Oglensky, York College, City University of New York, New York, UNITED STATES Abstract: Despite increasing awareness of the importance of clinical documentation to the delivery of effecti
Trang 1The International
JOURNAL
SOCIAL SCIENCES
Volume 3, Number 6
Record-Writing and Professional Socialization in
Social Work
Bonnie D Oglensky
Trang 2THE INTERNATIONAL JOURNAL OF INTERDISCIPLINARY SOCIAL SCIENCES
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Trang 3Record-Writing and Professional Socialization in Social Work
Bonnie D Oglensky, York College, City University of New York, New York, UNITED STATES
Abstract: Despite increasing awareness of the importance of clinical documentation to the delivery of effective social work services, little attention has been paid to training social work majors in professional writing In this article, I present an overview of efforts to address this gap through a workshop series for undergraduate social work students called “Writing
in the Field.” Applying the concepts of genre and cognitive apprenticeship from writing composition and learning theories,
I outline the theoretical underpinnings of the workshops Based on an analysis of “encoded ways of knowing” found in the structure and conventions of content of one social work record known as the “Psychosocial Assessment Report,” I argue that competent clinical report-writing reflects the development of cognitive processes that are aligned with and uphold the logic and values of the social work field As students learn how to write clinical records, they learn how to think about clients, behave like social workers, and begin to develop a sense of what it feels like to be a member of the profession Viewed in this way, clinical documentation is considered a powerful tool for the professional socialization of social work students.
Keywords: Professional Socialization, Writing to Learn, Field Writing, Record as Genre, Psychosocial Assessment Report
Introduction
SOCIAL WORK EDUCATORS and
practi-tioners have become increasingly aware of
the importance of professional writing to the
effective delivery of social work services
(e.g., Beebe, 1993; Reynolds, et al, 1995) The
ad-vent of managed care and ever-expanding systems
of accountability have served to underscore the
crit-ical role of documentation and report writing (e.g.,
Callahan, 1996; Swain, 2005) Yet, several have
noted that social work student skills are weak in this
area (Alter & Adkins, 2006; Ames, 1999; Rompf,
1995) My experience as Director of Field Education
in the Social Work Program at York College
(CUNY) over the past five years unfortunately
con-firms this Supervisors at internship sites often
com-plain about the quality of student writing—some
even feel the need to limit their writing of agency
records until some level of proficiency is
demon-strated
Beyond our duty to prepare students for the
everyday demands of social work jobs, the
acquisi-tion of report-writing skills—particularly clinical
report-writing skills–can be viewed as a way for
students to learn about the profession in a broader
sense A means of communicating with colleagues,
competent clinical report-writing reflects the
devel-opment of cognitive processes that are aligned with
and uphold the logic and values of the social work field Hence, as we learn how to write clinical re-cords, we can learn how to think about clients, be-have like social workers, and begin to develop a sense of what it feels like to be a member of the profession Consequently, both the employability
and professional socialization of social work
gradu-ates would seem to depend upon mastery of these skills Given its centrality to professional functioning,
it is surprising that so little attention has been paid
to training social work majors in this kind of writing Supported by a university grant and in collabora-tion with a Writing Fellow,I developed and piloted
a workshop series called “Writing in the Field”1to soon-to-be graduating baccalaureate social work students during spring 2008 on a voluntary, non-graded basis Designed like a professional confer-ence–replete with a light breakfast, packets, badges, certificates of completion, and “shmooze” or network-ing time—21 students attended the series which featured 2 workshops held one month apart—entail-ing 6-hours of in-class trainapart—entail-ing, video-role play activities, the use of a rubric outlining 12 report-writing competencies, and a take-away report-writing task
in which students were asked to apply skills they learned in the workshop to assemble, analyze, and write a “Psychosocial Assessment Report” based on
a social work case on the Internet.2The goal of the
1 This project is supported by a federal Title III grant administered through the Center for Excellence in Teaching and Learning (CETL)
at York College, City University of New York Thanks to Title III grantee group members and Dr Debra Swoboda as well as colleagues and students in the Social Work Program for helping to get this project off the ground Special thanks to CUNY Writing Fellow Jennifer Worth for her commitment and fine collaborative work on this project.
2
The simulated on-line case material was developed by Dr Annette Bailey, Sacred Heart University, Fairfield , Ct.
