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A Case for Case Studies in Social Work Research

Jane F. Gilgun, PhD, LICSW, is associate professor, School of Social Work, University of Minnesota, 224 Church Street, SE, Minneapolis, MN 55455.

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Jane F. Gilgun, A Case for Case Studies in Social Work Research, Social Work , Volume 39, Issue 4, July 1994, Pages 371–380, https://doi.org/10.1093/sw/39.4.371

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Case study research is a good fit with many forms of social work practice. Although disparaged as uncontrolled and uninterpretable, the case study has great potential for building social work knowledge for assessment, intervention, and outcome. This article defines case study research, presents guidelines for evaluating case studies, and shows the relevance of case studies to social work research. Guidelines for evaluation also are guidelines for developing and interpreting case studies that will meet the rigorous demands of scientific research and be useful to social work practitioners.

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Social Work Practice with Carers

Case Study 2: Josef

Download the whole case study as a PDF file

Josef is 16 and lives with his mother, Dorota, who was diagnosed with Bipolar disorder seven years ago. Josef was born in England. His parents are Polish and his father sees him infrequently.

This case study looks at the impact of caring for someone with a mental health problem and of being a young carer , in particular the impact on education and future employment .

When you have looked at the materials for the case study and considered these topics, you can use the critical reflection tool and the action planning tool to consider your own practice.

• One-page profile

Support plan

Transcript (.pdf, 48KB)

Name : Josef Mazur

Gender : Male

Ethnicity : White European

Download resource as a PDF file

First language : English/ Polish

Religion : Roman Catholic

Josef lives in a small town with his mother Dorota who is 39. Dorota was diagnosed with Bi-polar disorder seven years ago after she was admitted to hospital. She is currently unable to work. Josef’s father, Stefan, lives in the same town and he sees him every few weeks. Josef was born in England. His parents are Polish and he speaks Polish at home.

Josef is doing a foundation art course at college. Dorota is quite isolated because she often finds it difficult to leave the house. Dorota takes medication and had regular visits from the Community Psychiatric Nurse when she was diagnosed and support from the Community Mental Health team to sort out her finances. Josef does the shopping and collects prescriptions. He also helps with letters and forms because Dorota doesn’t understand all the English. Dorota gets worried when Josef is out. When Dorota is feeling depressed, Josef stays at home with her. When Dorota is heading for a high, she tries to take Josef to do ‘exciting stuff’ as she calls it. She also spends a lot of money and is very restless.

Josef worries about his mother’s moods. He is worried about her not being happy and concerned at the money she spends when she is in a high mood state. Josef struggles to manage his day around his mother’s demands and to sleep when she is high. Josef has not told anyone about the support he gives to his mother. He is embarrassed by some of the things she does and is teased by his friends, and he does not think of himself as a carer. Josef has recently had trouble keeping up with course work and attendance. He has been invited to a meeting with his tutor to formally review attendance and is worried he will get kicked out. Josef has some friends but he doesn’t have anyone he can confide in. His father doesn’t speak to his mother.

Josef sees some information on line about having a parent with a mental health problem. He sends a contact form to ask for information. Someone rings him and he agrees to come into the young carers’ team and talk to the social worker. You have completed the assessment form with Josef in his words and then done a support plan with him.

Back to Summary

Josef Mazur

What others like and admire about me

Good at football

Finished Arkham Asylum on expert level

What is important to me

Mum being well and happy

Seeing my dad

Being an artist

Seeing my friends

How best to support me

Tell me how to help mum better

Don’t talk down to me

Talk to me 1 to 1

Let me know who to contact if I am worried about something

Work out how I can have some time on my own so I can do my college work and see my friends

Don’t tell mum and my friends

Date chronology completed : 7 March 2016

Date chronology shared with person: 7 March 2016

Young Carers Assessment

Do you look after or care for someone at home?

The questions in this paper are designed to help you think about your caring role and what support you might need to make your life a little easier or help you make time for more fun stuff.

Please feel free to make notes, draw pictures or use the form however is best for you.

What will happen to this booklet?

This is your booklet and it is your way to tell an adult who you trust about your caring at home. This will help you and the adult find ways to make your life and your caring role easier.

The adult who works with you on your booklet might be able to help you with everything you need. If they can’t, they might know other people who can.

Our Agreement

• I will share this booklet with people if I think they can help you or your family
• I will let you know who I share this with, unless I am worried about your safety, about crime or cannot contact you
• Only I or someone from my team will share this booklet
• I will make sure this booklet is stored securely
• Some details from this booklet might be used for monitoring purposes, which is how we check that we are working with everyone we should be

Signed: ___________________________________

Young person:

• I know that this booklet might get shared with other people who can help me and my family so that I don’t have to explain it all over again
• I understand what my worker will do with this booklet and the information in it (written above).

Signed: ____________________________________

Name :             Josef Mazur Address :       1 Green Avenue, Churchville, ZZ1 Z11 Telephone:        012345 123456 Email:            [email protected] Gender :         Male Date of birth :        11.11.1999        Age: 16 School :            Green College, Churchville Ethnicity :        White European First language :        English/ Polish Religion :         Baptised Roman Catholic GP :            Dr Amp, Hill Surgery

The best way to get in touch with me is:

Do you need any support with communication?

*Josef is bilingual – English and Polish. He speaks English at school and with his friends, and Polish at home. Josef was happy to have this assessment in English, however, another time he may want to have a Polish interpreter. It will be important to ensure that Josef is able to use the words he feels best express himself.

About the person/ people I care for

I look after my mum who has bipolar disorder. Mum doesn’t work and doesn’t really leave the house unless she is heading for a high. When Mum is sad she just stays at home. When she is getting hyper then she wants to do exciting stuff and she spends lots of money and she doesn’t sleep.

Do you wish you knew more about their illness?

Do you live with the person you care for?

What I do as a carer It depends on if my mum has a bad day or not. When she is depressed she likes me to stay home with her and when she is getting hyper then she wants me to go out with her. If she has new meds then I like to be around. Mum doesn’t understand English very well (she is from Poland) so I do all the letters. I help out at home and help her with getting her medication.

Tell us what an average week is like for you, what kind of things do you usually do?

Monday to Friday

Get up, get breakfast, make sure mum has her pills, tell her to get up and remind her if she’s got something to do.

If mum hasn’t been to bed then encourage her to sleep a bit and set an alarm

College – keep phone on in case mum needs to call – she usually does to ask me to get something or check when I’m coming home

Go home – go to shops on the way

Remind mum about tablets, make tea and pudding for both of us as well as cleaning the house and fitting tea in-between, ironing, hoovering, hanging out and bringing in washing

Do college work when mum goes to bed if not too tired

More chores

Do proper shop

Get prescription

See my friends, do college work

Sunday – do paper round

Physical things I do….

(for example cooking, cleaning, medication, shopping, dressing, lifting, carrying, caring in the night, making doctors appointments, bathing, paying bills, caring for brothers & sisters)

I do all the housework and shopping and cooking and get medication

Things I find difficult

Emotional support I provide…. (please tell us about the things you do to support the person you care for with their feelings; this might include, reassuring them, stopping them from getting angry, looking after them if they have been drinking alcohol or taking drugs, keeping an eye on them, helping them to relax)

If mum is stressed I stay with her

If mum is depressed I have to keep things calm and try to lighten the mood

She likes me to be around

When mum is heading for a high wants to go to theme parks or book holidays and we can’t afford it

I worry that mum might end up in hospital again

Mum gets cross if I go out

Other support

Please tell us about any other support the person you care for already has in place like a doctor or nurse, or other family or friends.

The GP sees mum sometimes. She has a nurse who she can call if things get bad.

Mum’s medication comes from Morrison’s pharmacy.

Dad lives nearby but he doesn’t talk to mum.

Mum doesn’t really have any friends.

Do you ever have to stop the person you care for from trying to harm themselves or others?

Some things I need help with

Sorting out bills and having more time for myself

I would like mum to have more support and to have some friends and things to do

On a normal week, what are the best bits? What do you enjoy the most? (eg, seeing friends, playing sports, your favourite lessons at school)

Seeing friends

When mum is up and smiling

Playing football

On a normal week, what are the worst bits? What do you enjoy the least? (eg cleaning up, particular lessons at school, things you find boring or upsetting)

Nagging mum to get up

Reading letters

Missing class

Mum shouting

Friends laugh because I have to go home but they don’t have to do anything

What things do you like to do in your spare time?

