus of Chapter 4 .

In reviewing different strategies to increase the health care sector's awareness of patient and population social risk and protective factors, the committee went on to ask whether increasing the health care sector's recognition of social risks alone could contribute to changes in health outcomes in the absence of dedicated social care interventions. Specifically, does asking equate to an intervention? This question could be especially relevant to the awareness strategies in which individual patients are asked about their social risks in the context of a health care delivery encounter. Does asking about social risks without coupling screening activities with a related social care intervention, such as, at a minimum, making a referral for a patient to follow up at his or her discretion, affect the provider–patient relationship in some way? Could asking have negative consequences, such as triggering or creating trauma ( Garg et al., 2016 )? The committee did not find a strong body of evidence to support either positive or negative consequences of implementing awareness strategies in isolation. This is likely because there are few clinical systems implementing clinic-based screening without some form of intervention.

Even in settings when relevant interventions are offered, patients do not consistently desire assistance, making it important to consider shared decision-making principles as part of patient-centered care planning that results from identifying social risk factors and social needs ( Swavely et al., 2018 ; Tong et al., 2018 ). Some research suggests that patients do not believe that social screening needs to be accompanied by interventions and may have salutary effects in isolation, although the evidence is mixed ( Byhoff et al., in press ; Palakshappa et al., 2017 ). As an example, patients' perceptions that they are receiving equity-oriented care—including care that is trauma-, culture-, and context-informed—are linked with comfort and confidence in care, which itself is associated with improved confidence in managing health problems ( Ford-Gilboe et al., 2018 ). Lower rates of patient–provider discussions about social demographic circumstances were found to be associated with six times higher odds of poor medication adherence ( Schoenthaler et al., 2017 ). More research is needed on how screening activities themselves affect patient–provider relationships.

Adjustment: Activities Where Social Risk Information Is Used to Inform Clinical Care Decision Making

There are many different ways in which an awareness of social risks (collected through any of the awareness strategies described above) can subsequently influence health care sector activities, leading to such things as providing social care coordination and services and augmenting the availability of social care resources (see assistance, alignment, and advocacy sections below). Social risk data also could be used to inform adjustments to care that focus not on resolving social risks directly but instead on altering clinical care to accommodate identified social barriers. Thus, social and economic barriers to high-quality care may be mitigated by changes to how the health care services are delivered in addition to any attempts to resolve the social risk itself.

Many examples of adjustment strategies were identified in the literature, including the delivery of language and literacy-concordant services; smaller doctor-patient panel sizes for cases with socially complex needs (e.g., teams caring for homeless patients in the U.S. Department of Veterans Affairs [VA] health system have panel sizes smaller than the size of other VA care teams); offering open-access scheduling or evening and weekend clinic access; and providing telehealth services, especially in rural areas ( Felland et al., 2003 ; VA, 2019 ). Other examples of ways that providers can adjust care based on known social risks involve changing insulin dosages at the end of the month when food benefits are more likely to run out ( Seligman et al., 2014 ) and shifting to indoor or supervised physical activity recommendations for patients who live in unsafe neighborhoods ( Waite, 2018 ). These adjustments can have a significant impact; for instance, providing last-shift or overnight dialysis beds, offering longer acting anti-hypertensive medications, or changing visit schedules may improve outcomes in homeless patients with end-stage renal disease ( Holley et al., 2006 ; Podymow and Turnbull, 2013 ). These examples highlight adaptations to traditional care designed to accommodate patients' social contexts but are not interventions focused on changing the underlying social risk.

The amount of evidence suggesting that adjustment interventions affect health varies depending on the type of intervention because there are many different activities in this general category. For example, a strong body of evidence supports providing interpreter services, which can be considered a form of adjusted care delivery since care modifications (as opposed to English classes) are provided based on an understanding of patient social and cultural characteristics that can be gained through better communication ( Ku and Flores, 2005 ; Wasserman et al., 2014 ). As described in the awareness section above, some evidence suggests that context-informed care can influence patients' experience of care, health behaviors, and health outcomes. Health services researchers have described clinical care that incorporates an understanding of social context as “contextualized care” ( Weiner et al., 2010 ). And while there is a relevant, intersecting body of evidence on shared decision making and patient-centered care approaches, research in those areas has not consistently and explicitly focused on care modifications or interventions that mitigate the impacts of social and economic adversity ( Sambare et al., 2017 ).

Social risk–adjusted payments also could be considered adjustment strategies if they are not linked explicitly to requirements like social care coordination or housing supports. Massachusetts is currently experimenting with Medicaid capitation rates that change based on patients' social risks (e.g., neighborhood deprivation and housing status) ( Breslin et al., 2017 ; Commonwealth of Massachusetts, 2017 ; Crumley and Marlise, 2018 ). Chapter 5 provides more details about risk-adjusted payments.

The increased focus on the intersection of social risk and health outcomes at a national level provides an opportunity to recognize, evaluate, and potentially incentivize contextualized care so that it can be implemented more systematically throughout the U.S. health care sector. The adjustment approach to social care integration is potentially the least controversial of health care strategies to strengthen social care since the focus of care remains within the traditional wheelhouse of medical care. Nonetheless, substantial gaps in knowledge exist about how adjustment strategies should affect disease-specific care decisions. For example, though many expert care guidelines on diabetes, hypertension, and obesity recognize the influence of social context, sparse information is provided in those social guidelines about how providers should alter their care based on specific social risks ( American Diabetes Association, 2017 ; Armstrong and Joint National Committee, 2014 ; Eckel et al., 2014 ; Jensen et al., 2014 ; Stone et al., 2014 ). Thus, it is not surprising that some research shows that clinical care is not systematically context-informed in U.S. health care settings. When social risk data are provided via verbal cues, for instance, providers inconsistently incorporate the information into care decisions ( Levinson et al., 2000 ; Tong et al., 2018 ; Weiner et al., 2010 ). In one study, providers given verbal cues about patients' complex contextual circumstances subsequently provided contextually appropriate care in less than 23 percent of cases ( Weiner et al., 2010 ). Health care workers may resist universal screening given the limited evidence on how to screen most effectively, insufficient support for referrals and follow up, and changes in procedures and workflow that may be necessitated by screening.

There are many outstanding questions about whether there should be more explicit adjustments to care recommended for patients with specific social risks (e.g., food or housing insecurity) in order to maximize the uptake of guideline-concordant care. For instance, the potential for such adjustments to widen rather than lessen health inequities must be considered. Concerns have arisen from concrete examples in the health care system where social risk factors have been wielded to deny evidence-based care to select populations. For instance, history suggests African Americans have been systematically denied adequate pain management due to both conscious and unconscious biases about pain perception and racialized depictions of addiction, substance abuse, social support, and a perceived inability to comply with pain management practices ( Primm et al., 2004 ). To avoid such discrimination caused by the presence of social risks, new care management guidelines must be thoughtfully designed both to incorporate social risks into personalized care and to provide guardrails against discrimination. As these guidelines emerge, appropriately applying them will require relevant training curricula and incentives ( Weiner and Schwartz, 2016 ). Training of the social care workforce is discussed in Chapter 3 , and payment and financing reform that can support this work is the focus of Chapter 5 .

Assistance: Strategies to Link Patients with Social Needs to Government and Community Resources

Beyond increasing awareness of patients' social risks and adjusting care to accommodate endorsed risks, there is a new focus on health care–based interventions on reducing social risk by providing assistance in connecting patients with relevant social care resources. The literature contains descriptions of a variety of assistance activities that have been undertaken by health systems and communities. These assistance activities vary in intensity, from lighter touch (one-time provision of resources, information, or referrals) to longer and more intensive interventions that attempt to assess and address patient-prioritized social needs more comprehensively ( Bickerdike et al., 2017 ; Gottlieb et al., 2017b ; Hannigan and Coffey, 2011 ).

Lighter-touch assistance activities can include providing information or vouchers for patients to obtain resources in the community (e.g., through curated resource lists) or referring patients to specific programs (e.g., to medical–legal partnerships to address legal barriers to housing or benefits, to eligibility counselors to enroll in Medicaid, or to social workers to obtain help with heating bills or short-term rental assistance). These lighter-touch interventions can include direct assistance (e.g., sending patients home with food if they report being hungry, providing rides directly to and from appointments, or offering respite care activities to support caregivers) ( Berkowitz et al., 2018 ; Chaiyachati et al., 2018 ; Lindau et al., 2016 ; Martin et al., 2015 ).

More intensive assistance activities are often directed to medically and socially complex patients, and they typically include processes such as relationship building, comprehensive biopsychosocial needs assessments, care planning, interventions (e.g., resource connections, ongoing case management, and behavioral activation interventions, such as motivational interviewing), and long-term community-based supports ( Burns and Essing, 2018 ; Lukens and McFarlane, 2004 ; Miller and Rollnick, 2012 ; NEJM Catalyst, 2017 ; Rizzo and Rowe, 2016 ). These more intensive assistance activities can enable the identification of co-occurring mental health concerns (such as low self-esteem, loneliness, and a history of trauma) and physical health barriers. As a result, intensive assistance activities can contribute to care adjustments at the same time as they are supporting the different processes. This has made the impacts of social care assistance activities difficult to disentangle from other intervention activities targeted at high-complexity patients ( Gottlieb et al., 2017b ). The AIMS care coordination model and the IMPaCT model are two examples of a higher-intensity assistance approach (see Box 2-2 ).

Examples of High-Intensity Assistance Activities.

Assistance is sometimes provided directly by clinical care team members, such as primary care providers or registered nurses. Other times, these activities are assigned to individuals whose roles are more focused on social care, such as social workers ( Altfeld et al., 2012 ; Boutwell et al., 2016 ; Fabbre et al., 2011 ; Fraser et al., 2018 ; Gehlert et al., 2015 ; Rizzo and Rowe, 2016 ; Stanhope and Straussner, 2017 ), patient navigators, community health workers, or care coordinators ( Berkowitz et al., 2018 ; Chinman et al., 2015 ; Dale et al., 2008 ; Gunderson et al., 2018 ; Kangovi et al., 2015 ; Repper and Carter, 2011 ; Salzer et al., 2010 ). These staff may be employed by health systems or by partner community-based organizations ( Schrage, 2018 ). Systematically integrating assistance activities into health care organizations may necessitate changes in workflow, team dynamics, and organizational culture, and it may demand strategies to engage patients that depart from usual care. Together these requirements can present substantial barriers to implementation ( Helfrich et al., 2016 ; also see Chapter 6 ).

Despite substantial evidence concerning the connection between social risks and health outcomes and use, there are few rigorously designed studies on the impact of assistance interventions on outcomes or use among participants ( Gottlieb et al., 2017a ). Rather, most evaluations of interventions have focused on process outcomes, such as patient satisfaction and self-reported health-related measures, and have not differentiated between specific intervention components ( Gottlieb et al., 2017a ). Moreover, many assistance interventions have evolved over time under principles of continuous quality improvement and learning health systems, using techniques such as pre–post analyses rather than more rigorous randomized control trials ( McGinnis et al., 2014 ). Further research is needed in this area on the wide range of interventions that are and could be used to reduce patients' social risk. This research will need to more clearly articulate the added value of providing assistance services, particularly for specific populations who may report the same social need but have differing complexities and benefit eligibility that should inform assistance activities. The health care sector's approach of providing assistance with basic material needs, for instance, to patients who are medically complex is likely to differ from providing assistance to healthier populations.

