Complexity Theory for Social Work Practice 3031386760, 9783031386763

Table of contents :
Preface
Acknowledgements
Contents
List of Figures
List of Tables
About the Authors and Contributor
Authors
Contributor
Part I: Complex Practice in a Complex World
Chapter 1: Introduction: Social Work in a Changing World
1.1 Introduction and Learning Opportunities
1.1.1 Brief History of Social Work’s Emergence and Adaptation
1.1.1.1 Origins
1.1.1.2 The Information Age and Globalisation
1.1.1.3 Twenty-First Century: COVID-19
1.1.2 Social Work
1.1.2.1 Person-in-Environment
1.1.2.2 Theories and Models
1.1.2.3 Tensions and Challenges
1.1.3 Social Work in the First Quarter of the Twenty-First Century
1.1.3.1 Complexity Theory, Complex Adaptive Systems and Pragmatism
1.1.4 Introduction to the Book
References
Chapter 2: The Strengths and Limitations of Social Work
2.1 Introduction and Learning Opportunities
2.2 Strengths of Social Work
2.2.1 Ethical Commitment
2.2.2 Value Base
2.2.3 Valuing Reflective Practice
2.2.4 Relationship Focus of Practice
2.2.5 Foundational Location Within Social, Geographic and Cultural Contexts
2.2.6 Person-in-Environment: Micro, Meso, Macro
2.2.7 ‘Borrowing’ of Theory, Models and Concepts
2.2.8 Commitment to Collaboration
2.2.9 Pragmatic Approach to Taking Action
2.2.10 Challenges for Social Work: Uncertainty, Risk and ‘Not Knowing’
2.2.11 Wicked Problems, Risk and Uncertainty
2.3 Moving Ahead: Complexity Theory
2.4 Conclusion
References
Chapter 3: Becoming a Complexity Thinker: Towards an Epistemology of Social Work Practice
3.1 Introduction and Learning Opportunities
3.2 Starting Out
3.3 What Do We Know?
3.3.1 Complexity Theory and Complex Adaptive Systems
3.3.2 Micro, Meso, Macro
3.3.2.1 The ‘Micro’ Level
3.3.2.2 The Macro ‘Level’
3.3.2.3 The Meso ‘Level’
3.3.3 What Is Complexity Theory?
3.3.4 Complex Adaptive Systems
3.3.4.1 Emergence
3.4 Where CT Takes Social Work
3.4.1 How Do We Know?
3.4.2 Pragmatism
3.4.3 Organising What We Know
3.5 Conclusion
References
Chapter 4: Thinking Complexity and Acting Pragmatically
4.1 Introduction and Learning Opportunities
4.2 Constructing the Narrative
4.3 Starting Where the Client Is
4.3.1 Nested CAS
4.4 The Centrality of the Narrative
4.5 From Narrative to Strategy
4.6 Thinking Complexity in Action
4.6.1 A Guide to Thinking Complexity and Acting Pragmatically
References
Part II: Thinking Complexity in Practice
Chapter 5: Early Doing and Thinking Complexity: The Multiple and Complex Needs Initiative
5.1 Introduction and Learning Opportunities
5.2 The Context of Legislating for MACNI
5.3 Development of the Multiple and Complex Needs Initiative
5.4 Program Emergence: Development and Implementation/Evolution
5.5 Operation of MACNI
5.5.1 Assessment, Formulation and Care Planning
5.6 Coordinating Complexity Thinking Across Systems: Integration and Conceptual Development
5.6.1 Emergence of a Stance of Enquiry as Care Plans Are Implemented
5.6.2 Thinking Complexity as Research
5.7 Lessons Learned Through Thinking Complexity for Five Years
5.7.1 Assessment and Care Planning
5.7.1.1 Reflecting on the Individual/Person Aspects of MACNI Assessments
5.7.1.2 Reflecting on the Complex Service System Aspects of MACNI Assessments
5.8 Care Plan Coordination
5.9 Review, Feedback and Termination
5.9.1 Review Sessions of the Panel
5.9.2 Feedback and Reflection
5.9.3 Endings: MACNI Terminations
5.10 Conclusions
References
Chapter 6: Thinking Complexity Across Fields of Practice: Children and Older People
6.1 Introduction and Learning Opportunities
6.2 Context
6.3 Thinking Complexity in Work with Individuals
6.4 Challenges of Thinking Complexity
6.4.1 Ethical Dilemmas
6.4.2 Challenging the Primacy of Self-Determination
6.4.3 Understanding the Nature of Risk
6.4.4 Casework Challenges
6.4.5 Working with Uncertainty
6.5 Conclusion
References
Chapter 7: Thinking Complexity in Management
7.1 Introduction and Learning Opportunities
7.2 Context
7.3 Management
7.4 Thinking Complexity
7.4.1 How I Started Thinking Complexity
7.4.2 How You Can Think Complexity in Management
7.5 Management in a Community Services Setting
7.5.1 Introduction
7.5.2 Example 1: Privacy Breach and Complaint
7.5.3 Example 2: Strategic Planning
7.5.4 Example 3: Pandemic
7.5.5 How Does Thinking Complexity Help Us Understand and Act?
7.6 What Do We Know About Thinking Complexity in Management?
7.7 Conclusion
References
Chapter 8: Thinking Complexity in Community Development
8.1 Introduction and Learning Opportunities
8.2 Context
8.3 Community Development
8.4 How You Can Think Complexity in Community Development
8.5 Community Development: Wollert
8.5.1 Introduction
8.5.2 The People and the Place
8.6 How Does Thinking Complexity Help Us Understand the Context and Initial Conditions?
8.6.1 Context
8.6.2 Initial Conditions
8.6.3 Expectations Versus Reality
8.7 How Does Thinking Complexity Help Us Prioritise and Take Action?
8.7.1 Getting Started
8.7.2 The Community Development Worker(s)
8.7.3 Adaptation (Impact of Time)
8.8 How Does Thinking Complexity Help Us Improve Community Outcomes?
8.9 What Do We Know About Thinking Complexity in Community Development?
8.10 Conclusion
References
Chapter 9: Thinking Complexity in Hospital Social Work Practice
9.1 Introduction and Learning Opportunities
9.2 The Australian Hospital System
9.3 Thinking Complexity in the Emergency Department
9.4 Thinking Complexity and Acting Pragmatically in the ED: Case Examples
9.5 Jessica
9.5.1 Thinking Complexity
9.5.2 Acting Pragmatically
9.6 Taylor
9.6.1 Thinking Complexity
9.6.2 Acting Pragmatically
9.7 Sam and Anh
9.7.1 Thinking Complexity
9.7.2 Acting Pragmatically
9.8 Conclusion
References
Part III: Thinking Complexity in Public Policy, Research and Education
Chapter 10: Thinking Complexity in Public Policy
10.1 Introduction and Learning Opportunities
10.2 Defining Public Policy
10.2.1 Policy Narratives
10.2.2 Factors Driving Policy
10.3 Complexity Theory and Policy
10.4 Social Workers and Policy
10.5 What to Do? Thinking Complexity and Acting Pragmatically
10.5.1 COVID-19 Pandemic
10.5.2 COVID-19 and the Response of Front-Line Social Workers
10.5.3 Impacts
10.6 Conclusions
References
Chapter 11: Thinking Complexity in Research
11.1 Introduction and Learning Opportunities
11.2 Beginning the Research Journey
11.3 First Steps in Research
11.3.1 Theoretical Position
11.4 Epistemology and Ontology
11.4.1 Research Design
11.4.2 Case Comparison
11.5 Methods
11.5.1 Sampling
11.5.2 Multiple Methods
11.5.3 At the Micro Level
11.5.4 At the Meso Level
11.5.5 At the Macro Level
11.5.6 Ethics
11.5.7 Data Analysis
11.5.8 Bringing It All Together
11.6 Complexity Thinking in Social Work Research
11.6.1 Key Points for Thinking Complexity in Research
References
Chapter 12: Thinking Complexity in Social Work Education and Professional Practice
12.1 Introduction and Learning Opportunities
12.2 CT and CAS in Educational Settings
12.2.1 Pragmatism
12.3 Curriculum Development
12.3.1 Thinking Complexity
12.3.2 Acting Pragmatically
12.4 Thinking Complexity and Acting Pragmatically in Supervision
12.5 Conclusion
References
Chapter 13: Next Steps: What Do We Know About Thinking Complexity and Acting Pragmatically in Social Work?
13.1 Introduction and Learning Opportunities
13.2 Key Points
13.3 Common Themes
13.4 Ways Forward
13.5 Conclusion
Bibliography
Index

Citation preview

Fiona McDermott Kerry Brydon Alex Haynes Felicity Moon

Complexity Theory for Social Work Practice

Complexity Theory for Social Work Practice

Fiona McDermott • Kerry Brydon •  Alex Haynes • Felicity Moon

Complexity Theory for Social Work Practice

With contributions by Margaret Hamilton

Fiona McDermott Department of Social Work, Faculty of Medicine, Nursing & Health Sciences, School of Primary & Allied Health Care Monash University Caulfield East, VIC, Australia Alex Haynes Whittlesea Community Connections Inc. Epping, VIC, Australia

Kerry Brydon Social Work Practitioner Melbourne, VIC, Australia Felicity Moon Emergency Department Royal Melbourne Hospital Parkville, VIC, Australia

ISBN 978-3-031-38676-3    ISBN 978-3-031-38677-0 (eBook) https://doi.org/10.1007/978-3-031-38677-0 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover image: Trafalgar Square, London, circa 1991. Photograph by © Anthony McKee (www. anthonymckee.com). This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Paper in this product is recyclable.

In Memoriam

Kerry Brydon. (Courtesy of the Brydon Family)

On completing this book, we received some very sad and unexpected news that our co-author, colleague and friend Dr. Kerry Brydon had died. Kerry played a key role in the conceptualisation and writing of this book, bringing to it her considerable experience as a front-line social worker in both the child protection and ageing fields. Her contribution has been essential. In fact, without her determination, hard work and commitment, we would not have arrived at

its completion. Kerry brought to the author group her insights and intellectual knowledge, but equally importantly, her friendship, good humour and generosity of spirit was a constant over the 18 months we worked together. We are extremely sad that Kerry will not be here to hold the book in her hands. She was very excited and thrilled at the prospect of its publication. For us, her co-authors, this book is a tribute to a talented, down-to-earth, committed social work practitioner who was never afraid of new ideas and challenges: vale Kerry.

Preface

In this book, we introduce social workers to Complexity Theory (CT) and the characteristics of Complex Adaptive Systems (CAS). Complexity Theory provides explanatory theory and a meta view about the nature of social reality, which, we argue, builds on and expands earlier concepts of person-in-environment and the biopsychosocial model upon which much of social work theory and practice has been built. Importantly, in order to demonstrate how CT can usefully provide insights and strategies for practice, we propose that Pragmatism with its emphasis on the need for practical action, in order to address the complicated problems social workers encounter, be adopted alongside a complexity theory-informed approach. Thus, throughout this book, we encourage social workers to ‘think complexity’ and ‘act pragmatically’. Three of the authors are practitioners who, by providing examples of how they ‘think complexity’ and ‘act pragmatically’, bring to life this way of understanding and doing social work. Other chapters provide accounts of complexity thinking and pragmatic action in the development of a program for people with multiple and complex needs, in doing research, in policy and in social work education and workplace supervision. We believe that this book will provide an easily accessible account of CT and Pragmatism in practice, policy, research and educational settings, advancing social work theorising so that practitioners are better able to meet the ever-increasing demands and fast-paced changes synonymous with twenty-first-century challenges. Caulfield East, VIC, Australia Melbourne, VIC, Australia Epping, VIC, Australia Parkville, VIC, Australia

Fiona McDermott Kerry Brydon Alex Haynes Felicity Moon

vii

Acknowledgements

We wish to acknowledge the invaluable contribution of Associate Professor Catherine Flynn in reading and commenting on earlier drafts of this book. We are very appreciative of her generosity in so doing, whilst being mindful that the authors collectively remain responsible for the contents of the book.

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Contents

Part I Complex Practice in a Complex World 1

 Introduction: Social Work in a Changing World����������������������������������    3 1.1 Introduction and Learning Opportunities������������������������������������������    3 1.1.1 Brief History of Social Work’s Emergence and Adaptation����������������������������������������������������������������������    4 1.1.2 Social Work��������������������������������������������������������������������������    6 1.1.3 Social Work in the First Quarter of the Twenty-First Century����������������������������������������������������������������������������������   10 1.1.4 Introduction to the Book ������������������������������������������������������   12 References��������������������������������������������������������������������������������������������������   16

2

 The Strengths and Limitations of Social Work ������������������������������������   19 2.1 Introduction and Learning Opportunities������������������������������������������   19 2.2 Strengths of Social Work������������������������������������������������������������������   20 2.2.1 Ethical Commitment ������������������������������������������������������������   20 2.2.2 Value Base����������������������������������������������������������������������������   20 2.2.3 Valuing Reflective Practice ��������������������������������������������������   21 2.2.4 Relationship Focus of Practice����������������������������������������������   21 2.2.5 Foundational Location Within Social, Geographic and Cultural Contexts ����������������������������������������������������������   22 2.2.6 Person-in-Environment: Micro, Meso, Macro����������������������   23 2.2.7 ‘Borrowing’ of Theory, Models and Concepts ��������������������   24 2.2.8 Commitment to Collaboration����������������������������������������������   25 2.2.9 Pragmatic Approach to Taking Action����������������������������������   25 2.2.10 Challenges for Social Work: Uncertainty, Risk and ‘Not Knowing’ ��������������������������������������������������������������   26 2.2.11 Wicked Problems, Risk and Uncertainty������������������������������   27 2.3 Moving Ahead: Complexity Theory ������������������������������������������������   30 2.4 Conclusion����������������������������������������������������������������������������������������   31 References��������������������������������������������������������������������������������������������������   32

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Becoming a Complexity Thinker: Towards an Epistemology of Social Work Practice ��������������������������������������������������������������������������   35 3.1 Introduction and Learning Opportunities������������������������������������������   35 3.2 Starting Out��������������������������������������������������������������������������������������   35 3.3 What Do We Know? ������������������������������������������������������������������������   37 3.3.1 Complexity Theory and Complex Adaptive Systems ����������   37 3.3.2 Micro, Meso, Macro ������������������������������������������������������������   38 3.3.3 What Is Complexity Theory?������������������������������������������������   42 3.3.4 Complex Adaptive Systems��������������������������������������������������   43 3.4 Where CT Takes Social Work ����������������������������������������������������������   44 3.4.1 How Do We Know?��������������������������������������������������������������   45 3.4.2 Pragmatism ��������������������������������������������������������������������������   46 3.4.3 Organising What We Know��������������������������������������������������   47 3.5 Conclusion����������������������������������������������������������������������������������������   48 References��������������������������������������������������������������������������������������������������   48

4

 Thinking Complexity and Acting Pragmatically����������������������������������   51 4.1 Introduction and Learning Opportunities������������������������������������������   51 4.2 Constructing the Narrative����������������������������������������������������������������   52 4.3 Starting Where the Client Is��������������������������������������������������������������   54 4.3.1 Nested CAS��������������������������������������������������������������������������   55 4.4 The Centrality of the Narrative ��������������������������������������������������������   58 4.5 From Narrative to Strategy����������������������������������������������������������������   60 4.6 Thinking Complexity in Action��������������������������������������������������������   61 4.6.1 A Guide to Thinking Complexity and Acting Pragmatically������������������������������������������������������������������������   62 References��������������������������������������������������������������������������������������������������   62

Part II Thinking Complexity in Practice 5

Early Doing and Thinking Complexity: The Multiple and Complex Needs Initiative ����������������������������������������������������������������   67 Margaret Hamilton 5.1 Introduction and Learning Opportunities������������������������������������������   67 5.2 The Context of Legislating for MACNI��������������������������������������������   68 5.3 Development of the Multiple and Complex Needs Initiative ����������   69 5.4 Program Emergence: Development and Implementation/Evolution����������������������������������������������������������������   70 5.5 Operation of MACNI������������������������������������������������������������������������   72 5.5.1 Assessment, Formulation and Care Planning ����������������������   72 5.6 Coordinating Complexity Thinking Across Systems: Integration and Conceptual Development����������������������������������������   74 5.6.1 Emergence of a Stance of Enquiry as Care Plans Are Implemented������������������������������������������������������������������   74 5.6.2 Thinking Complexity as Research����������������������������������������   75

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5.7 Lessons Learned Through Thinking Complexity for Five Years������   77 5.7.1 Assessment and Care Planning ��������������������������������������������   78 5.8 Care Plan Coordination��������������������������������������������������������������������   82 5.9 Review, Feedback and Termination��������������������������������������������������   84 5.9.1 Review Sessions of the Panel������������������������������������������������   84 5.9.2 Feedback and Reflection ������������������������������������������������������   85 5.9.3 Endings: MACNI Terminations��������������������������������������������   86 5.10 Conclusions��������������������������������������������������������������������������������������   86 References��������������������������������������������������������������������������������������������������   87 6

Thinking Complexity Across Fields of Practice: Children and Older People��������������������������������������������������������������������������������������   89 6.1 Introduction and Learning Opportunities������������������������������������������   89 6.2 Context����������������������������������������������������������������������������������������������   90 6.3 Thinking Complexity in Work with Individuals ������������������������������   92 6.4 Challenges of Thinking Complexity ������������������������������������������������   93 6.4.1 Ethical Dilemmas������������������������������������������������������������������   93 6.4.2 Challenging the Primacy of Self-Determination������������������   96 6.4.3 Understanding the Nature of Risk����������������������������������������   97 6.4.4 Casework Challenges������������������������������������������������������������  100 6.4.5 Working with Uncertainty����������������������������������������������������  102 6.5 Conclusion����������������������������������������������������������������������������������������  104 References��������������������������������������������������������������������������������������������������  105

7

 Thinking Complexity in Management ��������������������������������������������������  107 7.1 Introduction and Learning Opportunities������������������������������������������  107 7.2 Context����������������������������������������������������������������������������������������������  108 7.3 Management��������������������������������������������������������������������������������������  109 7.4 Thinking Complexity������������������������������������������������������������������������  109 7.4.1 How I Started Thinking Complexity������������������������������������  109 7.4.2 How You Can Think Complexity in Management����������������  111 7.5 Management in a Community Services Setting��������������������������������  112 7.5.1 Introduction��������������������������������������������������������������������������  112 7.5.2 Example 1: Privacy Breach and Complaint��������������������������  113 7.5.3 Example 2: Strategic Planning����������������������������������������������  115 7.5.4 Example 3: Pandemic ����������������������������������������������������������  117 7.5.5 How Does Thinking Complexity Help Us Understand and Act?��������������������������������������������������������������������������������  119 7.6 What Do We Know About Thinking Complexity in Management?��������������������������������������������������������������������������������  120 7.7 Conclusion����������������������������������������������������������������������������������������  120 References��������������������������������������������������������������������������������������������������  121

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 Thinking Complexity in Community Development������������������������������  123 8.1 Introduction and Learning Opportunities������������������������������������������  123 8.2 Context����������������������������������������������������������������������������������������������  124 8.3 Community Development ����������������������������������������������������������������  124 8.4 How You Can Think Complexity in Community Development ������  125 8.5 Community Development: Wollert ��������������������������������������������������  126 8.5.1 Introduction��������������������������������������������������������������������������  126 8.5.2 The People and the Place������������������������������������������������������  127 8.6 How Does Thinking Complexity Help Us Understand the Context and Initial Conditions?��������������������������������������������������  128 8.6.1 Context����������������������������������������������������������������������������������  128 8.6.2 Initial Conditions������������������������������������������������������������������  129 8.6.3 Expectations Versus Reality��������������������������������������������������  130 8.7 How Does Thinking Complexity Help Us Prioritise and Take Action?������������������������������������������������������������������������������  131 8.7.1 Getting Started����������������������������������������������������������������������  131 8.7.2 The Community Development Worker(s)����������������������������  132 8.7.3 Adaptation (Impact of Time)������������������������������������������������  133 8.8 How Does Thinking Complexity Help Us Improve Community Outcomes?����������������������������������������������������������������������������������������  133 8.9 What Do We Know About Thinking Complexity in Community Development? ����������������������������������������������������������������������������������  135 8.10 Conclusion����������������������������������������������������������������������������������������  135 References��������������������������������������������������������������������������������������������������  136

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 Thinking Complexity in Hospital Social Work Practice����������������������  137 9.1 Introduction and Learning Opportunities������������������������������������������  137 9.2 The Australian Hospital System��������������������������������������������������������  138 9.3 Thinking Complexity in the Emergency Department ����������������������  140 9.4 Thinking Complexity and Acting Pragmatically in the ED: Case Examples����������������������������������������������������������������������������������  140 9.5 Jessica ����������������������������������������������������������������������������������������������  141 9.5.1 Thinking Complexity������������������������������������������������������������  141 9.5.2 Acting Pragmatically������������������������������������������������������������  142 9.6 Taylor������������������������������������������������������������������������������������������������  144 9.6.1 Thinking Complexity������������������������������������������������������������  144 9.6.2 Acting Pragmatically������������������������������������������������������������  146 9.7 Sam and Anh ������������������������������������������������������������������������������������  147 9.7.1 Thinking Complexity������������������������������������������������������������  147 9.7.2 Acting Pragmatically������������������������������������������������������������  148 9.8 Conclusion����������������������������������������������������������������������������������������  149 References��������������������������������������������������������������������������������������������������  149

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Part III Thinking Complexity in Public Policy, Research and Education 10 Thinking  Complexity in Public Policy ��������������������������������������������������  153 10.1 Introduction and Learning Opportunities����������������������������������������  153 10.2 Defining Public Policy��������������������������������������������������������������������  154 10.2.1 Policy Narratives����������������������������������������������������������������  155 10.2.2 Factors Driving Policy��������������������������������������������������������  156 10.3 Complexity Theory and Policy ������������������������������������������������������  157 10.4 Social Workers and Policy��������������������������������������������������������������  158 10.5 What to Do? Thinking Complexity and Acting Pragmatically ������  160 10.5.1 COVID-19 Pandemic����������������������������������������������������������  160 10.5.2 COVID-19 and the Response of Front-Line Social Workers ������������������������������������������������������������������������������  161 10.5.3 Impacts��������������������������������������������������������������������������������  162 10.6 Conclusions������������������������������������������������������������������������������������  165 References��������������������������������������������������������������������������������������������������  166 11 Thinking  Complexity in Research����������������������������������������������������������  169 11.1 Introduction and Learning Opportunities����������������������������������������  169 11.2 Beginning the Research Journey����������������������������������������������������  169 11.3 First Steps in Research��������������������������������������������������������������������  170 11.3.1 Theoretical Position������������������������������������������������������������  170 11.4 Epistemology and Ontology ����������������������������������������������������������  171 11.4.1 Research Design�����������������������������������������������������������������  173 11.4.2 Case Comparison����������������������������������������������������������������  175 11.5 Methods������������������������������������������������������������������������������������������  175 11.5.1 Sampling ����������������������������������������������������������������������������  175 11.5.2 Multiple Methods����������������������������������������������������������������  176 11.5.3 At the Micro Level��������������������������������������������������������������  176 11.5.4 At the Meso Level��������������������������������������������������������������  177 11.5.5 At the Macro Level ������������������������������������������������������������  177 11.5.6 Ethics����������������������������������������������������������������������������������  177 11.5.7 Data Analysis����������������������������������������������������������������������  178 11.5.8 Bringing It All Together������������������������������������������������������  179 11.6 Complexity Thinking in Social Work Research������������������������������  180 11.6.1 Key Points for Thinking Complexity in Research��������������  181 References��������������������������������������������������������������������������������������������������  181 12 Thinking  Complexity in Social Work Education and Professional Practice������������������������������������������������������������������������������������������������������  185 12.1 Introduction and Learning Opportunities����������������������������������������  185 12.2 CT and CAS in Educational Settings����������������������������������������������  186 12.2.1 Pragmatism ������������������������������������������������������������������������  187 12.3 Curriculum Development����������������������������������������������������������������  188 12.3.1 Thinking Complexity����������������������������������������������������������  188 12.3.2 Acting Pragmatically����������������������������������������������������������  189

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12.4 Thinking Complexity and Acting Pragmatically in Supervision����  190 12.5 Conclusion��������������������������������������������������������������������������������������  192 References��������������������������������������������������������������������������������������������������  192 13 Next  Steps: What Do We Know About Thinking Complexity and Acting Pragmatically in Social Work?��������������������������������������������  193 13.1 Introduction and Learning Opportunities����������������������������������������  193 13.2 Key Points ��������������������������������������������������������������������������������������  193 13.3 Common Themes����������������������������������������������������������������������������  195 13.4 Ways Forward ��������������������������������������������������������������������������������  197 13.5 Conclusion��������������������������������������������������������������������������������������  197 Bibliography ����������������������������������������������������������������������������������������������������  199 Index������������������������������������������������������������������������������������������������������������������  209

List of Figures

Fig. 5.1 Ingredients for effective service and coordinated care plan partnerships ����������������������������������������������������������������������   82 Fig. 5.2 Care plan coordination: key ingredients ������������������������������������������   84 Fig. 6.1 The casework relationship����������������������������������������������������������������   98 Fig. 7.1 Strategic directions 2022+����������������������������������������������������������������  116 Fig. 10.1 The complexity of factors driving policy������������������������������������������  155

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List of Tables

Table 4.1 Table 4.2 Table 4.3 Table 4.4

Client’s stressors����������������������������������������������������������������������������   56 Client’s strengths����������������������������������������������������������������������������   57 Social worker stressors ������������������������������������������������������������������   57 Social worker strengths������������������������������������������������������������������   58

Table 11.1 Research stakeholders and data sources ����������������������������������������  173

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About the Authors and Contributor

Authors Fiona McDermott,  BA, Dip Soc Studs., M. Urban Planning, PhD (Melb) has taught across the curriculum in the social work departments at The University of Melbourne and Monash University, where she is adjunct Associate Professor. From 2009 to 2018, she held a joint appointment in the social work departments of Monash University and Monash Health, her role being to establish and develop practitioner research. She was Editor of the journal Australian Social Work from 2017 to 2022. Her publications are in the fields of research development, health and mental health and working with groups. Fiona has published several books, many book chapters and refereed articles. She has a particular interest in qualitative research approaches and practitioner research. Kerry Brydon,  B Comm, BSW (Melbourne), MSW (research) (Monash), PhD (Monash)  has always been a practitioner at heart. She commenced practice in statutory welfare where she remained for over two decades: as well as working as a stipendiary probation and parole officer she also worked with complex, multi-problem families in the then child welfare and later child protection fields. She had responsibilities at case work, supervisory, management and case planning levels. She then spent a decade in academia, at Monash University, teaching at both undergraduate and post graduate levels as well as co-ordinating the first Australian tertiary program to offer a qualification in an offshore setting. She also became a participant in the collaborative program with the University of Papua New Guinea striving to strengthen academic offerings from that university. More recently, she has worked in the aged care sector where, once again, complexity permeates both client presentations and day-to-day interventions at all levels of service delivery. Alex  Haynes,  PhD candidate (Monash); Grad Dip Business (RMIT); Grad Dip Environmental Studies (UA); BArch (UniSA)  has a strong record of achievement in a wide range of organisations in the for-purpose, education and xxi

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About the Authors and Contributor

commercial sectors and in successfully leading complex and difficult projects. She has a deep understanding of the importance of place-based approaches to addressing disadvantage that she brings to her current role as CEO of an integrated placebased community service in Melbourne, Australia. Alex has a longstanding commitment to effective community engagement in the development of services, policy and investment frameworks. She has expertise in research design and management in both the international development context and Australian urban and rural contexts and has worked in the areas of learning and education, community development, community services, gender, urban and community planning, environment, food security and climate variability. Felicity Moon,  BSW (Hons), Graduate Certificate in Loss, Grief and Trauma Counselling, PhD (Monash)  began her career in residential aged care as a personal care assistant while completing her undergraduate social work degree. Her honours thesis topic examined the potential role for social work in relation to residential aged care facilities in Adelaide. Following graduation, she worked as a social worker at the Royal Adelaide Hospital, Monash Medical Centre and the Alfred Hospital, predominantly in general medicine and the emergency departments. She is currently practising as a senior social worker at the Royal Melbourne Hospital in emergency. Felicity completed her PhD exploring end-of-life care for patients with dementia in hospital, and has completed additional research focussed on hospital end-of-life care and social work practice. She has been a unit coordinator and teaching associate at Monash University, teaching across the ageing, hospital, health and mental health electives in the Masters of Social Work program.

Contributor Margaret  Hamilton,  AO (Prof.)  With over 50  years’ work grounded in her background in social work/psychology and public health, Margaret has worked particularly in public health, including alcohol and drug policy development, direct practice and research as well as in homelessness, youth services and mental health domains. She has been an educator and mentor to others and has led various inquiries, advisory boards and committees as well as serving internationally on UN bodies as an expert and then representing Civil Society on a global task force more recently. In Victoria, Australia, after holding an academic position for some years, she was the Founding Director of Turning Point Alcohol and Drug Centre (10 years) and then Chair of the Victorian Multiple and Complex Needs Panel (5 years). She served on the Australian National Council on Drugs for over 12 years and on the Prime Minister’s Council on Homelessness for 3 years. She has also been President of the Cancer Council Victoria and remains a life member of many alcohol and drug linked organisations. She has recently (2023) been honoured with the naming of the Hamilton Centre in Victoria (a combined addiction and mental health treatment

About the Authors and Contributor

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centre). Professor Hamilton now holds an honorary position at the University of Melbourne, School of Population & Global Health and is ‘retired’ but ‘remains active’. She treasures her family – husband Bill, step-children, children and (almost) nine grandchildren, and she has nurtured the bush and a garden where she lives on the outskirts of Melbourne for over 40 years.

Part I

Complex Practice in a Complex World

Chapter 1

Introduction: Social Work in a Changing World

1.1 Introduction and Learning Opportunities It’s not difficult to understand why social workers find their chosen profession to be challenging. Its primary and dual focus is on understanding how social and material contexts shape human experience and on intervening in order to ameliorate situations where that intersection damages or limits people’s life chances and opportunities. What we mean by ‘context’, in social work terms, encompasses the biological, physical, geographic, climatic, economic and material elements within which humans live and which shape them and which they shape as they act in and on them. With its defining focus on person-in-context, social work situates itself (intentionally) in a location, which is forever changing. By the end of this chapter, readers will have: • Learned about the historical context in which social work took form in the late 1800s. • Considered the enormous changes during this period following the Enlightenment, including the industrial revolution, the introduction of philosophical positivism, the impact of these on science and knowledge development, the emergence of the Information Age prompting globalisation and the significant impact of the digital revolution and climate change. • Recognised the traces of these developments in social work’s current use of person-­in-environment and the biopsychosocial model to guide practice. • Noted some of the ongoing tensions and challenges facing social work. • Considered whether person-in-environment and the biopsychosocial model is adequate in supporting practice in an interlinked world that is forever changing, uncertain and unpredictable.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_1

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• Been introduced to complexity theory and pragmatism as offering a further evolution in social work thinking and practice that is better suited to the challenges in the contemporary world. • Been guided through the content of this book.

1.1.1 Brief History of Social Work’s Emergence and Adaptation How social work has defined and framed the context which shapes its engagement and practice reflects the historical changes that have unfolded and emerged since the profession was established and which motivated its establishment. As we shall discuss, the trajectory of social work as a profession demonstrates the ways in which it has adapted to, accommodated and sometimes struggled against those influences and developments it has been and is a part of. 1.1.1.1 Origins Social work is a relatively recent discipline. Its origins lie in the late nineteenth century in Europe and North America, a period considerable influenced by the philosophical thinking drawn from the Age of Enlightenment in the seventeenth and eighteenth centuries. The Enlightenment represented a major change in the ways in which people understood their place in the world: the emergence of science, its focus on identifying the relationship between cause and effect and the belief that, with research, innovation and intervention, scientific approaches could deliver mastery over natural, material, biological and social phenomena. The utilisation of scientific approaches to engineering enabled the developments that gave rise to the Industrial Revolution of the nineteenth century, particularly in the Western context, but later in other societies, whereby methods of mass production became possible. Road and railway construction facilitated both the movement of people from rural to urban settings in order to work the factories and the transportation of raw materials and goods to factories and markets. Inevitably, this revolution created problems not encountered before, chiefly related to the growth in numbers of rural and urban poor, erosion of traditional extended family structures, child labour and housing shortages. Those who did not own the means of production created wealth for those who did. Positivist philosophy emerged during the nineteenth century through the work of Compte, Durkheim and others, with the adoption of scientific methods for the study of society, the focus being on identifying the laws that underpinned society. Positivism sought to understand how society shaped human experience as well as

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considering the laws upon which people and society would operate in what appeared to be a new social order created by industrialisation (Howe, 1994). The development of the scientific model for research, with its roots in positivism, has been highly successful and continues to be so. The significant contribution of Enlightenment thinking about causes and effects, the quest to identify the laws that regulated behaviour and action can be seen in medicine and psychiatry in late nineteenth and most of the twentieth and twenty-first centuries. For example, the development of drugs, which were highly successful in enabling the deinstitutionalisation of people with mental illness, beginning in the 1950s, comprises an important outcome of these advances in scientific thinking and research (Meadows et al., 2021). However, in the social sciences, the shortcomings of the scientific approach can be seen in the appearance of general systems theory in the 1960s, which reflected an attempt to avoid the reductionism and mechanistic depictions arising from scientific views of the social world, proposing a more holistic and interactive account of the nature of societies. Further, the realisation that factors relating to human existence may not be able to be subjected to positivist methods of analysis saw the emergence of a paradigm shift championed by Kuhn (2012) in the 1960s motivating a number of different approaches to knowledge and the understanding of human experience – post positivism, social constructivism and post modernism. 1.1.1.2 The Information Age and Globalisation Industrialisation, the subsequent advances in engineering and technology presaged the next wave of world-changing events with the arrival of what has been termed the Information Age. To an extent, the growing ease of communication, the interlinking of people across countries and time zones, travel, trade, emergence of new markets and exchanges between countries were reliant for their impact and opening up of possibilities and innovations by the digital revolution. This is globalisation. However, as the twentieth century drew to a close, the rise of globalisation demanded a rethink of concepts as it gained ascendency as the dominant global paradigm. Globalisation has become a contested concept, challenged by a rise in nationalism at the same time as voices representing minority and identity groups, for example, populations earlier colonised, people of colour, indigenous peoples, ethnic minorities, gender diverse and disabled people began to exert their right to be recognised and to be heard. Closely linked to globalisation has been the acceleration of climate change, witnessed in the greater frequency and destructiveness of weather events, which despite many warnings of its likelihood has only recently begun to be tackled, albeit as the time available to do so appears to be running out. Already, the toll of inaction is being witnessed in high rates of human suffering from such events and an increase in climate refugees seeking safety as their homelands become unliveable.

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1  Introduction: Social Work in a Changing World

1.1.1.3 Twenty-First Century: COVID-19 The global pandemic in the first quarter of the twenty-first century compounded these trends in light of political, social and economic challenges. This, combined with war and conflict in Europe having global impact on energy and food supply chains, changing and as yet unresolved jockeying for influence amongst world powers, both current and emerging, finds us in the first quarter of the new century in what seems like a disordered and chaotic world. Conditions continue to evolve and change, and COVID-19 offers an excellent example of the emerging of a potentially catastrophic event, highlighting the need to find new ways of managing crises (Garrett, 2021). The pandemic’s ongoing trajectory has accentuated deeper fault lines in the global context, fault lines that challenge the world order that has largely been familiar, secure and predictable across the latter half of the twentieth century. Also, the pandemic represents a consequence of environmental, social and economic change whereby both environmental degradation and climate change have affected disease pathways (Duckett et al., 2020). Duckett et al. (2020, p.13) argue that such infectious diseases, especially of new variety, entail risks to individual health, risks to health systems and risks to the economy that need to be addressed by governments as being interrelated, not as trade-offs. The global pandemic has revealed itself to be more than a global health crisis. It has revealed deep chasms across and within societies. Long-held values concerning freedom of movement and freedom of association, for example, have been challenged, heightening the inadequacy of simplistic solutions to very complex situations, which need complex and sophisticated responses. At the same time, we have seen diminished faith in formerly valued institutions and worsening health of public life (McKenzie-Murray, 2022), as well as rising protests that highlight both distrust in science and government as growing numbers are motivated by fear of societal collapse, or a specific social or economic grievance or conspiracy (Dexter, 2022).

1.1.2 Social Work Social work, as we noted earlier, appeared in the late nineteenth century – a period similar to the current one in terms of recording a dramatic change in previously taken-for-granted understanding of the global, national and local status quo. In the late 1800s, the ‘fall out’ of the Industrial Revolution impacted on ordinary people, much as COVID-19 has in our own time. In the nineteenth century, there were concerns emerging about poverty, homelessness, work houses, undermining of extended family structures and child labour. The early ‘trail blazers’ sought an inclusive society and focused efforts on achieving social reform so that this was possible (Powell, 2001). Thus, the profession’s origins reflected the humanitarian movements of the nineteenth century, which were concerned with improving the desperate conditions of the poor, and achieving social reform through awakening the social conscience of

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the public (Friedlander, 1968). These origins imprinted social work’s continuing focus on the impact of environment and context on shaping human lives. This was especially true of the social work pioneers, in particular – Mary Richmond and Jane Addams in the United States. Addams’ work in establishing Hull House, a settlement house that brought together people in the neighbouring communities and offered educational, philanthropic and charitable services, was particularly influenced by pragmatism, a philosophical perspective that emphasises the need to focus and deal with problems and issues in straightforward, practical ways. Pragmatism is an important thread in this book, which we will return to, particularly in Chap. 3 and at various points throughout the book. Addams’ intention in the establishment of Hull House was that it demonstrates the ‘…reciprocal relationships between knowledge and experience, whereby ideas about reality are put to the test through practical action’ (Berringer, 2019 p.616). As Hothersall (2019, p.863) notes, Pragmatism ‘is well suited to supporting the core values of social work…experience-based, action-oriented framework whereby the purposes and practices of enquiry are simply (but not simplistically) seen as being ways of helping us to address the issues of dealing with how we experience and come to understand the world in a practical sense’. Social work’s context-embedded location means that it is always cognisant of the impact of social structures serving more often to exclude and deny access to resources and power of those with whom they work. A generally accepted definition of social work states that it is. …a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing (Australian Association of Social Workers July 2013).

1.1.2.1 Person-in-Environment The early developments of the profession are perceptible in what we might think of as social work’s ‘flagship’ concept: person-in-environment (PIE). PIE refers to the fact that human actions and experiences can only be understood with respect to their grounding in a context. In order to develop this idea, social work scholars such as Gitterman and Germain (2008) and many others argue for the centrality of the biopsychosocial model, that is, the concept that the biological, psychological and social elements of human lives are inextricably bound up together. PIE and the biopsychosocial model clearly reflect the influence of general systems theory (GST) which, though providing a more nuanced and dynamic view of the social world, retains a perspective that considers systems as driven by an impetus for avoiding disorder and arriving at equilibrium and a steady state. Coupled with the concept of person-in-­ environment and in response to realisation that a ‘softer’, fuzzier understanding of the impact of social systems was needed, a multidimensional vision of context and

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environment was proposed. This considered ‘environment’ as comprising micro (individual lives and experiences), meso (collective impacts of, e.g., a group or community) and macro (national and global inputs such as policies and phenomena like global warming) ‘levels’. Such a viewpoint attempts to capture the ways in which the interactions and influence of biology, psychology and the social must simultaneously remain the focus of social workers’ attention as they strive to understand and to ameliorate individual problems, strengthen and build communities and develop programs, policies and research. 1.1.2.2 Theories and Models A number of theories and models, traditionally adopted by social work, remain utilised by contemporary social workers to direct and guide their practice. For most part, these are derived from GST. Chief amongst them are ecological systems theory, psychodynamic theory, and cognitive behavioural theories. These theories and models advocate technico-rational ways of thinking, that is, thinking that searches for causes, often identified by the theory or model, which explain the effects perceptible in, for example, a service user’s mental state, or problems caused by a client’s ‘faulty’ reasoning. The social worker is often situated outside the problem, their task being to analyse and engage the client (or community or team) in solving it. In other words, their task is to attempt to make an apparently disordered situation more orderly or returned to something of its (presumed) previous steady state. Technico-rational approaches to problem-solving are often apparent in the design of various protocols and templates, which guide social workers in making assessments and arriving at decisions. While these can be helpful in shaping a logical way of gathering what is considered to be relevant information, social workers often feel that such templates and protocols, while offering a rationale for the decision made and demonstrating the social worker’s accountability, are perceived by them as falling short with respect to actually describing and capturing the client’s lived experience, serving rather to reduce their problems in living to a set of selected possibilities. Practitioners also find themselves frequently challenged by the need to work both within and across service systems. Every agency has its own set of eligibility criteria, prescribed time frames directing the length of intervention and their own boundaries and requirements for service delivery. Clearly, this may be appropriate for a client with a single problem and minimal need for interventions but is less helpful where the presenting situation is multifaceted, multidimensional and needing a ‘whole of service’ response. However, it is worth noting that there are currently a number of attempts to bridge these gaps through developing multi-agency and multi-system risk assessment protocols, see for example, Humphreys et al. (2018) and Jolliffe Simpson et al. (2023). Social workers have also questioned whether these more traditional approaches to problem-solving were indicative of a tendency to ‘blame the victim’, thus obscuring the role society has played in the creation of individual problems, which as we saw earlier was a key insight and motivator of the early social work pioneers. The

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emergence of structural social work in the 1970s and 1980s argued that dominant social structures and discourses had influenced access to opportunity, resources and power for certain groups leading to both individual and collective oppression (Hick & Murray, 2009 p.  88). Structural and feminist social work (Dominelli, 2002) mounted arguments and proposed strategies for practitioners to explicitly articulate challenges to the dominant social and economic structures of patriarchal capitalism, colonialism, racism, ableism and ageism as fundamental causes of oppression rather than problems emerging due to individual pathology (Hick & Murray, 2009, p.86). Much critical social work theory, like the traditional theories and models earlier mentioned, has inherited the approach from positivism and post-positivism, seeing the challenges as being to trace the linear pathway from causes located in social structures to their effects on human lives. One exception to this, however, is evident in models of participatory action research, which draw on critical theory but, as we will consider in Chap. 10, assert the importance of processes of action, feedback and new action in a spiral-like rather than linear pathway towards change. It is very common for social work practitioners, across fields and programs, to voice concern at the apparent lack of fit of the theoretical models taught in academia and the practical realities faced. And sometimes, when asked to account for the theoretical base informing practice, many practitioners may struggle to do this (see, e.g. McDermott et  al., 2017). What this may be indicative of is the strongly felt distance of theory from practice, either because the theory ‘doesn’t fit’ or has been developed at some distance from ‘on the ground’ realities. 1.1.2.3 Tensions and Challenges The last 150 years since its emergence have, as we have sketched above, been years of enormous social change driven by advances in science and technology and bringing with them, human and social problems and dislocations. During the late twentieth century and the opening up of the world through globalisation, social work began to spread beyond its European, American and Anglophone origins, advancing into Eastern Europe, China, Africa and the Asia Pacific. One difficulty with the continued reliance on Enlightenment thinking as an organising framework for social work is that the lens is largely Eurocentric in orientation. It reflects the philosophical and developmental pathways of the Anglo/ European world in which social work took root. However, social work’s newer locations in contexts such as Africa, China and Eastern Europe encounter patterns of philosophy and development, which are widely varied. It did not go unnoticed amongst social work scholars that caution needed to be exercised about, even implicitly, assuming that paradigms from one cultural context would be valid in another (Chakrabarity, 2000 cited in Garrett, 2021, p.3). Thus, the tension also becomes one of how to reconcile a discipline founded not only in the Anglophone context but also in the context of Enlightenment thinking with a discipline in contemporary context that needs to be understood as multidimensional, multinational and international.

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The many developments we have noted – global, national and local – indicate that social work’s context has evolved and changed since the late 1800s. In its attempts to accommodate a changing world, social work remains heir to numerous challenges impacting its conceptual and espoused value base, which raise many confronting questions. For example: • How to respond to the tensions between the individual and the structural in a contemporary world conscious of the legacy of patriarchal capitalism, colonialism, racism, ableism and ageism? • How to maintain a commitment to upholding human rights and advocating for those excluded, oppressed and vulnerable, especially when critique emerges that suggests human rights may not be globally applicable so much as being a consequence of Western individual philosophical thought (Ife, 2001)? • To what extent ought social work be concerned with activism (Maylea, 2020)? To what extent ought it be concerned with protest against social injustice (Fronnek & Chester, 2016)? To what extent ought it be concerned with maintenance of the status quo (Davies, 1994)? • How to balance individualised need and broader issues of the relationships between the individual and the state as well as the relationship between the social work profession and the state? • Should social workers be primarily working for individual or for social change? Should they be actively involved in climate activism? From a structural or critical perspective, how is it possible to address both individual difficulties and the societal structures that have created these? • How to work from a theoretical base that seems distant from practice realities?

1.1.3 Social Work in the First Quarter of the Twenty-First Century In thinking about the origins of social work as a context-bound profession and its continuing commitments to social change, human rights and human well-being, the question arises as to whether its adherence to current conceptualisations of person-­ in-­environment and the biopsychosocial model render it up to the task of working with the challenges the twenty-first century has delivered. Since its origins, the world has definitely changed: new knowledge derived from science especially in relation to our understanding of the human body, the impacts – positive and negative – of globalisation, the digital revolution and the pervasiveness of social media and the likely increasing negative effects of climate change including the threat posed by the emergence of new and deadly viruses are amongst many of the challenges confronting it. Different problems and issues are apparent, such as those relating to mass migrations, threats of escalating world conflicts and the increasingly audible voices of racial, cultural, sexual and disability minority groups demanding the right not just to be heard but to be empowered.

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Social work is situated at the interface of these multiple and often-conflicting voices. And as Rescher (1998, p.57) notes: With the expansion of knowledge new insights render previously enjoyed modus operandi less effective, evolution, either natural or rational, ongoingly confronts us with products of greater and greater complexity. Old theoretical structures become obsolete unable to fit the full range of available fact.

1.1.3.1 Complexity Theory, Complex Adaptive Systems and Pragmatism The motivation underlying this book springs from realisation that, in our view, PIE and the biopsychosocial model are no longer keeping pace with these momentous developments. While GST may have grounded social work’s biopsychosocial model in a version of systems theory, what is lacking is an account of how systems actually interlink and how they mutually influence human action and behaviour. Social work needs a meta perspective or explanatory system that is fit for twenty-first century understanding of the nature of social and material reality. This, we believe, is what complexity theory and an understanding of complex adaptive systems will provide. While the commitment to the person-in-environment concept remains relevant to social work, the concept of environment has changed, no longer able to be comprehensively explained by GST or structural theory, for example, but needing deeper, more adaptive and more sophisticated analysis to appreciate practice in the twenty-­ first century. Human beings are not properly understood as cogs in a universal machine but rather as complex systems evolving within larger complex systems, which evolve within a larger biotic system within a larger physical one, best captured in the notion of nested systems (Geyer & Rihani, 2010, p.52). There is similarity here with social work’s adherence to PIE and the concepts of micro, meso and macro levels of practice but incorporation of these levels in decision-making and strategic action is hampered by the static nature of these concepts and the lack of explanation as to how micro, meso and macro actually mutually influence and mutually inform each other. As we inhabit a world of greater complexity, social work needs to embrace explanatory frameworks and theories that enable the delivery of social work from new and deeper perspectives that better equip practice, research and policy to respond to contemporary conditions. Accordingly, the challenges emergent over the past 30 years offer social work many opportunities. These comprise a challenge to understand the nature of social and material reality through the meta view and belief system advanced by CT; it is an opportunity to both transform and strengthen social work. In this book we argue that complexity theory, as explanatory theory, offers a view of the nature of social and material reality through which to navigate practice in all its forms. Lambert et al. (2007), p.58) suggest that CT may (metaphorically speaking) be understood as revealing the world as a vortex in which the interconnectedness of pattern, structure and process both co-exist and co-evolve. This suggests that we cannot understand a complex case or a community, a policy or a program, or

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indeed the impact of a pandemic, by taking apart their individual components but rather need to accept that the phenomenon of interest exists in a context much larger and more complex than the phenomenon (as a system) itself, eschewing control or prediction (Heylighen et al., 2007). Social workers are always challenged by limitations to their capacity to predict and to control, as well as by the need to consider multiple variables and to problem solve from a backdrop of complexity with an uncertain outcome. We argue that, whilst CT provides social work with explanatory theory about ‘how the world works’, we recognise that social workers are the same practical people that Jane Addams identified in the late nineteenth century. Explanatory theory without a way of thinking about ‘what to do’ and ‘how to act’ retains the perceived divide between theory and practice, which has been a constant stumbling block for many social workers. Our argument here is, then, that pragmatism in partnership with CT provides an epistemology and ontology about the nature of human being and the necessity of action. Pragmatism is about ‘doing something’. Twyoniak et  al. (2021), p.299,300) explain it like this: Pragmatism is the social process of enquiring amongst and between different ‘levels’ of analysis – micro, meso, macro – with the commitment to taking practical action in order to find solutions when these are required. Earlier, we identified a number of tensions and challenges confronting social workers. We are not proposing that CT and pragmatism, together or separately, will dissolve or mitigate these tensions. Rather, we are proposing that the knowledge and understanding each offers individually and in conjunction will become considerations and factors influencing social workers’ strategies and decisions, enabling them to manage these tensions rather than necessarily to solve problems. In this book, we set out what is new that CT brings to social work. Our purpose is to explain and demonstrate that the uncertainty, unpredictability and disorder of everyday life is what emerges when multiple complex adaptive systems interpenetrate to ‘produce’ the outcomes we encounter and simultaneously create, as we strategise and make decisions with our service users and communities. Importantly, we argue that while CT may not provide solutions to problems or resolution of the many tensions endemic to social work, it will give social workers an understanding about how to deal with and manage them. Accompanied by a pragmatic philosophical basis, we argue that the task for social workers is to learn to ‘think complexity’ and to ‘act pragmatically’.

1.1.4 Introduction to the Book In this book, our intention is to do two key things: firstly, to acknowledge the importance of social work’s location at the interface of person and context and the need for explanatory theory to advance understanding of ‘how the world works’ in a way that recognises the challenges of practice in the contemporary world. This, we argue, is what CT offers.

