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Case Study Research in Practice

• Helen Simons - University of Southampton, UK
• Description

- Rationale, concept and design of case study research

- Methods, ethics and reflexivity in case study

- Interpreting, analyzing and reporting the case

- Generalizing and theorizing in case study research

Rich with 'tales from the field' and summary memos as an aide-memoire to future action, the book provides fresh insights and challenges for researchers to guide their practice of case study research.

This is an ideal text for those studying and conducting case study research in education, health and social care, and related social science disciplines.

'This is a particularly useful book for educational research students, for researchers looking to use case study methods for the first time, or for those about to teach a course on case study methods...For a book on research methodology, this is also a remarkably lively read. A case study is like great art, to adapt Simons' quote from MacDonald and Walker, in which 'content and intent emerge in form'. As such, Simons has written a manual for creating great art in educational research' - Teacher Development

'Practical and immensely helpful… With its highly readable style, it is well suited to the needs of research students. Throughout it addresses the practicalities at a level that connects immediately to thorny issues in relation to the quality of the data, the quality of the analysis: in short the quality of the research' - Jane Payler, University of Winchester

'…unravelling the complexity of 'the case'…makes this kind of research very challenging. This book provides a practical and reflective approach to doing case study research and will be a valuable resource for students, supervisors and researchers' - Professor Brendan McCormack, University of Ulster

'From soundings of the depths of her experience in art, teaching, cinema, program evaluation and policy study, Helen Simons brings counsel to the making of case studies. She locates… particularization and situated generalization centrally in qualitative inquiry, an inquiry that reckons with story telling and contested meaning as much as with the functional relationships of social science' - Professor Robert E. Stake, University of Illinois '

'This book prompts readers and researchers to consider ways in which the robustness of their work can be improved. It is the clarity with which this is achieved and the encouragement it provides to readers that are the real strengths of this book' - Nurse Researcher

great and helpful book to be recommended

This book is great for students who want to learn more about case study research. Giving great insight how researchers develop their case study research.

Case study research is often misunderstood, how to carry it out in practice is also subject to many myths and misconceptions. This book allows students to see how they should conduct a case study in real life. It is a good guide and a useful addition to any set of texts on methods for MA students.

Case study reserach is often misunderstood, how to carry it out in practice is also subject to many myths and misconceptions. This book allows students to see how they should conduct a case study in real life. It is a good guide and a useful addition to any set of texts on methods for MA students.

Provides a good insight into the case study approach.

Extremely well written, detailed and informative text book that will appeal to, and help, any researcher considering using a case study approach. Quite pragmatic, but with essential theory and a good chapter on ethical issues to consider. Lays out key concepts in aappropriate language for UG and PG students.

This is an excellent book for guiding students generally. Explanations are given with clarity and I specifically recommend it for the design stage of a case study and strongly suggest that students return to this book for guidance when writing up of the methodology chapter.

An excellent guide for those undertaking case study research. Logically presented and clearly discussed

A useful text that students could use to support their methodology.

Preview this book

Sample materials & chapters.

Introduction

Chapter One

Chapter 6: 'Whose Data Are They? Ethics in Case Study Research'

For instructors

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Case Study Research in Practice

• Helen Simons - University of Southampton, UK
• Description
• The rationale, concept and design of case study research
• Methods and ethics in case study
• Interpreting, analyzing and reporting the case.
• Generalizing and theorizing in case study research

Including examples and summary memos the author has created a dynamic text that presents readers with choices and challenges to inform the conduct of their case research. This is an ideal text for students studying and conducting case study research in education, health and social care, and related social science disciplines.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

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'This is a particularly useful book for educational research students, for researchers looking to use case study methods for the first time, or for those about to teach a course on case study methods...For a book on research methodology, this is also a remarkably lively read. A case study is like great art, to adapt Simons' quote from MacDonald and Walker, in which 'content and intent emerge in form'. As such, Simons has written a manual for creating great art in educational research' - Teacher Development

'Practical and immensely helpful… With its highly readable style, it is well suited to the needs of research students. Throughout it addresses the practicalities at a level that connects immediately to thorny issues in relation to the quality of the data, the quality of the analysis: in short the quality of the research' - Jane Payler, University of Winchester

'…unravelling the complexity of 'the case'…makes this kind of research very challenging. This book provides a practical and reflective approach to doing case study research and will be a valuable resource for students, supervisors and researchers' - Professor Brendan McCormack, University of Ulster

'From soundings of the depths of her experience in art, teaching, cinema, program evaluation and policy study, Helen Simons brings counsel to the making of case studies. She locates… particularization and situated generalization centrally in qualitative inquiry, an inquiry that reckons with story telling and contested meaning as much as with the functional relationships of social science' - Professor Robert E. Stake, University of Illinois '

'This book prompts readers and researchers to consider ways in which the robustness of their work can be improved. It is the clarity with which this is achieved and the encouragement it provides to readers that are the real strengths of this book' - Nurse Researcher

great and helpful book to be recommended

This book is great for students who want to learn more about case study research. Giving great insight how researchers develop their case study research.

