The Computer Social Worker: Regulatory practices,regulated bodies and science

Introduction: The Computer Social Worker

She spots me in the rehabilitation waiting room. She comes over to ask me if I am a relative. My relative is in an examination room with the physiatrist. She says she is the social worker in the department and she has ‘some things to ask’. She tells me that we will go to her office around the corner. She does not actually ask if this is ok, but I do not ask her anything either. I follow behind her as she turns the corner. Suddenly she turns around and goes back in the direction we came, muttering something about needing to ask someone about something. She knocks and opens the door of the room that my relative is in. She asks my relative if she can talk to me – she does not tell him about what. She does not tell me either. He ‘gives consent’; for the unknown. I follow around the corner again, as she walks into an office that has a sign on the door with her name and ‘Social Worker’. She immediately turns on a computer. The computer is situated on a table in front of her desk, facing the wall. She points to me to sit directly beside the computer. There are two other chairs in the room, one which faces the computer and one which is behind her desk. She makes a comment about the computer being slow and as we wait for the computer to come to life, she strides over to her desk. After a few minutes the computer lights up and she sits in front of it, staring at the computer screen. A few more minutes pass as she hits some keys. Satisfied with what she sees in front of her, she begins.

She asks me a host of demographic questions. As she cursorily moves to questions about my relative’s daily life, I begin to realize that she is completing a formal assessment. She asks the questions without any hesitation or curiosity; just filling in blanks. Does he make his bed? Does he take his own medication? Can he bathe himself? Question after question, my answers punctuated by her next question. She periodically glances up at me and nods. Who takes care of the finances? Who does the cooking? Who does the groceries? She chops his day, his life into a series of functions. There is no room to explain the things that actually make up the day, his day; a life, his life.

Almost in passing, she comments, ‘his score was perfect’, ‘he scored 30/30 on the cognitive test’. She is talking about the Montreal Cognitive Assessment (MoCA) test – commonly used by social workers as a way to determine cognitive impairment. Her notation that he is 30/30 intimates that someone of his age is supposed to fail this test – I wonder if the fail mark is 15. I wonder what she says when the score is not ‘perfect’? Her barrage of computer questions carries on. She asks the questions on the computer screen as though the answers are facts. Even the question on spirituality is ironically asked as though spirituality is a fact of life. She marks his life, his body, his movement as a series of tasks. Satisfied, she dismisses me with a pre-packaged envelope of papers on making a will, a pamphlet on advanced care planning and her business card, even though I did not request any information on these topics, and even though it does not feel as though she would want anyone to call her.

There is nothing unique about this situation; this scene repeats itself many times a day. I heard it as a social worker, and I hear it as a researcher and as a friend. It is this loss of specificity, as related to the details of my own life and my family member’s, which highlights the value of narratives to qualitative social work research. In keeping with the autoethnographic approach, I am interested in the experience of patients and families as a cultural experience. Autoethnography in particular, rests within a reflexive frame of qualitative research, allowing for the exploration of historically and culturally embedded social processes (Anderson, 2006; Witkin, 2014). For this reason, it is considered an approach to ontological research, employed in order to understand how our lives are ordered and knowledge is socially constitutive (Hughes and Pennington, 2017). To do so, autoethnographic researchers open up their own cultural experiences for analysis by presenting a visible rendering of that experience to the reader. For this reason, autoethnography is considered highly relational in its evocations (Anderson, 2006).

In this article, I use the autoethnographic narrative in order to evince a conversation about the politics of experience, subjectivity, and the corporeal presence in the everyday. Indeed, social work is rolled out as I describe in my narrative, in many outpatient and inpatient departments. Everything the social worker did, and the way the space in her office was organised, reduced social work to a task. The computer mediates (literally and geographically) the space between herself, as the clinician and myself, as a caregiver. In this article I am interested in examining how we might understand this moment. While social workers are often required to apply standardised tools, how do they choose these tools as their point of departure for doing social work? How do technologies, like computers and telephones operate to mediate the relationship between social worker and services users? I begin by discussing the state of regulatory practices of social work.

Regulatory practice

What – aside from meaningless noise – would be gained by asking the New York Philharmonic to play Beethoven’s Ninth Symphony faster and faster each year (Jackson, 2012)?