THE INTERNATIONAL JOURNAL OF INTERDISCIPLINARY SOCIAL SCIENCES,
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Trang 4workshop series is to strengthen clinical
record-writing skills while building habits of thinking and
practice that instill professional identity, role, and a
sense of practice responsibility in budding social
workers “Writing in the Field” is also conceived as
an action-research project focused on the design,
implementation, and outcomes of the workshops A
forthcoming paper will present the project outcomes
and research findings
This article will focus on the conceptual and
the-oretical underpinnings of the “Writing in the Field”
workshop series I will outline the relevant literature,
explicate concepts from writing composition theories
that are fundamental to my pedagogical approach,
and offer a set of proposals as to how training in
clinical documentation can groom students to think
and behave like professional social workers I
con-clude with considerations about future direction and
challenges ahead
Literature Review
There is a relatively sparse literature on pedagogical
work on professional report-writing in social work
This is probably due to the fact that there are few
educational initiatives addressing this kind of writing
While some universities offer courses in professional
writing in social work, a review of syllabi reveals
that these tend to skim the surface, covering a range
of written products such as research papers, advocacy
letters, brochures, and resumes (e.g., Sarnoff, 2007;
George Mason University Social Work Dept, 2007;
Ohio University, 2007) Among these courses, one
class session is usually devoted to report–writing
and within that session, the aim is to offer general
guidelines about various types of records social
workers write And there are many Hence, coverage
tends to be quite superficial
Of course, “Writing Intensive” or
discipline-spe-cific writing courses are now offered at a number of
colleges An extension of the Writing Across the
Curriculum movement in higher education, these
courses offer students the opportunity to practice and
improve writing skills, yet the
“writing-in-the-discip-line” focus is on gaining knowledge of relevant
content material (Carter, et al., 2004) So, for
ex-ample, in the writing intensive “Generalist Practice”
course offered in the social work program at my
college, writing assignments are focused on social
work interventions with formal organizations and
communities—not the acquisition of professional
writing skills Even courses expressly designed to
teach professional writing such as one (also at my
college) called “Research and Writing for
Profession-al Programs”—neglect the more practicProfession-al kinds of
writing—concentrating instead on the skills of
writ-ing a research paper A review of course bulletins
and syllabi from a cross-section of colleges in the
U.S reveals that when writing is explicitly addressed
in social work curricula, the emphasis is almost al-ways on academic, not workplace writing
Still within the realm of academic writing, a seg-ment of social work literature deals with experiential writing—in which low-stakes writing approaches designed by social work faculty to teach or use writing in coursework are evaluated Broadly speaking, the goal of these pedagogical projects is either to help students improve writing in a general sense, for example, by gaining confidence in their ability to write (e.g., Rompf, 1995), or by using the process of writing to help students enhance other social work practice capacities For example, writing journals (Dolejs, et al., 2000) or reflective papers (Rai, 2004) has been shown to expand capacity for self-awareness—a crucial skill in building rapport and a working alliance with clients
Notwithstanding the dearth of scholarship on the pedagogy of record-writing in social work, there is
an emerging literature on social work documentation itself A fair number of articles and books deal with the nuts and bolts of record-writing in social work and related professions These tend to be how-to oriented (e.g., Reynolds, et al., 1995, Beebe, 1993; McKane, 1975), offering the practitioner technical guidelines, focused on mechanics Some of these publications (e.g., Beebe, 1993) appear on the syllabi for social work courses in professional writing and
in this sense, could be considered instructional ma-terial There are also a few studies which look at documentation through the lens of audience or con-text; for example, the need for social workers to write reports that can pass muster in managed care, court,
or legal proceedings as social workers advocate for (or sometimes unwittingly against) their clients (e.g., Cumming, et al., 2007, Callahan, 1996, Swain, 2005) Concerns about risk and liability are in the forefront
