Care Services Research Articles

Social Work and Common Sense by Paul Michael Garrett

Social Work and Common Sense by Paul Michael Garrett

Highlights and Areas of Inquiry in the HSR Special Issue: Social Care and the US Health Care Sector.

Highlights and Areas of Inquiry in the HSR Special Issue: Social Care and the US Health Care Sector.

Brexit and social care in Scotland: An exploration of the perceived impact on workforce sustainability

A major challenge facing policymakers in Scotland, like most western economies, is how to sustain the workforce required to provide care and support for its ageing population. As a secondary segment of the labour market, the social care sector relies heavily on migrant labour force with a significant proportion of the workforce in Scotland being made up of nationals from EU countries. However, Brexit poses additional challenges to the sustainability of the social care workforce. For example, post-Brexit policies such as ending the ‘freedom of movement’ have some knock-on effects on the social care labour market in Scotland. This study explores the perspectives of some relevant stakeholders on how the social care workforce would be impacted by post-Brexit policy changes by employing a combination of qualitative and qualitative research techniques involving in-depth semi-structured interviews of ‘care managers’ in Scotland as well as online surveys of some EU nationals who are frontline workers in the sector. Findings from this study highlight the concerns of the stakeholders about the effects of restrictive immigration policies and inadequate funding of the social care sector on workforce sustainability considering the perennial problem of labour shortages in the sector and an increasing demand for social care.

Current issues with social work field education and ideas for change

ABSTRACT Field education is a significant component of social work education and might be the signature pedagogy. Yet current issues limit the quality of experience that students can receive from practicum. These issues include austerity policies, exhaustion of altruism, trends toward clinical social work and privatized human services, and a lack of student readiness. Degree granting institutions, such as universities, have long relied on altruism to run social work field education programs but austerity measures may mean that historical altruism can no longer be relied upon. The lack of compensation for practicum students and field instructors is unethical and may contribute to conflicts of interest and exploitation in practicum. This article details these present challenges in social work field education through incorporating scholarship and reflection and presents ideas for change. Enhanced orientation and stipends for practicum students and field instructors have shown preliminary promise in mitigating modern social work field education difficulties. For field education to be social work’s signature pedagogy, practicum planning and associated policies must be treated with respect and rigor, constantly scrutinized and improved upon as the field develops and changes.

A cross-sectional needs assessment for a trauma-informed care curriculum for multidisciplinary healthcare providers

BackgroundTrauma-informed care (TIC) is a framework that recognizes the pervasive impact of trauma, aiming to enhance both patient outcomes and provider well-being. Given the high prevalence of trauma among individuals seeking healthcare, it is essential for healthcare providers (HCPs) to be trauma informed. However, standardized TIC curricula for training healthcare staff are lacking. This study assessed perceptions towards TIC among multidisciplinary HCPs, patients, and leadership staff at two urban hospitals in Canada.MethodsThis mixed-methods prospective cross-sectional study employed Kern’s six-step approach for curriculum development. A needs assessment was conducted via an online questionnaire for HCPs and semi-structed interviews with individuals from the three participant groups: HCPs, patients, and leadership staff. The questionnaire assessed knowledge, skills, and attitudes regarding TIC. Semi-structured interviews explored perspectives on TIC, including curriculum priorities and potential implementation barriers. Findings informed the development of a virtual TIC curriculum, with iterative feedback collected to refine and assess its acceptability.ResultsAmong 106 HCP questionnaire respondents including Medical Doctors, Social Workers and Registered Nurses, 96 (90.6%) identified as women, and 97 (91.5%) as providers of direct patient care. Despite 93 (87.7%) having prior TIC education, 77 (72.6%) reported low confidence in applying TIC knowledge in clinical practice. Key perceived challenges to TIC training implementation included time constraints and lack of standardization across disciplines. A multimedia, self-paced course was the preferred solution. Thematic analysis of interviews with 28 participants (10 HCPs, 10 patients, 8 leadership staff) revealed six major themes: healthcare interactions, TIC implementation, training needs, system level barriers, curriculum preferences, and systems level improvements. Participants underscored the risk of re-traumatization to patients in healthcare settings without TIC and emphasized the need for universal TIC training for all staff.ConclusionThis study revealed a strong interest in a TIC course for multidisciplinary HCPs, supports the translation of knowledge into practice and incorporates a focus on cultural humility. Integrating insights from key stakeholders in this needs assessment phase resulted in the development of a TIC curriculum inclusive of diverse voices and viewpoints and strengthened the understanding of contextual factors that will support effective TIC implementation.

