Comprehensive Social Services Research Articles

A Framework for Elimination of Perinatal Transmission of HIV in the United States

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age.

Looking beyond Harlem: International Insights for Area-Based Initiatives

Area-based initiatives in France and United Kingdom offer lessons for other countries.Partnerships connecting schools, families, and community-based organizations are a characteristic of successful schools cited in This We Believe: Keys to Educating Young Adolescents (National Middle School Association [NMSA], 2010), and middle level scholarship widely supports notion that beyond school are associated with adolescents' social and academic experiences (e.g., Clark & Clark, 2003, 2005; Epstein, 1996; Rothenberg, 1996; Sanders, 1999; Werderich, 2008). Moreover, collaboration with external partners can enhance a middle level school's capacity to effectively educate young adolescents who have traditionally been marginalized, including English language learners (Walqui & van Lier, 2010) and students with disabilities (Kennedy & Fisher, 2001). Much of this literature addresses discrete student subgroups and focuses on student, classroom, and school levels. However, in recent years, increased attention has been paid to macrostructural developments, most notably move toward area-based (ABI) policies modeled after Harlem Children's Zone (HCZ).HCZ has garnered much attention for its provision of comprehensive social, educational, and health services to families in a 97-block area of New York City. HCZ offers a wide range of resources to more than 8,000 children and 5,000 adults, including Head Start, early-childhood learning programs, parenting programs, after-school and summer tutoring for middle grades students, and health care. HCZ appears to have led to numerous positive outcomes for local community and has, in fact, been lauded by President Obama and U.S. Department of Education as a model to be replicated in other high-needs areas throughout country. Accordingly, since 2009, U.S. Department of Education has promulgated its Promise Neighborhood program, which awards funds and guidance on a competitive basis for planning and implementing HCZ-like initiatives. The enthusiasm for and promise of such ABIs, however, are accompanied by a number of concerns as to whether HCZ idea is actually replicable or if it can be a widely effective and efficient initiative on a larger scale. In considering such matters, we suggest that, although middle level and wider P-12 policy fields can glean many valuable lessons from HCZ, instructive insights should also be gained from other countries' experiences with ABIs.Replicating HCZThe ecological philosophy underlying HCZ and other ABIs has been supported in recent years by research suggesting that multiple environments associated with children's development-including families, community-based organizations, and neighborhoods (the relationships within and among them)-need to be engaged to reap significant and sustainable social and educational benefits (Berliner, 2006; Bronfenbrenner, 1999; Rothstein, 2004). HCZ's attention to such matters has been associated with academic successes of its Promise Academy II Middle School as well as other five HCZ schools (all labeled Promise Academies), which have been highlighted in academic literature (Dobbie & Fryer, 2009) and in popular media (e.g., Time Magazine, 60 Minutes, and film documentary Waiting for Superman). In fact, New York Times columnist David Brooks (2009) referred to HCZ's efforts as the Harlem miracle, noting that HCZ had eliminated black-white achievement gap (p. A31). HCZ has been widely regarded as a gold-standard ABI, and much consideration has been given to developing more programs like it elsewhere. However, there are a number of questions regarding HCZ's wide-scale replicability.One of most common questions is whether comprehensive community planning models such as HCZ are economically feasible. HCZ has assets of nearly $200 million and an annual operating budget of close to $84 million-two-thirds of which is from private donations. …

Abstract A58: Impact of Nueva Vida's model on quality of life, distress levels, and self efficacy in Latinas with breast cancer