It is a quantifying of lives alike: service users, their families and the social worker. And as relationality works, these groups of people are interconnected. For example, the way time together is counted. Statistical units for social workers in hospitals are often counted in 10 minute units; I was 2 units of time. The time (literal time) I spent with The Computer Social Worker was used as a business interaction; I felt like a business unit. She had a time-limited and time-sensitive task to complete and I had the information she needed to do so. Indeed, as I left and she provided me with forms to complete, I was conceptually seen by her as the ‘bundle of preferences waiting to be satisfied’ (Pollitt, cited in Coleman and Harris, 2008: 592). This kind of business approach to human practices is what Pollitt calls ‘people-processing’.

In social work, assessment tools define ‘people-processing’. As discursive structures, assessment tools are embedded in features of productivity whereby work can be defined by measureable outcomes, and be completed faster by fewer qualified social workers. For example, risks are pre-defined and measurable with the use of particular tools. Furthermore, the tools and information technology (IT) systems that manage the risks are part of overall efficiency standards. Some writers have noted that the increase in the efficiency of social work practice – or managerialism – has been made operational by the development and implementation of rational-technical knowledge, which of course in turn, aids productivity (Roose et al., 2012). Such is the cyclical and knotted nature of knowledge production; knowledge begets knowledge. In his article, Jackson wonders if there is not a limit to such productivity. He writes:

the care and concern of one human being for another is a peculiar ‘commodity’. It can’t be stockpiled. It becomes degraded through trade. It isn’t delivered by machines. Its quality rests entirely on the attention paid by one person to another. Even to speak of reducing the time involved is to misunderstand its value. (2012, no pagination)

Historical location

Over a decade ago, Orme (2001) writing from a UK context, predicted such productivity in social work practice – specifically prescribed checklists, assessment schedules and standardised assessment records – would introduce ‘reductionist approaches to complex aspects of human interaction and behaviour’ (619). Orme argued that:

the combination of a competence based approach to training and a managerialist approach to defining and achieving quality will require social workers to implement actions and judgments decided by government in the context of managerialism rather than responding to individual and collective situations within a professional framework. (619)

Whether we can rest knowledge production with researchers as Weick suggests, or within institutional practice (in Foucauldian tradition) or on the State (in the Marxist tradition), subsequent social work research has borne Orme and Weick’s predictions. Prophetically, as Weick describes, governments and institutions (including professional regulatory bodies) have introduced tools at rapid paces. These tools are increasingly embedded in technological methods, for example Call Centres where social work assessment are done via phone, or the UK Common Assessment Framework, where social work assessment are computer entered. Technological developments have been pervasive, affecting social workers, social work students and service users alike. For social workers, as Hyslop notes, ’the focus is on gathering information to fit pre-existing categories of danger and risk as opposed to engaging with ambiguous realities from which new stories may emerge’ (2012: 418). This kind of effect reduces social work skills, knowledge and practice to a functional activity, where social workers in some countries, like the UK, have sometimes (particularly noted in statutory children’s services) become computer entry technicians (White et al., 2010). As Braverman suggests, social workers become an instrument. Certainly this was my experience with The Computer Social Worker. For social work students, education is often framed within critiques or realities of State or institutional relations, leaving little possibility to see social work outside of State and institutional relations. The educational sector has taken its cue from government agendas (particularly in welfare states) and introduced learning competencies, which are focused on the achievement of certain employment-ready skill sets (cultural competencies, communication competencies and so on). And, for service users and caregivers, technological and tool developments have encouraged them to be ‘assessment compliant’ (Harris, 2012), while being commodified as ‘information patterns’ (Parton, 2008), often in a highly intrusive manner (Devine, 2015).