Alignment and Advocacy: Activities Where Health Care Organizations Partner and Collaborate with Other Sectors

Increasingly, health care delivery organizations, health plans, and other health care stakeholders play roles in aligning health care assets with existing social care assets in communities and advocating for more social resources to improve community health and well-being. The committee defined alignment activities to include those undertaken by health care systems to understand existing social care assets in the community, organize them in such a way as to encourage synergy among the various activities, and invest in and deploy them to prevent emerging social needs and improve health outcomes. The committee defined advocacy activities as those in which health care organizations work with partner social care organizations to promote policies that facilitate the creation and redeployment of assets or resources in order to improve health outcomes and prevent emergence of unmet social needs. While providers, patients, and caregivers also can advocate to improve social resources for individual patients, the committee defined health care sector advocacy as activities that are aimed more broadly at increasing the availability of community resources for groups of patients. The net effect of both of these types of activities (alignment and advocacy) is to achieve what the Centers for Medicare & Medicaid Services defined as the objective of the alignment track of the Accountable Health Communities Model, which is to “optimize community capacity to address health-related social needs” ( CMS, 2019 ).

In both the alignment and advocacy categories, health care organizations leverage their political, social, and economic capital within a community or local environment to encourage and enable health care and social care organizations to partner and pool resources, such as services and information, to achieve greater net benefit from the health care and social care services available in the community. Since 2009, reports from the Agency for Healthcare Research and Quality; the National Academies of Sciences, Engineering, and Medicine; 2 the U.S. Preventive Services Task Force; and other organizations have recommended improving the integration of clinical, public health, and community-based services and focusing on increasing the uptake of clinical preventive services ( AHRQ, 2016 ; ASTHO, 2015 ; Dzau et al., 2017 ; IOM, 2012 ; Long et al., 2017 ; Ockene et al., 2007 ). Cross-sector collaboration is also a foundational strategy in the Robert Wood Johnson Foundation's Action Framework to build a Culture of Health and has been described in multiple reports on how partnership-driven work can integrate health care and social care services to improve population health ( Plough, 2015 ; Towe et al., 2016 ). An important limitation of these collaborations is that they often occur in the context of uneven power dynamics and historical fragmentation between sectors due to differing funding sources and workforces.

Though such partnerships are not new, health care organizations are engaging in collaborative work in increasingly varied ways. However, despite national recommendations and increasing activity concerning the use of intersectoral work to strengthen community resources, the literature on the effectiveness of the health care sector's alignment and advocacy work in large part remains limited to case studies. Some evidence suggests that alignment and advocacy activities can improve a variety of health outcomes, from infection control to asthma and cardiovascular outcomes ( Boex et al., 1998 ). One study demonstrating effectiveness found significantly lower death rates from potentially preventable conditions among communities with multi-sector networks supporting population health activities with alignment and advocacy strategies extending well beyond the boundaries of the traditional health care system to include policy changes supporting improved health outcomes (e.g., smoking bans and increasing access to healthy food) ( Mays et al., 2016 ). Reporting bias may skew the literature toward positive outcomes narratives, including impacts on health care use, expenditures, and overall population-level health outcomes.

With the above caveats, a handful of illustrative examples are available to demonstrate three strategies that health care stakeholders have taken to increase alignment and advocacy in their communities.

Partner with social care agencies to fill known gaps in services for beneficiaries. One approach used by health care organizations to improve alignment and advocacy is to strengthen collaborations with social care organizations to directly provide needed services. For instance, the network Area Agencies on Aging coordinates with community-based organizations to provide community case management, home-delivered meals, and caregiver respite to aging populations ( Brewster et al., 2018 ). This partnership formalized the referral infrastructure and established a compensation mechanism for these services that supports the assistance activities of the clinics while also aligning and investing in local resources and helping sustain and strengthen local, trusted institutions. In another example, the Henry Ford Health System partnered with Uber, Lyft, and Ford Motor Company to provide transportation to its patient population, with a particular focus on those in underserved communities ( Knowles, 2018 ; Martinez, 2018 ). At the same time they are campaigning to modify existing transportation infrastructure in the city of Detroit in order to facilitate access in vulnerable communities. An increasing number of health care organizations are also investing in low-income housing. For example, UnitedHealth Group invested $50 million in low-income housing tax credit funds managed by the Greater Minnesota Housing Fund and Enterprise Community Investment, resulting in the development of multi-family rental units for very low-income and special needs households ( UnitedHealth Group, 2013 ).

Develop anchor institution strategies. A growing number of health care initiatives explore roles that the health care sector can play in improving the social, economic, and political landscape of local economies. In these cases, health care organizations adopt place-based, health-equity-focused strategies that recognize that social and economic determinants are largely responsible for health outcomes. These organizations often describe an “anchor mission” that helps them realign institutional assets to broadly combat social and economic disparities by investing in communities. Hospitals and health systems spend $782 billion annually, employ more than 5.6 million people, and hold investment portfolios of more than $400 billion ( Ubhayakar et al., 2017 ). Investments made through anchor institution strategies sometimes rely on community development financial institutions, which provide access to capital often unavailable from traditional lenders, or on social impact bonds, in which case private funds are used to catalyze initiatives to address community needs. In 2019, more than 40 health care delivery organizations were participating in an anchor institution collaborative activity ( Healthcare Anchor Network, 2019 ). For example, Rush University Medical Center's (RUMC's) anchor strategy involves hiring individuals from underserved communities to provide them with economic opportunity, establishing local and minority-owned business preferences for vendor and supply chain contracts, and creating a local financial investment strategy ( Harkavy, 2016 ; Ubhayakar et al., 2017 ). As part of this approach, since 2017 RUMC has provided $6 million in loans to community development financial institutions, such as one supporting the city of Chicago's Neighborhood Rebuild Training pilot program. In programs like these the funding can be used in various aspects of the community, including renovations to homes in high crime areas and providing on-the-job training and credentialing opportunities to youth and ex-offenders ( Chicago Community Loan Fund, 2018 ; Community Development Financial Institutions, 2019; RUMC, 2017 ). While it is difficult to gauge the impact of such long-term investments and collaborations, more outcome data will become available as more health care stakeholders undertake and report on their anchor activities. Another example is Stephen and Sandra Sheller 11th Street Family Health Services, a federally qualified health center in Philadelphia, Pennsylvania ( Waite, 2018 ). 11th Street works with neighborhood residents in cooperation with schools, churches, and community groups and agencies to provide for the biological, psychological, and social needs of its patients by offering a wide range of services, including creative arts therapies, fitness training, and nutrition classes.

Organize and engage in cross-sector coalitions. Other alignment and advocacy activity involves more actively organizing and engaging in multi-sector coalitions generally aimed at place-based community improvement. Johns Hopkins University, located in Baltimore, Maryland, is a member of the East Baltimore Development Initiative, a multi-stakeholder coalition seeking to revitalize the East Baltimore neighborhood ( East Baltimore Development Inc., 2010 ). The university has engaged with the community through the Homewood Community Partners Initiative (HCPI) in 10 neighborhoods located around its main campus ( JHU, 2019 ). HCPI has worked with the Central Baltimore Partnership, various community and neighborhood organizations, and other stakeholders, such as foundations and anchor institutions, to develop an implementation plan for the area. This plan contains 29 priority recommendations for action, including blight removal, housing and commercial development, and fundraising. From 2013 to 2016 Maryland established health enterprise zones in five communities to stimulate alignment and advocacy activities among local health departments, health care delivery organizations, and social care and community-based organizations; the effort resulted in a net cost savings of $93.39 million (across all zip codes that participated) due to reduced inpatient hospital visits ( Gaskin et al., 2018 ). Hennepin Health, a Minnesota-based managed care program, reported similar notable gains coordinating assets at the county level, including across social care agencies, county-based health departments, multiple health systems, and a nonprofit health plan ( Vickery et al., 2018 ). Together these agencies reported reductions in emergency department use and increased primary and preventative care use for Medicaid beneficiaries.

These strategies alone or in combination may be funded by health care organizations via community benefit programs—the required contributions that nonprofit health care delivery systems must make to earn their tax-exempt status.

The committee recognizes that health care organizations can bring funds, data, and political and other forms of capital to catalyze community activities—including through the various strategies described in this chapter. But the health care sector has not consistently wielded this capital in the interest of primary prevention of clinical conditions or prevention of the complicating social conditions. Effective strategies to strengthen social and health care integration are likely to require more attention to the experience and expertise of community stakeholders. This will demand organizational humility from the health care sector, particularly as it moves from health care delivery to community-focused activities. Alignment and advocacy initiatives should incorporate patients, families, and community members in program planning and execution to help avoid historical missteps.

As effective strategies emerge, attention will need to be given to implementation feasibility and program sustainability, including the workforce, technology, and payment models that will support the strategies and enable long-term interventions and corresponding reductions in health disparities.

• Five complementary types of activities can facilitate the integration of social and health care. They are awareness, adjustment, assistance, alignment, and advocacy.
• These types of activities should not be considered mutually exclusive, and one does not necessarily build on another. The exception involves awareness activities, which typically are foundational to the others.
• Some health care systems have had success with using these strategies to strengthen social care services and, subsequently, to link social care activities with improved health outcomes.
• Robust outcome evaluations have not been conducted on social care integration activities, which limits the committee's ability to draw conclusions and make recommendations about specific evidence-based practices.
• A one-size-fits-all approach is neither feasible nor advisable, since context should influence the adoption of specific social and health care integration activities.
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Patient-centered care is defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions ( IOM, 2001 ).

As of March 2016, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM). The IOM name is used to refer to publications issued prior to July 2015.

• Cite this Page National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington (DC): National Academies Press (US); 2019 Sep 25. 2, Five Health Care Sector Activities to Better Integrate Social Care.
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health and social care level 3 unit 14 assignment brief

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Health and social care

A health and social care degree covers a range of areas and helps you develop skills to build a career in health, social care, education, charities, or public services

Job options

Jobs directly relevant to your degree include:

• Advice worker
• Care manager
• Community development worker
• Community education officer
• Family support worker
• Health improvement practitioner
• Health service manager
• Youth worker

Jobs where your degree would be useful include:

• Adult nurse
• Education mental health practitioner
• Equality, diversity and inclusion officer
• Operating department practitioner
• Psychological wellbeing practitioner
• Social worker

Remember that many employers accept applications from graduates with any degree subject, so don't restrict your thinking to the jobs listed here.

Work experience

Gaining work experience can improve your skills, enhance your career confidence, and provide you with vital insights into career options and industries. Take advantage of opportunities to do a short-term or sandwich (year-long) placement while studying to gain invaluable experience and practical knowledge.