Do you feel you have enough time to spend with your friends or family doing things you enjoy, most weeks?

Do you have enough time for yourself to do the things you enjoy, most weeks?  (for example, spending time with friends, hobbies, sports)

Are there things that you would like to do, but can’t because of your role as a carer?

Can you say what some of these things are?

See friends after college

Go out at the weekend

Time to myself at home

It can feel a bit lonely

I’d like my mum to be like a normal mum

School/ College Do you think being your caring role makes school/college more difficult for you in any way?

If you ticked YES, please tell us what things are made difficult and what things might help you.

Things I find difficult at school/ college

Sometimes I get stressed about college and end up doing college work really late at night – I get a bit angry when I’m stressed

I don’t get all my college work done and I miss days

I am tired a lot of the time

Things I need help with…

I am really worried they will kick me out because I am behind and I miss class. I have to meet my tutor about it.

Do your teachers know about your caring role?

Are you happy for your teachers and other staff at school/college to know about your caring role?

Do you think that being a carer will make it more difficult for you to find or keep a job?

Why do you think being a carer is/ will make finding a job more difficult?

I haven’t thought about it. I don’t know if I’ll be able to finish my course and do art and then I won’t be able to be an artist.

Who will look after mum?

What would make it easier for you to find a job after school/college?

Finishing my course

Mum being ok

How I feel about life…

Do you feel confident both in school and outside of school?

Somewhere in the middle

In your life in general, how happy do you feel?

Quite unhappy

In your life in general, how safe do you feel?

How healthy do you feel at the moment?

Quite healthy

Being heard

Do you think people listen to what you are saying and how you are feeling?

If you said no, can you tell us who you feel isn’t listening or understanding you sometimes   (eg, you parents, your teachers, your friends, professionals)

I haven’t told anyone

I can’t talk to mum

My friends laugh at me because I don’t go out

Do you think you are included in important decisions about you and your life? (eg, where you live, where you go to school etc)

Do you think that you’re free to make your own choices about what you do and who you spend your time with?

Not often enough

Is there anybody who knows about the caring you’re doing at the moment?

If so, who?

I told dad but he can’t do anything

Would you like someone to talk to?

Supporting me Some things that would make my life easier, help me with my caring or make me feel better

I don’t know

Fix mum’s brain

People to help me if I’m worried and they can do something about it

Not getting kicked out of college

Free time – time on my own to calm down and do work or have time to myself

Time to go out with my friends

Get some friends for mum

I don’t want my mum to get into trouble

Who can I turn to for advice or support?

I would like to be able to talk to someone without mum or friends knowing

Would you like a break from your caring role?

How easy is it to see a Doctor if you need to?

To be used by social care assessors to consider and record measures which can be taken to assist the carer with their caring role to reduce the significant impact of any needs. This should include networks of support, community services and the persons own strengths. To be eligible the carer must have significant difficulty achieving 1 or more outcomes without support; it is the assessors’ professional judgement that unless this need is met there will be a significant impact on the carer’s wellbeing. Social care funding will only be made available to meet eligible outcomes that cannot be met in any other way, i.e. social care funding is only available to meet unmet eligible needs.

Date assessment completed :            7 March 2016

Social care assessor conclusion

Josef provides daily support to his mum, Dorota, who was diagnosed with bipolar disorder seven years ago. Josef helps Dorota with managing correspondence, medication and all household tasks including shopping. When Dorota has a low mood, Josef provides support and encouragement to get up. When Dorota has a high mood, Josef helps to calm her and prevent her spending lots of money. Josef reports that Dorota has some input from community health services but there is no other support. Josef’s dad is not involved though Josef sees him sometimes, and there are no friends who can support Dorota.

Josef is a great support to his mum and is a loving son. He wants to make sure his mum is ok. However, caring for his mum is impacting: on Josef’s health because he is tired and stressed; on his emotional wellbeing as he can get angry and anxious; on his relationship with his mother and his friends; and on his education. Josef is at risk of leaving college. Josef wants to be able to support his mum better. He also needs time for himself, to develop and to relax, and to plan his future.

Eligibility decision :                Eligible for support

What’s happening next :            Create support plan

Completed by Name : Role : Organisation :

Name: Josef Mazur

Address 1 Green Avenue, Churchville, ZZ1 Z11

Telephone 012345 123456

Email [email protected]

Gender: Male

Date of birth: 11.11.1999 Age: 16

School Green College, Churchville

Ethnicity White European

First language English/ Polish

Religion Baptised Roman Catholic

GP Dr Amp, Hill Surgery

My relationship to this person son

Name Dorota Mazur

Gender Female

Date of birth 12.6.79 Age 36

First language Polish

Religion Roman Catholic

Support plan completed by

Organisation

Date of support plan: 7 March 2016

This plan will be reviewed on: 7 September 2016

Signing this form

Please ensure you read the statement below in bold, then sign and date the form.

I understand that completing this form will lead to a computer record being made which will be treated confidentially. The council will hold this information for the purpose of providing information, advice and support to meet my needs. To be able to do this the information may be shared with relevant NHS Agencies and providers of carers’ services. This will also help reduce the number of times I am asked for the same information.

If I have given details about someone else, I will make sure that they know about this.

I understand that the information I provide on this form will only be shared as allowed by the Data Protection Act.

Josef has given consent to share this support plan with the CPN but does not want it to be shared with his mum.

Mental health

The social work role with carers in adult mental health services has been described as: intervening and showing professional leadership and skill in situations characterised by high levels of social, family and interpersonal complexity, risk and ambiguity (Allen 2014). Social work with carers of people with mental health needs, is dependent on good practice with the Mental Capacity Act where practitioner knowledge and understanding has been found to be variable (Iliffe et al 2015).

• Carers Trust (2015) Mental Health Act 1983 – Revised Code of Practice Briefing
• Carers Trust (2013) The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in England
• Mind, Talking about mental health
• Tool 1: Triangle of care: self-assessment for mental health professionals – Carers Trust (2013) The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in England Second Edition (page 23 Self-assessment tool for organisations)

Mental capacity, confidentiality and consent

Social work with carers of people with mental health needs, is dependent on good practice with the Mental Capacity Act where practitioner knowledge and understanding has been found to be variable (Iliffe et al 2015). Research highlights important issues about involvement, consent and confidentiality in working with carers (RiPfA 2016, SCIE 2015, Mental Welfare Commission for Scotland 2013).

• Beddow, A., Cooper, M., Morriss, L., (2015) A CPD curriculum guide for social workers on the application of the Mental Capacity Act 2005 . Department of Health
• Bogg, D. and Chamberlain, S. (2015) Mental Capacity Act 2005 in Practice Learning Materials for Adult Social Workers . Department of Health
• Department of Health (2015) Best Interest Assessor Capabilities , The College of Social Work
• RiPfA Good Decision Making Practitioner Handbook
• SCIE Mental Capacity Act resource  
• Tool 2: Making good decisions, capacity tool (page 70-71 in good decision making handbook)

Young carers

A young carer is defined as a person under 18 who provides or intends to provide care for another person. The concept of care includes practical or emotional support. It is the case that this definition excludes children providing care as part of contracted work or as voluntary work. However, the local authority can ignore this and carry out a young carer’s need assessment if they think it would be appropriate. Young carers, young adult carers and their families now have stronger rights to be identified, offered information, receive an assessment and be supported using a whole-family approach (Carers Trust 2015).

• SCIE (2015) Young carer transition in practice under the Care Act 2014
• SCIE (2015) Care Act: Transition from children’s to adult services – early and comprehensive identification
• Carers Trust (2015) Rights for young carers and young adult carers in the Children and Families Act
• Carers Trust (2015) Know your Rights: Support for Young Carers and Young Adult Carers in England
• The Children’s Society (2015) Hidden from view: The experiences of young carers in England  
• DfE (2011) Improving support for young carers – family focused approaches
• ADASS and ADCS (2015) No wrong doors: working together to support young carers and their families
• Carers Trust, Supporting Young Carers and their Families: Examples of Practice
• Refugee toolkit webpage: Children and informal interpreting
• SCIE (2010) Supporting carers: the cared for person
• SCIE (2015) Care Act Transition from children’s to adults’ services – Video diaries
• Tool 3: Young carers’ rights – The Children’s Society (2014) The Know Your Rights pack for young carers in England!
• Tool 4: Vision and principles for adults’ and children’s services to work together

Young carers of parents with mental health problems

The Care Act places a duty on local authorities to assess young carers before they turn 18, so that they have the information they need to plan for their future. This is referred to as a transition assessment. Guidance, advocating a whole family approach, is available to social workers (LGA 2015, SCIE 2015, ADASS/ADCS 2011).