In essence, as Orme was forecasting, social work practice would become defined by governments and institutions, rather than by disciplinary values and principles such as social justice, dignity and well-being. But this is not new, this has always been part of the discipline of social work, and can be firmly situated historically. As Ferguson (2004) describes, the history of social work is one of bureaucratic modernity. Certainly there is ample evidence that social work has always been embedded in bureaucratic and governmental agendas. For example, under the guises of ‘helping’ and ‘assessment’, social workers have acted as gatekeepers of the welfare state with a variety of populations – ‘single mothers’, ‘unmarried mothers’, ‘poor people’, people on welfare, Aboriginal peoples and immigrants (Carniol, 2010; Kohli, 2007; Kunzel, 1993). Although the historical practices of assessment that constructed, reiterated and were applied to these groups/people, were not digitised nor standardised by the State and institutions, they were, none the less, mechanistic, or as Foucault (1977) articulates, technologies of practice that organised normalising discourses. In fact, Hennum (2011) argues that current modern technologies do no more than reorder assumptions that are already present in the prevailing discourses about what is normal or abnormal. In this way, assessments, regardless of their form, may ‘satisfy bureaucratic demands’ (Hennum, 2011: 336) and will continue to distribute social identities and social positions. I will discuss to this point later in this article. It may very well be that the kind of normalising function of social work continues because of, or maybe regardless of, principles of productivity, IT innovation and accompanying mechanistic practices. For example, it has been noted with some horror that social workers spend between 60% and 80% of their time at the computer screen (White et al., 2010). However, this is only meaningful if we assume that this time in front of the computer would have otherwise been spent in more client-centred or social justice type ways. Ferguson’s point about the history of modernity cautions us to make such a leap.

Both Marx and Foucault have argued that the threat to positivistic lenses (for example, bifurcations such as normal-abnormal) is within the human body. Marx saw possibility in the analysis of the embodied existence of the working class, while Foucault asked us to consider how to produce conditions of possibility that enable different kinds of embodiment. Indeed, we can see in the history of medicine (Stafford, 1994) that disease and illness clash with attempts to control and manage the physical body via scientific-rational approaches. Adelman and Ruggi (2016) argue that in order to understand the effects of the current culture on the physical body, we must go beyond regulating techniques (such as normalising practices) to explore the very relational dimensions of corporeality. Indeed, I would suggest that some people, some bodies, know this dimension more viscerally than others. For example, in the study of pain, I have argued that the body is not simply an expression of our life; it is the very life we live (Phillips, 2007). Subjectivity and corporeality are interwoven and lived in, and on, one body; a body that is bound by public and institutional spaces, and shaped through material and regulatory dimensions of particular forms of social relations (Phillips, 2009).

Tesio (2009) points out in her research in rehabilitation medicine, ‘elderly, disabled, chronically ill, non responsive and terminal patients’ are not ‘rewarding’ subjects in the allocation of public resources (6). So, for example, the MoCA tool highlights a particular social shaping of the body, even in experiences that are axiomatic (like aging). The social (work) moment I describe in my narrative is borne of these cultural and political practices. While the corporeal body has become the object of technologies, and the tools developed are intended, in part, to manage the unwieldy nature of biology, the tools respond to (and produce) more than just a biological body. The physical body, the corporeal, is more than a commodity. It is not as though corporeality is unrelated to subjectivity, or subjectivity is unrelated to corporeality. In turning to the body now, I am attempting to put these back together in the way we live, to not separate biology and culture, or the body and the mind, or the corporeal and subjectivity.

Producing social work, producing bodies

The belief that one can actively distance oneself, and then regulate that distance in order to come to know, has also been referred to as alienated consciousness as the disenchantment of knowing. [It] has left us alienated from each other, from nature, from ourselves. (Heshusius, 1994: 16)

In previous research, I have argued that technology is not always perceived by services users as cold or dispassionate. I have suggested that attention to technology can be a form of caring that provides knowledge and comfort (Phillips, 2012). Our lives are enmeshed with technology. Certainly in medical care this entanglement is quite present and obvious. Hadders (2009) gives the example of dying in an Intensive Care Unit, where death is interconnected with technology: ‘electronic monitoring works as an active medium, in a network of other actors, within which death becomes tangible and real for health care personnel and relatives’ (585). What is interesting in this moment with The Computer Social Worker is the extent to which a human being is marked by technology even when there is no direct physical, bodily contact. Foucault (1977) argues that in modern times the body is very minimally touched by the State, by disciplines or by institutions. For example in regards to the discipline of law, he argues that the relationship to the body has changed, whereby the notion of punishment no longer directly acts on the body. Foucault argued that disciplines function through acts of power, such as normalisation, which act (directly) on the body by regulating conduct and more indirectly by ‘encouraging’ good and compliant behaviour. Indeed, I was the docile subject (Foucault, 1977) of The Computer Social Worker, as she applied norms of functionality to judge/assess my relative.