Case study research is often misunderstood, how to carry it out in practice is also subject to many myths and misconceptions. This book allows students to see how they should conduct a case study in real life. It is a good guide and a useful addition to any set of texts on methods for MA students.

Case study reserach is often misunderstood, how to carry it out in practice is also subject to many myths and misconceptions. This book allows students to see how they should conduct a case study in real life. It is a good guide and a useful addition to any set of texts on methods for MA students.

Provides a good insight into the case study approach.

Extremely well written, detailed and informative text book that will appeal to, and help, any researcher considering using a case study approach. Quite pragmatic, but with essential theory and a good chapter on ethical issues to consider. Lays out key concepts in aappropriate language for UG and PG students.

This is an excellent book for guiding students generally. Explanations are given with clarity and I specifically recommend it for the design stage of a case study and strongly suggest that students return to this book for guidance when writing up of the methodology chapter.

An excellent guide for those undertaking case study research. Logically presented and clearly discussed

A useful text that students could use to support their methodology.

Preview this book

Sample materials & chapters.

Introduction

Chapter One

Chapter 6: 'Whose Data Are They? Ethics in Case Study Research'

For instructors

Select a purchasing option, related products.

This title is also available on SAGE Research Methods , the ultimate digital methods library. If your library doesn’t have access, ask your librarian to start a trial .

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• Fam Med Community Health
• v.7(2); 2019

Fundamentals of case study research in family medicine and community health

Sergi fàbregues.

1 Department of Psychology and Education, Universitat Oberta de Catalunya, Barcelona, Spain

Michael D Fetters

2 Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA

The aim of this article is to introduce family medicine researchers to case study research, a rigorous research methodology commonly used in the social and health sciences and only distantly related to clinical case reports. The article begins with an overview of case study in the social and health sciences, including its definition, potential applications, historical background and core features. This is followed by a 10-step description of the process of conducting a case study project illustrated using a case study conducted about a teaching programme executed to teach international family medicine resident learners sensitive examination skills. Steps for conducting a case study include (1) conducting a literature review; (2) formulating the research questions; (3) ensuring that a case study is appropriate; (4) determining the type of case study design; (5) defining boundaries of the case(s) and selecting the case(s); (6) preparing for data collection; (7) collecting and organising the data; (8) analysing the data; (9) writing the case study report; and (10) appraising the quality. Case study research is a highly flexible and powerful research tool available to family medicine researchers for a variety of applications.

Significance statement

Given their potential for answering ‘how’ and ‘why’ questions about complex issues in their natural setting, case study designs are being increasingly used in the health sciences. Conducting a case study can, however, be a complex task because of the possibility of combining multiple methods and the need to choose between different types of case study designs. In order to introduce family medicine and community health researchers to the fundamentals of case study research, this article reviews its definition, potential applications, historical background and main characteristics. It follows on with a practical, step-by-step description of the case study process that will be useful to researchers interested in implementing this research design in their own practice.

Introduction

This article provides family medicine and community health researchers a concise resource to conduct case study research. The article opens with an overview of case study in the social and health sciences, including its definition, potential applications, historical background and core features. This is followed by a 10-step description of the process of conducting a case study project, as described in the literature. These steps are illustrated using a case study about a teaching programme executed to teach international medical learners sensitive examination skills. The article ends with recommendations of useful articles and textbooks on case study research.

Origins of case study research

Case study is a research design that involves an intensive and holistic examination of a contemporary phenomenon in a real-life setting. 1–3 It uses a variety of methods and multiple data sources to explore, describe or explain a single case bounded in time and place (ie, an event, individual, group, organisation or programme). A distinctive feature of case study is its focus on the particular characteristics of the case being studied and the contextual aspects, relationships and processes influencing it. 4 Here we do not include clinical case reports as these are beyond the scope of this article. While distantly related to clinical case reports commonly used to report unusual clinical case presentations or findings, case study is a research approach that is frequently used in the social sciences and health sciences. In contrast to other research designs, such as surveys or experiments, a key strength of case study is that it allows the researcher to adopt a holistic approach—rather than an isolated approach—to the study of social phenomena. As argued by Yin, 3 case studies are particularly suitable for answering ‘how’ research questions (ie, how a treatment was received) as well as ‘why’ research questions (ie, why the treatment produced the observed outcomes).