• SCIE (2012) At a glance 55: Think child, think parent, think family: Putting it into practice
• SCIE (2008) Research briefing 24: Experiences of children and young people caring for a parent with a mental health problem
• SCIE (2008) SCIE Research briefing 29: Black and minority ethnic parents with mental health problems and their children
• Carers Trust (2015) The Triangle of Care for Young Carers and Young Adult Carers: A Guide for Mental Health Professionals
• ADASS and ADCS (2011) Working together to improve outcomes for young carers in families affected by enduring parental mental illness or substance misuse
• Ofsted (2013) What about the children? Joint working between adult and children’s services when parents or carers have mental ill health and/or drug and alcohol problems
• Mental health foundation (2010) MyCare The challenges facing young carers of parents with a severe mental illness
• Children’s Commissioner (2012) Silent voices: supporting children and young people affected by parental alcohol misuse
• SCIE, Parental mental health and child welfare – a young person’s story

Tool 5: Family model for assessment

• Tool 6: Engaging young carers of parents with mental health problems or substance misuse

Young carers and education/ employment

Transition moments are highlighted in the research across the life course (Blythe 2010, Grant et al 2010). Complex transitions required smooth transfers, adequate support and dedicated professionals (Petch 2010). Understanding transition theory remains essential in social work practice (Crawford and Walker 2010). Partnership building expertise used by practitioners was seen as particular pertinent to transition for a young carer (Heyman 2013).

• TLAP (2013) Making it real for young carers
• Learning and Work Institute (2018) Barriers to employment for young adult carers
• Carers Trust (2014) Young Adult Carers at College and University
• Carers Trust (2013) Young Adult Carers at School: Experiences and Perceptions of Caring and Education
• Carers Trust (2014) Young Adult Carers and Employment
• Family Action (2012) BE BOTHERED! Making Education Count for Young Carers

Download The Triangle of Care as a PDF file

The Triangle of Care Carers Included: A Guide to Best Practice in Mental Health Care in England

The Triangle of Care is a therapeutic alliance between service user, staff member and carer that promotes safety, supports recovery and sustains wellbeing…

Download the Capacity Tool as a PDF file

Capacity Tool Good decision-making Practitioners’ Handbook

The Capacity tool on page 71 has been developed to take into account the lessons from research and the case CC v KK. In particular:

• that capacity assessors often do not clearly present the available options (especially those they find undesirable) to the person being assessed
• that capacity assessors often do not explore and enable a person’s own understanding and perception of the risks and advantages of different options
• that capacity assessors often do not reflect upon the extent to which their ‘protection imperative’ has influenced an assessment, which may lead them to conclude that a person’s tolerance of risks is evidence of incapacity.

The tool allows you to follow steps to ensure you support people as far as possible to make their own decisions and that you record what you have done.

Download Know your rights as a PDF file

Tool 3: Know Your Rights Young Carers in Focus

This pack aims to make you aware of your rights – your human rights, your legal rights, and your rights to access things like benefits, support and advice.

Need to know where to find things out in a hurry? Our pack has lots of links to useful and interesting resources that can help you – and help raise awareness  about young carers’ issues!

Know Your Rights has been produced by Young Carers in Focus (YCiF), and funded by the Big Lottery Fund.

Tool 4: Vision and principles for adults’ and children’s services to work together to support young carers

Download the tool   as a PDF file

You can use this tool to consider how well adults’ and children’s services work together, and how to improve this.

Click on the diagram to open full size in a new window

This is based on ADASS and ADCS (2015) No wrong doors : working together to support young carers and their families

Download the tool as a PDF file

You can use this tool to help you consider the whole family in an assessment or review.

What are the risk, stressors and vulnerability factors?

How is the child/ young person’s wellbeing affected?

How is the adult’s wellbeing affected?

What are the protective factors and available resources?

This tool is based on SCIE (2009) Think child, think parent, think family: a guide to parental mental health and child welfare

Tool 6: Engaging young carers

Young carers have told us these ten things are important. So we will do them.

• Introduce yourself. Tell us who you are and what your job is.
• Give us as much information as you can.
• Tell us what is wrong with our parents.
• Tell us what is going to happen next.
• Talk to us and listen to us. Remember it is not hard to speak to us we are not aliens.
• Ask us what we know and what we think. We live with our parents; we know how they have been behaving.
• Tell us it is not our fault. We can feel guilty if our mum or dad is ill. We need to know we are not to blame.
• Please don’t ignore us. Remember we are part of the family and we live there too.
• Keep on talking to us and keeping us informed. We need to know what is happening.
• Tell us if there is anyone we can talk to. Maybe it could be you.

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Social Work in the Time of COVID-19: A Case Study from the Global South

Lee john henley.

1 Children’s Future International, Battambang, Ek Phnom, Cambodia

Zoey Allen Henley

Kathryn hay.

2 Kunenga ki Pūrehuroa, Massey University, Palmerston North, Aotearoa, New Zealand

Sonthea Pheun

This article explores the experiences of social workers at a non-governmental organisation (NGO) involved in disaster responses to COVID-19 in a rural and resource-challenged region of Cambodia. The views of Khmer and international social workers in the NGO were gathered through an internal auditing process utilising survey and structured conversation methods. Key themes related to the importance of prioritising the safety of staff and clients, effective communication methods, responsiveness of case management systems, public health responses and adapting to emerging needs. To ensure responsiveness to future disaster events consideration should be given in strengthening partnerships, ensuring case management systems are effective for current use but able to be adapted in new circumstances, and that preparation incorporates a focus on diversified funding streams and open communication channels between staff and management. These elements will enable social workers to continue their practice, reassured and with the flexibility required in the post-disaster context.

Teaser text

Acknowledging Gabriel García Márquez’s well-known novel Love in the Time of Cholera, this article explores the challenges of delivering social work services at the time of COVID-19, in the Global South. Staff experiences while working for a small rurally based Non-Governmental Organisation (NGO) in Ek Phnom, Cambodia are presented. A staff survey and structured conversations were used while completing an internal auditing process. This audit was undertaken to assess responses to the challenges of the virus and how to increase safety of staff and people using services. Key themes arising were:

• effective communication methods;
• responsiveness of case management systems;
• public health responses; and
• adapting to emerging needs.

These gathered data resulted in a range of recommendations:

• strengthening partnerships can improve responsiveness to disasters case management systems need to be effective for current use but able to be adaptable to new circumstances;
• disaster preparation should incorporate a focus on diversified funding streams; and
• open communication channels between staff and management are required.

The outcomes of this work are useful for NGO directors, managers and social workers, consideration of recommendations will enable social workers to continue delivering services within a post-disaster context, in the Global South.

Introduction

Delivering effective social work services in communities during a public health disaster is challenging. The COVID-19 pandemic in 2020 presented such a challenge to Children’s Future International (CFI), a Non-Governmental Organisation (NGO), in Cambodia. CFI is situated in a rural region outside the city of Battambang, Cambodia. As a social work organisation, its primary focus is on child protection and supporting family cohesion and well-being. With the rapid onset of COVID-19 in early 2020, the organisation was faced with a myriad challenges, as well as opportunities for new learning regarding service delivery, this article focuses on an early period of the disaster between March and June 2020. CFI has a pivotal role in its local community and its positioning as a social work organisation became even more important during this disaster. Strategies included adapting current practice to meet new COVID-19 regulations, working with local authorities, and training them to assess needs and deliver emergency supplies to at-risk families. While Cambodia’s level of diagnosed virus cases was low, the societal impact was extremely high as food insecurity, which was a regular feature of life before COVID-19, became exacerbated.