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Our second aim is to advocate for a pragmatic approach to practice. While CT expands and (in our view) enhances understanding of context, social workers need to act. The ‘chorus’ accompanying all the chapters in this book – ‘think complexity and act pragmatically’– will, we anticipate, provide helpful, though far from simplistic, encouragement. The book is presented in three parts. Part I  In this first chapter, we have described the emergence of social work in the post-Enlightenment world, noting the changed and constantly changing world, which is the context within which social workers work. Since its establishment 150 years ago, social work has identified that it is where individuals and their context intersect, where the biopsychosocial elements conceptualised as impacting and shaping action at micro, meso and macro ‘levels’ interpenetrate, usefully captured in the concept of person-in-environment, that comprises social work’s ‘home base’. We noted the limitations of its contemporary theorising and ‘world view’, arguing that understanding and incorporating the view of social and material reality that CT advances offers social work an explanation for ‘how the world works’. Adopting a pragmatic stance complements this world view with its imperative to act. Chapter 2 begins by outlining the strengths of social work, arguing that these considerable strengths offer a solid basis for the development of thinking complexity and acting pragmatically. Chapter 3 outlines the key ideas encompassed by CT and the elements characterising complex adaptive systems. The link between CT and pragmatism is made, demonstrating how these two bodies of thought combine to provide social work with explanatory theory or a meta view of the nature of social and material reality, as well as an epistemology (how social reality can be known) and ontology (what it is to be human) to undergird practice. Chapter 4 describes how both CT and pragmatism might guide practice, analysing a case example and concluding with a number of pointers or guidelines for so doing. Part II  In Part II of this book, we turn to thinking about the different ways in which programs demonstrate, and practitioners themselves explain, how their reflections, analysis and strategic decision-making are grounded in complexity theory. The implications of this grounding for acting pragmatically are discussed, and each chapter concludes with several reflective questions to guide thinking and encourage application in fields other than those specifically addressed here. The first chapter in Part II is designed to take the reader from a broad, over-­ arching depiction of an innovative program, exemplifying complexity theorising – the Multiple and Complex Needs Initiative (MACNI). This is followed by five chapters referring to particular demonstrations of social work practice in a number of fields. The first of these five chapters also takes a broad approach, identifying crucial factors common across many if not all fields of social work practice – ethical dilemmas, self-determination, risk and uncertainty. The examples in this chapter are from casework practice with children and with older people. The following three

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chapters explore social work practice in management, community development and a hospital emergency department. The authors invited Margaret Hamilton to contribute Chap. 5, which leads Part II. Margaret had been inaugural chair, responsible for the implementation of one of the first legislated attempts to provide an appropriate response to people with multiple and complex needs. The Multiple and Complex Needs Initiative (MACNI) was established under the Victorian Human Services (Complex Needs) Act 2003 and later amended but continued in the Human Services (Complex Needs) Act 2009. Margaret describes her reflections and accumulating experience in this innovative and novel undertaking as she as chair and the members of the MCNI Panel ‘thinking complexity’ explored and experimented with the establishment and implementation of this novel program from 2004 to 2009. We decided to make this the first chapter in Part II because the MACN Initiative demonstrates early work informed by CT.  Indeed, as you will read, Margaret describes a cycle of ‘doing – thinking – doing’ (doing while thinking/thinking while doing), in which the meta view provided by very early accounts of CT in practice settings was in its infancy in social work, requiring the panel to extend their enquiries into minimally chartered territory. At times, CT illuminated reflections on what had occurred and at times prompted ways to advance this innovative program. Further, Margaret’s account highlights the reflective ways in which social workers go about making decisions and formulating interventions. The subsequent chapters in Part II describe contemporary, ongoing social work practice in which this cycle of ‘doing – thinking – doing’ is clear in their accounts. While we encourage social workers to ‘think complexity and act pragmatically’, how they do this in the thick of real-world practice is perhaps better captured by recognising the cyclical process, characterised by constant feedback and re-focus. In this way, Chap. 5 Early Doing and Thinking Complexity: the MACNI sets the scene for subsequent chapters in Part II in that it describes a program that is designed to improve the situations of people (and the services they presented to) who demonstrated many of the characteristics of people whom we would consider complex, that is, they presented with a range of co-occurring issues related to health, mental health, homelessness, isolation, disability and encounters with criminal justice. How CT assisted the panel in arriving at decisions and strategies that focused on conceptualizing and ameliorating the situation at micro (the service user), meso (the agencies and services involved) and macro (the community) levels provides a vital account of the challenges involved. These multilayered depictions of the difficulty of working across and within systems are taken up in subsequent chapters where the focus is placed on specific sites of social work practice. Of course, in thinking complexity, social workers are always thinking systemically and pragmatically, but in the following chapters in Part II, particular aspects are drawn out by the authors, highlighting the way in which thinking complexity and acting pragmatically has informed their practice and their ‘doing – thinking – doing’. Each of the authors has brought to the task of writing this book experience in particular fields of practice. Thus, in Chaps. 6, 7, 8, and 9, we hear their individual

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voices, presenting their different experiences, reflections and viewpoints arising from a specific field of practice. In Chap. 6, Kerry draws on her long-standing experience as a social work practitioner to distil and explore some of the most difficult and contentious issues that arise in many – if not most – practice situations where caseworkers are confronted with numerous dilemmas, some of which resonate with the tensions noted in Chap. 1. These relate to respecting self-determination, working with uncertainty, with ethical and moral challenges and the ever-present theme of risk. Through using many examples from work with children and older people, Kerry demonstrates the usefulness of thinking complexity and acting pragmatically in order to find a way through when knowledge is incomplete and outcomes never clear. Alex draws on her diverse and rich background in architecture, international development and social work research to describe her own ‘embeddedness’ in complexity thinking. How this has influenced her conceptualisation of management of a large community agency in outer-metropolitan Melbourne and the initiatives taken in beginning to engage and strengthen a community-in-process is the subject of Chaps. 7 and 8. In Chap. 9, Felicity draws on her experience as social worker working the evening and weekend shifts in the Emergency Department of an inner-city hospital serving a diverse population. Felicity argues that in such crisis situations where the unexpected and the challenging is the ‘order of the day’, it is possible to see in microcosm the vital role that social workers play within a health system. Thinking complexity and acting pragmatically provide both conceptual guidance and the confidence to make decisions and act strategically, often under considerable pressure. While each of the authors of the chapters in Part II has tackled their topics in (appropriately) individual ways, what each shares is an understanding of the nature of thinking complexity. The explanatory theory that is CT and the ten characteristics of CAS discussed in Part I of Chaps. 3 and 4 are highlighted, not as somewhat abstract ideas, but brought to life in relation to the work social workers actually do, whether designing and implementing a novel program as with the MACNI, with managing an agency, planning and working with communities, practicing in the dynamic and turbulent world of a hospital emergency department and in the day-to-­ day casework practice of many social workers working in many different fields. Emergence and adaptation, nested systems, fuzzy boundaries, distributed control and self-organisation, sensitivity to initial conditions, non-linearity, non-­equilibrium, phase changes and unpredictability are signposted in these chapters. These chapters contain authors’ reflections from their meso location and comprise narratives constructed to demonstrate their thinking and analysis, their search for patterns and understanding. While the focus of each chapter differs, what is worth noting is that each author situates themselves as part of a team, either comprising other professionals or a range of stakeholders, and thus identifies the inter-twining and interpenetration of similar and different ideas, drawn upon to guide strategies and actions. In reading these accounts of practitioners thinking complexity and acting pragmatically, you are invited to reflect on how you might do things differently or imagine other possible outcomes as you consider the elements and factors in your own

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situations. These chapters not only add real-world examples to what is known about the benefits of thinking complexity, but they each conclude with some guidelines and suggestions for practitioners to use to reflect on your own practice with clients, colleagues and communities. You will also notice that in each of these practice or field chapters, not all characteristics of CAS are noted or identified, and in some chapters, some characteristics are noted more often than others. This may usefully demonstrate that working within a CT frame of reference does not mean that every aspect of what characterises CASs needs to be identified or ‘applied’ but rather that, depending on your context and role, some characteristics are more powerfully present than others and thus form the context within which that practice is framed. Our purpose is therefore to convey as well as we can how social workers informed by CT ‘go about things’. Part III  What the three chapters comprising Part III have in common is both a ‘step back’ from direct practice and a ‘step forward’ to present an integrated understanding of CT and CAS, detailing how this over-arching perspective may influence the understanding of policy (Chap. 10), the conduct of research (Chap. 11) and the development of curricula for social work, including in field practica and in supervision of graduate social workers and other agency staff (Chap. 12). Part III concludes with Chap. 13 which draws together the main ideas and learning to be taken from reading this book, highlighting specific points to assist social workers to progress their capacity to think complexity and to act pragmatically. Reflective Questions • What does the history of social work tell you about its ‘place in the world’ and its ‘goodness of fit’ in tackling twenty-first century problems? • Some tensions and internal contradictions characterising social work have been described here: what other tensions or challenges confronting social work and social workers occur to you? • What limitations or shortcomings with current conceptualisations of PIE and the biopsychosocial model have you noticed?

References Australian Association of Social Workers. (2013). Practice standards. AASW. Berringer, K. (2019). Reexamining epistemological debates in social work through American pragmatism. Social Services Review, 93, 608–639. https://doi.org/10.1086/706255 Davies, M. (1994). The essential social worker: An introduction to professional practice in the 1990s (3rd ed.). Ashgate. Dexter, R. (2022). Experts warn of lone-actor risk among ‘freedom’ protestors. The age newspaper. Dominelli, L. (2002). Feminist social work theory and practice. Palgrave Macmillan. Duckett, S., Mackay, W., Stobart, A., & Swerrison, H. (2020). Coming out of COVID-19 lockdown: The next steps for Australian health care, the Grattan institute report no 2020-09. Retrieved from: https://grattan.edu.au/report/coming-­out-­of-­covid/ Friedlander, W. (1968). Introduction to social welfare (3rd ed.). Prentice-Hall.

References

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Fronnek, P., & Chester, P. (2016). Moral outrage: Social workers in the third space. Ethics and Welfare, 10(2), 163–176. https://doi.org/10.1080/17496535.2016.1151908 Garrett. (2021). Dissenting social work: Critical theory, resistance and pandemic. Routledge. Geyer, R., & Rihani, S. (2010). Complexity and public policy: A new approach to 21st century politics, policy and society. Routledge. Gitterman, A., & Germain, C.  B. (2008). The life model of social work practice: Advances in knowledge and practice (3rd ed.). Columbia University Press. Heylighen, F., Cilliers, P., & Gershenson, C. (2007). Philosophy and complexity. In J. Bogg & R. Geyer (Eds.), Complexity science and society (pp. 117–135). Radcliffe Publishing Ltd. Hick, S., & Murray, K. (2009). Structural social work. In M. Gray & S. Webb (Eds.), Social work theories and methods (pp. 86–97). Sage Publications. Hothersall, S. J. (2019). Epistemology and social work: Enhancing the integration of theory, practice and research through philosophical pragmatism. European Journal of Social Work, 22(5), 860–870. Howe, D. (1994). Modernity, post-modernity and social work. British Journal of Social Work, 24, 513–532. https://doi.org/10.1093/oxfordjournals.bjsw.a056103 Humphreys, C., Healey, L., Kirkwood, D., & Nicholson, D. (2018). Children living with domestic violence: A differential response through multi-agency collaboration. Australian Social Work, 71(2), 162–174. Ife, J. (2001). Local and global practice: Relocating social work as a human rights profession in the new global era. European Journal of Social Work, 4(1), 5–15. https://doi. org/10.1080/7145052835 Jolliffe Simpson, A. D., Joshi, C., & Polaschek, D. L. (2023). Unpacking multiagency structured professional risk assessments for family violence. Journal of Interpersonal Violence. https:// doi.org/10.1177/088620522147069 Kuhn, T. (2012). The structure of scientific revolutions (4th ed.). University of Chicago Press. Lambert, R., Brown, C., & Bogg, J. (2007). Health and complexity. In J. Bogg & R. Geyer (Eds.), Complexity science and society (pp. 51–75). Radcliffe Publishing Ltd. Maylea, C. (2020). The end of social work. British Journal of Social Work, 51, 772–789. https:// doi.org/10.1093/bjsw/bca203 McDermott, F., Henderson, A., & Quayle, C. (2017). Health social workers sources of knowledge for decision making in practice. Social Work in Health Care. https://doi.org/10.1080/0098138 9.2017.1340391 McKenzie-Murray, M. (2022). Pandemic fans flames of discord. The age newspaper. Meadows, G., Farhall, J., Fossey, E., Happell, B., McDermott, F., & Rosenberg, S. (Eds.). (2021). Mental health and collaborative community practice: An Australian perspective (4th ed.). OUP Australia & New Zealand. Rescher, N. (1998). Complexity: A philosophical overview. Transaction Publishers. Twyoniak, S., Lavagnon, I., & Bredillet, C. (2021). A pragmatist approach to complexity theorising in project studies: Orders and levels. Project Management Journal., 52(3), 298–313.

Chapter 2

The Strengths and Limitations of Social Work

2.1 Introduction and Learning Opportunities In the previous chapter, we have presented a brief outline of the history of social work, largely within Western liberal democracies and its origins in the nineteenth century in order to demonstrate the philosophical and political factors influencing its emergence in the contemporary world. We also noted the frequently contested nature of its role in relation to the state – liberator or agent of social control. These twin considerations underpin social work’s concerns for humanity and anxiety about social order. Both have been present throughout social work’s history, encapsulating both the care and control dichotomy that pervades social work service delivery and reflecting the tensions between individual responsibility and state provision. They also underscore the messiness and often contradictory world of direct service delivery. Our purpose in this chapter, however, is to describe the strengths of social work’s contribution to the human and social sciences, which provide a firm basis for the next steps in its development. These strengths comprise its: • • • • • • • •

Ethical commitment Value base Valuing of reflection and reflective practice Relationship focus of practice Foundational location within social, geographic and cultural contexts ‘Borrowing’ of theory, models and concepts Commitment to collaboration Pragmatic approach to taking action In this chapter readers will:

• Identify the strengths of social work and social workers with reference to their ethics, values and characteristic approaches to practice © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_2

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• Identify the limitations of social work’s theoretical base in relation to the demands and challenges of contemporary practice • Identify the challenges for social work theory and practice posed by uncertainty, risk and ‘not knowing’ • Learn how the strengths of social work provide a comprehensive base for further building on social work’s expertise through adopting practice informed by complexity theory and pragmatism

2.2 Strengths of Social Work 2.2.1 Ethical Commitment Social work’s espoused values form the context in which its ethical commitments are manifested, and these pivot around three core principles: respect for persons, social justice and professional integrity (International Federation of Social Workers, 2018; Australian Association of Social Workers, 2020). Such principles reinforce social work’s commitment to recognising and respecting diversity and cultural difference in relation to the beliefs, values, goals, needs and desires of those with whom they work. These principles underscore the importance of social workers adhering to a frame of reference that is embedded in concern for social justice and human rights. While clearly these espoused ethical commitments cannot be argued with, how social workers keep them centrally in mind as they negotiate and work with the complex issues they encounter amongst the (generally) many stakeholders in each presenting situation, perhaps with conflicting perspectives, understandings, experiences and mandates, is often a challenging process. It requires social workers to confidently know their role and to know what ethical principles may be at stake.

2.2.2 Value Base We have noted that social work is a values-based profession. The common values underpinning social work include individualisation, expression of feelings, non-­ judgemental attitudes, self-determination and confidentiality (Dominelli, 2002). Also, values encompass recognition of the inherent worth of individuals and challenges to societal oppression. While social justice is an attractive concept in some contexts, it is a concept inherently concerned with the formation of an egalitarian society based on principles of solidarity and equality (Zajda et al., 2006). As these are largely aspirational goals, they can be difficult to realise in a context of social work action being largely vested in state-sponsored activity, itself subject to the vicissitudes and shifting political and economic forces. Social justice largely reflects Western philosophy and may have less currency in the non-Western context but,

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nevertheless, should not be fully rejected given the position of the International Federations of Social Workers’ (2014) definition of social work: Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledges, social work engages people and structures to address life challenges and enhance wellbeing. The above definition may be amplified at national and/or regional levels.

The single uniting value and shared perspective is the foundational concept of person-­in-environment (Hare, 2004) to which we shall return in detail shortly. Further, the demonstrable value social workers place on learning from and by experience sensitises them to acknowledging the importance of the views of service users, often seeing themselves as ‘the voice’ of the service user or making provision for service users themselves to voice their own opinions. In contemporary times, however, issues about who can speak for whom and about what are emerging as contentious and not to be taken-for-granted, challenging social workers to re-think how their commitment to social justice and advocacy can better be realised (see, e.g., Smith et al., 2016).

2.2.3 Valuing Reflective Practice A high value is placed on the idea of and engagement with reflective practice (Watts, 2021). Reflective practice (Schon, 1992) proposes that it is through examination by the practitioner, their exploration and analysis of what is happening, what happened in earlier or other similar situations and what strategies might be available that the practitioner derives knowledge and understanding of how to ‘go on’. This, coupled with understanding of relevant or chosen theories, models and a grasp of the best available evidence, enables the practitioner to act. Reflective practice, at least in Schon’s (1992) view, is essentially an epistemology of practice, that is, it refers to the branch of philosophy that addresses the questions of how social reality can be known. Reflective practice receives primacy of attention in the way most social work courses are structured with the practicum or placement the centre around which learning revolves, where, through reflection, mental models are constructed and theory and practice are integrated.

2.2.4 Relationship Focus of Practice Student social workers are often exhorted to ‘first build a relationship’ when they prepare for practice. The interest in building relationships and providing social work engagement, support and assistance through the medium of a relationship is a

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central tenet of social work practice (and perhaps an explanation for why so many social work researchers favour qualitative research). This capacity to build and sustain relationships with service users and other colleagues is undoubtedly a strength of social work (see Rollins, 2019; Furlong, 2013). The ability to build relationships amongst an often diverse range of different people, organisations and stakeholders is crucial to the delivery of social work interventions. It requires many skills: the capacity to observe, to listen, to engage, to speak, to convey empathy and understanding and simultaneously to keep in mind the goals and purpose, which the encounter and the developing relationship is designed to effect. The building and sustaining of the relationship also require that the social worker recognises that there will be a great deal that remains unknown and that the interpretations he/she makes of the situation of the other and the other’s perspective will always be partial and incomplete. Importantly, any relationship is evolving and changing as each participant connects, however imperfectly, with the other. What will emerge from the encounter cannot be predicted and, knowing this, requires that the social worker adapt to and ‘go with’ the evolving and changing situation.

2.2.5 Foundational Location Within Social, Geographic and Cultural Contexts Social work is – intentionally – context-bound and for that reason always ‘reshaping’ itself in relation to the current context. Indeed, from its inception, social work placed itself at the intersection of person and environment. Certainly, over time and with the ongoing development of knowledge over what comprises ‘environment’, this location has served it well. It has ensured that what we might term a ‘social work perspective’ continues to characterise and often distinguish social work practice from other disciplines. As knowledge about the nature of what comprises environment continues to unfold, social work too evolves in order to take account of this. Similarly, its structural and critical perspective has enabled social work to ‘call out’ the negative impacts on people regarding their health, welfare, access to resources and sources of power, which social structures – as environmental contextual factors – inflict, privileging some people and depriving others. Recognition of the changing understanding of how such factors as gender, sexual orientation, geographic location and ability are implicated in the realisation of life chances resonates with what might elsewhere be referred to as the Social Determinants of Health (Australian Institute of Health & Welfare, 2022). This context is constantly changing as social and political elements evolve. The history of the family in relation to the state provides an example of how social work has, and not without contradictions and ambiguities, altered its role and accountability with reference to child removal, child support, adoption and so on. As another example, coming to see service users differently, not as clients in receipt of a service but as people who can actively participate in the design and delivery of services

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reflects cultural change in how difference (at least in Western liberal democracies) can be viewed as a strength not a weakness. This is, in effect, to loosen the so-called professional boundaries between social worker and client, to actively work to redistribute and share power across boundaries. Social work constantly evolves as its context evolves, as social changes occur and influence and impact the context within which social workers act. We see this very markedly in relation to the newly emergent role of service users and consumers of services, the digital revolution, climate change and perhaps in the contemporary reshaping of the global post globalisation order.

2.2.6 Person-in-Environment: Micro, Meso, Macro As was discussed in Chap. 1, much theoretical and conceptual work within social work has focused on understanding the social and environmental context and how to work with and in it. The conceptual division of context into micro, meso and macro sets up a viewpoint, which proposes that macro-level factors (e.g. climate, geography, nations) mutually intersects with meso level factors (e.g. organisations, groups, communities, teams), which mutually intersects with micro level factors (e.g. human bodies, individuals, families), and vice versa. Social workers recognise that problems with day-to-day life exist at varying levels. At the micro level, they exist in the guise of obstacles encountered by individuals, groups and communities that are actually confronting challenges in living. At a meso level, social workers are invested in the agencies and institutions charged with assisting those who are struggling. At the macro level, these challenges emerge in the guise of broad policies, and politics, that direct the nature of interventions as well as allocating resources for implementation. By locating itself at the intersection of person and context, social work is demonstrating that it is characterised by the ‘loose boundaries’ we noted earlier. This recognition of the ‘looseness’ of boundaries separating people and their context is a strength: it encourages social workers to recognise that contextual factors are impacting on a person and to act to ameliorate them by, for instance, at the micro level manipulating boundaries – interfering in them, for example, by getting families to see how tightly closing boundaries against ‘outsiders’ (non-family) may heighten not lessen family conflict; or at the meso level, recognising that a damp physical environment – poor housing – can damage health; or at the macro level, advocating to government for increased payments to the unemployed. In these ways, crossing boundaries to improve family relationships, or pay attention to the physical state of the house in order to deliver health benefits, or to attempt to increase financial security suggest that the social worker’s understanding of context is not so much as something ‘wrapped around’ but rather as something in which action is embedded and from which it springs.

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2.2.7 ‘Borrowing’ of Theory, Models and Concepts One of the primary criticisms of social work that is often voiced is that it does not possess a social work-specific body of knowledge to define the discipline. Instead, social work has always drawn upon theories borrowed from a variety of disciplines. Thus, social work finds itself located in concepts of politics and philosophy, roles and relationships, psychological selves and social reality, values and judgements, the personal and the political (Howe, 2014:112). Social workers draw on a range of theories, and this is a strength; though as we will discuss below, it also poses some limitations. The reality of social work, and social work practice, is the need to draw on multiple perspectives when engaging with human problems across a spectrum of diversity stemming from both diversity of clients and diversity of their problems. This is why, as we shall shortly discuss, pragmatism provides a ‘home-base’. It is a strength to be able to share theories and models with other disciplines, potentially expanding understanding and enabling social workers to ‘think with’ other disciplines, often finding useful points of connection. These adopted theories and models have often proved useful and applicable to understanding the problems and issues social workers encounter from multiple perspectives. Chief amongst the theories that social work has borrowed are ecological systems theory (from psychology), psychodynamic theory (from analytic psychiatry and psychology), cognitive behavioural theory (from education and learning theory) and critical theories, for example, feminist theory (from social theory). And from these, a number of different models for ‘translating’ the theoretical ideas into action are commonly in use. Models and theories differ. Models usually form the basis for theories, suggesting a process whereby what is proposed can be theorised, that is, the reason why the model works or makes sense is demonstrated in the theory derived from experimenting or exploring it. However, theories might also come first, with models proposed to explore or experiment in order to see if the theory holds water. For example, CBT proposes that behaviour can be learned. In order to ‘fix’ problematic behaviour, a model of learning to think differently might be proposed for the social worker to experiment with. Theories then are conceptual accounts of how social reality may be understood, whilst models are proposed strategies that derive their logic and rationale from the theory. Social work has borrowed and developed some of the following models and approaches, which are derived from the broad theories noted above: • • • • • • •

Human development models Problem-solving models Task-centred practice models Solution-focused therapy models Narrative therapy approaches Cognitive-behavioural therapy approaches Crisis intervention models

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Many of these theories, models and approaches are derived from general systems theory, which has clearly provided social work with an essential foundation, particularly for underpinning its major adherence to a person-in-environment perspective. This, combined with understanding derived from cybernetics as developed by Gitterman and Germain (2008) and other influential social work theorists, emphasised the interdependencies amongst elements in a person’s context and the feedback mechanisms characterising interactions amongst phenomena (Wolf-Branigan, 2009).

2.2.8 Commitment to Collaboration The ‘borrower’ nature of social work and its familiarity and utilisation of theories and models often developed in other disciplines also reinforces the emphasis social workers place on working together, collaboratively. Many social work positions locate them as part of a team – the multidisciplinary health or mental health team, the community development team of planners, community workers, citizens and various advocacy and stakeholder groups. Often social workers position themselves as working with families, carers, consumer and service user groups, taking on a role of supporting and developing such groups in order for their voices to be heard and amplified to decision and policy makers. The importance of seeing themselves as power brokers or representing or supporting others to meet their own needs is a strong thread in practice. They like to form alliances with service users or those on the margins. Critical and feminist social work theories and models in particular have provided a conceptual and intellectual base to work from. We could say in the light of this that their professional boundaries are sometimes ‘looser’ than those of other professionals: these relatively loose professional boundaries are generally valued and put to use in, for example, advocacy for their service users to other professionals or in a multidisciplinary team where this contribution is often respected. Social workers’ collaborative interest is, in some respects, an outcome of where they are located within state organisations and institutions, in community settings, or within non-government or voluntary agencies, and relatively rarely in private practice settings. Indeed, the majority of social workers across various fields work with multidisciplinary teams – in health, ageing, child protection, mental health.

2.2.9 Pragmatic Approach to Taking Action Most social workers value practical knowledge. They are essentially ‘practical people’: they want to do something, to take action, to better or at the least stabilise a problematic situation. Personal experience in addition to professional knowledge has increasingly become valued in social work, and it is the capacity to reflect

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critically on this personal experience in order to know how to ‘go on’ that frequently is what social workers assert guides them. Sometimes, the elements in the processes involved in reflection may remain in the realm of tacit knowledge or practice wisdom, that is, knowledge drawn from experience or professional or personal experiences, which may be difficult to verbalise but which influences actions and decisions. Social workers are also adept at borrowing ideas and models from a range of sources, including from their non-social worker colleagues. This point is also made by Payne (2014 p. 68) who comments that social workers frequently talk together, talk with their clients, reflect, utilise supervision and in this way theory and practice act as a ‘…mutual process in which each has influence over the other’. We see this in evidence in the struggle most social workers have in navigating the knowledge/practice divide, applying theory to understand their observations and actions, or using theoretical models to plan and make decisions regarding actions to take. Research by McDermott et al. (2017) exploring the knowledge social workers in a health network identified as informing their decision-making revealed that participants identified reliance on past experience and contextual/situational information as underpinning their decisions. Despite the availability to the research participants of a repository of empirical evidence on intervention outcomes, no respondent made use of this. Interestingly, social workers in the study drew on sources of knowledge for practice located at micro (the patient, colleagues, self-­ reflection), meso (the multidisciplinary team, theoretical knowledge) and macro (laws, policies and protocols) ‘levels’, bringing insight from all three together in their decision-making. While these findings appeared to demonstrate that the social workers held a multilevelled view of the social world, none of them specifically referred to concepts of person-in-environment. They did, however, indicate that systems understanding characterised their theoretical perspective on their practice. These findings were in accord with other research, which also found social workers to be essentially pragmatic in their approach. Practitioners would seem to subscribe to the view asserted by Evans and Hardy (2010, p. 170–3) that social work practitioners reflect the essence of the pragmatist position, that is, a belief that knowledge is a vehicle for problem solving and uncertainty something to be worked with rather than taken for granted.

2.2.10 Challenges for Social Work: Uncertainty, Risk and ‘Not Knowing’ To a certain extent, the evolution of social work has reflected a world of certainty. The adoption of a person-in-environment perspective derived from social work’s adherence to understanding informed by general systems theory presents a world that appears orderly, stable and rational. Boundaries between different systems are asserted, although ‘loosened’ by the possibility of feedback enabling change but the intention being to return to a state of homeostasis and equilibrium (Warren et al.,

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1998). There is an assumption in this understanding of systems that disorganisation is potentially problematic, hence the need to try and return to a steady state. What many if not all of these theories and models have is common is what might be referred to as technico-rational ways of thinking, that is, that one can discern causes, which lead to effects in a linear manner. The social worker is (theoretically) positioned outside and independent of the systems being observed and in relation to which they need to make decisions. This positioning is, however, somewhat in contrast to their adherence to the value and necessity of reflective practice, an activity that requires them to think about how they are indeed part of and implicated in what they are observing, experiencing and understanding. For example, most practitioners in a range of fields are familiar with various protocols and templates to assist in or even direct their assessment of situations and decision-making. These, generally, reflect technico-rational approaches to arriving at a rationale for the decision made. Prominent examples include various psychosocial assessment protocols and risk assessment schema (see for example, Milner et al., 2020). Others include various depictions of psychosocial ages and stages (e.g. Erickson’s eight stages of psychosocial development, Freud’s psychosexual stages of development, Kohlberg’s theory of moral development) and such tools as the Liverpool Care Pathway for the Dying. Technico-rational approaches to understanding human or moral development or protocols identifying the points professionals need to intervene at when a person is suffering from serious illness or is dying describe the individual as moving through fixed stages rather than as existing within a dynamic interactive relationship with their environment. They suggest that there will be uniformity in development from infancy to old age, from illness to death, indicating what people might be ‘likely to do’ at particular ages and stages rather than exploring the different elements in a person’s environment, which will have a profound impact on their progression and what capacities they have.

2.2.11 Wicked Problems, Risk and Uncertainty Many of the problems social workers deal with are what might be described as ‘wicked problems’. A wicked problem is one where there are no solutions in the sense of definitive and objective answers (Rittel & Webber, 1973 cited in Termeer et al., 2019, p. 168). Wicked problems involve multiple actors and are socially and politically complex (Peters, 2017), occurring across most human service systems and particularly evident in situations identified as involving risks. According to Peters (2017, p. 388), the characteristics of wicked problems include the following: • • • • •

They are difficult to define, and there is no definite formulation. Wicked problems have no stopping rules Problems have no clear solutions and perhaps not even a set of possible solutions. Solutions to wicked problems are not true or false but good or bad. There is no immediate or ultimate test for solutions

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All attempts at solutions have effects that may not be reversible or forgettable. Every wicked problem is essentially unique Every wicked problem may be a symptom of another problem. There are multiple explanations for the wicked problem The planner, policymaker or caseworker has no right to be wrong

In diverse fields  – child protection, aged care, health and mental health  – the issue of risk is a central concern in decision-making. Situations characterised as risky clearly pose dilemmas for the social worker in their decision-making. Risks might be seen to relate to the service user, the community and the social worker themselves, and it is often the social worker (as one member of a multidisciplinary team) who is charged with addressing and at the least minimising them. Paradoxically, under conditions of risk aversion, there is a presumption that we should be able to anticipate, avoid, remove and prevent risk (Howe, 2014), presumptions clearly at odds with the uncertainty and ambiguity of practice. Indeed, the notion of risk and efforts to eliminate or at least minimise it is clearly a reflection of the uncertainty characterising all social life, heightened perhaps in contemporary times with, for example, growing understanding – and evidence – of the effects of climate change and the global disruption and pain inflicted by war. As we have noted, social workers (and many other professionals and organisations) are not comfortable with and frequently seek to reduce the level of uncertainty over what they do. Neither organisations, politicians nor managers like unpredictable environments as this makes them nervous and risk averse (Howe, 2014). Gradually, the focus of social work has shifted from concerns about improvement of the human condition towards the management of risk and protection (Webb, 2006 cited in Howe, 2014 p. 44). Indeed, social workers have to accept that both risk assessment and decision-making will be scrutinised by the political context (Davies, 1994). With concerns about risk, there comes an expectation, perhaps more implicit than explicit, that we should be protected from risk as never before (Cree & Wallace, 2009). But as the global pandemic has illustrated, risk has become increasingly difficult to identify let alone control. It presents generally as a wicked problem. Whilst laws and policies shape what practitioners must do, there is no precise definition of risk on offer, although as Scoones (2019) points out, there are a range of different ways in which risk and uncertainty have been understood across cultures, philosophies, histories, disciplines and contexts. Indeed, no doubt adding to feelings of uncertainty is the sense that it is up to individual practitioners to find ways of working with risk. One of the difficulties with the rise of concerns about risk, and the trend towards the use of prescribed matrixes for risk assessment, is that they, by default, place the framework for understanding risk at the micro level of presenting client issues. They do not easily lend themselves to issues concerned with the more nuanced forms of risk embedded in complex human relationships, nor do they easily lend themselves to the notion of competing risk vested in the reality that any intervention to ameliorate risk is likely to introduce new risks.

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Clearly, in addressing the question of risk, there comes into play a tension between fundamental human rights of the individual (which are never absolute as noted by Glass (2021)) and social work’s espoused ethical commitment to human rights and the need to afford protection at a broader level to other citizens and community members. Despite the promise of technico-rational theories about human behaviour, the social worker cannot expect a linear path indicating ‘what to do’ to be self-evident. There is no certainty that the chosen course of intervention will be without unintended consequences and, given the challenges of never being able to fully comprehend the inner world of the client, a lack of certainty as to whether the chosen pathway will be the ‘right’ one. Social workers recognise that the relationships practitioners build and work within – with service users, other stakeholders, colleagues  – rarely proceed along ordered paths and almost never describe a linear trajectory. People are unpredictable; human lives are immensely complicated; outcomes can often be surprising, or what happens may even be in the opposite direction to what was planned. In the world of social work practice, we will most likely encounter only the ‘tip of the iceberg’ of any client presentation. We will only ‘know’ what the client chooses to reveal including a view tempered by client perceptions and understanding of their world. Certainly, we can add to our limited knowledge of the client through follow up with relatives, friends and other professionals, for example, but we do so with the knowledge that such ancillary information is equally likely to be filtered by subjective insights. This is not to suggest that either clients or their referees will seek to offer anything less than ‘truth’ but that ‘truth’ is inevitably filtered through the summation of not only life experiences but that biography is also shaped by race, ethnicity and culture. Indeed, as Grant (2021) notes, identity is also shaped by historical events pertinent to the dominant cultural narrative of the group under review. These factors leave social workers in a position of not knowing: of operating from a perspective of incomplete knowledge where the actions of any player are influenced by both explicit and implicit past and present events and where such events and experiences can have disproportionate impact compared to their original weight. Whilst ‘knowing’ there is a single, clear solution to any problem appeals as a comforting idea, in many instances, the problem is ambiguous, and multiple ‘solutions’ offer themselves. But as we’ve also noted, social workers have a strong pragmatic bent; their valuing of practical knowledge and reflective practice means that they often appear to discard theory in favour of action – doing whatever is necessary to stabilise a situation or prevent a catastrophe. Being pragmatists has, however, some limitations. Social workers can be overly keen to identify themselves as active agents, so much so that they risk ignoring other sources of knowledge, for example, research evidence, preferring their own reflections and lived experience to light the way (see McDermott et al., 2017). In addition, the twenty-first century, in particular, has achieved substantial advances in biology and neuroscience, fundamentally changing our understanding of the human body and the nature of its complex interrelationships with the

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environment. Such more nuanced and in-depth understanding, particularly that derived from neuroscience and challenges to linear depictions of human development, its proposed ages and stages, and the nature of environment has increasingly been drawn into social work’s knowledge base (see for example Cameron & McDermott, 2007). The answers to questions about how person and environment actually intersect and how the complicated and contradictory world ‘works’ do however remain under-theorised in social work, leaving practitioners considerably under-prepared for twenty-first century practice. Earlier, we discussed the ‘borrowing’ that social work has greatly benefitted from, but borrowing also has its limitations. These might be revealed in a lack of a coherent, guiding conceptual framework, confused thinking, uncertainty about social work’s role and contribution. Indeed, many social workers when they are part of multidisciplinary team comment that they are more adept at working with others and other professionals’ concepts and ideas than they are about asserting their own when decisions need to be made. In addition, the degree of effective collaboration might depend on other professions being familiar with the particular knowledge base that the social worker brings to the collaboration. Indeed, as Asquith et  al. (2005) report in their review of the role of the social worker in the United Kingdom, it is vital that social workers can maintain a high profile within a multidisciplinary team setting, ensuring that social work values, particularly in health and education settings, and a focus on the needs of service users are not diminished or diluted. This requires that social workers themselves are clear and informed about the actions they intend to take, and the rationale for doing so, in effect that they are able to assert that they work from both a strongly articulated theoretical and evidence informed base. As we have noted earlier, social work is intentionally and quintessentially context-­bound. The twenty-first century context is changing rapidly, and already, in the first two decades, the world has been significantly altered by digital and social media advances, mass migrations, the arrival of what may turn out to be a post-­ globalisation world and the COVID-19 pandemic to name only a few. These considerations and the identification of the strengths, which we have outlined and which clearly characterise social work, stand in need of revisiting and building upon. In our opinion, it is the world view and explanatory theory, complexity theory offers, which will provide the firm and consistent basis for social work theory, practice and research.

2.3 Moving Ahead: Complexity Theory In a world of increasing complexity, and perhaps also chaos, complexity theory emphasises disorder, irregularity and randomness (Jackson, 2019, p. 112). Its central concepts, which will be described in the following chapter, reflect notions that relationships are not linear; collective behaviours are difficult to predict (Flack & Mitchell, 2020); and problems rarely present as individual entities but often as

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‘wicked problems’, as sets of intertwined phenomena (Jackson, 2019). Crucially, systems are not able to be understood by merely studying and understanding the parts. Rather, it is the interactions amongst the parts, and the consequences of such interactions, that are central. In fact, our mental modelling of the world around us needs to be as dynamic as the phenomena that we are studying, and it needs to recognise that we are always a part of the system that we are observing – there is no neutral observer status. The strength rather than the weakness of this perspective is argued by McDermott as ‘…it is at the level of practice/intervention (emphasis in the original) that the interconnectedness and interdependency of systems are revealed with particular clarity, confronting practitioners with the reality of what complexity is and means…’ (McDermott 2014, p. 181).

2.4 Conclusion Our purpose in this chapter has been to identify and discuss the strengths, which characterise social work, and to argue that these strengths provide a strong foundation for further development of social work knowledge for theorising, practice and research. We have noted that current social work perspectives, in particular the recognition of the complexity of the social world reflected in an understanding of social reality as being comprised of micro, meso and macro ‘levels’, has served it very well. However, social work theory and practice have been hampered by a mismatch between the lived experience of practice as complicated, confusing and always changing and the adoption of theories and models that present a static and generally linear, technico-rational approach to conceptualising and practicing. This state of affairs strongly suggests that practitioners and researchers are in need of a more nuanced and reality-based explanation for ‘how the world works’. This, as we will argue in the following chapters, is what an understanding of complexity theory and complex adaptive systems will provide: further exploration of these ideas is the focus of the next two chapters. Reflective Questions • Which of the strengths of social work identified in this chapter do you think you possess? • Are there other strengths or limitations characterising social work theory and practice that you think should be included? • Can you identify a particular ‘wicked problem’ characterising your placement experience? • How comfortable do you feel in situations where you are concerned about risks which your client or service user might face? What do you do in such situations? • What sources of knowledge do you draw on in making decisions in practice situations? • What strategies do you use to manage situations of uncertainty?

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References AASW. (2020). Code of ethics https://www.aasw.asn.au/document/item/92 Asquith, S., Clark, C., & Waterhouse, L. (2005). The role of the social worker in the 21st century  – A literature review, Edinburgh: Scottish Executive Education Department. Retrieved from: https://www.webarchive.org.uk/wayback/archive/3000/https://www.gov.scot/Resource/ Doc/47121/0020821.pdf Australian Institute of Health and Welfare. (2022). Social determinants of health. https://www. aihw.gov.au/reports/australias-­health/social-­determinants-­of-­health Cameron, N., & McDermott, F. (2007). Social work and the body. Palgrave Macmillan. Cree, V., & Wallace, S. (2009). Risk and protection. In R.  Adams, L.  Dominelli, & M.  Payne (Eds.), Practising social work in a complex world (2nd ed., pp. 42–56). Palgrave Macmillan. Davies, M. (1994). The essential social worker: An introduction to professional practice in the 1990s (3rd ed.). Ashgate. Dominelli, L. (2002). Anti-oppressive social work theory and practice. Palgrave. Evans, T., & Hardy, M. (2010). Skills in contemporary social work. Polity Press. Flack, J., & Mitchell, M. (2020), Uncertain times: The pandemic is an unprecedented opportunity – Seeing human society as a complex systems opens a better future for us all, Aeon Essay. Retrieved from: https://aeon.co/essays/complex-­systems-­science-­allows-­us-­to-­see-­new-­paths-­forward. Furlong, M. (2013). Building the client’s relational base. The Policy Press. Gitterman, A., & Germain, C.  B. (2008). The life model of social work practice: Advances in knowledge and practice (3rd ed.). Columbia University Press. Glass, D. (2021). The Ombudsman for human rights: A case book, Melbourne: Victorian Government Printer. Retrieved from: https://assets.ombudsman.vic.gov.au/assets/The-­ Ombudsman-­for-­Human-­Rights-­A-­Casebook-­Aug-­2021.pdf. Grant, S. (2021). With the falling of dusk. Harper Collins. Hare, I. (2004). Defining social work for the 21st century: The International Federation of Social Workers revised definition of social work. International Social Work, 47(3), 407–424. https:// doi.org/10.1177/0020872804043973 Howe, D. (2014). The compleat social worker. Palgrave. International Federation of Social Workers. (2014). Global definition of social work. International Federation of Social Workers. Retrieved from: https://www.ifsw.org/what-­is-­social-­work/ global-­definition-­of-­social-­work/. International Federation of Social Workers. (2018). Global social work statement of ethical principles. https://www.ifsw.org/global-­social-­work-­statement-­of-­ethical-­principles/ Jackson, M. (2019). Critical systems thinking and the management of complexity. Wiley. McDermott, F. (2014). Complexity theory, transdisciplinary working and reflective practice. In A. Pycroft & C. Bartollas (Eds.), Applying complexity theory. Policy Press. McDermott, F., Henderson, A., & Quayle, C. (2017). Health social workers’ sources of knowledge for decision making in practice. Social Work in Health Care, 56, 794. https://doi.org/10.108 0/00981389.2017.1340391 Milner, J., Myers, S., & O’Byrne, P. (2020). Assessment in social work (5th ed.). Macmillan Education Ltd. Payne, M. (2014). Modern social work theory (4th ed.). Lyceum Books. Peters, B. (2017). What is so wicked about wicked problems? A conceptual analysis and a research program. Policy and Society, 36(3), 385–396. https://doi.org/10.1080/14494035.2017.1361633 Rittell, H. W. J. & Webber, M. M. (1973). Dilemmas in a general theory of planning. Policy Sciences, 4, 155–169. Rollins, W. (2019). Social worker-client relationships: Social worker perspectives. Australian Social Work, 73(4), 395–407. https://doi.org/10.1080/0312407X.2019.1669687 Schon, D. (1992). The reflective practitioner: How professionals think in action. Routledge.

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Scoones, I. (2019). What is uncertainty and why does it matter. STEPS Centre Working Paper 105. Retrieved from: https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/14470/ STEPSWP_105_Scoones_final.pdf?sequence=1&isAllowed=y Smith, J., Puckett, C., & Simon, W. (2016). Indigenous allyship: An overview. Wilfred Laurier University. Social Determinants of Health. (n.d.). https://www.aihw.gov.au/reports/australias-­health/ social-­determinants-­of-­health Termeer, C., Dewulf, A., & Biesbroek, R. (2019). A critical assessment of the wicked problem concept and usefulness for policy science and practice. Policy and Society, 38(2), 167–179. https://doi.org/10.1080/14494035.2019.1617971 Warren, K., Franklin, C., & Streeter, C. (1998). New directions in systems theory: Chaos and complexity. Social Work, 43(4), 357–372. Watts, L. (2021). Values, beliefs, and attitudes about reflective practice in Australian social work education and practice. Australian Social Work, 1. https://doi.org/10.108 0/0312407X.2021.1874031 Wolf-Branigin, M. (2009). Applying complexity and emergence in social work education. Social Work Education, 28(2), 115–127. https://doi.org/10.1080/02615470802028090 Zajda, J., Majhanovich, S., & Rust, V. (2006). Introduction: Education and social justice. International Review of Education, 52(1), 9–22. https://doi.org/10.1007/s11159-­005-­5614-­2

Chapter 3

Becoming a Complexity Thinker: Towards an Epistemology of Social Work Practice

3.1 Introduction and Learning Opportunities This chapter describes the epistemological and ontological basis for CT and pragmatism, arguing that human beings are best understood ‘in context’, amidst – and as part of – the ‘swirl’ of intersecting and interacting CAS, in relation to which they adapt and change. In order to journey towards ‘thinking complexity’, we need to know what is meant by CT, the nature of CAS and pragmatism. This understanding will enhance and strengthen theoretical and practice knowledge. Emphasis is placed on the centrality of emergence and the importance of actively participating in interdisciplinary practice. In this chapter, readers will: •• Learn what it is to ‘think complexity’ •• Learn what it is to ‘act pragmatically’ •• Consider three questions in order to guide their journey towards ‘thinking complexity’ and ‘acting pragmatically’: •• What do social workers know? •• How do social workers know? •• How do social workers organise what they know?

3.2 Starting Out We begin by focusing on ourselves, as social workers, acting in and on the world. Despite the influence of theories, models and training about how to ‘be’ a social worker, most of us would agree that it is the bank of experience – personal and professional – which is what we primarily draw on in order to make sense of the world © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_3

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and our role in it, to make decisions regarding the situations presented by service users, other professionals, organisations and community scenarios. In this important sense, social workers are thinking subjects, no stranger to complexity but perhaps unfamiliar with ‘thinking complexity’ (Morin, 2008). Mining this lived experience, which is observed, reflected upon, critically reviewed facilitates our capacity for ‘thinking complexity’. As Morin says (2008, p. 93), ‘every human being is a veritable cosmos…how impossible it is to rationalize a human being down to a formula’, each of us embedded in and shaped by our relationships -as parents, partners, children, fellow citizens, community members. We are simultaneously autonomous subjects (with a unique brain, mind, genetic make-up) and yet dependent (on our education, language, culture and society). Pragmatists (more about them later) echo this view, asserting that human nature ‘(is) inherently holistic, social, relational, complex, and temporal. Pragmatists view individuals as plural and paradoxical: they have multiple and often contradictory selves, ‘…capable of both following rules and doubting and questioning them’ (Fajoun et al., 2015, p. 1790). When we place ourselves as knowers and subjects at the centre of our world and our social work practice, we are placing ourselves within innumerable and complicated clusters of open systems. However, within these systems, there is self-­ organisation, whereby disorder and order as antagonists merging and intersecting with one another produce a process of self-organisation, the spontaneous emergence of collaborative behaviour among elements in a system in response to disorder. An example here might be the formation of a family and how it changes with the birth of the first child. The constant and ongoing processes whereby self-organisation takes place (in all organisations, including our bodies) confront us with uncertainty, unpredictability and yet as social workers, living and practicing means taking action amidst this prevailing uncertainty and risk. But we also know from our lived experience that sometimes when we take action, it seems to lead to outcomes that are not always those we had predicted. The phenomenon of emergence, explored in detail later, makes it seem that chance or serendipity is at play. Those unexpected outcomes however are also opportunities, perhaps leading us to change what we had proposed doing, or invent a new strategy, or hunt for different solutions, to, in effect, enable the emergence of something new. In this sense, the unexpected is both an opportunity and a source of hope (Morin (2008), p. xxxiv). Our aim is to describe how social workers can learn to ‘think complexity’. Posing (and answering) three questions may advance our learning: What do we know? How do we know? How do we organise that knowledge? (Morin, 2008, p. xxvi).

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3.3 What Do We Know? We know that the world of practice is complex and messy and that action requires a step into the unknown and a capacity to deal with risks. Social work in every field is enormously complex, even though understanding of what is meant by ‘complex’ may differ (Manning & Gagnon, 2017). Social workers have told us this, for example, those in the study by McAlinden et al. (2013) of hospital social workers whose varying understanding of complexity appeared influenced by the extent of their knowledge, experience and capacity to disentangle different aspects of cases, contexts and broader service systems. Social work’s foundational concept of person-in-environment highlights this complexity. Drawing originally from GST, it proposed that social reality could best be comprehended as being comprised of systems operating at the macro, meso and micro ‘levels’. As such, person-in-environment and the notion of micro-meso-­ macro ‘levels’ offered an understanding of practice focused on working with the consequences or effects of these interrelationships on the person/s at the centre of attention. As social work’s primary focus has always been on the person-in-context, this makes sense, demonstrating that doing social work means grappling with the elements that comprise the context at the centre of the social worker’s attention. More importantly, the social worker’s task is, usually, to attempt to maintain or change this context in a strategic and thoughtful way in order to effect some kind of desired outcome, which improves human lives and life chances.

3.3.1 Complexity Theory and Complex Adaptive Systems Various theories and practice models that have been developed (as described in Chap. 2) demonstrate a prevailing concern with how a social worker might think about the context in which a problem or situation has arisen and how best to strategically intervene to bring about a solution – even if that might mean maintaining the status quo. However, as we saw in Chap. 2, the actual way in which person and environment are interlinked and mutually affecting has not usefully been conceptualised. We propose that an understanding of CT and CAS in partnership with pragmatism may advance the social work project. We have not yet defined and discussed these theories and concepts, although this is where we are heading. In order to get there, however, we want to embed our discussion within that foundational social work concern – person-in-environment/context – as it is this notion that is at the heart of social work theory and practice. By adopting the metaphor of a camera lens, we can show the ways in which elements detectable at micro, meso and macro ‘levels’ are implicated in ‘what happens’ and how these multiple levels of social and physical reality can be better understood in order to inform strategic action.

