Social Services Involvement Research Articles

Sealing the cracks: Preliminary findings from an inter-ministry initiative to address chronic homelessness in British Columbia

It is well documented that homeless individuals with severe mental illness (SMI) are in frequent contact with multiple public systems including housing, health, criminal justice, income assistance and various community-based programs. However, this subpopulation of the homeless continues to experience significant unmet needs. This report examines preliminary findings from British Columbia's Homeless Intervention Project, an interagency collaboration designed to improve outcomes for adults with SMI who are chronically homeless. Administrative data from three provincial ministries were used to examine a variety of outcomes for 362 participants with histories of criminal justice involvement. Comparisons of the pre-enrollment period (2 years) and post-enrollment period (6 or 12 months) indicate significant improvements in health and social service involvement and reductions in offending. These findings suggest that interagency collaboration, particularly co-location and sharing of information and administrative oversight, can result in better outcomes for this hard-to-serve population than when agencies are working in isolation.

Admissions following assault in children and young people

AimsWith frequent reports of knife and gun crime in the local area we aimed to determine the incidence of young people requiring admission to an inner city hospital following assault....

Is the Incredible Years programme effective for children with neuro-developmental disorders and for families with Social Services involvement in the “real world” of community CAMHS?

Over the past few years parenting has become the focus for political attention in an attempt to tackle high levels of disruptive and anti-social behaviour. The Incredible Years (IY) programme (Webster-Stratton, 1999) is one of the parenting training packages that has been identified as a treatment of choice. There are, however, few studies available to demonstrate the clinical relevance in real world Child and Adolescent Mental Health Services (CAMHS) and even less knowledge about how children affected by a neuro-developmental disorder and families involved with Social Services can benefit. The BASIC IY videotape parent training programme was used for consecutive groups of parents across two neighbouring CAMH services (n = 128). Data were collected before and after intervention using the Eyberg Behaviour Checklist (Eyberg & Ross, 1978) and a number of Visual Analogue Scales. The effectiveness of the group was compared to that of other studies and the outcomes for two sub-groups--children with a neuro-developmental disorder and families with Social Services involvement--were evaluated. Statistically significantly post-intervention scores were found for all groups showing moderate to large effect sizes. The results are comparable to other effectiveness studies (e.g., Gardner, Barton, & Klimes, 2006; Scott, 2005). They also show that the IY is equally effective for children diagnosed with a neuro-developmental disorder and for families with multiple and complex needs.

Predictors of parenting concern in a Mother and Baby Unit over a 10-year period

To review the characteristics of 462 mothers consecutively admitted to a co-joined mother and baby unit and to examine the incidence and predictors of social services input and separate discharge. Admissions to the Birmingham Mother and Baby Unit from 1998 to 2007 were reviewed. Demographic and clinical information, social services involvement and parenting outcome data were collected from case notes and computerized records. One hundred and forty six (146) women received some form of social services input (32%); 44 cases of separate discharge were identified (10%). Diagnosis, involuntary admission, single status, younger age, Afro-Caribbean ethnicity and social services referral predicted parenting concern. Only 9% of separations were to women suffering a new postpartum mental illness; most were to women experiencing the continuation of an existing illness. Poor parenting skills, absence of a good partner relationship and alcohol/substance misuse were frequently reported in those discharged without their baby. The incidence of separate discharge is lower than in other studies. Potential reasons for this difference are discussed. Further work must be conducted to understand the social inequities and regional differences in social service intervention during perinatal psychiatric admission and determine if parenting outcomes can be improved in women at risk of separation.