Given its potential for understanding complex processes as they occur in their natural setting, case study increasingly is used in a wide range of health-related disciplines and fields, including medicine, 5 nursing, 6 health services research 1 and health communication. 7 With regard to clinical practice and research, a number of authors 1 5 8 have highlighted how insights gained from case study designs can be used to describe patients’ experiences regarding care, explore health professionals’ perceptions regarding a policy change, and understand why medical treatments and complex interventions succeed or fail.

In anthropology and sociology, case study as a research design was introduced as a response to the prevailing view of quantitative research as the primary way of undertaking research. 9 From its beginnings, social scientists saw case study as a method to obtain comprehensive accounts of social phenomena from participants. In addition, it could complement the findings of survey research. Between the 1920s and 1960s, case study became the predominant research approach among the members of the Department of Sociology of the University of Chicago, widely known as ‘The Chicago School’. 10 11 During this period, prominent sociologists, such as Florian Znaniecki, William Thomas, Everett C Hughes and Howard S Becker, undertook a series of innovative case studies (including classical works such as The Polish peasant in Europe and America or Boys in White ), which laid the foundations of case study designs as implemented today.

In the 1970s, case study increasingly was adopted in the USA and UK in applied disciplines and fields, such as education, programme evaluation and public policy research. 12 As a response to the limitations of quasi-experimental designs for undertaking comprehensive programme evaluations, researchers in these disciplines saw in case studies—either alone or in combination with experimental designs—an opportunity to gain additional insights into the outcomes of programme implementation. In the mid-1980s and early 1990s, the case study approach became recognised as having its own ‘logic of design’ (p46). 13 This period coincides with the publication of a considerable number of influential articles 14–16 and textbooks 4 17 18 on case study research.

These publications were instrumental in shaping contemporary case study practice, yet they reflected divergent views about the nature of case study, including how it should be defined, designed and implemented (see Yazan 19 for a comparison of the perspectives of Yin, Merriam and Stake, three leading case study methodologists). What these publications have in common is that case study revolves around four key features.

First, case study examines a specific phenomenon in detail by performing an indepth and intensive analysis of the selected case. The rationale for case study designs, rather than more expansive designs such as surveys, is that the researcher is interested in investigating the particularity of a case, that is, the unique attributes that define an event, individual, group, organisation or programme. 2 Second, case study is conducted in natural settings where people meet, interact and change their perceptions over time. The use of the case study design is a choice in favour of ‘maintaining the naturalness of the research situation and the natural course of events’ (p177). 20

Third, case study assumes that a case under investigation is entangled with the context in which it is embedded. This context entails a number of interconnected processes that cannot be disassociated from the case, but rather are part of the study. The case study researcher is interested in understanding how and why such processes take place and, consequently, uncovering the interactions between a case and its context. Research questions concerning how and why phenomena occur are particularly appropriate in case study research. 3

Fourth, case study encourages the researcher to use a variety of methods and data types in a single study. 20 21 These can be solely qualitative, solely quantitative or a mixture of both. The latter option allows the researcher to gain a more comprehensive understanding of the case and improve the accuracy of the findings. The four above-mentioned key features of case study are shown in table 1 , using the example of a mixed methods case study evaluation. 22

Key features of case study as presented by Shultz et al 22

There are many potential applications for case study research. While often misconstrued as having only an exploratory role, case study research can be used for descriptive and explanatory research (p7–9). 3 Family medicine and community health researchers can use case study research for evaluating a variety of educational programmes, clinical programmes or community programmes.

Case study illustration from family medicine

In the featured study, Japanese family medicine residents received standardised patient instructor-based training in female breast, pelvic, male genital and prostate examinations as part of an international training collaboration to launch a new family medicine residency programme. 22 From family medicine residents, trainers and staff, the authors collected and analysed data from post-training feedback, semistructured interviews and a web-based questionnaire. While the programme was perceived favourably, they noted barriers to reinforcement in their home training programme, and taboos regarding gender-specific healthcare appear as barriers to implementing a similar programme in the home institution.

A step-by-step description of the process of carrying out a case study

As shown in table 2 and illustrated using the article by Shultz et al , 22 case study research generally includes 10 steps. While commonly conducted in this order, the steps do not always occur linearly as data collection and analysis may occur over several iterations or implemented with a slightly different order.

Ten steps for conducting a case study

SPI, standardised patient instructor.

