This paper works to engage with this gap in literature by assessing the perceptions social workers have of sex working clients and its effect on the services offered by social workers. Concurrently, this paper assesses the ideologies of power implicitly and explicitly implemented by the institution where social workers are employed and how these ideologies are expressed.
Methods: This study used a multi-method approach including in-depth interviews of 14 social workers working within a medical institution, as well as a content analysis of the Employee Handbook of the institution they work under. The interview protocol presented narratives of potential clients, created with the guidance of a key informant to ensure appropriate representation. The “thinking out loud” method of cognitive interviewing was used as participants provided professional recommendations to each narrative. Interviews were transcribed verbatim and guided by both inductive and deductive methods.
Foucauldian Discourse Analysis (FDA) was used in analysing the Employee Handbook to uncover the ways the institution itself enacts a preferred ideology down to it’s employees through the discourse surrounding their employment within the institution. Key questions being engaged with through this process involved how the institution framed the relationship between the worker, the client, and the institution itself.
Findings: Preliminary findings of the interviews suggest that social workers’ professional recommendations for sex working clients differ from those who do not engage in sex work. Social workers' employment of characterological legimitizations, as well as resource gatekeeping and embracing punitive, carceral methods were prevalent in the decision-making process. Themes of surrounding institutional pressures and the influence of prior experience were also discussed.
FDA of the New Employee Handbook reflected the ways in which the institution promoted and embedded hierarchical structures within its workforce. Employees are designated as “at will”, establishing a dynamic that places their success as an employee dependent on how they conform to the policies and practices of the institution. Individuals seeking services at the institution are referred to both as “consumers” and “patients”, promoting their interactions as transactional rather than personal, and as medical subjects lacking bodily autonomy. These results help contextualize social workers perceptions and recommendations towards sex working clients.
Conclusions and Implications: Medical social workers are often the first contact for individuals in need of social services. These findings highlight the particular disadvantages sex workers face through social service gatekeeping and the entanglement of institutional ideology and social work practice. Social workers can better engage with and earn the trust of marginalized communities by being more critical of the ways in which they police their clients and endorse oppressive systems through their recommendations.