Abstract Background: Latina survivors appear to have greater distress related to their diagnosis and treatment than non-Latina White women due to lower access to care, financial, linguistic barriers & cultural issues. These concerns have a significant influence on women's quality of life yet research indicates their impact may be buffered by the presence of mental health and social support services. Based on this data and the lived experiences of Latinas with breast cancer in the Washington, DC area, NV was founded in 1996 by a group of Latina breast cancer survivors and health professionals. Purpose: The goal of this community based organization-academic partnership project is to evaluate the impact of NV's social support model on levels of self-efficacy, psychological distress, and quality of life. The NV model provides comprehensive services including patient navigation, support groups, individual counseling, peer support, and information. This study is looking at the impact of this model on participants over one year. Methods: A time-series design with time 1 (T1) data collection on the day of initial contact with NV, time 2 (T2) within 3–10 days of initial contact, time 3 (T3) at 4 months, and time 4 (T4) at 12 months. The instruments used in this study include: Cancer Behavior Inventory - Version 2.0 (CBI) measuring self-efficacy, the Brief Symptom Inventory-18 (BSI-18) measuring psychological distress, and the Satisfaction with Life Domains Scale-Breast Cancer (SLDS-BC) measuring quality of life. The sample includes women diagnosed with breast cancer who contacted NV and agreed to participate in the study. The interventions offered over the course of the twelve months include, individual counseling, various support group participation, patient navigation, and peer support. Results: Data collection took place between March 2008 to December 2010. Eighty-nine participants completed data at Time 1, 69 at T2, 64 at T3, and 57 at T4. At T1 62.9% of the participants reported distress needing psychosocial intervention. This is almost twice as the prevalence rate of 32.8% for breast cancer among the general population reported by Zabora et al. (2001). There was a statistically significant decrease in depression (p< .05), overall distress (p< .05), and QOL (p < .01). There was a decrease in anxiety (p = .07) and somatization (p =.07) but no change in level of self-efficacy. Conclusions: The findings support the model that NV uses in improving the lives of Latinas diagnosed with breast cancer. Its findings demonstrate that a community based organization with comprehensive social support services can help reduce distress levels and increase quality of life. The high rate of distress is an important finding and highlights the need for community organizations to be prepared to provide support for Latinas with breast cancer. No change in self-efficacy has brought into question the instrument selected to measure this variable in this population. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A58.

Conceptualising corporate social responsibility (CSR) and corporate social investment (CSI): the South African context

PurposeWith globalisation pressures and increasing burdens on governments to provide comprehensive social services, there is now a need to better understand how firms play their part in sharing these burdens. Views vary from those who believe that CSR and CSI are distractions from profit maximisation to those who argue that participation in such activities contributes to positive social transformation and also benefits participating firms themselves. This paper seeks to conceptualise these debates.Design/methodology/approachThe paper largely utilises a literature review to derive the research conclusions. Specifically, it examines how CSR, CSI and the socially responsible investment (SRI) index has been used to evaluate corporate behaviour in South Africa, as a novel way of addressing pressing development problems.FindingsCSI has emerged from the specificities of South African historical development, and it has arguably been driven primarily by legislation and industry charters. It is in this context that CSI, with its paraphernalia of the SRI Index and social capital market, promises to present a new and radical way of addressing developmental problems.Originality/valueThis paper is one of the few studies examining the phenomenon of corporate social investment from a developing economy context.

The PACE Program: Home-Based Care for Nursing Home–Eligible Individuals

The Program for All-Inclusive Care of the Elderly (PACE) is a Medicare/Medicaid managed care benefit for frail adults aged 55 years and older who, although certified by the state as nursing home eligible, choose to live in the community. The PACE model features comprehensive medical and social services coordinated by an interdisciplinary team whose goal is to promote independence and quality of life.

Corporate Social Responsibility and Corporate Social Investment: The South African Case

Corporate social responsibility (CSR) and corporate social investment (CSI) have become terms that are used to examine some activities of businesses. With globalization pressures and increasing burdens on governments to provide comprehensive social services, the microscope has been trained on how firms play their part in sharing this burden. Views vary from those who believe that CSR and CSI are a distraction from profit maximization to those who argue that participation in such activities contributes to positive social transformation, while benefiting participating firms themselves. In this article, the author seeks to organize these debates within particular theoretical frameworks, positing CSR and CSI, together with the Socially Responsible Investment Index that has been used to evaluate corporate behavior in South Africa, as a novel way of addressing pressing development problems.

Comparing Clinic Retention Between Residents and Nonresidents of Kibera, Kenya

Comparing Clinic Retention Between Residents and Nonresidents of Kibera, Kenya

Health Disparities Across the Lifespan

Health Disparities Across the Lifespan

Outpatient Treatment Engagement and Abstinence Rates Following Inpatient Opioid Detoxification

Many patients with chronic opioid dependence are referred to drug-free outpatient treatment following inpatient detoxification even though successful outpatient treatment engagement and abstinence from opioids occur only in a minority of cases. This retrospective cohort analysis of medical records documents the post-discharge outcome in a treatment setting that maximizes the support during transition to abstinence-oriented outpatient care, with comprehensive social, medical and mental health services, including the availability of naltrexone. Participants were male veterans (N = 112) admitted at an urban VAmedical center. Most patients (78%) successfully completed acute detoxification, 49% initiated naltrexone, and 76% accepted a VA aftercare plan. At 90-day follow-up, only 22% remained in aftercare, and < 3% had toxicology-verified abstinence from opioids. At one-year follow-up, 1 out of 5 had been readmitted for detoxification and 4.5% had died. Most patients successfully detoxified from opioids, but very few remained engaged and stabilized in abstinence-oriented outpatient treatment.