Step 1. Conduct a literature review

During the literature review, researchers systematically search for publications, select those most relevant to the study’s purpose, critically appraise them and summarise the major themes. The literature review helps researchers ascertain what is and is not known about the phenomenon under study, delineate the scope and research questions of the study, and develop an academic or practical justification for the study. 23

Step 2. Formulate the research questions

Research questions critically define in operational terms what will be researched and how. They focus the study and play a key role in guiding design decisions. Key decisions include the case selection and choice of a case study design most suitable for the study. According to Fraenkel et al , 24 the key attributes of good research questions are (1) feasibility, (2) clarity, (3) significance, (4) connection to previous research identified in the literature and (5) compliance with ethical research standards.

Step 3. Ensure that a case study is appropriate

Before commencing the study, researchers should ensure that case study design embodies the most appropriate strategy for answering the study questions. The above-noted four key features—in depth examination of phenomena, naturalness, a focus on context and the use of a combination of methods—should be reflected in the research questions as well as subsequent design decisions.

Step 4. Determine the type of case study design

Researchers need to choose a specific case study design. Sometimes, researchers may define the case first (step 5), for example, in a programme evaluation, and the case may need to be defined before determining the type. Yin’s 3 typology is based on two dimensions, whether the study will examine a single case or multiple cases, and whether the study will focus on a single or multiple units of analysis. Figure 1 illustrates these four types of design using a hypothetical example of a programme evaluation. Table 3 shows an example of each type from the literature.

Examples of published studies using the four types of case study designs suggested by Yin 3

Types of case study designs. 3 21

In type 1 holistic single case design , researchers examine a single programme as the sole unit of analysis. In type 2 embedded single case design , the interest is not exclusively in the programme, but also in its different subunits, including sites, staff and participants. These subunits constitute the range of units of analysis. In type 3 holistic multiple case design , researchers conduct a within and cross-case comparison of two or more programmes, each of which constitutes a single unit of analysis. A major strength of multiple case designs is that they enable researchers to develop an in depth description of each case and to identify patterns of variation and similarity between the cases. Multiple case designs are likely to have stronger internal validity and generate more insightful findings than single case designs. They do this by allowing ‘examination of processes and outcomes across many cases, identification of how individual cases might be affected by different environments, and the specific conditions under which a finding may occur’ (p583). 25 In type 4 embedded multiple case design , a variant of the holistic multiple case design, researchers perform a detailed examination of the subunits of each programme, rather than just examining each case as a whole.

Step 5. Define the boundaries of the case(s) and select the case(s)

Miles et al 26 define a case as ‘a phenomenon of some sort occurring in a bounded context’ (p28). What is and is not the case and how the case fits within its broader context should be explicitly defined. As noted in step 4, this step may occur before choice of the case study type, and the process may actually occur in a back-and-forth fashion. A case can entail an individual, a group, an organisation, an institution or a programme. In this step, researchers delineate the spatial and temporal boundaries of the case, that is, ‘when and where it occurred, and when and what was of interest’ (p390). 9 Aside from ensuring the coherence and consistency of the study, bounding the case ensures that the planned research project is feasible in terms of time and resources. Having access to the case and ensuring ethical research practice are two central considerations in case selection. 1

Step 6. Prepare to collect data

Before beginning the data collection, researchers need a study protocol that describes in detail the methods of data collection. The protocol should emphasise the coherence between the data collection methods and the research questions. According to Yin, 3 a case study protocol should include (1) an overview of the case study, (2) data collection procedures, (3) data collection questions and (4) a guide for the case study report. The protocol should be sufficiently flexible to allow researchers to make changes depending on the context and specific circumstances surrounding each data collection method.

Step 7. Collect and organise the data

While case study is often portrayed as a qualitative approach to research (eg, interviews, focus groups or observations), case study designs frequently rely on multiple data sources, including quantitative data (eg, surveys or statistical databases). A growing number of authors highlight the ways in which the use of mixed methods within case study designs might contribute to developing ‘a more complete understanding of the case’ (p902), 21 shedding light on ‘the complexity of a case’ (p118) 27 or increasing ‘the internal validity of a study’ (p6). 1 Guetterman and Fetters 21 explain how a qualitative case study can also be nested within a mixed methods design (ie, be considered the qualitative component of the design). An interesting strategy for organising multiple data sources is suggested by Yin. 3 He recommends using a case study database in which different data sources (eg, audio files, notes, documents or photographs) are stored for later retrieval or inspection. See guidance from Creswell and Hirose 28 for conducting a survey and qualitative data collection in mixed methods and DeJonckheere 29 on semistructured interviewing.