Special Topic on Reducing Technology Related Stress and Burnout: Digital Compassion Fatigue as an Emerging Phenomenon for Registered Nurses Experiencing Techno-stress.

Registered nurses increasingly work in remote care and digital interaction roles, offering flexibility and expansion of their scope of practice. These roles may expose nurses to digital compassion fatigue, a phenomenon proposed to be characterized by the negative psychological and emotional impact of caring for patients remotely through the use technology. The first objective of this work is to propose the phenomenon of "digital compassion fatigue" as a potentially further evolved and differentiated form of "compassion fatigue." The second objective is to produce a comparative analysis of attributes, antecedents, and consequences through literature reviews. An evolutionary concept analysis approach was selected as a guide for this concept exploration and evaluation. Concept analysis has been used to identify, explore, and clarify concepts, particularly given the dynamic nature of technology and practice. The process of conducting a concept analysis includes consideration of diverse and multi-disciplinary perspectives. As a result, those in caring, educational, and/or support service roles (e.g., social work, counseling, teaching) for which distance suffering and techno-stress could feasibly be present were also included. Healthcare-specific often included nurses in the sample, but may not have differentiated their specific insights or data points in the results. The concept analysis explored the attributes, antecedents, and consequences of digital compassion fatigue, differentiating it from its evolutionary parent, compassion fatigue. Key antecedents included techno-stress, distant suffering, and the unique challenges of delivering care remotely and digital interactions. A major confounding variable was the COVID-19 pandemic which may have heightened or introduced new technology related stressors or highlighted the existence of digital compassion fatigue. Further defining and understanding digital compassion fatigue is crucial for developing effective strategies to support nurses who may experience it or who are at risk.

Provider, Caregiver, and Patient Experiences of an Integrated Care Program for Older Adults Designated as Alternate Level of Care: A Qualitative Case Study

Introduction: Following hospitalization, older adults with complex health and social care needs are often deemed to need an “alternate level of care” (ALC) where care needs are misaligned with resources. Coordinated networks can implement integrated care programs for this group in home settings. Understanding the experiences of providers, caregivers, and patients will inform ongoing implementation efforts. Methods: A qualitative case study was undertaken of North York Community Access to Resources Enabling Support (NYCARES), a novel integrated care program implemented during the COVID-19 pandemic. Data collection consisted of semi-structured interviews, document analysis, and observational field notes; data were thematically analyzed. Results: Thirty-six providers, caregivers, and patients were interviewed. Three themes were developed: 1) NYCARES as a lifeline; 2) Experiences tempered by expectations and connection; and 3) The role of integrated care. Discussion: The NYCARES program was seen as valuable, but implementation posed challenges for each participant group due to varying expectations and perceived degree of connection between patients, families, and providers. Conclusions: The local coordinated network successfully implemented the NYCARES program for ALC patients despite challenges in stakeholder connections. Similar programs should formally support caregivers and forefront multidirectional communication, particularly between providers in different implementation roles.

A framework for extending the health-related quality adjusted life year by combining instruments

Current measurement systems focus mostly on health, and not on multiple constructs of quality of life outcomes (for example health and social outcomes) together. This means we don’t capture all that is of value to those receiving treatments, and to society more broadly. Recent research has explored how to extend the quality adjusted life year (QALY) beyond a narrow focus on health-related quality of life (HRQoL) aiming to improve the allocation of scarce health and social care resources. Measures of different constructs, including the EuroQol-Health and Wellbeing (EQ-HWB), and different versions of the Adult Social Care Outcomes Toolkit (ASCOT) and ICEpop CAPability (ICECAP), have been developed. Another approach to extending the health focused QALY is to combine existing descriptive systems with different foci into a single instrument. This has the advantage of using available information and allowing trade-offs between the domains of the descriptive systems to be made explicit. The aim of this paper is to propose a framework to guide this approach and outline the methodological process for generating broader descriptive systems. The first section of the paper explains the framework for combining existing instruments and discusses advantages and disadvantages. Advantages include increasing measurement sensitivity to the wider combined quality of life (QoL) impacts of many interventions and using value sets encompassing preferences that are based on trade-offs across diverse constructs. This enables values informed by impacts on broader QoL with relevance across diverse populations, to be used. Disadvantages include theoretical limitations linked to the constructs of QoL included, and practical difficulties combining instruments. The second section of the paper describes the methodological process for generating combined descriptive systems. This includes how to identify which constructs of QoL could be included, and a description of the mixed methods work required to generate a descriptive system that is psychometrically valid, and appropriate for valuation. Combining constructs of QoL from existing instruments offers a promising way to extend the QALY that differs to developing instruments de novo. Future research can use the framework outlined to develop combined instruments and explore the feasibility and wider applicability of the approach, and the use of the instruments generated in resource allocation decision making.