Relevant opportunities for work experience might include working part-time in a local hospital, completing an internship for a health-related charity, or contributing to a research project through your university. Depending on your aspirations, you could also work in an early years education setting or an addiction support service. Gaining experience in support work, befriending, or advice may be useful for careers relating to social work and case work.

If you're interested in arts and health, you could explore work experience within art, play, or drama therapy. Volunteering or working on a community health project may also be useful for developing a career as a social prescribing link worker .

Other relevant work experience includes working at a local school, at a fitness centre in health promotion, or within a local authority.

Search for placements and find out more about work experience and internships .

Typical employers

Many health and social care graduates work in roles across education, health, public services, and the charity sector. Typical employers include:

• local authorities including social services
• charities, not-for-profits, and community organisations
• schools, colleges, early years organisations, or adult education settings.

There are a variety of opportunities available across the private sector, for example, within care companies and private healthcare businesses. Graduates can also work within social prescribing, employed by either the NHS or a private healthcare company and working in partnership with community groups.

Find information on employers in healthcare , social care , charity and voluntary work , and other job sectors .

Skills for your CV

A degree in health and care provides students with knowledge of complex issues across the health and care sectors and prepares students for relevant careers. It provides students with an understanding of health and social care from practical and academic perspectives. On the course you'll learn to:

• recognise and understand management practices in health and social care
• research and analyse complex topics related to health and social care using inter-disciplinary approaches
• formulate and present arguments through a range of assignment methods, including reports, essays, presentations, and group projects
• produce an independent dissertation on a topic of your choice, applying research methods and analysing relevant data effectively.

You'll also develop a range of skills and competencies, including:

• written communication skills - to present your knowledge and argument effectively through reports and essays
• verbal communication and presentation skills - to effectively engage in lectures, tutorials, presentations, and supervision meetings with academics
• the ability to work independently and as part of a team - to engage in independent research and contribute to group projects
• research skills and data analysis - to critically analyse information and data and apply it to a specific assignment
• time management and project management skills - managing multiple deadlines and planning assignments from start to finish
• multi-tasking and problem-solving skills - managing competing priorities while studying.

Further study

Health and social care graduates may decide to progress onto further study at Masters, diploma, or postgraduate certificate level. For many health-related careers, including social work, occupational therapy, counselling, nursing and speech and language therapy, you'll need to complete further training. For some careers, there are shortened postgraduate options available, so you won't need to complete a full degree course. There are also a range of degree apprenticeship options available, particularly within the NHS and private healthcare providers.

For more information on further study and to find a course that interests you, see Masters degrees and search postgraduate courses in health and social care .

What do health and social care graduates do?

The majority of health and social care graduates were in work 15 months after graduation, with 16% working as care workers and home carers. 

Find out what other economics graduates are doing 15 months after finishing their degrees in  What do graduates do?

Graduate destinations data from the Higher Education Statistics Agency.

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Cambridge nationals health and social care level 1/level 2 – j835 teaching from 2022.

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Maslow’s Hierarchy of Needs

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Key Takeaways

• Maslow’s hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid.
• The five levels of the hierarchy are physiological, safety, love/belonging, esteem, and self-actualization.
• Lower-level basic needs like food, water, and safety must be met first before higher needs can be fulfilled.
• Few people are believed to reach the level of self-actualization, but we can all have moments of peak experiences.
• The order of the levels is not completely fixed. For some, esteem outweighs love, while others may self-actualize despite poverty. Our behaviors are usually motivated by multiple needs simultaneously.
• Applications include workplace motivation, education, counseling, and nursing.

What is Maslow’s Hierarchy of Needs?

According to Maslow (1943, 1954), human needs were arranged in a hierarchy, with physiological (survival) needs at the bottom, and the more creative and intellectually oriented ‘self-actualization’ needs at the top.

Maslow argued that survival needs must be satisfied before the individual can satisfy the higher needs. The higher up the hierarchy, the more difficult it is to satisfy the needs associated with that stage, because of the interpersonal and environmental barriers that inevitably frustrate us.

Higher needs become increasingly psychological and long-term rather than physiological and short-term, as in the lower survival-related needs.

1. Physiological needs are biological requirements for human survival, e.g., air, food, drink, shelter, clothing, warmth, sex, and sleep.

Our most basic need is for physical survival, and this will be the first thing that motivates our behavior. Once that level is fulfilled, the next level up is what motivates us, and so on.

The human body cannot function optimally if physiological needs are not satisfied. Maslow considered physiological needs the most important as all the other needs become secondary until these needs are met.

Once an individual’s physiological needs are satisfied, the need for security and safety becomes salient.

2. Safety needs –  people want to experience order, predictability, and control in their lives.

Safety needs can be fulfilled by the family and society (e.g., police, schools, business, and medical care).

For example, emotional security, financial security (e.g., employment, social welfare), law and order, freedom from fear, social stability, property, health, and well-being (e.g., safety against accidents and injury).

After physiological and safety needs have been fulfilled, the third level of human needs is social and involves feelings of belongingness.

3. Love and belongingness needs   refers to a human emotional need for interpersonal relationships, affiliating, connectedness, and being part of a group.

Examples of belongingness needs include friendship, intimacy, trust, acceptance, receiving and giving affection, and love.

This need is especially strong in childhood and can override the need for safety, as witnessed in children who cling to abusive parents.

4. Esteem needs are the fourth level in Maslow’s hierarchy and include self-worth, accomplishment, and respect.

Maslow classified esteem needs into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the desire for reputation or respect from others (e.g., status, prestige).

Esteem is the typical human desire to be accepted and valued by others. People often engage in a profession or hobby to gain recognition, which gives them a sense of contribution or value.

Low self-esteem or an inferiority complex may result from imbalances during this level in the hierarchy.

Maslow indicated that the need for respect or reputation is most important for children and adolescents and precedes real self-esteem or dignity.

5. Self-actualization needs are the highest level in Maslow’s hierarchy, and refer to the realization of a person’s potential, self-fulfillment, seeking personal growth, and peak experiences.

This level of need refers to what a person’s full potential is and the realization of that potential. 

Maslow (1943, 1987, p. 64 ) describes this level as the desire to accomplish everything that one can, and  “to become everything one is capable of becoming”.

Individuals may perceive or focus on this need very specifically. For example, one individual may have a strong desire to become an ideal parent.

In another, the desire may be expressed athletically. For others, it may be expressed in paintings, pictures, or inventions.

Although Maslow did not believe that many of us could achieve true self-actualization, he did believe that all of us experience transitory moments (known as ‘peak experiences’) of self-actualization.

Such moments, associated with personally significant events such as childbirth, sporting achievement and examination success), are difficult to achieve and maintain consistently.

Maslow posited that human needs are arranged in a hierarchy:

“It is quite true that man lives by bread alone — when there is no bread. But what happens to man’s desires when there is plenty of bread and when his belly is chronically filled? At once other (and “higher”) needs emerge and these, rather than physiological hungers, dominate the organism. And when these in turn are satisfied, again new (and still “higher”) needs emerge and so on. This is what we mean by saying that the basic human needs are organized into a hierarchy of relative prepotency” (Maslow, 1943, p. 375) .

Maslow (1954) proposed that human beings possess two sets of needs. This five-stage model can be divided into deficiency needs and growth needs. The first four levels are often referred to as deficiency needs ( D-needs ), and the top level is known as growth or being needs ( B-needs ).

Deficiency needs

Deficiency needs concern basic survival and include physiological needs (such as the need for food, sex, and sleep) and safety needs (such as the need for security and freedom from danger).

Behaviors associated with these needs are seen as ‘deficiency’ motivated, as they are a means to an end.

Deficiency needs arise due to deprivation and are said to motivate people when they are unmet. Also, the motivation to fulfill such needs will become stronger the longer they are denied. For example, the longer a person goes without food, the more hungry they will become.

Maslow (1943) initially stated that individuals must satisfy lower-level deficit needs before progressing to meet higher-level growth needs.

However, he later clarified that satisfaction of a need is not an “all-or-none” phenomenon, admitting that his earlier statements may have given “the false impression that a need must be satisfied 100 percent before the next need emerges” (1987, p. 69).

When a deficit need has been “more or less” satisfied, it will go away, and our activities become habitually directed toward meeting the next set of needs we have yet to satisfy. These then become our salient needs. However, growth needs continue to be felt and may even become stronger once engaged.

Growth needs

Growth needs are more psychological and are associated with realizing an individual’s full potential and needing to ‘self-actualize’. These needs are achieved more through intellectual and creative behaviors.

Growth needs do not stem from a lack of something but rather from a desire to grow as a person. Once these growth needs have been reasonably satisfied, one may be able to reach the highest level, called self-actualization. Growth needs are achieved more through intellectual and creative behaviors.

Every person is capable and has the desire to move up the hierarchy toward a level of self-actualization. Unfortunately, progress is often disrupted by a failure to meet lower-level needs.

Life experiences, including divorce and the loss of a job, may cause an individual to fluctuate between levels of the hierarchy.

Therefore, not everyone will move through the hierarchy in a uni-directional manner but may move back and forth between the different types of needs.

The expanded hierarchy of needs

It is important to note that Maslow’s (1943, 1954) five-stage model has been expanded to include cognitive and aesthetic needs (Maslow, 1970a) and later transcendence needs (Maslow, 1970b).

Changes to the original five-stage model are highlighted and include a seven-stage model and an eight-stage model; both developed during the 1960s and 1970s.

• Biological and physiological needs – air, food, drink, shelter, warmth, sex, sleep, etc.
• Safety needs – protection from elements, security, order, law, stability, freedom from fear.
• Love and belongingness needs – friendship, intimacy, trust, and acceptance, receiving and giving affection and love. Affiliating, being part of a group (family, friends, work).
• Esteem needs – which Maslow classified into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the need to be accepted and valued by others (e.g., status, prestige).

Cognitive needs – knowledge and understanding, curiosity, exploration, need for meaning and predictability. Cognitive needs drive our pursuit of knowledge and understanding. For instance, a student’s desire to understand complex mathematical theories, a traveler’s curiosity about diverse cultures, or an individual’s quest for life’s deeper meanings all exemplify these needs. Meeting these needs facilitates personal growth, comprehension, and a deeper understanding of life and its complexities.

Aesthetic needs – appreciation and search for beauty, balance, form, etc. Fulfilling these needs leads to a deeper sense of satisfaction and harmony in life, as individuals seek environments and experiences that are pleasing and resonant with their sense of beauty. This involves the appreciation and pursuit of art, music, nature, and other forms of aesthetic expression. Fulfilling these needs isn’t just about physical beauty but also the emotional and psychological satisfaction derived from experiencing order and elegance.

• Self-actualization needs – realizing personal potential, self-fulfillment, seeking personal growth, and peak experiences. 