Step 8. Analyse the data

Bernard and Ryan 30 define data analysis as ‘the search for patterns in data and for ideas that help explain why these patterns are there in the first place’ (p109). Depending on the case study design, analysis of the qualitative and quantitative data can be done concurrently or sequentially. For the qualitative data, the first step of the analysis involves segmenting the data into coding units, ascribing codes to data segments and organising the codes in a coding scheme. 31 Depending on the role of theory in the study, an inductive, data-driven approach can be used where meaning is found in the data, or a deductive, concept-driven approach can be adopted where predefined concepts derived from the literature, or previous research, are used to code the data. 32 The second step involves searching for patterns across codes and subsets of respondents, so major themes are identified to describe, explain or predict the phenomenon under study. Babchuk 33 provides a step-by-step guidance for qualitative analysis in this issue. When conducting a single case study, the within-case analysis yields an in depth, thick description of the case. When the study involves multiple cases, the cross-comparison analysis elicits a description of similarities and divergence between cases and may generate explanations and theoretical predictions regarding other cases. 26

For the quantitative part of the case study, data are entered in statistical software packages for conducting descriptive or inferential analysis. Guetterman 34 provides a step-by-step guidance on basic statistics. In case study designs where both data strands are analysed simultaneously, analytical techniques include pattern matching, explanation building, time-series analysis and creating logic models (p142–167). 3

Step 9. Write the case study report

The case study report should have the following three characteristics. First, the description of the case and its context should be sufficiently comprehensive to allow the reader to understand the complexity of the phenomena under study. 35 Second, the data should be presented in a concise and transparent manner to enable the reader to question, or to re-examine, the findings. 36 Third, the report should be adapted to the interests and needs of its primary audience or audiences (eg, academics, practitioners, policy-makers or funders of research). Yin 3 suggests six formats for organising case study reports, namely linear-analytic, comparative, chronological, theory building, suspense and unsequenced structures. To facilitate case transferability and applicability to other similar contexts, the case study report must include a detailed description of the case.

Step 10. Appraise quality

Although presented as the final step of the case study process, quality appraisal should be considered throughout the study. Multiple criteria and frameworks for appraising the quality of case study research have been suggested in the literature. Yin 3 suggests the following four criteria: construct validity (ie, the extent to which a study accurately measures the concepts that it claims to investigate), internal validity (ie, the strength of the relationship between variables and findings), external validity (ie, the extent to which the findings can be generalised) and reliability (ie, the extent to which the findings can be replicated by other researchers conducting the same study). Yin 37 also suggests using two separate sets of guidelines for conducting case study research and for appraising the quality of case study proposals. Stake 4 presents a 20-item checklist for critiquing case study reports, and Creswell and Poth 38 and Denscombe 39 outline a number of questions to consider. Since these quality frameworks have evolved from different disciplinary and philosophical backgrounds, the researcher’s approach should be coherent with the epistemology of the study. Figure 2 provides a quality appraisal checklist adapted from Creswell and Poth 38 and Denscombe. 39

Checklist for evaluating the quality of a case study. 38 39

The challenges to conducting case study research include rationalising the literature based on literature review, writing the research questions, determining how to bound the case, and choosing among various case study purposes and designs. Factors held in common with other methods include analysing and presenting the findings, particularly with multiple data sources.

Other resources

Resources with more in depth guidance on case study research include Merriam, 17 Stake 4 and Yin. 3 While each reflects a different perspective on case study research, they all provide useful guidance for designing and conducting case studies. Other resources include Creswell and Poth, 38 Swanborn 2 and Tight. 40 For mixed methods case study designs, Creswell and Plano Clark, 27 Guetterman and Fetters, 21 Luck et al , 6 and Plano Clark et al 41 provide guidance. Byrne and Ragin’s 42 The SAGE Handbook of Case-Based Methods and Mills et al ’s 43 Encyclopedia of case study research provide guidance for experienced case study researchers.

Conclusions

Family medicine and community health researchers engage in a wide variety of clinical, educational, research and administrative programmes. Case study research provides a highly flexible and powerful research tool to evaluate rigorously many of these endeavours and disseminate this information.

Acknowledgments

The authors would like to acknowledge the help of Dick Edelstein and Marie-Hélène Paré in editing the final manuscript.

Correction notice: This article has been corrected. Reference details have been updated.

Contributors: SF and MDF conceived and drafted the manuscript, and approved the final version of the manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; internally peer reviewed.

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These case studies, developed with carers, address different situations where social work can offer input to carers. Each has information about the situation and case records, and highlights important topics that relate to that situation with questions for practice.

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We have always said we would stay together till the very end. That is all I want, to be together in our own home.

Anne has been married to Arthur for over 70 years. Arthur has end-stage Chronic Pulmonary Disease and is nearing the end of his life.