of these Principles for training students and practi-tioners to write records that simultaneously protect social workers, clients, and agencies while upholding professional ethics are proposed While technical assistance with report writing is helpful, the use of report-writing as a tool for continuous learning and
reflection on one’s own practice and development is
seldom mentioned in this literature
Unpacking the ‘Psychosocial’
Taking seriously the opportunity to learn from re-cord-writing, this project introduces a novel approach
to professional writing in social work honing in on the competencies needed to write one document in particular This narrative record, known as the
“Psychosocial Assessment Report” is a prototype in the social work field (Vourlekis & Hall, 2007) The most universal and comprehensive record that
Trang 5prac-titioners are expected to write, the
“psychoso-cial”—as it is commonly referred to—has evolved
historically as a staple of social work practice (Crisp,
et al., 2004) Most other social work reports contain
subsets of the kinds of information and assessment
material contained in the psychosocial, so learning
to write this document can provide a solid foundation
for writing most other clinical reports in the field
A few words on the role and functions of the
psychosocial are in order The psychosocial is
actu-ally a process, one outcome of which is the report
Social workers write this document after gathering
information about the client—from interviews with
and observations of the client, exchanges with
indi-viduals associated with the client (e.g., family
members, friends), collateral contacts (e.g., other
professionals who have knowledge of or are also
working with the client in some capacity), and review
of written records (e.g., from the agency, referral
source documentation, and other documents
includ-ing: psychological, psychiatric, medical and
educa-tional tests, and court and legal records) The process
of gathering this information typically occurs within
the first few weeks after the social worker has met
the client and the report is generated shortly
there-after
The psychosocial assessment report has several
functions Similar to a medical history, it is the
pro-fessional’s protocol for compiling information
relev-ant to arriving at some educated guesses about what
the client “clinically speaking” is dealing with (in
medical fields this is known as diagnosis; in social
work—it is called assessment) ultimately for the
purpose of generating a treatment plan including
in-terventions and recommendations for service As
such, it serves as the initial study of the client
Be-cause it is written at an early point in time, the
psychosocial also functions as a baseline document
Assessments of client progress based on goals from
the original report can be made Intervention
ap-proaches and the goals themselves can be
re-ex-amined against the original report, and revised as
fitting
The commonplace view of the psychosocial is that
it is a means of communication with agency
col-leagues; when the social worker is not available, the
record can be consulted to access information about
the client From a bureaucratic standpoint, however,
the psychosocial record—like any other official
re-cord—is a testament to the fact that even though the
social worker has been assigned to work with the
client and this person becomes “his or her client”,
that person is, in fact, a client of the agency The
re-cord has a clear formal dimension of accountability:
it can be inspected in an agency audit, forwarded to
insurance companies, subpoenaed by attorneys, and
increasingly—with the advent of federal patient protection regulations—reviewed by clients
Little has been made of the fact that the psychosocial, apart from its official status as an agency document, has a critical function in how a social worker metabolizes casework practice Re-cently, I met up with a colleague who shared a story about the importance of writing to her understanding
of one of her clients A seasoned therapist in private practice, the colleague had just finished seeing a cli-ent who she felt “stumped” by She said she “could not put her finger on what the client was dealing with”—she “couldn’t get a handle on him.” It wasn’t until she wrote out her report and in so doing brought
to light and thought through her more nascent impres-sions, that she understood how to frame the client’s difficulty This story—a version of which I have heard repeatedly from students and colleagues alike—underscores the invisible function of the psychosocial as a structure and process of figuring things out about the client In this sense, writing the
psychosocial is ‘doing social work.’