Multidisciplinary antenatal care for opiate-using women: Child-care issues

The fact that particular parents suffer afflictions limiting their ability to care does not mean that they should automatically be deemed unsuitable parents. Prompted by neonatal team concerns about child-care issues, a local multidisciplinary group was set up to care for substance-abusing pregnant women in our region. This project was conducted in order to review the records of all the women who had been discussed at our management planning meetings over the past 5 years. Our assessment tool records were reviewed and analysed using spss. A total of 233 women were assessed. The majority of patients booked before 20 weeks (62%) and 96 women (41%) attended over 80% of their antenatal appointments. There was little change in substance use during the course of pregnancy. Overall, at delivery, 196 of the 233 women (84%) used methadone and 89(38%) used heroin. There was no correlation between usage and foster care of the baby (methadone: chi(2) = 0.5, P = 0.8 NS) (heroin: chi(2) = 3.1, P = 0.08 NS). There was an absolute correlation between social services involvement and foster care (chi(2) = 2.33, P < 0.0001). Adherence with planned antenatal appointments significantly increased the likelihood of a child being discharged with his mother (chi(2) = 6.7, P = 0.009). The majority of newborns were discharged home with their mothers directly with the most significant factor in placing a child in foster care being prior involvement of social services. However, many of these families will continue to need support during the children's early years.

Animal-Assisted Therapy in the Treatment of Substance Dependence

ABSTRACTThe purpose of this study was to evaluate the effect of animal-assisted therapy (AAT) on the therapeutic alliance with an adult, residential, substance abuse population in group therapy. We used randomized samples and controlled conditions to establish the effects of chosen variables that influence outcome. A total of 231 people took part in the study (control group [without therapy dog]: n = 96; experimental group [with therapy dog]: n = 135) in which there were 26 group sessions. The results of the study indicate that, overall, the therapeutic alliance is enhanced with the addition of a therapy dog: the AAT group had a more positive opinion of the therapeutic alliance, as measured using the Helping Alliance Questionnaire (HAQ-II), than the control group (ANOVA: F(1,229) = 25.44, p < 0.001). Clients seeking treatment for a dual diagnosis, clients with state social service involvement, and clients seeking treatment for alcohol addiction had similar opinions of the therapeutic alliance, whether in the experimental group or the control group. Males, females, pet owners, court ordered clients, and clients seeking treatment for polysubstance, cannabis, and methamphetamine dependence all were more positive about the therapeutic alliance if they were in the experimental group than if they were in the control. This study demonstrates that addiction professionals could increase treatment success by adding this complementary, evidence-based practice.

Did the Faith-Based Initiative Change Congregations?

We use national surveys of congregations conducted in 1998 and 2006-2007 to assess whether or not the faith-based initiative increased congregations’ social service involvement, government funding, or collaborations with government or nonprofit organizations. More congregations indicated interest in social services and government funding in 2006-2007 than in 1998, but congregational involvement in social services, government funding, or collaborations has not increased since 1998. An in-depth local study of partnerships between congregations and nonprofit social service agencies leads to the same conclusion. The faith-based initiative did not change congregations’ behavior or expand their role in our social welfare system because it overlooked congregations’ longstanding role in community systems, and it was built on false assumptions about congregations’ latent capacity to expand that role and the extent to which they constitute a meaningful alternative to existing organizational networks of social support.

Early Social Service Involvement May Decrease Inpatient Hospice Stays

Early Social Service Involvement May Decrease Inpatient Hospice Stays

The economic and social burden of compulsive hoarding

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants ( N = 864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants ( N = 655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1–3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.

Factors Associated With a Six-Month Return to Emergency Services Among Child and Adolescent Psychiatric Patients

This analysis identified factors associated with emergency department recidivism among pediatric psychiatric patients and factors that may differentiate repeat and one-time visits. The researchers examined six-month recidivism among a sample of 509 patients of ages four to 18 years who made mental health visits to an urban pediatric emergency department in 2004. Patients who made repeat visits were more likely to be involved in mental health and social services than patients who did not return to the emergency department. Repeat visitors were also more likely to be African American, have a history of psychiatric hospitalization, and present with suicidal or disruptive behaviors. These results suggest that the emergency department is being used as part of the continuum of care for patients already in treatment, particularly those displaying disruptive behavior. Additional research is needed to determine whether this recidivism is clinically indicated or reflects a lack of available or appropriate care in community settings.

A case analysis of MDT with an adolescent with conduct personality disorder and fire setting behaviors.