Read more about Anne's story below. 

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Read Anne’s story

Anne Woolsey is married to Arthur, 94. They have been married for over 70 years and live in their own bungalow in a village. Anne and Arthur have two daughters, five grandchildren and eight great-grandchildren. The family are quite dispersed across the country. Their nearest daughter Carol, who lives 40 miles away, visits twice a month. Daughter Jean visits every other month. Both daughters phone regularly. Their neighbour Betty calls in most days.

Arthur has end-stage Chronic Pulmonary Disease (COPD) and is nearing the end of his life. Arthur is currently housebound, using oxygen at home. He has support from a Community COPD nurse. Anne has provided care for Arthur for eight years, and the support that he needs is increasing. The COPD affects Arthur’s mobility and he is unable to get to the toilet in time at night. Most mornings he awakens with soiled sheets which distresses him. Anne continues to look after the home and has started to manage the finances, which previously Arthur did. Anne and Arthur find it difficult to talk with each other about Arthur’s death. They would both like Arthur to die at home, with his wife and daughters.

Anne’s health is generally good, though she has mild arthritis and takes tablets for angina. However, she is becoming less strong and more tired. Anne has some hearing impairment and finds it difficult to read small print. Anne devotes her time to caring for Arthur and no longer goes to church. Both were previously active in the community and attended a local lunch club. Anne is determined to be there for Arthur and does not like to leave him, even with someone else. Her main concern is that she will not be able to support Arthur till the end. Anne is beginning to find it difficult to look after the home and garden, and to feel quite isolated. She is not confident in managing the family finances and is not sure how she will manage when Arthur is gone.

Carol is concerned about her mother not sleeping well and looking tired. She rings the local authority.

You are the social worker, and go out to see Anne and Arthur.

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• What potential is there in the Care Act 2014 to support Anne flexibly as things change?

How can you develop integrated support for the family in this end-of-life phase?

How can social work’s therapeutic role support Anne and Arthur?

It’s my choice to care for my family and I want to keep on doing that, and be a good mum and a good daughter.

Eve is a carer for her father, who has early-stage vascular dementia and numerous health problems. She has two children: a son, Matt, who is 17 and has Crohn’s disease, and a daughter, Joanne, who is 15.

Read more about Eve's story below. 

Download the About Eve case study (PDF)

Read Eve's story

Eve Davies lives in a town. She has two children, a son, Matt, who is 17 and has Crohn’s disease, and a daughter, Joanne, who is 15. Eve’s mother died four years ago, and her father, Geoff, lives close by. Geoff is living with early stage vascular dementia and numerous health problems relating to a heart attack he had two years ago. Eve works part time in an administration role at a local college. She has lost contact with her friends and lost touch with her hobbies (swimming and singing in a choir) because she has prioritised her family.

Matt is at college studying for his A levels. He is frustrated that his illness is interfering with all aspects of his life. Joanne is becoming more withdrawn and resentful as an increasing amount of Eve’s time is taken up with other family members. Geoff often forgets to eat or wash, and is finding it more difficult to carry out daily tasks. Following a social care assessment, he has a befriending service stop by every week and a homecare team each morning to check he’s ok and supervise his medication, which Eve sets up for them. The care agency have reported that there’s a possibility Geoff has been accessing his medication and taking it. Geoff remains adamant that he is fine, and with Eve’s support he can manage.

Eve is feeling stressed and isolated. She wants to increase her working hours for financial reasons, but is unable to as she needs to be available for Geoff. Eve is having problems with sleeping and feels generally run down, and recently has been suffering from stomach pain and nausea. She says that she feels ‘withdrawn from normal life.’ She tried attending a carers’ group but found that listening to other carers’ problems highlighted her own. Instead, she sometimes uses an online forum at night when everyone else is asleep.

Eve was recently referred by her GP for a carer’s assessment.

You are the social worker and go to see Eve.

How can the Care Act 2014 duty to assess how far a carer is willing and able to care empower Eve?

How can a whole family approach help everyone to understand and respond to this situation?

What does a strengths-based approach look like for someone living with dementia?

About George

Just tell me what help is out there and I will get it sorted.

George helps out their friend David who lives 150 miles away across the Welsh border. David has depression and has been in and out of hospital.

Read more about George's story below. 

Download the About George case study (PDF)

Read George’s story

George Cook and David Taylor grew up in the same small border town and went to the same all-boy’s school in Wales. George moved away to London and became a lawyer. They are nonbinary (pronouns they, them), and have a busy work and social life. David was diagnosed with depression when he was in his late 30s. He lives alone and is often unemployed, and is a regular drug user. David’s parents are both dead and his friends have drifted away, apart from George.