There are few qualified social workers in Cambodia ( Fronek et al. , 2019 ). While all of CFI’s social workers hold degrees in a range of disciplines, including community development, none hold social work qualifications. CFI is led by two British qualified social workers, both holding Master’s degrees from New Zealand and a Khmer Technical Director. The leadership and social work staff at CFI are committed to applying social work theoretical approaches to practice. CFI social workers receive annual training from a licensed trainer in an international intervention modality, Signs of Safety (2020) , a strength-based approach to practice, and in-house training on an international risk assessment tool, the Child Status Index. Additionally, all social workers receive ongoing professional development to ensure social work approaches are employed appropriately within the context of the local environment. As in most community-based NGOs in Cambodia, social workers’ tasks are varied and include child protection, assessment, intervention, family strengthening, prevention of child/family separation and addressing violence against children. In Cambodia, there is a reliance on NGOs for the provision of practical items such as food, shelter and clothing. CFI is committed to reducing service dependency and so actively works to support family and community strengths, independence and self-sufficiency ( Henley et al. , 2019 ).

In the Global South, there are significant risks that funding and practice foci be shifted to a presenting public health disaster which then overshadows pressing child protection and other safety concerns ( The Alliance for Child Protection in Humanitarian Action, 2020 ). This may result in pressure on social service staff to focus solely on the presenting health disaster rather than core business. This article explores Khmer and international social worker reflections on their experiences of continuing to deliver social work services after the onset of COVID-19. The role of social work, key factors that contributed to service delivery success, and implications for future practice are considered.

COVID-19 is an infectious disease caused by a newly discovered coronavirus ( World Health Organisation, 2020 ). In March 2020, COVID-19 was identified in Cambodia and many local business and service organisations began to reduce or close their services ( Henley et al. , 2020 ). The infection rates of COVID-19 in Cambodia have been low. To date (30 March 2021), only 2,273 people have been diagnosed as being infected, with 1,152 having recovered and 11 recorded deaths, 668,542 people have been tested ( Worldometer, 2021 ). However, the impact of COVID-19 on the local community extends well beyond reported infections.

At the time the virus was detected in Cambodia, CFI employed thirty-eight Khmer (local nationals) and two international staff (from New Zealand). All staff were living and working locally, attending the CFI office daily. Founded in 2009, CFI delivers services to a rural community with high levels of poverty. The organisation aims to prevent human rights abuses and to protect and uphold the dignity of some of Cambodia’s most at-risk children. Initially, the vision of the NGO was to provide supplementary education for at-risk children and return children not in education to public schooling. An orphanage was also established, caring, on average, for forty children. Over time, the organisation recognised that with the right support and partnerships, families could be strengthened to look after their children in a way that reduced risks and enhanced well-being. By refocusing efforts and using strength-based social work approaches, all children were safely returned to community living (CFI, 2020).

Since 2016, CFI’s social work model has focused on supporting children to safely live within families in the community. As part of two national child protection networks, Family Care First/REaCT and 3PC, the NGO’s primary aim is to support children and youth to break the poverty cycle through child protection, community development, educational programmes and community support. Programmes are offered within a community experiencing abject poverty, malnutrition, unsafe migration, exploitive labour practices, physical and sexual abuse and secondary post-traumatic stress disorder (generational) from the Khmer Rouge genocide in the 1970s.

CFI has an established approach to provide services within clearly designed service pathways. It recognises service dependency as a risk and therefore exits families from services when safe to do so ( Family Care First/REaCT, 2019 ). CFI’s operations are located within the community, all direct practice is delivered by Khmer nationals. The post-genocide environment in Cambodia presents several challenges for children and their families including poverty, unemployment and a lack of available community services. Families survive on minimal resources and food insecurity is common. Understanding of child protection in Cambodia is nascent, with residential care institutions (RCIs), known to the Global North as orphanages, presenting risks of child and family separation ( Fronek et al. , 2019 ). Recent local research, undertaken by CFI as part of a community Harm Prevention campaign, funded by FCF/REaCT (submitted for publishing), suggested local communities view RCIs as positive places for children to grow up. CFI seeks to provide alternative opportunities for at-risk children and families.

The onset of COVID-19 significantly added to the challenges faced by many local families. People suddenly found themselves unemployed and thus further in debt. This exacerbated existing problems as before the advent of COVID-19 many families required loans of both food and finances to survive. Additionally, significant numbers of Khmer (approximated at 15,000 people) migrated back across the Thai border after COVID-19 became apparent in Thailand ( Long, 2020 ). Consequently, not only did many families lose incomes from remittances but they also had more people to feed and accommodate.

From March 2020, in partnership with local authority staff and following the Royal Cambodian Government’s advice, CFI began to deliver community-based training focused on effective handwashing, symptom recognition and physical distancing for community members, while also disseminating personal protective equipment and training local authorities in how to prioritise families of the highest need. CFI adjusted existing services to meet the requirements set out in Government guidelines, such as how to deliver positive parenting, gender and sexuality workshops and alcohol reduction sessions, safely. These programmes need to be reconfigured to ensure families were supported in a way that minimised public health concerns. The following section considers social work practice and disaster preparedness within the local context.

Local context of social work

A combination of many factors, including genocide, conflict and colonialisation, have resulted in Cambodia’s unique challenges regarding infrastructure, social structures and poverty ( Fronek et al. , 2019 ). Cambodia became part of the international commitment to protect the rights of children by ratifying the United Nations Convention on the Rights of the Child in 1992 ( Joamets and Muy, 2019 ). However, there remains a need to eradicate poverty and hunger while endeavouring to achieve a sustainable future that ensures adequate nutrition, food security and physical development ( Karpati et al. , 2020 ).

However, many social services continue to be delivered by a multitude of NGOs ( Fronek et al. , 2019 ), as these needs are not fully met by the Royal Government. NGOs face many competing challenges such as unequal distribution of services and a social care workforce which, while developing, remains inexperienced and underqualified ( Fronek et al. , 2019 ). With approximately 3,000 NGOs currently providing social services, Cambodia is second only to Rwanda in the number of NGOs per capita, with approximately one active NGO for every 10,000 Cambodians ( CDC, 2020 ).

In Cambodia, NGOs have for many years performed important functions, delivering community-based programmes in areas confronted by issues such as poor infrastructure and embryonic health and social systems ( UNDP, 2013 ). Increasingly, in the Global South, consideration is being given to whether NGOs are simply delivering services or in fact creating further dependencies ( Sahoo, 2013 ). This is complicated further when international donors fund services on a quantitative rather than qualitative basis, seeking discreet measurable outcomes within short periods of time. Increasingly, services are being funded on international ‘best practice’ approaches, rather than considering local context, values or need ( Stanford, 2015 ). Like many NGOs, much of CFI’s work is driven not by creative engagement with the community but by overseas agendas connected with funding ( Khieng and Dahles, 2015 ). These impact on its ability to engage and fulfil a range of civic obligations ( Malena et al. , 2009 ). In locally conducted research (submitted for publishing), CFI found the highest perceived risks for the local community did not always align with those of overseas funding agencies.

Social work training is also still in a developmental phase in Cambodia with the first-degree course having commenced in 2008. There are few qualified social workers working in communes or villages, meaning practice is varied ( Fronek et al. , 2019 ). Work is underway to strengthen and improve systems, but there remains a need to comprehensively understand and address families’ needs ( Fronek et al. , 2019 ). The combination of these factors has led to a fractured picture of service delivery ( Fronek et al. , 2019 ). Of note is the recently released ‘Guidelines on basic competencies for the social workforce in Cambodia’ ( MOSVY, 2019 ). These extensive guidelines contain over forty competencies for social workers, presenting a challenge as to how anyone could demonstrate proficiency in such a range of skills.

In terms of practice guidance in Cambodia, the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MOSVY) is responsible for child welfare and represented locally by the Department of Social Affairs, Veterans and Youth Rehabilitation. These agencies offer direction for how services should be provided. Following the outbreak of COVID-19, guidance for practice was disseminated via ‘Guidelines on Case Management During Infectious Disease Outbreaks (COVID-19)’. These MOSVY guidelines instructed NGOs on how to ensure children of the highest need were identified and directed how community-based interventions should be delivered. While this document was important for CFI’s work, guidance was also sought from The Alliance for Child Protection in Humanitarian Action (2020) . This group issued a comprehensive list of child protection risks from COVID-19, including physical and emotional maltreatment, gender-based violence, unaccompanied and separated children and child labour. The following section considers social work in disasters as part of the wider context of CFI’s work during the pandemic.