Abstract This case study examines a 16.5-year-old male adolescent who engages in fire setting, severe aggression and self injurious and impulsive behaviors. He was treated with Mode Deactivation Therapy (MDT) for four months and his problem behaviors have been reduced significantly. He was previously treated with Dialectical Behavior Therapy (DBT). It appears that in this case study MDT was effective in reducing his severe behaviors. Keywords: MDT, fire setting, physical aggression, self injurious behaviors, adolescent males, personality disorders. Introduction In this case study a 16 year old adolescent male was treated successfully after MDT. The MDT therapist was trained by the first author of this case study in an intensive MDT training. MDT was shown to be more effective with aggressive adolescent males with conduct and personality disorders then Cognitive Behavior Therapy and Social Skills Training. MDT has been demonstrated to be effective in reducing aggression, personality disorders beliefs and symptoms of Post traumatic stress disorder (Apsche, Bass, Murphy 2004; Apsche & Ward 2004, Apsche, Bass, Jennings, Murphy, Hunt, Siv (2005). After a thorough literature review this appears to be the first case study that examines the effects of MDT with an adolescent with fire setting behaviors. Case Summary This case analysis is a step-by-step case study, with a corresponding theoretical analysis based in mode deactivation therapy (MDT). The methodology known as MDT suggests potential for effective treatment of youngsters with similar backgrounds as Peter. Peter is a 16.5-year-old Caucasian male. He has been diagnosed with Post Traumatic Stress Disorder, Conduct Disorder and Personality Disorder Traits. Peter demonstrated a pattern of continuous disruptive behaviors including; fire setting, lying, social phobia, aggressive and threatening posturing, property destruction, academic performance problems and school behavior problems, peer relationship problems and torturing animals. He also has tortured animals in front of other children and he had a history of early sexual experience, specifically sexual touching of other children. Client Family History Peter had demonstrated significant behavioral and impulsive problems since early childhood, which were manifested more prominently when he was four. During this time he was removed from his mothers care due to her continuous substance abuse. She reported using alcohol, cocaine, and crack cocaine during her pregnancy. He was the second youngest of six children all of whom have delinquent problems and are in Department of Social Services custody or involvement in some way. He was placed with his grandmother who also failed to provide adequate supervision; as a result he was removed from her care. From 2000 to 2003 he was placed in nine inpatient settings, including residential placements and hospitals. He was removed from most of the nine placements due to disruptive, aggressive, suicidal behaviors. Peter preformed at the normal grade level at school, but he required increased structure and individualized attention. Peter has a history of repeated violations of school rules and disruption in class. He often was aggressive and cut school. He was placed briefly at a hospital then moved to a residential setting on an island. Within a couple of days, out of staff supervision he started a fire, which destroyed over 40 acres of protected woodlands. This led to his brief placement as an inpatient at a local Hospital prior to being admitted. Upon admission he has disclosed for the first time the he was sexually abused (repeated anal rape) by a 16 year old male cousin, in his grandmother's home, for several years starting at the age of seven. He reported that he told his grandmother, who did not believe him and punished him as a result of his disclosure. Later one of his older sisters eventually believed him and reported the crime. …

Achieving Permanence for Looked after Children through Special Guardianship: A Study of the Experience of New Zealand Guardians with Implications for Special Guardianship in England

Special guardianship orders will be introduced in England in 2005 as an integral part of the Government's policy to create more opportunities for permanent family placement, thereby reducing the numbers of looked after children. Special guardianship is designed to fill a niche in permanence provision by persuading both foster carers and kinship carers to offer a home, free of regular social services involvement, to children who would otherwise remain looked after. Particular targets are older children for whom adoption is inappropriate or unachievable for those wishing to maintain a positive relationship with a birth parent. However, similar predecessors, such as custodianship and residence orders have foundered due to lack of interest from such carers. What is likely to make a difference this time around? What will tempt carers to make a move away from their dependence on local authorities and take that final step towards legal permanence? This study by Peter Ward describes New Zealand's experience of guardianship which has been available there since 1968. Discussions with 20 NZ guardians and their former foster children indicate what special guardians in England will require to make such an option attractive to them and effective for young people.