George loves their childhood friend and wants to make sure he is ok. They go back to visit David every 4-6 weeks, whenever work allows. It is a 3 hour trip each way, and George usually stays overnight, tidies up, encourages David to go out for a walk, and brings shopping and anything David needs. George usually gives David some money, though they worry what David might spend it on.

George is finding the physical toll of the visits is getting too much. The greatest impact, though, is emotional. David sends frequent messages, including through the night, and George doesn’t feel able not to respond. At times, the messages are very low and George will call and be on the phone for hours. One time, David did not answer and George drove to see him, missing an important work meeting.

George has no idea what would help. They have called the council and said they need to talk to someone who knows about social services. The person they spoke to said that they could talk to a social worker to get some advice but it is complex because David lives in Wales.

You are the social worker and arrange a video call with George.

How can you ensure that borders are not a barrier to good social work?

How can you support George to have the relationship that they want with their friend?

How can you help people to balance risk enablement and risk management?

It’s lonely and I could do with somewhere to let off steam.

Jake supports his second wife Deborah, who has Parkinson’s. He does not see himself as a carer.

Read more about Jake's story below. 

Download the About Jake case study (PDF)

Read Jake's story

Jake Adler is 63 and looks after his wife Deborah. Deborah was diagnosed with Parkinson’s two years after they got married. They were both widowed and met through the Jewish community group. They each have two sons, who visit regularly, as well as friends and neighbours that they see often.

Over the last year, Deborah has found it increasingly difficult to leave the house and is reluctant to have visitors. Jake has gradually given up his social activities and has not renewed his season ticket for the football.

Jake was an engineer so he has done some DIY in their home to make things easier for Deborah. He provides all the physical help that she needs and manages everything in the home. Jake has taken pride in not asking anyone for help. A few months ago, a friend suggested that he went along to a support group for family of people with Parkinson’s. Jake found that most people there were women and that he didn’t want to talk about Deborah’s illness. He just wanted someone to talk to about the things he was interested in.

Deborah has become more withdrawn and Jake misses her even though she is there. The social network had been maintained by Deborah and so they are now falling out of touch with people.

One of the neighbours suggested that Jake ask the council about a ramp to get in and out of the house, and so he phoned up and agreed to a carer’s assessment.

You are the social worker and arrange to meet Jake in a café to talk.

• How can social work empower people as carers if they do not see themselves as having this role?
• How do gender differences and socially configured roles affect the experiences of caring?
• What is the social work role in tackling loneliness?

About Josef

I’d like some free time on my own to have time to myself or go out with friends. I need someone to talk to about mum.

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.

Read more about Josef's story below. 

Download the About Josef case study (PDF)

Read Josef's story

Josef Mazur 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 online 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 a social worker.

You are the social worker and have a meeting with Josef.

• How can a human-rights approach empower Josef?
• What social work capabilities are needed to build a relationship with Josef?
• What considerations are there around capacity, confidentiality and consent?

About Michelle and Joel

We need to know what will happen when we can’t look after Daniel.

Michelle and Joel have been married for 45 years and have two sons, Clinton in Scotland and Daniel, who is 34 and lives with them. Daniel has a learning disability.

Read more about Michelle and Joel's story below. 

Download the Michelle and Joel case study (PDF)

Read Michelle and Joel's story

Michelle and Joel Tyndell live in a city. They were both born in Kingston, Jamaica, and moved to the United Kingdom in the 1970s just after they were married. They have been married for 45 years and have two sons, Clinton in Scotland and Daniel, who is 34 and lives with them. Daniel has a learning disability. Michelle gave up work when Daniel was 16 to support him. Joel retired three years ago. Over the years they have sought support through the council but it has never worked very well.

Daniel volunteers at a local charity a few days a week, helping with teas and coffees. He would like to live independently. Joel and Michelle are worried this won’t work. Daniel is well known in the local community. He is also known to the police due to a few incidents where he has been violent. Daniel is often misunderstood as it is not immediately clear that he has a learning disability, and people who don’t know him can react to his behaviour. This is made worse by racist stereotyping also affecting how people react to him. Daniel has some friends from volunteering and some other friends from the local area.

Joel and Michelle support Daniel to ensure he is washed and dressed appropriately, has had his medication and knows where he needs to be. Sometimes Daniel refuses his medication. Daniel has a mobile phone which he is able to make and receive calls on. Sometimes Michelle drives Daniel and sometimes they take him to the bus. Daniel has his own money but it is not clear what he is spending it on. Michelle and Joel are concerned that Daniel may be giving money to his friends.