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3.3.2 Micro, Meso, Macro As a starting point, the ‘levels’ of micro, meso and macro provide a useful heuristic. Imagine that you are using a camera fitted with a lens with capacity to zoom in and out. The wide-angle view provided by the ‘zoom out’ brings into view the ‘big picture’, for example, a view of the Himalayas, Mt. Everest visible in a veil of cloud at its very top and lower peaks and rocky outcrops covered with snow. This scene encompasses a thicket of scrubby trees, green meadows and a rushing river at the base of the mountains. As you view the scene, you might think about its impact on you: How do you feel? Does your heart beat faster at the sight of something so beautiful? Are you experiencing a slight ‘twang’ of anxiety by observing its sheer scale in comparison to your own? Are you absorbed in the sight, not thinking so much as just caught up in its magnificence? Are you intrigued by the thought that the river seems to have carved its way alongside the steep terrain and both are in some kind of mutual interaction? Zooming in a little more, we focus on the mid-range view of the lower slopes where it is possible to discern scattered houses, steep mountain trails, a group of farmers harvesting a crop on the lower slopes, fishing in the river and yaks grazing in the meadows. Again, how do you feel viewing this scene? Are you moved by the sight of a gentle pastoral scene? Do you feel excluded from it? Do you find yourself feeling sad that your own life does not appear so calm and ordered? Do you wonder with some anxiety how long this kind of pastoral life can continue, knowing what you do about the stretch of globalisation and the impact of climate change? Next, we zoom in to the narrowest view, focusing on one of the farmers as he works. We can see his movements, what he’s wearing, the colour of his skin, the tools in his hands, his facial expressions and perspiration on his forehead. He’s brought so closely into focus at this point that it looks as if we could talk to him. How do you feel looking at him? A little guilty or uncomfortable that he is unaware of your gaze? Curious about the difference between what his life appears to be like and your own? Enchanted by the idea he represents of living ‘close to the earth’? Maybe regretful or even angry that he has to work so hard and so physically when you are only familiar with the comforts of an urban existence? Maybe you feel jealous or envious? Maybe you feel worried for him that this apparently settled and calm existence might change dramatically with climate change and the impact of corporate farming enterprises? When we zoom out again taking the widest view, the farmer, the crops and livestock, the houses and river lose detail and become blurred or invisible. What this metaphor of the camera, with its different lenses and what they enable the viewer to see, demonstrates is the way in which what we term the macro, meso and micro aspects of environment and context ‘look like’. For example, a social worker might know that all aspects of a client’s situation are always present but may find herself looking only at one aspect at a time. However, each element is inextricably part of the other elements, mutually affecting and influencing each other,

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often in unexpected and unplanned ways. In our example, the camera view reveals a high-altitude landscape, governed by weather systems and the earth’s annual trajectory around the solar system, enabling people who live there to work outdoors, farming, fishing and livestock grazing during the summer months. But if our focus is limited to the mid-level view of houses and groups of people, we might wonder at the architecture and the roughness of the terrain they need to negotiate. Closing in still more so we can only see the farmer himself, we might wonder why he’s doing such hard manual labour, why he’s dressed as he is and why he doesn’t seem to be relaxing in the sun. However, once the full picture is revealed, things make more sense  – inhospitable terrain, high altitude, short growing, harvesting and grazing period, houses built to withstand harsh weather conditions and thick, work-friendly clothing. Importantly, it is a view that includes the viewer insofar as the viewer has emotional and bodily responses to what she is seeing and can’t avoid interpreting what she sees through her own knowledge or beliefs about a situation. Nevertheless, it’s also the case as Morin (2008, p. 99) points out that we are very adept at seeing complexity visually, whilst thinking complexity requires concentrated intellectual effort. Keeping the camera metaphor firmly in mind, we can now explore in a little more detail what comprises the micro, macro and meso ‘levels’ of the social, biological and physical environment, which makes up social work’s person-in-environment/ context knowledge base. 3.3.2.1 The ‘Micro’ Level Let’s start with a system very close to us – the human body itself. Human bodies are enormously complex systems of endocrines, hormones, muscular-skeletal and genitourinary systems, in constant and dynamic flux as they exchange and interact with systems both internal and external to the body. The arrival of a new virus into our system, for example, causes immediate reactions as the body attempts to protect itself from damage. Some of these bodily attempts may cause damage rather than aid repair (e.g. allergic reactions to environmental elements). And we have all become increasingly aware of the power of vaccination to protect us during the arrival of COVID-19, enabling the body to build its defences, developing antibodies to affect some degree of immunity from what might otherwise be a deadly encounter with the virus. The outside world  – interactions with other bodies (human and non-human), climate, weather conditions – constantly bombard us with signals about whether we are too hot or too cold, uncomfortable and so on. These outside signals to the internal body enable it to adjust to a steadier state, or to seek out remedies to fend off such discomforts, or to adapt as might, for example, a person who has a stroke and loses part of their peripheral vision but whose brain compensates so that no visual deficit is apparent. Importantly, we are also sensitive to the emotional state of those around us (anger, sadness, anxiety, frustration), which in turn affects our own emotions, for

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example, being shouted at by a passer-by may make us fearful or angry and may make our heart beat faster. As we grow from infancy to adolescence, we learn to regulate our emotions. Where the developing brain is impacted by trauma or violence serious consequences for poor emotional regulation have been identified as this process is interrupted and damaged (Cameron & McDermott, 2007). Many of these so-called outside factors and their impact on us as they, in effect, become part of our internal complex adaptive systems may initially be outside our awareness, while many of them can be brought (at least to some extent) into our awareness. Importantly, as Kinsella (2007) notes, the act of reflecting on practice is also an embodied activity, whereby we use our brains and mental capacities to make sense of and interpret the world and our actions within it, as we change and adapt to what we are observing, considering and learning. This ability to adapt to the outside world can give us increased capacity to manage our lives with less disruption, to respond in creative and innovative ways, perhaps in directions we have had to be told about or to learn, for example, the benefits of yoga and meditation to calm emotions and the value of physical exercise and diet to elevate mood. Our brains (including autonomic nervous system) function both to regulate our internal systems and to enable us to think about and respond to internal and external stimuli, giving us an ongoing and dynamic capacity to adjust and adapt to and interact with the world. 3.3.2.2 The Macro ‘Level’ At the macro ‘level’, the complex adaptive systems are those that, for example, influence climate, that influence the systems which structure societies in relation to gender, race, age, ethnicity, sexuality, health; income; education; the impact of stigma and prejudice; of history, eg colonisation; of political organisations and systems of government; of social media. For example, it is well established that the health of Indigenous Australians and expected length of life, both of which are poorer and lesser than for other Australians, is determined more by social neglect, stigma and the ongoing impact of colonisation than it is by anything else. Generally, when these three ‘levels’ are considered, description of the meso is placed between the micro and macro. However, as we will discuss below, the meso ‘level’ is, conceptually-speaking, better placed last. 3.3.2.3 The Meso ‘Level’ This comprises the complex adaptive systems evident in phenomena such as the daily life in communities where we live, the dynamics of groups we encounter, the organisations we work with and the teams we are part of. The meso level can be thought of as both separate from and interlinked with the micro and the macro; it is the level that derives its meaning and importance from elements at the micro and macro for it is here that we make sense of and act on the information, understanding

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and interpretation of data derived from micro and macro. For example, the alterations to the environment wrought by climate change may not be immediately apparent to us although we know about them, but we may be aware of experiencing higher daily temperatures and a growing sense of unease or anxiety. We balance ourselves at the interfaces of micro and meso, macro and meso and micro, meso and macro, sensitive to ways in which we can use our micro skills of engagement, harnessing emotional awareness and capacity for reflection and simultaneously enlisting macro sources of theoretical and conceptual knowledge about how the world ‘works’. This gives us the opportunity to act and to participate in and undertake strategies and efforts to, for example, curb the effects of climate change, such as joining a climate action group or ensuring that the local council provide recycling bins. Our actions at the meso level then put in place further CAS impacting at all levels. The thrust of social work occurs at the meso level, but practitioners must be familiar with the elements of all three levels of practice and grapple with how they interact however imperfectly. In other words, an essential attribute of social work is curiosity: that is, practitioners need to be curious as to how the person came to be as they are; what factors, physical, biological, personal and contextual have shaped them; and what ways forward present themselves. The aims of intervention need to be concerned not so much with a ‘fix’ to the problem but an overall shift away from formal helping systems and towards a non-problem saturated life situation. The practitioner, at this level, strives to reconcile insights from both the micro and macro levels. The central task is not so much the gathering of information pertinent to the particular role and/or function but to making sense of the information gathered. Individuals are at once complex and products of their context and the sum of their life experiences. They are also individuals who have a role in society that can be assigned according to gender, economic status, ethnicity, sexuality, their level of ableism and their age across the lifespan. It is at the meso level that the practitioner needs to manage incomplete information, complex information, competing priorities, organisational imperatives and ‘surprises’ with outcomes. The challenge is to make sense of complex information, often characterised by non-linear relationships and incomplete information and where there are multiple actors impacting on the outcomes that might be achieved as distinct from outcomes that are ideal. In most fields of practice, the multidisciplinary team at the ‘meso’ level is at the centre of decision making and strategy development. Clearly, other disciplines and professions – and of course other stakeholder groups – hold a range of theories and views about the nature of the social and physical world drawn from their professional or life experiences. No perspective encompasses the whole. However, in order to work with other disciplines and stakeholders, practitioners need to become aware of their own and others’ assumptions and the different ways in which different disciplines construct knowledge. Importantly, the focus needs to be on the issues to be decided, not the disciplinary agenda. For example, in Chap. 2 we described what ‘risk’ may look like to a social worker making a risk assessment but how is ‘risk’ understood by a physiotherapist, a doctor, by the patient or service user and by the service user’s family (McDermott, 2014)?

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Working with other disciplines at the meso level – interdisciplinarity – is a sine qua non of complexity thinking.

3.3.3 What Is Complexity Theory? Definitions of CT are varied and not always in agreement. Long et al. (2018) note in their review of the literature that it has been defined variably as a methodology, a conceptual framework, a metaphor, a world view, a frame of reference or a loose set of concepts and analytical tools. However, it always involves describing a system by describing the interactions and relations amongst the parts (Ladyman & Wiesner, 2020, p. 7) and, importantly, recognising that the boundaries between these interactions and relations are always fuzzy and always feature multiple nested systems. The emphasis in CT is placed on disorder, on irregularity and randomness. The organisation (whether it be the human body, a family, a society, an agency) is an ongoing process, evolving, organic and reflexive. It is located within a context and simultaneously comprises that context. CT draws our attention both to the systems that produce these complex structures and the structures themselves (Ladyman & Wiesner, 2020, p. 8). For example, in order to understand what a family is, we need to know something about the society within which it is both nested and produced. Or where a social worker assesses an aged person, the focus may be on the aged person themselves, but it must simultaneously be on the social, familial and community structures that ‘produce’ the situation. As Hothersall (2019, p. 852) notes, knowledge acts as a set of beliefs that underpin the preparedness and capacity for acting. The explanatory theory provided by CT tells us that reality is unpredictable because it is constantly changing, re-forming and self-organising, in which cause and effect are unclear, and it is their consequences that matter. CT is not yet at the point of being considered a new paradigm, although it could be said (as Morin does (2008, p. 98)) to be at the brink of being so recognised. What it does offer with its central focus on the nature of agents and action, their interactions and impact on emergent system outcomes (Long et  al., 2018) is a clear ontology. CT provides us with what Morin calls (2008, p. 98) a meta point of view. This meta point of view is constructed out of our beliefs about CAS, our self-­observations and reflections on our current and past experiences, all of which shape our view of what is real. This meta point of view enables us to recognise disorder, uncertainty and the dynamism of change and, importantly, to ‘look it in the face’ and to act. To do so, to ‘think complexity’ is ‘…always local, situated in a given time and place…(knowing) in advance that there is always uncertainty’ (Morin, 2008, p. 97).

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3.3.4 Complex Adaptive Systems In thinking about what CAS are, it is helpful to tease out their elements. Long et al. (2018) and Ladyman and Wiesner (2020 p. 65, 66) identify ten key features: 1. Embeddedness/nested systems: CAS are systems embedded within a wider context and within other CAS, as in the earlier example about the nature of a family demonstrates. 2. Fuzzy boundaries: Boundaries between systems are permeable and hard to define, for example, the blurred boundaries between a community and the society which is its context. As Byrne and Callaghan (2008, p.  155) comment, drawing on Cilliers’ work (2001), a boundary needs to be seen ‘…as something that constitutes that which is bounded…the boundary…enabling rather than confining’. Boundaries are dynamic and shifting, encompassing sites of intercommunication, and always appear fuzzy or out of focus. 3. Distributed control and self-organisation: System patterns are not created by top-down control; instead, autonomous agents interact to create outcomes. Thus, organisation in a CAS emerges naturally from local rules held by agents, for example, the social worker in relationship with the service user who, conscious of the need to start by forming a relationship, draws on their skills and knowledge in order to set the ‘ground rules’ for that relationship. 4. Emergence: Interactions between agents create system outcomes that are not directly intended and are greater than the sum of the individual agent behaviours. (We will discuss this in greater detail below – 3.3.4.1.) 5. Unpredictability: The behaviour of a CAS cannot be predicted due to its non-­ linearity, sensitivity to initial conditions and historicism. For example, the social worker cannot know exactly how the service user will react to their ‘first contact’, knowing little about them or their personal journey. While we can look backwards and generate accounts of what is and how things might have come to be (Byrne & Callaghan, 2008, p. 174), we are unable to specify causes because of this unpredictability, but we can see the effects in the situations we confront, and it is these effects that need to be front of mind. 6. Non-linearity: The magnitude of system input and agent interactions is not linearly related to the magnitude of changes in the system. A CAS can react suddenly to minor inputs or fail to change despite overwhelming external pressure. A social worker who is ‘thinking complexity’ will expect to see unpredictable and erratic responses (Gerrits, 2008). For example, she wears a face mask (a minor COVID-19 related change), and the patient then becomes disoriented and panicky (a major change in their affect), or a carer may refuse to accept their relative’s discharge. Despite many efforts to facilitate this (a major external pressure), the carer remains adamant (no change). 7. Phase changes: A small change in the system inputs results in a qualitative change in the system’s state. For example, the client becomes angry and disruptive because the worker is slow to attend to them.

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8. Sensitivity to initial conditions and historicism: Future agent actions are affected by past changes in the system, leading initial conditions to exert a strong influence on system behaviours. For example, the social worker’s knowledge of how a parent has reacted previously to the removal of their child will affect their approach to the next instance when removal is being proposed. 9. Non-equilibrium: CAS are characterised by continual change and do not reach equilibrium. The time scale is important because the social worker may observe at one moment that situations are stable, but this could be temporary (Gerrits, 2008). As reflective practitioners, observing what happens over time, the history and the narrative constructed become important in teasing out which elements and events seem to demonstrate contingency or possible causality, or perhaps suggest themes or patterns. Identifying these will assist in formulating interventions. 10. Adaptation and co-evolution: Agents and systems evolve together, reacting to changes in the context to ensure optimal functioning and survival. The kind of actor who is described by both CT and pragmatism presents a challenging role, someone able to ‘change as circumstances change, to adapt and, where appropriate, transform rather than continuing to do the same thing faster and better’ (Bristow & Healy, 2014, p. 94). 3.3.4.1 Emergence While all these features are important characteristics of CAS, the notion of emergence is of particular significance and is a central concept in CT. The concept of emergence highlights that social workers are working with multiple interacting elements, which lead to unpredictable and uncertain outcomes (Byrne & Callaghan, 2008, p. 189–199). Emergence is where, or what happens, when different systems intersect. What emerges is something new, an outcome, or event or situation, which evolves into something new, unexpected but shaped by history and context and characterised by forms or patterns, which develop, grow and change. Complexity then is a joint property of the system and its interaction with other systems. For example, where the social worker makes an aged care assessment, what emerges within the worker-client relationship is likely to be unpredictable but central to the outcome.

3.4 Where CT Takes Social Work Social work theorising tells us that the concept of person-in-environment is vital to knowing ‘how a person or the world works’. However, social work theories rarely tell us how elements discerned at the micro, meso and macro ‘levels’ actually impact: rarely are they portrayed as dynamic. Rather what is offered are descriptions of what we need to take into account and what we believe affects and

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influences what we see. It is here that CT can advance our understanding and knowledge. The twin notions of self-organisation and emergence are defining concepts within CT, proposing that it is at the boundaries between systems and ‘levels’ that self-­organisation occurs and emergence is apparent. What emerges – what happens at and within and as constituent of the boundaries of systems – can rarely be predicted: rather this process ‘unleashes’ constant change, dynamism, fluidity and thus unexpected outcomes. CT offers social workers an explanation or a meta position from which to view the way in which social and physical reality can be apprehended. CT thus takes social work beyond its notion of a somewhat inanimate person-in-­environment understanding towards a more dynamic and informative recognition of what social workers often intuitively know as they work within constantly changing and evolving scenarios. But how are social workers to use this understanding in order to act? In our view, pragmatism offers an epistemology and ontology congruent with how social workers already understand themselves and their mission. This, combined with an understanding of the nature of CAS, suggests a way forward.

3.4.1 How Do We Know? Social workers make decisions in situations that are complicated, contested by many stakeholders, contradictory, political, and where the decisions they make – or decide not to make  – lead to outcomes, which are generally uncertain and usually risky. Decisions are made in contexts that are dynamic, sometimes dangerous and rarely final. Social workers are decision-makers in concert with professionals from different fields, with differing views, insights and expertise. It is usually the social worker’s job to decide on actions to take/not take in order to, aspirationally at least, better the situation of their service user(s), influenced by their espoused values and ethics. These decisions comprise adaptive responses in which behaviours and actions reflect what we see, learn and come to understand. Importantly, the service users and groups with whom we work generally present us with immediate and sometimes volatile situations, which impact our emotional and cognitive systems. We cannot, nor should we seek to, avoid the power of such encounters for, not only do they influence (sometimes unconsciously) our own reactions but also provide us with rich data for further building relationships and advancing understanding. How we use these data, bringing as much of it as we can into consciousness, is that aspect of practice that comprises the skills of the reflective practitioner. Albeit not a social worker, Schon’s influential book The Reflective Practitioner (1992) gave recognition to what he described as the messy ‘swamplands’ of practice. He proposed that practitioners used or could make use of their lived experience, understanding and reflection to solve tangled and sometimes chaotic problems, the more effective practitioners adopting improvisation to do so. Reflective practice

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(as we saw in Chap. 2) is a valued social work skill. Through reflection, social workers develop mental models as the means whereby they integrate theory and practice. They engage in praxis, that is, reflection and action on the confronting situation in order to change it (see Byrne, 2007, p. 161). Importantly, these mental models that a social worker ‘thinking complexity’ develops will be as open and dynamic as the phenomena they are considering, including themselves as embedded in what is happening (Wolf-Branigan, 2014, p.  70). Schon’s (1992) insights built upon earlier work within pragmatist philosophy.

3.4.2 Pragmatism Social workers are strategists and decision-makers – this is their ‘default’ or adaptive behaviour in situations where they have to do something. Pragmatism is about ‘doing something’, about what Twyoniak et al. (2021, p. 299) describe as the social process of enquiring amongst and between different ‘levels’ of analysis – micro, meso, macro – with the commitment to taking practical action in order to find solutions when these are required (Twyoniak et al., 2021, p. 300). The social worker who is ‘thinking complexity’ locates themselves at the meso level: this is where reflection and critical analysis takes place. It is where, metaphorically speaking, they can ‘survey’ the micro and the macro in order to generate (or observe) emergent meaning, mobilising resources for action (Twyoniak et al., 2021, p. 307). Interestingly, as Twyoniak et al. point out (2021, p. 309), the meso level has been neglected in research and theory, nor has it been proposed as the central positioning for social work practice. However, it is at the interface of interactions and transformations between micro and macro level factors and elements that outcomes emerge: ‘…in order to bring back together the micro and macro levels of theorising…we need to pay greater attention to the less researched connective points at the meso level, where key interactions between micro and macro levels emerge…’. Pragmatists (see Berringer 2019), drawing on the work of Dewey, James and Pierce and others in late nineteenth century American philosophy, recognise that theory and practice are not usefully separated. Actors take action despite uncertainty. Whilst recognising the complexity of social reality, a pragmatist will not try and reduce it, but rather acknowledge and work with it, seeking useable models and theories to guide their decision-making. Pragmatists use what might be termed their ‘practical rationality’ in order to learn as they act, to solve problems in an iterative fashion, concerned more with understanding the processes perceptible as situations unfold. Such processes are considered as narratives, identifying signal events that have disrupted the status quo and pointing to likely actions that could be taken to achieve some stability and the restoration of some order. Pragmatism prompts social workers to think non-­ dualistically, avoiding dichotomies such as actor and structure, theory and practice, person and context. In its place, the social worker thinks across multiple levels of

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analysis – micro, meso and macro. A pragmatic, CT-informed social worker may thus re-think a problem, recognising that it can often not be solved so much as managed (Love & Stockdale-Otarola, 2017, p. 28). Pragmatists adopt theories and models that are useful. As Ansell and Geyer (2017, p. 152) note ‘…pragmatism contextualises but does not abandon the goal of collecting and using knowledge. It is sensitive to the need to bring different types of knowledge together and reflexive about the value inherent in knowledge production’. A model for a pragmatist is a meaning-making aid rather than a prescription and theorising a process of generating categories that are interrelated (Twyoniak et al., 2021, p.  301). Theorising is an ongoing activity because of the interrelationship between action and meaning. The pragmatic social worker’s task becomes an iterative process through which they endeavour to construct the narrative of the situation’s trajectory. Where doubts arise as to the appropriateness or effectiveness of an intervention, these are welcomed, advancing the practitioner in efforts to make meaning of a situation, opening up further areas for enquiry. To possess all relevant informant simultaneously is probably an unrealistic expectation and unrealisable goal. Instead, the challenge is to weigh reasonable information against a reasonable course of action, within a context in which the ethical precept is to do no harm and the most viable course of action is to adopt the least damaging option, to focus on the practical and achievable rather than the theoretical or ideal (Long et al., 2018). Earlier we proposed that CT is not an epistemology but a meta view about the nature of the world. In contrast, pragmatism offers a view of the world and a view of actions that is both epistemology and ontology. Indeed, as Hardy (2016, p. 772) points out, social workers’ experience of acting in situations of uncertainty, complexity and risk ‘…pushes us towards an understanding of the nature of social work as an inherently pragmatic undertaking’. Faced with having to ‘do something’ where outcomes are unclear and situations constantly in flux, the need for trying out or experimenting with different interventions with persevering in the hope of finding something that ‘works’ (Hardy, 2016) is the day-to-day reality for social work practitioners.

3.4.3 Organising What We Know How well do CT and pragmatism complement each other? How do we organise what we know? As several writers have noticed (Twyoniak et al., 2021, Ansell & Geyer, 2017; Long et  al., 2018), a pragmatist view of social reality is very similar to that of CT. Both CT and pragmatism: •• Aim to create ‘useful’ and ‘useable’ knowledge •• Emphasise the centrality of context and environment as key processes and sources of meaning making

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•• Reject reductionist thinking and embrace an expansive understanding of social reality •• Prioritise understanding over theoretical and methodological dogmatism •• See learning and understanding as always ‘in process’ • Recognise the necessity of incorporating the perspectives of diverse stakeholders The social worker who is thinking complexity and acting pragmatically holds a perspective that reflects a particular epistemology of practice. How social reality can be known, in turn, underpins the ways in which we interpret what we observe and learn, influencing how we act. In short, in drawing together these concepts and ideas we will be capable of organising what we know.

3.5 Conclusion Our argument so far is that, drawing on our own reflections and professional knowledge, in combination with the beliefs about social and physical reality and the meta perspective offered by CT, and pragmatism as well as recognising that much of social work practice takes place in interdisciplinary settings, we are organising what we know. We are ‘thinking complexity’ and ‘acting pragmatically’. Reflective Questions •• In what ways does CT advance social work knowledge about person-in-environment? •• What are characteristics of CAS? •• What does it mean to ‘think complexity’? •• From your practice experience, can you describe situations which exemplify CAS? •• What are the advantages of interdisciplinary practice? •• How might you describe a pragmatic social worker? •• What does it mean to ‘act pragmatically’?

References Ansell, C., & Geyer, R. (2017). Pragmatic complexity a new foundation for moving beyond ‘evidence-­ based’ policy making. Policy Studies, 38(2), 149–167. https://doi.org/10.108 0/01442872.2016.1219033 Berringer, K. R. (2019). Reexamining epistemological debates in social work through American pragmatism. Social Services Review, 608–639. Bristow, G., & Healy, A. (2014). Building resilient regions: Complex adaptive systems and the role of policy intervention. Raumforschung und Raumordnung, 72, 93–102. https://doi.org/10.1007/ s13147-­014-­0280-­0

References

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Byrne, D. (2007). Complexity, cities and social action: A consideration of the implications of the complexity frame of reference for praxis. In J. Bogg & R. Geyer (Eds.), Complexity science and society. Radcliffe Publishing. Byrne, D., & Callaghan, G. (2008). Complexity theory for the social sciences. Routledge. Cameron, N., & McDermott, F. (2007). Social work and the body. Palgrave Macmillan. Cilliers, P. (2001). Boundaries, hierarchies and networks in complex systems. International Journal of Innovation Management, 5(2), 135–147. Farjoun, M., Ansell, C., & Boin, A. (2015). Perspective  – Pragmatism in organizational studies: Meeting the challenges of a dynamic and complex world. Organization Science, 26(6), 1787–1804. Gerrits, L. (2008). The gentle art of co-evolution: A complexity theory perspective on decision making over estuaries in Germany. Erasmus University, Rotterdam (CC). Hardy, M. (2016). ‘I know what I like and I like what I know’: Epistemology in practice and theory and practice again. Qualitative Social Work, 15(5–6), 762–778. Hothersall, S. J. (2019). Epistemology and social work: Enhancing the integration of theory, practice and research through philosophical pragmatism. European Journal of Social Work, 22(5), 860–870. Kinsella, L. A. (2007). Embodied reflection and the epistemology of reflective practice. Journal of Philosophy of Education, 41(3), 395–409. Ladyman, J., & Wiesner, K. (2020). What is a complex system? Yale University Press. Long, K., McDermott, F., & Meadows, G. (2018). Being pragmatic about healthcare complexity: Our experiences applying complexity theory and pragmatism to health services research. BMC Medicine, 16, 1–9. https://doi.org/10.1186/s12916-­018-­1087-­6 Love, P., & Stockdale-Otárola, J. (Eds.). (2017). Debate the issues: Complexity and policy making, OECD insights. OECD Publishing. https://doi.org/10.1787/9789264271531-­en Manning, E., & Gagnon, M. (2017). The complex patient: A concept clarification. Nursing and Health Sciences, 19, 13–21. https://doi.org/10.1111/nhs.12320 McAlinden, F., McDermott, F., & Morris, J. (2013). Complex patients: Social worker’s perceptions of complexity in health and rehabilitation services. Social Work in Health Care, 52(10), 899–912. https://doi.org/10.1080/00981389.2013.834032 McDermott, F. (2014). Complexity theory, transdisciplinary working and reflective practice. In A. Pycroft & C. Bartollas (Eds.), Applying complexity theory. Policy Press. Morin, E. (2008). On complexity. Hampton Press. Schon, D. (1992). The reflective practitioner: How professionals think in action. Routledge. Twyoniak, S., Lavagnon, I., & Bredillet, C. (2021). A pragmatist approach to complexity theorising in project studies: Orders andlevels. Project Management Journal, 52(3), 298–313. Wolf-Branigan, M. (2014). Complexity and the emergence of social work and criminal justice programmes. In A. Pycroft & C. Bartollas (Eds.), Applying complexity theory. Policy Press.

Chapter 4

Thinking Complexity and Acting Pragmatically

4.1 Introduction and Learning Opportunities We concluded the previous chapter by noting the congruence between CT and pragmatism and proposed that such a perspective comprised an epistemology of practice. We now want to ground and develop this discussion by bringing personin-context into partnership with our understanding of complex adaptive systems and a pragmatism-­informed practice strategy. Importantly, we also considered what kind of a social actor social workers are seen through the perspective of both CT and pragmatism. We recognised that CAS, comprised of diverse individuals (such as the service users, the family members, the co-workers in the MDT), or elements (such as social structures, policies, climate) are constantly interacting and influencing our behaviour as we act and react in relation to them. These actions and reactions continually evolve as each feeds back on each other and as we, as agents, learn and develop our understanding. From these dynamic and continuous actions and reactions, self-organisation occurs: patterns and structures emerge that are more than and beyond those that occur in relation to an individual actor. As Bristow and Healy note (2014, p.  95), ‘these complex self-organising systems are constantly adapting such that their adaptive capacity is not simply change in response to episodic events or conditions. It is the ability of systems – households, people, communities, ecosystems, nations – to generate new ways of operating, new systemic relationships’. Human agents – or social workers – act with awareness and deliberation, making those decisions, which require ‘floating’ possibilities, negotiating and strategising amongst the range of possible actions they might take. And of central significance, social workers need to recognise that the scenario is constantly changing as service users act and react to what is happening, each participant (including the social worker themselves) adapting and changing as the situation unfolds and unpredictable emergent properties are revealed.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_4

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Social workers will be wary of considering themselves as ‘managing’ a situation because the locus of control is so dispersed and fluid; rather, they might better recognise that they are participants in an ongoing, evolving process in which their own capacity to adapt is vital and their ability to assist service users or clients to adapt is likely to be of central concern. Further still, they are actors within many of those very same complex adaptive social systems as their clients and, in an ethical sense, remain obliged to act within and not from outside them (Byrne et al., 2007, p. 163). In this chapter, readers will learn how a case the social worker is working with: • May be analysed from a CT/CAS informed approach • The social worker’s tasks may be identified using a pragmatic perspective • Requires central focus on the construction of the case narrative in order to detect and analyse patterns and themes • Highlights the importance of identifying the nested CAS to reveal the strengths and limitations for both social worker and client • Suggests the usefulness of adopting some guidelines for thinking complexity and acting pragmatically

4.2 Constructing the Narrative The focus of this chapter is on exploring complexity thinking in practice. To do this, we will begin with a case study. However, in reading the description of the case, it is very important to bear in mind that the ongoing nature and fluidity of the process of both client and social worker in interaction as we have considered in the previous paragraphs is a challenge to adequately capture fully through the static use of words and tabular representation. Nevertheless, let’s start by describing the case of Joan. Case Example  Joan is an 85-year-old woman being assessed by a social worker undertaking an aged care assessment, which is designed to identify and approve her eligibility for government subsidised services. The social worker’s interview with Joan takes place during a lockdown enforced as part of governmental precautions during the COVID-19 pandemic. However, because the social worker has been designated an ‘essential service’ and there are concerns (expressed by neighbours) about Joan’s well-being, a brief and single home visit has been approved as appropriate. The social worker visits alone and is required to abide by mask wearing mandates and social distancing. Contemporary policy for older people in Australia emphasises support to sustain people, over the age of 65 years, both in the own homes and for as long as possible. To establish eligibility for Commonwealth Government financial supports, people are required to undergo a standardised aged care assessment and to meet the eligibility criteria set out in relevant legislation (the Commonwealth Aged Care Act 1997). One such woman is Joan, aged 85 years and a widow who lives alone. She

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has four adult children and describes them as being very supportive. She had a prior assessment 3 years before the current assessment, and as a result, a low level of in-­ home support was put in place and a case manager involved: by the time of the current (re) assessment, her needs had clearly changed, and she required an increased level of support. In advance of the assessment, the assessing clinician was contacted with concerns expressed by neighbours pertaining to self-neglect, non-compliance with medication, non-compliance with a diabetic diet (and with testing of her blood sugar levels), absence of direct family support and concerns that there had been a decline in cognition although initial ‘dementia screening’ did not support these concerns. On the day of the assessment, Joan had to be roused from bed having forgotten the appointment despite reminders (both verbal and written) from her case manager. While she was agreeable to the assessment, she also indicated she was ‘fine’ and there were ‘no problems’. As the discussion proceeded, a number of concerns became evident. The first of these was that Joan had clearly not had breakfast and was generally unable to explain her routines regarding regular meals; despite being diabetic, there were numerous bottles of soft drink evident as well as boxes of chocolates; there was a reasonable level of clutter in the home as well as numerous loose mats and a shaky handrail by the entrance steps. Joan had clearly not showered that day, and her nightwear suggested a faecal accident; she could not explain her medication regime, and numerous packages were strewn across the kitchen benches. While asserting her family to be supportive, it was ascertained that the closest lived a 2-hour journey away and others were in other states with Joan being unable to offer contact details for family, advising also that most of her friends have died. While Joan declined to participate in formal cognitive screening, in discussion, she was unable to offer specific detail about any topic under consideration, did not appear to appreciate the extent of her functional decline and could not offer a plan for how she would manage in an emergency (e.g. contacting emergency services). Further, Joan did not appear to appreciate the need for urgent intervention to assist with monitoring of her blood sugar levels and maintenance of an appropriate dietary regime. Whilst the immediate goals of the aged care assessment were realised, insofar that Joan agreed to seek additional in-home supports, it was clear that there was a relatively urgent need for follow up in order to better understand Joan’s level of cognitive functioning, to alert her family to presenting concerns and to monitor her ongoing safety at home. Within Joan’s situation, there were a number of players or stakeholders. Of course, Joan was the primary stakeholder, capable of asserting her preference to remain at home but with questionable ability to fully appreciate her potential lack of safety precautions or to grasp the entire range of options available to her. Joan’s family was also a stakeholder but for various reasons was unable to offer direct and practical assistance although they wished Joan to remain safe. The case manager already involved clearly helds a stake in wanting maximum possible supports in place while the aged care assessor needed to ensure adherence with assessment standards and to ensure service provision options cohered with relevant legislation and policy guidelines. There were also indirect stakeholders, including the neighbour who had alerted the service, policy makers (and elected politicians) whose

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ongoing tenure depends on policy meeting need, and ultimately the community, which holds an expectation that vulnerable older people will be kept safe from harm, and where shortfalls in meeting such expectations can lead to public outcry and even Royal Commissions and other reviews into the quality of the service provided.

4.3 Starting Where the Client Is The social worker’s task is to develop a strategy to identify and assist Joan in meeting her needs, which, as Morin (2008, p. 96) argues, is in essence the art of working with uncertainty. Indeed, the social worker’s action is itself a strategy, given that what will emerge from her actions is unlikely to be predictable and – whatever it is that happens – will shape what comes next. The social worker recognises that her first task is to understand Joan’s situation; identify any problems; identify strengths and stressors impacting on her, be knowledgeable about the context and its effect on her, be knowledgeable about any resources that could be brought in to remedy problematic issues; and to make a decision (or perhaps a series of decisions) about what to do next. Very importantly, the social worker knows that, by and large, she can’t do anything without the cooperation of the client, but she also knows that taking action (being strategic and pragmatic) requires her to engage in ‘thinking complexity’. In reading this narrative account of Joan’s situation, it is apparent that the social worker has collected numerous facts about Joan, about her situation and about the resources, which may be available to improve her situation. Each fact we might consider to be similar to a thread in a knitted garment, which, when pulled, will reveal how that particular ‘thread’ or fact was woven into the whole of what we can call ‘The case of Joan’. These threads point us towards seeing Joan and her situation as embedded in numerous nested CAS. In pragmatic terms, the social worker has constructed a narrative, prompted by the signal event of a request to undertake an assessment. The narrative runs like this: Joan is a woman aged 85 years: pull this thread, and we can see that that is shorthand for: • A female in late life • As an older female, likely to be someone who is generally somewhat marginalised and excluded • Someone who was born and lived through many decades in Australian society when women were seen as primarily wives, mothers and home-makers • Someone who has lived through some critical life experiences, such as being a young child during World War 2, an adult and mother during the boom years of the 1950s, as seeing the arrival of TV (but who was not exposed until in her 70s to the massive technological and digital changes of contemporary life – social media, 24-h news, email, mobile phones)

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• A woman living alone, distant from family • A woman who may already have endured many losses – of a partner, her health, close relationships • At an age when particular biopsychosocial needs may come into focus, considering that it is likely she may be suffering a number of physical and perhaps cognitive disabilities • Likely to be on a fixed income or pension These assumptions about Joan, which the social worker holds, are drawn from her experience of working with people of similar age and life stage, from her theoretical knowledge of human development and from her own personal experience of family life and life in the community.

4.3.1 Nested CAS Let’ s start by identifying various threads that comprise the complex and nested adaptive systems at the micro, meso and macro levels at the moment when Joan and the social worker meet together to undertake an assessment. These nested systems revolve around Joan, an embodied person, part of a family, a community, a service system, living in a particular geographic location, itself located within a Western liberal democracy. Joan and the social worker meet as embodied persons in interaction with each other. In relation to each of these nested systems and threads, there are likely stressors (e.g. Joan’s cognitive capacity to understand the purpose of the meeting) and likely strengths (e.g. the availability of relevant resources and services). It is important to note that the designation of ‘micro’ or ‘meso’ or ‘macro’ in the tables below must be understood as non-exclusionary terms; rather, they are attempts to label what might constitute the major preoccupation or feature discernible in the behaviour described. Their boundaries are, at best, fuzzy and permeable, and these terms are, above all, heuristic devices. Furthermore, the metaphor we used earlier of a thread is pertinent here: in a knitted garment when we see a loose thread, we may be cautious about pulling it, not knowing exactly what will happen. Likewise, the social worker will realise that all the ‘threads’ presented here are not necessarily linear: rather as complexity theory tells us, unpredictable and non-linear outcomes may eventuate as we try to disentangle them and expand our knowledge of the nested systems, which they comprise. Additionally, the stressors and strengths noted for both Joan and the social worker in column 1 of each table describe consequences or evident outcomes rather than causes, and it is these consequences that become the focus of attention. While Tables 4.1, 4.2, 4.3 and 4.4 provide a useful way of ‘dissecting’ a ‘case’ and identifying various CAS at play across various ‘levels’, does it tell us anything about the lived experience of complexity that the social worker is encountering? Or about what is emerging or likely to emerge? To a certain extent, it tells us that the complexity resides both in the task (making an assessment of Joan, drawing on

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Table 4.1  Client’s stressors Likely stressors on Joan Her age – entering late life; many friends may have died, been hospitalised etc. Multi comorbidities

Level Micro – meso

Complex adaptive systems Absence of or severely restricted system comprising friends and family

Micro

Multi stressors within various bodily CAS, which combine and interweave to create further disability Cognitive system damaged and may lead her to adapt in ways that lead to the emergence of unhelpful outcomes

Cognitive decline that she may be Micro – partially aware of and attempting to meso compensate for, for example, by saying she has contact with children; she could feel confused and anxious Isolation Micro – meso Cluttered house – may make her Micro – anxious about falling and may also meso make her feel depressed about the state of the house and her limited capacity to tidy up ‘Non-compliance’ – this is the name Micro – given to her reaction to what she might meso experience as the stress of other’s demands

Lack of family support

Meso

Lack of family finances

Macro

Poor personal care re hygiene, eating and sleeping

Micro

Poor medication compliance – she might feel less well than she could if she was taking medication

Micro – meso

Absence of or severely restricted system comprising friends and family Cognitive system damaged and may lead her to adapt in ways that are less helpful

The perceived stress of other’s demands makes her adapt emotionally and behaviourally in ways that might be less helpful in terms of meeting her needs, for example, by being fearful or anxious, ‘stubborn’ Absence of or severely restricted system comprising friends and family Restricted capacity and lack of access to get assistance from ‘wider’ resource systems Cognitive system damaged and maladaptive, which may lead to emergence of further difficulties, for example, weight loss, infection Cognitive system damage: may result in the emergence of behaviour, which may exacerbate cognitive damage and her capacity to engage with others

skills, theories, knowledge) and of the task (working with Joan who is expressing some cognitive disabilities, as well as working with and engaging a range of other people and organisations). In other words, complexity of and in the case is a property of the system and of the interactions with other systems, across these levels. The social worker is engaged in ‘thinking complexity’.

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4.3  Starting Where the Client Is Table 4.2  Client’s strengths Likely strengths of Joan Age – relatively long life: likely to have learned strategies for managing challenges and losses

Level Micro-­ meso-­ macro

Her situation has become known

Meso – macro

Relationship with SW – trust may be able to be built

Micro – meso

‘Non- compliance’ a positive in so Micro-­ far as she can make her experience meso known through non-complying, be a ‘person to be reckoned with’

CAS Reasonable longevity suggests earlier life which she has survived, presumably because a range of systems at micro, meso and macro were able to be influenced and adaptive to her Her situation noticed and responded to systemically at meso level – services, resources, care Existence of these services and resources outcomes of adaptive systems at level of policy (macro) Depending on skills of SW and Joan’s earlier experiences, these may assist her adaption and engagement with others systemically at meso level Joan’s adaptation and use of emotional and relational abilities may impact organisational and service system responses, perhaps making them adapt to her demands

Table 4.3  Social worker stressors Likely stressors on social worker Inconveniences of working during COVID – restrictions, masks, distancing etc. – adds stress

Level Micro – meso – macro

Joan’s personal hygiene creates discomfort re smell, re state of the house – perhaps distracting: feelings of annoyance? Revulsion? SW has limited time to spend with Joan due to caseload adds strain because much ground needs to be covered; perhaps creates anxiety for SW who fears she may rush some aspects of the assessment Joan’s ‘non-compliance’ makes SW wary

Micro

SW recognises that she is administering a program, is part of a system and may be ambivalent about this, and about the shortcomings of the system

Meso – macro

CAS SW needing to adapt to requirements instigated at organisational and policy system levels SW’s capacity to adapt within her emotional and sensory systems in order to manage

Micro – meso – macro

SW needing to adapt on personal emotional level to requirements instigated at organisational and policy system levels

Micro – meso

SW’s capacity to adapt within her emotional systems in order to manage both at micro level as well as to respond to task demands at meso system level SW’s capacity to adapt to demands at organisational and macro (policy) system levels in order to respond to task demands at meso system level

4  Thinking Complexity and Acting Pragmatically

58 Table 4.4  Social worker strengths Likely strengths of social worker Level SW feels she’s building a good Micro – relationship with Joan meso

SW has sympathy for Joan

Micro

SW is ‘professional’ – aware that she needs to monitor her own feelings and reactions so they don’t interfere with the relationship and the tasks

Micro – meso – macro

SW has skills and experience from working with similar clients

Micro

SW has knowledge about resources, services, eligibility criteria

Meso – macro

Cas SW adapts her responses and way of working to meet client’s emotional needs and agency tasks: Feelings of warmth and emotional engagement emerge SW adapts her emotional responses as she gets to know and understand Joan SW adapts her responses and way of working to meet client’s emotional needs, agency tasks, and ‘wider’ system demands – Professional, organisational, community expectations, most of all a duty of care, or ethical responsibility around safety for Joan SW’s skills and experience in the 1:1 have honed her adaptive capacities to form relationships with range of clients: Feelings of care and commitment to making things better emerge SW has professional knowledge and ongoing self-development ensures she continues to learn, can adapt to and manipulate the resource system as it changes and adapts, in response to policy changes, community demand etc. A sense of her own competence and the challenge of making things better for Joan emerges

4.4 The Centrality of the Narrative The case of Joan is presented as a narrative, written by the social worker. The problems are presented in the initial discussion of the case, and the signal events that have disrupted the situation are noted. The narrative also details the many assumptions the social worker appears to have about Joan. The likely elements that the social worker will bring to the task or actions she might instigate in order to arrive at an outcome characterised by some return to stability and order are proposed. The social worker wants to take practical action – she is a pragmatist – in the face of doubt, risk, uncertainty and constant change. She has, through her knowledge of situations like Joan’s and her knowledge of Joan’s situation, a good grasp of the likely history shaping Joan’s current situation, the forms and patterns at work, for example, Joan’s growing isolation, her age-related physical and mental deficits etc. She likely holds a relational view of social reality, considering that individuals are outcomes and manifestations of their dynamic relationships with others – including the social worker – and vice versa (the social worker and Joan). The social worker has her own view of history, knowledge of the way the world ‘works’, the impact of social structures on life chances and opportunities, how these evolve, change, emerge and develop. All these sources of understanding will infiltrate and influence her actions in the present with Joan.

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Importantly, as Cooksey (2001) notes, narratives such as we have constructed for Joan are basically incomplete and evolving stories. They are attempts to make sense of her life by ordering events into a narrative plot containing a history of events, interpreted by the social worker in conversation with Joan, in relation to her context and the visible evidence of how her life is lived in her home. Both the social worker and Joan highlight in their interactions what is important now and what might be important next. But as CT informs us, the capacity to predict just what will happen is not possible. Things may of course stay the same – but the presence of the social worker in Joan’s life suggests otherwise. The social worker then, ‘thinking complexity’, will focus on the range of possible future outcomes that may eventuate. Central to this challenge is Joan’s story for it is her history that may allow the social worker to get a sense of what has happened to Joan over time – the trajectory of Joan’s life emerging through her narrative. In this way, the social worker may be alert to the consequences for Joan of life decisions she has made (or not made) and events that have occurred, which perhaps point to contingencies and causes (Byrne & Callaghan, 2008, p. 175), the ‘what might be’ for Joan in the future. So, to make sense of Joan’s situation, to theorise, analyse and act in and on it, the social worker needs to accommodate the knowledge gleaned across these three levels of analysis – micro, meso and macro. However, her starting point must be to locate herself at the meso level. And here is a key point, which will be further explored in later chapters and case examples: it is very often the experience of practitioners that they begin at the micro (or are mandated to begin there), at the immediate presenting situation. What we are suggesting here however is that it is at the meso level that decisions are made and strategies put in place. As we noted earlier, it is at the meso level that the impact and influence of factors active at the micro and macro levels may most clearly be observed and understood. Here too, that emergence may be manifested. Importantly, the social worker ‘in real life’ will (or should) constantly move between various ‘levels’ and, in the process, no doubt sometimes make somewhat imperfect connections or detect themes, which are not present – ‘case threads’ can be deceptive. As she does so, she will surely encounter contradictions and tensions between and across ‘levels’. This is what thinking complexity entails. In so doing, she recognises that what she seeks is the best possible explanation for how things are and what they mean, given the limitations of her position and the resources she has at hand, for example, the opportunity for minimal contact with Joan because of agency regulations during the outbreak of COVID-19. What we see in this case example is that the social worker is the one charged with making an assessment, with acting strategically. As the ‘knower’, she herself is a subject of enquiry, self-reflection and self-analysis. She is in a process of self-­ organising, using her reflections, knowledge of CAS and her pragmatic intent, to ‘coax’ or enable or perhaps just to witness the emergence of patterns and forms as outcomes towards the goals or intentions she has in mind or is charged with securing for and with Joan. She is in this moment an embodiment of what Morin (2008, p. 23) has termed a ‘thinking subject, the ultimate development of self-organising complexity’.

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4.5 From Narrative to Strategy The social worker starts by organising her knowledge of situations like Joan’s and her sensitive appreciation of the uniqueness of Joan’s situation, asking herself the question, ‘what do I know?’ She is aware (as she ‘thinks complexity’) that while seeking a context-specific explanation for how things are, this context is always changing and thus so must her understanding of it. As we have noted, the social worker is essentially developing a narrative account of ‘how things are’ and analysing this narrative for themes and patterns and answering the question, ‘how do I know’. This narrative might be shaped around seeking preliminary answers to these questions (see Ansell & Geyer, 2017): 1 . What is problematic? 2. For whom is it problematic? 3. What values are at stake? 4. What is possible? In so doing, the social worker’s capacity to think complexity and her orientation as a pragmatist will be guided by attention to each of these further factors: 1. She recognises that complexity inheres both in the case (what’s happening) and of the case (what it’s a case of). 2. Thus, she begins from a position that acknowledges and does not reduce complexity. 3. She remembers to see theory and practice as in dialogue and interplay, not in opposition. 4. She begins to construct the case narrative, to, in effect, organise what she knows. 5. She remains alert to and reflects on her own emotional reactions to and during the encounter. 6. She teases out various threads, elements and levels, the CASs in play. 7. She considers how these micro, meso and macro ‘levels’ and structures are nested and how they may possibly interpenetrate. As the social worker reflects on all these aspects, she then poses for herself these questions: 8. What do these cross-level interpenetrations tell me? • About Joan • About the strengths and limitations both she and I bring to the situation 9. What do they tell me about what I could do? • About how much time I have to make future arrangements and instigate them • About where I might best start 10. What do I need to know? • About how to better build my relationship with Joan

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• About the strengths and limitations of the service system and available resources • About the other service providers who form the multidisciplinary team or are key stakeholders with interests in the ongoing planning decisions • About what members of the team or other stakeholders know and don’t know 11. What do I not yet know? • • • • •

About how Joan is likely to react to my interventions About the availability of services that I think she needs About how willing Joan might be to accept these services About how other service providers and stakeholders will view the situation About how other service providers and stakeholders will judge my decisions regarding Joan’s needs • About those features of Joan’s situation which, collectively, no one amongst other professionals and stakeholders knows about These steps and questions are, importantly, initial steps and questions. Our understanding of CAS informs us that, in the interpenetration of systems, emergence of something unpredictable or unexpected is likely. For example, the social worker may believe that she has established a warm and trusting relationship with Joan; however, Joan may (unexpectedly) refuse to meet with her at her next visit. The emergence of what the social worker believes to be hostility, though unexpected, is paradoxically also an opportunity for something different to take place, and perhaps, some feedback from Joan may lead to the social worker acting differently if she is to develop trust and cooperation, or perhaps the occupational therapist may take leadership of the case at Joan’s behest. The important point here is that the social worker’s work, whether with a service user or an organisation or another discipline or stakeholder is an ongoing and recursive process in which complex adaptive systems, responding to moments of disorder or perturbation as they ‘rub up against’ other CAS are always in a state of becoming – emerging into something new or other. In this sense, the social worker’s work is never done.

4.6 Thinking Complexity in Action This foregoing discussion highlights the social worker’s challenge in thinking complexity and in acting pragmatically. So, in bringing this all together, what are some of the elements that will guide us in developing our capacity to think complexity and act pragmatically?