Women in Congregations and Social Service Provisions

The role of women in American congregations is a topic that has gained attention in the past twenty years. The majority of work has focused on leadership and clergy roles and the willingness, or reluctance of, denominations to ordain women. In this article, we report on women as members, lay-leaders, and clergy in Philadelphia congregations, and we assess the factors that explain the rate of women in any of these roles. We find that regardless of the advancement in many areas of society, women are still the majority members yet are a minority among the clergy. Finally, we study how the gender composition of members, lay-leaders, and clergy explain the congregation's involvement in social service provisions. In this respect, gender composition of members, lay-leaders, and clergy made little impact on the congregational social service involvement. A variety of explanations are provided to account for women's little impact in this domain.

What Users Have to Say about their own Organisations: A Local User‐Controlled Study

Based on the experience of Wiltshire and Swindon Users' Network, this article presents findings from a small user‐controlled study of members' perceptions of their own organisation. Peer support, information provision and speaking with a ‘collective voice’ emerged as key aspects of their involvement which members valued. Although WSUN provided a range of opportunities for involvement in social care and health services, members identified training and recruitment of professionals and presentations as areas for greater involvement. The study calls for greater recognition of the important role that usercontrolled organisations can play in empowering users on a personal level, as well as bringing about change in social care and health services through effective user involvement.

Enquiry about the needs of children whose mothers are admitted to psychiatric hospitals

The objective of this study is to assess whether children's needs are taken into consideration in female patients who are admitted to an adult psychiatric hospital. A retrospective case note audit of 100 female inpatients aged between 18 and 55 years over a 6‐month period were randomly selected. The medical and nursing case notes of patients with children aged between 0 and 17 were assessed using a proforma. The information collected on mothers consisted of diagnosis of illness, type of admission (whether voluntary or detained), duration of admission, previous psychiatric admissions, patient age, marital status, whether or not employed, relationship with partner, mental health of partner, history of violence, medical history of relevance, family history of mental illness, and whether other agencies were involved. Children data collected consisted of number of children per patient and their ages, an enquiry into the child's welfare, emotional and behavioural development, educational/cognitive development, physical health and development, relationship with family and peers, children's knowledge of parent's illness, alternative care arrangements for child during mother's admission and their relationship to carer, child's involvement in their parents' illness as a carer and actions taken on behalf of the child. Of the 100 patients, 62 had children aged between 0 and 17 years. There was an enquiry into children's welfare in 15 (24%) cases and an enquiry into children's knowledge of their parents' illness in three (4.8%). Actions were taken on behalf of children in 13 (21%) cases, in five cases this was not necessary as children resided elsewhere, and in one case a social work assessment was requested but no subsequent documentation of this being completed. There was no documentation of actions taken in the remaining 43 (69.4%) cases. The results of this retrospective case note audit suggest that children's welfare is not routinely enquired about in female patients admitted to psychiatric hospitals. Actions taken on behalf of children occurred often when there was social services involvement. As a result of this study guidance was issued to all new junior psychiatric staff as part of their induction process to make enquiries about children and their welfare.

Comparison of self-report versus agency records of service utilization in a community sample of individuals with alcohol use disorders

Health services research has become an important area for evaluating the cost effectiveness of interventions. When used in treatment outcome research, the accuracy of self-report data is essential. The reliability and validity of self-report service utilization among alcohol and drug addicted individuals is questionable and largely unexplored. This study assessed the accuracy of self-report utilization of services compared to service record abstraction in a sample of treatment seeking individuals with alcohol use disorders. The results of the comparative analysis found that the level of agreement for some services, particularly medical, psychiatric and substance abuse inpatient admissions, and social service involvement was good. There was less agreement in emergency room visits and arrests. Factors related to discrepancies between self-report and records were explored.