CFI, social work and disasters

Social work has long been a feature of disaster or crisis response ( Alston et al. , 2019 ; Hay, 2019 ). Social workers are taught to consider situations comprehensively, taking into consideration psychosocial, environmental and social factors ( Taubman and Weisz, 2019 ). In the post-disaster context, social workers may engage with current and new service users, helping them to access resources. They may also undertake complex coordination with relevant agencies and work directly with communities ( van Heugten, 2014 ; Alston et al. , 2019 ). Social workers may also engage in community research, advocate for disadvantaged groups and challenge social policies. Establishing connections between NGOs and government resources are also important while considering the psychosocial impact of those affected ( Taubman and Weisz, 2019 ).

CFI identifies itself as part of the international social work context. To this end, social workers abide by the global definition of social work, placing principles of social justice, human rights and collective responsibility at the centre of the organisation ( IFSW, 2018 ). CFI’s experience during the COVID-19 pandemic was related to many aspects of disaster management. For instance, in terms of post-disaster response and recovery, there was a clear expectation within the local community and the local authority that CFI would take a lead role in coordinating activities and supporting communities. Although CFI social workers were willing to be engaged in this manner, many had no prior experience or training to help them navigate these new responsibilities. This was a challenging time both personally and professionally for all staff. The following sections consider the approaches presented in this article.

Due to the rapidly changing work environment where CFI staff were required to initiate new programmes and work remotely, the leaders of CFI, in consultation with senior staff, decided to undertake an auditing exercise. The purpose of this was to explore some of the immediate consequences of the COVID-19 disaster, on the social workers and other staff. An internal survey was written by the Managing Director, and peer reviewed by the Executive and Technical Directors. Ethical consideration was given to informed consent and voluntary participation. For instance, staff were provided with written information in Khmer about the purpose of the survey and informed that they did not have to participate. To enable confidentiality of responses, an anonymous google form was used for data collection. The survey, which included a majority of qualitative questions, was completed by thirty-three staff, including nine social work staff. The gathered data were analysed by the Data Analysis and Reports Officer who employed a thematic approach ( Lietz and Zayas, 2010 ). The results were disseminated via email and then discussed with the staff group as a whole. Following the survey and discussion, social work staff were also invited to engage in a structured conversation led by one of the Khmer authors. All of the social workers chose to participate in this structured conversation that explored in more depth aspects of the survey results such as changes to their practice, communication, and concerns about the evolving situation. This series of ‘open questions’ were designed to elicit further information about their experiences of working in the COVID-19 environment. While this was an organisational audit, the resulting reflections were identified to be of considerable value, not just for CFI staff, but potentially for other NGOs in the Global South. It is acknowledged that there are limitations in an internal audit as survey and interview questions can be biased and not subject to the usual rigours of academic research. That said, the survey questions were written and checked by more than one senior staff member, then translated to Khmer. Conversations were semi-structured in nature and so participants were able to have some influence on the direction of the conversation. The strength of the conversational approach was that staff were able to speak in their own language with a trusted colleague about a shared experience and offer their opinions about their experience of working in the context of the pandemic. This core narrative approach ( Burck, 2005 ) elicited several common themes that are discussed below. The following section draws on findings from the survey and structured conversations and details what occurred within the organisation following the onset of the pandemic. The experiences of working in a COVID-19 environment from the perspective of the international managers, the two primary authors, are detailed separately.

From 23 March 2020, all CFI staff were directed to work remotely from the office as a high infection rate was expected in densely populated Cambodian communes. This resulted in clear impacts summarised by one social worker in the survey as: ‘I miss all my colleagues!’. They were, however, able to continue to make their own assessment as to the safety of visiting high-risk families in the community.

The survey results indicated that staff were committed to continuing to be as responsive as possible to the local community during the initial stages of the COVID-19 disaster. Concerns during this time primarily related to their own and their clients’ safety, as illustrated by one social worker: ‘I worry that I myself and other staff, plus other families get infected by COVID-19’. Government guidelines directed social workers to quickly assess community needs in the event of a disaster, potentially exposing CFI staff to infection ( MOSVY, 2019 ). CFI’s policies and adaptations supported safety within this context, which resulted in practice changes. As per CFI guidance, the social workers would call ahead to check the health and well-being of families, wore disposable face masks and observed good hand hygiene. During the structured conversation, a social worker commented about the new rules ‘Prevention yourself as staff when go to community such as using masks, alcohol, gel and gloves’.

The survey results showed that over a third of participants thought that an advantage of working remotely was being able to ensure their own families were safe. As one social worker remarked in the structured conversation: ‘I was able to take accountability of my tasks and take care of my family and my crops’. Despite their concerns, social workers continued to be flexible and responsive in their practice approaches. For instance, one social worker described that they would ‘call to the families or children to follow their situation in order to find their needs such as health care, food support, study and security’. Safety is a primary consideration in any setting, but in the context of a highly infectious virus, it was even more important that CFI provided an environment where staff felt they were able to focus on their own family’s safety, while providing community support.

Case management

CFI’s case management approach aims to reduce incidences of child and family separation and service dependency ( FCF/REaCT, 2019 ; Henley et al. , 2019 ), this is especially challenging when working in a disaster context. A clear service pathway begins with regular intake meetings to consider referrals and ensure that the NGO only works with families with the highest need. Children are only allocated essential interventions, a clear plan for exit is made at the point of entry, and the level of intervention is reduced alongside risk, reducing risks of dependency ( Save The Children, n/d ). Further to the case management pathway, the social workers’ interventions are based on Save The Children’s Steps To Protect approach ( Henley et al. , 2021 , in press). Social workers also utilise a strength-based intervention approach based on Signs of Safety (2020) . These approaches are used to give families a voice which is particularly important in a hierarchical society where poor uneducated families are frequently voiceless, and decisions are made for them by hierarchical powers.

The social workers noted in the structured conversation that established case management and organisational structures were beneficial during the COVID-19 disaster. For example, regular fortnightly intake and exit meetings continued online. Practicing within the recognised guidelines and structure provided stability as one social worker highlighted ‘the manager sets the schedule for members of the team to work on different days and we share our work plan through google calendar’. Several social workers reflected on the importance of basing practice approaches on established guidance which provided reassurance their work was safe.

School closures, resulting from COVID-19 meant children were often not being seen outside of their family unit. This increased the risk of families using their children as labour, for trafficking and entry to RCIs ( MOSVY, 2020 ); therefore, children of the highest risk still needed to be visited in the community. One social worker explained: ‘If there is an urgent case we still follow directly face to face and follow COVID-19 prevention’. There were also concerns regarding education as ‘The children cannot learn or absorb the lesson’. This continuation of face-to-face visits followed CFI protocol in which children of the highest risk needed to still be seen in person ( MOSVY, 2020 ; The Alliance for Child Protection in Humanitarian Action, 2020 ). This accounted for nearly half of the social workers’ current caseloads. The maintenance of some degree of routine enabled staff to continue to continue to deliver quality services despite presenting challenges. One social worker was optimistic about the new working arrangements and commented: ‘Staff are working well as normal even though there is COVID-19 disease’. The social workers were therefore able to remain responsive to the disaster situation.

The challenges described above resulted in staff having some unmet needs themselves as illustrated in this direct statement ‘What I need from CFI is more motivation’ . This was useful for CFI’s leadership to hear and they promptly responded by increasing online contact with staff. Some social workers, however, felt comfortable with the new working from home arrangements, for example: ‘I think we are already doing great and I appreciate that we have weekly meetings on Google Meets to follow up on our work! Great to speak with everyone!’.

Communication

Comprehensive communication in times of disasters is essential. In communities where most people are not connected to the Internet, nor have access to television, public health messages need to be delivered in alternative ways. The social workers emphasised the importance of ‘communicating well with families and local authorities’. Online access to the CFI electronic case management tool, Open-Source Case-management and Record-keeping system ( CIF, 2020 ), was noted by over three quarters of staff in the survey as the most challenging aspect of working from home (access to home-based Wi-Fi is challenging). In response to this CFI bought staff modems and allocated additional funds for connectivity, thereby directly responding to staff concerns about inadequate communication: ‘Working from home we spend much money for the Internet, sometime can't contact family if we work directly with them, they feel worried about the COVID-19’ . Despite attempts to resolve, many challenges remained regarding connectivity: ‘The Internet is really slow, when I need some documents, sometimes I have to come to CFI, late to respond and reply, disturbing family members’. This led to some practice challenges, as described by this social worker: ‘I have difficulty such as following children at home because some children don't have a phone and it’s hard to motivate children to learn through online learning and individual counselling’.