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4.6.1 A Guide to Thinking Complexity and Acting Pragmatically While our illustrative example has been drawn from casework, these guidelines may also have utility in group work, community development, management, policy and research, serving as prompts to thinking complexity and acting pragmatically. We might pay attention to: • Understanding CT and CAS (what systems are, how disorder and order generate emergence) and its usefulness in shaping action that is strategic and pragmatic • Mining our lived experience through reflection, considering our emotional and physical reactions as events unfold; being self-analytical, self-critical • Always being aware that it is the context within which we are working that is of central importance • Teasing out and uncovering the assumptions driving our perspective • Locating ourself at the meso ‘level’ • Working in an interdisciplinary way with key stakeholders • Focusing on the issue rather than the disciplinary or stakeholder agenda • Constructing the narrative • Looking for themes and patterns within it • Expecting the unexpected • Being prepared to consider a range of possible solutions or ways problems might be dealt with • Being prepared to adapt to what may unexpectedly emerge as relationships unfold and strategies are put in place While in this chapter we have used an illustrative example from a direct practice situation, in the chapters that follow we will use examples and practice experiences, in addition to casework scenarios, relating to program development, community development, management and research. Reflective Questions • What patterns and themes do you see in Joan’s narrative? • What strategies would guide your interventions with Joan? • The case narrative provided is written by the social worker: how might Joan construct her own narrative? How might it differ from the social workers?

References Ansell, C., & Geyer, R. (2017). Pragmatic complexity a new foundation for moving beyond ‘evidence-­ based’ policy making. Policy Studies, 38(2), 149–167. https://doi.org/10.108 0/01442872.2016.1219033 Bristow, G., & Healy, A. (2014). Building resilient regions: Complex adaptive systems and the role of policy intervention. Raumforschung und Raumordnung, 72, 93–102. https://doi.org/10.1007/ s13147-­014-­0280-­0

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Byrne, D., & Callaghan, G. (2008). Complexity theory for the social sciences. Routledge. Byrne, D. (2007). Complexity, cities and social action: A consideration of the implications of the complexity frame of reference for praxis. In J. Bogg & R. Geyer (Eds.), Complexity science and society. Radcliffe Publishing. Cooksey, R. W. (2001). What is complexity science? A contextually grounded tapestry of systemic dynamism, paradigm diversity, theoretical eclecticism and organisational learning. Emergence A Journal of Complexity Issues in Organizations and Management, 3(1), 77. Morin, E. (2008). On complexity. Hampton Press Inc.

Part II

Thinking Complexity in Practice

Chapter 5

Early Doing and Thinking Complexity: The Multiple and Complex Needs Initiative Margaret Hamilton

5.1 Introduction and Learning Opportunities This chapter reflects on the experience of implementing one of the first legislated attempts to provide an appropriate response to people with multiple and complex needs: the Multiple and Complex Needs Initiative (MACNI), established under the Victorian Human Services (Complex Needs) Act 2003 that was subsequently amended to extend an early sunset clause (2006) and then continued with some changes in the Human Services (Complex Needs) Act 2009. The purpose of this chapter is to provide some historic context showing the emergence of complexity thinking of the chair and members of the Panel established to participate and guide the implementation of the MACNI from 2004 to 2009. At the end of this chapter, the reader will have some understanding of: • The context in which the MACNI emerged in the early 2000s in Victoria, Australia. • This early example of deliberative complexity work in responding to people with multiple and complex needs: emergence of ‘doing – thinking – doing’. • Complexity as systemic, existing in more than an individual’s presentation. • Guides and conceptual tools from the experience of the MACNI including: • Elements of individual assessment • Examining assessment of service system • Beginning concepts for complexity work including service sequencing, sharing of risk and coordination. • Coordinating services and ingredients for successful service partnerships. • The possible role and characteristics of a care plan coordinator. • The use of description, reflection, a research stance, theorizing on the job, adaptation, feedback and review.

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• Flexibility, feedback and ongoing tweaking/learning and adaptation in responding to complexity; the emergence of theory and practice. • Specifically, the following concepts regarding complex adaptive systems (CAS) will be included or inferred: fuzzy boundaries, emergence, unpredictability, dynamic systems beyond person-in-situation thinking, micro-meso-macro understanding, importance of historic experience (client, worker(s), services, and their interactions) and the consequences of these dynamic interactions, a place for intuition, reflection, pragmatism, theory with praxis and inter-cross-­ multi-trans-disciplinary thinking.

5.2 The Context of Legislating for MACNI After 10 years as the director of a statewide health and welfare organisation, I was appointed to chair the MACNI Panel in 2004. Many human service providers had for some time been raising the difficulty of effectively and efficiently1 responding to people who presented repeatedly for their service, often with the same illness, dysfunction, problems or unmet needs. They presented at hospital emergency departments, courts, housing services and elsewhere with physical and/or mental health troubles, drug use, significant disabilities including suspected acquired brain injuries (ABI) and various life crises and disruptive social situations with sometimes multiple, negative life events dominating their lives. Over the preceding decade, our human service systems had undergone enormous change in how they were funded, the nature of expectations under contracted service provision and the requirements of service delivery. Transitioning from historic funding and operation of services that had emerged over decades, often from religious or values-based organisations, had produced a somewhat patchy, inadequate, or inefficient system of care. At the start of the 1990s, with a newly elected market-­ oriented government, new models of service funding and provision emerged (O’Neill & Alford, 1994). At their respective extremes, this might be described as transitioning from a care and concern values base to one now characterised by the commodification of care and support. Both extremes are overstated. This resulted in more systematic planning of what government (representing us, the community) felt our society was responsible to provide, then prescribing what services would be funded (including ‘deliverables’) and then competitively contracting these services out, sometimes to previously funded organisations and sometimes to new ones.

 Importantly, the context of contracted service provision made this a particular problem for balancing the key performance indicators (KPI’s) for services where numbers provided with a particular service, depending on the specific service provision, were sometimes measured as mere counts (how many came through the door/got some sort of service) and/or (less commonly at that time), numbers ‘successfully’ treated/serviced using crude success indicators. In my experience, this meant some services were choosing the ‘easier to treat’ to achieve their targets over efforts to prioritise people’s needs which meant that some of the neediest were effectively excluded. 1

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In this process, many people with significant and often long-standing complex needs were falling through the cracks, since for them, services had become somewhat fragmented, now only providing specific, contracted service types. ‘It is not surprising that where diagnostic categories are the basis of systemic “silos” and, in turn, the specific service contracts they oversee, agencies focus on treating or responding to specific problems of their clients that they are funded to attend to and struggle when they have to meet needs of clients beyond their remit’ (Hamilton, 2010, p. 309). The capacity and resources of people with limited personal, social and/or financial resources, or who were in a crisis or had significant impairments, to put this all together for themselves, was limited. The experience of services was the focus of a survey conducted by the (then) Department of Human Services (DHS) in cooperation with the Department of Justice (DHS, 2003). This research identified a relatively small number of individuals across Victoria, sometimes colloquially referred to as the ‘frequent flyers’, who were repeatedly and frequently presenting or being brought to emergency and other services, requiring a crisis response. While many of the services had tried to respond to these crises and the apparent chaos of these people’s lives, the services’ opportunities and capacity to engage to achieve lasting adaptive and sustainable change in their lives were negligible.

5.3 Development of the Multiple and Complex Needs Initiative From this collected experience, the MACNI was initiated to respond to those people in Victoria who were requiring significantly greater coordinated responses than the now contracted out system could provide. This led to legislation that established the formal elements of the MACNI: principles, eligibility criteria and processes were set out in the Act, referral pathways and governance oversight of the DHS, the MACN Panel, a contracted Multidisciplinary Assessment and Care Planning service and a separate Intensive Case Management Service were defined. Explanatory information was provided at that time in a pamphlet. ‘The Multiple and Complex Needs Initiative, The MACN Initiative provides a time-limited specialist intervention for those 16  years and older who are identified as having multiple and complex needs including those with combinations of mental illness, substance abuse issues, intellectual impairment, acquired brain injury and forensic issues and who pose a risk to themselves and/or to the community. Stated objectives: to develop a more effective and coordinated approach to supporting this client group so that they can achieve stability in health, housing, social connection, and safety, as well as being linked into comprehensive ongoing support’ (DHS/MACNI, 2004).

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This chapter will discuss the MACNI Panel’s role and experience from the perspective of the chair. Under the legislation, the primary function of the Panel was to determine eligibility for assistance under the MACNI and to oversee the development and implementation of Care Plans based on a comprehensive assessment, including allocation of brokerage funds where appropriate. It was from this experience that the necessity to manage interconnected elements and to think both broadly and deeply emerged; what I call thinking complexity.

5.4 Program Emergence: Development and Implementation/ Evolution There were inherent challenges in this work including having to establishing a new statutory body and recruiting staff: building a team with shared values and commitment with people from diverse professional backgrounds and experience and working with a number of bureaucratic parts of the two departments involved and many people in other statutory roles such as the Public Advocate and those with legal responsibilities in other domains such as the Mental Health Review Board (now the Mental Health Tribunal), guardians and from my own professional commitment – consideration especially of the people who were subject to the initiative themselves, their families and carers including those services which were already involved, as far as possible. Preliminary Work  Prior to starting, I attempted to develop linkages with appropriate people and bodies who might facilitate a culturally sensitive and knowledgeable source of advice regarding the interests, experience and needs of sub-groups including those that work with the First Nation’s Community. In addition to these systemic and practical activities, including setting up an office, IT systems and administrative procedures, it was necessary to interrogate the meaning and intent of the legislation, given we were to do this for the first time. Legislative clauses relating to eligibility included those relating to consent, diagnostic criteria, risk, need for supervision and support and potential to derive benefit from the MACN initiative. Beginning Reflections  In interpreting the Act, I decided to carefully read the Definitions Section of the Act, but deliberately did not to go to the extensive Legal Department of DHS for help. Instead, I used Panel members experience, after exploring the intent of the Parliament by reading the Green and White Papers from the Parliamentary debate at the time the legislation was considered. I realised that the MACNI legislation could be ‘used to urge services to respond and support people’s rights to service and that this could then occur in supportive rather than coercive relationships’ (Hamilton, 2010, p. 320).

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The Panel then worked to apply this law pragmatically, avoiding getting too tied up in intricacies of legal interpretation. While the Panel then adopted a relatively liberal interpretation of the diagnostic and risk related criteria, a tighter definition of the ‘derive benefit’ clause (Section 15 d) seemed prudent. This was intended to differentiate those who might derive benefit (potentially thousands) from those who were understood to be the target for MACNI. In consultation with other Panel members and DHS, I developed interpretive statements including: ‘The MACN Initiative is for that small number of particularly troubled people with complex presentations and situations; where the current services are unable, in any reasonable way, to respond and/or be configured to support and maintain them in reasonable health in an environment that is safe for them and for other’ (Hamilton, 2005, p. 1).

This then required a more thorough assessment of a person’s history of service use, not just assessment of the person and their situation. Exploration of theoretical models about managing complexity were a focus. Matching the systems of care that were then available and the needs of the target population had become a ‘wicked problem’ (Termeer et al., 2019), particularly following the contracting out of many services. This was to require us to act pragmatically across fuzzy boundaries to find novel conceptual frames, including using mixed research strategies and methods involving diverse disciplines. It meant inter-­ cross-­multidisciplinary thinking, emerging theoretical efforts in Integration and Implementation Sciences (Bammer, 2005) and even consideration of emerging ‘hard or pure’ scientific literature on complexity, while grounding our thinking in practice knowledge and practice wisdom and benefiting from intuition arising from the long, combined experience of MACNI Panel members. Yes, these people had wants, needs and problems; some aspects of which were self-defined and not always consistent with funded ‘service types’ or available ‘menus’ of service organisations. It became apparent that ‘people with complex needs’ were, in fact, quite ‘usual people’ with many needs presenting in diverse ways and places requiring the multi-layered (micro-meso-macro) approach now suggested by complexity theorists. These people with disparate needs and wants who were often presenting for help in a crisis were now caught up in navigating complex systems, often with limited medium- or long-term benefit. The complexity in this situation lay as much or more in the systems than in the individuals seeking help or remedies. From this, the dual focus for the MACNI emerged: the person in situation within a web of complex systems, each impacting and influencing the other, with inherent fluctuations over time and place. This was not a static phenomenon and required a dynamic and interactive set of ideas, theories, perspectives and skills to assess, formulate a plan, implement it and then maintain sufficient flexibility to allow for adaptation.

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5.5 Operation of MACNI For the purposes of making decisions about individual people, the Panel consisted of the chairperson and two community Panel members with a member of the DHS also attending. Once a person was deemed eligible, a referral was made to the Multidisciplinary Assessment and Care Planning Service which was responsible for the development of a comprehensive, individualised assessment and proposed Care Plan draft. The chair was involved in providing support, advise and progress tracking and providing feedback on the development of material for Panel deliberation and decision-making. The Panel’s formal sessions then considered and formally decided on Care Plans and appointment of a Care Plan Coordinating service.

5.5.1 Assessment, Formulation and Care Planning Most of the MACNI clients had been well known to many services over an extended period. Assessment and Care Plan development was much broader than the activity of one agency, or over one period. Assessment  Needed to include usual case considerations of descriptive information about the person’s sociocultural background and history of use of crisis and other human services together with assessment of risk. Many people came to the MACNI with detailed specialist assessment reports. It remained important to think about ‘knowing what we don’t know’ as well as making meaning of what we do. Getting the balance of reliance on former assessments and initiating further specialist assessments were important, and what is now referred to as historicism was important. The person’s experience of using services and, where possible, the services’ attitude and experience of working with the person were critical to decision-making. It often called for secondary consultants’ reports, a step not traditionally used formally in social work practice. A person-centred needs assessment was necessary to achieve any matching of needs and services. This might seem self-evident, but in the context of most services now being funded to deliver only targeted service types/ episodes of care, assessments were becoming service centred, not client or person centred, primarily focussed on the question: Is this person eligible for our service? Assessment required synthesis of information and thoughtfulness, necessitating a high level of integrative skills (not necessarily expertise in each of the domains relevant to a particular client). It was necessary to sense gaps in the information available and to know what type and level of expertise was required to fill those gaps. This synthesis was needed in coming to an understanding of who the client is, how he or she comes to be the way they are at this time, what their wishes and needs are and how these can best be met: their story.

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Formulation  This synthesising or integrating process requires formulation (Johnstone & Dallos, 2006) that might be understood as a hypothesis about the person’s difficulties and strengths, including resilience and their capacity to engage, which draws on data from the biological, psychological and social domains and uses a stated theory or theories in its development. Formulation has been described as a story constructed rather than a discovered story. In summary, a formulation, or a construction of the client’s narrative, provides a map of how things are, how they came to be that way, to what extent they are changeable and how such change can be achieved. As a hypothesis, a formulation needs constant revision based on emerging data, on changing circumstances and on the effects of intervention(s). As a member of the MACNI Panel reflectively theorising wrote: ‘The concept of formulation might usefully be thought of as a piece of creative curiosity posing interventions worth trying to avert escalating chaos’ (Smith, 2008). The Panel was faced with dense description from time to time, together with intense service engagement with people and often involving several services. While these are vital ingredients, the addition of careful reflection and formulation of ‘meaning’ amid this ‘working’ was crucial. Adding value to the overall understanding and provision of service was seen to be a conceptual task requiring ongoing development and became a focus of the MACN Panel. Developing a notion of what the person and their situation was all about  – formulation  – required :  expertise, experience to allow confidence and then an advanced capacity to communicate, both verbally and in writing. Care Planning  The aim of a Care Plan was to achieve a cohesive and integrated, systemic response to the person/situation/needs and wants in a carefully configured network of services that often necessitated many service providers. It was quickly apparent that gaining agreement and clarity about roles required sensitivity, skill, commitment, time, flexibility and ongoing negotiation. Current knowledge of service access and eligibility criteria together with an assessment of the likelihood of successful cooperative arrangements between services (and potential costs) was fundamental to achieving agreement about common short medium-term goals. Once satisfied that the Assessment and Care Plan was appropriate and that the person and proposed services were agreeable, the Care Plan was formally determined for implementation including appointment of a Care Plan coordinator and the allocation of any agreed necessary brokerage provided for as one of the legislated elements of MACNI. A formal review of progress occurred at least every 6 months in order to discuss progress, explore options and sometimes pose alternatives, solve problems and occasionally resolve disputes as well as provide a significant amount of feedback, elaboration and mentoring. Importantly, these reviews always included consideration of the intent of the care plan and progress toward some medium- and longer-­ term goals as well as achieving current stability.

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This allowed review of aspects of the person’s situation that might have become more salient such as involvement of the original referring service(s), family or carer engagement, emerging identity matters including cultural heritage, physical health issues, early childhood trauma and specific issues that might require additional detailed assessment as they became more relevant over time. Collaborative service involvement was necessary, sometimes requiring careful use of the authority of the Panel as it was necessary to start planning transition from the MACNI to an appropriate mix of usual services in the longer term.

5.6 Coordinating Complexity Thinking Across Systems: Integration and Conceptual Development Much was learnt about the people as Care Plans were implemented. For example, we might learn how a person responded to different circumstances, just what they would and could do when engaged with a worker and what happened when services were initiated, continued, changed or ended. This information and experience enriched the Care Teams’ understanding, and sometimes this was more important than the initial MACN assessment. Care plans always needed to be understood as evolving. This required a constant stance of enquiry and reflection. As a plan was implemented, new options were identified, operationalised, monitored and tested with feedback leading to review of the plan. Only when engagement was achieved and service commenced were the interventions refined, developed and refocussed.

5.6.1 Emergence of a Stance of Enquiry as Care Plans Are Implemented Increasingly, this was conceptualised as our challenge and research task: to discover, discern and establish whether and how a person could be sustained in the community and establish what services and resources were necessary to achieve this. We thought of this as researching while doing (akin to what elsewhere might be called action research): observing, reflecting and considering commonalities or themes and conceptualising ideas, ready for further consideration or testing of hypotheses. Ultimately, the work was to sort out what is the least restrictive, least expensive option for sustaining the person in the community. The challenge was: what more can we discover? Every effort was made to achieve stability, and if, and when it was achieved, it provided an opportunity to test the next emerging idea, possibility and hypothesis, or to explore alternative ways of achieving desired outcomes for the person and the services involved. It allowed testing of ‘hypotheses’ about the person’s potential and then, based on the evidence collected, indicate what was needed.

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The rationale for recommendations, actions and for plans was examined. We asked to see the formulation of goals and sometimes explicit hypotheses. These then framed the monitoring and review work the MACNI sought to test/trial regarding what was required, to discover what works and what does not, how elements or interventions work and under what circumstances. It involved asking: what resources are required and what difference does it make if the resources are provided in particular ways? What level of support, supervision or restrictions are necessary? Can we achieve the same result with different resources or with a different constellation of services? As expressed at that time: ‘. . . we are not merely seeking a settled state (for the clients), albeit an exceptional achievement if/when this is possible, but always posing new questions, testing, and checking. This is an opportunity to try … ‘what if questions’ such as, …what if we supported this person to be housed in the community, what if we assisted them to embark on some training, what if we had a … Occupational Therapy assessment to inform how best to work with someone with this specific acquired brain injury, what if .. the OT provided training (and mentoring) for all of the care team …; what if we funded a community development approach to a broader support group (possibly including carers) ..to facilitate their understanding and capacity to respond consistently alongside services, (even) what if this person was moved to a different location or town with fresh service provision, …’ (Hamilton, 2006, p. 2).

We also worked to clarify what constitutes success. For example, we regarded a situation where a person did not improve in any area and required considerably more support and supervision than previously available, as a potential success provided that several options or ‘experiments’ had been tried, to extend opportunities for a person to have developed greater capacity and stability. It was also important to imagine the future, asking what a person might be doing in (say) five- or ten years’ time and how the MACNI might be used to work towards this vision, including what else needed to be learned.

5.6.2 Thinking Complexity as Research In addition to the direct work of the MACNI Panel, we convened forums to facilitate research thinking about complexity. The Panel observed that there was an emerging theoretical and practice literature on transdisciplinary work and multidisciplinary

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teams and some early writing on complexity and risk sharing (Green, 2006).2 However, much of this had not been validated and/or applied to social work, where using integrative skills to achieve understanding and possibilities in different contexts was increasingly necessary. The task of the MACNI was thus to work toward integration of various sources of information, advice and knowledge of options alongside development of concepts and approaches to complex situations to progress thinking and actions. Formulation thinking and planning potential pathways for each person’s situation within the service networks is when professionals involved had to confront complexity. It is this comprehensive mix of foci that is often avoided in specialist clinical assessments. The work of parallel matching the formulation of a person’s situation to service availability and agility or capacity for adaption was the sphere of complexity thinking necessary to implement care plans. To achieve a humane approach, we had to be pragmatic. Risk sharing provides an example of how more thoroughly exploring a concept in practice can assist in developing strategies to overcome what might otherwise be impediments to service engagement. It became necessary to build mechanisms for risk sharing in collaborative partnerships to successfully implement Care Plans in the context of the MACNI clients. This was facilitated by attention to the concern of program managers when it emerged that a general risk averse stance was the initial response when considering the implications of being involved in service provision to high-risk people who, by their very nature and histories, posed some threat. While it might be assumed that this was centred on issues of workers’ safety, it emerged that concern about the risk to the organisation’s reputation, especially in the eyes of their departmental source of program funds, was more significant. Through engaging clients together with service providers in talking through these issues, services became more ready to try. Reflecting on this, the research thinking, or approach used, started with a mix of detailed description of the phenomenon (getting services to tell us about reluctance to ‘sign up’) while engaging clients in discussion about the triggers for behavioural disturbance, alongside professional assessments. This then allowed for a deeper analysis of what the problem was and then opened new doors to allow planning using the initial draft scenario prepared by the Assessment and Care Planning Service, imagination, sometimes brainstorming techniques to gather ideas, and then the experience of Panel and Care Planning MACNI personnel to sift and consider response options and exploration of what might work or what story might fit and what it might look like. This was followed by the negotiation of specific arrangements with each service provider to achieve individualised contracts. In this process, we learned that an intrinsic aspect of many clients’ care and support plans had to be development of focussed risk and behaviour management  Between 2004 and 2012, various occasional written contributions in the form of short papers were developed by David Green who, prior to his appointment as Deputy Chair of the MACNI, had been the independent Public Advocate in Victoria, Australia, and had considerable experience of thinking about and managing risk in that and other roles (Green, 2006, 2012). 2

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strategies. This made it easier to contract specific services as they could now share the risks of involvement. This proved to be one of the most successful strategies for development of clients’ capacity to manage their lives in the community. Allowing increased independence through close and consistent use of these plans made it possible to stretch boundaries. Given that the process of bringing a range of services to the point of agreement and commitment to an integrated Care Plan was the most difficult aspect and greatest cause of delay in managing the complexity of the MACNI, this proved to be vital.

5.7 Lessons Learned Through Thinking Complexity for Five Years Perhaps, the most significant work of the MACNI Panel over the 5 years of operation arose from constant use of the experience to reflect on what was learned and ongoing adaptation. These lessons learned were captured in a detailed report submitted to the DHS and responsible Minister at the end of this period (Hamilton & Elford, 2009). Unfortunately, this challenge was not formally considered in any depth in the external, independent evaluation contracted by DHS, and although it used a mixed methods approach and was particularly useful to the government in deciding the structure of its ongoing support, the main findings of the report were focused on the description of the elements of MACNI, some cost/benefit analysis regarding outcomes and structural options (DHS, 2007a, b, c). Other reviews were conducted during the initial implementation phase and subsequently, as well as critiques and supplements to these reviews (DHS, 2007a, b, c). These were then available to the DHS in redesigning the MACNI (DHS, 2011). As this chapter is about the doing and thinking of complexity work, it will not focus on the evaluations and outcomes reports nor the ‘Snapshot Studies’ that involved detailed case studies (DHS, 2009). In summary, the quantitative outputs/outcomes evaluation (DHS, 2007a, b, c) in response to the questions posed concluded that improvement in individual (client) outcomes, improvement in service coordination and the adequacy of legislation had all been achieved. The question of achievement of cost-benefit was less clear and difficult to assess because there had been insufficient time to draw conclusions and it had been difficult to get appropriate data (especially from central agencies). The rest of this chapter summarises and describes these lessons learned such that it might be possible to read the following chapters looking for evolution of this (then) thinking and reflecting on the theoretical content that is in the earlier chapters.

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5.7.1 Assessment and Care Planning There were two domains for assessment: the client or person focus and the service system focus, and complexity existed particularly where these two met. The boundaries between and within elements of human systems are never clear, usually fuzzy. Hence, this division into two major domains is somewhat artificial and omits other dynamic aspects such as the policy context, or research evidence of effective interventions. A focus on these two domains nevertheless assisted with practical analysis. 5.7.1.1 Reflecting on the Individual/Person Aspects of MACNI Assessments As this has been a major focus of social work writing and thinking over much of the past 50–100 years, much is written about assessment of individuals, even individuals in situations and systems. Importantly, the MACNI experience was a reminder that: • Although social work has recognised the importance of including the person (and potentially those close to them) in their own assessment, there have been challenges in maintaining this value stance at times with increasingly tight funding and service contracts. • Engaging the person in their own situational assessment takes time and thoughtful listening: to allow the person to express their perception of their situation, their hopes and wishes as well as them considering what opportunities they want to pursue and what they can contribute. • Common features among MACNI clients’ histories included early childhood trauma; sometimes poor or uncertain physical health (often missing information in welfare service records exhibiting a dysfunctional division in our systems of care) and histories of significant homelessness and housing problems. However, they were still alive and thus had capacity for survival! • Secure, safe and stable housing is a necessary ingredient to any case plan for a person with multiple needs. This is especially important for groups such as women who have children and for those leaving prison as this is crucial, affecting their capacity to engage with and sustain engagement in programs and functional social worlds (DHS, 2007a, b, c). • It was vital to consider peoples’ strengths and resources as well as limitations, deficits or problems, the latter having been the dominant focus of historic social work assessments. This might include exploring their capacities, interests, resilience and resources in the context of potential services involved and their interaction with those services. These aspects were as important as identifying crises, difficulties, deficits and dysfunction that had often been the dominant focus of assessments. Sometimes, there is little that can be done to resolve deficits except build or strengthen positive attributes and potential. This requires sensitivity to

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• • •

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peoples’ stories and historic responses to varying situations, interactions and interventions. Complexity resided more in the service system and the interaction of the person in the service system than inherently in the person themselves, making this interface the important focus for assessment thinking and understanding of consequences. Complexity thinking is not about ‘cures’ or even extraordinary humane responses to individuals; it is more about how to sustain people in relative stability in the community, allowing them to achieve the best life they can. Humane care is necessary, but it is not sufficient. The value of maintaining continuity with usual service systems as far as possible needs to be at the forefront of complexity thinking to facilitate sustainability. A change in service providers for a person might be necessary but should not be assumed. Assessment needs precision for thorough Care Planning and an understanding of historic efforts. An example is provided below to illustrate this. Learning Through Precision: Case Example A statement that a person is ‘a poly-drug user who had unsuccessfully attempted detoxification seven times’ is inadequate. There is no information about what the person gives as a reason or what use means/what they are trying to achieve in using them. Nothing about which drugs, when, in what combinations; the preferred drug of use, direct and indirect problems experienced by the person because of or associated with their drug use. Further, there is nothing about what has been learned regarding service responses tried nor a detailed examination of the episodes of treatment or any attempts they have made to change their drug use, their preferences, and their own ideas. Also, it does not address the person’s reasons for trying to stop or change; does not answer the questions why would they/what’s in it for them to do this? Has ‘treatment’ ever contributed to less harmful drug use or other functional outcomes? After all these resources have been used this provides no guide for future treatment planning. The person and the services need to learn from each attempt: what might be better next time/what hypotheses are then being tested, etc. Ask anyone who has ever given up smoking nicotine tobacco; few succeed on their first attempt, but they learn from each trial how to approach the next attempt.

5.7.1.2 Reflecting on the Complex Service System Aspects of MACNI Assessments Although much of the framework for the MACNI model had been designed around an understanding that the target population had multiple problems and complex histories, the reality that emerged was that these people’s needs were quite clear and

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often not generically complex. What was complex were the systems, programs and services that might be necessary or helpful in responding to their needs. There was a need for conceptual framing of service systems. While there are numerous formats and frameworks for the presentation of an individual’s story, case history, current situation and areas of life that need to be included in an individual’s assessment, there were few, if any, adequate frameworks to guide assessors in describing the service systems across location, time and the individual’s experience of them. Some analytic tools were emerging (e.g. Kim & Anderson, 1998), but given the diverse disciplines involved, they were not easy to ‘discover’. Service system analysis was the least well developed in assessments. There was no clear or consistent frame for analysis and no headings to write under generally provided in professional social work or related literature. This was further complicated by the concern or hesitation associated with being critical or ‘looking in on’ others’ services. The assessment task of available services and networks was, in part, sorting out what needs to be assessed. It required the assessment of complexity itself, and the MACNI Panel made some attempt to start this, with the following elements as part of what was learned. • There is a need to continue to grow the language, understanding and capacity to articulate complexity. We need to contribute to the growth in status, recognition and capacity of the complexity specialists. In recent history, professional paradigms and service structures have separated people and services. Professions have rewarded detailed, specialist expertise that can be efficiently used. However, this can be antithetical to a comprehensive and well-integrated appreciation of complexity as these single specialist perspectives are not sufficient to ensure integration. We must recognise the need for a new brand of specialist in this context: Care Plan Coordination (see below). • Essential issues of access, eligibility, service system contracts, expectations, domains and worker capacity were considered. Then came the need for other knowledge, negotiation and liaison skills requiring good communication skills, persuasion and leverage (often through a mix of perceived authority of the Panel and/or brokerage funding) to achieve agreement and then delivery of services in a cooperative and collaborative arrangement. This proved to be the bigger challenge. • Thinking complexity is shared work, and relationships between participating services are fundamental as this can include sharing risk, consultation and support, mentoring, supervision and sometimes containment. Professional social workers recognise and understand the importance of trust in relationships between workers and consumers or clients. In addition, trust was needed between services, organisations and workers, requiring some clear boundaries and understandings of roles and responsibilities grounded in shared understandings of the intent of a Care Plan. • Hope and optimism are necessary. Some enthusiasm, optimism supported by a belief that it is possible to make a difference, was in stark contrast to the

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•

•

•

•

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(­sometimes) cynicism or exhaustion, burn-out or hopelessness exuded in some workers’ approach to case management and service provision. While a building block of social work values is a belief in a person’s capacity to change, so too must be a belief in the capacity of services and systems to be changed. This is an attribute needing nurture and acknowledgement. It must be treasured since hope and optimism are necessary to sustain work with complexity. Complexity work requires engagement. Many people participating in MACNI had been traditionally difficult to work with. Worker and service capacity to engage were crucial to success. It is more than mere coordination, requiring commitment and ongoing capacity to reflect and adapt while ‘doing’ reflective practice and reflective research combined or doing while thinking and thinking while doing – both about what one is doing as well as what one is learning about the impact and consequences of this ‘doing’. Clarity required agreement on goals, specificity of each service’s role and consistency were vital for successful implementation of care plans (Hamilton, 2006). This must include monitoring and sequencing of services and ongoing close cooperation, feedback and flexibility regarding focus and timing. Sequencing of service interventions had not been formally anticipated in the early emergence of MACNI but soon became critical to success. Clearly, the timing of elements of responses can make a difference to how someone can use resources or assistance. It was the complexity of assessments considered in the context of availability of services that explicitly required consideration of sequencing. There is little value in providing family therapy, physio- or occupational therapy, for example, if a person does not have a safe, secure, stable home. Thus, priority setting and sequencing of responses and services were necessary to maximise synergies in delivering a range of services. This was sometimes hard to achieve, especially when waiting lists and limited services were involved, which meant developing holding plans and re-thinking short- and medium-term elements that might be achieved during transitions towards overarching or longer-­term goals. This became a major task of the Care Plan Coordinator. The provision of brokerage funds under this legislation3 was a useful platform of the MACNI, and while sometimes necessary, this was not the main ingredient of service cooperation.

Coordination was vital. Figure 5.1 details elements of service system partnerships required to achieve desired outcomes. This then created the need for particularly skilled and experienced people/services to manage this: Care Plan Coordination involving holding, monitoring and manipulating the dual and dynamic aspects of both the individual and the service system elements together. This is addressed in the next section.

 This chapter will not detail matters regarding brokerage except to suggest that given the significantly increased policies and programmes that are now operational in the Australian context, particularly for example, the National Disability Insurance Scheme, reflection on this aspect of thinking and doing complexity work achieved in the MACNI would require a whole chapter! 3

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Ingredients for Effective Service and Coordinated Care Plan Partnerships • • •

•

•

Consistency of purpose - especially regarding the client Respectful, collaborative processes - built on trust. Sharing of: o understanding of the approach to be used and the rationale for this o risk o information (thoughtfully and differentially targeted) o learning - including targeted training. o care team thinking, including willingness to make hunches or hypotheses explicit, and o feedback. Clarity o of roles (including distinction between care plan coordination and case management) o of sequence and timing of specific services (and capacity to deliver this) o regarding monitoring of indicators of change relevant to the person, goals and the services involved – including costs/use of resources to assess the value of specific interventions. Capacity for flexibility of service provision and willingness to modify arrangements and resource/support levels in conjunction with monitoring the impact of change.

In addition, other facilitators could include: • Access to brokerage as an incentive to assist with timely and targeted contributions and for additional assessments. • Clear authorisation and ratification or agreement to the overall proposals and resource allocation/distribution from some external body (this occurred in the first five years of the MACNI)

Fig. 5.1  Ingredients for effective service and coordinated care plan partnerships

5.8  Care Plan Coordination To ensure that the Care Plan as agreed was implemented required careful coordination which also involved ongoing tweaking and adaption, review and sometimes re-contracting of services. At the time, this was described as maintaining a directional client-centred focus in the context of dynamic and complex service responses beyond just the person-in-situation or environment. Coordination was the most important element of success of the MACNI, and the DHS commissioned evaluation acknowledged this (DHS, 2007a, b, c), though it did not elaborate all of the issues identified in this chapter. Care Plan Coordination, with complex clients involving multiple agencies, is clearly a practice that has considerable potential and was the subject of a major section of the paper written by the Panel to contribute to future planning for the MACN Initiative (Hamilton, 2008). The service responsible for the Care Plan Coordination, Indigo, at that time itself commissioned an evaluation that was conducted by a group including the lead author of this text (Absler & McDermott, 2009). A significant role of Care Plan Coordinator (CPC) was leading and supporting change through improved practice attempts with individual clients by working with and through other services. The effort could influence systemic improvement and modifying how services worked together in relation to a client. However, to achieve

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this required a vision beyond the immediacy of necessary ‘client settling’ or alleviating a crisis. It had to include a commitment to longer time frames than usual and a systemic focus. The CPC was not responsible for delivering specific services to the client. This was most often done by a case manager who was responsible for day-to-day decisions about delivery and coordination of care and interventions ‘on the ground’. The task for the Care Plan Coordinator, and one of the practices that differentiated it from case management, was not with the client but with the services that provided for the client. This required setting and pursuing goals that included both the person and the service system. CPCs were asked to systematically address the extent to which their ‘hunches’ or hypotheses about the person and their interface with services had been tested and the results of these trials. This required development of indicators that could be used to monitor the impact and outcome of specific interventions or arrangements. This then contributed to Care Plan Review decisions about additional or next aspects of service delivery for trying. This detail and systematic review had been largely missing in most people’s previous experience with services. Care Plan Coordination was not usually a role that could be filled by inexperienced workers. Both the Assessment and the Care Plan Coordination services under MACNI had employed a range of experienced welfare and health/education/housing and justice backgrounds who brought an innovative, committed stance to these roles, making the emergence of the role of Care Plan Coordinator possible by their willingness to ‘experiment’. Workers in these roles required ongoing support including supervision, peer review and access to experts in the field. We observed that it was relatively difficult to achieve all three of these. From the perspective of the Panel, we had noted that complex clients are often unpredictable and require innovation and flexibility. There was still no specific training for this role available at the time. Green (2012, p. 2) noted: ‘These clients, [consumers] or patients with multiple and complex needs constantly present new, unpredictable, even counter-intuitive, and sometimes very challenging issues to services. Cause-effect relationships are rarely linear and customary responses may not work. The demands on services can be idiosyncratic and confound customary expectations. Standard practices may be ineffective’. Further reflecting on these first 5 years, Green suggested: ‘The next phase of the Initiative must give greater attention to the effective knowledge, skills and practices which have emerged, but are at this stage fragile and under-conceptualised’. From our experience, the Panel discerned some key ingredients for successful Care Plan Coordination.4 This included a mix of specific traits or qualities of the individual CPC and the agency or service that was expected to provide the support, supervision and training required to facilitate this complexity work (Fig. 5.2).

 More recently, the Victoria Government Department of Families, Fairness and Housing (2021) has published a Guide for Service Providers on the MACNI regarding Care Plan Coordination 4

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Care Plan Coordination – Key Ingredients Individual Care Plan Coordinator A sound mix of competence and confidence is needed including: •

• • • • • •

capacity to: o engage people who have often been traditionally difficult to work with o manage with and through others (often without necessarily having contact with the client) o share experience, information, work, risk, and responsibility o analyse and formulate assessment/plans while maintaining a cycle of exploration. significant experience in case work and case management broad experience of welfare and (ideally) /or health and/or justice service delivery confidence in the appropriate use of authority (with clients and with service providers) communication skills, including good negotiating and writing skills ability to strategically use focussed consultation (primary and secondary) other personal qualities including humane concern, empathy with both the client issues and service providers’ experience, imagination, hope and optimism.

Agency providing Care Plan Coordination • • •

•

acknowledgement of the specific skill set (above) required to undertake the work effectively desire to integrate complex clients into service provision framework(s) capacity and interest in provision of supervision and support, and management understanding of a stance of constant inquiry and an ability to pose options, oversight the implementation of an agreed Care Plan/means of achieving goals, monitor and assess achievement (or failure), analyse, consider, and provide feedback and develop new options or approaches accounting practices that allow for recording of expenditure and resource allocation in parallel with service activity and monitoring of the impact on client and service specific outcomes in person centred funding arrangements.

Fig. 5.2  Care plan coordination: key ingredients

5.9 Review, Feedback and Termination Finally, a note regarding review, transitions, and terminations.

5.9.1 Review Sessions of the Panel The Panel’s hardest thinking was done in formal individual Care Plan Review Sessions: ‘interrogating evidence’ included reading, sometimes consulting other experts, and asking questions or suggesting options and often providing mentoring of MACNI service personnel or, sometimes, clear advice. Reviews were crucial to the progress of many Care Plans and were conducted quite formally to ensure they carried the appropriate authority behind the expectations, including timing, of what was to be delivered. While all service providers espouse the goal of commitment to timely and well-coordinated or integrated effort,

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the nature of work and human endeavour suggests that it was sometimes the upcoming review that evoked action and responsiveness. Reviews needed to be systematic and sometimes involved bringing in new assessments through the inclusion of experts in specific areas to help clarify diagnoses, explain behaviours, point to alternative ways of working with a person or identify other services from less usual sources or point out training gaps. In addition to the Care Plan Coordinator, Panel sessions could include the client and/or carers, guardians, consumer advocates and legal representatives, service providers, specialist input or consultants and sometimes DHS Regional Coordinators. The process of reviews generally took up to half a day, beginning with the Care Plan Coordinator’s verbal report, which briefly described the person and provided the context of their progress to date, updated any events or information that had changed and systematically reviewed the specific goals or intent of the Care Plan outlining the achievements and difficulties experienced with implementation. The rationale for any recommendations for change from any participant was interrogated, and the future direction of the Care Plan, including transition beyond the person’s involvement in the MACN Initiative, was included. Review sessions used various forms of sharing information including written reports, sometimes photos or videos, occasionally clients’ art works, verbal reports and reactions and experts’ written reports or secondary consultation input. They then allowed for questions and challenges as a means of seeking clarification, round table problem-solving providing a forum for new ideas, further exploration and contributions towards the next phase of working together. Reports were crucial tools informing decision-making (Hamilton, 2009). Panel review sessions could formally determine variations to the original Care Plans (required to ensure clarity of purpose and arrangements for all involved) and were also held at the end of a person’s involvement with the specific MACNI.

5.9.2 Feedback and Reflection Formal written feedback was always provided by the Panel chair following Panel sessions. As a standard aspect of our work, Panel members would spend a minimum of 30 additional minutes reflecting on lessons learned from the case. This was useful in building knowledge about complexity as well as a check and summary of the discussion and decisions made about the person’s care plan in the session. A comprehensive summary was then provided that always sought to acknowledge progress and then identified agreed areas of focus in the ensuing period, articulated any allocations of brokerage and identified follow up actions or recommendations for the attention of the Care Plan Coordinator. This feedback formed the basis of the formal Session Reports that served as official records. These attempted to capture the ‘findings’ about the person interacting with the services involved as well as helping to inform the evolution of the MACNI itself.

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5.9.3 Endings: MACNI Terminations Since endings were understood to be as important as beginnings, terminating reviews were also formally reported and provided as feedback to the client and, importantly, ongoing services to ensure that arrangements were in place for the transition of responsibility to the usual service systems. These reports attempted to review what had been learned about the person and the services, including the person’s individual strengths and their responses to support and interventions used: what worked/ didn’t work – and how it worked, the ongoing level of support needed with a summary of the services involved and engaged at the time of termination and potential future service providers. It also identified service system gaps and successes, possible opportunities and costs. The terminating reports endeavoured to tell the story of the person through their time of involvement with the MACNI.

5.10 Conclusions The MACNI continued beyond the period described in this chapter with some different arrangements following the evaluation and review of these first 5 years (DHHS, 2017). I hope and assume that the ongoing emergence of conceptual thinking and practical approaches that occurred in these first 5 years of the MACNI continued. MACNI still exists with some differences as a government funded program, though it is now (in 2023) managed through the Department of Families, Fairness and Housing. Its continuation suggests that it is a vital part of the mix of services that our communities require – especially for those people who are perceived as having multiple and complex needs that are not well managed in the myriad of service networks. As described in our final report, ‘The MACN Initiative was never designed as a preventative program but as a remedial response to an existing configuration of service challenges’ (Hamilton & Elford, 2009, p. 64). It seems it was a necessary part of the service matrix, with ever increasingly greater complexity that then as now was seen as inevitable, driven by so many of the social, economic and environmental problems confronting contemporary governments (Higginbotham et al., 2001). From my own professional perspective as a social worker, I have had a privileged opportunity to be involved in the emergence of thinking and doing complexity work and striving conceptually and practically to respond to the challenge of assisting services and workers to focus and coordinate their resources on assisting people to enhance their life chances and, sometimes, to save lives. The work of thinking about complexity, of managing the policy, program and practices of this earlier complexity service and the opportunity to now reflect on it more than a decade later, has been exciting, sometimes scary, and always interesting. I thank all that have been involved; before my involvement, during and

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since – those clients who were the subjects of the project and the workers who were enthusiastic and energized by the opportunity of working in the MACNI. My role involved some ‘doing’, but the focus of my effort was on thinking, though it was the thinking that produced the next effort of ‘doing’. Thinking complexity remains at the core of most of our lives in an increasingly intertwined world, and the task of delivering services in this context is, in my view, where social work as a profession has the preeminent role. It has been interesting to re-visit and share this experience. Reflective Questions • In Part 1, Chap. 3, we described ten characteristics of complex adaptive systems: which of these can you identify in this account of the MACNI? • How did the MACNI Panel’s thinking evolve over the 5 years recounted in this chapter? What elements do you think emerged that shaped their thinking and action? • This chapter describes how the Panel’s ideas, thinking complexity and acting pragmatically developed during the early 2000s: do they still resonate with your experience two decades later? • Which elements of this innovative program remain useful today in the policy, programme development, research and practice of social work?

References Absler, D., & McDermott, F. (2009). Holding the System, An evaluation of Care Plan Coordination (Commissioned by Indigo – The then Care Plan Coordination service within MACNI). Bammer, G. (2005). Integration and implementation sciences: Building a new specialisation in ecology and society. Society, 10(2), 6. Department of Families, Fairness and Housing. (2021), October. Care plan coordination: A guide for service providers on the Multiple and Complex Needs Initiative (word). https://providers. dffh.vic.gov.au/care-­plan-­coordination-­guide-­service-­providers-­multiple-­and-­complex-­needs-­ initiative Last accessed 30 Jan 2023. Department of Health and Human Services. (2017, December). Service provision framework: Multiple and Complex Needs Initiative ISBN 978-1-76069-206-3 (pdf/online). http://providers.dhhs.vic.gov.au/multiple-­and-­complex-­needs-­initiative. Last accessed 31 Jan 2023. Department of Human Services. (2003). Responding to People with Multiple and Complex Needs: Phase One Report. Previously available at www.dhs.vic.gov.au Department of Human Services. (2007a–2012). Reports and Reviews available at that time. All previously available at http://www.dhs.vic.gov.au/about-­the-­department/documents-­and-­resources/ reports-­publications/macni-­development-­review-­reports Department of Human Services. (2007b, March). Accommodation Options Survey. Department of Human Services. (2007c). Evaluation of Multiple and Complex Needs Initiative Final Report. http://www.dhs.vic.gov.au/__data/assets/pdf_file/0007/329227/KPMG-FINAL-­ REPORT-December-2007pdf. Accessed 18 May 2011. Department of Human Services. (2009). Review of client status post termination from the Multiple and Complex Needs Initiative Snapshot Study May 2008 – July 2008. Department of Human Services. (2011). Revised multiple and complex needs Initiative model; June 2009 – February 2011 MACNI mini-review, Summary of findings. 4 May 2011. Department of Human Services/MACNI Panel. (2004). Information pamphlets. Taken from hard copy at that time. Currently accessible short version: DFFH, Multiple and Complex Needs

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Initiative 17250 https://providers.dffh.vic.gov.au/multiple-­and-­complex-­needs-­initiative-­17250 Accessed on 23 Feb 2023. Green, D. (2006). Evaluating the MACN Project  – Thinking about outcomes and how they are identified and measured. Paper prepared in conjunction with MACN Panel meeting with Department of Human Services MACN Central Team. October 2006. Green, D. (2012, March). Confronting the problem of complexity and integration in human services. Unpublished paper provided to the author. Personal Professional papers of the author. Hamilton, M. (2005). Early MACN Panel thinking. Presentation to Workshop on the MACN Initiative. June 2005. Personal professional papers of the author. Hamilton, M. (2006). Taken from presentation by Panel Chair, at a MACN Initiative Assessment and Care Planning Workshop on 20 October 2006. Personal professional papers of the author. Hamilton M. (2008). Complex problems, complex clients and complex service systems: Why complex practice is an important part of the next stage of development of the MACN Initiative. Unpublished paper. (Referenced in DHS (2012b)). Hamilton, M. (2009). Thoughts on writing reports and assessments: A Reader’s perspective. In H. Cleak (Ed.), Assessment and report writing in the human services (pp. 40–51). Cengate. Hamilton, M. (2010). People with complex needs and the criminal justice system. Current Issues in Criminal Justice, 22(2), 307–324. Hamilton, M., & Elford, K. (2009). The Report on the Five Years of the Multiple and Complex Needs Panel, accessed online https://www.dhhs.vic.gov.au/sites/default/files/documents/201712/5-­ Years-­of-­the-­Multiple-­and-­Complex-­Needs-­Panel-­Aug-­09-­.doc Accessed 31/1/2023 [Formerly at: at http://www.dhs.vic.gov.au/operations/regional-­operationsperformance/ multiple-­and-­complex-­needs-­unit/references-­and-­reports]. Higginbotham, N., Albrecht, G., & Connor, L. (Eds.). (2001). Health social science: A transdisciplinary and complexity perspective. Oxford University Press. Johnstone, L., & Dallos, R. (2006). Formulation in psychology and psychotherapy. Making sense of people’s problems. Routledge. Kim, D.H., & Anderson, V. (1998). Systems Archetype Basics, From Story to Structure, Pegasus Communications, Inc [Digital version December 2011. PDF]. O’Neill, D. L., & Alford, J (Eds.) (1994). The Contract State: Public Management and the Kennett Government. (Deakin Series in Public Policy and Administration; No. 6). Centre for Applied Social Research, Deakin University. Smith, G. (2008). Unpublished occasional notes provided to the author. MACN Panel deliberations. Termeer, C., Dewulf, A., & Biesbroek, R. (2019). A critical assessment of the wicked problem concept and usefulness for policy science and practice. Policy and Society, 38(2), 167–179. https://doi.org/10.1080/14494035.2019.1617971

Chapter 6

Thinking Complexity Across Fields of Practice: Children and Older People

6.1 Introduction and Learning Opportunities Casework, arguably, represents the most basic form of the one-to-one helping relationship upon which all forms of social work intervention are built. Case management reflects a form of individualised service that typically encompasses social casework, clinical casework and case management (Chenoweth & McAuliffe, 2012). However, as pointed out by Gursansky et al. (2012), case management differs from casework insofar that casework tends to suggest a single agreed problem for work, whereas case management comes into play where complex needs are presenting and a single service response is not appropriate for the situation. Throughout the casework relationship, initial and sustained engagement is central. Even where there is reluctance to engage, choice must be respected but the reasons underpinning that choice explored (Preston-Shoot, 2016). Like most relationships, casework remains a relationship that can be ambiguous at best, messy and fractious at worst, unfolding over time with many unanticipated factors impacting on its strength. The relationship is also shaped by the lens, biases and perceptions through which social workers view the world and weigh various elements of the available evidence in varying ways. Under such conditions, typically accompanied by time pressures, it must be recalled that clinical encounters are more than a collection of decisions that may be articulated by the completion of prescribed instruments or measures as these decisions reflect complex social interactions (Goldenberg, 2009; Greenhalgh & Wieringa, 2011). Chronological age is frequently a marker for legal and policy determinants. What children and older people have in common is that both groups are able to access universal services such as education (children) and aged care pensions (older people). In addition, some will need to access the secondary service system such as child guidance and family support (children) and domestic care and personal care

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(older people), and some will require intervention at the tertiary level such as statutory child protection and adult guardianship services. In working with children and older people, social workers assume diverse roles. They may take roles such as family violence workers (relevant to both child abuse and elder abuse); they may be drug and alcohol workers; they can act in advocacy roles; they can work in foster care or broad family support. They can also be aged care assessors, and they can be child protection practitioners. While the roles social workers can assume are diverse, so too are the theoretical approaches to practice. However, casework is arguably the most common approach, offering a one-to-one relationship upon which engagement and intervention is built. At the end of this chapter, readers will: • Understand the nature of thinking complexity and acting pragmatically in casework practice noting that appropriate intervention requires a delicate, and continuous, mix of doing, thinking and doing. • Have a framework for conceptualising working with individuals across a range of domains and transferrable to different field of practice. • Identify particular characteristics of CAS with focus on fuzzy boundaries, emergence, adaptation and co-evolution and non-linearity. • Through the presentation of case narratives, understand how a social worker who is thinking complexity might act pragmatically in response to the dilemmas and uncertainties that arise in relation to ethics, self-determination, uncertainty and risk and be able to begin to apply this thinking to their particular field of practice.