Joel and Michelle love their son, however they are exhausted and feel undervalued by providing his care. They have had to make choices to put Daniel first, have few friends and rely on each other. Joel had a heart attack last year and they are fearful about what will happen with Daniel in the future. Before children, Michelle and Joel were keen music fans.

Michelle and Joel recently rang the council and asked for someone to talk to them about their situation.

You are the social worker go out to see Michelle and Joel.

• How does the Care Act 2014’s duties around preventing needs help you to plan for the future?
• How can you balance the needs of the different family members involved?
• How can you ensure your practice is sensitive to any cultural difference?

About Muhammed and Maryam

I want to fulfill my responsibility to my daughter.

Muhammed and Maryam have one child Layla who is 17 years old. Layla was born with Spina Bifida and has been attending a residential college.

Read more about Muhammed and Maryam's story below. 

Download the About Muhammed and Maryam case study (PDF)

Read Muhammed and Maryam's story

Muhammed and Maryam Hossain live on the edge of a large city. Muhammed’s parents came to the UK from Bangladesh in the 70s and he was born here. He married Maryam from Bangladesh 25 years ago and she came to live in the UK then. They have one child Layla who is 17 year’s old. Layla was born with Spina Bifida. She uses a walking aid and has an electric wheelchair. Layla has been attending a residential college where she has made good friends. She hopes to keep studying and to move in with friends.

Muhammed and Maryam want to support Layla and also to ensure that she is safe and her religion (Islam) is respected.

Muhammed and Maryam are conscious that people they know through the college had a difficult experience when their children turned 18. They want to ensure that Layla has the right support and opportunities, and to start planning for that now. They don’t have any savings themselves. Muhammed’s job is not well paid and they don’t have a house of their own. Recent increases in bills have made it difficult for them to manage when Layla comes home as the house needs to be warmer and they use more electricity.

Muhammed rang the council and asked to speak to a social worker.

You are the social worker and go out to visit them with an interpreter as Maryam finds complex topics in English difficult.

• How does the Care Act 2014’s duties around transition help you to empower this family?
• How can you ensure that both carers are fully involved and their needs are considered?
• What is the social work role in promoting economic wellbeing?

About Susan

I’d like someone to discuss my concerns with and talk things through, so I feel reassured I am making the right choices, for both of us. I must get it right.

Susan is the carer for her partner Grace who is 82. Grace has become increasingly frail and, following hospital admission and rehabilitation, has agreed to a trial for three months in a care home.

Read more about Susan's story below. 

Download the About Susan case study (PDF)

Read Susan's story

Susan Reinfeld is 70 years old. She is primary carer for her partner, Grace Wilson, who is 82. In their younger days Susan and Grace travelled widely, they had a large network of friends and although they don’t have any children of their own, they have nieces and nephews. Susan is particularly close to her nephew Graham. Grace has generally taken the lead in decisions and in the relationship. Sometimes now she gets angry with Susan if she doesn’t do things the way Grace expects or if Susan makes a suggestion that Grace sees as ‘stupid.’ Grace’s family has at times struggled with her sexuality and while her relationship with her nieces and nephews is good, her relationship with her brother Clive has been more difficult.

Over recent years Grace has become increasingly frail and has relied on Susan to get washed and dressed, and use the toilet, as well as maintain the home and cook meals. Two months ago, Grace had a fall and was admitted to the hospital. She was discharged to a rehabilitation bed in a care home. Before the hospital admission Susan and Grace were not in contact with services. Whilst in hospital and the care home, Susan has visited every day and helped Grace with personal care. Grace frequently phones and texts Susan. After six weeks of rehabilitation, Grace continues to need support to walk and with all her personal care, including support at night. You have been involved in a multi-disciplinary assessment which has recommended that Grace needs 24-hour care. As part of this assessment, Susan talked about how exhausted she is, and said that she no longer feels able to support Grace at home because of the impact on her health. Grace has agreed to a trial three months in a care home.

Susan and Grace are not legal partners, as they have not entered into a civil partnership nor are they married. Susan has no power of attorney for Grace. Susan is worried about the costs of a home and how this will be paid for. She feels guilty about ‘letting Grace down’ and sad about the future she will no longer have with Grace. Susan is also worried about Clive’s reaction.

Susan has asked to speak to someone about her concerns.

You are the social worker and go to meet Susan.

• How can a human rights perspective help you to empower Susan and Grace?
• How can you act as a navigator to make the systems around Susan and Grace transparent and understandable?
• How does an intersectional view of Susan’s and Grace’s identities (seeing the overlapping aspects of identity) help you to understand how they respond to social care?

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