Transcendence needs – A person is motivated by values that transcend beyond the personal self. Beyond self-actualization, they represent the human desire to connect with a higher reality, purpose, or the universe. This level emphasizes altruism, spiritual connection, and helping others achieve their potential. Individuals seek experiences that move beyond personal concerns, aiming to achieve a deep sense of unity, understanding, and belonging within the vast expanse of existence. Examples of transcendence needs include mystical experiences and certain experiences with nature, aesthetic experiences, sexual experiences, service to others, the pursuit of science, religious faith, etc.).

Self-Actualization Needs

Instead of focusing on psychopathology and what goes wrong with people, Maslow (1943) formulated a more positive account of human behavior which focused on what goes right. He was interested in human potential, and how we fulfill that potential.

Psychologist Abraham Maslow (1943, 1954) stated that human motivation is based on people seeking fulfillment and change through personal growth. Self-actualized people are those who are fulfilled and doing all they are capable of.

The growth of self-actualization (Maslow, 1962) refers to the need for personal growth and discovery that is present throughout a person’s life. For Maslow, a person is always “becoming” and never remains static in these terms. In self-actualization, a person comes to find a meaning in life that is important to them.

As each individual is unique, the motivation for self-actualization leads people in different directions (Kenrick et al., 2010). For some people, self-actualization can be achieved through creating works of art or literature; for others, through sports, in the classroom, or within a corporate setting.

Maslow (1962) believed self-actualization could be measured through the concept of peak experiences. This occurs when a person experiences the world totally for what it is, and there are feelings of euphoria, joy, and wonder.

It is important to note that self-actualization is a continual process of becoming rather than a perfect state one reaches of a “happy ever after” (Hoffman, 1988).

Maslow offers the following description of self-actualization:

“It refers to the person’s desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. The specific form that these needs will take will of course vary greatly from person to person. In one individual it may take the form of the desire to be an ideal mother, in another it may be expressed athletically, and in still another it may be expressed in painting pictures or in inventions” (Maslow, 1943, p. 382–383).

Characteristics of Self-Actualized People

Although we are all, theoretically, capable of self-actualizing, most of us will not do so, or only to a limited degree. Maslow (1970) estimated that only two percent of people would reach the state of self-actualization.

He was especially interested in the characteristics of people whom he considered to have achieved their potential as individuals.

By studying 18 people, he considered to be self-actualized (including Abraham Lincoln and Albert Einstein), Maslow (1970) identified 15 characteristics of a self-actualized person.

Characteristics of self-actualizers :

• They perceive reality efficiently and can tolerate uncertainty;
• Accept themselves and others for what they are;
• Spontaneous in thought and action;
• Problem-centered (not self-centered);
• Unusual sense of humor;
• Able to look at life objectively;
• Highly creative;
• Resistant to enculturation, but not purposely unconventional;
• Concerned for the welfare of humanity;
• Capable of deep appreciation of basic life-experience;
• Establish deep satisfying interpersonal relationships with a few people;
• Peak experiences;
• Need for privacy;
• Democratic attitudes;
• Strong moral/ethical standards.

Behavior leading to self-actualization :

• Experiencing life like a child, with full absorption and concentration;
• Trying new things instead of sticking to safe paths;
• Listening to your own feelings in evaluating experiences instead of the voice of tradition, authority or the majority;
• Avoiding pretense (“game playing”) and being honest;
• Being prepared to be unpopular if your views do not coincide with those of the majority;
• Taking responsibility and working hard;
• Trying to identify your defenses and having the courage to give them up.

The characteristics of self-actualizers and the behaviors leading to self-actualization are shown in the list above. 

Although people achieve self-actualization in their own unique way, they tend to share certain characteristics.  However, self-actualization is a matter of degree, ‘There are no perfect human beings’ (Maslow, 1970a, p. 176 ).

It is not necessary to display all 15 characteristics to become self-actualized, and not only self-actualized people will display them.

Maslow did not equate self-actualization with perfection. Self-actualization merely involves achieving one’s potential. Thus, someone can be silly, wasteful, vain and impolite, and still self-actualize. Less than two percent of the population achieve self-actualization.

Applications & Examples

Workplace organizations and employee motivation.

The theory applies to organizational structures and the motivation of employees. To enhance performance, the organizational culture and HR strategies must address and fulfill the needs of employees.

HR strategies, including compensation, benefits, job design, training, cultural development, and performance evaluations, can be tailored to cater to Maslow’s hierarchy of needs (Jerome, 2013).

1. What can managers do to motivate employees with physiological needs?

At the foundational physiological level, organizations should provide wages that sustain a decent standard of living and comprehensive benefits, ensuring employees can comfortably cater to necessities such as food, shelter, and medical care.

• Offer comprehensive healthcare benefits – Quality health insurance, dental, vision, mental health coverage, and wellness programs demonstrate you care about employees’ overall health and ability to afford care.
• Subsidize gym memberships – Some companies offer monthly gym subsidies or onsite fitness centers to support physical health and stress management.
• Make the space ergonomic – Ensure workstations, chairs, keyboards, etc. are height adjustable and comfortable to work at for extended periods to prevent bodily strain or injury.
• Pay for wellness services – Some companies offer perks like free annual flu shots, smoking cessation programs, or biometric screenings to proactively address health.

2. What can managers do to motivate employees with safety needs?

For the safety tier, offering job stability, secure working conditions, and equitable compensation is essential. Employees are more motivated when they feel both financially stable and physically safe within their workplace.

• Establish anti-harassment policies and reporting procedures – Ensure strong systems are in place for reporting issues confidentially and without retaliation.
• Cultivate psychological safety – Foster an environment where people feel safe to take risks, make mistakes, and speak up without fear of embarrassment or punishment.
• Define and reinforce ethical standards – Clearly establish and model expected conduct to prevent ethical lapses that undermine security.
• Promote transparency in pay and promotion practices – Clearly communicate compensation structure, advancement criteria, and salary negotiation options to build trust.

3. What can managers do to motivate employees with social needs?

Addressing social needs involves cultivating an inclusive community within the organization. Team-building exercises, social gatherings, mentorship initiatives, and transparent communication can foster a sense of belonging. Motivation is heightened when employees feel appreciated and integrated within their teams.

• Develop mother’s rooms – Providing clean, private lactation rooms supports new mothers’ needs to pump breast milk during work hours.
• Train supervisors in mental health first aid – Equip leaders to recognize signs of depression, anxiety, substance abuse and properly intervene or connect employees with help.
• Develop a mentorship program – Allow experienced employees to mentor newer ones to establish interpersonal bonds and a sense of support.
• Model inclusive language and behavior – Use words and actions that are welcoming and respectful to all groups.
• Share vulnerability and imperfections – Leaders should open up on mistakes, challenges, and lessons learned to humanize the workplace.

4. What can managers do to motivate employees with esteem needs?

To cater to esteem needs, organizations should implement recognition systems, merit-based promotions, and leadership roles.

• Leverage unique talents – Properly designated titles that reflect an individual’s role and status can also be beneficial.
• Make the most of performance reviews – Regular performance evaluations not only offer recognition but also highlight areas for growth, feeding into the employees’ need for esteem. Thoroughly highlight strengths, progress made, and areas of influence.
• Entrust employees with mentoring roles – Having them share knowledge and coach others recognizes their expertise.

What can managers do to motivate employees with self-actualization needs?

For self-actualization, organizations should ensure that job roles align with employees’ talents and passions. By empowering employees, presenting them with challenges, and fostering an environment that encourages innovation, organizations can facilitate their journey toward self-actualization.

• Foster innovation – Dedicate time and resources for experimenting with new ideas without pressure.
• Sponsor continuing education – Provide tuition reimbursement or subsidies for advanced courses and certificate programs. Offer paid time for relevant reading, online courses, conferences, and seminars.

The hierarchy provides a framework for understanding patients as multifaceted human beings.

Patient care should be holistic, not just medical. Nurses must assess and address the spectrum of patient needs – physical, mental, emotional, and social (Jackson et al., 2014; Toney-Butler & Thayer, 2023).

Doing so motivates greater engagement in care, faster healing, and improved outcomes.

• A – Airway: Ensure the patient has an open airway.
• B – Breathing: Assess and support adequate breathing and gas exchange.
• C – Circulation: Evaluate and maintain proper blood circulation.
• D – Decreased level of consciousness: Monitor for any changes in behavior or mental status.
• Safety needs – Maintain a clean, quiet environment with call bells for assistance. Prevent injuries through fall precautions, blood clot prevention, and pressure ulcer avoidance. Explain tests, treatments, and medications to patients to relieve anxiety. Keep patient info confidential. Foster a climate of trust through compassionate listening. Prevent medication errors.
• Belongingness – Loneliness impedes healing. Make patients feel welcomed and included. Introduce them to other patients. Allow for family visitation and spiritual practices.
• Esteem – Show respect through courteous communication and cultural sensitivity. Maintain dignity and privacy. Empower patients in care decisions. Explain care in an easy-to-understand way. Listen attentively to their concerns. Make them feel valued.
• Self-actualization— Align care with patient values and aspirations. Perhaps share motivational stories of those with similar diagnoses who stayed active or provide resources on coping with grief over health changes.

Special Considerations

• Pain Management : While pain is typically considered a physiological need, its priority can vary. Acute, severe pain or pain indicating a life-threatening condition should be addressed immediately.
• Hospice Care : For end-of-life care patients, comfort and quality of life may take precedence over addressing physiological needs.

Maslow’s (1962) hierarchy of needs theory has made a major contribution to teaching and classroom management in schools. Rather than reducing behavior to a response in the environment , Maslow (1970a) adopts a holistic approach to education and learning.

Maslow examines an individual’s complete physical, emotional, social, and intellectual qualities and how they impact learning.

Applying Maslow’s hierarchy theory to the work of the classroom teacher is obvious. Before a student’s cognitive needs can be met, they must first fulfill their basic physiological needs.

For example, a tired and hungry student will find it difficult to focus on learning. Students need to feel emotionally and physically safe and accepted within the classroom to progress and reach their full potential.

Maslow suggests students must be shown that they are valued and respected in the classroom, and the teacher should create a supportive environment. Students with a low self-esteem will not progress academically at an optimum rate until their self-esteem is strengthened.

Maslow’s hierarchy provides a humanistic lens for teaching the whole child.

Maslow (1971, p. 195) argued that a humanistic educational approach would develop people who are “stronger, healthier, and would take their own lives into their hands to a greater extent. With increased personal responsibility for one’s personal life, and with a rational set of values to guide one’s choosing, people would begin to actively change the society in which they lived”.

Here are some ways a teacher can apply Maslow’s hierarchy of needs in the classroom:

• Physiological – Ensure students have access to water, food, restroom breaks, and movement. Allow snacks, flexible seating, and adequate breaks.
• Safety – Maintain an orderly classroom with clear expectations. Prevent bullying. Build trust through consistency and fairness. Allow students to make mistakes safely.
• Belongingness – Facilitate community and collaboration. Foster teamwork through group projects. Learn student names and backgrounds. Appreciate diversity.
• Esteem – Recognize student strengths and progress. Display student work. Empower leadership roles like line leader or tech helper. Praise efforts, not just achievement.
• Self-Actualization – Help students pursue interests creatively. Assign passion projects. Encourage goal-setting. Provide enrichment opportunities. Support challenging oneself.

