Case Study – Social Work and Anxiety / Stress

Two case studies about barriers to practice placements and how these were overcome.

Case Study A

This information was taken from Sapey, B. et al. (2004). "Access to Practice: Overcoming the Barriers to Practice Learning for Disabled Social Work Students." SWAP LTSN.

M has acquired dyslexia after she injured her brain falling from a horse at about 11 years. She has a history of academic underachievement and has relatively little self-confidence, however academically she developed well on the postgraduate social work course and has registered a consistent level of improvement. She also performed well in her first assessed placement.

Her final placement was much more problematic; she found the work stressful and the assessment processes difficult to manage while the uncertainty of duty work was particularly hard on her to manage. One of the effects of her impairment was a need to segment the work into separate manageable chunks and to focus on one thing at a time. Her practice teacher saw her as making slow progress and was concerned that she would not meet the practice requirements. This made the student more stressed and when stressed her anxiety increased and her performance declined. In her tutor’s view, her disability was at the root of this, but the practice teacher saw her as someone who could not meet the core competencies and she failed the placement.

If practice assessors are unaware of the effects that certain impairments can have on the performance of a student they will be unable to make suitable adjustments and will make bad decisions about disabled students’ ability to practice social work. It is essential that practice assessors are able to learn from their students about the way their impairments may affect their learning on placement. Higher Education Institutions should ensure that practice assessors are competent to supervise and assess a disabled student.

It is also important for managers in Higher Education Institutions and agencies to create an atmosphere in which the student feels free to disclose, and where the issues can be clearly communicated to the practice teacher. Tutors and assessment panels need to ensure they pick up on these issues when placements are reviewed.

Case Study B

This information was taken from (information accessed and extracted September 2008)

Hannah was a first year social work student with mental health difficulties. She had experienced agoraphobia and acute anxiety for a number of years which she had managed well in the three years before her arrival at university. When she became particularly worried or stressed she experienced anxiety attacks and her blood pressure would rise. Whilst attending university, a range of support measures were put in place, and with the exception of one occasion when she had needed to leave a lecture, she had successfully completed her first semester. She was about to undergo her first placement with a statutory agency providing services for children and families. Like all social work students, she was particularly worried about how she would manage this new and demanding experience.

A number of different issues were identified with Hannah by the university disability adviser. She felt that she became very tense in new and/or unusual situations and that this might result in anxiety attacks. She was aware that she would have to meet with service users (people she didn’t know) and go to new environments. She did not want to be seen as ‘not able to cope’ and wanted to perform well in practice. She was especially concerned that she might experience an attack when she was with a family. She could recognise when an anxiety attack was coming on and usually found that going for a walk and taking ’10 minutes out’ was sufficient for her to manage her anxiety. Stress often exacerbated her condition and she needed to take regular breaks throughout the day to prevent this building up.

Adjustments negotiated:

The following adjustments were agreed with Hannah to enable her to meet her practice learning outcomes. They were then agreed with the university department and the practice agency to ensure that they did not compromise any academic and/or professional standards:

  • A pre-placement visit to enable Hannah to familiarise herself with the physical environment and be introduced to key members of staff including her practice assessor/teacher. A member of disability support staff also came on this visit to provide additional support to Hannah in negotiating her adjustments.
  • The practice assessor/teacher and agency staff were asked to take into consideration Hannah’s need to be adequately prepared and supported when undertaking a first visit to a family or when confronting other new experiences. A system was to be set up for Hannah to have accompanied first visits with a gradual reduction in support over time to allow her to complete visits independently as the placement progressed. The level of support and its reduction were discussed and agreed between the practice assessor/teacher and Hannah throughout the placement.
  • Hannah was given the opportunity to take regular breaks throughout the day in agreement with her practice assessor/teacher and in accordance with the schedule of activities/workload asked of her (e.g. coffee break, lunch break).
  • The adjustments were reviewed at the end of the third week of the placement by the practice assessor/teacher and Hannah.
  • Hannah took responsibility for communicating any additional needs or concerns to the practice assessor/teacher.

Both Hannah and the Practice Assessor/Teacher agreed that it might be necessary at times for these support arrangements to be adjusted slightly to meet the requirements of the placement learning experience (for example, a break might not be possible as scheduled). All the agreed adjustments were formalised in a letter to Hannah, the practice assessor/teacher and the department placement co-ordinator by the member of staff from the Disability Support Service.


Hannah successfully completed all learning outcomes for the placement and met the required national occupational standards. The level of support she needed for working with families was gradually reduced over a two month period when both Hannah and the practice assessor/teacher were confident that this was no longer necessary. Hannah continued to experience anxiety at times throughout the placement but worked closely with her practice assessor/teacher to develop strategies to manage this.


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