Conceptual Sketch
Framed by the norms and customs of social work practice, I am viewing the psychosocial as a “writing genre” defined by Schryer as a “specific literary practice—evolving within a specific context” (1993,
p 200) Using this definition, other writing genres include, for example, the English composition in a college classroom, a peer-reviewed paper given at a professional conference, and a rejection letter sent
by a corporate headhunter to a job applicant As a routine and conventionalized way of communicating,
a writing genre is “a dynamic patterning of human experience” (Devitt, 1993, p 573) Put another way,
a writing genre shapes our thinking, sensing, and sense-making of the “thing itself”–that is, whatever
it is we are writing about (Paré, 2000)
For biology professors Carter, Ferzli, and Wiebe (2007), the lab report is a writing genre; it is not only
a set of mechanical and literary conventions but in
the process of learning how to write it and in the actual writing of it, it is also a way of informing and
shaping how biologists think, appraise, consider, in-terpret, understand, render opinions about, make sense of, and communicate about experiments As such, learning to write the lab report is part of what Carter, et al., (2007) refer to as “cognitive apprentice-ship.” Challenging the traditional dichotomy in the academy between learning versus doing, the learning model of cognitive apprenticeship is “based on the principle that the ways of doing that define an authen-tic activity in a knowledge domain embody the ways
of knowing that domain” (p 283)
9 BONNIE D OGLENSKY
Trang 6My work takes off from these precepts as I have
adopted the perspective that in-depth, hands-on
training in writing the psychosocial is “a way of
bringing authentic activities of a knowledge domain
to the classroom” (Carter, et al., 2007, p 283)
Stu-dents are offered instruction in how to compose a
quality report and thus develop marketable skills for
the jobs they will likely hold Just as importantly, in
the process of undergoing such a training, students
are exposed to the inner workings of the specific
re-cord-writing genre This includes it logic, the purpose
of various sections, the rationale for its sequence,
the rules and norms for gathering, presenting, and
evaluating client material, the role of evidence,
ob-jective fact, and subob-jective impressions, and the
standards and expectations for arriving at and
articu-lating treatment decisions and recommendations
Moreover, the social work values of respect,
trans-parency, empathy, objectivity, humility, and
account-ability are also are a part of the inner workings of
the psychosocial—embedded in the competencies
needed to write the report This kind of integrative
training linking the conceptual and ethical
underpin-nings of report-writing with work-specific
conven-tions and guided practice offers the student a unique
type of anticipatory socialization—that is, a
“rehears-al” opportunity to transition into the profession and
to begin to view oneself as a member in it (Merton,
1957)
Grounded in the language of dialectical thinking,
this project thus views learning to write and writing
to learn as inverse processes that should not (and
cannot) be pulled apart from each other, except for
heuristic purposes Teaching social work students
how to write the psychosocial, while certainly a
worthy end in and of itself, takes on a loftier role as
it offers a cognitive apprenticeship and mode of
so-cialization into the professional community
The Psychosocial as a Tool for
Professional Learning
So how, then, can training in writing the
Psychoso-cial Assessment Report prepare soPsychoso-cial work students
to think and behave like full-fledged practitioners?
What is it about writing the psychosocial that
encour-ages professional socialization? I am proposing that
this occurs as the student learns about and practices
writing with a consciousness of two distinct aspects
of the genre: the psychosocial report structure and
its conventions for content.
According to Carter et al (2007), the genre of the
report “encodes a way of knowing in its structure.”
What this means is that the way the report is
built—its format, list and sequence of topics, and
discursive conventions—becomes a guide for
knowing the work of social work In perhaps the
most elemental way, the specific topics addressed in
the psychosocial reflect areas of concern and expert-ise that a social worker is expected to possess The social work student must become familiar with these topics and must organize the data he or she collects from the client in terms of these categories of the trade As Goodwin (1994) notes, classification is a basic human cognitive activity involving sorting and transforming various phenomena “into the categories and events that are relevant to the work of [a] profes-sion” (p 608)
The topics on the psychosocial (see Figure I) in-clude client background and current functioning with respect to: family relationships, education, employ-ment, psychological issues, medical concerns, social connections, basic necessities, coping capacities, spirituality, legal matters, and community supports This particular variety of topics—bridging individual and community/societal considerations—is a hall-mark of the social work profession, historically dis-tinguishing it from psychology and psychiatry whose central focus has primarily been on the individual Hence, the social work student learns about and takes part in reaffirming the profession’s commitment to understanding human suffering and growth in the context of both individual and environmental factors—each time he or she writes up an assessment
Moving through the sequence of the psychosocial