Unmet needs for comprehensive services in outpatient addiction treatment

Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

Bridging the Transition to Kindergarten: School Readiness Case Studies from California’s First 5 Initiative

Recent advances in science have underscored how critical children’s first five years of life are to their later success in school and life. It has also been recently recognized that early childhood interventions, particularly those that combine child-focused educational activities with parentchild relationship building, can positively influence children’s readiness for school, particularly for those at-risk for poor developmental outcomes. Though early childhood services have traditionally received fewer resources than those for school-aged children or adults, many states have tried to address this inequity by sponsoring early childhood initiatives aimed at providing comprehensive health and social services to children ages 0 to 5 and their families. The current article presents an overview of one such initiative—California’s First 5—and provides three Southern California case studies of how it is being implemented at the county level. Implications for policy makers, school psychologists, and other educational stakeholders are discussed.

Gay Men Living with Non-HIV Chronic Illnesses

For reasons embedded in historical, social, cultural and biological phenomena, the sociocultural experiences of gay men living with chronic illnesses other than HIV have remained unexamined within gay communities, within gay affirmative medical and social services, and within broader, heterosexually focused medical and social service systems. As a result, the specific needs of these men are largely undefined and potentially unmet. This article focuses a lens of inquiry on the psychosocial issues and social service needs of gay men living with chronic illnesses other than HIV, offers recommendations for providing services that respond proactively to the specific needs of these men, and advocates for more inclusive and comprehensive social service and health care systems.

Conceptualizing and validating the human services integration measure

This paper proposes both a model and a measure of human service integration through strategic alliances with autonomous services as one way to achieve comprehensive health and social services for target populations. Diverse theories of integrated service delivery and collaboration were combined reflecting integration along a continuum of care within a service sector, across service sectors and between public, not-for-profit and private sectors of financing services. A measure of human service integration is proposed and tested. The measure identifies the scope and depth of integration for each sector and service that make up a total service network. It captures in quantitative terms both intra and inter sectoral service integration. Results are provided using the Human Service Measure in two networks of services involved in promoting Healthy Babies and Healthy Children known to have more and less integration. The instrument demonstrated discriminate validity with scores correctly distinguishing the two networks. The instrument does not correlate (r=0.13) with Weiss (2001) measure of partnership synergy confirming that it measures a distinct component of integration. We recommend the combined use of the proposed measure and the Weiss (2001) measure to more completely capture the scope and depth of integration efforts as well as the nature of the functioning of a service program or network.