Environmental disability – a languageless diffuse stigma

ABSTRACT The rising number of individuals affected by illnesses linked to everyday chemicals has become an urgent public health concern. The article aims to scrutinize the Institute of Public Health (FHI)’s language use and the potential consequences of its linguistic choices when discussing environmental disability (ED). The central research questions are: What characterizes the discourse through which FHI presents ED? And how might this influence social policy regarding ED as a disability? Utilizing Critical Discourse Analysis (CDA) as a methodological framework, the study analyses FHI’s discourse and its impact on public understanding and social policy related to ED. The findings reveal that FHI’s discourse potentially obscures the lived experiences of individuals with ED, hindering their inclusion in social work practices and policies. This lack of representation could leave those affected without the necessary support. The implications of these findings are significant for social workers and policymakers, underscoring the need for a more inclusive and representative discourse on ED.

‘We’re not professionals when it comes to dogs:’ Social work encounters with dogs and their implications for education and practice

Abstract In the past few years, there has been a rise in UK dog attacks, including fatal harm to children and detriment to social workers who were not able to adequately assess risks or were the subjects of direct dog attacks. This rise in attacks is accompanied by a growth in UK dog ownership, partly as a result of the Covid-19 pandemic, making it increasingly likely that social workers will encounter dogs through their routine work. However, despite this, a literature search returned no results for specific social work research in this area, which appears to be neglected as a topic, within both academic study and social work education. This article addresses the gap by reporting the findings of a mixed-methods research study involving forty-three social workers. Five themes, drawn from the data, highlight concerns around direct dog aggression, but also around religious and health considerations, together with a lack of education and training in this area. Respondents agreed that further support and training were vital to support encounters with dogs, alongside opportunities to share narratives in this previously under researched area.

The impacts of forum theatre in social work practice: A scoping review

Abstract This scoping review delves into the impact of Forum Theatre in social work practice, filling a gap in limited existing literature. The study’s primary aim is to identify key themes within relevant research, covering the implementation of Forum Theatre, its target audiences and issues, and outcomes on both individual and community levels. Additionally, it assesses the benefits and constraints associated with integrating Forum Theatre into social work practice. Twelve articles from 1990 to 2024 were included after initial screening from prominent online databases. These articles were categorized into themes highlighting Forum Theatre’s positive effects on community actors, spect-actors, and its contributions to different social work intervention stages. The analysis highlights Forum Theatre’s positive effects: enhanced psychological safety, increased participant confidence, amplified client voices, and raised critical awareness among community actors. It also fosters empathy, awareness of power dynamics, and collaborative problem-solving among spect-actors. Forum Theatre’s versatility in social work intervention, from remedial to preventive stages, makes it valuable for social workers. Future research should consider a systematic review, employing explicit criteria to select and assess empirical studies, while also exploring other elements of Theatre of the Oppressed and Applied Theatre methods in the realm of social work practice.

Impact of a multidisciplinary team model on discharge efficiency and accuracy in internal medicine resident teams.

Efficient discharge planning is crucial for improving hospital capacity and patient care. Multidisciplinary rounds (MDRs) have been shown to enhance communication and coordination, yet their impact on resident teaching teams' discharge efficiency is less studied. To examine how embedding dedicated case managers (CMs) and social workers (SWs) into internal medicine (IM) resident teams impacts discharge efficiency. We conducted a retrospective cross-sectional study at The Queen's Medical Center comparing two resident multidisciplinary teaching (MDT) teams that included dedicated CMs and SWs with two resident standard care teams over an 8-month period (October 18 2023-June 25 2024). The outcomes assessed included length of stay (LOS), expected discharge date (EDD) accuracy, readmission rates and the rate of conditional discharge orders placed. A total of 1944 patients were included. The MDT teams showed significantly improved EDD accuracy (72.0% vs 66.7%, P = 0.0120) and more frequently placed conditional discharge orders (61.7% vs 43.8%, P < 0.0001) compared to standard care teams. No significant difference was observed in LOS or readmission rates. Embedding dedicated CMs and SWs within resident teams improved EDD accuracy and the rate of conditional discharge orders placed, suggesting an opportunity to integrate MDRs as a standard within IM residency training to enhance discharge planning efficiency.