Predictors of Urgency in a Pediatric Psychiatric Emergency Service

To test the hypothesis that youth present to a psychiatric emergency service (PES) at least 25% of the time for nonurgent reasons, to examine the demographic characteristics that distinguish urgent from nonurgent visits, and to develop a model to predict urgency. Psychiatric emergency visits of all patients under 18 years from July 1, 1997, through June 30, 1998, were ed and coded as to level of urgency using Rosenn's classification system. Age, gender, ethnicity, arrival status, social service involvement, violence, substance abuse, and diagnosis were examined with respect to urgency in bivariate and multivariable analyses. Forty percent of visits to the PES were not urgent. Demographic factors distinguished urgent from nonurgent visits. Independent predictors of urgency for the entire sample were age, diagnosis, arrival status, social service involvement, and violence. Only violence remained an independent predictor of urgency for the attention-deficit/hyperactivity disorder subgroup. A large percentage of pediatric visits to the PES were for nonurgent reasons. This suggests that there are considerable unmet mental health needs of children and adolescents. These findings can be applied to improve and design appropriate services.

Poverty Reduction in Chile: Has economic growth been enough?

This paper analyses the relationship between growth, education, health status, and poverty in Chile. A comparative analysis with four countries is also undertaken. It is argued that long government involvement in social services has been a key factor in enabling many sectors of the population to increase their human capital, making it possible for them to take advantage of the opportunities given by growth to escape poverty.

Homeless adolescents: Common clinical concerns

Homeless youth are at alarmingly high risk for a myriad of physical and psychological problems as a result of both the circumstances that prededed their homelessness, and as a direct consequence of life on the streets. Sexually transmitted infections (STIs), pregnancy, trauma, tuberculosis, uncontrolled asthma, and dermatologic infestations are a few of the health problems with which these youth commonly present. These somatic problems are compounded by high rates of drug and alcohol abuse as well as depression and suicide. Despite the obvious need for medical services, homeless youth often do not receive appropriate medical care due to numerous individual and systems barriers impeding health care access by this population. In addition to the barriers experienced by the adult homeless population, homeless adolescents confront further hurdles stemming from their age and developmental stage. Some of these impediments include a lack of knowledge of clinic sites, fear of not being taken seriously, concerns about confidentiality, and fears of police or social services involvement. Improved access to appropriate health care is necessary if we are to better support and care for this population of young people. To effectively manage and treat homeless youth, individual providers must be aware of the diagnoses associated with homelessness, as well as the community resources available to these youth. Finally, providers need to be the voices advocating for improved services for this disadvantaged and silent population. © 2003 Elsevier Inc. All rights reserved.

Research and development at the health and social care interface in primary care: a scoping exercise in one National Health Service region.

The present project aimed to identify research activity at the health and social care interface in primary care within one National Health Service region, and to determine levels of research capacity and support within social services. The study was commissioned by a primary care research network (PCRN) in order to assess opportunities to increase research capacity within social services. Data were collected in two phases from 61 managers, team leaders and senior practitioners in social care, and six public health representatives in health authorities, using telephone interviews and focus groups. The findings highlighted a lack of infrastructure and support for research and development in social care. However, many social care respondents wanted opportunities to develop research skills with healthcare colleagues. Despite poor support, many small-scale projects were described, and many respondents showed an enthusiasm for engaging with research. Methods in use included surveys, action research, needs analysis and evaluation of service developments. Many examples of user involvement were given. Interface projects were usually instigated by interagency forums and funded from multiple sources. Most project work was motivated by service improvement or development, rather than aiming to produce generalisable knowledge. Barriers to conducting research included lack of confidence, research skills and time, as well as workload demands, lack of cover to release staff for research and lack of supervision. Research was not seen as legitimate work in some social care environments or as part of a career path. Existing joint working initiatives (such as the National Service Frameworks) were highlighted as flashpoints for potential research and evaluation activity. The findings suggest clear opportunities for PCRNs to develop research capacity at the interface with social care; for example, by signposting available resources, providing training grants and secondments for social care staff, and supporting interagency networks with a focus on evaluation. In turn, experience in promoting user involvement in social services could add value to research expertise at the primary care-social care interface.