6.2 Context Each client is unique, and rarely straightforward, in terms of either problem identification or solution. The client seldom sits neatly within the particular parameters of the role held by the social worker, noting the client ‘rarely reads the rule book’. They also present with problems and issues that span service systems characterised by fuzzy boundaries amongst and between these systems. For example, a psychiatrist treating an adult patient for mental illness may have to consider the implications for family violence and whether reports need to be made to police in response to alleged assaults and/or to child protection in light of child safety concerns, signalling that confidentiality of the therapeutic relationship is not absolute nor is the professional role limited to the primary client only. Complex cases present with intersectional characteristics. For example, in a child protection referral, there may not only be questions of safety for the child but substance abuse and/or mental health concerns, as well as issues relating to insecure housing. Such a presentation suggests that the intervention needs to stretch across different service systems with each service system holding a different primary focus and a different threshold for entry. This gives rise to a need to collaborate with players from a range of service systems. However, collaboration can be undermined by

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differing entry points, different key performance indicators and differing service availability, or indeed no service availability at ‘worst’ and long waiting lists at ‘best’. Collaboration can also be challenged by incomplete information and/or differing organisational imperatives about privacy, confidentiality and requirements for how information can be shared and when. It is also important to remain mindful that intervention into one dimension of the problem can yield unmet needs or unanticipated outcomes in other dimensions of the problem, or the service user might simply ‘fall through the cracks’ as one service agency can rarely meet all needs. This means, for example, addressing acute health needs is unlikely to focus primarily on  meeting needs for secure housing, mental health interventions and child protection considerations. A reality is that time-limited intervention is generally neither indicated nor appropriate for many clients but is often required in a service context that privileges short-term intervention over long-term casework. Other contextual factors invariably embedded in casework are factors that most social workers are familiar with, but, somehow, they are factors that ‘simmer beneath the surface’ and do not readily get articulated in day-to-day practice. Firstly, there is an emphasis on risk assessment whereby a pre-occupation with risk can infringe on the rights of the individual, and those laws and policies designed to protect can actually become a threat (Sayce, 2009). This means that overly zealous intervention can pose the same degree of threat that is posed by no action. Secondly, there are questions of capacity, particularly pertinent for both children and older people, or the ability of individuals to decide what advice they can accept or reject. According to the New South Wales Government (2020 p.18), a person has capacity when they are able to: …do all of the following. Understand the facts involved, understand the main choices, weigh up the consequences of the choices, understand how the consequences affect them and communicate their decision.

In considering the question of capacity, it is important to note that most practice settings will have clear parameters around who is able to determine capacity and under what circumstances, with legal definitions and practice realities sometimes being different. It is also important to be mindful that capacity and expression of preferences are separate considerations. For example, a five-year-old child may be able to clearly identify a preference to return to parental care but be unable to appreciate the risks to safety associated with this preference if parents have been unable to successfully address the protective concerns. In similar vein, a 92-year-old person may clearly indicate a preference to return home from hospital but, for reasons associated with lack of capacity, be unable to appreciate that family members can no longer reasonably be expected to meet their care needs in view of diagnosed dementia, falls, incontinence and a need for full nursing care. Thirdly, questions also arise about state intervention in private lives whereby human societies each experience anxiety about real or potential social disorder (Payne, 2005) and seek to discipline and regulate social life (Howe, 1996). These are considerations inherently concerned with the degree of coercive intervention

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that is acceptable in any situation and within a relevant framework that seeks to impose checks and balances between the need for state intervention to protect individuals on the one hand and awareness of the dangerousness of state intervention on the other hand. These considerations are embedded in the moral framework that underpins social work activity. Bisman (2004) holds that the core of social work has always been the moral imperative to care for others. Ethics entail rules to be pursued and the reasons for such pursuit and relate to responsibilities towards self and others (Malik, 2014).

6.3 Thinking Complexity in Work with Individuals When we undertake casework, we typically adopt a preferred theoretical approach whether it be ‘problem-solving’ or ‘solution focussed’ to name but two options. There may be a pervasive sense that adherence to program and policy guidelines can act as a technico-rational means of solving the problem. However, what is needed is a more situated, nuanced and relational approach to finding the most appropriate course of action (Braye et al., 2017 p. 329). This resonates with the characteristics of CAS, introduced in Chap. 3, such things as fuzzy boundaries and nested systems. When we think complexity, we recognise that situations are always multifaceted, single solutions to problems are rare but rather diverse pathways to understanding, and action might be sought, offering a multiplicity of answers (Gilpin & Murphy, 2008 p. 34). As such, we need to accept that surprise, uncertainty and lack of determinacy are fundamental elements emphasising the need for social workers to develop less a clear pathway and more a menu of contingencies (Gilpin & Murphy, 2008 p. 43). By a menu of contingencies, we mean that social workers need to be prepared to respond to unknown or unplanned events as they emerge. It is also a willingness to abandon, or at least modify, an agreed plan that turns out to be poorly suited to those emergent circumstances. The advantage of thinking complexity, for working with children and older people, is that it is a perspective that seeks to understand the parts that contribute to the whole by understanding how the parts interact with other parts and emerge to form a new entity (Turner & Baker, 2019), noting that solutions cannot be imposed but rather are emergent (Snowden & Boone, 2007). Reaching a decision is complicated, and the ‘right answer’ is often elusive, decisions needing to be made on the basis of incomplete information (Snowden & Boone, 2007). As we begin to delve and explore, it becomes clear that casework is almost always characterised by ambiguity, uncertainty and no readily apparent pathway forward. As well, there is a need to consider whether there is an expectation that casework intervention will work towards the situation returning to equilibrium or whether, as we understand from our knowledge of CAS, that the return is not to ‘normality’ but to a transformation to something new with different characteristics (Bristow & Healy, 2014).

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Beyond perhaps a broad goal of wanting to reach an ‘improved position’, goal setting is of limited virtue as it implies a level of certainty about a desired future state and a certain rationality that all problems in fact have solutions (Lambert et al., 2007). Indeed, reaching goals tends to reflect more a trial-and-error approach, noting that in thinking complexity there is recognition of the interconnectedness of pattern, structure and process that both co-exist and co-evolve (Lambert et  al., 2007 p. 58). Thinking complexity encourages caseworkers to move from the comfort of ‘knowing’ towards a position of uncertainty, incomplete knowledge and understanding. It also demands a level of curiosity, a cautious sense of optimism and a need to delve more deeply to understand the ‘missing pieces’, including those pieces we may not, at first, know are missing. Instead of working in silos, practitioners need to find strategies to work across silos, seeking ways to re-interpret taken for granted ‘rules’ in new light but in ways that do not entail transgressions of laws or dereliction of ethical responsibilities. The essence is that all involved need to accept the invitation to step out from individual silos in pursuit of a shared quest to journey to a resolution acceptable to all, including the client, wherever possible. Simple as it may at first appear, social workers need to develop sound working relationships with those who may hold differing perspectives and role definitions and be prepared to engage in robust, but respectful, professional dialogue and debate that enables the pursuit of strategies as the social worker strives to ‘think outside the box’.

6.4 Challenges of Thinking Complexity The foregoing discussion suggests that in addressing a client presentation, we need to be cognisant of, and explore, a range of issues that extend beyond the obvious. This is not to say that thinking complexity with children and older people implies an ‘anything goes’ approach. Rather, the suggestion is that social workers approach situations through constantly reviewing their assumptions about the situations presented by their clients.

6.4.1 Ethical Dilemmas While social work ethics refer to the norms of right action, good quality of character and values relating to the relevant code as espoused in direct service delivery (Banks, 2008 p.1238), it has also been argued that ethics formulations are too general and imprecise to ensure consistent and dependable decision-making while also failing to appreciate the complexity of decision-making (Braye et al., 2017 p. 324). Equally, Braye et al. (2017) propose that uncritical adherence to ethical principles can give rise to unsophisticated approaches that view autonomy to be ‘good’ and paternalism ‘bad’.

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In responding to complexity in practice, social workers need to understand families, communities and society as inherently complex systems that do not necessarily respond to the procedures commonly set in place to guide practice as those procedures are largely reflective of a linear understanding of the world (Stevens & Hassett, 2007). The need is to conceptualise ethics from a more nuanced, and less dichotomised, standpoint that accepts that protection does not equate with denial of individual wishes, nor does it imply removal of all risks and a guarantee of safety (Braye et al., 2017). In its search for an evidence base, social work has been criticised for neglecting the values dimension of human interaction (Gray, 1995). The challenge is to seek balance between scientific evidence and human interest when striving for objectivity. Ethical considerations are ever present and permeate day-to-day practice. Ethical dilemmas largely reflect that: … in reality problem solving is never a structured, linear process of decision making; people are not always available for consultation (and may or may not give good advice when available); clients often do not understand the position they are in; there is always the potential for unintended consequences; and it may not be possible to get all sides of the story (Gray & Gibbons, 2007 p. 225).

Issues of care and control frequently highlight ethical dilemmas for social workers, in particular where they concern children and older people. For instance, in considering a move of children from parental care, it is necessary to consider the wider social context that frames simultaneous demands to protect children within a context of preference for parental autonomy (Dingwall et al., 1984). Research tells us that child abuse and neglect are commonly accompanied by a range of adverse impacts on child development and later outcomes including social skills, educational achievement, language abilities, risk of engagement in criminal activity and the like (Australian Institute of Health & Welfare, 2020 p. 328). But while moving a child from a compromised home situation may offer immediate relief and safety, the decision also exposes children to an uncertain future in the care of strangers in a child welfare system of contentious quality for out-of-home care and concerns about under intervention and over intervention (Parton, 2004). With respect to older people, the global pandemic has highlighted dilemmas. Two key trends have emerged. The spread of the virus in aged care homes, which are designed to ensure care and safety, bearing in mind high mortality rates among this cohort, occurred at a time when services designed to support older people at home had become intermittent at best as providers struggled to staff shifts. Example 1: Care and Control Mrs. Smith, in her mid-80 s, whose deteriorating cognition has led to her no longer being permitted to drive, no longer able to safely cook meals and needing to be accompanied at all times in the community. Her husband of 60 years, a little older than his wife, appears unable to appreciate the extent to which his wife’s independence has become compromised, nor is he able to compensate for her difficulties.

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Reflection Points • What are the care and control challenges? • What are the implications for client-centred care? • What are the more nuanced considerations for decision-making in this scenario? • How might social workers resolve these tensions and to what extent does (or does not) social work offer frameworks for action? • Which pieces of the jigsaw do we possess? Which pieces do we need to find? How might thinking complexity help us? Issues at a Glance • Does the alternative have more to offer than the presenting situation? • What are the implications? Thinking Complexity and Acting Pragmatically At this point, the social worker clearly occupies the meso space in a context where the micro and macro levels are not in alignment. As we know from CT, the ‘right answer’ is not readily apparent, and the available information is far from perfect (Snowden & Boone, 2007), noting that both concrete case-specific information and matters of values and judgments will also come into play. It is also a point at which duty of care comes sharply into focus: that is the need to think about the values of ‘the person in the street’ and his/her views on what is reasonable, along with acute awareness that both a decision to take action or a decision not to take action are equally fraught with difficulty and potential for unintended consequences. Also, CT tells us that the capacity to predict what will happen is not possible. The boundaries between the systems in operation are fuzzy and complicate the available courses of action. Thus, we begin to appreciate the complexity that permeates decision-making: the emotional component raises concerns about ‘getting it wrong’ but within a context that removal from one situation of risk does not mean that the alternative will be without risk. For example, if we advocate that Mrs. Smith re-locates to aged residential care, how confident might we be that there will be a full complement of qualified staff – a concern heightened in the context of the global pandemic? What too might be the ‘cost’ of a married couple becoming separated due to the force of their circumstances? We might want to wonder how Mrs. Smith would construct the narrative of her own story, noting that narratives are typically incomplete and evolving stories. In essence, we need to be mindful of the characteristics of CAS, in particular the concepts of emergence, non-linearity and phase changes. We also need to adopt a ‘healthy dose’ of pragmatism as what is needed is action (Greenhalgh & Engebretsen, 2022), however incomplete our information might be. Ultimately, in resolving ethical dilemmas, we can only offer signposts, or perhaps light bulb thoughts, that prompt social workers to grapple with both the complexity and the nuance of the situation. Intervention is about insisting that time is taken to explore themes and issues, to seek connections and coherence and to accept that in many, if not most, instances risks have to be taken in order to mitigate risks. That is, decisions reflect consideration of which potential pathways carry the least risk and best quality of life given all relevant circumstances.

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6.4.2 Challenging the Primacy of Self-Determination Self-determination, an important social work value, is centrally concerned with personal autonomy and the freedom to make one’s own life decisions. However, self-­ determination must be tempered by questions of capacity as well as the need to balance autonomy and protection (Braye et al., 2017). It has been argued that individual wishes should always be the starting point for personalised service, but autonomy has tended to become the default position where principles are in conflict to an extent that capacity tends to be overlooked and protection becomes a poor relation to autonomy (Braye et al., 2017 p. 324). In thinking complexity, we can see the concept of emergence as the issues unfold and give rise to the need to constantly evaluate and balance questions of autonomy, privacy and capacity as these elements change and modulate over time. Where the client is reluctant to engage, they may be construed as resistive, and as such, reluctance to engage is incorrectly interpreted as an active choice rather than potentially an underlying fear that needs to be explored. Preston-Shoot (2016) introduces the notion of the need for concerned curiosity whereby the social worker perseveres with exploration of the pertinent issues, cautioning that premature case closure due to difficulties with engagement, and the privileging of self-­determination, may compromise not only client well-being but also their fundamental safety. Example 2: Self-Determination and Capacity Eighty-five-year-old Mr. JH is adamant that he wishes to return home from hospital. He is equally adamant that his 82-year-old wife will continue to look after him. The marriage has always been traditional insofar as Mr. JH acted as the breadwinner, while his wife attended to child raising and home duties. Mr. JH’s daughter confided that while the marriage was outwardly a happy one, Mr. JH has always been insistent that his views would prevail, tending to become verbally abusive if challenged. His daughter also confided that her mother had become increasingly frail, exhausted and overwhelmed but remained fearful of admitting she is not sure she can continue in the carer role. In the hospital in-patient setting, it has become increasingly evident that Mr. JH is experiencing some cognitive decline, but medical practitioners have stopped short of determining he lacks capacity. When discharge planning options are raised, Mr. JH becomes verbally abusive and threatens to self-discharge, regardless of medical advice. Reflection Points • What factors may limit the client’s self-determination? • Whose self-determination is paramount? • To whom do we owe a duty of care? • What are the potential safety issues in play? • Which pieces of the jigsaw do we possess, which pieces do we need to find and how might CT help us?

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Issues at a Glance • What are the limitations, if any, of self- determination? • What are the ‘lifetime’ patterns and choices and what are the ‘new’ patterns and choices? • Can/should self-determination impose burdens on others even if they ‘accept’ these burdens? • How do we apply concerned curiosity? Thinking Complexity and Acting Pragmatically For Mr. and Mrs. JH, the equilibrium of decades has been disrupted and replaced with uncertainty about the future. It is relatively simple to construct Mr. JH as resistive and lacking insight. However, if we adopt a stance of concerned curiosity (Preston-Shoot, 2016), we can develop an appreciation of underlying concerns as identified by the client. We might also reflect on the notion of phased changes, suggesting that the client response to the mere introduction of a notion that effective discharge planning requires consideration of options beyond his preferred course of action, particularly in view of his wife’s ability to meet his needs, has become compromised The recognition that non-equilibrium is characterised by continuous changes is also a signal that the social workers needs to reflect on and consider the ways in which the narrative has been constructed over time. Ultimately, in this case, the strategy adopted was the promotion of ongoing dialogue, rather than a single problem-solving conversation, in response to Mr. JH’s initial position. In such situations, it is unreasonable to expect that the gravity of the decision confronting the client, and his family, can be resolved through a single conversation. In other words, we need to ensure that we develop a menu of contingencies (Gilpin & Murphy, 2008) rather than a direct route from problem to solution.

6.4.3 Understanding the Nature of Risk Stevens and Hassett (2007) argue that trying to predict outcomes based on in-depth knowledge of pertinent factors is fallacious as the notion of prediction is based on linear constructions of risk and basic beliefs concerning cause and effect. Those authors argue that thinking complexity alerts us to the realisation that interpretations of situations are indicative rather than predictive: while it is known that certain events will occur, it is not known where, when or how they will occur (Stevens & Hassett, 2007 p. 129). Our understanding of CAS suggests the work that both the client and the social worker do together will adapt and evolve as they engage in the process of deciding together which risks can be mitigated and which risks are acceptable or unacceptable and the reasons for this. In situations of working with risk, social workers need to manage multiple interacting elements, as illustrated earlier in Fig. 6.1, giving rise to unpredictable and uncertain outcomes. What emerges is invariably something unexpected and new. Emergence means that while the system strives for order, the system that is to

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Fig. 6.1  The casework relationship

emerge inevitably takes time to reveal itself (Stevens & Hassett, 2007 p. 131). In other words, prediction is negated by the interrelatedness of the component parts present in families, communities and service systems (Stevens & Hassett, 2007). A reality for social workers is that, under conditions of a litigious society, there are endless dilemmas around balancing risk management and person-centred care (Robinson et al., 2007). Indeed, the dominant view of risk is that it is something that needs to be managed, minimised and avoided wherever possible (Robinson et al., 2007 p. 390). However, such a view suggests that risk is something real and objective, whereas it is, in reality, subjective, value-laden and moderated by social and cultural processes (Robinson et al., 2007). Further, the identification of risk tends to focus on discrete events as distinct from consideration of the situation in its complex entirety, often comprising the family/client, the professionals involved, the time frames involved and all surrounding environments that influence judgements made (Stevens & Hassett, 2007 p. 132). Example 3: Child Welfare or Child Protection? Margaret, in her mid-30 s, has a mild intellectual disability diagnosed in early childhood. She attended special school for developmental delay for a time but was later able to attend mainstream schooling with specialist supports. She left school at age 16 years and was able to successfully hold employment as a waitress in a coffee shop. She has two young children one of whom is school age. With the assistance of supportive parents and disability support staff, Margaret has been successfully able to parent her children, including after a relationship breakdown two years ago.

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Margaret has always presented as having a bright and cheerful personality, has always been willing to engage with offers of assistance, has taken pride in her home and personal appearance and has been reliable in attending appointments. In recent months, however, her presentation has begun to subtly change: she has begun to show a pattern of not attending appointments, has reduced contact with her parents and other family members and has begun not to send her older child to school. Margaret insists that ‘nothing has changed’; it’s just that she should be able to make her own decisions and wants to be left alone like other people. When pressed, Margaret admits that she is fearful ‘her children will be taken away if she tells’, and, anyway, she can ‘see whoever she likes’. Reflection Points • It would appear that something may have changed within Margaret’s immediate network, but thus far, Margaret is not open to discussion of this possibility. • It would appear that engagement has to enter a new phase and for the helping relationship to be re-negotiated. • What values and perceptions come into play when thinking about the risks that may be facing Margaret’s children and also the risks to Margaret? • Are the children the only source of potential risk in this scenario? • What unintended outcomes may result from either under intervention or over intervention? • Which pieces of the jigsaw do we possess, which pieces do we need to find and how might CT help us? Issues at a Glance • ‘Warning signs’ • Informal and formal support systems. • Strength of engagement at any point. • Episodic management versus longer-term support. • Questions of capacity. Thinking Complexity and Acting Pragmatically The warning signs of risk were quite overt, but as no harm had (yet) occurred, these warning signs had to be understood as indicative rather than predictive. The previously supportive networks, both formal and informal, had broken down, and one could only wonder if they had been ‘strong’ only in the face of the mother’s compliance rather than actual engagement. The social workers also need to consider the extent to which Margaret could make an informed choice and to fully weigh up the consequences of that choice (New South Wales Government, 2020), noting that the mere presence of an intellectual disability does not equate to the absence of capacity so much as indicating a need for additional assistance, and time, to reach a position of informed decision-making. Legal action to protect the children certainly needed to be ‘on the drawing board’, but the potential consequences of legal action had to be weighed up as well, given the fragile stage that engagement had reached. In acting pragmatically, the social worker decided that time-limited intervention over the

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longer term was the better approach in order to develop a sustainable support network based on deeper engagement.

6.4.4 Casework Challenges Much of the traditional ways of thinking about the world are infused with a desire for an orderly world in which cause and effect are clearly linked (Bolland & Atherton, 1999). The reality of casework is that it takes place in a world of significant caseloads, inadequate resources and agency policy that is ambiguous, conflicting or vague (Ash, 2010). While practice dilemmas are commonly seen as intrinsic to difficult family structures and dynamics that pre-date the casework intervention, agency context appears to privilege accountability, efficiency, competition, intensifying standards, performance indicators and monitoring and audit (Ash, 2011). In thinking complexity, the social worker’s view of the context is one seen as characterised by disorder, randomness and irregularity, where groups and societies are recognised as complex systems, constituted by multiple agents interacting with each other in multiple ways (Stevens & Hassett, 2007). As such, prediction of outcomes is rarely possible. Social workers who are thinking complexity analyse and review client presentations, comfortable with allowing themes to unfold. Thinking complexity ‘sits with’ the understanding that emergence and adaptation arise from the interactions of smaller phenomena that emerge from seeming disorder (Stevens & Hassett, 2007). Example 4: Case Planning Dilemmas The family under review consists of eight children ranging in age from three months to 16 years. Both parents present with a history of significant, but very different, past trauma, and throughout the many years of their contact with child welfare and child protection systems, meaningful engagement has been minimal, punctuated with incidents of verbal and physical abuse towards professionals. Neither parent has been diagnosed with a mental health condition nor have there been concerns relating to substance abuse or criminal activity. Overt physical abuse has not been an issue, but the family has struggled with insecure housing, non-payment of bills, poor school attendance, neglect (e.g. instances of severe sunburn due to inadequate cover in hot weather) poor school attendance and poor academic performance and constant complaints from neighbours that exacerbate secure housing concerns. The older six children have been subject to various Children’s Court orders over the years, whilst the youngest two have never resided in parental care. All legal proceedings have been vigorously contested. Finally, legal processes have been exhausted and the children subject to guardianship orders, with plans for permanent placement out of parental care. The social worker now has to proceed with planning with the parents, children and substitute care givers and other agency practitioners, all of whom are engaged in the process.

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Reflection Points • The children present with a heightened sense of identity as a sibling group, but there is no identifiable family able to assume care for such a large group. • Each child presents with a significant level of individual need across emotional, developmental and educational domains. • Each child presents with a strong sense of bond with their mother despite the fact that she has been unable to consistently meet their needs. • Organisational policy emphasises both family-based options and maintenance of sibling groups as a priority for planning. • How does the social worker proceed? • Which pieces of the jigsaw do we possess, which pieces do we need to find and how might CT help us? Issues at a Glance • Engagement. • Obscuring of issues needing attention and diversion of primary focus – that is, ensuring child safety. • Engagement across service systems but striving for focus on the issue to hand rather than the perspectives of the different players. • Whose self-determination is being weighted and how? • Defining cumulative risk. • Short-term objectives versus long-term goals and outcomes. Thinking Complexity and Acting Pragmatically Throughout the discussion, we remain mindful that the social worker is located at the meso level, striving to bring together the policy and legal imperatives from the macro level into a degree of coherence with the lived experience of the family at the micro level. The case reached an impasse: the mother was construed as aggressive and threatening; social workers, not unreasonably, became afraid for their safety. The focus had shifted from the children towards maintaining worker safety. It was time to return to basics, that is, to bring together the elements of: mining lived experience of reflective practice, self-reflection, self-analysis and self-critique, striving to uncover assumptions underlying the social worker’s perspective. Thinking complexity and understanding how CAS tend towards disorder and the generation of emergence made sense of what was being observed. Acting pragmatically directed the social worker towards maintaining a focus on pertinent issues rather than discipline-­ specific imperatives, mindful that ‘expecting the unexpected’ was front of mind. In this scenario, the social worker’s interpretation was informed by several factors: (a) hints contained in the family history that might facilitate a re-framing of what has occurred to lead to the parents’ behaviour, (b) the accumulated evidence of cumulative harm to the children, (c) understanding what has/has not worked thus far and (d) building strategic alliances across the service system, understood as made up of nested systems. A pragmatic threefold strategy was devised. Firstly, to focus on ensuring that the siblings’ relationships and connections could be maintained, even though this might not actually mean the sharing of a household. Secondly, to begin to ‘hear’ the parents differently, as an essential element in helping social

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workers to manage anxiety about direct contact. Thirdly, to creatively consider ways in which the service system could be managed in a less conventional way that entailed taking risks to effect permanency and minimise disruption through placement instability. Ultimately, the parents agreed not to contest the orders sought but only on the basis (it was noted) that they were not consenting: on the surface, this may seem like a contradiction in terms, but in fact, it was an acquiescence to reality and one that enabled the parents to become part of the solution instead of remaining part of the problem.

6.4.5 Working with Uncertainty Casework is delivered in an environment whereby decisions are not context free. Drawing on CAS characteristics of non-linearity, we can ‘predict’ that some relatively small changes can have significant impact, while in some instances, significant changes can have negligible impacts. The broader practice environment involves social, cultural, professional, legal and relationship dynamics (Preston-­ Shoot, 2016) and is the place where the micro, meso and macro levels of practice intersect. This means that norms cannot be understood without knowledge, not only of the context but of the subjective meanings ascribed by people to events in specific context (Fraser et al., 1991). To explain this in another way, Bolland and Atherton (1999 p. 369) argue that ambiguity, non-linearity, asymmetry, regular irregularity and unpredictability come to be accepted as ‘normal’. When we work with clients, we inevitably work with incomplete information. As such, uncertainty and ambiguity commonly encompass complicated moral issues that can only be resolved through a process of dialogue and moral reasoning where knowledge, theory, values, skills and ethical guidelines come together (Gray & Gibbons, 2007). When we speak of moral issues, we are speaking of issues that entail a level of nuance with fluid options, whereas it is not possible to distinguish between two extremes because there are an infinite number of nuanced options in between (Keinemanns & Konne, 2013 cited in Braye et al., 2017 p.328). The inherent value of uncertainty is that it frees social workers from the certainty promised by ideological dogma often interpreted as knowledge (Gray, 1995). Uncertainty relates not only to understanding the presenting scenario but also to the forward pathway. There is never a prescribed pathway guaranteed to realise the preferred outcome. In most instances, each option entails a certain level of cost: that is, decision-making involves choices, not so much around the ‘best outcome’ as around the ‘least hazardous’ outcome for the client and perhaps also for their family. As CT holds, small changes typically entail ripple effects across the wider system. Example 5: What Do We Know, ‘Sense’ and Not Know? Bill and Mary have been married for 64 years. They have two adult children neither of whom live locally and neither of whom offer substantial support: practically – because they do not live locally – and emotionally because both are preoccupied

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with their own lives. Bill and Mary were both tertiary qualified people and have always enjoyed an active social life: music, theatre, travel and contact with a wide circle of friends as well as being active in community service activities in their local community. About three years ago, Bill experienced a stroke, which left him with minimal expressive speech (and questionable receptive speech), declining mobility, weight loss and a pattern of falls with ongoing falls’ risk. More recently, significant continence issues have emerged, but no continence aids have been put in place. Mary has rejected in-home support services, insisting that she can manage in the face of her own advancing years, emergent frailty and deteriorating health. Nevertheless, Mary insists she can manage all personal care for Bill as well as his incontinence. Gradually, friends have withdrawn at a time when they have also become critical of Mary’s ‘refusal to face reality’ and possibly her reluctance to ‘spend money on the care needed’. Mary persists in asserting that she can manage and is equally adamant that it is not yet time for Bill to enter aged residential care. As far as can be ascertained, Bill acquiesces with the plan for him to remain at home although his capacity has not been evaluated. Issues at a Glance • What are the ways in which the scenario can be constructed? • How does the social worker manage their feelings of anxiety? Is capacity absolute or nuanced? • How do we balance lifelong autonomy with frailty and erosion of autonomy that will impact on the sense of self? • How do we apply concerned curiosity? Thinking Complexity and Acting Pragmatically There are multiple levels of ambiguity inherent in Bill and Mary’s situation: questions of capacity, questions of risk, questions of preparedness to engage (and with what outcomes in mind) and questions of what the community might consider to be a reasonable standard of care. The boundaries are all somewhat fuzzy, signalling a blurring between societal expectations and private decision-making, noting that boundaries are dynamic and shifting and often out of focus. Thus, a critical question becomes one of the extents to which this couple will allow the social worker to enter into family life, noting there is no legal mandate to enforce engagement and noting that the couple have independently managed their lives for a very long time and loss of independence poses a direct challenge/threat to one’s sense of self. It is at this point that the social worker needs to consider the concept of concerned curiosity, striving to make sense of what is presented on the surface and what is clearly incomplete information. It is through a stance of curiosity and ‘not knowing’, a key message from CT, that the social worker is enabled to gradually appreciate the client’s interpretation of their subjective experience. While at first glance the scenario suggests resistance, denial and non-cooperation, such formulation minimises the clients’ meaning making of what is confronting them. At the same time, there are inherent risks present for Bill, but equally, a move to a residential aged care setting will not eliminate the risk of falls, for example, nor will it eliminate the need to

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manage continence issues. Questions of societal expectations are suggested by the ‘secondary stakeholders’, in this instance friends, who have signalled their concerns and disapproval and their ability to raise their concerns in a wider range of forums. Thus, the social worker remains in a position of uncertainty, with varying levels of anxiety and a level of unpredictability as to what will unfold, and when, but also within a context of time pressures imposed by organisational key performance indicators and embedded professional views about what needed to happen. Ultimately, it was not so much casework that made a difference as Bill experiencing another fall. That event opened up new pathways for dialogue with his wife, enabling her to reveal the fears and despair that had characterised her responses. It also revealed her ultimate sadness at needing to ‘bow to the inevitable’: she had needed time to come to her own realisation, and acceptance, about the way forward.

6.5 Conclusion Whilst casework can appear as a simple, linear process of building relationships through discrete phases of the engagement, closer examination generally reveals issues of concern arising in most situations. These are not so much related to the casework process as to the casework context and permeate all phases of relationship building. These contextual issues embrace the nature of risk and risk assessment, complex questions of capacity, state intervention into private lives and professional ethics that are intertwined with a legal duty of care. We can see that CT offers a meta perspective for understanding the client. Social reality comprises aspects, or parts, that interact with each other in unpredictable ways and that may then give rise to emergent understanding. Pragmatism enables us to make use of scientific and other evidence in partnership with ‘real-world’ experience. As we have discussed in this chapter, drawing on examples from social work with children and older people, casework is characterised by uncertainty, ambiguity, typically an absence of any clear pathway forward and all options being inextricably intertwined with ethical dilemmas. Thinking complexity, and acting pragmatically, confronts social workers with an invitation to deepen frameworks for understanding around ethics, the primacy of self-determination and the nature of risk. Ultimately, social workers are challenged to sit comfortably with ‘not knowing’ whilst striving to identify ‘what works’. Reflective Questions • How might thinking complexity and acting pragmatically influence that way in which you practice in your particular field? • In your field of practice, what particular challenges posed by uncertainty, risk, self-determination and ethical issues, discussed in this chapter, arise? How might thinking complexity and acting pragmatically help you in working with them?

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New South Wales Government. (2020). Capacity toolkit, Sydney: New South Wales Government Department of Communities and Justice. Retrieved from: https://www.justice.nsw.gov.au/ diversityservices/Documents/CapacityToolkit2020ElectronicAccessible.pdf Parton, N. (2004). From Maria Colwell to Victoria Climbe: Reflections on a generation of public inquiries into child abuse. Child Abuse Review, 13(2), 80–94. https://doi.org/10.1002/car.838 Payne, M. (2005). The origins of social work: Continuity and change. Palgrave Macmillan. Preston-Shoot, M. (2016). Towards explanations for the findings of serious case reviews: Understanding what happens in self-neglect work. The Journal of Adult Protection, 18(3), 131–148. https://doi.org/10.1108/JAP-­10-­2015-­0030 Robinson, L., Hutchings, D., Corner, L., Finch, T., Hughes, J., Brittain, K., & Bond, J. (2007). Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia. Health, Risk and society, 4, 389–406. https://doi.org/10.1080/13698570701612774 Sayce, L. (2009). Risk, rights and anti-discrimination work in mental health. In R.  Adams, L.  Dominelli, & M.  Payne (Eds.), Practising social work in a complex world (2nd ed., pp. 99–113). Palgrave Macmillan. Snowden, D., & Boone, M. (2007). A leader’s framework for decision making. Harvard Business Review, 85(11), 68–76. Retrieved from: https://www.systemswisdom.com/sites/default/files/ Snowdon-­and-­Boone-­A-­Leader's-­Framework-­for-­Decision-­Making_0.pdf Stevens, I., & Hassett, P. (2007). Applying complexity theory to risk in child protection practice. Childhood, 14(1), 128–144. https://doi.org/10.1177/0907568207072535 Turner, J., & Baker, R. (2019). Complexity theory: An overview with potential applications for the social sciences. Systems, 7(1), 1–22. https://doi.org/10.3390/systems7010004

Chapter 7

Thinking Complexity in Management

7.1 Introduction and Learning Opportunities Thinking complexity in management situations and processes can help you see the interdependencies and interactions among the elements of a problem or an approach and ultimately develop skills to manage unpredictable situations and outcomes and how to engage constructively with uncertainty. This chapter draws on learning from three worked examples to demonstrate practical applications of thinking complexity. The cases are real-world challenges including: • A client complaint about privacy that requires immediate action with potentially significant but unknown consequences for individuals and the organisation. It also requires balancing compliance and care and concern for individuals and the knock-on effect of the initial small decisions. • A strategic planning and priority setting process in an organisation, where the interplay of insights, data, ‘intuition’, lived experience, policy settings and organisational values need to be considered, and we require ways to test assumptions and prioritise complex and persistent issues and responses. • A period of uncertainty at the onset of the COVID-19 pandemic during which the environment, behaviours of individuals and governments and likely outcomes are largely unknown and chaotic. This period required managers to step up and into the chaos, needing to ‘do’ at the same time as investigate, understand and anticipate and look out for the signals of what might happen next. At the end of this chapter, readers will have: • Built on their capacity to conceptualise CT’s influence on practice. • Understood how thinking complexity informs and shapes practice and decision-­ making in management situations.

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• Become familiar with characteristics of CAS  – in particular, embeddedness/ nested systems, non-linearity, adaptation, collaboration and emergence. • Learned from practice examples how a manager or team leader works with uncertainty and unpredictability to make strategic decisions in light of their understanding of CT.

7.2 Context This chapter, thinking complexity in management and the following on community development, is a small contribution to allaying some of the frustration and disillusion felt by practitioners when faced with escalating complicatedness and the uncertainty and unpredictability of contemporary social work practice on both a practical and personal level. Often, this is coupled with the realisation that many things will remain unknown, and others will be ambiguous. As noted earlier in the book, many social work practitioners work to protocols or assessment guidelines. These have been criticised for their likelihood of leading to routinised practice, which, perhaps literally, ‘ticks boxes’ and answers to organisational, legal and community demands rather than requiring social workers to think deeply, advocate and work more closely from a client-centred point of departure. Plsek and Greenhalgh (2001, p.  627) suggest that there ‘is an insoluble paradox between the need for consistent and evidence-based standards of care and the unique predicament, context and priorities, and choices of the individual patient’. Many of the problems social workers face are unique, not simple or predictable. They arise in uncertain and turbulent circumstances, and as Klein (2004) suggests are often value-laden, multidimensional and ambiguous. For these problems, social workers need an understanding of systems that can incorporate the principles of change and the strength and value of relationships; that can acknowledge the interconnectedness of individuals, families and environments and their agency and capacity to adapt; and one that enables us to account for surprise, creativity and emergent phenomena. As presented in Part I, complexity theory provides this expanded understanding of systems and can strengthen social work research and practice. In this chapter, and the following one, I provide descriptions and reflections of what complexity theory informed social work practice might look like in a community setting. These two practice chapters seek to highlight how we might incorporate perspectives sensitive to difference, explain how the environment impacts on humans and take account of the nature and character of technologies, contexts and influences impacting individual, organisational and community life. The reflections included in these two chapters have emerged through my combined research and practice that have progressively drawn on complexity theory to better illuminate and explain the experiences of people and groups and the varying influences of dynamic contextual and environmental factors. More specifically, they

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are drawn from current work in a place-based community organisation in a rapidly growing area on the edge of one of Australia’s largest cities, Melbourne. In sharing my experiences, I hope to demonstrate how complexity theory provides scope to develop a nuanced and dynamic understanding of acting and working in the social world. This builds on the earlier discussion in Chap. 3 of some of the limitations of person-in-environment perspectives so central to social work and the description of the key elements of complexity theory and their potential application within social work. These chapters not only add real-world examples to what is known about the benefits of thinking complexity, but they each conclude with some guidelines and suggestions for practitioners to use to reflect on your own practice with clients and communities.

7.3 Management Management is a very broad area of research and practice that applies to all sectors and industries. In this chapter, we use the term management loosely to describe a series of activities or responsibilities and an approach. The work is at the same time planning, problem identification and analysis, investigation, decision-making, reflection and further action. It is less about direct client work or service delivery and more about how those services are delivered, evaluated, sustained and improved. Management in a community service setting can be management of an organisation, a team, a project or a campaign. As a social worker, you may find yourself working in a team leader or manager role supervising staff, volunteers and students, leading an integrated service and multidisciplinary team, managing an internal change program or have an external focus managing a policy or advocacy project with partners and stakeholders.

7.4 Thinking Complexity 7.4.1 How I Started Thinking Complexity Before I begin outlining the management examples, it is important to explain that I have a multidisciplinary background (architecture, community development, urban planning and social work). This influences the way I use complexity theory as I draw from a broad range of sources and ideas to help build my framework for reflection and action. I am not an expert in any particular field. I was an architect for 13 years with a strong environmental interest and then went into small business consulting, supported social enterprises, engaged in women’s policy development and advocacy at

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the Federal level, did research in international development contexts, specifically in Bangladesh and the Solomon Islands, and more recently worked on community planning, engagement and research projects with local governments and communities including in Australia’s rural areas. I have managed a range of projects and programs across the fields of research, strategic project management, consultation and community development. This experience has been in a wide range of organisations in the for-purpose, education and commercial sectors and in leading complex and difficult projects. So, I am a generalist. I know a little about a lot of things. I like seeing how these things intersect and borrowing models and learning from one area or sector to help understand another. I think of myself as having a natural leaning towards thinking complexity and acknowledge that I am prone to draw on discrete elements or concepts or combine elements in different ways to help guide decision-making. This aligns with commentary at the end of Chap. 1 that suggests not all characteristics of CT are present in thinking and doing with some more useful than others depending on context, presenting issues and the role of the practitioner. One of the necessary breakthroughs for me in being able to think complexity was understanding that it challenges conventional notions of stability and change. Manson (2001, p. 19) argues that ‘complexity research is more concerned with how systems change over time than with indicators of apparent system complexity’, suggesting that we are not looking for complexity as a self-evident property, as in ‘complex needs’, but rather complexity theory helps us build models of reality (as opposed to describing reality itself). This is an important distinction, between the perceived realities (complex needs) and using complexity as a model of reality with enhanced explanatory power. Thinking complexity suggests that systems cannot be understood by reducing them to their parts or by looking at the whole as an inextricable combination of interrelated parts, that is, that the parts are implicated in each other. Rather it suggests that systems are affected by the intricate relationships between those parts, but the relations among the parts are contingent, that is, not necessary. This means there may be little correspondence between input into the system and the output that follows and that any cause-effect analysis can distort more than it illuminates. This changes the way we might explain different life trajectories or significant changes in group dynamics. For example, the trajectory of a person seeking asylum can be significantly changed through meeting one person who supports and advocates for them, as much, or perhaps differently, to any government changes to legislation affecting them. I found complexity theory’s core concepts such as emergence, self-organisation, non-linearity and adaptiveness helpful for studying the dynamic and collaborative nature of everyday life. Complexity challenges us to deal with unpredictability and indeterminism in human behaviour and in the methods we use to study it and/or participate in it. It can take account of the non-linear nature of people’s lives and influence both the nature of the problem and how it should be addressed.

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7.4.2 How You Can Think Complexity in Management Particular insights that complexity theory provides for management practice relate to the nature of systems, the benefits of looking for patterns, incorporating feedback and seeing interdependencies and self-organisation, that is, how much intervention or direction is required for individuals or groups to start problem-solving themselves. When faced with an incident, challenge or opportunity, a manager has many possible sources of information, different ways to view the issue, challenge or opportunity and many potential courses of action. There are also many unintended outcomes, which, at best, remain opaque. As you make decisions, you can see the feedback from your actions and make adjustments as you proceed. This ongoing reflection and attention to nuanced responses and micro feedback ensures you are factoring all new information into your decision-making. This is part of the cycle of ‘doing – thinking – doing’, which characterises my approach to action and intervention. Thinking complexity in a management setting helps you keep an open mind as new information becomes visible, and the impacts of your initial decisions come into view. It helps you keep looking for the intersections across systems to minimise the duplication of effort, maximise data and knowledge sources and positive outcomes across the setting. Applications of complexity theory and its key concepts to management are diverse and can include the following: • Conceptualizing and framing the issue or desired outcome – What has happened or is likely to happen, who is involved and what is the history or prior knowledge? Where do we want to end up? • Undertaking, documenting and analysing the idea or issue – What are our reference points, what perspectives can help us think constructively about this? • Investigating the external forces affecting the issue or process and how change can be made. • Understanding where staff, students and volunteers are ‘coming from’ – What is their experience, their training or discipline and lived experience and how do all these characteristics inform their current view, position or capacity for action and how can thinking complexity support their growth. • Designing the process(es) by which you can progress or intervene. • Understanding how targeted interventions or solutions often have indirect or flow on affects that cannot always be anticipated. • Respecting the knowledge to be garnered from having others with diverse perspectives and experiences contributing to the process. • Identifying process or response improvements, and developing processes that encourage or enable continuous learning and improvement. An orientation to complexity enables you as the manager, or as part of the management process, to frame your role as that of an interventionist while at the same time providing an opportunity to think of yourself as outside the problem and solution albeit momentarily. This correlates with the idea proposed earlier of social work interventions (or non-interventions) being seen as creating a complex system.

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The manager is part of a complex system, an agent along with their team, clients and/or stakeholders. Given the range of people and options involved, we need to look beyond ‘the solution’ or ‘the explanation’ but look for intersections, patterns and themes that help build a greater range of possibilities, help us understand potential consequences outside our immediate sphere of influence and develop more nuanced explanations or actions. Returning to Chap. 3’s metaphor of the camera lens, we might look at a management situation or challenge knowing we don’t have enough information to feel confident and we need to act regardless. We might concentrate on the long view, the outcomes we are seeking for the community and/or the organisation or perhaps the legislation or funding requirements we are working within and then the middle ground, being the organisation’s or team’s priorities and performance, and further zoom in to the individuals and particular circumstances involved. We need to keep these different perspectives in view to ensure we can see as many potential outcomes, options and localised impacts as possible. Management is a day-to-day experience where the small everyday decisions need to be made in the context of all that surrounds them.

7.5 Management in a Community Services Setting 7.5.1 Introduction Based on my own practice, I have included three curated examples to start to demonstrate how complexity’s theoretical concepts or metaphors have contributed to my understanding of management and provide some direction for reflection and action, or as described elsewhere the cycle of doing-thinking-doing. They have been chosen to demonstrate a range of instances or situations that thinking complexity can support. The three examples are recent real-world practice situations in which thinking complexity has aided resolution, enhanced the scope and approach of organisational planning and helped manage anxiety and disruption and developed new ways of working, in a time of great change. As you read the examples, consider these questions: • How does thinking complexity help understand the situation/context? • How does it help prioritise and take action? • What are you mulling over, reflecting on, or puzzled by?

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7.5.2 Example 1: Privacy Breach and Complaint This example concerns a privacy breach and subsequent client complaint about the breach. It was characterised by a short timeframe, human error, the need to manage compliance and care and concern for individuals and the knock-on effect of the initial small decisions. On reading the event and response description below it may seem a simple example – what can thinking complexity add to this? While it is written simply the emotional turmoil and uncertainty for the client, the student, the staff and manager involved, the potential harm that may be caused to the client or the anxiety that is likely to be experienced from the perceived threat made working through it and resolving the complaint much blurrier. Thinking complexity played a role in helping prioritise the different streams of response – the student, the client, the caller and the risks and responsibilities of the organisation. It also particularly influenced the subsequent review and ongoing improvements. The Event  A social work student, with several years of university social work education, was answering community inquiries in our contact centre and gave an anonymous caller one of our client’s contact details. This was a direct breach of our privacy and confidentiality policy and code of ethics. They had read, signed and been trained on these policies and their application. They realised their mistake as soon as they hung up and told their supervisor who was able to listen to the call recording so knew exactly what information had been shared. The Response  Both the student and client required discrete but simultaneous and immediate responses and the ongoing or further risks needed to be assessed. The student was removed from the contact centre and provided support as they were distraught, particularly as the potential consequences started to sink in. They were very keen to know what would happen. The student’s supervisor called the institution and arranged a call with the placement coordinator and a support person. Consensus was quickly reached to end the placement. This was resolved within 2 h of the event. While it was human error, described by the student as a ‘brain fade’, the call was over 5 min in length and despite the unusual nature of the call at no time did the student’s natural instincts, sense of caution or need to consult with a colleague kick in. It is a hard lesson to learn, but a mistake like this could easily result in harm or death as has happened in family violence cases where a victim’s location has been disclosed to a perpetrator. It is tempting to dwell on why the student gave the information to an unidentified caller. The client surmised ‘surely it’s something that even untrained people off the street wouldn’t do’, but that questioning doesn’t get you very far and is not helpful in a situation like this. People make mistakes, and if responded to well, they can be a great learning and improvement opportunity provided no significant harm is done to anyone.

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It was not clear from the call why the caller wanted the client’s details, so the potential for harm to the client had to be considered grave. We rang the client, explained in brief what had happened, apologised, reminded them to call the Police if they felt unsafe and advised them of the avenues for complaints both with us and the authorities. The client did send through a written complaint, and in line with our complaints policy, I needed to ring them and offer an opportunity to share anything else they wanted to say. I knew the client whose details had been shared would be devastated – many clients accessing this particular service have lost trust in mainstream services or find it difficult to access them. This was likely to shatter that trust again and make it difficult for them to seek support in the future. I wanted to have answers for them when I rang, but I knew they would want a quick response. Rather than delay until I had more reference points about what might be done in these situations, I rang, apologised again and asked if there was anything they would like to add to the complaint. I gave them a chance to reiterate what was most important to them and feel heard and validated. I then asked what they would like me to do to resolve the complaint  – they wanted me to consider compensation and to review training of the contact centre workers to ensure it didn’t happen again. This gave two distinct avenues to follow up. Thinking complexity suggests decisions and effects are nested, and you make one decision that then opens/closes others, and this interacts with timing – I wanted to give myself time to feel confident in the options available to me and make sure I didn’t have a ‘knee-jerk’ reaction, but both the student and the client wanted it resolved quickly to minimise their uncertainty and distress. My experience suggests problems like this are often solved more quickly and with better results if they are shared. Different people with even the smallest amount of information can offer insights and perspectives that nuance, or in some cases, completely change your line of thinking. If people are removed from the emotion and detail and have different experiences, they can be extremely helpful. In the case of the student response, the strategy was to share the decision with their institution, so the decision is made in the context of the student’s overall training program and previous performance not just the event and the risks we identified in keeping them in the contact centre. In the case of the client response, I was able to share my thoughts with an external person who had done some work with us. I rang and articulated the ways I was thinking I would respond and my rationale, and he acted like a ‘devil’s advocate’. After the call, he sent through a link that had a very clear table of examples of privacy breaches, the real or potential harms and a financial settlement range. That is not explicitly why I rang, but it made the next few steps with the client much more straightforward. A trustworthy external reference makes you feel more confident, both that others have gone through similar events, and there is a benchmark of sorts to frame your response. In situations you haven’t experienced before, you need some trusted external confidants, courage to share your thoughts even when they don’t seem coherent and openness to really hear others’ perspectives and use them to test your thinking.

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Most complaint processes require resolution and closure – we investigated, took action and resolved the complaint – but they can also be a really significant indicator of system or process problems or opportunities to improve. By reflecting on what the event or incident might be an early indicator of, what systems and processes it connects to, and what other parts of the organisation the learning can inform, we can start to see the systems involved and how broader improvement may be achieved. Following the client’s request to review the contact centre training to ensure further privacy breaches were avoided, I commissioned an external review of the recruitment, induction and training related to the contact centre. We combined the findings from this review with performance data from the contact centre and team reflection on learning from the event but also more broadly other ideas for improvement. While an incident or complaint are drivers for change, they also create opportunities to incorporate related process improvements. Making one change, like improving the training for contact centre agents, creates flow on impacts. For example, the training takes longer, and people need more shadowing opportunities to develop skills, which in turn affects resourcing and capacity issues but increases the quality of the response. The concept of nested systems helps to see the discrete event in its own contact centre system, which is closely connected to the student placement and volunteer program systems and also loosely connected with the services that the contact centre acts as an entry point for. Thinking complexity encourages you to move between these systems and their connections looking for points of weakness, while remaining focused on the objective to ensure a welcoming and effective contact centre experience for community members. Each event or incident and each improvement add to the system’s history and help inform and support future actions.

7.5.3 Example 2: Strategic Planning Strategic planning and priority setting are something all teams and organisations do  – it is an explicit requirement of organisations. It involves the interplay of insights, data, ‘intuition’, lived experience, policy settings, organisational values and capacities and requires ways to test assumptions and prioritise complex and persistent issues and actual and potential responses. Unlike the next case example relating to the pandemic, in which the external stimuli were predominant, strategic planning involves a timely and planned process and internal reflection. There are numerous ways people approach strategic planning, and there isn’t a perfect formula. I think there needs to be a strong fit between the values and aspirations of an organisation and the approach and processes that are used to develop the priorities and/or plan and the ways the organisation’s progress against it will be evaluated. The level of detail and certainty provided in the plan and the timeframe it covers also vary, and sometimes, this reflects the demands or expectations of key funders.