When these foundational needs are met, students are more motivated to learn and perform well academically. But needs fluctuate. Be observant and nurture needs as they arise. 

Critical Evaluation

The most significant limitation of Maslow’s theory concerns his methodology. Maslow formulated the characteristics of self-actualized individuals by undertaking a qualitative method called biographical analysis.

He looked at the biographies and writings of 18 people he identified as being self-actualized. From these sources, he developed a list of qualities that seemed characteristic of this specific group of people, as opposed to humanity in general.

From a scientific perspective , there are numerous problems with this particular approach. First, it could be argued that biographical analysis as a method is extremely subjective as it is based entirely on the opinion of the researcher.

Personal opinion is always prone to bias, which reduces the validity of any data obtained. Therefore Maslow’s operational definition of self-actualization must not be blindly accepted as scientific fact.

Furthermore, Maslow’s biographical analysis focused on a biased sample of self-actualized individuals, prominently limited to highly educated white males (such as Thomas Jefferson, Abraham Lincoln, Albert Einstein, William James , Aldous Huxley, and Beethoven).

Although Maslow (1970) did study self-actualized females, such as Eleanor Roosevelt and Mother Teresa, they comprised a small proportion of his sample .

This makes it difficult to generalize his theory to females and individuals from lower social classes or different ethnicity. Thus questioning the population validity of Maslow’s findings.

Furthermore, it is extremely difficult to empirically test Maslow’s concept of self-actualization in a way that causal relationships can be established.

It is difficult to tell in Maslow’s theory where the scientific leaves off and the inspiration begins. His theory is seen as more speculative than empirically proven, with a tendency to substitute rhetoric for research.

Another criticism concerns Maslow’s assumption that the lower needs must be satisfied before a person can achieve their potential and self-actualize. This is not always the case, and therefore, Maslow’s hierarchy of needs in some aspects has been falsified .

Through examining cultures in which large numbers of people live in poverty (such as India), it is clear that people are still capable of higher-order needs such as love and belongingness.

However, this should not occur, as according to Maslow, people who have difficulty achieving very basic physiological needs (such as food, shelter, etc.) are not capable of meeting higher growth needs.

Also, many creative people, such as authors and artists (e.g., Rembrandt and Van Gogh) lived in poverty throughout their lifetime, yet it could be argued that they achieved self-actualization.

Psychologists now conceptualize motivation as a pluralistic behavior, whereby needs can operate on many levels simultaneously. A person may be motivated by higher growth needs at the same time as lower-level deficiency needs (Wahba & Bridwell, 1973).

Contemporary research by Tay and Diener (2011) has tested Maslow’s theory by analyzing the data of 60,865 participants from 123 countries, representing every major region of the world. The survey was conducted from 2005 to 2010.

Respondents answered questions about six needs that closely resemble those in Maslow’s model: basic needs (food, shelter); safety; social needs (love, support); respect; mastery; and autonomy. They also rated their well-being across three discrete measures: life evaluation (a person’s view of his or her life as a whole), positive feelings (day-to-day instances of joy or pleasure), and negative feelings (everyday experiences of sorrow, anger, or stress).

The results of the study support the view that universal human needs appear to exist regardless of cultural differences. However, the ordering of the needs within the hierarchy was not correct.

“Although the most basic needs might get the most attention when you don”t have them,” Diener explains, “you don”t need to fulfill them in order to get benefits [from the others].” Even when we are hungry, for instance, we can be happy with our friends. “They”re like vitamins,” Diener says about how the needs work independently. “We need them all.”

Maslow’s theory differs from more purely physiological representations of human motivation because motivation is seen as being not just concerned with tension reduction and survival but also with human growth and development.

While Maslow’s work was indeed relatively informal and clinically descriptive, it did provide a rich source of ideas, and as such, a framework for discussing the richness and complexity of human motivation that goes beyond homeostatic models and other biological models.

Frequently Asked Questions

What are some of the weaknesses of maslow’s theory.

Maslow proposes a positive view of humans, however, it could be argued that this might not be very realistic when considering everyday reality such as domestic violence and genocides.

Furthermore, the hierarchy’s focus on meeting our needs and fulfilling our growth potential reflects an individualistic, self-obsessed outlook that is part of the problem faced by our society rather than a solution.

How many levels are there in Maslow’s pyramid of needs?

There are five levels in Maslow’s pyramid. From the bottom of the hierarchy upwards, the needs are: physiological (food and clothing), safety (job security), love and belonging needs (friendship), esteem, and self-actualization.

Maslow asserted that so long as basic needs necessary for survival were met (e.g., food, water, shelter), higher-level needs (e.g., social needs) would begin to motivate behavior.

Why is Maslow’s hierarchy of needs important?

Maslow’s theory has given rise to a new way to look at people’s needs. For example, Maslow’s hierarchy of needs is widely used in health and social work as a framework for assessing clients’ needs.

Problems or difficult circumstances at one point in a person’s life can cause them to fixate on a particular set of needs, and this can affect their future happiness.

For example, a person who lived through a period of extreme deprivation and lack of security in early childhood may fixate on physiological and safety needs. These remain salient even if they are satisfied.

So even if this person later has everything they need they may nonetheless obsess over money or keeping enough food in the fridge.

This, for Maslow, was the root cause of many ‘neurotic’ mental health problems, such as anxiety or depression.

What is at the top of Maslow’s hierarchy of needs?

According to Maslow, the highest-level needs relate to self-actualization, a process by which we achieve our full potential.

Self-actualizing people have both a more efficient perception of reality and more comfortable relations with it. This includes the detection of what is phony and/or dishonest and the accurate perception of what really exists – rather than a distortion of perception by one’s needs.

Self-actualizers accept themselves, others and nature. They are not ashamed or guilty about being human, with shortcomings, imperfections, frailties, and weaknesses.

Nor are they critical of these aspects in other people. They respect and esteem themselves and others.

Geller, L. (1982). The failure of self-actualization theory: A critique of Carl Rogers and Abraham Maslow. Journal of Humanistic Psychology, 22, 56–73.

Hoffman, E. (1988). The right to be human: A biography of Abraham Maslow . Los Angeles, CA: Jeremy P. Tarcher.

Ivtzan, I. (2008). Self actualisation: For individualistic cultures only? International Journal on Humanistic Ideology, 1 , 113–140.

Jackson, J. C., Santoro, M. J., Ely, T. M., Boehm, L., Kiehl, A. L., Anderson, L. S., & Ely, E. W. (2014). Improving patient care through the prism of psychology: Application of Maslow’s hierarchy to sedation, delirium, and early mobility in the intensive care unit.  Journal of Critical Care ,  29 (3), 438-444.

Jerome, N. (2013). Application of the Maslow’s hierarchy of need theory; impacts and implications on organizational culture, human resource and employee’s performance.  International Journal of Business and Management Invention ,  2 (3), 39-45.

Kenrick, D. T., Neuberg, S. L., Griskevicius, V., Becker, D. V., & Schaller, M. (2010). Goal-driven cognition and functional behavior: The fundamental-motives framework . Current Directions in Psychological Science, 19 (1), 63-67.

King-Hill, S. (2015). Critical analysis of Maslow’s hierarchy of need.  The STeP Journal (Student Teacher Perspectives) ,  2 (4), 54-57.

Maslow, A. H. (1943). A theory of human motivation . Psychological Review, 50 (4), 370-96.

Maslow, A. H. (1954). Motivation and personality . New York: Harper and Row.

Maslow, A. H. (1962). Toward a psychology of being . Princeton: D. Van Nostrand Company.

Maslow, A. H. (1970a). Motivation and personality . New York: Harper & Row.

Maslow, A. H. (1970b). Religions, values, and peak experiences. New York: Penguin. (Original work published 1966)

Maslow, A. H. (1987). Motivation and personality (3rd ed.) . Delhi, India: Pearson Education.

Mittelman, W. (1991). Maslow’s study of self-actualization: A reinterpretation.  Journal of Humanistic Psychology ,  31 (1), 114-135.

Neher, A. (1991). Maslow’s theory of motivation: A critique. Journal of Humanistic Psychology, 31 , 89–112.

Tay, L., & Diener, E. (2011). Needs and subjective well-being around the world . Journal of Personality and Social Psychology, 101 (2), 354-356.

Toney-Butler, T.J., & Thayer, J.M. (2023, April 10). Nursing Process. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499937/

Wahba, M. A., & Bridwell, L. G. (1976). Maslow reconsidered: A review of research on the need hierarchy theory . Organizational Behavior and Human Performance, 15 (2), 212-240.

Wulff, D. M., & Maslow, A. H. (1965). Religions, values, and peak-experiences. The Journal of Higher Education, 36 (4), 235.

Further Information

• Maslow’s Theories
• Maslow Hierarchy of Needs Infographic Poster
• Hierarchy of Needs
• Maslow Reconsidered: A Review of Research on the Need Hierarchy Theor
• BBC Radio 4 Programme: Maslow and the Hierarchy of Needs
• Questionnaire: Are you self-actualized? How to Write a Psychology Essay

Hierarchy of Needs and Nursing

• A Nursing Diagnosis Using Maslow’s Hierarchy of Needs
• Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU
• Maslow’s Hierarchy of Needs Adapted for Nursing (Image)

Hierarchy of Needs in the Workplace

• Organizational Culture, Human Resource and Employee’s Performance
• Improving Workplace Productivity: Applications of Maslow’s Need Theory and Locke’s Goal-Setting

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Article Contents

Introduction, research design.

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Social Work as a Human Rights Profession: An Action Framework

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Didier Reynaert, Siebren Nachtergaele, Nadine De Stercke, Hildegard Gobeyn, Rudi Roose, Social Work as a Human Rights Profession: An Action Framework, The British Journal of Social Work , Volume 52, Issue 2, March 2022, Pages 928–945, https://doi.org/10.1093/bjsw/bcab083

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Human rights are foundational to social work, as recognised in the global definition, leading many to consider social work a human rights profession. Although human rights has become an important compass for social work, comprehensive frameworks for understanding the ‘practice’ of human rights in social work are still limited. Only recently attempts have been made to fill this gap. This article seeks to continue these efforts and contribute to a better understanding of how social work constructs, deconstructs and reconstructs ideas of human rights in daily practice. We investigated the following research question: ‘How do social workers “act” when using human rights as a framework for practice?’ We used a qualitative research design consisting of ethnographic research and focus groups, with both social workers and service-users participating. Based on our research, we developed five building blocks for an action framework for human rights in social work: (i) systemworld-oriented action; (ii) lifeworld-oriented action; (iii) participatory action; (iv) joined-up action and (v) politicised action. These building blocks give a comprehensive account for the discursive practice of human rights in social work.