Foucault’s analysis of how disciplines operate in relation to the body is a significant assertion about the theoretical understanding for social work because he is underlining the centrality of the body to disciplines, such as social work. Even though the body is not touched, it is still marked. The Computer Social Worker marked my relative’s life as a series of tasks, and his body as a conduit for these tasks; the body as a series of physiological functions. How did this happen? What are the moves The Computer Social Worker made? How did her assessment choice mark the body?

de Certeau conceptually uses ‘the apparatus’ to analyse how the body is marked by disciplines. Like Foucault, de Certeau uses the law as an example – ‘in order for the law to be written on bodies, an apparatus is required that can mediate the relation between the former and the latter’ (1984: 141). Within the ‘apparatus’ (the discipline and the body), in-between the discipline and a body, is a social space made up of a series of objects aimed at the body, marking it. Within the law, de Certeau defines these objects as tools or instruments:

from the instruments of scarification, tattooing, and primitive initiation to those of penal justice, tools work on the body. Formerly the tool was a flint knife or needle. Today the instruments range from the policeman’s billyclub to handcuffs and the box reserved for the accused in the courtroom. These tools compose a series of objects whose purpose is to inscribe the force of the law on its subjects, to tattoo him in order to make him demonstrate the rule, to produce a ‘copy’ that makes the norm legible. This series forms an in-between; it borders on the law (it is the law that provides it with weapons) and it aims at the body (in order to mark it). (1984: 141)

The series of objects (the tools or instruments), bordering on social work and aimed at the body, has always existed. The body has always been marked, the apparatus has always existed, the series of instrument the same. What is different in this historical moment is that form, literally determined content. While interviewing, assessment tools, charting, and interventions are instruments that have always existed and have always been part of the apparatus of social work and the body, what is new in this historical moment is that conflation of these instruments. For example, for The Computer Social Worker, the interview, the assessment tool and charting were collapsed into one, indeed the interview was almost completely – except for her attempt to seek consent, which she almost absented – framed by the assessment tool. Her charting or clinical recording was the boxes of the assessment tool. Interviewing and charting, key skills of social work, were flattened to the form, literally.

de Certeau argues that this series of instruments organises the social space between the social worker and the services user, separating the instrument from the body, while becoming intelligible only when it rests on that particular body. I would further argue that these tools and instrument do not just organise the space in-between, but they also define the space in between the social worker and the service user. For example, any other concerns related or unrelated to the assessment tool – that might be addressed by other instruments (interventions or resource counselling or supportive counselling) – were constructed as problems. She turned the very complex matter of advanced care planning into a problem, which was then ‘turned into requests for information’ (Coleman and Harris, 2008), even though I had not made the request. Let me now shift to a closer examination of the body.

Regulated bodies

Social work instruments, though less material than the tools described by de Certeau, have two effects: one, rendering an individual intelligible through norms that mark or ‘tattoo’ their body; and two, ensuring those norms become a text through such realization and repetition. Historically the body in social work was understood through the principles of the Enlightenment – rationality, objectivity, science (Irving, 1999). The body and the patient’s experience, is ‘something’ to be discovered, as though spatial designs of interview and counselling rooms and instruments (for example, assessment tools and interview questions), do not define the norms of service users’ narratives and responses to questions. Kunzel (1993) describes that historically the interview was an attempt to create objectivity. Instead of meeting around mealtimes or while doing household activities, social workers would organise formal interviews where clients were given questionnaires to complete (Margolin, 1997). Certainly, The Computer Social Worker, in working directly with the computer and relying on it to provide the question, makes it difficult for a service user to request to have a dialogue, or indeed to argue with the computer. The Computer (Social Worker) asked questions only of physical and mental function. She did not step outside or beyond the instrument to measure or mark the quality of life in any other frame but that of the assessment tool in which life was a series of daily tasks to be completed successfully – or risking being ‘a problem’!