Navigating Displacement: The Ukrainian Refugee Crisis in Europe

ABSTRACTRussia's full‐scale invasion of Ukraine in 2022 triggered one of the most significant displacement crises in modern European history, with over 6.3 million Ukrainians fleeing to Europe. The European Union's activation of the Temporary Protection Directive facilitated immediate access to housing, employment, and social security benefits for Ukrainian refugees, setting a stark contrast to past refugee crises. This Special Issue of Global Networks critically examines the European Union's response, the solidarity shown towards Ukrainian migrants, and the evolving nature of forced migration governance. It highlights the innovative practices in housing and support provision and the challenges faced by social workers. The issue also explores refugee experiences and the motivations behind volunteer engagement. It contributes to discussions on migration policy, resilience, and the long‐term implications of temporary protection measures for future migration governance and refugee protection in Europe.

Analysis of the Need for Safe Houses for Victims of Elder Abuse from the Perspective of Police Officers and Social Workers

Analysis of the Need for Safe Houses for Victims of Elder Abuse from the Perspective of Police Officers and Social Workers

Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team.

Early serious illness communication (SIC) has numerous benefits for patients with cardiopulmonary illnesses, yet engaging patients in this complex, iterative communication process is challenging due to constraints on clinician time, limited clinician training in these conversations, and a lack of patient readiness. This study reports secondary SIC outcomes of a previously reported clinical trial. In a randomized clinical trial of a nurse and social worker palliative telecare team, one visit with the nurse and/or social worker focused on SIC using a protocolized guide. Participants were at high risk of hospitalization or death, had poor health status, and chronic obstructive pulmonary disease and/or heart failure or interstitial lung disease. Documented SIC, advance directive (AD) completion, and the four-item readiness to engage in advance care planning scale (ACP-4) were measured at baseline and 6 months. Differences in change between intervention and usual care were analyzed using linear models and linear mixed models. The 306 participants were on average 68.9 years, 90.2% male, 80.1% White, with multiple comorbidities (mean of 7.6). All outcomes were similar at baseline. ACP-4 increased more in the intervention group at 6 months compared to usual care (difference in change scores: 0.49; 95% CI 0.22-0.66, p < 0.001). Documented SIC at 6 months was higher in the intervention group compared to usual care (122/154, 79.2% vs. 7/152, 4.6%); adjusted difference in proportions 74.6% (95% CI 67.3-81.9, p < 0.001). The difference in proportion of participants with an AD at 6 months was not significant; adjusted difference in proportions, 0.01%, (95% CI -0.04-0.07, p = 0.64). After participation in a telephonic, protocolized SIC intervention, documented SIC increased, and readiness to engage in ACP increased. Future research should evaluate how documented SIC is used and the effect of SIC on downstream outcomes of healthcare decisions and patient well-being. ClinicalTrials.gov NCT02713347, https://clinicaltrials.gov/ct2/show/NCT02713347.

Hospital-based specialist palliative care involvement before and during the COVID-19 pandemic: secondary analysis of a regional retrospective decedent cohort study in Ottawa, Canada

ObjectivesTo determine the occurrence and clinicodemographic associations of hospital-based specialist palliative care (SPC) referral before and during the COVID-19 pandemic, timing of completed SPC consultation and comparative prevalence of ‘no...