Some families began receiving telephone contact so that social workers could deliver intensive face to face services to those presenting with being at-risk. One social worker detailed what the discussion might cover and what different approaches were employed: ‘facebook because sometimes calls get through the phone then invite children or families through messenger video calls to join training. For example, invite students to join youth participation event or some families to join rice support group day’. The social workers expressed pride in being able to keep children safe during this time, but remained worried about other families. They also reflected that it was much harder to maintain relationships with people they only contacted by phone, but demonstrated commitment in continuing: ‘We continue to make relationship or communication between families and staff’.

Public health response

As per the guidance from MOSVY, CFI’s response to the disaster began with training staff in relation to effective hand washing, symptoms of COVID-19 and how to keep themselves and community members safe. This was emphasised as important during the structured conversation with one social worker indicating that ‘Staff and families wash with soap before joining each training’.

The social workers delivered in-person sessions to specified numbers of community members at a time. These were not only families working with CFI as the NGO recognised the need for wider public health messages. This work instilled the need for physical distancing and meeting the disaster requirement of establishing an action plan, resulting in a robust public health response ( MOSVY, 2019 ). Sessions included the distribution of government posters funded byUSAID and UNICEF, distribution of soap, along with question-and-answer sessions. These sessions were delivered quickly before COVID-19 could spread, although some social workers were concerned this may not have been enough as ‘children and families did not know/get information very clearly’. Staff felt challenged to get the balance right between health and child protection and often spent longer than usual identifying risk and need once initial training about COVID-19 had occurred: ‘We feel more confident to deliver more attention on COVID-19 prevention as families and children know how to prevent or protect themself’. Social workers also noted in the structured conversation extremely challenging aspects of delivering these services in such an evolving challenging environment: ‘We do less work on other works, like government form, usual training to the families and children, fun activities with children, double works on training (because less than 10 people joining), and sometimes we have to do the same work several times’. To encourage effectiveness, work was undertaken in partnership with village chiefs and the Commune Council for Women and Children (CCWC) services, two key support networks within local communities and CFI was supported by Family Care First/REaCT and 3PC ( The Alliance for Child Protection in Humanitarian Action, 2020 ).

Social workers highlighted that working directly with local authorities during a disaster such as COVID-19 increased the effectiveness of keeping children safe and having established relationships was vital for ensuring child safety. For example, ‘Working with the local authority, they inform us when there is an issue. We also ask them for help if we cannot do it right away’. Working in partnership with local authorities was therefore important as it; demonstrated approval at a local level, transferred some skills to local authorities who had better access to more people; and ensured all parties were aware that decision-making powers rest with families and local authorities, not with CFI. There was a risk of community trust and collaboration breaking down and of community members abusing their positions of power ( MOSVY, 2020 ). CFI’s existing partnership with local authorities meant these risks were able to be recognised and somewhat reduced.

New needs and responses

A significant challenge of COVID-19 in Cambodia was the large numbers of people migrating back from Thailand. These families, most of whom migrated unsafely (without required legal paperwork and visas), returned with little by way of resources, to family members already struggling financially. When asked specifically what they were worried about regarding COVID-19, one social worker responded: ‘The families and children still migrate in the county because of financial, even though they know about the disease’.

Several steps were taken by social workers to support these families. CFI secured unrestricted activity funding from two overseas donors, which allowed for consultation to discover what the community saw as important. Not wanting to risk further dependency, a basic prioritisation tool was created and local authorities were taught how to identify families of the highest need. After two rounds of emergency supplies were delivered, CFI and the CCWC jointly delivered safe migration workshops in an attempt to reduce migration risks. Income generation packages and small business workshops were also delivered. All of this work was designed to reduce risks while not creating dependencies and as highlighted by one social worker, to ‘Work with families to build capacity’. Connecting clients with needed resources within a conflict area are seen as critical ( MOSVY, 2019 ).

Positive parenting workshops and alcohol support groups, which had stopped at the beginning of COVID-19 featured as recommencing responses several months after the onset of the pandemic. Established groups were split into smaller cohorts and interventions run in locations with room for physical distancing. Social workers identified challenges of not being able to complete effective community follow-up work. The most significant concern was families attending virus safety education but not putting learning into place in their local community: ‘Afraid that families or children only come to join training but do not follow COVID prevention as practice at home or in the community’. Despite this concern the social workers hoped for a ‘snowballing’ effect with ‘.. families and children sharing COVID-19 prevention to neighbour or community’.

International staff perspectives

As CFI social workers began working remotely, the two international directors returned to their home country. This presented additional challenges, such as ensuring processes and systems remained effective, communication with the team and funders and securing ongoing and new funding. The directors were concerned that funding sources may become unstable and so this became the immediate focus at the onset of the disaster. The executive group were unaware how many staff were also concerned about this and in hindsight immediate communication about the financial position of CFI would have been highly beneficial. As the social workers expressed: ‘Because of COVID, I heard some NGO/company had to reduce some staff or cut down their staff salary’ and ’CFI is broke’.

The overseas directors enrolled in online training to learn to effectively manage services virtually. Effective communication was emphasised in the training, and this was certainly an area of some challenge with social work staff identifying miscommunication as a particular concern. This led the directors to focus on regular communication including daily working-from-home tips led by the human resources team. Weekly management reports were completed and discussed at regular management meetings along with direct discussions on morale and health. This provided an opportunity for candid discussions with all staff regarding how they were feeling about continuing to deliver services.

An effective team culture had been developing over some time at CFI, meaning conversations were able to be open and constructive. A CFI ‘tagline’ was added to social media posts: ‘stay safe, stay healthy and stay connected to your loved ones’, this important message was repeated throughout CFI’s social media. Internal relationships were managed by increasing contact and ensuring formal supports such as supervision remained in place. Social work supervision occurred mainly via online meeting rooms as these established relationships continued to provide stability. Of note was the need for strong established relationships, which supported critical changes in approach and had implications for practice. These are considered below.

COVID-19 infections were not the disaster in Cambodia at this time, it was rather the collapse of tourism which significantly contributed to the increase in poverty and hardship for many local families. It also affected many Cambodians based in nearby Thailand who chose to return to their extended families in Cambodia. CFI social workers started working in an educative way regarding COVID-19, but this approach soon needed to be changed. This indicated the need to be flexible in identifying the most pressing challenges and responding to them, for example, food insecurity. The social workers provided support to a significant proportion of the local population through the provision of emergency food and economic stimulus packages to generate income and promote self-sufficiency. Even storage of food is a challenge in an environment where families do not have fridges.

CFI modified traditional case management approaches to ensure the community remained safe, as exemplified by introducing telephone communication and working with returned migrants, thereby supporting a change to safe migration approaches ( MOSVY, 2019 ). Although funding was a significant concern, it did not collapse as feared. One of the important reasons for this was the existence of CFI having diverse funding streams which meant not being reliant on only one means of resourcing. Rather, the organisation continued to access smaller sums from private, corporate and formal grant funding both nationally and internationally. In a disaster, funding can easily become redirected leaving children with increased vulnerability and CFI was determined to prevent this occurring in their local community ( The Alliance for Child Protection in Humanitarian Action, 2020 ). Some local partners, who were reliant on singular funding approaches, such as social enterprises based on tourism, or corporate-giving programmes reliant on strong economies, have not fared as well, placing staff and stakeholders in difficult positions.

CFI remained mindful of maintaining a focus on their core business responsibilities, despite some work becoming redirected. This was vital in ensuring that children remained safe. Retaining a focus on priority work is important despite the challenges of the post-disaster environment and displays the flexibility required of community-based social workers ( Alston et al. , 2019 ; MOSVY, 2019 ). CFI social workers learned and implemented new skills and approaches, shifting some attention to public health education, learning and using new technologies.

Overall CFI has, so far, weathered the storm of COVID-19. The lessons learnt have placed the NGO in a strong position and provided opportunities to work with funders and local authorities in a variety of ways which strengthened relationships. As noted, the health impact of COVID-19 in Cambodia has, to date, been low. However, a longer-term financial impact is expected, further damaging impoverished communities. Over time, the impact of this financial impact may shape additional changes to the services delivered by social workers such as requiring greater emphasis on economic stimulus and well-being. While COVID-19 had a significant impact on CFI’s social work practice, adapting has resulted in positive changes in practice and allowed for significant learning. Based on the experiences of the social workers, the following recommendations are offered:

Partnership

Partnership during a disaster is essential for success. Partnership with local authorities ensures alignment and cohesion with community responses and national frameworks. It also provides a platform for challenging inequitable distribution of goods and services and unsuitable political decisions ( Hay, 2019 ). Having established patterns of partnership means that changes to working patterns and approaches are able to be implemented more easily. Internal communication and strong leadership are key to a coherent partnership approach throughout a disaster.