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In our organisation, we are agile, creative and responsive, so the plan is focussed on direction setting not focused on targets or outputs. It doesn’t prescribe how we proceed towards our short-, medium- and longer-term outcomes or impact but relies on our ability to design suitable responses and measure our progress and our impacts to fine-tune or redesign our approach or service delivery where needed to better meet our objectives. It also recognises how quickly our community is changing and growing and builds in capacity for us to respond to these changes. While structural inequities around housing and employment are likely to persist, we can target our responses to best suit our community needs, the stakeholders we can harness and changes in government policy and funding. This may not be enough for many organisations, particularly those heavily reliant on government funding. We have five strategic priorities (Fig. 7.1 below) that guide our work at both a strategic and operational or day-to-day level. These priorities are not focused on what we can deliver and the services we are currently funded to provide or the capacity needs of our organisation, but they reflect the key issues our community is experiencing and the opportunities we see that we can play an active role in responding to. The issues come from both our service and client data, broader independent data sources, insight from staff, volunteers and clients and our assessment of

Fig. 7.1  Strategic directions 2022+

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external drivers like policy shifts. These were workshopped and tested with various internal and external audiences before they were finalised. In addition to our five priorities, our process identified climate change as an emerging priority. While climate change has been well recognised for decades as an international issue requiring significant action, we had some information to suggest it was becoming more important to our community, and it was something we felt we should and could demonstrate local leadership and proactively engage with, alongside our community. In our plan, we noted it as a marker without being certain what our role could be. Within a year of the plan’s development, a range of staff and volunteers have led projects and initiatives that directly contribute to our future direction around this priority. Signalling it as an emerging priority in the plan had the effect of setting the direction and giving permission for staff to consider and trial how best we might contribute and evolve our knowledge and responses. Thinking complexity provides freedom to look at a range of data and look deeply at small data sets that may highlight particular gaps or groups that require focus. Small elements can have disproportionate impacts, so the need for consistency is diminished. Thinking complexity acknowledges the fluidity and emergence of the contexts and relationships we work within and help shape, and this directly informed the way we framed our plan with priorities and directions, rather than specific actions and targets. If we are constantly identifying trends, micro impacts and monitoring external factors, we can evolve our responses to best effect.

7.5.4 Example 3: Pandemic The onset of the pandemic and the huge upheaval it generated throughout society provides a topical example to examine. In Melbourne, Australia, the pandemic and the Victorian Government’s interventionist approach to managing it created both personal and professional challenges due to significant restrictions to our daily lives. We had a series of months long ‘lockdowns’ involving restrictions and curfews, for example, we could only travel 5 kilometres from our home, only leave the house once a day for essential shopping and medical needs. Only a set of narrowly defined ‘essential workers’ could attend workplaces with most people needing to work from home including children and young people studying. These restrictions and the health impacts had flow on effects on the demand for services and the need to find new ways to deliver services despite a huge number of unknowns. Anyone in a management position as COVID-19 took hold would have felt the pressure to step up and into the chaos, along with the need to respond and ‘do’, with very little time available to investigate, understand and anticipate and look out for what was coming next. In other words, there was an urgent requirement for doing and no time for thinking. People’s time horizons shrank – they were glued to daily reporting of case numbers creating a predominant focus, which was paralysing for some. Earlier on a public narrative emerged that ‘we are all in this together’, but as the government struggled to get ahead and imposed more restrictions, it became clear

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that the impacts were being felt quite differently across the population. This is where the concept of emergence and looking for patterns at both a broad population level and across the organisation’s staff, volunteers and clients provided cues about what was happening or likely to happen. When we took small steps in response to these emerging trends or patterns, we were often better placed to respond as the trend strengthened or changed shape. The speed of change meant that if you waited until the pattern was clear and there was data to substantiate it, you left yourself no time to develop and activate a response before the next shift happened. Some groups and organisations slowed down or stopped when they could not operate in business as usual, while others adapted and sought to provide support in different ways with different resources and strategies. As a responsive place-based organisation, we were able to operate outside normal ecosystems to fill gaps and emerging needs and seize opportunities. For example, we built on our relationships with a learning provider and health provider in our region to develop a Bi-cultural Health Navigator program to respond to the health information needs of our community and capitalise on government funding to create employment opportunities for those experiencing barriers to employment. One of the tenets of thinking complexity that resonated during this period was to learn from a system’s history, or organisation’s history in this case. Learning how a system has evolved over time provides insight into its present patterns of behaviours, what types of relationships have been the most intense, relied on in a crisis, or relied on when thinking about what to do next. I reflected on a time when we had experienced a shock or disruption – it may not look anything like the one in front of us, but it can provide some insight. We had previously experienced a flood in our office and couldn’t access or work from the office for 8 weeks. It was before our client records were online in databases, more than half the staff didn’t have mobile phones and we didn’t have a continuity plan. I was new to the organisation, and what I saw was staff and volunteers self-organising and problem-solving together to work out how to keep delivering. Their focus was on clients and their needs, and this drove their priorities. Alternate workplaces were found through the generosity of partners and other services – largely the way forward was made clear by the staff and their external relationships and networks. This learning meant that at the onset of COVID-19, we were able to draw on this tendency for iterative problem-solving and as managers provide the orientation and support for ideas and the confidence that we will be able to work it out. We checked in and made explicit attempts to get as much feedback into the system as we could to ensure we weren’t going too far off track, and we could make improvements in real time. Another tenet that was relevant and helpful was that of emergence (feedback). It became clear through the different stages of the pandemic that this was not a temporary state, but the changes were becoming embedded as time went on, and they were unlikely to be rolled back. The world had changed and was operating in a new state. The significant changes to the way we work, where and how we do our work, were accelerated tenfold through the upheaval of COVID-19. I focused on making micro adjustments to keep momentum and confidence but not increase anxiety related to change.

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It is easy to focus on the negative impacts of COVID-19, but there was, and remains, a significant opportunity to change long-held practices, systems and expectations, like hybrid work and service delivery methods. These opportunities come with most change. Thinking complexity helps us explore incidental impacts and opportunities through open enquiry, explicitly looking for connections between seemly disparate things and being able to generate feedback through different channels, partnerships and networks.

7.5.5 How Does Thinking Complexity Help Us Understand and Act? As has been highlighted in previous chapters, thinking complexity is a way of getting theory and practice together to help inform action. It helps us work through the contradictions in service systems, clients’ lives, expectations and our own values. It may also help you take responsibility for the authority you have in difficult situations and help you represent and balance the other things that influence our decisions, like social licence, law and financial obligations. Thinking complexity can support us to expect the unexpected  – this is much easier to say and write than to do. Without history or lived experience of something, it is very hard to imagine the scope, scale and dimensions of the ‘unexpected’. But we can learn to manage our initial reactions, reduce the shock and surprise and develop strategies to make those initial investigations that help us learn and understand as much as we can and draw links between fragments or threads of this initial information. It helps me to stay in a state of uncertainty longer to give myself time to work through scenarios and options rather than heading to a solution. It embeds the notion that new information and relationships will continue to emerge, and decision-making is more a series of micro steps than one moment of clarity. Decisions can appear larger or more significant when looked at in isolation so being able to make smaller decisions that can support a continuous processing of emerging information and initial results. We can then review, amend or build on earlier decisions. I think this helps to manage the anxiety about the high level of unknowns – you can focus on what can be known in the time available. Thinking complexity enables you to capitalise on dimensions of relationships by bringing others into the discussions or deliberations early. If you can articulate what is going on for you, what you are agonising over and get feedback, new information and insight, you can incorporate that into the decision process much earlier. You need to build a network of trusted colleagues or peers who might be one or two steps removed from your work and context.

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7.6 What Do We Know About Thinking Complexity in Management? By understanding the nature of complex systems as embodied in complexity theory, we can: • Expect the unexpected – develop skills to manage unpredictable situations, outcomes, responses and focus on how to manage or engage with uncertainty. • Be sensitive to dimensions of relationships – explore the quantity and quality of connections and pay attention to a wide variety of dimensions (not just race and gender) to try to understand the impact of diversity. • Study the interdependencies and interactions among the elements of a system and across the boundaries of systems and look for patterns across levels (Watts, 2003). • Learn from a system’s history – learning how a system has evolved over time provides insight into its present patterns of behaviours, what types of relationships have been the most intense, relied on in a crisis, or relied on when thinking about what to do next. • Manage the tensions – a complexity approach may undermine the value of predictive instruments or assessments and formal documents and policies can mask the informal or spontaneously occurring events, structures, processes, groups and leadership that may provide critical insights into motivations and behaviour.

7.7 Conclusion By continuing to explore the practical application of complexity theory to the quality of the judgements and decisions made by social work practitioners, we will strengthen the translation and feedback between theory to practice. I believe thinking complexity has enormous potential to help social workers and the organisations they work within fundamentally reorientate the ways they frame and respond to issues, problems and opportunities. A fulsome engagement with complexity theory, particularly the development of capabilities to think with a complexity mindset – whether in researching or evaluating, developing policy, enhancing practice, working with communities, groups, individuals or families – holds great potential to advance social work knowledge and develop and sustain social work practice across all domains. It also has the potential to better support day-to-day decision-making in practice, perhaps indirectly improving practitioner’s confidence and well-being as well as client and stakeholder outcomes. Working together on this book, as authors with different backgrounds, provides an exemplar of the contribution complexity theory can make in interdisciplinary work, highlighting that it is work at, and across, disciplinary boundaries that can advance our research and practice knowledge.

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Reflective Questions • This chapter describes the management strategies and some emergent outcomes: what do they tell you about how CAS infiltrate and influence outcomes? • If you were the manager in these circumstances, where would you start? • Are there other strategies and actions not described here that you might consider doing?

References Klein, J. (2004). Interdisciplinarity and complexity: An evolving relationship. E:CO Special Double Issue, 6(1–2), 2–10. Manson, S.  M. (2001). Epistemological possibilities and imperatives of complexity research. Geoforum, 34(1), 17–20. Plsek, P. E., & Greenhalgh, T. (2001). Complexity science: The challenge of complexity in health care. British Medical Journal, 323(7313), 625–628. Watts, D. J. (2003). Six degrees: The science of a connected age. W.W Norton & Company.

Chapter 8

Thinking Complexity in Community Development

8.1 Introduction and Learning Opportunities Community development is an evolving story of everyday life. This chapter draws on a community development project in a diverse and rapidly growing outer metropolitan area of Melbourne, Australia. It explores how we might seek to understand a community development project or challenge, knowing we never have all the information we need, and never at the same time, and we need to draw from a range of like situations and experiences to fill in the gaps. This chapter follows the previous one in providing commentary on how thinking complexity acts as a framework for action and reflection, or doing-thinking-doing, which can directly support and influence practice in the community sector. It illustrates how thinking complexity supports decision-making and learning in community development activities and settings. The worked examples demonstrate the benefits of integrating key concepts such as emergence into practitioners’ conceptual models. In seeking to answer the question ‘how does thinking complexity help in community development’, the chapter uses key concepts of emergence, non-linearity, adaptation, embeddedness/nested systems, those clusters of open systems and, in particular, the spontaneous emergence of collaborative behaviour (within the organisation and the community, and the service ecosystem locally). It also employs the observer lens (what is happening without intervention) and then influencer lens (how do we decide what to do, with whom and how) and what happens (both anticipated and hoped for outcomes and unexpected but positive outcomes). Thinking complexity can help us to have the confidence to make decisions and take small actions, to make sense of what we know, can see, is visible and think complexity to provide ways to enter the space and act while observing and noting how things emerge, evolve or adapt.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_8

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At the end of this chapter, readers will have: • Built on their earlier learning in the previous chapter, which set the scene for conceptualizing complexity theory’s (CT) influence on practice. • Understood how thinking complexity informs and shapes practice in community development. • Learned from practice examples how a community developer works with uncertainty, unpredictability, making strategic decisions in light of their understanding of CT.

8.2 Context As I outlined in the previous chapter, I consider I have a natural leaning towards thinking complexity. I took this ‘leaning’ a step further in my still-to-be completed PhD studies investigating how people make their lives in new places. This study developed from my engagement with the place and people in and around the outer northern suburbs of Melbourne, Australia. Through my early literature review, I found previous empirical studies in this research area were generally about a particular type of place – new suburb, gentrification, scene of disaster, and/or about a particular population – young families, refugees or diverse communities, mothers, young people and were often quite policy focused. I wanted to see how things intersected and how decisions people made were influenced by a range of different factors and sources that changed over time. It became evident very quickly that there was a huge disconnect between the vision, planning and developers’ marketing pitch for new suburbs and the actual delivery of both physical environments and services/programs. This is further compounded by different levels of responsibilities between levels of government. You want to know what it’s like… Well there’s the isolation, daily pressures of living, limited services and infrastructure… these all make it difficult. You add a few financial and other stresses and you get strained relationships, you feel incompetent as parents, it’s hard to get around, there’s no time and place to meet people so you have limited connections. This all adds up to health issues, anxiety and depression and maybe family breakdown, and at its worst, family violence (Growth area resident, research participant).

While often the stories told were about hardship or disappointment, I could also see the potential to support community advocacy and innovation.

8.3 Community Development The United Nations multilingual database for official terminology (UNTERM, 2023) defines community development as a process where community members come together to take collective action and generate solutions to common problems.

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While this is not the place to define community development as it has its own body of literature and professional practice, I would add to the definition above in that, within community development, community members are often supported by agencies to identify and take collective action, but those individuals are considered to be experts in their lives and communities, and their community knowledge, wisdom and ideas are valued. This is the case in our example. I also think it is important to highlight that community development is grounded in the principles of human rights, inclusion, social justice, empowerment and collective action. It often develops over a long period of time. In this chapter, we use the term in its broadest sense to describe an active focus on the people and places within a geographical area. The work is at the same time data collection and analysis, observation, investigation, relationship building, group work, activities and events and reflection and further action. The case discussed is a combination of community development and community-based work, things like service outreach, and development of networks. As a social worker or community development professional, you may find yourself working in a neighbourhood house or community centre, leading a social justice program or community advocacy project. A community development approach is appropriate for all these settings or types of activities.

8.4 How You Can Think Complexity in Community Development Particular insights that complexity theory provides for community development practice relate to the nature of interventions, in understanding the limits of human autonomy and self-determination, the occurrence of unpredictable outcomes and the opportunities that emerge when agents locate themselves in the spaces ‘between’ systems (see Green & McDermott, 2009). The uncertainty and unpredictability that comes with a complexity theory understanding is clear: for the practitioner, there are many possible courses of action, and there are many possible sources of and interpretations of data. This provides freedom to examine information in different ways with different lens over time. Ongoing reflection and noticing the nuances in the data helps you make micro adjustments to your actions. Integrating a complexity theory conceptualisation means being mindful of relationships and processes, valuing learnings and understanding as well as knowledge. It’s about the question and the process of answering the question. Applications of complexity theory and its key concepts to community development practice are diverse and can include the following: • Conceptualizing the question – Why are we doing this work? What do we hope to understand or change? • Understanding the initial conditions of the place, community and residents  – Where are the boundaries and intersections?

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• Undertaking, documenting and analysing community engagement activities. • Understanding how advocacy or support groups establish and organise. • Respecting the knowledge to be garnered from having participants with diverse perspectives and experiences strengthening the group. • Engaging in broader issues of policy and social justice when complexity encourages social workers to investigate the external forces affecting their and others’ lives and activities or attempt to deconstruct social policies. • Understanding the historical emergence of social movements. • Identifying service and capacity gaps and developing services that support inclusion and self-determination. By integrating complexity concepts or models, social workers in a community development context should not expect an exact fit or complete explanation, but should seek resonances (Cox, 2012) or patterns. An orientation to complexity enables the community development practitioner to frame their role as that of an ‘intruder’ or interventionist, which provides an opportunity to observe how the system dynamic unfolds as it adapts to that intruder (Burton, 2002). In community development settings, responses to the social worker or the engagement process can provide information about the nature of the community (or system) itself. The role of intruder changes over time as a result of the fact that the system changes, and the system changes as a result of the intruder’s presence. Entry into the setting may make a different setting altogether, or as Gleick (1987, p. 24) suggests, ‘the act of playing the game has a way of changing the rules’. This correlates with the idea proposed earlier of social work interventions (or non-­ interventions) being seen as creating a complex system. The social worker therefore is part of a complex system, an agent along with their team, clients and/or community members. Returning to Chap. 3’s metaphor of the camera lens, we might look at a community development project or challenge, knowing we never have all the information we need and, never at the same time, always zooming in and out to get a better focus. We might concentrate on the long view, the community or geography as a whole, and then the middle ground, which might be a group, or a particular community within the area, and further zoom in to the individuals and families participating. We learn things from each of these focus points that we can use to inform the others, and we can also draw from a range of like situations and experiences to fill in the gaps. Community development is an evolving story of everyday life.

8.5 Community Development: Wollert 8.5.1 Introduction We began work on the Wollert Community Project in outer metropolitan Melbourne in November 2020 aiming to understand the growing community and explore options to meet their needs and aspirations.

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When conceptualizing a project like this, it is important to understand your motivation for doing community development as this informs your approach. Thinking complexity can help in conceptualizing and answering the question – What do we hope to understand or change? Where are the boundaries and intersections? In our case, we had reviewed our service data, which showed a low uptake of our services from people living in Wollert. As a rapidly growing area with limited infrastructure and local service provision, it was important for us to investigate and learn more to ascertain if we could provide more and/or different support. The key questions addressed in this section include how thinking complexity helps us to: • Understand the situation/context and the initial conditions. • Prioritise issues and take action. • Improve community outcomes.

8.5.2 The People and the Place As is common when embarking on this type of project, we looked for demographic data from public sources like the Australian Bureau of Statistics (ABS) Census of Population and Housing and development data like Forecast ID that might help us to understand the place and the people, now and in the future. Rapidly Growing  Wollert is one of the fastest growing suburbs in Victoria. The population is predicted to increase from 2832 in 2022 to 36,594 in 2041, an overall increase of 1192% (ABS Census). These increases are now expected to occur more rapidly than originally predicted, due to a boom in property sales during COVID-19. An average of 596 homes are due to be built in Wollert each year (Forecast.ID). Wollert is a relatively large geographical area, and people and resources are thinly distributed as only a fraction has been developed, and due to the different developers in the area, there is a disconnection between pockets of development, which can add to the isolation, dispersement, lack of destinations and the overall incompleteness. The area is bounded and divided by major roads and ongoing roadworks, making getting in and out everyday problematic but necessary due to limited offerings inside. Some areas have streets too narrow for buses, and to accommodate all the cars, people have to deal with commuting long distances to work, which also means less time to spend with their families. Multicultural and Newly Arrived Communities  Wollert is very multicultural, and a large proportion of the population are new to Australia. According to the ABS census 2021, 45.2% of the population was born overseas, and 59.5% spoke a language other than English (compared to Greater Melbourne averages of 33.8% and 32.3%). Twenty-two percent of people living in Wollert in 2016 arrived in Australia within 5 years prior to 2016. The majority of overseas-born residents are from India,

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with significant populations from Sri Lanka, North Macedonia, Iraq, Italy and a number of other countries. The majority of Wollert residents born in India arrived on either skilled migrant or family visas. Wollert residents born in Iraq and Iran were more likely to have arrived on humanitarian or asylum seeker visas. This has implications for service provision with differences in eligibility for services depending on migration stream. High Proportion of Young Families and Disengaged Youth  Like many growth areas, Wollert has a high proportion of young families with children (60% family households compared with 43.6% Greater Melbourne). Over half (57%) of Wollert residents are aged under 34 (compared with 37.9% Greater Melbourne). Youth disengagement is higher in Wollert (11%) than Greater Melbourne (7.5%). High Rates of Mortgage Stress  The vast majority of Wollert residents have mortgages (61.9% compared with 34.3% Greater Melbourne), and there are relatively low numbers of renters. According to the 2021 census, 20% of people in Wollert are living in poverty and 27% of residents experience mortgage stress, compared to 15.4% in Greater Melbourne. Increases in living expenses and rising interest rates are likely to place more financial stress on families. Infrastructure Needs  As is often the case in rapidly growing outer metropolitan areas, infrastructure in Wollert has not kept pace with development. Community members repeatedly cite the need for more public transport, shopping centres, childcare centres, sports and recreation facilities, libraries and community centres. Even from these data headlines, we can start to see there is a clear need for an enhanced response by government, developers, services and community stakeholders to meet the needs of the Wollert community, both now and into the future. With much of the land in the area yet to be developed, there is an opportunity for this response to be implemented in stages and for some services and activities to be in place when new developments are opened and people need them.

8.6 How Does Thinking Complexity Help Us Understand the Context and Initial Conditions? 8.6.1 Context Most real-world systems, like communities, are open, meaning that they cannot be screened off from their environment, so the effect of exogenous influences must be taken into account. These influences can change over time and with sensitivity to initial conditions. A complex system is not beholden to its environment – it actively shapes, reacts and anticipates and remembers. We drew on the idea of open systems that have permeable boundaries to loosely define the geographical area but also not

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rule places, activities or people in/out of the Project. People’s lives happen in many places, not just where they live, so they are influenced by things across any pre-­ defined borders or boundaries. Thinking of open and nested systems enables the people involved in the Project to see connections between people and places as evolving and allows them to adjust to emerging boundaries and recognize feedback from different systems or arrangements. It helps frame questions such as, ‘What is the impact of having so many people that have been in Australia less than 5 years? how is their behaviour influenced by those in their home countries or their experiences from there’?

8.6.2 Initial Conditions Thinking complexity helps us interrogate and connect different data and anecdotal evidence. The rate of development has a big impact as it appears critical mass is important for a sense of community. The first 1000 people can’t generate much activity, and people moving in later were often happier than those who came as development started. Residents report that habits are formed early, in the first few months, so even if new people and activity comes, it takes a lot to change people’s behaviour. Some of the early residents describe their challenges: • ‘We just slept there… we packed everyone in the car and left for the day… we ate, worked, socialised, shopped somewhere else… no mobile coverage or shops for 5 years… we weren’t the only ones, it was like a sort of mass exodus’. • ‘We are all dealing with “newness”, everything is unfinished’. • ‘We were surrounded by empty paddocks and/or half-finished houses… we felt isolated with nothing to feel part of… now we miss the paddocks’. • ‘I don’t want to meet any new residents, I’ve got a circle and stick with it, it makes it hard for new people to break in but it’s exhausting’. • ‘All the promised physical infrastructure lags so far behind housing – there is road congestion, nowhere for social programs/services and no community meeting places, no one knows what’s going on or who is responsible for what’. If we connect the census data indicating a high percentage of people under 35 with the really visible presence of young families, you start noticing that all the facilities and services revolve around young families, meaning there is likely to be a big gap for others. The ‘community’ is not a single entity We don’t all play football – some of us sing, play the guitar, do gymnastics or tai-chi… we have different family types and might have family members from overseas, aging parents or widowed parent, nephew that lives with us… And there are a few single people here too. You know it’s not so simple as young working families (Wollert resident).

The physical separateness of pockets of development combined with people from overseas moving in can point to isolation. It doesn’t take long talking to people

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to understand the lack of social networks in growth areas. It’s all new – no existing graininess, social history, relationships, networks, groups or limited information, communication channels and people are often moving away from personal ‘bonding’ networks of family and close friends. It takes time to transition to broader ‘bridging’ networks generated through participation in education, employment and public life (sport, volunteering, clubs, etc.), and these areas are yet to establish ‘governance’ networks that link communities to decision-making institutions such as local government.

8.6.3 Expectations Versus Reality The demographics, motivation for moving there and/or moving out, employment possibilities, range of community groups and networks, knowledge of and access to services and political capacity all factor into how a community forms and evolves over time. One of the early themes from conversations with residents was disappointment that it hadn’t, or wasn’t, living up to expectations, but some also said they are not sure what they were expecting. People don’t always plan or anticipate what it’s going to be like. This is a totally new kind of life. It’s partly me adapting to retirement and thinking about what I miss from Canberra… I wouldn’t have at all predicted what was going to happen to me, where I would be at this stage when I was thinking about moving in, and even shortly after I moved in. We were getting married and building the house, we both had jobs so there wasn’t much time to think about what it would be like. We were just excited to be getting a home and starting a family… In hindsight it was all just too much at once. We didn’t give ourselves anytime to adjust, or make the transition because it’s a whole new kind of life out here. You know the development is all done for community living (bikeways, open spaces, facilities) but it doesn’t happen. You don’t see people out and about much, in the street or using the parks… It’s like the promise of a different life but you just can’t seem to make it happen… (Epping North – Wollert residents).

One of the concepts from understanding CAS that is useful here is non-linearity. Changes in one element or component are not directly proportional to change in other components. A non-linear system is one without a unique future trajectory and for which inputs are not proportional to outputs, that is, a small or large change in one variable does not necessarily have a small or large effect on other variables or the whole (Rickles et al., 2007). Non-linearity helps us to problematize our instinct to jump to causal conclusions. In the development of new communities, we can’t rely on the design, service provision, demographics or any particular combination of factors to influence people’s behaviour and their enjoyment of the area. The future trajectory of any particular community might be influenced by things as random as an ethnic grocer moving in, a delay in telecommunications provision or an emergency or disaster that brings people together.

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Just like people everywhere our lives are not linear or predictable, we don’t always plan everything, we want diversity in housing, places, spaces, organisations, groups, activities, opportunities – we want choices (Wollert resident).

8.7 How Does Thinking Complexity Help Us Prioritise and Take Action? 8.7.1 Getting Started With work like this, you can design and plan it or just start engaging to understand more about the community and see what issues, challenges and opportunities the community identifies. This is our approach: creating space and conditions for things to emerge as opposed to pre-determined or pre-conceived outputs. It allows for you to be opportunistic and go where the energy is to get started. It also allows you to focus on the information and issues you are identifying and think about what responses might be available to you, at the same time as doing (creating space and activities that are generating relationships and identifying issues). Again, the cycle of doing-thinking-doing reflects the simultaneous and evolutionary nature of community development work. Recognising the way systems or organisms create their environment and are in turn moulded by that environment, that is, how they coevolve is important. One element affects others, which in turn can affect the original element. Feedback can be positive or negative and can occur between levels (micro, meso and macro) so that micro level interactions between the subunits generate some patterns in the macro level that then back-reacts onto the subunits, causing them to generate a new pattern. As social workers, we know the benefits of social networks: better physical and mental health, positive parenting and improved child development, success at school, better employment outcomes, more positive aging, the spread of information and innovation, a sense of solidarity and respect for others (social cohesion) and often increasing inclusive attitudes and respect. From a community development perspective, we know that connectivity through social networks can increase a community’s belief it can, and its willingness to, act collectively towards shared goals. So, it’s a good place to start to try to generate connections and support people to build social networks. We asked residents what they would like to do in terms of community activities, and a lot of it focused on cooking, craft and cultural celebrations. There were learnings from those initial activities: • Most participants were first-generation migrants with permanent residency and citizenship. • There was good participation in activities, and community members were keen to engage even when activities were moved to online delivery due to COVID lockdowns.

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• Participants were interested in opportunities to celebrate culture, and there was a strong desire to pass on cultural knowledge to children through the celebration of important cultural days and festivals. • There was a clear need for child-friendly activities or childcare arrangements for face-to-face activities. Most parents brought their children along, and many stated that they wouldn’t be able to attend if they couldn’t bring their children. • Most participants held traditional family values, and women were largely responsible for caring for children and household duties. • Women were concerned about the impact of COVID lockdowns on their children and worried about them missing school, feeling isolated and lacking recreation opportunities. • There was strong interest in school holiday programs; however, not all families could afford school or group programs. • There was strong interest in small business and work from home business options with many participants looking for ways of working and achieving work/life balance.

8.7.2 The Community Development Worker(s) To explain how complex adaptive systems affect and are affected by their surroundings, Cox (2012, p. 584) advances the notion that agents have ‘…the capacity to share information among themselves, with others in their environment, and to adjust their behaviour as a result of the information that they process’. These agents have agency; they are influenced by their history but not determined by it, and they develop and adapt as the environment changes. Agents, as the unit of analysis, can be individuals, families, groups and teams; complexity helps us see the interactions and the competitive and cooperative tendencies between these agents. In contrast to person-in-environment, this concept of agents and open systems, intimately linked to their environment, can tell us how humans act to actively impact the environment and how the environment actually impacts on humans. One of the decisions that needs to be made in projects like this is who the community development workers (or agents) will be as the environment adapts to their characteristics and approach, influencing outcomes. We know the demographics of the residents, and there would be a strong argument for employing someone to match that group to get maximum reach into the community. But then minorities may be more excluded. We started the activities with a social worker with South Asian background and quickly found participants were predominantly from South Asian backgrounds, the majority cohort. As we had anticipated this, we worked hard to ensure others felt welcome, and the activities were designed to appeal to others outside this cultural/linguistic group. Within the first few months, more than 20 different cultures other than South Asian were represented. As participants developed trust in the Community Engagement worker through their participation in activities, a number of people approached her for support with other issues/

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concerns. She was able to facilitate a number of referrals. Would this have happened, or happened to the same extent, if their backgrounds were not similar? Emergence is a useful concept here, suggesting relationships shift and change and new system properties may emerge. With similar backgrounds, the women quickly bonded and built networks that enabled them to include others and build a sense of confidence. These shifts are often as a result of self-organisation, a property of complex systems that enables them to develop or change in order to cope with or manipulate their environment (Cilliers, 1998).

8.7.3 Adaptation (Impact of Time) Often, community development needs time, considerable time for individuals to connect, build confidence and develop networks. This is not often readily available to community organisations or workers. We need to develop ways to be able to look ahead and see how things may change. In this project, talking to people who have different time horizons provided some insight into how people adapt to the newness and isolation. Adaptation is a useful concept – it refers to the way complex systems change in response to changes in their environment. Complex systems are open to modify themselves in the face of pressure and perturbations from the wider environment. So complex systems have an ability to organise themselves relative to their environment and can co-evolve in interaction with other systems. We love it here now.. Really since my wife got a part time job at the school, we have met so many people, found our way around, have great neighbours.. And she is much happier, and the kids are doing gymnastics in Mill Park, we do some dog fostering so always going down to Lalor to pickup/drop off dogs. I try to get to the community garden every month… good to catchup with local news. There was a sense of feeling quite lonely when we came here and there wasn’t much of a connection with the community being a new area… now (ten years on), I feel settled, I love my home. I don’t think I ever want to move from there… I can’t think of myself even being two blocks away because it would mean connecting to the people in that street and I may not connect, and it’s a scary thought (Epping North – Wollert residents).

8.8 How Does Thinking Complexity Help Us Improve Community Outcomes? If there are no corner shops to walk to, nowhere to buy the milk or paper, people have to get into the car, which limits opportunities for social connection and health and wellbeing. The design of suburbs with narrow streets that buses and garbage trucks can’t get down and houses built to the boundaries that don’t accommodate families with 3 or 4 cars and limited or no public transport, can have the effect of building in conflict (Epping North resident).

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With all the resources, technology and research available to us, why aren’t we doing better in supporting healthy connected life in outer growth areas? Compared to the Greater Melbourne average (ABS Data, 2021), our growth area residents have: • • • • • • •

Higher rates of family dysfunction and violence Financial stress Lack of social cohesion Higher rates of physical and mental health problems Difficulties in managing work and caring responsibilities More young people disengaged from education and employment Lower civic participation rates

Despite what we know about how people live and what supports they need, we are often not able to put it into practice – it is genuinely difficult, but not impossible. According to VicHealth (2016) research on the planning and designing of new developments in growth areas, the two most important social determinants (of health) in relation to growth area communities are access to employment and transport. These determinants are often delivered separately to the provision of local services and amenities and well after residents have moved in, affecting health outcomes. Political and economic priorities override social and environmental outcomes, and there is often a lack of accountability, responsibility or incentive to deliver social/environmental outcomes despite some reputational risk. If a land developer or government agency delivers a new suburb and in 20 years, there are high rates of crime, youth disengagement, family violence or obesity – no one holds them responsible – we all pay for it in higher costs of health, policing and crisis intervention. Do we understand the interdependencies of how life is lived by residents? How planning effects everyday life? Or how work in community services affects life in people’s homes? These things matter to people, and materially affect them. How we work goes to the heart of our professionalism, we carve our roles into “specialisms” and distance ourselves from the immediacy and messiness of reality, limiting us from learning… we need structures, and opportunities for thinking together instead of things that keep us apart, which means we are less able to be part of social change, to facilitate social change… (Council staff members).

It’s important for us to look at the way we think about how we plan and change our viewpoint to help prioritise: Imagine life as a teenager in a new growth area – where would you go, what would you do, how would you get around, where would your friends live, how would you feel about catching the bus to school at 7 a.m., or spending 45 min in the car to get there. Young people aren’t voters, or ratepayers. But young people matter greatly for both positive and negative social outcomes. Young people live in a different world than their parents… there are growing generational differences due to rapid changes in lifestyle and the impact of technology. Adults have a different experience and world-view to young people, and in some cases a different language (Local school teacher).

Thinking complexity helps us view situations and challenges from different perspectives at the same time, at different scales, and it can help us connect the

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influencing factors, agents and the environment. This is important for developing an advocacy platform or policy response but equally in our everyday work in the community.

8.9 What Do We Know About Thinking Complexity in Community Development? When facing a situation or project: • Develop a mindset – be open to seeing the world in terms of systems, patterns and different types of boundaries (Ansell 2010), for example, political, geographical, functional, time. • Engage in possibility thinking – recognise there are always a range of possible ways of acting and, as social workers, we have choices about how to respond to situations. • Try multiple approaches – let direction arise by gradually shifting time and attention towards those things that seem to be working best. • Search for patterns – pay attention to flow of behaviour rather than describing static behaviour and look where practices, values and memories and phenomena perpetuate themselves over time. • Shift emphasis, shift foreground and background to create new views of systems to better understand them (Lissack, 1999). • Understand that we, and those we work with, are agents – with agency, ability to communicate with others, share information, have capacity to act in unpredictable ways, to adapt to their changing environment and to influence their environment  – social workers have the ability to create functional and informational linkages outside the silos they may find themselves within.

8.10 Conclusion Integrating complexity theory into social work research and practice in the area of Community Development enables the creation of knowledge that is open to revision and improvement, can accept local contexts and uncertainty and explores the interface between different ways of knowing and the patterns of interplay between different cultural and natural processes in human situations. It embraces participation of agents and actors and engagement with society, both instrumental and critical, and is very relevant to real-world problem settings. This orientation fuels a creative interplay of theory and practice, and of researcher and researched, of practitioner and service user. It supports social workers to both think and do, or act pragmatically.

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We’ve noted from the outset of the book that social workers are, at heart, pragmatists: they want to act, to do something and to make something better. Pragmatists make use of everything available to them to help them act strategically, make decisions and reflect – theories, models and research findings are all brought to bear in the decision to act in order to influence (as far as possible) a better outcome than that which would occur if they did something else, or even did nothing. Thinking complexity assists us as practitioners to develop the cycle of doing-thinking-doing, which builds capacity and confidence and values thinking as much as doing. Reflective Questions • This chapter describes the community development strategies and some emergent outcomes: what do they tell you about how CAS infiltrate and influence outcomes? • If you were the community development worker in this area, where would you start? • Are there other strategies and actions not described here that you might consider doing?

References Ansell, C. (2010). Managing Transboundary Crises: Identifying the Building Blocks of an Effective Response System. https://doi.org/10.1111/j.1468-­5973.2010.00620.x Australian Bureau of Statistics ABS Census Data. (2021). https://www.abs.gov.au/census/ find-­census-­data Burton, C. (2002). Introduction to complexity. In K. Sweeney & F. Griffiths (Eds.), Complexity and healthcare – An introduction (pp. 1–18). Radcliffe Medical Press. Cilliers, P. (1998). Complexity and postmodernism: Understanding complex systems. Routledge. Cox, P. (2012). Complexity science: Understanding research processes and improving research practice. Special Issue of Journal of Social Services Research, 38(5), 582–590. ISSN 0148-8376. Forecast ID. https://forecast.id.com.au/ Gleick, J. (1987). Chaos: Making a new science. Viking Penguin. Green, D., & McDermott, F. (2009). Social work from inside and between complex systems: Perspectives on person-in-environment for today’s social work. British Journal of Social Work, 46(1), 83–101. Lissack, M. (1999). Complexity: The science, its vocabulary, and its relation to organisations. Emergence, 1(1), 110–126. Rickles, D., Hawe, P., & Shiell, A. (2007). A simple guide to chaos and complexity. Journal of Epidemiology and Community Health, 61(11), 933–937. United Nations (UNTERM). (2023). https://web.archive.org/web/20140714225617/http://unterm. un.org/DGAACS/unterm.nsf/8fa942046ff7601c85256983007ca4d8/526c2eaba978f00785256 9fd00036819?OpenDocument VicHealth. (2016). Planning and designing healthy new communities: Selandra Rise. https://www. vichealth.vic.gov.au/search/selandra-­rise

Chapter 9

Thinking Complexity in Hospital Social Work Practice

9.1 Introduction and Learning Opportunities Social work within hospitals is contoured by organisational influences, particularly around acuity and urgency. Complexity manifests in unpredictability and uncertainty, and social workers must often make decisions without having a perfect understanding of the driving forces and life stories of the people requiring intervention. Perhaps, the best illustration of this is social work practice within the Emergency Department (ED), where these elements and agents converge within a pressured and chaotic environment (Moore et al., 2017). To ‘work’ with psychosocial complexity, social workers integrate clinical evidence, legislation, policy frameworks and experiential knowledge while collaborating with other disciplines and professionals who may be internal or external to the hospital (such as case managers and community-based practitioners). At the end of this chapter, readers will have: • An orientation to social work in hospital settings and understanding of the hospital as a complex adaptive system (CAS) • Been introduced to three fictionalised case examples that demonstrate common psychosocial characteristics or types of presentations to ED, to exemplify how thinking complexity offers an ontology for social work practice in hospitals • Recognition of the value of a pragmatic approach to responding to case complexity in hospital social work practice

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_9

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9.2 The Australian Hospital System In Australia, hospitals include both publicly (government) and privately funded entities that provide a range of acute and sub-acute medical, surgical and psychiatric care across the lifespan. Social workers are mostly employed in public hospitals as part of health networks that provide health care for populations based within geographical regions. Private hospitals tend to be governed by healthcare companies that may operate independently, or belong to national or multinational healthcare networks. The range of available treatment and services within hospitals is also shaped by local context and region. For example, most tertiary hospitals that have specialists’ centres are located within cities and urban areas, while the range of care for populations in regional and remote areas is less comprehensive (AIHW, 2022). Correspondingly, rurality creates additional challenges for hospital social work practice, such as access to resources, that are absent in metropolitan social work practice (Harvey & Jones, 2021). We often see a ‘hospital’ as a specific healthcare facility or building, yet hospitals are usually services embedded within or alongside other systems, rather than stand-­ alone entities with impermeable boundaries. Often, the functioning of hospitals is dependent on the availability of support from external systems, such as the frequently politised phenomenon referred to as ‘bed-blocking.’ In these instances, people who require inpatient care are unable to be admitted to a hospital bed, often because admitted patients are medically stable but are awaiting community resources, such as residential aged care (Kallianis et al., 2017) or disability supports (Redfern et al., 2016). Thinking complexity integrates an awareness of psychosocial adjustment to health changes, knowledge of relevant community services and facilitating movement from the hospital back to the community (termed ‘discharge planning’). Narrowly conceptualising social work as practicing ‘within’ hospitals is misleading, as much of clinical practice involves collaboration with agents and systems external to the hospital system. Like most systems, hospitals demonstrate dynamics involving input, throughout and output, usually referred to as ‘patient flow’. Moving back now to a focus on what patient flow ‘looks like’ in hospital, typically the medical care of patients is organised through streams of specialties, usually defined by an organ system, location within the hospital (such as intensive care unit or emergency department), or disease. Patients may receive care across a range of physical locations in the hospital, irrespective of which medical unit is providing treatment. For example, a patient may initially present to the ED with chest pain and quickly be diagnosed with a cardiac event. The patient may initially have their treatment directed by both a cardiology team and the intensivists within the intensive care unit, before being transferred to one of the hospital wards. They may also receive consultations from other medical disciplines in response to comorbid medical issues, such as from the renal physicians, or require medical assessment by a rehabilitation physician or geriatrician to determine their suitability to undergo physical rehabilitation. At each stage

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of the patient’s movement through the hospital, there are multiple professionals collaborating with the patient and their family around health and discharge decisions. While hospitals are closely associated with the medical and nursing professions, the landscape of the hospital workforce consists of multiple clinical and non-­clinical professional groups working in patient-facing or behind-the-scenes roles. The functioning and care of each hospital reflects the efforts of individuals and groups collaborating at several levels with the shared purpose of quality clinical care. This highlights that, like most social institutions, hospitals are hierarchical. Thinking complexity suggests we recognise structure and function, rather than implying levels of status of responsibility and interdependence between action at a micro level resulting in global organisation. However, hierarchy in the context of hospitals also denotes professional organisation, whereby biomedically trained physicians and surgeons hold greater power than other professional disciplines, including nursing and allied health. This may reflect the primary purpose of hospitals to provide acute medical care, the ultimate responsibility for which belongs to the treating medical/ surgical or psychiatric physician. However, care for hospitalised patients and their families often requires a multidisciplinary approach to facilitate appropriate care and discharge planning, including contributions by allied health. While there is no precise definition or boundary that delineates allied health disciplines from medical and nursing professions, allied health professions usually focus on the impact of health and illness on broader biopsychosocial well-being, such as mobility, movement, cognitive and social functioning. Social work, along with professions such as occupational therapy and physiotherapy, tends to be situated under the umbrella of allied health. While earlier it was established that social workers are ‘borrowers’ of theories and philosophies to understand the shared social realities of the people we work with, hospital social work requires a reasonable understanding of relevant clinical and health data, including biomedical information. For example, when working with older patients presenting with health conditions or injuries such as falls, understanding their prognosis and ability to mobilise safely requires engagement and consultation with medical and physiotherapy clinicians. In most cases, prior to engaging and speaking with patients themselves, social workers have already formed a partial and incomplete impression of patients’ situations through narratives sourced from other clinicians, such as from referrals or handover meetings. This narrative might offer explanation for the reasons for presentation to hospital and identified needs. Initially, the narrative itself is a fluid and loose-ended one, rather than a fixed set of facts or principles indicating what precise action must be taken. The narrative of the patient will be revised and edited throughout the course of a patient’s presentation in collaboration with other relevant figures, such as family and friends, service providers and other hospital clinicians. Therefore, the process of psychosocial assessment and intervention does not take place between social work-practitioner and patient alone, but reflects multiple interactions with other agents within the care system. It is often argued that what distinguishes hospital social work from other allied health professions is a holistic person-in-environment systems framework and a

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focus on the social, rather than medical, determinants of health. However, this disregards that to a certain extent, all health professionals working within modern health care share an appreciation for the social and human factors driving health and medical needs. For example, as part of discharge planning, assessment of environmental and social domains – such as home set-up, access to infrastructure, and services– is shared between multiple disciplines. Alternatively, the role of hospital social work is often associated with conceptualisations of psychosocial vulnerability and complexity – particularly working with patients experiencing traditionally ‘social problems’ such as abuse, homelessness and poverty.

9.3 Thinking Complexity in the Emergency Department Emergency departments are usually the initial point of access for hospital care. Within the emergency department, there may be sub-systems such as a resuscitation area, a short stay unit, ambulatory care, and psychiatric beds. Patients may self-­ present and be triaged from the waiting room, be transported to ED by an ambulance or even be bought in by the police. Upon presentation to an ED, patients are triaged by nurses according to the Australasian triage scale, which determines the urgency in which they need to be reviewed and treated by a physician. While statistics highlight the diagnostic reasons that people present to the ED, the reason for social work involvement is rarely solely in response to a medical condition. Presentation to an ED, and hospitalisation in general, usually is experienced as an unexpected crisis in a person’s life. Likewise, social workers must respond immediately to unpredictable events that necessitate a doing-thinking-­ doing approach as discussed in Chap. 1. Engagement and intervention with patients and those involved in their care is a continually evolving dynamic that is shaped by rapidly evolving input, output and feedback, including the effects of medical treatment, interpersonal engagement between agents, information that emerges during assessment and response to social work, multidisciplinary, and collaborative interventions.

9.4 Thinking Complexity and Acting Pragmatically in the ED: Case Examples The following three cases are based on composite cases that demonstrate common demographic and clinical needs for patients and families within the emergency department.

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9.5 Jessica Jessica is a 24-year-old woman who was bought to hospital overnight by an ambulance due to chest pain. While applying the electrocardiogram (ECG) leads to her chest, Jessica received several text messages from her partner and became highly distressed. Jessica disclosed to the nurse that her partner had called her a ‘bad mother’ and accused Jessica of fabricating her symptoms to ‘have a break’ from their kids. Jessica described how her partner could be highly critical and controlling of Jessica, such as preventing her from seeing her friends and family. Although she denied physical and sexual violence, she was fearful of him, particularly when he drank alcohol. The nurse queried where the children were, and Jessica confirmed that their two children aged 6  months and 3  years old were at home with their father. Jessica believed that the children were safe with their father while she was in hospital and clarified that he was a ‘good dad’ and that he would never hurt his own children. Initially, Jessica would not provide consent for a social work referral and only reluctantly agreed to speak with a social worker under the recommendation of the consultant physician. Jessica subsequently disclosed feelings of suicidal ideation to the nurse, and that her GP had recently diagnosed her with post-natal depression (PND).

9.5.1 Thinking Complexity Standing back from this scenario, it is possible to start to see some of the emerging and dynamic concerns we need to address. It might initially be useful to conceptualise each presenting issue discretely, such as mental health, family violence, child safety and physical health. However, it is important to recognise that these individual concerns cannot be addressed and ticked off in a linear fashion. For example, Jessica’s current suicidal ideation may be a response to the situational stressors she is experiencing and exacerbated by concerns about her children’s safety (and perhaps what social work will ‘do’), rather than purely a reflection of her diagnosis of post-natal depression. If we took this reductive approach, we would simply assume her suicidal ideation will dissipate following psychiatric treatment. Both Jessica and the social worker form a system of agents, and perhaps, it helps to get a sense of ‘who’ is involved. In one sub-system, we would situate Jessica, her partner and children. At a meso perspective, there are different disciplines and teams (which could also be considered sub-systems), within the ED including social work and the mental health team. External to the hospital are relevant service providers such as the police, family violence agencies and child protection. From a local environment perspective, the case takes part within an ED where opportunities to achieve a safe and private space in which to hold potentially distressing and confronting conversations with patients is limited. The social worker moves between these subsystems and levels throughout assessment and intervention.

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This case presents the social worker with an unfolding situation that involves multiple risk elements, necessitating collaboration with Jessica and other professional groups internal and external to the hospital system. The social worker must consider what level risk is posed from both a family violence and mental health perspective, to both Jessica and her children; address any immediate concerns about safety; and formulate an intervention plan that preserves the welfare of the family unit within the time pressures of the emergency department.

9.5.2 Acting Pragmatically The numerous ethical tensions in cases like Jessica’s demonstrate the need for sensitive pragmatic intervention. The high-risk factors evident, including her risk of mortality due to family violence or suicide and the present safety of the children, require urgent decision-making and action. A referral to social work can elicit various responses from victim-survivors. The most immediate challenge is developing enough rapport and trust between Jessica and the social worker. This includes considering what relevant biopsychosocial factors will influence our ability to engage with Jessica (Cameron & McDermott, 2007). Physically, Jessica is experiencing pain, and given she is a mother to a newborn, her sleep patterns are likely to be disrupted. Jessica has a relevant psychiatric diagnosis and is expressing thoughts of suicide, demonstrating her high levels of distress. Given the close association between child protection and social work (and the public perception of this role as primarily being oriented to child removal rather than preservation of family units), Jessica may feel anxious (Antle et al., 2010). This presents a dilemma to the social worker: although Jessica may distinguish between how her partner uses violence towards her, while engaging in appropriate parenting with their children, the children’s safety and well-­ being is inextricably linked with their mother’s (Taylor et al., 2013). Women experiencing family violence or other psychosocial issues may have previous experience, positive or negative, with child protection and welfare authorities, which will colour their perception of social work in hospitals. There can be an ethical tension when responding to presentations involving mothers experiencing family violence; there is a priority to ensure child safety may require involvement of child protection authorities while also wanting to maintain trust and provide support and care for the mother-patient. From a general ethics perspective, we must respect a patient’s rights to confidentiality and attempt to obtain consent for the purposes of an assessment and intervention. This is particularly relevant when working with family violence victim survivors who may already be feeling powerless and fearful. Having hopefully established trust with Jessica, a psychosocial assessment would establish an understanding of her general health, family, legal and social domains, alongside an appropriate risk assessment framework to explore Jessica’s experiences of family violence. It would be relevant to explore Jessica’s experiences of service engagement in relation to her mental health and family violence and get

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a sense of how she will respond to potential recommendations around referrals for safety upon discharge. Exploring whether Jessica has had any previous exposure or experiences with child protection, in relation to the family violence or any other historic concerns, would also be highly relevant. Alongside the identified risk factors for serious injury and mortality, Jessica’s own perception of her safety would be fundamental to establishing potential lethality should she be discharged to her home environment. However, we would prioritise and address any immediate safety concerns such as the whereabouts of the person who uses violence and current location of any dependent children or young people. We would also need to establish a victim-survivor’s safety within the hospital. For example, in the absence of a legal orders (variously termed intervention orders or family safety notices depending on the state), we cannot prevent a person who uses violence from presenting to the hospital and visiting a victim-survivor. Furthermore, there is a tension between needing to take action to ensure the safety of Jessica and her children – which will involve discussion of traumatic and distressing issues – and a desire to minimise Jessica’s suicidality and poor mental health. Jessica’s earlier expressions of suicidal ideation must be assessed and interpreted in relation to any relevant psychiatric diagnosis and treatment and the current evolving situation. For example, it would be valuable to enquire as to whether this is the first instance since Jessica was diagnosed with PND that she has experienced suicidal ideation. Further assessment by the treating physician will determine whether consultations with the mental health team is required, and consideration whether any relevant mental health legal orders are required to keep Jessica safe. The assessment and management of Jessica’s mental health will influence safety planning in relation to family violence and child safety issues. For example, if it is established that Jessica is experiencing ongoing suicidal ideation but does not require inpatient psychiatric treatment, the prospect of being discharged home to her partner or alternatively into safe accommodation with her children (if she elected to exit the relationship) would result in additional risks. Likewise, it would be highly likely that the interactions and interventions that take place between Jessica, social work and other relevant professionals (including child protection and the police), as well as any medications administered in ED, will heighten or lessen the acuity of her experience and her ability to participate in decision-making. The emergent vulnerabilities must be balanced alongside Jessica’s strengths, which could include psychological factors, relationships and social network and access to and willingness to work with relevant agencies. Despite all the challenges in cases involving mental health, family violence and child protection, there are numerous strengths and possibilities and a range of choices open to the social worker and patient. Most obviously, while Jessica is in the ED, she is physically safe and can be protected from further harm. Hospitalisations can provide victim-survivors with access to a range of supports and services to exit violent relationships safely.