Human rights are foundational to social work, as recognised in the global definition, leading many to consider social work a human rights profession ( Healy, 2008 ; Staub-Bernasconi, 2016 ; Mapp et al. , 2019 ). Staub-Bernasconi (2016) , together with Gatenio Gabel (2015) , among others, acknowledges the historical connection of social work with human rights. In recent years, the recognition of social work as a human rights profession gained renewed attention in social work scholarship. In his book ‘ Practicing rights. Human rights-based approaches to social work practice ’, Androff (2016) makes a comprehensive account of the state of human rights in social work. He shows how (inter)national social work organisations adopted human rights in their codes of ethics, how social work scholars increasingly published books and articles on human rights or how social work education developed a range of training materials and educational programmes on human rights. Based on his analysis, Androff concludes that ‘The growth of scholarship and education focused on human rights suggests that the field is turning towards human rights, rediscovering its rights-based roots. It is now undeniable that there is a consensus that human rights are important and relevant to social work.’ ( Androff, 2016 , p. 10). These observations are in line with conclusions of Cubillos-Vega (2017) , who conducted a study on the scientific output on human rights in social work based on articles published in international indexed journals between 2000 and 2015. She notes that in recent years, the academic output on social work and human rights gradually increased. However, Cubillos-Vega’s (2017) study also reveals that published articles were primarily of theoretical nature. From the fifty-seven articles analysed, hardly one-third (sixteen) were of an empirical type. This trend is striking, Cubillos-Vega argues, because of the nature of the discipline of social work, taking a position between theory and practice. Already in 2012, Ife came to a similar conclusion: ‘Much of the academic debate about human rights remains at the theoretical level; less has been written about the practice of human rights. … There is little articulation of what it means in practice for professionals to claim that their work is based on human rights, and so human rights remain a “nice idea” rather than a solid foundation for the development of practice theories and methodologies.’ ( Ife, 2012 , pp. 10–11). Despite the ground-breaking work of several pioneers in the domain of social work and human rights (e.g. Reichert, 2003 ; Wronka, 2008 ; Ife, 2009 , 2012 ; Lundy, 2011 ), the practice of human right still remains a black box. To date, social work scholarship insufficiently succeed to gain practical knowledge showing how social workers ‘act’ when using the framework of human rights. Together with Ife, we acknowledge the presumption that human rights in social work have a discursive character, as they need to be permanently constructed, deconstructed and reconstructed throughout social work practice. ‘Social workers need to see themselves as active participants in this discursive process, and indeed social work practice itself can be seen as part of the ongoing process of the reconstruction of human rights. It is partly through social work practice that human rights are operationalised, and hence defined.’ ( Ife, 2012 , p. 133). Social work should recognise its actorship or agency in constructing human rights and social work scholarship should conscientiously scrutinise this construction process of human rights through social work practice.

Recent launches in social work scholarship rose to this challenge. In 2015, the SpringerBriefs in Rights-Based Approaches to Social Work were launched. The series aims to develop a social work practice grounded in human rights by presenting and reflecting on new methods ( Gatenio Gabel, 2015 ). The Journal of Human Rights and Social Work, established in 2016, has similar aims. In the inaugural issue, the editors-in-chief state that the journal ‘offers the opportunity for educators, practitioners, administrators, and students in this and related disciplines to have a voice and to expand their knowledge base on issues within human rights practice, knowledge of human rights tools, and to develop skills practicing from a human rights perspective’ ( Gatenio Gabel and Mapp, 2016 , p. 1). Additionally, several social work scholars have been developing practice approaches for human rights in social work. Androff (2016 , 2018 ), for instance, seeks to integrate the five-principles framework of human rights (human dignity, non-discrimination, participation, transparency and accountability) into the social work arena. According to Androff, this framework can offer an integrative account across a wide range of social work practices (see also Mapp et al. , 2019 ). One step further is the proposal of McPherson ( McPherson, 2015a ; Mapp et al. , 2019 ; McPherson and Abell, 2020 ), which contains a comprehensive framework for human rights practice in social work (HRPSW). It comprises three pillars of practice: a human rights lens, human rights methods and human rights goals. McPherson (2015a ) explains that the HRPSW model can be useful for both social work practice and social work education. What these practice models demonstrate is the increased academic interest in practice approaches of human rights in social work ( McPherson, 2015b ).

In this article, we build upon these efforts and present an action framework for human rights in social work. Our action framework expands the above mentioned models in an important way. It provides an understanding of human rights in social work in the context of a different welfare regime. Both the studies of Androff and McPherson are USA based, thereby confirming Cubillos-Vega’s (2017) observation of an Anglo-Saxon hegemony in social work scholarship on human rights. However, different social welfare regimes show different traditions of social work ( Lorenz, 2001 , 2008 ), associated with different understandings of human rights ( Alseth, 2020 ). Our study was conducted in Belgium, which is generally conceived as a conservative welfare state, distinct from the liberal welfare regime of the USA. Conservative welfare regimes have a certain tradition with social rights in particular. Additionally, conservative welfare regimes are characterised by a welfare state architecture of corporatism, balancing civil society’s interest and state power ( Esping-Andersen 1990 ; Lorenz, 2001 ; Dean, 2002 ). It is within this corporatist structure that human rights take shape with social workers developing a human right-based practice.

Because of the open character of our research question (‘How does social workers act when using human rights as a framework for practice?’), we chose a qualitative research design ( Shaw and Holland, 2014 ; Carey, 2012 ), developed in two parts. The first part consists of ethnographic research; the second, of focus groups.

Ethnographic research

Ethnographic research allows one to understand complex practices in their ‘natural setting’ ( D’Cruz and Jones, 2004 ) by being ‘ involved in the ongoing, daily world of the people being studied’ ( Fielding, 2008 , p. 269). Being part of and participating in human-rights-based practices in social work allows the ethnographer to get to know the logic, dynamics and meanings behind these practices. For this study, collaboration was set up with one of the eight regional institutions for community development in Flanders, Belgium. These institutions are recognised and subsidised by the Flemish government through the 1991 Act on Community Development. The overall mission of the institutions for community development is to contribute to realising the right to a decent life for people living in vulnerable life conditions. The institutions for community development explicitly use human rights as a framework to realise their mission. In particular, they focus on social rights as they are recognised in the Belgian Constitution: the right to decent housing, the right to education, the right to social security, the right to health care, the right to work, the right to a healthy living environment and the right to cultural and social development. The participatory approach is typical for the work of the institutions for community development. They are not working just ‘for’, but above all ‘with’ people living in vulnerable life conditions. Therefore, the institutions for community development are an interesting case for investigating the meaning of social work as a human rights profession. Our research took place in the institution for community development in East Flanders, one of the five Flemish provinces in Belgium. In collaboration with the institution, we decided to select two human rights domains to study: housing and education. These domains could be considered as exemplary to study social work as a human rights profession.

Research methods used in ethnographic research can be very diverse. For this study, we used a documentary review, participant observation and conversation-style interviews with key informants ( D’Cruz and Jones, 2004 ). For the documentary review, we used documents produced by social workers who are active in the institution for community development. These documents gave us an insight into the work of the institution regarding the role of social work in ‘doing’ human rights. Policy notes, minutes of meetings, annual reports, etc. were all considered. Because in ethnographic research, it is important to understand the particular historical and socio-cultural context of the practices being researched ( Bryman, 2012 ), additional documents produced outside the institution for community development were selected. They were used to develop an environmental analysis in order to ‘capture’ the work of the institution in relation to the broader policy context (demographic data, a ‘map’ of the available welfare organisations, the history of particular neighbourhoods, etc.).

For the participant observation, the relevant activities to understand the work of the institution for community development were selected in mutual consultation with a ‘gatekeeper’ ( Fielding, 2008 ) of the institution. Gradually, the researcher also spontaneously took part in a variety of activities. Participation by the researcher was always overt (see Bryman, 2012 ). Field notes were kept during or directly after the participant observation. These field notes took the form of detailed descriptions of particular events and of people’s actions in these events, as well as the researcher’s initial reflections on these events. In total, participant observations took four months and more than 400 h. Time was divided equally between the domains of education and housing.

The third method we used was conversation-style interviews with key informants. In order to guarantee the validity of the observations, provisional ideas on the findings, striking observations or remaining questions were ‘shared with the member’s world’ ( Fielding, 2008 ) and checked. These ‘ethnographic interviews’ often took the form of ‘interviews on the spot’ and gave a deeper understanding of the practice being studied. For both education and housing, 26 people participated in an interview (total n  = 52). In the case of education, the group consisted of eight community development workers, twelve social workers from partner organisations (civil servants from the city, school social workers, school directors, social workers from the public centre for social welfare [PCSW], social workers from poverty-related organisations, etc.) and six service-users from the institution for community development. The service-users all had a background of living in poverty, and were selected as members of a parent group from a local school for primary education.

In the case of housing, the participants were six community development workers, eleven social workers from partner organisations (civil servants from the city, social workers from the social housing company, social workers from the PCSW, social workers from poverty-related organisations, etc.) and nine service-users. The service-users were selected based on their participation in the working group on housing that is organised by the institution for community development. This working group consists of people who all face problems with regard to housing. All interviews were audiotaped and transcribed. The researchers had no personal connection whatsoever with the institution for community development. The only professional link that the researchers had with the research context was expertise in the domain of community development and encounters with representatives of the institution in the context of education-related activities (e.g. internships).

Focus groups

In the second part of the study, focus groups were set up. While the general aim of a focus group is to discuss a specific topic ( Bryman, 2012 ), we had an additional 2-fold goal. First, we wanted to flesh out several issues that were not clear after the ethnographic research (deepening). Second, we wanted to explore whether the findings of our ethnographic research that took place in the context of community development were applicable in other domains of social work (broadening). We chose focus groups because they allow for creating rich data, enabling in-depth analysis. We selected people with a more expert profile in social work and human rights. The selection criteria used for participants were (i) being familiar with human rights in a social work context and (ii) having a generalist view on social work practice or policy. Participants from the focus group were senior staff members of various social work organisations, as well as lecturers and professors who teach social work at universities and universities of applied sciences in Flanders. Four focus groups of four to six people were organised (total n  = 18). In addition, seven in-depth interviews were organised with experts who, because of practical considerations, were not able to attend the focus groups. All the focus groups were led by two people: the researcher who conducted the ethnographic research and whose role it was to bring up the content for discussion and a supervisor who was the moderator of the focus group. Each focus group lasted approximately an hour and a half, and each was organised around three statements: (i) Participatory action, as a foundation of a human rights-based approach in social work, can also exclude people; (ii) a human rights-based approach in social work contributes to individualisation and responsibilisation and (iii) a human rights-based approach that starts from rules and laws (a top-down perspective) obstructs an approach that starts from the needs of people (a bottom-up perspective). The discussion in the focus groups was organised based on the five-stage model proposed by Cronin (2008) : (1) introduction; (2) opening; (3) introductory statement; (4) key questions and (5) ending questions. Both the focus group discussions and interviews were audiotaped and transcribed.