Social work practice approaches require consideration in a disaster situation. Following established guidance but allowing for adaptations can reduce workers concern. This enables social workers to be able to assess and identify the impact on individuals and communities in the event of a crisis and do so in a way that allows case management approaches to be reviewed and changed where needed. Developing strong case management pathways before a disaster ensures these can be easily adapted when required. In turn ensuring these consistent, reliable practices are maintained allows good service decisions to continue to be made. Reliability and familiarity are critically important in the face of managing the unpredictability of a disaster. That said, managers should remain open to improvements so that localised responses that can build better communities remain at the fore ( Alston et al. , 2019 ).

Preparation

Preparation for unanticipated disaster events should be undertaken. A diversified funding stream means NGOs are not reliant on single sources which can become compromised during a disaster ( van Heugten, 2014 ). Critically, reviewing online coverage as part of preparation is required to ensure effective communication can be more likely immediately following a disaster event. Senior staff should communicate early and clearly about an organisation’s financial and operational status as this can reduce stress for social workers.

This article has presented reflections from social work staff at CFI in Cambodia during the early stages of the COVID-19 disaster. Consideration was given to social work responses to the pandemic, implications for practice and recommendations in terms of preparedness for future disaster events. Key findings established the need to maintain a flexible but familiar approach to social work practice once the true impact of the disaster became apparent, and the importance of strong and ongoing communication internally and externally to the organisation.

Acknowledgements

CFI would like to acknowledge the technical support, equipment and programme funding from Family Care First/REaCT and 3PC and the unrestricted funding support from BASAID and South East Asia Foundation.

ORCID ids: ORCID0000-0001-6359-3550 (L.J.H.); OECID 0000-0003-4801-114X (Z.A.H.); ORCID 0000-0002-3899-056X (K.H.); ORCID 0000-0003-2109-490X (P.S.)

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Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

• The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
• The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
• The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
• The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
• The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

• What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
• Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
• What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
• How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

• Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
• Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
• Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
• Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
• Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
• Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
• Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
• If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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Assessing Initiatives Taken to Safeguard and Support Victims of Sexual Abuse in Dowa District: A Case Study of the Spotlight Initiative Under the Girls Empowerment Network (GENET)

• Published: 06 April 2024

Cite this article

• Daniel Devoted Matemba   ORCID: orcid.org/0009-0000-6301-4897 1 &
• Christina Banda 1  

In Malawi, sexual abuse disproportionately affects girls and young women, emphasizing the need for effective interventions to safeguard their well-being. The Spotlight Initiative, a significant effort to combat violence against women and girls, has been implemented in Malawi, addressing various forms of gender-based violence, including sexual abuse. One funded project, Girls Action to End Violence against Women and Girls (GATEVAWG), aims to empower girls through mentorship in combating gender-based violence. This study assesses the effectiveness of initiatives and support mechanisms for sexual abuse victims in Malawi’s Dowa District. The population size includes data from at least 10 victims or project beneficiaries, 5 community authorities (traditional authorities), and at least 5 organization representatives leading the Spotlight Initiative project. Findings reveal the pervasive nature of sexual abuse in the study area, where men exploit vulnerable women and girls. While community authorities play a crucial role in intervention and support, neglecting some cases leads to adverse consequences for victims and their families. Support provided includes health care, psychosocial, emotional, and social assistance, facilitating recovery and societal reintegration. The study highlights the positive impact of the Spotlight Initiative, empowering girls with knowledge of their rights and sexual reproductive health. However, challenges persist, necessitating continuous efforts to combat harmful social and gender norms. Recommendations include encouraging girls to report abuse, raising awareness among families and community leaders, and strengthening follow-up mechanisms for addressed cases. The study also recommends future investigations into how survivors, supported by community-based initiatives, experience long-term physical, psychological, and emotional well-being.

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Data Availability

All data supporting the conclusions of this research are available upon reasonable request.

Amnesty International. (2002). Kenya: Rape-The Invisible Crime. https://www.amnesty.org/en/documents/afr32/001/2002/en/

BC, U. B., Pokharel, S., Munikar, S., Wagle, C. N., Adhikary, P., Shahi, B. B., Thapa, C., Bhandari, R. P., Adhikari, B., & Thapa, K. (2021). Anxiety and depression among people living in quarantine centers during the COVID-19 pandemic: A mixed method study from western Nepal. PLoS One, 16 (7), e0254126. https://doi.org/10.1371/journal.pone.0254126

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Matemba, D.D., Banda, C. Assessing Initiatives Taken to Safeguard and Support Victims of Sexual Abuse in Dowa District: A Case Study of the Spotlight Initiative Under the Girls Empowerment Network (GENET). J. Hum. Rights Soc. Work (2024). https://doi.org/10.1007/s41134-024-00302-6

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• Volume 14, Issue 4
• Chronic loneliness and chronic social isolation among older adults: a study protocol for a systematic review, meta-analysis and meta-regression
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• http://orcid.org/0000-0002-6886-2745 André Hajek ,
• Giuliana Posi ,
• http://orcid.org/0000-0001-5711-6862 Hans-Helmut König
• Department of Health Economics and Health Services Research , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
• Correspondence to Dr André Hajek; a.hajek{at}uke.de

Introduction There are around 20 studies identifying the prevalence of chronic loneliness and chronic social isolation in older adults. However, there is an absence of a systematic review, meta-analysis and meta-regression that consolidates the available observational studies. Therefore, our objective was to address this knowledge gap. Here, we present the study protocol for this upcoming work. Such knowledge can help in addressing older individuals at risk for chronic loneliness and chronic social isolation.

Methods and analysis Established electronic databases will be searched. Observational studies reporting the prevalence of chronic loneliness and chronic social isolation among individuals aged 60 years and over will be included. Disease-specific samples will be excluded. The focus of data extraction will be on methods, sample characteristics and key findings. The Joanna Briggs Institute (JBI) standardised critical appraisal instrument for prevalence studies will be used for assessing the quality of the studies. Two reviewers will be responsible for carrying out the study selection, data extraction and assessment of study quality. The results will be presented through the use of figures, tables, narrative summaries and a meta-analysis and meta-regression.

Ethics and dissemination No primary data will be collected. Thus, there is no need for approval from an ethics committee. We intend to share our results through publication in a peer-reviewed journal.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-080399

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STRENGTHS AND LIMITATIONS OF THIS STUDY

First work: aimed to identify the prevalence and factors associated with chronic loneliness and chronic social isolation in older adults.

Study quality will be evaluated.

Key stages (such as study selection, data extraction and assessment of study quality) will be undertaken by two reviewers.

Meta-analysis and meta-regression are planned.

Search focused on peer-reviewed articles.

Introduction

In late life, individuals often encounter various challenges. Among these challenges, chronic loneliness and chronic social isolation emerge as significant concerns. With the progression of age, individuals may experience a reduction in their social relationships, influenced by factors such as retirement, the loss of close friends and family members, or physical limitations. 1 These transformations can contribute to (chronic) loneliness and social isolation 1 which can have detrimental impacts on mental as well as physical health and longevity among older adults. 2 More precisely, a previous review and meta-analysis showed medium-to-large effects of loneliness on different health outcomes such as physical health, general health, sleep, cognition or mental health—whereby the largest effects of loneliness were found for mental health outcomes. 3 Another systematic review of systematic reviews (ie, a systematic overview) also revealed (1) an association between social isolation and cardiovascular diseases and (2) an association between social isolation and all-cause mortality. 4 Moreover, particularly such chronic feelings (compared with temporary feelings of loneliness) can have harmful effects for health. 5 6

Chronic loneliness among older adults is more than a temporary feeling of solitude; it reflects an enduring and distressing emotional state of dissatisfaction with one’s own social connection. 7 It can be characterised as a deficiency in meaningful social interactions, companionship in their lives or emotional support. 8 Factors such as living alone, loss of spouse or friends, restricted access to transportation or a decreased social engagement can contribute to chronic loneliness. 9

Chronic social isolation, although connected, establishes itself as a distinct concept apart from chronic loneliness. It indicates a situation in which older adults have restricted interactions with social networks and sustain a persistent lack of involvement in social activities. 10 A previous study also showed that chronic social isolation is associated with higher subsequent depression scores. 11

Thus far, numerous studies have examined (temporary) loneliness and social isolation in old age (as an overview, see Refs. 1 2 ). Considerably fewer studies have investigated the prevalence and determinants of chronic loneliness and social isolation in old age. 12–15 To date, a systematic review, meta-analysis and meta-regression is missing exploring the prevalence of chronic loneliness and chronic social isolation—and the factors associated with them. Identifying the prevalence of chronic loneliness and chronic social isolation is of great importance, especially in light of the ongoing rise in the population of individuals aged 60 and above. Furthermore, our upcoming work aimed to examine the factors associated with chronic loneliness and chronic social isolation in this specific age group. This can assist in addressing individuals at risk for chronic loneliness and chronic social isolation. This in turn can help to sustain health and can contribute to successful ageing. 16 17 Overall, addressing chronic loneliness and chronic social isolation is important for policy-makers, healthcare providers and society as a whole. Additionally, this future work has the potential to identify research gaps and thus to guide future research in this area.