Editorial

Since the middle of the twentieth century there has been a strong commitment in the Nordic countries to creating and enhancing welfare services. High-quality education, as well as health and social services, have been available to all citizens, free of charge. Costs are paid through taxes, which have traditionally been high. For the general public in these countries this has meant access to free education through university, and comprehensive quality health and social services. All of this has now begun to change. Nordic countries, like other western countries, are experiencing changes in the demography of the population and in an increased demand for services, which have, in combination, resulted in a considerable increase in financial pressure. As a result, attempts are now being made to lower costs by organizing the provision of healthcare services in different ways, limiting access and increasing public participation in the cost of care by introducing service fees. These changes have led to more emphasis on home care, increased participation of relatives as informal caregivers, and less access to institutional and formal services. Many policy-makers and politicians have a strong faith in market solutions and are encouraging increased outsourcing of services and the introduction of private companies in healthcare services. These changes have created a healthcare system that is based on ideas and principles foreign both to the public and most healthcare workers. Although politicians still state that they are committed to maintaining the welfare state, the public is experiencing insecurity regarding some of their fundamental expectations. In light of decreased official support for health services, care of the sick and injured is no longer a certainty in Nordic countries, once renowned for their social services. These changes call for a forum for discussion regarding the development of healthcare services. This is the aim of the international, interdisciplinary ‘In Sickness and in Health’ conference to be held in Iceland in June 2004. It will be the second international conference addressing issues of power, practice and ethics in health-care, the first having been held in Melbourne, Australia, in 2002. The series was initiated by a group of nurses from different parts of the world who are interested in exploring the relationship between the state and the public as governmentality. The theme for the conference in Iceland is: ‘Shaping health care: Power and agency’. It will focus on ways in which healthcare workers and policy analysts can contribute to the creation of healthcare systems that successfully meet current needs of the population. The main themes will include ethical issues in health-care in the twenty-first century; technologies and health-care for health promotion, diagnosis, treatment, rehabilitation, monitoring, communication and record-keeping; ideas of citizenship or governmentality applied to social, cultural, professional and political transformations in the organization of health services; the conduct of health professionals and individuals’ experience of illness; the framing of disease and health in the light of science and technology; and feminist perspectives on health, illness and health-care. The conference will bring together scholars from diverse fields focusing on health and health services, such as nursing, medicine, allied health professionals, social scientists, historians, philosophers and geographers. The keynote speakers in Iceland this June will be: nursing scholar Mary Ellen Purkis from the University of Victoria in Canada; sociologist Alan Petersen from the University of Plymouth, United Kingdom; anthropologist Gisli Palsson, University of Iceland; and gender studies and sociologist Thorgerdur Einarsdóttir, University of Iceland. ‘In Sickness and in Health’ conferences provide a forum for international researchers, from a diverse range of disciplinary and professional backgrounds, to focus on critical scholarship pertaining to sickness and health in the twenty-first century. They provide the opportunity to examine the relationship between professional practices, policy-makers, and notions of health, treatment and the experience of illness. Out of this gathering we hope that new strategies will emerge to convince politicians and policy-makers of the importance of free and comprehensive healthcare services in the Nordic countries, and in the rest of the world.

Rehabilitation in Israel

This article briefly overviews the civilian and military rehabilitation systems in Israel, as described by two employees of those systems. Though Israeli systems provide comprehensive social services to individuals who were injured as civilians, Israeli rehabilitation practices appear to be more extensive for individuals who were injured while serving in the military.

A model of community-based interdisciplinary team training in the care of the frail elderly.

It is widely recognized that interdisciplinary team care is essential for effective management of complex patients such as the frail elderly. Physicians need to understand the operational mechanisms that drive the team care model. While such concepts should be an integral part of medical education, teaching such a model of care that demonstrates effective provider communication, coordination of multiple services, and the provision of cost-effective health care can be difficult. The Program of All-inclusive Care of the Elderly (PACE) is a well-established, high-quality program that has been replicated nationally and can serve as an effective teaching model. Achieving the goals of the PACE program requires strong team leadership and communication, clear patient-oriented goal definition, an understanding and appreciation of roles among various disciplines, skillful negotiation, and shared responsibility for the patient. The PACE model offers medical and family practice residents a non-traditional clinical setting with educational opportunities not available in most hospital or ambulatory settings. For several years the Fallon Healthcare System Elder Service Plan (ESP), one of 25 national PACE programs, has provided an educational setting for medical and family practice residents as a component of their clinical rotations in geriatrics. This training experience has been expanded to include additional residents in on-site interactive seminars that focus on effective communication using an interdisciplinary team approach to care. The ESP program provides comprehensive medical and social services to a frail, non-institutionalized nursing-home-eligible population. The aim of the program is to preserve the health and independence of its participants for as long as possible. The ESP team consists of physicians, nurse practitioners, nurses, nurse's aides, home health workers, social workers, therapists, nutritionists, and pharmacists. The seminar includes a slide and video presentation led by members of the ESP team using selected scenarios that portray both effective and poor team dynamics and communication. Definitions of a team, the process of establishing patient- and family-oriented goals, interdisciplinary role appreciation and responsibility, and the basics of financing a comprehensive health care delivery system for the frail elderly are discussed. Approximately half of each session is devoted to interactive discussion and critiquing of the scenarios by the residents and faculty, which is derived from the ESP team. For most of the medical and family practice residents, this experience represents their first exposures to this model of coordinated team care for the elderly. Preliminary evaluation results indicate that residents have generally been unaware of the services available to the elderly and of the opportunities for coordinated care using the expertise of multiple disciplines. There is a lack of knowledge of key non-physician professional roles. The expanded use of PACE models as training sites could be beneficial in preparing future health care professionals for interdisciplinary team care of the growing numbers of frail elderly.