Ethics statement

The study was approved and funded by the Research Council of the HOGENT University of Applied Sciences and Arts. It was carried out in collaboration with Ghent University in compliance with the ethical standards of both the institutions. Informed consent was obtained from all of the participants after an extensive explanation of the research project.

Data analysis

For the data analysis, an inductive approach was chosen ( Hodkinsons, 2008 ). More specifically, a thematic analysis was done on the materials obtained from the ethnographic research. The analysis was executed in two steps by the two first authors. In the first step, both authors separately analysed the same six interviews (two community development workers, two social workers form partner organisations and two service-users) for each domain (education and housing). The analysis was based on the six-step model developed by Braun and Clarke (2006 ; see also Teater, 2017 ). Initial codes were assigned to the materials and afterwards they were grouped around several themes or ‘building blocks’. To answer the question of how social work acts when using human rights, we were looking for themes or building blocks that constitute a comprehensive action-framework for human rights in social work. We were particularly looking for different or even conflicting interpretations or constructions of human rights by social work, as these different interpretations could clearly demonstrate the action component of our framework. After individual analysis by the two authors, the results were pooled and discussed. This working method increases the inter-rater reliability among the researchers ( Oluwatayo, 2012 ). The result of this first step was a first draft of an action framework for human rights in social work. In the second step, the second author continued the analysis of the remaining interviews and also analysed the documentary review and the participant observations.

Although the analysis was primarily data-driven, we, as researchers with an interest in social work and human rights, could not disengage from our pre-existing knowledge. As Braun and Clarke explain, ‘data are not coded in an epistemological vacuum’ (2006 , p. 14). So the research context of community development coloured our data to a certain extent. As explained earlier, the community development organisations explicitly use human rights as a framework for their practice. In recent years, they acquired a great deal of expertise in the field of human rights, which has been reflected in numerous reports, memoranda and suchlike. Furthermore, as social work is a practice characterised by interconnectedness with local communities, working with vulnerable people, both at the micro-level of individual support and at the macro-level of structural change, it is no coincidence that related themes emerged from the data. Altogether, the first phase analysis yielded five themes or building blocks for an action framework for human rights in social work: (i) systemworld-oriented action, (ii) lifeworld-oriented action, (iii) participatory action, (iv) joined-up action and (v) politicised action. In the next step, these findings were presented to all the authors and discussed. This did not result in any adjustments at the level of themes, but it did result in some changes to the topics included under each building block. The remaining points of discussion and things that were unclear were taken to the focus groups. After the focus groups were held, the same procedure was followed: the four transcribed focus groups and seven additional interviews were analysed by the two first authors, and then discussed with all the authors, until consensus was reached. Again, this did not result in any adjustments at the level of the building blocks.

Based on our data, an action framework for human rights in social work was developed, consisting of five building blocks. In the next part of this article, we present these five building blocks.

Systemworld-oriented action

The right to social support would be meaningless without social services; the right to education would be meaningless without schools; the right to decent housing would be meaningless without houses and the right to health care would be meaningless without hospitals. All these systems—social services, schools, houses, health care, social security, etc.—are considered parts of the systemworld . The systemworld can be defined as all the institutionalised societal resources necessary for the realisation of human rights. Access to these systems is often difficult for people living in vulnerable life conditions. They frequently experience high thresholds.

The problem is that you have to be well informed and to know the right person.  … How many people know about the income guarantee for elderly people? A lot of people probably know about the premium for housing, but how many of them are actually applying for it? Definitely not that many, because it requires a lot of jargon that keeps people from applying . (a service-user)

It is a recurring complaint that social systems are inaccessible, because people who need care and support must deal with bureaucracy. The problem is not just the large number of forms that need to be filled in. Social workers also send people from pillar to post, so that ultimately people give up and do not apply for the support they are entitled to. In the end, social rights are often not realised.

We do not understand just how high the thresholds are for people who are already in a vulnerable position, who are living in difficult circumstances, and who are then confronted with a multitude of services that are not working in an integrated way, have cultural thresholds, etc. We have no idea what it means to live in poverty, how hard that is … so that support by social services and an emancipatory approach don’t mean anything. (a social worker, institution for community development)

An important topic related to creating accessible social institutions concerns the distinction between ‘universal’ and ‘selective’ social systems. Based on a human rights perspective, social workers often argue for universal social systems. However, some social workers point out the risks of this approach.

Human rights are of course for everyone. But I think that certain groups are more easily deprived of them. These are certainly socially vulnerable groups.  … Other groups have more power to make their voices heard. In any case, they also have easier access to certain rights. Education, for example, is more in line with middle-class culture. (a social worker, institution for community development)

Another social worker puts it even more bluntly:

That is actually a waste of time and resources if we focus on all citizens.  … In such an inclusive organisation, time and energy are not focused on the most vulnerable people. (a social worker, institution for community development)

To resolve the tension between a universal and a selective approach, some social workers argue for so-called progressive universalism. According to this line of thinking, social support should in principle be universal in orientation, and therefore should be addressed to everyone. However, these universal social systems should simultaneously develop ways of supporting people living in vulnerable life conditions who may fall through the cracks, by supplementing them with selective measures ‘within’ these universal systems. So a community centre can be open to everyone, but for people living in poverty, extra support should be provided ‘within’ this community centre to guarantee their participation.

We shouldn’t become the home of the poor either. We have to keep it a bit open without opening it up again to everyone, because then you know that the weakest people will fall out again. (a social worker, institution for community development)

Lifeworld-oriented action

Systemworld-oriented action has its counterpart in lifeworld-oriented action. Lifeworld-oriented action is about social workers making connections with the experiences from people’s everyday lifeworld. The focus is not so much on institutionalised resources, but rather on the practices that people themselves develop to cope with daily experiences of injustice and with violations of human rights.

Actually, being in the field, close to the people, makes you better able to understand the underlying causes … you can more easily contextualise situations. People don’t always say what they want to say or what they think. If you know the context, you can understand that people formulate things in a certain way but mean it differently. (a social worker, institution for community development)

People living in vulnerable life conditions often find that their living environments are insufficiently understood by social workers as well as others. At the same time, they experience difficulties in explaining their own situation to social work organisations.

A lifeworld orientation also requires that social workers facilitate the opportunities to connect different lifeworlds. Connecting lifeworlds can contribute to sharing diverse experiences and to creating connectedness.

One time there was a ‘week of empathisation’. This is good for involving citizens so they can also experience it that way. They cannot imagine what it is like.  … It is good to involve them, so they get a very different view of our problems, because those people don’t normally have to deal with these problems. They should do this a lot more, through a campaign set up by the working group on housing, so these people are motivated to join our conversations and to experience what is going on. (a service-user)

Social workers also point out several risks that might be associated with a lifeworld approach. Specifically, they warn against a narrowing view on social problems where not only are social problems observed in the lifeworlds of people, but also solutions for these social problems are sought within the same lifeworlds. However, problems that manifest in the lifeworlds of people often originate from external causes, such as the labour market, the housing market or the school system. Therefore, social workers should always try to link issues raised in the lifeworld with the way social systems are organised.

That double movement has to be part of our work. That is why we say that you should not see our work merely as directed downwards. You have to work from the bottom up, but that movement must also go upwards.  … You have to link the work with a broader movement of social organisations. They help to raise the issues of social inequality, and they can move society in the direction of redistribution.  … It is even more necessary to set up broader alliances, so that all those little things that happen can become part of a broader context and become part of a wider environment. (a social worker, institution for community development)

The final crucial aspect of social work with lifeworld-oriented action is social duty in public deliberation.

The articulation of different needs of different groups is the core of democracy; that is a social issue. Which needs do we as a society recognise, and which not? Which needs can be defined as rights, how are they recognised, and can we organise ourselves accordingly? These are public debates. These are collective discussions, because not having your needs recognised, and, consequently, not being seen or heard in society, is usually a collective and structural problem. (a lecturer on social work)

Participatory action

Participation is a loose concept, but nevertheless a key notion when talking about an action framework for human rights in social work. After all, shaping human rights requires dialogue between social workers and citizens about how to construct human rights and for what purpose. Social workers point to two complementary features of participation. First, participatory action entails involvement, connection and reciprocity between social workers and citizens. Here, social workers focus on the ‘relational’ characteristic of the practice of participation.

Participative work cannot be one-sided. You cannot expect your client to participate in everything that comes out of your sleeve. I think the art is to participate with them, and to play it by ear: ‘What is going on here?’ If you as a social worker participate with them , you are going to exclude far fewer people than you would if you expect them to come and participate with you. (a social worker, institution for community development)

Social workers also recognise that participation is not simply a relational issue, but that it entails a ‘structural’ approach as well.

If I say that we have to be more individual, this doesn’t mean that we have to find an individual solution. What I mean is that we have to approach people individually and then hear from there what problems those people or those groups are experiencing. It is also important that policy acknowledges the stories of those people. (a social worker, institution for community development)

Participatory action comes with many pitfalls. One is the social exclusion caused by participatory practices. For social work, it is important to be aware of these processes of exclusion and to identify possible barriers and difficulties. In general, social workers indicate that ‘stronger’ people are the ones who participate in available activities, as these practices require a certain assertiveness or particular social or cultural skills.

Participation usually starts from a certain framework and not everyone fits into that framework. It also requires certain skills from clients—skills they don’t always have. So participatory practices exclude people, but at the same time, this makes us aware that we need to find a different way to involve those excluded. (social worker, institution for community development)

Another pitfall has to do with participation in social policy. One of the working methods of the institution for community development is to coach people who live in vulnerable life conditions to speak with policymakers. This involves a risk of instrumentalisation, not only by policymakers, but also by social workers, as these people adapt themselves to the preferences of social workers.

In everything we do, of course, it is important that we let people make their own choices. But to what extent we, as community workers, steer those choices … I’m not sure.  … We wouldn’t say it like that, but we do come up with the solutions.  … We start a project and then we involve people in it. (a social worker, institution for community development)

Joined-up action

Social work exists in many fields of practice. This can lead to physical or metaphorical borders between these fields. The over-organised professional field of social work often results in fragmentation or compartmentalisation. Social work from a human rights perspective should question these borders and even try to break through them. This is what is meant by joined-up action. Joined-up action aims to counteract structures and logic that withhold the realisation of human rights in social work.

A trend in the social field is to divide everything into separate human rights or compartments. That is how social policy is organised. A human-rights-based perspective implies an integrated or joined-up approach. This requires breaking through this administrative compartmentalisation of human rights. (a social worker, institution for community development)

Besides the limitations caused by the organisation of social work in different fields, social work is often restricted by the proliferation of rules, procedures, protocols, etc. From a human rights perspective, this requires social workers to push boundaries.

It is about pushing and crossing boundaries, looking outside the range of tasks, thinking outside the box. Laws are not violated, but rules are; these are agreements, and they can be interpreted more broadly or reinterpreted … . (a social worker, community health centre)

Social workers call for questioning rules and procedures. Joined-up action here means that social workers should use their professional discretion in order to be guided by their ethical duty instead of following fixed rules and arrangements.