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9.6 Taylor Taylor is a 40-year-old man who experiences frequent presentations to hospital due to public intoxication, expressions of suicidal ideation and traumatic injuries (which are usually caused by assaults or falls when Taylor is under the influence of substances). Taylor will self-present to multiple EDs within the CBD, or be bought in under police orders for mental health assessment. As a result, Taylor has landed the label of ‘frequent presenter’, a term denoting a patient with more than three presentations to ED a year (Shannon et al., 2020) and usually associated with significant psychosocial vulnerability (Bodenmann et al., 2015). Taylor’s file portrays a bleak narrative of his interactions with the ED. Taylor is often aggressive and requires high doses of benzodiazepines when he is withdrawing from alcohol. Taylor often expresses suicidal ideation in response to his sense of helplessness, particularly in relation to his ongoing homelessness. He has received various psychiatric diagnoses including antisocial personality traits, substance dependence, drug-induced psychosis and depression. He has been assessed by many different hospital social workers over the previous year, as well as input from addiction medicine, and the mental health team. His engagement with community-based homelessness agencies has been characteristically ‘poor’, as he refuses to accept tenancy in rooming houses, and has been banned from several crisis accommodation motels due to his violence. Nevertheless, a referral has been placed for social work as Taylor is requesting assistance around accommodation.

9.6.1 Thinking Complexity Just as we considered for Jessica, we need to consider Taylor’s case from a dynamic and evolving biopsychosocial perspective. Having attended handover and confirmed that Taylor is sobering up, we know that he is medically appropriate for social work assessment. There is already a narrative that is being constructed based on material from Taylor’s medical file and the collateral from the treating team. The written file – while thorough -provides an incomplete account of Taylor’s presentations and interactions with the health service. Psychiatric assessments describe Taylor’s early life punctuated by neglect and disruption. As an adult, he has attracted a diagnosis of a personality disorder, spent time in forensic settings, and engaged with community-­based alcohol and other drug (AOD) treatment services across various health networks. The focus of the file is what is ‘wrong’ with Taylor. There is little mention of Taylor as a person, his likes, dislikes and what gives his life meaning. Taylor’s own perspective around the reason for his frequent presentations is unknown. From a reductionist or problem-solving orientation, the obvious solution is that the social worker simply needs to find accommodation for Taylor and organise a referral to community-based alcohol and other drug (AOD) services. Ideally, this

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would address the root cause of his suicidal ideation, lessen his (and other’s) vulnerability in the community and reduce his preventable presentations to ED. However, the file has already established that Taylor has been assessed, reviewed and referred by multiple previous social workers who have done just this! Nevertheless, Taylor appears to be unable to maintain his equilibrium within the broader community. This demonstrates complexity at play  – the ‘problem’ is multifaceted, and his behaviour does not resemble a linear input = output or cause = effect pattern. Thinking complexity allows us to reframe Taylor’s interdependent problems, enabling a more holistic and fluid understanding of the interaction between presenting issues, rather than reducing the elements in Taylor’s life to be problems to be solved. This builds on existing theories of homelessness as an intersectional cycle of disadvantage (see Zuffrey, 2017), rather than simply an absence of physical accommodation. In Taylor’s case, homelessness could be the emergent property of a dynamic: his early experiences of trauma may have contributed to a distrust of authority figures (such as landlords or housing workers), and as Taylor had difficulty ‘following rules’ (which may have seemed arbitrary when he was concerned with his immediate survival), he has difficulty understanding long-term consequences of his often-impulsive decisions. As Taylor has difficulty with emotional regulation, he may use his money on substances to ameliorate his psychological distress, thereby reducing his ability to afford rent and resulting in further aggression to himself and others. Having considered how Taylor’s subjective situation and experience has been shaped by broader social policies and cultural influences (macro), trauma and adversity and repeated cycles of homelessness (chrono), interpersonal trauma and marginalisation (meso) and addiction and mental health vulnerabilities (micro), we are tasked with formulating an intervention relevant to his current presentation. The sheer enormity of the case raises a reasonable question about what is realistic and beneficial and within the boundaries or scope of the ED social work role. For example, what role does the social worker hold in response to Taylor’s entrenched pattern of unstable accommodation as opposed to a housing worker working in a community-­ based agency? How might these roles overlap, complement or conflict with each other? How would the ED social work intervention reflect and demonstrate consistency with reference to the overall purpose of the hospital and health organisation, in terms of funding and values? Given that the hospital is funded to provide medical and psychiatric treatment pertaining to a diagnosis, accommodation would be viewed as a ‘social’ issue. Yet, another perspective could argue that accommodation, or in Taylor’s case a lack of accommodation, is an important social determinant of health, which negatively impacts physical health and wellbeing. Critical reflection focuses on the scope, potential and limitations of what action is realistic and achievable in the context of a time-limited presentation to the emergency department.

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9.6.2 Acting Pragmatically Across Australia, the response to patients experiencing homelessness differs. Some health networks have formalised teams that work with patients to identify a safe discharge destination and patients cannot be discharged without accommodation being found. Elsewhere, patients are redirected upon discharge to housing and homelessness agencies that can provide crisis accommodation and ideally work towards longer-term goals. However, in many cases where the accommodation options are limited or unsatisfactory, patients will ‘cycle’ between hospitals and community services. Just because the ‘big picture’ of Taylor’s life seems intractably dysfunctional (at least from the perspective of the professionals working with him), it does not imply or confirm that Taylor would not benefit from continued efforts to engage him in treatment, or that intervention is futile. Pragmatism can be used in a humane way to reject overly idealistic approaches that seek to ‘fix’ difficult life situations but rather focus on the best intervention based on presenting needs. For example, one hypothesis worth considering is that due to Taylor’s experiences of trauma and disenfranchisement from a young age, what may be most beneficial for Taylor is a healthcare clinician validating his intrinsic human worth. This could also include the space and opportunity for Taylor to identify what a meaningful future existence may look like. A pragmatic response recognises both the seemingly insurmountable barriers and challenges that Taylor has experienced in obtaining long-term stability, alongside the opportunity that an ED presentation offers. While an overly idealistic goal would be to ‘fix’ Taylor’s homelessness once and for all, based on Taylor’s history, we know this is unlikely to be achieved during an ED presentation. If we understand homelessness as an emergent outcome reflecting multiple unstable factors, rather than simply a lack of physical shelter, we have clues about what intervention could have beneficial outcomes. This would also involve collaboration with other clinicians, such as addiction medicine who may be able to refer Taylor to a community-­ based addiction recovery agency. However, it would be vital to be guided by Taylor’s current conceptualisation of ‘the problem’ and his ability to exercise autonomy and agency within the constraints of what help is available. For example, it is unlikely to be the best environment or occasion to untangle how Taylor’s experience of childhood abuse has shaped his difficulty in building secure and safe attachments with others and whether this might explain antisocial behaviours such as violence towards others (noting of course, that correlation does not equal causation). While we could hypothetically conclude that there is a link between these elements that are highly relevant to the situation in the present, we could risk Taylor becoming emotionally dysregulated, and we are not able to provide ongoing monitoring and therapeutic intervention to establish containment and healing. Alongside any therapeutic interventions, the social worker is equally able to exercise power and authority by advocating for appropriate services within the community to respond to Taylor’s identified needs. The reality of work within an ED is

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often that it involves responding to aggressive and inappropriate behaviour, and de-escalation skills may be relevant, given Taylor’s established behavioural pattern of aggression towards authority figures. Regardless, Taylor’s presentation to hospital could be interpreted as an opportunity to work towards a better quality of life, rather than being viewed as a failure in Taylor’s engagement with community services, or a problem to be fixed.

9.7 Sam and Anh Sam is a 64-year-old man who is currently in the Trauma Bay after a fall from a ladder (approx. 5–6 m height) with a serious head injury. It is not clear what time of night or day he fell and how long he was lying on the ground. He cares for his mother Anh who has moderate dementia and speaks limited English. A neighbour called the emergency phone line after hearing Anh calling out in the backyard. Anh is currently with the neighbour according to the ambulance handover, and we do not have a contact number for her (paramedics were naturally focussed on Sam). Sam is non-responsive and will be taken to theatre for neurosurgery; however, a referral has been made to social work to ascertain the safety needs of his mother.

9.7.1 Thinking Complexity Compared to Taylor’s situation involving multiple cumulative crises, Sam’s situation seems to be a sudden and unpredictable event (at least for Sam and his family; according to AIHW and Bradley (2007), falls from ladders are the most common cause of DIY-related injuries and often require significant care and resources in the ED). Sam’s prognosis may be fatal, or he may live with cognitive and/or physical deficits. He is unlikely, at least based on the initial scan results, to return to his previous level of function, which will have a significant impact on Anh. As a social worker, we have been thrown into this situation where there are more unknowns than knowns. We have reasonable evidence from the ambulance handover that Anh is dependent on Sam. We do not know specifically how much care she requires, whether she has been linked in with aged care assessment or formal aged care services, whether she receives services, whether she has capacity to make decisions, how much she is aware of Sam’s prognosis, or would understand, the availability of family to care for her. More broadly, we do not know this family’s history, or the ‘rules’ around family caregiving expectations (such as the promise that a parent or spouse will never be moved into residential care in their advanced age). Although the fact that Sam was using a ladder to engage in gardening infers Sam had a reasonable baseline for his own health and function, we do not know at this point how long Sam will require acute hospital care, and what his recovery trajectory will look like.

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More immediately, we do not know how long the neighbour can care for Anh (and we do not know the neighbour’s phone number!). Like Taylor and Jessica’s cases, this case highlights that while the focus of hospital-­based intervention for most disciplines is patient-focussed and takes place within the walls of the hospital, often we find that social work intervention relates to needs that extend into the community. In this case, the patient is safe and receiving appropriate medical care, whereas as a social worker, our concern relates to the safety and welfare of the patient’s mother in the community. While the mother is not our patient, we could argue that her welfare needs should be explored and addressed by another agency. However, our mandate to care extends to the patient’s broader social environment and family, particularly given there are care issues requiring intervention. Sam’s medical care and the welfare of his mother external to the hospital are inextricably linked.

9.7.2 Acting Pragmatically In this case, the social worker’s intervention – or lack of action – has significant consequences for the welfare of Anh and her son Sam. All reasonable action must be taken to guarantee the safety of Sam’s mother, and this would involve collaborating with community-based sources of support. It would also be vital to assess what emotional support Anh will need, given the highly traumatic and distressing nature of Sam’s accident, and consider how to best meet her informational needs while Sam is in hospital. The ambulance report documents the address they attended where Sam and Anh live. Lacking any contact details for the neighbour, the next reasonable step would be to liaise with the police to perform a welfare check to the neighbour’s property and provide the neighbour with contact details for social work. From this point, the possible outcomes vary. The police and neighbour may establish that, despite her cognitive impairment, Anh is functionally quite independent and only required Sam for support around community access or transport. She may already access and receive supports through an aged care package, in which case the social worker could liaise with a case manager to inform them of Sam’s hospitalisation. The social worker’s psychosocial assessment would determine the availability of any other family, her general practitioner and other sources of support within her network to address her needs while Sam is in hospital and provide emotional support. It may be appropriate for the treating medical team to provide Anh with an update over the phone, with or without an interpreter. A referral could then be made to the ward social worker for ongoing support for Anh. Alternatively, it may be apparent that Anh’s needs exceed what can be safely managed in the community. If the neighbour is unable to bring Anh to the hospital, the social worker may need to coordinate a phone assessment using an interpreter to explore Anh’s understanding of Sam’s situation, make a rudimentary assessment of the severity of her cognitive impairment and facilitate crisis respite or a social admission to a hospital to ensure her

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immediate safety is preserved. While at the point of the referral these outcomes are unknown, the different pathways and possibilities reflect the need for social workers to develop often extensive understandings of relevant services and avenues of care in the community.

9.8 Conclusion This chapter has provided a snapshot into how complexity thinking and pragmatic action manifests in emergency department social work practice. Complexity thinking draws from sources of experiential, clinical and legal knowledge based on the different needs of patient populations. Complexity theory helps us make sense out of the unpredictable and unexpected situations we are confronted with, while upholding a responsibility to provide person and family-centred, ethical and evidence-­ based care. Correspondingly, pragmatism refocuses intervention and action on relevant evidence, ethics and professional experience to support clinical decision-making. Reflective Questions • How well does complexity thinking and pragmatic action address the biopsychosocial needs of the patients and their families in these cases? • How does embracing and anticipating unpredictability and uncertainty as a ‘natural’ characteristic of patient cases rather than a problem to be ‘fixed’ alleviate or increase our anxiety about cases involving crisis or risk?

References AIHW, & Bradley, C. (2007). Ladder-related fall injuries. AIHW. Antle, B., Barbee, A., Yankeelov, P., & Bledsoe, L. (2010). A qualitative evaluation of the effects of mandatory reporting of domestic violence on victims and their children. Journal of Family Social Work, 13(1), 56–73. https://doi.org/10.1080/10522150903468065 Australian Institute of Health and Welfare. (2022). Australia’s hospitals at a glance. Retrieved from https://www.aihw.gov.au/reports/hospitals/australias-­hospitals-­at-­a-­glance Bodenmann, P., Baggio, S., Iglesias, K., Althaus, F., Velonaki, V.-S., Stucki, S., Ansermet, C., Paroz, S., Trueb, L., Hugli, O., Griffin, J.  L., & Daeppen, J.-B. (2015). Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: A controlled, cross-sectional study. International Journal for Equity in Health, 14(1), 146–146. https://doi.org/10.1186/s12939-­015-­0277-­5 Cameron, N., & McDermott, F. (2007). Social work and the body. Palgrave Macmillan. Harvey, E., & Jones, M. (2021). Using complex adaptive systems theory to understand the complexities of hospital social work practice in rural and remote South Australia. The British Journal of Social Work, 52(5), 2669–2688. https://doi.org/10.1093/bjsw/bcab197 Kallianis, V., Joubert, L., Gorman, S., Posenelli, S., & Lethborg, C. (2017). “Unexpected and distressing”: Understanding and improving the experience of transferring palliative care inpatients

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to residential care. Journal of Social Work in End-of-Life & Palliative Care, 13(2-3), 193–204. https://doi.org/10.1080/15524256.2017.1331180 Moore, M., Cristofalo, M., Dotolo, D., Torres, N., Lahdya, A., Ho, L., Vogel, M., Forrester, M., Conley, B., & Fouts, S. (2017). When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services. Social Science & Medicine, 1982(178), 104–114. https://doi.org/10.1016/j.socscimed.2017.02.014 Redfern, H., Burton, J., Lonne, B., & Seiffert, H. (2016). Social work and complex care systems: The case of people hospitalised with a disability. Australian Social Work, 69(1), 27–38. https:// doi.org/10.1080/0312407X.2015.1035295 Shannon, B., Pang, R., Jepson, M., Williams, C., Andrew, N., Smith, K., & Bowles, K.-A. (2020). What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis. Internal and Emergency Medicine, 15(7), 1303–1316. https://doi.org/10.1007/s11739-­020-­02403-­2 Sims-Gould, J., Byrne, K., Hicks, E., Franke, T., & Stolee, P. (2015). “When things are really complicated, we call the social worker”: Post-hip-fracture care transitions for older people. Health & Social Work, 40(4), 257–265. https://doi.org/10.1093/hsw/hlv069 Taylor, J., Bradbury-Jones, C., Kroll, T., & Duncan, F. (2013). Health professionals’ beliefs about domestic abuse and the issue of disclosure: A critical incident technique study. Health & Social Care in the Community, 21(5), 489–499. https://doi.org/10.1111/hsc.12037 Zufferey, C. (2017). Homelessness and social work: An intersectional approach. Routledge.

Part III

Thinking Complexity in Public Policy, Research and Education

Chapter 10

Thinking Complexity in Public Policy

10.1 Introduction and Learning Opportunities Public policy functions to build the broad context for day-to-day life (Gratton & Scott, 2016). To an extent, policy regulates interaction between human beings and thus is important in shaping the nature of society, to emotional lives, cultural lives and the models under which human beings derive collective well-being (Bhattacharya & Sumption, 2021). Policies are arrangements put in place by governments not only to protect both internal and external security but also give rise to laws that codify the behaviours required under any given policy. Historical trends influence policy arrangements, but policy is rarely static: it evolves over time and is laden with both explicit and implicit political and ideological values. In this chapter, our focus is on public policy, which particularly influences and shapes social work practice in welfare settings. In this chapter, readers will: • • • •

Be introduced to definitions of and perspectives on public policy Consider some assumptions that underpin policy narratives Explore some of the drivers of policy Revisit CT, exploring how thinking complexity assists understanding of policy processes • Position social workers within the policy frame • Consider examples from social work practitioners during the Covid-19 pandemic demonstrating their pragmatic response to health policy directives • Draw out the ways in which social workers might think complexity and act pragmatically with respect to policy imperatives

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_10

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10.2 Defining Public Policy A defining aspect of policy concerns the relationship between governments and citizens (Howlett & Ramesh, 2003) and impacts on the distribution of resources designed to respond to human need (Chenoweth & McAuliffe, 2012). However, … policy almost by definition deals with generalities and always defaults to providing “mainstream” solutions and dividing clients into manageable categories based on presenting problems and diagnosis or demographic characteristics …. (Katz, 2016, p. 257)

Policy is, or ought to be, concerned with equality of opportunity and redressing issues of inequality (Piketty, 2021). The question of equality poses a vexed issue as analysis suggests that disparities in income, wealth and power, despite some improvements across the twentieth century, remain entrenched across the globe (Piketty, 2014, 2020, 2021). Governments construct policies within which they seek to deliver their ideals, preferences and political views, noting that policy decisions involve trade-offs between goals and interpretation of evidence. While there are differing definitions of public policy, one classic view is that: …. it is anything a government chooses to do or not to do. (Dye, 1972 cited in Howlett & Ramesh, 2003, p. 5)

A key emphasis arising from this definition is that public policy is clearly set by government and excludes the realm of private business, charitable organisations1, other interest groups and individuals (Howlett & Ramesh, 2003). Non-state actors do of course vie for highly significant influence, which can come at different stages in the policy development cycle – in identifying the need for policy, shaping the focus and priorities within a policy or reshaping it once it is announced. Importantly however, as Greenhalgh and Wieringa (2011) note, policymaking is not so much an exercise in rational decision-making but a process of argumentation to decide what is right and reasonable within a context of limited resources and competing priorities. Policymaking remains caught in a tension between fact and value (Sayer, 2020), and indeed at times, ideas may be more important than evidence as the primary driver for policy change (Smith, 2013 cited in Sayer, 2020, p. 242). However, political ideas and aspirations may sometimes ‘muddy the waters’ where the type and quality of evidence brought to support ideas might be selective, for example, with regard to competing views about whether COVID-19 lockdowns were the best response to the spread of the virus, especially in liberal democracies. Further, it is important to understand that policy emerges in a context of uncertainty and incomplete information, however much evidence is produced to support a particular policy position. Scoones (2019, p. iv) argues that uncertainty defines our time and the COVID-19 pandemic and issues such as climate change, natural disasters, financial volatility,  Except where such charitable organisations take up government contracts which often require strict adherence to government policy and practice imperatives. 1

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Fig. 10.1  The complexity of factors driving policy

cyber (in)security and political instability underscore that fact. The tendency of policymakers is to strive to minimise and manage risk within which lies an approach that implies that future outcomes can be controlled or at least reasonably estimated (Scoones, 2019), but in the realm of policymaking, there are both local factors and global factors in play, and governments have varying degrees of control over such factors (see Fig. 10.1 below).

10.2.1 Policy Narratives Policies are narratives, identifying problems perceived and responses to be enacted. In most public policies impacting on social workers and the organisations they work with, three themes highlighting shared assumptions underpin their development: 1. There is a notion that policy problems ought to be solvable, whereas many policy problems present as wicked problems, that is, problems that are multidimensional with their causes difficult to understand. Policy involves trade-offs between contested goals, and situations are often chaotic, whereby the relationship between cause and effect constantly shifts and manageable patterns are difficult to discern (Snowden & Boone, 2007).

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2. The nature of government will influence policy. The opening decades of this century have indicated a shift away from democracy towards authoritarian regimes, of varying degrees, accompanied by a rise in identity politics (Fukuyama, 2018). This has seen growing disillusionment with globalisation whereby what some countries perceive as ‘just’ other countries perceive as ‘abuse’ (Holslag, 2021), concerns about failure to attend to social cohesion (Holslag, 2021), preferences for a political elite committed to the leader and maintenance of power (Applebaum, 2020; Keane, 2020) and economic stagnation, income inequality and working class voters with limited skills feeling threatened, not only by globalisation but also by immigration and its attendant diversity (Keane, 2020). 3. Policy responses always reflect the political context. All governments espouse ideologies concerned with questions about the distribution of wealth, appropriate capital and income rations and how to address inequality (Kissinger, 2014; Piketty, 2014). At the same time, politics operates within time-limited frameworks that force choices between what we want now and what we wish to achieve in the longer term, highlighting a disconnect between wishful thinking and reality (Smils, 2022), making it difficult to tackle the ‘big issues’.

10.2.2 Factors Driving Policy Policy is driven by multiple factors, and these are presented in Fig. 10.1 – politics, economics, the law, the anticipated impact and other or unforeseen factors such as a pandemic or war or natural disasters. What we can discern is that these drivers are often in competition, and it cannot be known for certain which drivers will have the greatest impact. Indeed, the nested layers within each group (as noted in Fig. 10.1) provide no certainty as to which factor will become dominant, nor can we be certain how each will interact, or how each will frame the issue for which a policy response is desired. Timing and context are highly relevant and, as we have seen in relation to governments’ responses to, for example, the provision of housing for homeless people during COVID-19 lockdowns, a very quick response to a very long-standing problem was addressed with some immediacy, even if only in the short term. What is also unclear is which element will be weighted more heavily by policymakers as they shape policy. So, as we see in Fig. 10.1, how policy is developed, driven and sustained is well captured by the notion of a system in which each policy focus, for example, health, welfare and education, can be conceptualised as embedded in a system of interacting and interpenetrating elements, ‘driven’ by political, economic, legal and other clusters of interests. Values and beliefs, too, as we noted above, also invariably permeate policy choices and decisions.

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10.3 Complexity Theory and Policy Seeing the policy field as a system – or rather many interacting systems – takes us back to complexity theory and the elements characterising complex adaptive systems, which were described in Chap. 3. There we commented that CT always involves describing a system by describing the interactions and relations amongst the parts (Ladyman &Wiesner, 2020, p. 7) and, importantly, recognising that the boundaries between these interactions and relations are always fuzzy and always feature multiple nested systems. Drawing on the work of Long et  al. (2018) and Ladyman and Wiesner (2020, p. 65, 66), we noted ten key features of CAS: these are applied here specifically to policy issues. 1. Embeddedness/nested systems: For example, each of the nested elements noted in Fig. 10.1 under each policy driver comprises multiple CAS evident within, for example, various factional interests in a democratic government and their varying arguments regarding the nature of a proposed policy. 2. Fuzzy boundaries: For example, those boundaries uniting and separating various financial institutions with shifting views about how much of their budgets could be allocated to a policy initiative such as a national disability insurance scheme. 3. Distributed control and self-organisation: For example, the local rules, perhaps in relation to membership, operating in a lobby group such as a consumer organisation will self-organise to shape responses to policy proposals. 4. Emergence: For example, what emerges from policy debates within groups with similar or even with different agendas may lead to outcomes that go beyond what each group may have proposed independently. For example, what may emerge from their deliberations regarding steps to limit the impact of climate change is an increase in support for lower carbon emission levels, which neither group had actively campaigned for previously. 5. Unpredictability: For example, policymakers cannot know exactly how front-­ line health professionals will react to restrictions mandated in relation to the COVID-19 pandemic. 6. Non-linearity: As relationships in a CAS are non-linear, it can react strongly to minor changes in a policy or not react even when a major change is initiated, for example, during COVID-19 lockdowns in Victoria, a policy amendment (a relatively minor policy change) enabling homeless people to be accommodated in hotels resulted in a virtual end to rough sleeping during the lockdowns, simultaneously filling otherwise empty hotels. 7. Phase changes: Small changes can lead to big effects; for example, Greta Thunberg’s regular solo Friday protest about the need for action on climate outside the Swedish Parliament motivated numerous similar protests from school students across the world and has had a significant effect on drawing attention and stimulating action. 8. Sensitivity to initial conditions: For example, policymakers might be aware of earlier strong opposition to proposals for non-admission of children to child

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care who have not been vaccinated, taking this into account in subsequent redrafts of the policy in light of a measles outbreak. 9. Non-equilibrium: Even though a residents’ group in a new housing estate may appear to urban policymakers to be stable and settled, change is in fact continuous, and achieving equilibrium is not possible. 10. Adaptation and co-evolution: For example, staff adapt to working from home mandates during lockdowns, and their organisation evolves to working more productively than previously. As we commented earlier, policymaking always occurs in situations of incomplete information – how could it be otherwise with so many stakeholders and interests arguing and vying for attention and where the intention is to change outcomes for populations, such as homeless people, which can only be estimated based on assumptions about behaviour and about markets? In thinking complexity, we can note that policy is always ‘in process’, always ongoing as changes in one aspect of a CAS intersecting with another will lead to the emergence of what remains uncertain and unpredictable, where new and unexpected outcomes appear. Small changes in one system can have big effects, some of which may move action in the desired policy direction, others not (see Eppel et al., 2011). No two scenarios or services in which policy is being applied will be the same and thinking complexity tells us that not only do small differences matter, but as social work emphasises, context always matters. As policy directed changes mostly issue from a degree of distance from ‘on the ground’ actors, they are unlikely to be able to respond to the subtle differences in initial conditions in an organisation or agency. Thinking complexity at the agency or service level suggests that it is here – at the local level – that responses appropriate to these context-specific issues can be most fruitful. Indeed, CT’s emphasis on the importance of actors working across systems in interdisciplinary ways, bringing together different knowledge and expertise at the local level, is likely to be the most effective way of responding to the unpredictable and the unexpected.

10.4 Social Workers and Policy Policymakers need to exist in the real world, make decisions on behalf of the public interest, manage the public purse and accept facts whether they like those facts or not (Keane, 2021, p. 8). For practitioners, policy acts as a framework for service delivery offering guidelines for what is and is not possible in any given situation. Also, policy sits beside laws, ethics and budgets, all of which can constrain or liberate what is possible in practice. Essentially, policy affects service delivery as ideas and standards from policy underpin service provision and service availability. Of particular significance to social work, within debates about health, welfare and economic policies, two fundamental questions emerge. Firstly, to what extent ought there to be universal provision of welfare reflecting principles of social solidarity, equality of distribution and high levels of economic security

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(Esping-­Andersen, 1990)? Secondly, common to liberal and neo-liberal thought, to what extent can or should market forces be relied upon to meet human need, thus minimising state provision and constructing collective responsibility as shared responsibility (Esping-Andersen, 1983)? In the world of social work practice, public policy has profound influence because it is implicated in a number of important factors. Firstly, it shapes practice by offering the broad parameters within which social work responses and services must be delivered. To a significant extent, this is concerned with service users’ access and entitlements to services. Secondly, it gives rise to certain values to guide intervention. Thus, according to the particular service domain, we might hear catch phrases such as ‘minimum intervention’ and ‘the best interests of the child’ (commonly heard from child protection perspectives) and ‘least restrictive options’ (commonly heard in mental health practice and practice with older clients, both around the extent to which client autonomous decision-making can or should be constrained). However, these remain amorphous concepts that demand social workers grapple with the meaning in relation to each situation they need to deal with, knowing as we do (see Chap. 2) that social workers come to their work already ‘bearing’ particular values and commitments to human rights, self-determination and equality. Thirdly, policy influences practice at the micro, meso and macro levels with the knowledge that war, for example, commonly leads to involuntary migration. At the macro level, policies pertaining to refugees define how refuges are treated by the receiving country; at the meso level, it is likely that clients with a refugee history will be the focus of advocacy or discrimination, and at the micro level, each refugee will have a unique history shaping how they manage their re-location with any or no assistance. Fourthly, policy raises challenges and poses dilemmas regarding values that may be in contradiction to the social justice and advocacy aspects of practice. A fundamental uncertainty surrounds the social work role in any context. At the heart of this uncertainty is the question of whether the structures within which social work operates serve the needs of the vulnerable or whether these structures perpetuate that vulnerability (Asquith et al., 2005, p. 13). Further, how agencies and social workers decide which values are to have primacy in undertaking their mission necessarily remains an ongoing debate. A central element in working with clients, whether this is at the individual, family or community level, concerns the question of ‘fit’ between the presenting scenario and policy. That is, understanding the areas of both connection and disconnection between what is confronting the social worker and the relevant policies. Thinking complexity suggests the importance of weaving the client narrative into the policy narrative, interpreting the policy in relation to client needs or social worker interventions and to giving the relevant variables appropriate weighting according to the policy that is operative and the options available.

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10.5 What to Do? Thinking Complexity and Acting Pragmatically We argue in this book that the meta view of social and material reality captured by CT requires adopting a pragmatic approach in order to act. As we discussed in Chaps. 2 and 3, being pragmatic characterises the way in which most social workers approach their tasks and role, comfortable with a process of reflection, exploration and iteration (Hothersall, 2015). Being pragmatic enables them to move between the current situation and how it is understood from past experience and how it appears in the present, remaining open to new possibilities at any, and every, stage (Hothersall, 2015). To explore this further, we’ll now turn to (arguably) the greatest policy-driven challenge for social workers in front-line roles in contemporary times: the COVID-19 pandemic.

10.5.1 COVID-19 Pandemic Between 2020 and 2022, the detection and spread of a new and potentially deadly virus disrupted and confounded the world. For almost a year, no vaccines were available, and governments were hard-pressed to formulate and implement policies to protect citizens and health systems while the development of a vaccine was frantically sought. The impact of the pandemic has been to generate death and destruction and to exhaust social protection and government budgets (Bell & Nuzzo, 2021, p. 6). The virus, originating in one location, soon spread globally, highlighting the vulnerability of the domestic context to events in other contexts beyond the control of domestic decision-making. While the pandemic has affected all people, of all class levels in all countries, the impact has not necessarily been evenly distributed, nor has the accessibility to vaccines. For example, challenges have been evident with respect to disparities according to race and ethnicity, highlighting already known health inequality (Simmons et al., 2021), allocation of ventilators and decisions about the ‘most deserving’ recipients (Liddell et al., 2020), impact on migrants in high-income countries (Hayward et al., 2021) and uneven impact on livelihood for those able to work at home and those unable to do so. Later reviews noted that policies designed to restrict transmission of the disease had deleterious impact on mental health (Parliament of Victoria, 2021, 2022). In the nascent scholarship arising from the pandemic, one ‘stand out’ factor is the mismatch between pre-pandemic preparedness and actual pandemic performance of policy implementation in different countries (Greenhalgh & Engebretsen, 2022; Bell & Nuzzo, 2021). Although the pandemic, in its most fundamental form, represented a public health challenge, the selected policy responses created enormous impact on wider society and the economy accompanied by contradictions in relation to other polices such as those concerned with, for example, entitlements to education and the support of individual livelihoods (Williams et al., 2020).

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When the pandemic first emerged as a somewhat novel virus, the properties of which were largely unknown, as were the pathways it would follow, decision-­ makers were not prepared for the magnitude of spread and impact and yet forced to make decisions between competing priorities with information that was simultaneously ambiguous, unclear and incomplete. A basic difficulty, highlighted throughout the pandemic, was that rather than constructing intervention as a fixed sequence of activity, capable of being duplicated and repeated, intervention (and choices) was constructed without opportunity to reflect and adapt as the characteristics of this complex phenomenon emerged (Ling, 2012, p. 85). Thus, the early policy responses were largely concerned with the prevention of exposure, utilising ‘solutions’ such as travel restrictions, quarantine, curfews, workplace hazard controls, event postponement, work from home and voluntary or mandatory social distancing (Barrios & Hochberg, 2020). These early policy initiatives also emerged at a time when the magnitude of what was to come was yet to emerge. The experiences of the pandemic have presented a range of ethical dilemmas, ranging from the restrictions imposed on individual liberty through to questions regarding who might be prioritised for use of a ventilator and who should be privileged to access vaccines or even whether individuals should have a right to decline a vaccine in the face of government decreed mandates. Also, there has been suggestion that pandemic decision-making was characterised by excessive reliance on science. This was seen to lead to a conceptual reduction of complex problems to simple ones, removing facts from context in order to make them generalizable, and reliance on a small group of expert advisors. The outcome of these factors was that a limited range of scientific methods and moral positions was considered, and polarisation occurred whereby scientists and advisors tended to separate into camps rather than to engage in dialogue (Greenhalgh & Engebretsen, 2022). The pandemic unfolded to reveal stark choices: between public health and economic activity and between public health and individual liberty and freedom of movement. It threw traditional policy making paradigms into disarray, proved resistant to efforts to stem the flow of infections and demanded simultaneous attention to complex social, economic and political considerations. The capacity of domestic governments was hampered by non-domestic development. This included the virus itself but also matters affecting global supply chains, movement of people (notably foreign workers) and how to develop strategies to ensure the vaccine, when developed, could become globally and equitably available while giving some precedence to domestic requirements.

10.5.2 COVID-19 and the Response of Front-Line Social Workers The COVID-19 pandemic offers a ‘real-time’ opportunity to take a snapshot of policy at the level of social work service delivery. In 2020, the journal Australian Social Work invited social workers to share their brief and ongoing reflections about

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working with COVID-19 policy directives and mandates regarding their experiences under the restrictions imposed. These restrictions related to the wearing of personal protective equipment (PPE); infection control strategies; physical and social distancing; lockdowns; limitations on visiting people in hospital and care settings, including at end of life; restrictions on funeral attendance; and working from home where possible. While these policy directives and mandates were issued by government health departments, individual health organisations – health networks, hospitals, health services – were charged with responsibility to interpret and enforce them. Social workers as front-line workers along with medical and other health professionals bore the brunt of having to carry them out. Between 2020 and 2021, 11 responses from social workers to these changes in their working conditions were subsequently published in a special section of the journal entitled the Knowledge Exchange Project. While most contributors were from hospital or health settings (Hatzipashalis & Greenwood, 2020; Booth & Venville, 2020; John et al., 2020; Olivieri, 2020; Anastasi, 2020; Dragwidge, 2021), three contributors wrote from within other organisations or sites: a community setting in China (He, 2021); a justice service (Swida 2020), an adolescent mental health clinic (de Kam, 2020); one contributor reflected on their experience of working from home (Lording, 2020); and another as a social work student on placement in a hospital (Semmens, 2020).

10.5.3 Impacts All the contributors wrote about witnessing the impact of the restrictions on clients and their families and on themselves and their co-workers. Several noted that they and their service users were sharing a common universe: ‘…for the first time in my career I am experiencing something quite devastating along with my patients rather than it being external to me’ (Olivieri, 2020, p. 513). Another says, ‘(These) clients (are) not alone as the whole country (is) suffering from it’ (He, 2021, p.  519). Indeed, the recognition that they and their service users were sharing the COVID-19 experience helped increase empathy and understanding. In addition to moments of fear and a sense of being overwhelmed, contributors commented on the physical discomfort of PPE and wearing masks, where hearing what was being said could be difficult and where the tasks of rostering visits when there were limits was onerous and time consuming. As several social workers were restricted to using electronic in place of any face-­ to-­face forms of communication, there was anxiety about how well they were managing this: ‘…how do I observe the wringing of the hands, the flickering of the eyes, the subtle tearful moment, the slight smile through the fuzzy screen…how to use these physical responses to build on the therapeutic conversation?’ (de Kam, 2020, p. 512) Despite these major disruptions to work practices imposed by these restrictions, social work contributors also provided rich and thoughtful accounts of how they had

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adapted to these unprecedented, unprepared for and sudden changes (in initial conditions). They adapted by: • Accepting a request to work in a different setting due to the hospital’s struggle with increased deaths, in this case in the mortuary where no social work staff had previously been assigned and, once over initial apprehensions, finding this a source both of learning and of influence. • Learning to trust new colleagues and feel safe in debriefing with them. • Finding that they could draw on their knowledge of person-in-environment in a new way, which illuminated how the different levels on which COVID-19 impacted, at macro, meso and micro, could be conceptualised in a ‘real life’ situation. • Setting up on-line communities of practice to share ideas about how to adapt and innovate in reaction to the exceptional conditions imposed by restrictions, for example, ‘…the potential for lasting innovation is great and fills us with hope that these adapted approaches can be more widely available to meet the diverse needs of our community’ (Swida, 2020, p. 509). They recognised that their usual ways of working needed to evolve and shared examples of how they had had to: • ‘Think on their feet’ to deal with new and unexpected events at a pace that was not previously encountered. • Learn new skills in order to develop communication plans in collaboration with multidisciplinary team members to facilitate communications between staff, patients and families, for example, sharing information about different digital devices that could be utilised. • Find creative ways to facilitate communication between patients and families, especially at end of life. • Learn new referral pathways because of service closures, or services going online. They shared examples of the need to be creative and ‘think outside the box’ by, for instance: • Learning new ways of building rapport with service users, for example, on zoom calls to the client at home being able to talk about the home environment, for example, posters on the bedroom wall, or include the client’s pet who appeared during the call. • Recognising that there were gaps, for example, no available research evidence to guide bereavement innovations in ethically difficult situations, such as when families and carers are denied access and strategies were needed to reduce distress for loved ones at the end of life (John et al 2021). • Realising that, because of the restrictions and their impact on vulnerable people, new ways to advocate for service users needed to be developed, which could occur in a context of limited face-to-face engagement with decision makers who were themselves struggling with the challenges of managing service provision.

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What is clear from these social workers’ accounts is that, downstream from policy decisions, they are acting pragmatically, and in the face of tensions arising from what they think they ought to be doing and what they are expected to do, reflecting that, as is very often the case, it is they (the social workers) whose role it is to explore with their clients the choices and options available to them despite imposed restrictions. Their adaptations and strategies suggest that they were up to the task of responding to some shortcomings in policy, for example, being willing to be deployed to a mortuary because of the increase amongst deaths so that they could provide some emotional support in an unusual setting during an unprecedented emergency. Whilst they may have lacked real capacity to address such policy shortcomings as, for example, the possibility of providing personalised bereavement care, what we learn from these accounts is that they acted. They adapted and responded to the ever-evolving situations they were being challenged by, managing to move from a position of believing that policy and organisational mandates had constrained their practice towards a position where it became possible to grapple with the decisions made from above, seeking to enable a better alignment of policy goals and organisational mandates with their goals and those of their clients. Their accounts and reflections on front-line practice during the pandemic restrictions indicate that, to a significant extent, they achieved such alignment, reflecting an understanding of both the policy context and the client context, the areas of both connect and disconnect between the two. Their accounts demonstrate an ability to weave a coherent narrative that respects the preferred outcomes for both their organisation and the client. It would seem that the social workers managed to apply a wide lens of understanding from a macro perspective on policy, a meso recognition of organisational requirements and demands and a detailed appreciation of the micro level of the client situation as they attempted to match client needs and wishes in a context of policy imperatives and constraints, perhaps aware that some factors driving the policy directives were to an extent outside both organisational and government control. What we do not know, however, is whether these social workers were aware of the need to seek ways to develop feedback loops that might enable practice experiences in implementing policy mandates to inform future policy responses. Policymakers and the systems whereby policies are initiated, developed and implemented require opportunities and pathways for such feedback (Eppel et al., 2011). An understanding of policy that CT provides emphasises the participatory processes whereby constructive sense making and learning can evolve and emerge. As we know from CT, no one person or organisation can have adequate information or resources to understand a complex system, and as Fig. 10.1 (above) demonstrates, policy processes are quintessentially complex systems. The insights front-line social workers have revealed are crucial elements in the evolution of policy determinations and their feedback providing essential information to bolster what is known, and what is unknown, and to shape subsequent iterations.

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10.6 Conclusions This chapter has described some of the tensions and contradictions that public policy directives pose for organisations and social workers carrying out front-line work. The pervasiveness of these dilemmas reflects not just the challenge of navigating the influence of multiple stakeholders  – politicians, legal bodies, economists, interest groups – but their intersection (or even clash) with the values and beliefs that motivate social work and the organisations they work in. Through the example outlining social workers adapting to COVID-19 mandated restrictions and imposts, we saw that front-line workers and agencies do ‘make do’ and do find ways of reconciling their values and commitments to service users. What we do not know is the extent to which their insights were fed back through organisation hierarchies to policy implementation decision-makers. For example, were they able to secure opportunities in hospital settings to feedback to medical and other professionals regarding how they were managing? Were they able to seek discussion and collaboration in, perhaps, implementing other or different responses to meet client need? We know that social workers have prime and vital positioning in relation to understanding and advocating for service users and communities. Being also (often) the chief interpreters and implementers of policy directives suggests that this positioning can be a crucially important place to be, offering access to the lived reality of policy impact. How to ensure that social workers push for a ‘seat at the policy table’ requires strategising and action, considering different ways of so doing, for example, by documenting the impact of policies on service users and communities, doing research, working with others to build advocacy capacity and thinking about what is necessary to achieve change and with whom. Even more importantly, social workers might consider working in the policy field, using their value-base, knowledge and experience to directly input into the policymaking process. Thinking complexity and acting pragmatically with regard to policy means developing our understanding of the continuously evolving and consequential nature of policy and the capacity of social workers to influence it. Reflective Questions • What policies influence service delivery decisions within your field of practice? • What local or agency-specific policies are malleable and can be ‘massaged’ to find a better fit between directives and your ‘on the ground’ decision-making? • What are your experiences of working within policy constraints? • What strategies might you instigate in order to influence policy in your field of practice?

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Chapter 11

Thinking Complexity in Research

11.1 Introduction and Learning Opportunities The purpose of this chapter is not to provide a full account of the research process – this is the subject of many texts (Flynn & McDermott, 2016; Alston & Bowles, 2018; Shaw et al., 2013) – but rather to offer a way of thinking about and doing research, which is framed within complexity theory and pragmatism, an account of how to think complexity and act pragmatically in research. At the end of this chapter, readers will have: • Understood the implications of thinking complexity as a researcher • Considered the particular issues which pose challenges for research, especially with regard to time, bearing in mind the dynamism and fluidity of processes characterising emergence • Explored several research designs compatible with complexity thinking • Understood how pragmatism might influence both research design options and method choices • By viewing a hypothetical example of a social work practitioner researcher thinking complexity and acting pragmatically in research, be taken through the researcher’s thinking and analysis of a practice research question

11.2 Beginning the Research Journey We begin by drawing together the key points already made in this book, which set the scene for understanding complexity thinking in research. In Chap. 3, we characterised social work as premised on commitments to ethical principles, social justice, advocacy and collaborative engagement with service users and other professionals, along with a valuing of relationship-focused and reflective © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_11

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practice. Social work’s recognition of the primacy of context for shaping understanding and action is central, as is its facility in ‘borrowing’ theories, concepts and models. We further argued that CT and knowledge of CAS provides social work with foundational beliefs or a meta view about the nature of social and material reality. Pragmatism, we concluded, was central to social work, an epistemology that echoes social work’s core values, which seek to promote human well-being and ameliorate human suffering through practical action. We noted, along with Long et al. (2018) and others (see Ansell & Geyer, 2017), that both CT and pragmatism share common ground in their quest to create useable knowledge and reject reductionist thinking, prioritising understanding over theoretical and methodological dogmatism. In Chap. 4, we identified some of the elements that provide a guide for developing complexity thinking, in thinking complexity – mining lived experience, being reflective, locating ourselves at the ‘meso’, working in an interdisciplinary way with key stakeholders, constructing the narrative, expecting the unexpected. All these factors are essential components of thinking complexity in research.

11.3 First Steps in Research We begin with an example of a social worker arriving at research questions arising from his practice: Jim is a social worker in a hospital working with older patients who have multi co-­ morbidities. When their health situations have stabilised, Jim’s task with the Multi Disciplinary Team (MDT) is to prepare for and plan their discharge. He finds that most patients (when asked) say they wish to return home. However, he also observes that the majority of them end up being discharged to Residential Aged Care Facilities (RACFs). Reflecting on this, Jim becomes curious to know why and suspects (being a complexity thinker) that there are likely to be a number of factors influencing this outcome. He decides to do research in order to identify these likely influences and capture as best he can how they contribute to this outcome – what actions or interventions may lead to this outcome, and whether there may be unintended consequences arising from them. The value he places on self-determination and participation of service users (patients) in outcomes which affect them is very important to him and he is dismayed in his discovery that only a minority of patients achieve their desire of returning home. He is very concerned to find a way to make it more likely that patients’ wishes can be supported.

11.3.1 Theoretical Position Jim has been working in the hospital for several years, chiefly involved in the support of and discharge planning for patients with multi-comorbidities, most of whom are aged over 65 years. He has always ensured that he is up-to-date with the theoretical and research literature regarding social work practice with patients such as

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these, and because of his adherence to social work’s foundational biopsychosocial model, he is very aware of how elements characterised as social determinants of health can impact, given that many of his patients are older, sometimes isolated, with low incomes, perhaps indigenous, or speak languages other than English. In fact, Jim entered social work because of his belief in the importance of ensuring human rights extend to all, especially those who are marginalised or in situations of limited power, such as may be the case for people in hospital. He has kept a close eye on recent developments in CT, especially as they relate to social work practice and research (e.g. Sanger & Giddings, 2012; Byrne, 1998; Fish & Hardy, 2015; Wang & Wang, 2019; Moon et al., 2022). Jim believes that his practice is particularly informed by studies that examine the effect of hospitalisation on older, frail patients, both physically and emotionally; by studies of team dynamics and team decision-making; and organisational studies relating to social work practice in hospitals. Crisis intervention, task and solution-­ focused models of intervention have been useful, while he also has a deep interest in relationship-focused counselling. He makes time for supervision in order to ensure that his skill as a reflective practitioner continues to develop.

11.4 Epistemology and Ontology Social work, we have noted, is always context-bound. CT provides us with an understanding and a set of beliefs about what that context is and that social and physical reality is comprised of multiple CAS, interacting, changing and emerging in unpredictable and often unforeseen ways. Social work knowledge, gained through theory, experience, reflection and research, is always about and generated by context. Context changes constantly as events and outcomes emerge through time and processes unfold. This apparent messiness and unpredictability is, as we have seen, the ‘bread and butter’ of practice as social workers strategise and improvise towards some kind of stability and improvement in clients’ lives. For the researcher however, the task is – on the surface at least – very different. How is the research project going to ‘stop the clock’ in order to study the way dynamism and fluidity shape what happens, given that we know from CT that cause and effect are not always closely related in temporal terms? To arrive at useable findings in an ever-changing and unpredictable world? Pragmatism, however, perhaps provides a way forward by prioritising the quest for understanding, drawing insights from multiple perspectives and sources in order to address the kinds of ‘real-world’ questions social workers like Jim pose (see Jackman et al., 2021). For example, he wants to know why the majority of patients did not get discharged home: did the decisions made to discharge patients to RACFs work for and benefit the patients, despite their wishes being over-ridden or ignored or never sought? In coming to his research questions, Jim has already recognised that what he is observing and reflecting upon is complexity (Gerrits, 2008). He is, as we’ve seen,

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able to ‘think complexity’. The situations he works with – aged patients with multi co-morbidities in a hospital system – each one of them is in a constant state of complexity as their health may fluctuate, their families or carers report stress and anxiety about the future of the person for whom they are the carer, the ward staff are pressured by staff/patient ratios, hospital administrators want to free-up beds and the MDT members may be irregular in their attendance at meetings or perhaps demonstrate tense dynamics as they field these patient-carer-health staff-administration demands and stressors. Jim, by locating himself at the meso level, is able to ‘zoom in’ to the micro (the patients’ health, the carers’ anxieties, his own emotional reactions to each situation), observe at the meso (the MDT processes, the commonalities or themes discernible in each patient narrative) and ‘zoom out’ to the macro (hospital discharge policies, community resources, available housing options). He is aware that one theme characterising micro, meso and macro levels relates to various interpretations about risk. What risks do or might patients face if they remain in hospital? If they are discharged home? If they go (unwillingly) to a RACF? What risks to patients are MDT members, carers and family members willing to ‘live with’? Importantly, health professionals, carers, patients, administrators and policymakers’ perceptions of risk as well as political and community perceptions of risk and accountabilities for patient safety at discharge are unlikely to be the same (McDermott in Pycroft, 2014). What to do? As Cooksey points out (2001), there are no easy answers or simple solutions. Rather, thinking complexity directs the researcher towards recognising that there could be a multiplicity of answers to each of Jim’s questions: his research task is to work towards arriving at the best explanations for the questions he poses. In addition, the issue of time is important. In thinking complexity, the concept of emergence is, as we’ve seen, of central importance: complexity develops over time, and this will have particular implications for method choices. It may also, as Drury (2016) found, suggest that it is better to begin research with an ‘uncertain’ approach, or tentative research questions, which, having been posed and preliminary study having begun, may lead to the emergence of other or more specific questions. Jim’s understanding of complexity thinking highlights for him that he will not focus on identifying specific causes that lead to the outcomes he has observed: rather, given the non-linearity, recursiveness and unpredictability characterising CAS, this would not be achievable. As a pragmatic practitioner, what findings he does arrive at will be knowledge primarily related to the context of his study and always provisional yet of everyday practical consequences for his work with these patients and the MDT (Hothersall, 2019). In addition, because Jim wants to learn something about the consequences of decisions made for these patients regarding their discharge destinations – whether they work for or benefit the patients – he wants to arrive at knowledge about whether current practices are ‘good enough’ and whether changes might be needed in order to create different outcomes or effects for the patients. He recognises that CT underscores the unpredictability of social reality, so, clearly, he is not proposing that his findings can predict what should or would happen if changes were made, but he

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wants to arrive at findings that may point towards other outcomes or strategies that are likely to lead to different outcomes.