report also encodes a social work way of knowing The guidelines here are implicit The report has three main sections of material concerning the client: demographic information, the body of the report which is divided into subsections regarding the cli-ent’s background and current functioning with re-spect to the range of “psycho-social” areas including those listed above, and a final segment dealing with the social worker’s summary, assessment, recom-mendations, and plans for service
In terms of clinical reasoning, each section follows purposefully from the section prior Salient identity facts come first Issues like age and language spoken
by the client, for example, are characteristics which should direct choices about gathering and recording assessment material; the social worker would not necessarily ask about or complete the subsection of the report regarding employment, for instance, if the client is a young child But the social worker should—when exploring and documenting all the subsequent areas—present material that takes into account demographic characteristics of the client such as age, race, socioeconomic status—that are likely to affect the client’s life experiences and devel-opmental capacities These demographics should trigger certain lines of questioning, that is, when the social worker is gathering the data and writing up the report
Trang 7Although probably obvious, it is worth highlighting
that in anticipation of writing the psychosocial, the
social worker engages in the process of collecting
the data about the client; in this sense, the
psychosocial report organizes the clinical experience
of interviewing client—e.g., what questions to ask
and how to ask them, which questions to follow-up
on and which are less pressing, what non-verbal
be-havior to observe and how to watch for patterns
Hence, as mentioned earlier, the genre is not only a
set of mechanical and literary conventions, but
pen-etrates into the practice of clinical social work
Training students to write the psychosocial, therefore,
is embedded with training in practice skills
The case material presented in the body of the
re-port builds a picture of the client’s “story”—e.g., his
or her view of the “presenting problem”—that is, the
reason/s that the client has come to the agency for
help—as well as the client’s strengths, weaknesses,
support systems, resources, coping skills, and
histor-ical events and milestones as they relate to the report
topics The genre is organized such that the social
worker presents material about the client and
then—considering all of that material—synthesizes, prioritizes, hypothesizes, and offers an overall assess-ment and plan The key point here is that the social worker needs to develop a comprehensive description
of the client before impressions and treatment plans can be proposed This final section is the place where the social worker “makes something of the data” in the report, summarizing the main issues and render-ing professional opinion about what should be done
to assist the client The overall sequence of the psychosocial, thus, forms a logic—a series of steps (though not necessarily distinguished as such con-sciously) for constructing and thinking through a client’s story—to arrive at a set of clinical opinions and recommendations, preliminary ones, at least, about how to help This is where the record comes
to its final point—and the social worker is supposed
to navigate through the record, understanding the need to connect the dots
Beyond the structure of the report, the second way that writing the psychosocial serves as a socialization tool relates to issues of content—what data should
be included and how should it be expressed The
11 BONNIE D OGLENSKY
Trang 8conventions of how a psychosocial should be
writ-ten—including the appropriate use of language, facts,
impressions, detail, quotations, illustrations,
interpret-ations, speculinterpret-ations, and opinion—also encode a way
of knowing the field of social work As my
collabor-ator and I identified and delineated “competencies”
for a rubric to be used in the workshop series (see
Figure II), we became keenly aware of the fact that
the conventions for writing a good psychosocial are
in synch with and when applied, reinforce core
val-ues, ethics and practice principles in the social work
field I shall offer a few examples
Some of the alignments are obvious First, “uses
non-judgmental language and offers a non-biased
presentation” (Rubric Competency #4) fits with a
number of tenets in the National Association of
So-cial Workers (NASW) Code of Ethics (1999) The
section on “Social Workers’ Ethical Responsibility
to Clients,” contains a subsection on “Derogatory
Language” (p 13) which clearly states this
expecta-tion for the psychosocial genre: “…social workers
should not use derogatory language in their written
or verbal communications to or about clients Social
workers should use accurate and respectful language
in all communications to and about clients.” Another
subsection on “Cultural Competence and Social
Di-versity” (p 10) which states that “social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures” is also enacted and upheld as the student learns to recognize and use a bias-free language and approach in his or her presentation of the client in the psychosocial report
The ability to “use clear, descriptive, vivid lan-guage and quotes” (Rubric Competency #3) to depict the client in ways that acknowledge his or her unique qualities also adheres to an NASW ethical principle, that is, to “respect the inherent dignity and worth of the person” (NASW, 1999, p 8) By learning to avoid stereotypes and bland descriptions, the social worker is compelled—by the norms of the psychosocial —to continue developing and demon-strating in writing a “mindfulness of individual dif-ferences” (p 8) In addition to its value-basis, re-search findings support the clinical rationale for this principle–when people are lumped into labeled groups, the perceived range of possible behaviors decreases (Wilder, 1984) Keeping open to the indi-viduality of clients—and gaining practice in how to capture that in writing—socializes the social work student to reflect upon and question ingrained assump-tions about social groups