The attention of social workers to daily everyday life – the tasks – is not new. Margolin (1997) documents how seemingly capricious acts of culture – food choices, clothing choices and movement (such as facial expressions and posture) were used as signifiers for norms. They were the theme of social work documentation, and were synonymous with social workers’ definitions and demands to a norm. For example, social workers during this time were educated on the role of the mother. Well regarded journals in the first half of the 1900s, such as the Journal of Social Progress, alleged that the ‘mother of the family’, in providing a variety of food could generate and preserve ‘habits of order’ and ‘moral and social organization’ (Carroll, 1996: 150).

The attention to daily tasks (movement, dress and food) marks the objectification and the individualising of the subject and subsequently the disciplining of bodies. The body is entrusted with ensuring norms are maintained – this is the fiction that de Certeau is speaking of. The norm, embodied in The Computer Social Worker’s assessment and her induction of MoCA, instills a value and an expectation of ‘independence’ of the body, and is a reminder of suitable public conduct for those that are elderly.

Indeed, these types of assessment tools, used in these particular ways, are used to ‘tidy up the world into manageable categories’ (Coleman and Harris, 2008: 592). Goffman in his well-known 1961 book Asylums argues that the purpose of case recording or charting was to demonstrate why and how the person is ill, and why they must be detained. He concludes that records were not used as a way to demonstrate the acts of the client to manage their situation, but to prove why social work must be involved in a situation – to prove incapacity. The record was an inventory of occurrences that, according to Goffman had ‘symptomatic’ significance’ (156). This is no different than the current assessment tools, only now social workers titrate for problems. Having been a clinical social worker for many years, I know that The Computer Social Worker had a time frame in which to complete the initial assessment, and as my relative had been in the rehabilitation program for at least a month, an intake assessment was coming due. Doing an assessment on every service user is the standard in many institutional settings, where an assessment is required before a service is even offered, even though the assessment is not of any particular value to the service user (Devine, 2015).

de Certeau would suggest that assessment tools intend to present the body as it were waiting to be discovered and the tool a neutral object. The information gathered is all there is to gather. Certainly The Computer Social Worker was looking for evidence of ‘problems’. At rounds she will need to report of any ‘problems’, and anticipate any risks to a successful discharge. The assessment was only useful to her in the frame of an institution where she can report, ‘no problems’. The Computer Social Worker’s assessment was not useful to me, but maybe it was not intended to be.

Margolin (1997) views case recording as a technology that informed other promises. He suggests that case recording was a system of ‘continual monitoring’ whereby the purpose of recording information was to evaluate clients in relations to others, and to the norm. The Computer Social Worker’s tools (the MoCA and the one of the computer) were full of norms – a perfect scores; he should make his bed, he should cook, do the finances. It does not matter that he never did these tasks! To not do so as one ages would be a sign of incapacity, of not being able to manage ‘independently’. Social work, in this assessment tool frame, reiterates and relies on a certain bodily understanding to propagate identities based on physiological rationalizations – for example, disabled or aging bodies that move or act differently. The use of identity to test bodies and to place those of certain categories in institutions – asylums, residential schools, nursing homes – is based on a scientific discourse. I will now examine the role of the scientific in social work.

Objective measure, assessment tools and science

Wills (1995) argues that social work was rooted in the utilitarian philosophy of the nineteenth century, in which science, objectivity and rationality were at the core of a desirable moral order. As we can see from The Computer Social Worker, the question of science is not just ideological or theoretical, but rests in practice, for science is a way of managing service users and viewing technologies as a way to roll out social work. Haraway argues that

all knowledge is a condensed node in an agonistic power field … science is a contestable text and a power field; the content is the form. Period. The form in science is the artefactual-social rhetoric of crafting the world into effective objects. (1991: 185)

Returning to The Computer Social Worker, she applied scientific measures to mark the norms on a body. Those that are a ‘perfect’ 30/30 and those that fail other evidence-based tools, are categorised as a problem. The role of scientifically-based assessment tools is used by The Computer Social Worker to affirm certain norms and in turn, used to restrict the agency of those that are elderly, or seek to appoint someone else to consent to their treatment, care, and finances. Such assessment tools are used to take people’s (legal and perceptive) rights taken away; their right to decide what risks they take and how and where. For the lived body the social implications of age norms are immense.