Methods and analysis

The methodology for this review adheres to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. 18 Additionally, it is registered by the International Prospective Register of Systematic Reviews (PROSPERO, ID: CRD42023467646). This work began on mid-November 2023 (search) and we anticipate that it will be completed by 30 April 2024.

Eligibility criteria

Prior to establishing the final eligibility criteria, a preliminary examination was carried out involving the screening of 100 titles/abstracts. No adjustments to the criteria were made following this pretest. Detailed inclusion and exclusion criteria are shown in the subsequent sections.

Inclusion criteria

Final inclusion criteria were as follows:

Cross-sectional and longitudinal observational studies centred on chronic loneliness or chronic social isolation prevalence within individuals aged 60 years and above.

Validated instruments for evaluating loneliness/social isolation.

Studies accessible in either English or German and released in peer-reviewed scientific journals.

Exclusion criteria

The final exclusion criteria were as follows:

Studies solely focused on samples with particular conditions, such as samples only including individuals with cognitive or mental disorders.

Studies involving such disease-specific samples were excluded as it is unclear to what extent they can be generalised to the older population in general. However, it should be emphasised that samples are not excluded if they include people with diseases (as long as these studies are not purely disease-specific).

We focused on observational studies (and therefore excluded other designs such as randomised controlled trials so that respondents would not be influenced by any interventions). Moreover, it is important to highlight that the appropriateness of the instruments follows closely the criteria outlined in the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. 19 With regard to chronicity of loneliness (and social isolation), it will be based on the definition in the papers. We assume that the great majority of studies assume chronicity when loneliness (or social isolation) exists for several consecutive waves.

The electronic databases include PubMed, PsycInfo, CINAHL and Web of Science. The final search strategy for PubMed is displayed in table 1 (for the other databases: see online supplemental file 1 ). No restrictions will be applied in terms of time or location. Furthermore, two reviewers will manually explore the reference lists of studies that meet our ultimate inclusion criteria.

Supplemental material

• View inline

Search strategy (PubMed)

Data management

We will use Endnote V.20, developed by Clarivate Analytics (Philadelphia, Pennsylvania, USA), for importing the data. Additionally, Stata V.18.0 (StataCorp) will be employed to conduct a potential meta-analysis and meta-regression if feasible (ie, when the studies are not too different in their design, methods or sample to be combined statistically).

Study selection process

On completing the search, two reviewers (AH and GP) will assess the titles/abstracts to determine their potential inclusion based on the eligibility criteria. Following this, the full texts will be evaluated by these aforementioned two reviewers. If differences of opinions are present, discussions will be held to reach a consensus. If an agreement cannot be reached, a third party (H-HK) will be consulted.

Data collection process and data items

Data extraction will be carried out by two reviewers (AH and GP). The first reviewer (GP) will initially extract the data, and then the second reviewer (AH) will cross-verify it. In instances where clarification is needed, a third party (H-HK) will be engaged. Additionally, if necessary, communication with study authors via email will be initiated. Data extraction will encompass various elements such as study design, definition/assessment of key variables (ie, chronic loneliness and chronic social isolation), sample characteristics (if reported: sample size, mean age and proportion of female individuals), statistical analysis and key findings (prevalence of chronic loneliness and prevalence of chronic social isolation; also stratified by sex, if reported; correlates of chronic loneliness or chronic social isolation).

Regarding meta-analysis, random-effect models will be used to pool proportion across studies included in this upcoming work (since we assume heterogeneity across studies). We will use forest plots to display aggregated estimates and illustrate the degree of variation among the included studies. The Higgin’s I² statistic will be employed to evaluate the heterogeneity among the studies using the following categorisation: (1) 25%–50%, indicating low heterogeneity; (2) 50%–75%, and (3) 75%–100%, representing high heterogeneity. 20 If possible, subgroup analysis will be conducted based on, for example, sex or living arrangement (community-dwelling vs institutionalised settings). We will use funnel plots and conduct the Egger test to investigate the presence of publication bias. If possible, we will conduct meta-regressions to investigate the origins of heterogeneity (eg, tool used to quantify chronic loneliness, proportion of women, average age or country of origin).

Assessment of study quality/risk of bias

The Joanna Briggs Institute standardised critical appraisal instrument for prevalence studies 21 will be used for assessing the quality of the studies. Two independent reviewers (AH and GP) will individually evaluate the study quality. If necessary, discussions will be conducted until a consensus is achieved. In cases where consensus remains elusive, a third party (H-HK) will be consulted.

Data synthesis

On completion of the screening process, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram will be generated to illustrate the study selection procedure. In a narrative synthesis, we will present the most important findings. Similar to recent reviews and books, 1 2 our intention is to categorise the correlates into: socioeconomic factors (eg, sex, age, education or income), lifestyle-related factors (eg, physical activity, smoking, alcohol intake) and health-related factors (eg, self-rated health). If possible, we will conduct a meta-analysis and meta-regression.

Patient and public involvement statement

The present review protocol did not involve individual patients or public agencies.

A bulk of studies examined loneliness and social isolation in old age. However, there are far less studies focusing on chronic loneliness and chronic social isolation. Thus, the aim of our upcoming systematic review, meta-analysis and meta-regression will be to give an overview of observational studies examining the prevalence and (ideally) the correlates of chronic loneliness and chronic social isolation. In addition, we will assess the quality of the studies included. Our upcoming work could enhance discussions surrounding loneliness and social isolation in old age (and in other age groups). This may contribute to maintaining general health in later life and successful ageing.

Our upcoming systematic review, meta-analysis and meta-regression have the potential to uncover gaps in research. For example, it may be the case that more studies exist focusing on the prevalence of chronic loneliness rather than chronic social isolation among older adults. It may also be the case that the existing longitudinal studies only use data from only a few years (rather than decades). Additionally, we assume that there is an imbalance between the countries studied so far. For example, many studies could come from North America, Europe and Asia. The prevalence could also depend on variables such as the proportion of women, the tool used to quantify chronic loneliness/chronic social isolation or the geographical region.

Strengths and limitations

This will be the first systematic review, meta-analysis and meta-regression regarding the prevalence and correlates of chronic loneliness and chronic isolation among older adults. The upcoming work engages two reviewers in various tasks, such as study selection and quality assessment. It is intended to do a meta-analysis and meta-regression. It should be noted that our work is restricted to peer-reviewed studies published in English or German language which may exclude potential relevant articles. Moreover, the exclusive focus on peer-reviewed articles may exclude some studies which may be relevant. However, this choice ensures a certain quality of included studies.

Ethics and dissemination

No primary data will be collected. Therefore, approval by an ethics committee is not required. Our findings are planned to be published in a peer-reviewed journal.

Ethics statements

Patient consent for publication.

Not applicable.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Contributors The study concept was developed by AH and H-HK. The manuscript of the protocol was drafted by AH and critically revised by GP and H-HK. The search strategy was developed by AH and H-HK. Study selection, data extraction and quality assessment will be performed by AH and GP, with HH-K as a third party in case of disagreements. All authors have approved the final version of the manuscript.

Funding We acknowledge financial support from the Open Access Publication Fund of UKE - Universitätsklinikum Hamburg-Eppendorf.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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