JANSSEN ET AL. RESPOND

We appreciate the support expressed by the letters in response to our article on the Serostatus Approach to Fighting the HIV Epidemic (SAFE), which discusses expansion of prevention programs to include the prevention needs of HIV-infected individuals. We agree that certain concerns must be addressed to successfully implement this strategy. An important aspect of SAFE is targeting the prevention needs of those who are infected and of those at highest risk for infection. It is clear from 20 years of surveillance data in the United States that not all groups of people in the country are at equal risk for HIV infection. Resources for prevention have always been limited, and efficient use of resources, including targeting those at greatest need, is critical to successfully addressing the epidemic. We also agree that focusing programs on infected individuals has the potential to lead to further stigma, and thus we advocate programs that not only support individuals who learn that they are infected but also link such individuals to comprehensive social services, including services that can reduce the risks of violence. In addition, it is critical that programs be linked to care and treatment for HIV, substance abuse, and mental health problems. It will also be necessary to ensure that laws adequately prohibit discrimination against those who are HIV positive. Nevertheless, with the cautions expressed by Mills in mind, the way of the future will undoubtedly call for more voluntary HIV testing and interventions for the infected. We agree that “mainstreaming” HIV is essential to normalize HIV and reduce stigma. We have emphasized the need for voluntary HIV testing. In fact, in late 2001 the Centers for Disease Control and Prevention released new guidelines for HIV counseling, testing, and referral that continue to emphasize the need for voluntary HIV testing and continued support for anonymous testing. In other countries, political support from the highest levels of government will be critical in supporting increased noncoercive testing.

The PACE Model: Description and Impressions of a Capitated Model of Long-Term Care for the Elderly

The Program of All-Inclusive Care for the Elderly (PACE) is an innovative model of comprehensive long-term medical and social services. The system receives monthly capitation payments from Medicare and Medicaid for clients who are nursing-home eligible. PACE was developed originally by On Lok Senior Health Services in San Francisco's Chinatown in the late 1970s. PACE is based upon the concept of maintaining the independence, autonomy and dignity of frail and disabled elders nearing the end of life (Sapir, 1996). The program's underlying principle is to keep participants (PACE program enrollees) in the community for as long as it remains medically, socially, and economically feasible (Shen and Iverson, 1992). There is also a strong intention to preserve and support the older adult's family unit.

An Innovative School-Based Intergenerational Model to Serve Grandparent Garegivers

Summary There has been an enormous increase in foster care placements, especially with grandparents and other extended family members, since 1985. This is primarily attributable to problems associated with parental drug use, principally of crack cocaine. Drug. related problems that lead to kinship foster placement include prenatal drug exposure, child maltreatment, incarceration, and early death by violence or AIDS or other illness. Grandparents caring for their children's children have a variety of social, mental health, and medical needs because of this stressful role. Following a literature review, a comprehensive social service and medical program developed through the partnership of a large urban teaching hospital, a foundation involved in funding programs for older adults, and an inner city school district is described.

Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure

The objectives of this investigation were to prospectively assess medication compliance rates in elderly patients with congestive heart failure, to identify factors associated with reduced compliance, and to evaluate the effect of a multidisciplinary treatment approach on medication adherence. A total of 156 patients > or = 70 years of age (mean, 79.4 +/- 6.0; 67% female, 65% nonwhite) hospitalized with congestive heart failure were evaluated prospectively. Prior to discharge, patients were randomized to the study intervention (n = 80) or conventional care (n = 76). The intervention consisted of comprehensive patient education, dietary and social service consultations, medication review, and intensive postdischarge follow-up. Detailed data were collected on all prescribed medications at the time of discharge, and compliance was assessed by pill counts 30 +/- 2 days later. The overall compliance rate during the first 30 days after discharge was 84.6 +/- 15.1% (range, 23.1-100%). Compliance was 87.9 +/- 12.0% in patients randomized to the study intervention, compared with 81.1 +/- 17.2% in the control group (P = 0.003). A compliance rate of > or = 80% was achieved by 85.0% of the treatment group versus 69.7% of the control group (P = 0.036). By multivariate analysis, assignment to the treatment group was the strongest independent predictor of compliance (P = 0.008). Other variables included in the model were Caucasian race (P = 0.044) and not living alone (P = 0.09). A multidisciplinary treatment strategy is associated with improved medication compliance during the first 30 days following hospital discharge in elderly patients with congestive heart failure. Improved compliance may contribute to improved outcomes in these patients.