Based on physiology or on physiological rationalizations, social workers assist in constructing conditions of possibility for the production and reception of certain texts, narratives and identities, as well as their articulation in systems of norms – of what they will define as ‘good’ or ‘healthy aging’. But as Haraway (1991) counters, knowledge is not just a form of morality and a set of norms, but a methodology – a methodology used by the The Computer Social Workers to define problems, the moral, the normal of an aging individual.

Science and the objective measure, such as those that make evidence-based claims, clearly shape the practice of social work. Indeed, Haraway (1991) argues that the intentions of science have been misunderstood. She expresses her belief that science is ‘about a search for translation, convertibility, mobility of meanings, and universality’ (187). She calls these ‘reductive tasks’ whereby one particular language is the measure of transformations. Haraway stresses that reductionism is powerful in its performance – assailing objectivity and hierarchy in defining what counts as knowledge, experience, and truth. Science, or what is referenced as ‘evidence-based’ practice, continues to be a part of the process ‘that turns everything into a resource for appropriation’ (Haraway, 1991: 197). And as Haraway continues, a resource, ‘in which an object of knowledge is finally itself only matter for the seminal power … of the knower’ (197). We can see this in the Computer Social Workers where she relied on a tool to produce herself as a social worker, and me, as a caregiver.

Haraway’s comments (1991) on how science turns the world into an ‘effective object’ are crucial to understanding the apparatus/the in between (de Certeau, 1984) that marks social work on the body (inscribing moral regulation, demonstrating the rule, and reproducing the norm). As Haraway notes, moral and political discourses are usually concealed in scientific writings. Haraway attempts to open the conversation about science in order to suggest that methodologically, discussions about objectivity matter, in particular the invocation that our instruments, our tools are objective.

I suspect that science will continue to be called upon, perhaps even desired, in the practice of social work. Science represents the struggle to seek coherency among complexity – a struggle that Haraway (1991) warns us against because of its resulting production of people as objects. The role of the scientific in shaping social work practices is further problematic because the knowledge relied upon to mark the body is manufactured (or fictitious, as de Certeau argues), and inherent in the methodology of science is an investigative approach to social work.

Conclusion

Returning to where I began this article, perhaps the social worker was aware of how I was caught in her agenda, and it was intentional that I be the compliant, docile subject of her practice. I am familiar with the pressures on social workers, and can easily place her actions in a socio-political context of volume and numbers, ‘cases’ and time. At the same moment, none of this can minimise the political reverberations of an individual social worker. The complicity of social workers to fail to critically theorize their role(s) within the various networks and institutions of power, all the while suggesting they are ‘helping’ service users and caregivers, stands in contrast to the ‘thinking’ aspect of doing social work.

We must ask, what kind of body is being produced by current instruments? What norms? What is the text, the fiction produced? For my relative, his body was being marked on the basis of functional norms, which were based on his age, even though this may not be what made up his everyday corporeal life. For social workers in rehabilitation programs or on acute care medical floors, the norm is a physical one, a functional one – an assessment for ‘independence’. Historically, the norms of the physical body have been the foundation of knowledge during many periods in social work history – for example, the removal of Indigenous children to white families, or the placement of children with disabilities into asylums. Perhaps in time, the assessment of ‘the elderly’ for the purpose assigning ‘problems’, for removing rights, or determining institutionalisation to nursing homes, will be seen as equally problematic.

At the same moment, as social workers, we will do well to understand that regulatory practices, such as assessment tools, are socially and politically constitutive. In other words, the application of technologies and tools is not innocent; their usage produces a particular patient, caregiver and social worker. Of course these relations are conditioned and thus possible to interrupt and alter. As the Italian philosopher, Georgio Agamben argues, ‘we must … carry the political into the everyday’ (2016: xxi). The constitutive connection that unites a social worker and a service user is full of possibility for a deeper awareness about people’s experiences, and hopefully, an indeterminate future for social work.