Trang 9Rubric Competency #5—”is informationally
accur-ate”—also accords with a social work value—one
that has to do with pledging not to distort, exaggerate,
or misrepresent what a client says or does; to be
truthful in reporting This is plainly stated in the
NASW Code of Ethics subsection on “Client
Re-cords,” “Social workers should take reasonable steps
to ensure that documentation in records is
accur-ate…” (p 18) While this might seem
self-evid-ent—any reporter would be encouraged to strive for
absolute accuracy; it is valued on its own terms—in
social work it carries another charge as it is related
to how one represents and therefore “treats” the
cli-ent If documentation is viewed as an “integral part
of clinical practice,” writing about the client must
be considered part of treatment, “not merely an
ad-ministrative side-task” (Cumming, et al., 2007)
A final example can be found in Rubric
Compet-ency #10—”is judicious”—which deals with a social
worker’s capacity to neither “make too much nor too
little” with the data More nuanced perhaps than the
other examples, this competency emphasizes the
values of humility and risk The professional social
worker must say something about the client in the
psychosocial, she is expected to offer some
profes-sional viewpoint or hunch (stated as such, if
appro-priate) Yet the social worker must not be flagrant
or sloppy in clinical interpretation A scientific ethic
grounds clinical reasoning in social work practice
Hypotheses, opinion, and interpretation must be
supported by evidence, as stated in NASW Code
4.01, “[s]ocial workers should base practice on
recog-nized knowledge, including empirically based
knowledge…” When evidence is not clear, the social
work student and practitioner learn to acknowledge
uncertainty in the psychosocial process and as they
do so, they enact a professional stance of humility
Concluding Thoughts and Challenges
Ahead
Following the recommendations of social work
scholars (Dolejs & Grant, 2000; Levy-Simon, 1989)
“Writing in the Field” is a cross-disciplinary project
rooted in writing composition and learning theories
I have developed an argument in this article, based
on notions of genre and cognitive apprenticeship,
that a propitious relationship between writing,
thinking, and professional socialization in social
work can be cultivated by teaching social work
stu-dents the craft of clinical report-writing, specifically the psychosocial assessment While forthcoming project outcomes and research findings will shed light on the impact of our workshops—that is, the extent to which social work students do, in fact, im-prove in clinical record writing skills and build habits
of thinking and practice that enhance socialization into the profession—important pedagogical questions remain
A key question is whether it makes sense for social work educators to continue to teach the classic nar-rative style of the psychosocial record or adapt to and train students to use standardized formats that are de rigueur in many social service agencies As
in much of our efficiency and accountability driven society, the trend is social work administration is to require that social workers fill out check-off forms (Kagle, 1993), a method that may shrink down the effort and time that goes into writing about clients, but probably also lessen the thought that goes into
it This emerging transformation of the psychosocial process to a standardized format is patently anti-so-cial work as it dehumanizes the client—referring to the client impersonally in categorical terms, reducing the rich, clinically relevant description of a client to labeling, and quashing the opportunity for the social worker to use the writing process and time for thinking about the client in ways are needed for perceptive and helpful assessment
Institutional demands…suppress narrative, speculation, elaboration—all the lengthy and messy uses of language that promote explorat-ory thought (Paré, 2000, p 161)
As this analysis suggests, continuing to teach the
“messier” narrative genre of the psychosocial report may offer students a powerful opportunity to develop reflective, transparent, value-anchored clinical reas-oning skills These skills are not confined to the pen and paper work of social work, but are likely to in-filtrate into how the social worker views the client and defines his or her outlook on professional respons-ibility Moreover, they lend themselves to modes of thinking that are crucial for understanding the inev-itable complexities and ambiguities of the human condition My hope is that this project with its new way of looking at the value of report-writing can help us counter the bureaucratic trend and thereby avoid “painting the client [and social work practition-er] into a box” (Snyder, et al., 2006)
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About the Author
Dr Bonnie D Oglensky
Dr Bonnie Oglensky is a professor and Director of Field Education in the Department of Social Sciences at York College, City University of New York, U.S Trained as a sociologist and social worker, Dr Oglensky’s primary research interests are in pedagogy and professional socialization, authority and workplace relationships, and the socio-emotional dynamics of long term mentoring relationships She is co-author along with Cynthia
Fuchs Epstein, Carroll Seron, and Robert Saute, of The Part-Time Paradox: Time Norms, Professional Life,
and Gender (Routledge, 1999), and has published articles in journals such as Human Relations (Tavistock) and Management Learning (Sage).