Integration of the national HIV curriculum in medicine, nursing, and pharmacy programs in the United States

BackgroundIncreasing the number of students who have learned to provide competent HIV care and prevention services is expected to reduce future HIV workforce shortages. To achieve this goal, the Midwest AIDS Training & Education Center (MATEC) at the University of Illinois Chicago embarked on a project to integrate the existing National HIV Curriculum (NHC) into the curricula of accredited graduate programs in medicine, nursing, and pharmacy to enhance the quality of HIV education at 23 health profession programs (HPPs) in the midwestern part of the United States between 2019 and 2022. This article describes the curriculum integration process and presents outcomes at the student level.MethodsHPPs completed faculty pre- and post-integration surveys for each course in which they integrated content from the NHC. The data from these surveys were used to describe the integration process. After studying material from the NHC, students completed a retrospective endpoint assessment designed to measure changes in knowledge of HIV prevention and care and intent to provide care to people with HIV and those at high risk of HIV in their future careers. All the surveys were created in Qualtrics and administered online. Paired t-tests were performed using SAS v. 9.4 to assess changes in knowledge and intent to work with people with HIV.ResultsThe NHC was integrated into 211 courses with an enrollment of 12,822 students. Integration strategies varied by profession discipline, with nursing programs preferring to use online self-study, medicine programs incorporating the NHC in lectures, and pharmacy programs creating learning groups on the NHC’s e-learning platform. Students across all three health disciplines reported statistically significant increases in knowledge of HIV prevention and care services and intent to provide care to people with and at high risk of HIV.ConclusionsThe NHC can be successfully integrated into the curricula of HPPs with positive outcomes for students. Given the current shortage of HIV clinicians, this intervention can have a positive impact on expanding the HIV workforce and provide a model for integrating national curricula at the preprofessional graduate level.

“Enabling Families to Find Their Own Path” – A Narrative Exploration of the Role of Social Workers When a Child is Receiving End-of-Life Care in Hospital

Social workers are frontline professionals providing psychosocial care to families when children are receiving end-of-life care. To explore the social work role in this context, data was collected from a cohort of 12 social workers employed at a national children’s hospital in Ireland, via three focus groups, with four participants in each group. A two-part narrative process elicited social workers’ stories of end-of-life care, facilitating the recounting of experiences in the first part of the focus group and allowing the researcher to explore issues raised, in the second part. Following thematic analysis, an overarching theme “enabling families to find their own path” emerged, with four sub-themes: a) engaging with families and navigating across boundaries; b) mediating end-of-life care; c) negotiating competing discourses; d) enabling preferences to minimize regrets. The theme and sub-themes provide insight into empowerment of families at this critical time. The use of a narrative approach facilitated the emergence of knowledge about how this is achieved in a hospital setting. This article maps the essential components of practice identified in the study and charts the key contribution that social workers make in supporting families, with the purpose of informing future practice within this field.

Social workers’ evaluation of ChatGPT for solving ethical dilemmas within the limits of confidentiality

ABSTRACT This study examined how social workers evaluate the use of ChatGPT in solving ethical dilemmas related to confidentiality in social work. The study employed qualitative document analysis based on a phenomenological approach, analysing assignments of 70 master’s degree students in social work. Participants compared their own solutions to ethical dilemmas with those proposed by ChatGPT. The analysis revealed three main issues: disparities in analysing complex professional dilemmas, differences in reference to ethical codes and laws, and disparities in emotional aspects and empathy. Study participants perceived their responses as more comprehensive, legally based, and empathetic compared to ChatGPT’s solutions, which were perceived as superficial and lacking emotional understanding. While ChatGPT offers potential as a supportive tool, it cannot replace social workers’ ethical judgement and empathy. Recommendations include developing AI training workshops and examining AI tools for ethical training while maintaining the profession’s human element.

Reimagining the pedagogy of professional judgment and decision making in social work: teaching evidence-based practice in parallel with field practicum

ABSTRACT Social work practice occurs in varied practice contexts. To promote successful service user outcomes, professional judgment and decision making are key. However, services are delivered in settings that may be complicated by a myriad of factors, all of which may negatively impact professional judgment and decision making. This complexity of service delivery makes it difficult for social work education to promote the knowledge and skills required for ‘real world’ practice. Evidence-based Practice (EBP) is one route to ethical and effective service, as it is a method of promoting decision making skills. However, EBP is not taught consistently in pedagogy, conceptualization, or application. A pedagogical model for teaching social work students professional judgment and decision-making skills through EBP is presented in this manuscript. EBP is the equal consideration of four key factors—case context, service user values and preferences, worker and organizational biases and experiences, research—which are assessed and integrated via critical thinking. This model presents teaching EBP within a seminar in parallel with field placements, where students are required to work through a case from their field placement. This model provides the time necessary for students to engage meaningfully in the process of learning and applying EBP.