11.4.1 Research Design Jim’s reflections and observations suggest to him that the research design will need to answer his research questions, which he has formulated as below: • What are the many factors likely to be influencing patient discharge? • What actions or interventions may have led to the particular outcome for each patient? • Are there unintended consequences within the hospital system arising from these actions and interventions supporting discharge practices? • Did the decisions made to discharge patients to RACFs work for and benefit the patients even if their wishes were over-ridden or ignored or never sought? From his meso position, he identifies the following stakeholders and sources as likely to provide relevant data (Table 11.1). These sources will yield both qualitative and quantitative data. As a complexity thinker, Jim is aware that there may be various research designs that could be developed. He is influenced in his thinking by reading widely, Table 11.1  Research stakeholders and data sources Data sources Micro Patients

Families/carers Jim’s own reflections

Other health professionals not part of the MDT, for example, ward staff

Meso The MDT comprising:  Registrar  Nurse unit manager  Occupational therapist  Physiotherapist  Dietician  SW

Macro Hospital policy documents

Patient data from hospital records:  Length of stay  Demographics  Diagnosis  Treatment  Outcomes, for example, discharge/return to hospital Relevant literature and published research

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consulting in particular Greenhalgh and Papoutsi’s paper (2018) describing the difference between traditional approaches to research design in contrast to those informing complexity approaches in health services research. In light of their insights, Jim is confident that a complexity-informed design is appropriate to his research questions. The five examples of complexity-informed research published in the 2018 issue of BMJ Medicine (2018) encourage him that he is on the right track. Thus, the research design he is thinking about is one that will be theoretically sound, adapted to his context, and make use of a range of methods, which, whilst appropriate to the setting, may also be used flexibly. To further his quest to develop a research design consistent with his complexity thinking, Jim considers several possibilities. He explores action research (Wadsworth & Epstein, 1998) and social network analysis (Byrne & Callaghan, 2008; Colvin & Miller, 2020). He is also aware of designs adopting ethnographic methods such as Drury’s (2016) use of collaboration, observation and guided conversations with participants. He reviews action research in particular because of its shared ground with complexity theory in relation to the insights it provides about the unpredictability of outcomes and its focus on the emergent nature of actions as participants work together to draw in varying views and understandings of situations and events and the sharing and construction of meaning amongst stakeholders who engage to learn, develop and make change (Phelps & Hase, 2002; Wadsworth & Epstein, 1998). He knows that the complexity of the situation he is trying to study demands the use of multiple methods and the involvement of the many stakeholders he has identified, just as action research does. Further, he recognises that action research – like pragmatism – values reflection and reflexivity (Wadsworth & Epstein, 1998; Phelps & Hase 2002), just as he does. But he wonders whether he has the time and scope within his role to engage in ongoing dialogue and feedback and continuing analysis as each cycle of the research process reveals further data and understanding in an iterative way, capturing emergence in ‘real time’ with each of the stakeholders. After reading Colvin and Miller’s (2020) description of using CT and social network analysis (SNA) for examining child welfare service delivery systems, Jim becomes interested in the potential use of these two conceptual and methodological approaches in combination (Byrne & Callaghan, 2008; Colvin & Miller 2020). Both CT and SNA highlight the centrality of context for understanding social reality. Both focus on ways in which the complex dynamics of issues of interest (e.g. the MDT, patients’ experiences, hospital policies) and the linkages between and amongst them demonstrating adaptation and emergence might be observed and studied in order to understand the structural properties of these networks. SNA takes the meso level as it’s point of analysis, moving away from individual actors and actions to grasp how a collectivity, a set of CAS, a network of actors – operates as interdependent elements. In thinking about these multiple CAS, Jim becomes uncertain about how he can define the boundaries of these networks and is unsure how feasible it is for him to collect all the data related to each network, once defined (Colvin & Miller, 2020, p. 177), given his position as a sole researcher with limited time and no funding. His enthusiasm is further dampened by Colvin and Miller’s (2020, p.178) point that ‘…researchers may encounter emergent shifts, such as unexpected data collection

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and numerous choices…required to analyse interrelated data across methods and levels of analysis’. However, he does see, as Colvin and Miller (2020, p. 178) point out, that ‘…the potential to develop rich and deep understanding of the very complex person-in-environment circumstances of central interest to social workers…’ is appealing and continues to think about how, with adequate time, support and funding, he might do such research at a later date, perhaps for a PhD. As he looks at these different research designs, Jim becomes increasingly aware that, as a single researcher committed to practice-based research, he needs to acknowledge the limitations his situation imposes. Having looked at various research designs that facilitate a complexity-informed approach, he opts for case comparison.

11.4.2 Case Comparison Byrne and Callaghan (2008, p. 195) point out that case comparison may be a useful way of moving from a specific scenario, via comparison with a different scenario at a different time point, towards an understanding of what may be elements which are implicated in emergent situations. With this in mind, Jim’s design (whilst still quite large and ambitious) will include data gathering and analysis at two time points. He further intends that the literature review he is undertaking may deliver accounts of similar research in comparable contexts. At the same time, he is in regular contact with social work colleagues in other hospitals who he is encouraging to do research replicating his design. Data from these sources as well as his internal case comparisons will, he hopes, offer findings that may, pragmatically at the least, enable understanding of how the needs of patients on discharge are being and perhaps may be better met.

11.5 Methods In thinking complexity, Jim recognises that the methods he will use need to do two important things: 1 . They need to collect data at different time points. 2. They need to enable him to make comparisons.

11.5.1 Sampling Jim proposes to include all patients with similar co-morbidities whose discharge is planned by the MDT. He chooses two time points: January to June 2023; July to December 2023.

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11.5.2 Multiple Methods He proposes to use multiple methods – quantitative and qualitative – focused on collecting the same data during each data collection period, with the exception of the analysis of hospital policy documents and the literature review, which he will only conduct once.

11.5.3 At the Micro Level Face-to-face interviews with: Patients (where this is possible, practically and in terms of the patients’ cognitive capacities) prior to discharge. • Questions to be asked: –– Where do you want to be discharged to? Why? –– What will be good/less good about that? –– Do you have any anxieties about your discharge destination? Carers prior to discharge: • Questions to be asked: –– Where do you want the patient to be discharged to? Why? –– What will be good/less good about that? –– Do you have any anxieties about the discharge destination? Other health professionals not part of the MDT, for example, nursing staff prior to discharge • Questions to be asked: –– Where do you think the best placement for this patient will be? –– Are there any risks you foresee about this discharge destination? At this early design stage, Jim recognises that the actual questions he asks may be altered or amended once he begins interviews and depending on the responses he receives. Jim’s journal entries regarding the interviews will be organised around these questions: –– Were the patients, carers and health professionals not part of the MDT well-­informed about likely discharge destinations? –– How did I feel about the patient’s situation? The carer’s situation? –– What do I think is the best discharge destination for this patient? Why?

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When he has attended a meeting of the MDT team, he will make a journal entry with reference to: –– How did I feel during this MDT meeting? • Interview and journal record data will be transcribed by Jim • Jim proposes to use NVIVO (a computer-assisted data analysis tool) to analyse these data

11.5.4 At the Meso Level • Audio recording of each MDT meeting when patients in the study are being discussed in order to record the processes of decision-making and the decisions made. • The audio tapes will be transcribed by Jim and entered into NVIVO.

11.5.5 At the Macro Level • Content and thematic analysis of hospital policy documents in order to: • Identify specific policy guidelines or directives relating to patient discharge policy • These data will be analysed using NVIVO. • Gathering of hospital patient records of patients seen by the MDT in relation to: • • • •

Demographic data – age, gender, ethnicity, language, etc. Diagnosis Treatment plan Length of stay

• These data will be analysed using SPSS, a software program designed to analyse numerical data. • Systematic literature review of relevant articles: Jim proposes to use PRISMA, a program designed to guide literature reviews, to organise the findings from the review prior to critically analysing them. This will ensure that the articles reviewed meet evidence quality criteria.

11.5.6 Ethics The research questions, design and the methods proposed will be reviewed and approved by the hospital’s HREC prior to the project commencing.

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11.5.7 Data Analysis Analysing data within a CT frame highlights for Jim (as it did for Drury, 2016) that he himself is implicated in the whole and that data as ‘representatives’ of the phenomena being studied are not independent of him as an observer. Indeed, what Jim will see and learn will very much be shaped by his point of view and the meta beliefs he holds. His diary entries in particular will be very useful as a prompt to his reflections. As Morin (2008, p. 97) comments, complexity thinking is ‘…a thinking which is always local, situated in a given time and place…it knows in advance that there is always uncertainty’. The data available to Jim will combine both quantitative and qualitative material. The interviews, once transcribed, will comprise narratives that Jim will analyse thematically (Braun & Clarke, 2012; Miles et  al., 2014), perhaps making use of NVIVO. He will compare patient and carer and health professionals’ narratives to see if any internal patterns or themes have emerged. He will then compare these patterns and themes arrived at through a similar process of data analysis at each time point. Similarly, Jim’s journal entries will be considered a narrative, which he will thematically analyse. These will provide key data to assist him in recognising his own connectedness with the project and allow him to move (ideally) from a micro perspective to a more meso (objective) positioning. The taped meetings of the MDT will be transcribed as narratives and analysed thematically to see if there are themes and patterns discernible within them in relation to the MDT’s decision-making processes. These narrative data are very important as ways of mapping patient, carer, Jim’s own reflections and the MDT processes. As Byrne and Callaghan (2008, p. 154) comment, such narratives ‘… tell the stories of how things have come to be what they are, how they stay as they are, and – projecting into the future – how they might come to be different from what they are’. Statistical data from hospital patient records will be analysed in order to detect commonalities and differences. Jim may use SPSS to do so. The policy documents will be analysed in relation to a template that Jim will construct to assist in his content analysis (Braun & Clarke, 2012) in order to reveal relevant guidance, advice and protocols regarding length of stay and discharge. He may also enter these data into NVIVO. These various sources of data are then brought together in order to answer Jim’s research questions.

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11.5.8 Bringing It All Together As we discussed earlier, Jim is an experienced social worker with a strong grounding in a number of theoretical perspectives, practice models and in relevant current research. This theoretical and conceptual grounding will assist him in thinking about how the data emergent from various data sources may be interpreted, albeit in an incomplete and iterative manner. Having the interview, journal and MDT data collected at two time points provide him with the possibility of making comparisons. He will be looking to see what differences emerge during each of these time points, what outcomes diverge and what changes may be observed. He can explore these differences in order to understand the multiple possible factors, which may be at play in the emergence and adaptations he observes. While this process will to an extent reduce the complexity in Jim’s quest to generate understanding, it will offer useful context-relevant understanding of the complex adaptive systems at play (Allen, 2001); indeed, it will provide him with the best explanation he can arrive at, given the complexity of the systems he is studying and his limited resources. In analysing the data, Jim has the means to attempt to answer his research questions. The policy documents and the patient record data will provide him with a picture of what the hospital envisions will be the patient trajectory and provide a clear picture of who these patients are. The thematic analysis of the interviews, journal entries and MDT meetings at each of the time points will ideally have revealed themes that make sense of the data and enable him to deepen his knowledge of what happens for patients, carers and the MTD in the process of reaching a decision regarding discharge. The advantage of the two time periods he has selected is that he may be able to see what factors emerge as the various CAS interpenetrate, intersect and adapt with each other during each time period, whether these are similar or different, and if so, what this difference or similarity may be able to inform him about the emergent processes he is observing and analysing. The data may enable Jim to discern or reveal the way in which adaptation occurs, which may prove useful in his thinking about how these CAS transform themselves over time and within a context, offering insight into future possibilities for discharge planning (Allen, 2001, p. 41). In addition, if the literature review revealed other similar studies, which are comparable, he will have further data to compare and contrast with what he has gathered himself. While not able to use these findings for arriving at solutions to discharge dilemmas or predicting what may happen to patients such as those in his study who go through a similar journey towards discharge, or generalising from his findings, Jim nevertheless has at hand rich in-depth material, gathered from the many stakeholders involved, to consider whether there may be particular strategies or interventions that might be removed or introduced, which would likely enable other outcomes to emerge. For example, he may discover that patients and families are ill- or uninformed about discharge destinations other than RACFs or that the leadership in the MDT may be worth closer study to avoid a sense of inevitability pervading the

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decision-making process or that all participants in the process have divergent understandings of risk and that there may be room to have these shared openly in order to, perhaps, lower anxieties about potential risks and thereby to collectively strategise about taking decisions, which seem in the patients’ interest and are not exclusively governed by risk-avoidance.

11.6 Complexity Thinking in Social Work Research The context-embedded nature of social work and the problems in living that challenge practitioners’ interventions and strategic skills to manage, or at the least ameliorate, ensure that the world of practice cannot but generate a plethora of research questions. As we have seen, thinking complexity reveals a social reality comprising multiple interpenetrating CAS that are in a constant process of change, adaptation, self-organisation and emergence. Disorganisation and unpredictability prevail. For these reasons, research approaches that focus on identifying causes and effects, which attempt to ‘stop the clock’ and study the social world as if it is static and in which findings can be generalised across contexts, are in contradiction to the meta view of social reality, which CT advances. As we have argued, since its inception, social work has provided us with a concept of reality as perceptible and analysable at micro, meso and macro ‘levels’. This has served us very well, particularly in practice settings. However, thinking complexity and adopting or developing research designs that account for the fluidity and dynamism of the social world enable both research and practice to better capture our everyday experience of constant change and unpredictable outcomes. Although CT-informed social work research is in its infancy, it promises a rich and exciting future. The importance of research that acknowledges and incorporates the diverse views of the many stakeholders  – service users, service providers, organisations, professionals – fits closely with the values and beliefs of social workers with respect to collaboration and participation of those whose lives and interests are most often put at stake in any research. This, coupled with pragmatism, which is already the ‘default’ position of most social workers, reinforces the capacity of social workers to undertake complexity theory-informed research. For pragmatists, knowledge is a vehicle for managing, if not solving, problems and research findings contribute to that knowledge base. Methods choices will thus reflect what is possible, manageable, useful and likely to generate answers – or further questions. Data contribute to the building of narratives, offering insight into how things are or came to be and it is these narratives  – as in practice  – which provide insight or deepen understanding about other possible strategies, which might bring about other possible outcomes. In this process of thinking complexity, the researcher themselves continues to adapt and change as their understanding evolves and their insight into what may be answers to their questions emerge, or in which other questions surface. In this sense, the research is always ‘in process’, just as the social worker thinking complexity is always reflecting on what is happening, what is changing and how to manage what emerges.

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11.6.1 Key Points for Thinking Complexity in Research In reviewing this chapter, several key points have been made. The social work researcher who is thinking complexity requires: • Familiarity with complexity theory, the nature of complex adaptive systems and pragmatism • Capacity to make use of a range of theories, concepts and models in understanding social and human phenomena • Awareness that researchers from a complexity theory-informed perspective are not focused on identifying causes and effects, nor are they interested in generalising results across contexts and timeframes • Locating themselves primarily at the meso level whilst sensitive to gathering knowledge and information from micro, meso and macro sources • Formulation of research questions that attempt to get at what may be the factors, or range of factors, that lead to outcomes or consequences observed, some of which may have been intended, others unintended • Attention to be placed on identifying research designs that enable the impact and flow of time and change to be accounted for in data gathering strategies • Using research methods that are multiple and (often, though not exclusively) both quantitative and qualitative, ranging across multiple levels – micro, meso and macro • Using research methods that seek understanding from the range of stakeholders identified and involved • Data analysis that brings together and creates narratives able to be interpreted or themes identified in order to make sense of what can be learned at each of these levels in relation to the research questions posed Reflective Questions • Consider your practice or placement experience: What are you curious about? What do you want to know more about? • How might you formulate this interest into a research question that demonstrates your ability to ‘think complexity’? • What research design might generate the data that will assist you in exploring this question? • What factors might you need to keep firmly in mind as you develop your complexity-­informed research project?

References Allen, P. (2001). What is complexity science? knowledge of the limits to knowledge. Emergence A Journal of Complexity Issues in Organizations and Management a publication of The Institute for the Study of Coherence and Emergence, 3(1). Alston, M., & Bowles, W. (2018). Research for social workers (4th ed.). Routledge.

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Ansell, C., & Geyer, R. (2017). Pragmatic complexity a new foundation for moving beyond ‘evidence-­ based’ policy making. Policy Studies, 38(2), 149–167. https://doi.org/10.108 0/01442872.2016.1219033 BMJ Medicine. (2018) 16:95. https://doi.org/10.1186/s12916-­018-­1089-­4 Braun, V., & Clarke, V. (2012). Thematic analysis. In H.  Cooper, P.  M. Camic, D.  L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57–71). American Psychological Association. https://doi.org/10.1037/13620-­004 Byrne, D. (1998). Complexity and the social sciences. Routledge. Byrne, D., & Callaghan, G. (2008). Complexity theory for the social sciences. Routledge. Colvin, M.  L., & Miller, S.  E. (2020). The role of complexity theory and network analysis for examining child welfare service delivery systems. Child & Youth Services, 41(2), 160–183. Cooksey, R. M. (2001). What is complexity science? A contextually grounded tapestry of systemic dynamism, paradigm diversity, theoretical eclecticism and organisational learning. Emergence A Journal of Complexity Issues in Organizations and Management a publication of the Institute for the Study of Coherence and Emergence, 3(1). Drury, C. (2016, September). The application of complexity thinking to social work: Does having a complexity-informed theoretical approach to practice with early neglect enable a different approach to ideas of change and management of risk? Thesis submitted in fulfilment of the degree Doctor of Philosophy, School of Social Sciences Cardiff University. Fish, S., & Hardy, M. (2015). Complex issues, complex solutions: Applying complexity theory in social work practice. Nordic Social Work Research, 5(sup1), 98–114. https://doi.org/10.108 0/2156857X.2015.1065902 Flynn, C., & McDermott, F. (2016). Doing research in social work and social care: The journey from student to practitioner researcher. SAGE. Gerrits, L. (2008). The gentle art of co-evolution: A complexity theory perspective on decision making over estuaries in Germany, Belgium and the Netherlands. Erasmus University. Greenhalgh, T., & Papoutsi, C. (2018). Studying complexity in health services: Desperately seeking an overdue paradigm shift. BMC Medicine, 16(1), 1–6. https://doi.org/10.1186/ s12916-­018-­1089-­4 Hothersall, S. J. (2019). Epistemology and social work: Enhancing the integration of theory, practice and research through philosophical pragmatism. European Journal of Social Work, 22(5), 860–870. Jackman, M., McDermott, F., Sadler, J., El Hage, N., & Lee, H. (2021). Guardianship patient characteristics and outcomes in geriatric social work practice: Australian context. Social Work in Health Care, 60(8-9), 614–630. https://doi.org/10.1080/00981389.2021.1990189 Long, K., McDermott, F., & Meadows, G. (2018). Being pragmatic about healthcare complexity: Our experiences applying complexity theory and pragmatism to health services research. BMC Medicine, 16, 1–9. https://doi.org/10.1186/s12916-­018-­1087-­6 McDermott, F. (2014). Complexity theory, transdisciplinary working and reflective practice. In A. Pycroft & C. Bartollas (Eds.), Applying complexity theory. Policy Press. Miles, M. B., Huberman, A. M., & Saldana, J. (Eds.). (2014). Qualitative data analysis: A methods source book. SAGE. Moon, F., Kissane, D., & McDermott, F. (2022). Developing a complexity-informed approach to hospital end-of-life care for people with dementia and their families. International Social Work. https://doi.org/10.1177/00208728221108934 Morin, E. (2008). On complexity. Hampton Press Inc. NVIVO. (2023). https://www.qsrinternational.com/nvivo-­qualitative-­data-­analysis-­software/home Phelps, R., & Hase, S. (2002). Complexity and action research: Explaining the theoretical and methodological connections. Educational Action Research, 10(3), 507–524. PRISMA. https://www.prisma-­statement.org/ Sanger, M., & Giddings, M. M. (2012). A simple approach to complexity theory. Journal of Social Work Education, 48(2), 369–376. https://doi.org/10.5175/JSWE.2012.201000025

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Shaw, I., Briar-Lawson, K., Orme, J., & Ruckdeschel, R. (Eds.). (2013). The Sage handbook of social work research. SAGE. SPSS. https://www.ibm.com/au-­en/products/spss-­statistics Wadsworth, Y., & Epstein, M. (1998). Building in dialogue between consumers and staff in acute mental health services. Systemic Practice & Action Research, 11(4), 353–379. Wang, S., & Wang, Y. (2019). Integrating complexity theory with health social work practice. Journal of Advances in Humanities & Social Sciences, 5(3), 106–112.

Chapter 12

Thinking Complexity in Social Work Education and Professional Practice

12.1 Introduction and Learning Opportunities If we reflect on our own learning pathways, it is often clear that our trajectory is characterised by processes that more often seem spiral-like rather than linear. As we learn, we revise and adapt our understanding when new ideas or knowledge is gathered into our cognitive schema and mental maps, changing how we see things and how we act. This is the process of emergence. Indeed, as Alex recounted in Chap. 7, her thinking and ideas ranged across and drew on multiple sources and experiences. When we think about our own learning journeys, this is likely to be so for all of us. In coming to address the issue of social work education, both pre- and post-­ graduation, our intention is not to suggest that CT and pragmatism be taught as specific subjects within curricula. Rather, as we have been arguing throughout this book, CT provides explanatory theory, a meta view or set of beliefs about ‘how the world works’. Given this understanding, we are arguing that curriculum design and the content and process whereby social work students are educated into the profession and social workers’ practice, wherever they work in the field, should reflect or exemplify their ‘roots’ in CT and pragmatism. Thus, the educator’s aim would be that CT and knowledge of CAS become ‘second nature’, characterising their ‘being in the world’ as social work practitioners, researchers, policy makers, supervisors and managers. Acting pragmatically, as we have discussed, is already the preferred modus operandi of most social workers, but what that means, how pragmatism informs practice, requires learning in order to both ensure practitioners work with confidence and are able to account for what they do. In this chapter, readers will: • Revisit the key ideas characterising CT, CAS and pragmatism. • Explore the issues arising from these ideas, in particular, how they might stimulate innovative curriculum design and enhance our understanding of the learning process, learning to work with unpredictability and uncertainty. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_12

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• Recognise the importance of involving a diversity of different bodies of professional knowledge, different stakeholder perspectives, such as those of vulnerable or minority groups, in curriculum design, development and delivery. • Consider how CT, CAS and pragmatism might influence practicum learning and work-based supervision.

12.2 CT and CAS in Educational Settings Our understanding of CT placed focus on 10 characteristics of CAS. There are many examples of these characteristics apparent in educational settings, and here are some: 1. Embeddedness/nested systems: CAS are systems embedded within a wider context and within other CAS, for example, education incorporates numerous intertwined systems  – institutions, faculties, schools, agencies, placement organisations, research positions. 2. Fuzzy boundaries: Boundaries between systems are permeable and hard to define, for example, social work courses usually have curricula mandated by professional bodies. The dynamic, shifting and fuzzy boundaries between course providers and professional associations become particularly important sources of intercommunication during processes of accreditation. 3. Distributed control and self-organisation: System patterns are not created by top-down control; instead, autonomous agents interact to create outcomes. For example, while universities make top-down demands, the local rules determining social work curriculum development are held by academics in conversation with professional social work accreditation bodies and sometimes other key stakeholders such as social work agencies; from these, educational outcomes, specific for social work, self-organise to often produce innovative developments. 4. Emergence: Interactions between agents create system outcomes that are not directly intended and are greater than the sum of the individual agent behaviours. For example, the individual learning of students in classroom interaction will lead to emergent outcomes, which go beyond what individuals might achieve on their own. 5. Unpredictability: The behaviour of a CAS cannot be predicted due to its non-­ linearity, sensitivity to initial conditions and historicism. For example, fieldwork educators are unlikely to know with any certainty how a student social worker will fare on their first placement. 6. Non-linearity: The magnitude of system input and agent interactions is not linearly related to the magnitude of changes in the system. A CAS can react suddenly to minor inputs or fail to change despite overwhelming external pressure. For example, educators know that for some students a low grade on the first of several assignments will become a motivator to improve, whilst for others, it will seem to make no difference.

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7. Phase changes: A small change in the system inputs results in a qualitative change in the system’s state. For example, the provision of a welcome lunch for new students may have a significant impact on bonding the students into a coherent and supportive group, which endures beyond graduation. 8. Sensitivity to initial conditions and historicism: Future agent actions are affected by past changes in the system, leading initial conditions to exert a strong influence on system behaviours. For example, a student who has spent time in care during childhood may experience a field practicum in a child protection service to be (re)traumatising. 9. Non-equilibrium: CAS are characterised by continual change and do not reach equilibrium. For example, when an educator introduces a new skills component in a course, they will want to observe over time and over several student cohorts whether there are particular elements in the course that appear to suggest contingency or possible causality in relation to the intended skill development. 10. Adaptation and co-evolution: Agents and systems evolve together, reacting to changes in the context to ensure optimal functioning and survival. For example, skilled educators learn as their students learn, both adapting and changing in relation to the dynamics that emerge amongst them.

12.2.1 Pragmatism Social work education is very much a pragmatic undertaking. Universities, in which most social work programs are provided, have financial constraints with regard to the staffing and provision of courses. Social work courses have an additional demand to provide students with fieldwork placements, most often during the course, and how budgets incorporate the costs to agencies in providing learning opportunities and supervision is a constant consideration. The time limits for courses, an always-crowded curriculum, over-burdened staff attempting to maintain their own high research outputs are some of the numerous elements that influence the need to be pragmatic: that is, to deliver a high-quality course despite these constraints. Being pragmatic, educators situate themselves (metaphorically speaking) at the meso level, regarding macro-level factors (university policies, budgets, research outputs, staffing) and micro-level factors (students’ learning styles, their capacities to cope with placement and class teaching), and balancing these in the curricula devised, knowing that they will never be able to provide everything that a student may need. Furthermore, the doing of social work requires pragmatic and practical strategies, informed by a range of theories and models whereby students are taught that problem management rather than problem-solving may be the primary task. Hence, the field practicum is often recognised as at the heart of a social work program for here the understanding from pragmatism that theory and practice are best recognised as mutually informing contributions to knowledge makes sense  – ‘…(field education)… enables students to integrate classroom learning with professional

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practice so that students reflect on and refine their ways of thinking, doing and being. Field education socialises students into the profession through immersion in real practice contexts, while allowing a constructive and reciprocal learning space to develop. Students make sense of what it means to be a social worker by developing their professional identity, integrity and practice frameworks’ (Australian Association of Social Workers, 2021, p. 9).

12.3 Curriculum Development The focus of this book has been on thinking complexity and acting pragmatically, and we now turn to a discussion of how these ideas can become the framework and basis for teaching and learning in social work.

12.3.1 Thinking Complexity Thinking complexity is to see student thinking and learning as an emergent process, where ideas emerge in non-linear and unpredictable ways (Phelps & Hase 2002, p.  511) and where curriculum might be only partially planned, in effect leaving much unplanned. This suggests that curriculum might be designed is such a way as to facilitate this, for example, by designing course content that requires participation from both teachers and students in using class as opportunities to learn and arrive at understanding together. What emerges from class interactions will be greater than the sum of individual student contributions. Setting learning goals is, as we’ve argued in relation to casework scenarios, often aspirational, as what will actually emerge during discussion and exploration of ideas may be something quite different from what was proposed. The skill of the teacher may be to adapt and ‘mentor’ the process, perhaps stepping back to allow self-organisation and the development of the unplanned part of the curriculum to emerge, to observe the ‘local rules’ coming alive in the class, which prompt emergent outcomes supportive of student learning. Social work intentionally locates itself at the interface of person and environment as the impact of contextual and structural factors such as power, health, financial security and emotional well-being on human lives is of primary attention. But social workers never consider themselves as being in an ‘empty world’ for they share and contribute to this ever-dynamic context with countless other stakeholders. While a unique profession with its own mission and purpose, social work is simultaneously and inextricably bound up with the diversities of age, health, sexuality, ethnicity, gender, ability and sexuality, which characterise many of the populations with whom they work. Social work, as was highlighted in the hospital chapter, is rarely contained behind hospital (or any other) walls, forever changing and adapting to those people and communities with which it is involved.

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This suggests two important things with regard to thinking complexity in social work education. Firstly, it has been stressed that transdisciplinarity is the hallmark of thinking complexity, where different stakeholders share or contest world views, interpretations of the world, areas of expertise and influence. Curriculum development for a thinking complexity teacher might mean securing the involvement of relevant stakeholders in devising ‘what a social worker needs to know’ in relation to a specific field and from the point of view of stakeholders in that field. Secondly, accommodating areas of shared knowledge and being open to what is not known, learning how to work across systems and across disciplines and with diverse stakeholders are critical skills for social workers. This suggests that curriculum development informed by the view of the world that CT advances will draw on these multiple sources of knowledge and experience. Diverse stakeholders including service users and consumers might, for example, be involved in both subject development and in classroom engagement and sharing with students. Importantly, students need to learn skills about how to collaborate, how to work across and between systems, how to work in a transdisciplinary manner and how to be part of a team. In many areas, crucial moral and ethical issues will arise (as was discussed in Chap. 6) about which the social worker needs to strategise, for example, the extent to which the risks involved in the discharge home of a fragile patient might be weighed by the MDT of which the social worker is a member. Do MDT members share understanding of what is ‘acceptable’ risk? Can they collectively arrive at a decision that may be risky but that they can – together – ‘live with’? What skills does a social worker need to bring to the MDT to enable the emergence of ‘good enough’ decisions in the face of risk and uncertainty and unpredictability?

12.3.2 Acting Pragmatically Learning to act pragmatically speaks to the necessity of acting – doing something – where uncertainty and disorder, incomplete information and unpredictable outcomes are the order of the (social worker’s) day. Earlier (Chap. 4) we noted several strategies that need to be part of the social worker’s skill set if they are thinking complexity and acting pragmatically: • Understanding CT and CAS (what systems are, how disorder and order generate emergence) and its usefulness in shaping action that is strategic and pragmatic. • Mining lived experience through reflection, considering emotional and physical reactions as events unfold; being self-analytical, self-critical. • Always being aware that it is the context within which we are working that is of central importance. • Teasing out and uncovering the assumptions driving our perspective. • Locating ourselves at the meso ‘level’. • Working in an interdisciplinary way with key stakeholders. • Focusing on the issue rather than the disciplinary or stakeholder agenda.

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• • • •

Constructing the narrative. Looking for themes and patterns within it. Expecting the unexpected. Being prepared to consider a range of possible solutions or ways problems might be dealt with. • Being prepared to adapt to what may unexpectedly emerge as relationships unfold and strategies are put in place. These strategies are able to be taught (and indeed many of them are already taught both in the classroom and on placement). The point here is, however, that a curriculum grounded in the explanatory theory that CT provides can only ‘come to life’ if the practical and pragmatic imperatives of reflective thinking, coping with uncertainty, narrative construction and thematic analysis, openness to considering multiple solutions to singular problems and capacity to work across disciplines and interests are embedded in course offerings, consciously connecting them to the belief system articulated through CT.

12.4 Thinking Complexity and Acting Pragmatically in Supervision Supervision is a very important tool to strengthen social work practice across the professional continuum, including students on placements, research students and practitioners within human services. Perhaps, the most important place to start is to consider students and supervisees own “systems” and their experiences of being plunged into the uncertainty of placement, embarking on original research, or commencing a new practice role. They bring their own set of life experiences, attitudes and histories to this experience. These may include their own health and mental health issues, family and relationship factors, and they may be balancing work commitments and private lives. Students and supervisees may be from urban, rural and international backgrounds and have varying degrees of familiarity with relevant local welfare and health systems. They may lack experience in the workforce and may not have had opportunity to develop a professional identity nor experience of working within organisational hierarchies where they lack power (or work with service users who are similarly disempowered). Alternatively, as either student or staff member, they may see themselves as representatives of minority or non-­ mainstream groups. For both staff and students, arrival in an agency places emphasis on developing professional problem-managing approaches drawing from a broad range of knowledge sources beyond those that were offered in formal academic settings or in previous work places. These may include interpersonal skills, understanding of relevant legislation and policies and practice knowledge derived from related services and supports. This suggests that the first task of any supervisor is to find out something about the student or staff member  – what do they know of the agency’s context, the

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population receiving services from the organisation and what array of skills will be most relevant in practice? What strengths and limitations do they bring to the placement or the research or the job? The early days of the student/staff supervisee discussions might canvass how comfortable they are with uncertainty and unpredictability and how they (supervisor/student/staff member) might work together to support learning in the dynamic and fluid environment of most settings in which social workers work. Supervision may also begin with thinking about and reflecting on students’ and staff members’ positionality within rapidly shifting environments, multiple subsystems, competing demands and fuzzy boundaries between knowledge contexts. It may serve as an opportunity to explore adaptive learning practices to facilitate students’ development of a professional identity and staff members’ understanding of and commitment to an agency’s mission and purpose. This might occur through reflections on, and analysis of, work tasks, actions taken or not taken, surprises and unexpected outcomes. As we saw in Chap. 7, this might include dealing with mistakes or missteps. When a student begins a placement or a staff member joins an agency often means they are being thrust into an environment which demonstrates unpredictability and strain, but it is also an opportunity for them to hone their skills in working with other disciplines and stakeholders. In community-based placements, for example, there are opportunities to learn what communities are, how they function and how change might be negotiated or facilitated amongst a diverse range of stakeholders and citizens. Supervision may also help staff understand the way their supervisor and/or the organisation views and prioritises risks and opportunities, for example, what information and expertise is relied on when external advice is sought, how collaborative planning and decision-making processes are made, and how teams problem solve. In Chap. 7, for example, Alex’s account of the ways in which staff and managers worked together, drawing on past experience of collective problem-­ solving, enabled a flexible and effective response to the constraints imposed during COVID-19. There are of course some differences between student placements and ongoing supervision of staff. In relation to the field practicum, this has often been conceptualised as a phase of transitioning away from being a ‘student’, which implies passivity (at least in relation to practice) and apprenticeship, dependent on the expertise and guidance of others, to that of a professional with an implied sense of competence, responsibility and power. Commonly, exploration of students’ conceptualisation of themselves as practitioners, rather than students, takes place iteratively as they are confronted with issues and dilemmas that can be challenging from an ethical or values-based perspective. Alternatively, it could be argued that the process of ‘becoming’ a social worker or a fully-fledged practitioner in contrast to being a student (signified by completion of workbooks or portfolios) is less of a transition and more of an integration of identities, in recognition that the process of learning and adapting constantly evolves. The limitations and constraints placed on students and practitioners by organisational and policy frameworks can be challenging, as the ideals of ‘best practice’ are

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always difficult to implement. Discussions in supervision might highlight the importance of seeing presenting situations from micro, meso and macro perspectives simultaneously, exploring how macro-level influences and political tensions invariably impact on the delivery of services and care to marginalised populations and communities. In essence, supervision may be an important site in which the student or practitioner’s capacity to think complexity and act pragmatically is the focus of exploration, reflection and analysis.

12.5 Conclusion In this chapter, we have argued that CT and pragmatism should form the base and backbone of social work curriculum, evident in the ways in which courses and subjects are designed and teaching is undertaken. It is a perspective that emphasises the evolving and iterative nature of teaching and learning, in which teachers and students embark together on a process of developing their understanding and engagement drawn from varied sources of knowledge and knowledge holders, towards arriving at practical actions or interventions, which might improve or ameliorate or better manage problematic situations. Supervision, as an important social work task, begins with understanding who the supervisee is and what they bring to their task. It is an activity, like teaching and curriculum design, that is shaped around the evolving learning, personal and professional development needs of the supervisee, offering opportunities to engage across systems and disciplines with increasing confidence despite the uncertainties and contingencies that characterise ‘real-world’ scenarios. Reflective Questions • If you were asked to design a subject in a social work course, how might you ensure that it was informed by CT? • As a social work student on placement with a strong affiliation with CT and pragmatism, what would you look for in supervision?

References Australian Association of Social Workers, ASWEAS Field Education Standards. (2021). https:// www.aasw.asn.au/document/item/13188 Phelps, R., & Hase, S. (2002). Complexity and action research: Exploring the theoretical and methodological connections. Educational Action Research, 10(3), 507–524. https://doi. org/10.1080/09650790200200198

Chapter 13

Next Steps: What Do We Know About Thinking Complexity and Acting Pragmatically in Social Work?

13.1 Introduction and Learning Opportunities In this book, we have argued that the challenges social work faces in the twenty-first century underscore the need for working with the explanatory theory or meta view of the social and material world offered by complexity theory. Alongside CT, we proposed that pragmatism provides a guide to social work action, a way of working with which social workers are very familiar. In short, that social workers ‘think complexity’ and ‘act pragmatically’. At the end of this chapter, readers will have: • Reviewed and considered the main points made in this book about thinking complexity and acting pragmatically. • Considered several themes characterising thinking complexity and acting pragmatically, which are relevant across a range of practice settings. • Noted the great potential which both CT and social workers’ location in frontline positions offer in relation to understanding the way the world ‘works’ and the imperative arising from this for social workers to work for social change through engagement in policy development and research.

13.2 Key Points In Part I of this book, we outlined the ways in which becoming a complexity thinker required a grasp of the insights and understanding of social and material reality – how the world works – offered by CT. This, we proposed, provides a useful explanatory framework, meta view (or world view) and belief system, which informs how we come to know about practice as being ever-dynamic, fluid, self-organising and notable for its non-linear outcomes. Social reality is always changing and in flux as © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0_13

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ideas or events or interpretations and understanding emerge. We described ten features of complex adaptive systems, highlighting the central importance of the notions of emergence and adaptation, those joint properties of both the system and its interaction with other systems, which creates a current reality that is always ‘becoming’, always unpredictable. In many respects, CT takes our understanding and knowledge of practice far further, expanding beyond the conventional person-in-context framework that permeates social work epistemology and practice. The interpenetration of elements, factors, events at micro, meso and macro confound and compound but also explain the complexity and complicatedness of social life with which social workers are so familiar. The challenge that accompanies CT is how does one work or practice within a constantly changing, emergent and unpredictable world? We have proposed that it is pragmatism, both as epistemology and ontology, which may provide a way forward whereby the motivation to act, in the face of uncertainty, using theories, methods and approaches, which best suit the situation and which prompt action and strategic decision making. These considerations led us to propose a number of pointers for social workers in thinking complexity and acting pragmatically. We included amongst them the importance of self-reflection of working in an interdisciplinary way with all stakeholders when constructing and analysing client, research data, policy and organisational narratives for themes and patterns. We have argued for social workers to act despite uncertainty, while being strengthened by the knowledge that there will always be a range of possible solutions and outcomes. In Part II of the book, our intention has been to bring this ‘marriage’ of CT and pragmatism to life, demonstrating and describing how social workers in different fields have ‘thought complexity’ as they intervene and strategise pragmatically. Part II opened with a description of the Multiple and Complex Needs Initiative (MACNI), located at the start of the practice chapters in order to demonstrate a program, designed for people and agencies challenged by multiple co-occurring issues  – mental illness, disability, homelessness. MACNI has been embedded within a CT understanding of the world and thus specifically designed to work in an interdisciplinary cross-sectional way with service users and service providers. This over-­ arching program and response to the ‘wicked problems’ characterising social work practice sets the scene for the subsequent practice chapters. Chapters 6 took a cross-­ field approach to practice, identifying key dilemmas and challenges, which frequently characterise practice in many if not most fields  – ethical issues, self-determination, risk, uncertainty –and explored these through examples drawn from work with children and older people. The subsequent Chaps. 7, 8 and 9  – focused on particular fields of social work practice, management, community development and health in which each of the authors demonstrated and described their complexity thinking and how ‘thinking complexity’ in partnership with pragmatism has influenced and informed their work. Importantly, also described in the practice chapters are different ways in which social workers do things, the cycle of ‘doing – thinking – doing’ which characterises their approach to action and intervention.

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In Part III, we have been considering other domains – policy, research and social work education – in order to bring together those aspects of CT and CAS, which when joined with pragmatism illuminate how this explanatory theory, epistemology and ontology open up ways of thinking about and doing social work, which build on and strengthen the foundational person-in-environment and the biopsychosocial perspective. Some of the key points that were made in Parts II and III may be summarised as follows: • Complexity does not exist solely in service users’ or community groups’ characteristics but is also present within service systems: service users’ and agencies’ needs and interests extend beyond narrow silos, impelling social workers to engage and collaborate within and across service systems. • Clients and communities tend not to ‘read the rule book’. Their narratives are typically fluid and loose ended, subject to editing not only over time but by the narrators themselves. • When working with the complicatedness of social life and the problems in living which social workers deal with, there is need to propose possibilities or intended outcomes, setting up preliminary hunches to work towards (as in the case example of Bill and Mary in Chap. 6 where a way forward needed to be found, or Jim’s development of a research question in Chap. 10). These goals are necessarily limited because of what we know about CAS, but they are an important feature of acting pragmatically. • Assessments reflect what we know or come to learn about clients and communities: they also need to reflect what we know we do not know. Being curious and acknowledging uncertainty prepares us for always expecting the unexpected.

13.3 Common Themes As each of chapters in Part II and Chaps. 10 and 11 in Part III highlighted, practice within a CT frame recognises that the social worker is working in contexts characterised by incomplete information, imperfect, ambiguous and often contradictory policy and legal contexts, tensions between organisational aims and objectives and the lived client or community’s experience of their needs and objectives. Importantly, in most fields of practice, resources are less than what is required to address problems, and pathways forward are usually unclear. Across all the chapters, some common themes were evident: these highlight issues that can serve as guideposts for the social worker who wishes to ‘think complexity and act pragmatically’. We have identified five ‘take-aways’. A social worker who is thinking complexity and acting pragmatically, who is cycling between doing – thinking – doing, will 1. Recognise that they are always working in and with uncertainty: CT, broadly, and pragmatism more specifically offer a way to understand and to respond to

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uncertainty. To respond to uncertainty suggests a process of pause and critical reflection as the starting point, the floating of provisional hypotheses and the ‘playing with’ of likely (even perhaps unlikely) outcomes. It epitomises the cycle of doing – thinking – doing. 2. See the need to integrate theory and practice rather than oppose them: Social workers who are thinking complexity whilst acting pragmatically will use ­whatever theory assists them in making sense of a situation. CT alerts them to the range of possible outcomes as CAS interpenetrate, adapt and change. Further, as we hope we have demonstrated in this book, CT itself is ‘practitioner-friendly’. As the practitioners in Part II have described, at some points and in some contexts, not all of the concepts CT and the characteristics of CAS offer will be appropriate simultaneously. Perhaps, only some will be helpful in the cycle of ‘doing – thinking – doing’, and it is these that might be a focus for analysis. 3. Be strategic: Determining a way forward in order to simultaneously meet client or community need, organisational need, policy directions and legal frameworks. Relationships between policies, laws, institutions, organisational priorities and the perspectives of the client are by no means linear and straightforward, so much as opaque, contradictory and emergent as scenarios unfold and CASs interpenetrate. In seeking the most positive option – as distinct sometimes from the ideal option – the social worker is likely to be engaged in a series of decisions as new information or feedback is sought or received, decisions made and evaluated and further decisions made. The pragmatic and strategic way forward may thus reflect a process in which knowledge and information will be ‘in dialogue’ over time. 4. Focus on identifying patterns and constructing narratives. Each of the accounts of practice that we have read in this book either suggest or demonstrate the importance of constructing a narrative. Each client’s or community’s life history and narrative shared with the social worker is likely to be very different from that of the social worker’s own narrative: at times, this will demand empathy and the careful listening that creates a safe space for their joint work in a cycle of doing, thinking and doing in order to create a working relationship. The aim is to strive for the emergence of understanding, rather than knowledge as an endpoint. Ultimately, this entails not only reflecting on and exploring the client’s narrative but also on the social worker’s own narrative. 5. See the value of engaging in possibility thinking: Given that CT captures the lived experience of social work practice in all its uncertainties and unpredictability, it also recognises that social work practice is a creative endeavour. As such, it ‘liberates’ social workers to use their imaginations and lateral thinking to play with a range of possible outcomes to every situation. The permeability of systems, the fuzziness of boundaries and the non-linearity of processes highlight that there are always many solutions or many ways of managing a problem or a situation. Social workers need to engage with issues and problems as they arise, ones that are not necessarily within the remit of their specific mandate. This, in turn, reflects the reality that many (if not most) clients do not present with problems that fit neatly into the silos of service provision. This necessitates, more often than not, working across services rather than within them.

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13.4 Ways Forward The shared themes discussed above provide helpful pointers to the ways in which social work practitioners might think complexity and act pragmatically. However, what is perhaps an even more powerful contribution of CT is that it offers a comprehensive and persuasive account of ‘how the world works’. Social workers are extremely well placed with their exposure to and understanding of how the inequalities and unfairness of social structures damage and constrain human lives, to see and to seize opportunities to work for change. Advocacy may take many forms, but chief amongst them is through engagement with policy and research, finding the evidence or the possible options available to facilitate change. Social workers’ locations in frontline settings can provide them with the insights and understanding that can make them exceptional advocates for change. CT’s explanatory theory builds on and advances person-in-environment perspectives, demonstrating how concepts of person and environment actually mutually inform and influence ‘what happens’. What matters most may be not walking away from these insights but rather being able to step into and utilise this knowledge in ways that may create change in systems and structures. Building research knowledge, engaging in policy development and advocating noisily all offer ways forward, or indeed, it can be argued, taking such action is a responsibility, which social workers are highly well placed to shoulder.

13.5 Conclusion We conclude this chapter with several reflective questions. Answering them may be useful in developing and honing skills in thinking complexity and acting pragmatically: Reflective Questions • What has ‘thinking complexity’ revealed about your area/field of practice? • Are there particular aspects of thinking complexity and acting pragmatically that you can see as relevant or helpful in your area of practice? • How was ‘thinking complexity’ helpful? • How has ‘being pragmatic’ made action possible in your field? • How well do you feel you understand your personal/professional preferences and ways of working? • How well (or not) does thinking complexity and acting pragmatically fit with or be compatible with your previous or favoured theoretical and practice approaches? • What are your thoughts about uncertainty and not knowing? • How comfortable are you with uncertainty and not knowing? • What strategies do you have for dealing with uncertainty? • How do you make the connections between theory and practice? • What are your experiences of being strategic and pragmatic?

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• How well does ‘thinking complexity and acting pragmatically’ help achieve your individual aims, or the aims of groups you are part of or have observed? • From within the frame of CT and your knowledge of CAS, how can you work – or what can you do – to achieve the broader aims of social work such as becoming advocates for social justice and human rights?

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Index

A Addams, J., 7, 12 B Biopsychosocial model, 3, 7, 10, 11, 16, 171 C Case comparison, 175 Casework and complexity theory, 62, 92–93, 98 Community development, 14, 25, 62, 75, 108–110, 123–136, 194 Complex adaptive systems (CAS), 15, 16, 35, 37, 41–45, 51, 52, 54–59, 61, 62, 90, 92, 95, 97, 101, 102, 108, 121, 130, 136, 137, 157, 158, 170–172, 174, 179, 180, 185–189, 195, 196, 198 Complexity theory and casework, 62, 92–93, 98 Complexity theory and hospital social work, 125–126 Complexity theory and management, 62, 109, 111 Complexity theory and narrative, 59 Complexity theory and policy, 157–158 Complexity theory and program design, 86 Complexity theory and research, 169–171, 180, 181 Complexity theory and social work education, 185, 195 Complexity theory and social work practice, 48, 108, 120, 171, 190, 194, 196

Complexity theory and supervision, 187, 190, 191 Complexity theory curriculum, 185, 186, 189, 192 Complexity theory definitions, 42 Complexity theory research design, 180 Complex service systems, 79–82 Curiosity and social work, 103 E Emergency department social work, 149 Ethics, 19, 45, 90, 92–94, 104, 113, 142, 149, 158, 177 Ethics and complexity theory, 93, 104 H Hospital social work, 137–149 M Micro, meso, macro, 12, 23, 38–42, 46 Multidisciplinarity, 109, 139, 140 Multiple complex needs, 67, 83, 86 N Nested CAS, 52, 54–56 P Person-in-environment, 3, 7–8, 10, 11, 13, 21, 23, 25, 26, 37, 39, 44, 45, 109, 132, 139, 163, 175, 195, 197

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 F. McDermott et al., Complexity Theory for Social Work Practice, https://doi.org/10.1007/978-3-031-38677-0

209

210 Place, 4, 16, 21, 25, 28, 36, 41, 42, 46, 48, 52, 53, 59, 61, 62, 68, 71, 86, 94, 100, 102, 103, 124, 125, 127–129, 131, 139, 143, 148, 153, 162, 165, 170, 178, 190, 191 Policy and pragmatism, 165 Pragmatic epistemology, 12, 45, 47, 48 Pragmatism and research, 174 Pragmatism and social work education, 187, 195 Pragmatism and social work practice, 48, 194 R Reflective practice, 19, 21, 27, 29, 45, 81, 101, 169–170 Risk, 6, 8, 13, 15, 20, 26–31, 36, 37, 41, 47, 58, 67, 70, 72, 76, 77, 80, 90, 91, 94, 95, 97–104, 113, 114, 134, 142, 143, 146, 149, 155, 172, 176, 180, 189, 191, 194 S Self-determination, 13, 15, 20, 90, 96–97, 101, 104, 125, 126, 159, 170, 194

Index Social work action, 20, 193 Social work and complexity theory, 4, 11–14, 171 Social work and pragmatism, 4, 11–12 Social work curriculum, 186, 192 Social work decision-making, 46 Social work history, 4–6 Social work limitations, 19–31 Social work policy, 158, 159, 161 Social work practitioner research, 169, 180 Social work strengths, 19–31 Social work theory, 9, 20, 25, 30, 31, 37, 44 Strategy, 9, 12, 14, 15, 21, 24, 31, 36, 41, 51, 54, 57, 59–62, 71, 76, 77, 93, 97, 101, 114, 118, 119, 121, 136, 161–165, 173, 179–181, 187, 189, 190, 197 U Uncertainty and social work, 195, 196 W Wicked problems, 27–31, 71, 155, 194 Working across systems, 158