Having sufficient professional discretion is very important, especially if you work with the most vulnerable groups. You need to take the side of these people instead of working with a double agenda. In any case, they will feel this immediately. But secondly, the more professional discretion social workers use in a system, the more they can defend the rights of vulnerable groups in society.  … It is important that they make full use of their professional discretion in order to develop a social reflex as much as possible. (a social worker, institution for community development)

Politicising action

Politicisation concerns questioning and contesting power. Power is mostly conceived of as something that belongs to societal structures, like politics or the judiciary system. Exercising power may result in injustice and in inhuman living conditions. The role of social work is thought to be to collectivise individual experiences of human rights violations and to bring these to the public debate. Politicised social work should use political advocacy to denounce structures and systems of power that cause violations of human rights.

You can try to help the person on an individual level to realise his or her rights, but you will always come across structural issues. (a social worker, institution for community development)

Power is also something that is situated in speaking about particular social issues. These discourses of power have a significant impact on people. The role of social work is to question these dominant orders of society. A social worker from a poverty-related organisation working with young people explains:

Many of the young people who arrive at our organisation are caught up in the ‘it’s your own fault’ discourse … . These young people are caught in a system and therefore they often blame themselves: ‘I think it’s me’ … . For example, education is an often recurring subject: 90% have attended special education. How is that possible? Is it only because of the context of poverty that they are being referred to this type of education, largely determining their future? In our organisation, they learn that this is happening not only to them, but this is something systemic. We explain that it is caused by our educational system failing to give everyone equal opportunities. By doing this, we are ‘de-blaming’ them: there is an individual responsibility, but there is also a social responsibility. For them, this is a process of awareness-raising about how society works and about who decides what. In the beginning, this often alienates these young people, these issues of politics, policy, human rights. (a social worker, poverty organisation).

However, because of the often extensive subsidisation of social work organisations by the government, the politicising role of social work is frequently at odds with the autonomy and independence of the organisation.

You are actually in a sort of a split, which keeps you from going fully for human rights. We cannot just be a protest movement. We can never go full 100 per cent. We can do that, but only with the blessing of a minister. (a social worker, institution for community development)

Therefore, social workers should be aware of depoliticising tendencies that increasingly emphasise the controlling side of social work over its emancipatory character.

The pressure is increasing for social workers to exercise control. I think it is important that social workers be very conscious of this: what is my task? … You see that organisations that are not complying are experiencing consequences. … We owe it to ourselves to say why we stand for. If we don’t do that, we do not take our clients seriously. We must unite as social workers to make it clear to policymakers: this is social work and this is not social work. … We must be able to define our role as social workers: what do we serve? We cannot be used for everything. (a social worker, organisation supporting people with a migration background)

Social workers indicate that they should be much more concerned with their self-critical role. Their own actions as social workers should also be scrutinised in some form of ‘self-politicisation’.

Our qualitative research on how social work acts when aiming to realise human rights reveals five building blocks. They flesh out what it can mean for social work to be a human rights profession. It is important to consider these five building blocks in connection to one another as an action framework for human rights in social work. The key point of this framework is the recognition that human rights in social work are collectively constructed and that social workers play a crucial role in this construction process. To state that human rights are collectively constructed is to acknowledge the discursive, contested and complex nature of human rights in social work ( Cemlyn, 2008 ; Ife, 2012 ). There is no single way to construct human rights. On the contrary, trying to realise human rights is a process characterised by a plurality of potential constructions, based on the plurality of interests of the communities and community members involved. Part of our data also show opposing constructions of human rights ‘within’ building blocks. The discussion on systemworld-oriented action, for instance, demonstrates that some social workers are in favour of selective social services, while others defend universal ones. The same goes for participatory action: being recognised as an agent and being acknowledged as a partner in dialogue can conflict with instrumentalising tendencies. It is remarkable that the conflicting perspectives each underpin their opposite positions from the same framework of human rights. Another part of our data show opposing views on human rights ‘between’ building blocks. This is probably most obvious in the building blocks of lifeworld-oriented action and systemworld-oriented action, which can be considered opposites. The approach of starting from the needs experienced by communities seems to be difficult to reconcile with the bureaucratic procedures of institutions within a system, although both rely on human rights.

Our action framework has an ambiguous relationship with previous action models. It resonates only partially with Androff’s five-principles framework ( Androff, 2016 ), particularly regarding the principle of participation. The principle of accountability in Androff’s model is closely linked to the building block of politicised action. For the other principles, the two frameworks can be considered complementary. The same goes for McPhersons’s HRPSW framework (2015; see also McPherson and Abell, 2020 ). Some of the human rights methods in her model share similarities with our action framework: participation is a shared concern; accountability and activism correspond to politicised action; community and interdisciplinary collaboration are related to lifeworld-oriented action and micro/macro integration and capacity building resonate with systemworld-oriented action. On the other hand, the human rights lens and human rights goals are absent from our action framework. As for earlier research in the Flemish context, our action framework agrees with some aspects of it but not others. Vandekinderen et al. (2020) conducted a research project to explore the common ground of social work in Flanders. They identified five building blocks that are considered the DNA of social work in Flanders. Of these, politicising work is the only building block that both frameworks have in common. It is no surprise that this building block also shows up in our results, as politicising work is a main concern in the work of community development organisations in Flanders.

The observed divergences between our own action framework and the practice approaches of Androff and McPherson can be explained in different ways. In part, this is probably due to the different research contexts in which the projects took place. In our project, collaboration was set up with organisations in the field of community development. Although we included focus group discussions to see whether our findings were transferable, additional research in other social work domains could reveal different emphases or even different building blocks. Furthermore, comparative studies between countries could provide more insight into the international transferability of our action framework. As explained in the ‘Introduction’ section, the nature of social work is closely linked to the welfare regime of a country, which in turn ‘set the scene’ for understanding human rights. How different welfare regimes affect the translation of human rights in social work practice remains a blind spot in social work scholarship. However, this is of particular relevance as welfare regimes all over the world are facing far-reaching transformation that have a significant impact on how human rights in social work are understood. Further research might reveal the link between the nature of different welfare regimes and the way social workers use human rights in their practice. Finally, although we included the voices of service-users in our research project, they often remain left out of rights-based practice literature. Further research on human rights in social work should pay much more attention to the perspective of service-users and to the way that a human rights framework affects their situations and life conditions. These issues require an empirical shift in order to fully understand social work as a human rights profession. Understanding these issues could lend more nuance to the discussions on the relationship between social work and human rights, and would move this debate beyond empty slogans and catchphrases.

Alseth A. K. ( 2020 ) ‘ Human rights as an opportunity and challenge for social work in a changing Norwegian welfare state’, European Journal of Social Work , 23 ( 6 ), pp. 920 – 13 .

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Development of healthcare and social care services for the elderly population

Affiliations.

• 1 Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
• 2 Moscow University for Industry and Finance «Synergy», Moscow, Russian Federation.
• PMID: 36197003
• DOI: 10.2217/cer-2022-0133

Background & aim: The percentage of older people has been growing in all economically developed countries over the past several decades. The purpose of this research was to optimize the healthcare and social care model based on the in-depth study of social, hygienic and clinical characteristics of elderly individuals. Materials & methods: The authors' study included individuals aged 65 years and older. Results: The proportion of elderly and senile individuals increased from 15.3% in 2011 to 18.6% in 2020. The authors found that the existing healthcare system does not meet the needs of the aging population and thus developed a new organizational model for healthcare and social care services designed to integrate the activities of social welfare centers and local polyclinics. Conclusion: Implementation of the authors' model enables a range of healthcare and social care services and allows for management of a patient's health based on individual characteristics.

Keywords: elderly; geriatrics; gerontology; healthcare; senile individuals; social care.

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• Improving Access to Vision Care for…

Improving Access to Vision Care for Youth in Foster Care: We Can’t Lose Sight of This Fundamental Back-to-School Need

Date posted:.

Ads for children’s back-to-school supplies are everywhere this time of year. While the notebooks and backpacks featured in these ads are important, they’re missing a critical need for some students: glasses.

Vision is tied to multiple aspects of well-being including physical, emotional, developmental, and social. Uncorrected vision problems among children can impair learning, participation in extra-curricular activities and social development.

Accessing glasses can be particularly challenging for youth in foster care. Undetected and undertreated health problems are common among children entering foster care, and they can experience unique health care access barriers during placement. Seeing the barriers children in foster care face firsthand as a clinician in Children’s Hospital of Philadelphia (CHOP)’s Fostering Health Program led our team to launch a new project aimed at ensuring our patients have access to the vision care they need.  

Youth in Foster Care Face Unique Challenges to Accessing Vision Care

While caring for youth in the Fostering Health Program, we noticed that many children with abnormal vision screens did not have access to glasses. In research to further understand this issue, we reviewed the charts of 190 children seen at our clinic over a one-year period. Out of 55 patients with a documented history of needing glasses, only 12 (22%) had access to them. We performed eye chart vision screens for 120 patients and 71 (59%) were abnormal. Almost all youth with abnormal vision screens (66/71, 93%) did not have access to glasses.

We also noted that children in foster care face unique challenges in accessing vision care. Fragmented health care and schooling resulted in missed opportunities for routine vision screens. Some children reported their glasses did not transition with them as they entered foster care or moved placements. And caregivers, especially non-relative foster parents, reported being unaware that children in their care needed glasses.

Further, children in foster care are at increased risk for health problems that can be compounded by uncorrected vision issues, including academic delays and behavioral manifestations of trauma experiences such as hypervigilance.

A Coordinated Approach to Supporting Vision Care Needs

Our team, composed of Fostering Health Program and PolicyLab professionals, is excited to launch a project funded by the Warby Parker Impact Foundation aimed at helping children in foster care access the vision care they need.

As part of this project, patients of CHOP’s Fostering Health Program with abnormal vision screens will receive case management to help coordinate optometry visits, support with associated costs such as transportation, optometry exams and glasses, as well as help using technology to facilitate ordering glasses.

Multiple systems are involved in delivering care to children in foster care including health care, payors, courts and child welfare agencies. In tandem with implementation of additional care supports within the Fostering Health Program, we will take a multi-stakeholder approach to understand system-level barriers and opportunities for improving vision care and continuity of vision care for youth in foster care. This will inform the development of targeted educational materials and policy recommendations.

Additionally, we will evaluate the impacts of the clinical intervention on access to glasses and multiple domains of well-being. We are putting youth and caregivers at the center of this work, inviting intervention participants to share their experiences and insights in interviews. This information will be paired with assessment of outcomes such as time to receipt of glasses after abnormal vision screens.

It is always inspiring to hear the goals of children served by the Fostering Health Program. Many youth report long-term goals focused on careers that will allow them to help other children involved with foster care. In the short term, many would like to re-engage in their favorite activities such as sports and writing and connect with their siblings.

Helping youth in foster care access the glasses they need to learn, participate in the activities they love, interact with others, and recover from trauma experiences is an essential first step towards supporting these goals.

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