Care Services Research Articles

Provider perspectives on non-medical barriers to GI cancer care at a regional cancer center.

807 Background: Disparities in care for patients with gastrointestinal (GI) cancers are well-documented, but solutions remain elusive. Understanding the barriers faced by healthcare providers is essential to improving care equity. This study explored the perceptions of healthcare providers at a regional academic health system regarding barriers to care for GI cancer patients. Methods: A cross-sectional survey was conducted among healthcare providers, including physicians, advanced care providers (APPs), nurses, dietitians, social workers, care coordinators, and physical/occupational therapists who directly care for patients with GI malignancies. Survey items assessed specific barriers encountered in clinical practice and suggestions for improving care. Descriptive statistical analysis evaluated the quantitative data from the closed-ended questions across professional roles. A thematic analysis was performed on open-response items and assessed to further identify key barriers to care based on respondents' clinical roles and experiences. Results: Seventy-nine healthcare providers responded to the survey. Initial treatment planning was consistently identified as the phase with the most significant barriers across all disciplines. Health literacy was cited as the most critical barrier to diagnosis, while insurance coverage, financial constraints, geographic location, lack of transportation, and social support were the primary obstacles to treatment. The importance of these barriers varied by profession: physicians noted geographic and transportation limitations, while nurses and social workers emphasized gaps in health literacy, insurance, and social support. Systemic issues such as limited access to specialized care and healthcare personnel shortages were also noted. Notably, 55% of physicians spent 10-30% of their time addressing non-medical barriers to treatment, while 38% of nurses spent 30-50%. Care coordination across disciplines was commonly cited as a challenge, with many calling for improved communication and establishing multidisciplinary clinics. Food insecurity, housing stability, and language/cultural barriers were less prominent concerns at this institution. Conclusions: Oncology providers at a large regional cancer center spend significant time addressing non-medical barriers to treatment for GI cancer patients, particularly during initial treatment planning. The most common challenges reported were insurance, transportation, health literacy, and social support. We will use these findings to guide in-depth provider and patient interviews and develop a team-based, equity-focused intervention. These efforts aim to improve care delivery at our institution and serve as a model enhancing GI cancer care in broader healthcare settings.

Engaging With a Community of Practice in Dementia: Impacts on Skills, Knowledge, Networks and Accessing Support.

To deliver implementable, meaningful research and advance knowledge, different stakeholders need to be brought together regularly via a suitable platform or community of practice. The Liverpool Dementia & Ageing Research Forum, set up in 2019, is a public/professional community of practice, providing in-person and remote events and activities to connect people living with dementia, unpaid carers, health and social care professionals, Third Sector representatives and commissioners. The aim of this study was to qualitatively explore the experiences and impacts of engaging with Forum events by different stakeholders. Attendees of any Forum events were eligible to take part. We conducted remote semi-structured interviews about the experiences and impacts of engaging with the Forum between November 2023 and April 2024. Anonymised transcripts were coded by three research team members, including a trained public advisor (unpaid carer), using inductive thematic analysis. Seventeen attendees participated in the study. These included people living with dementia, unpaid carers, Third Sector representatives, academics and health and social care providers. Four overarching themes were identified in the data: facilitated networking within and outside of personal expertise, improved knowledge and capacity, empowerment by having one's voice heard and diversity in stakeholders but not the background. The Forum events were utilised on a drop- in and -out basis for most attendees, often picking events that were of immediate interest to them, whilst some attended almost all events. Engaging with the Forum was found to strongly facilitate increased networking and building relationships, especially outside of stakeholder background, whilst diversity in backgrounds of attendees, such as ethnic diversity, was lacking. This Community of Practice has successfully brought together diverse stakeholders to network and expand their relationships, and increased knowledge and capacity in different stakeholder groups. Whilst the Forum was considered inclusive, future outreach work needs to ensure that greater diversity in backgrounds and personal experiences is reflected in attendees, and that a continuous flow of new attendees joins. One unpaid carer was involved as a public advisor and was supported in coding two anonymised transcripts and interpreting the findings. They also helped codesign the semi-structured topic guide.

A good start for all children: integrating early-life course medical and social care through Solid Start, the Netherlands’ nationwide action programme

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Caregiver preferences and willingness-to-pay for home care services for older people with dementia: A discrete choice experiment in the Milan metropolitan area.

Dementia is a major health and social care challenge in high-income countries where most people are cared for in their own homes. This study aimed to elicit caregiver preferences for alternative bundles of home care services in the Milan metropolitan area. A binary discrete choice experiment was administered to a sample of informal caregivers of people with dementia recruited through a network of non-profit organizations. The experiment included four attributes: 1) number of home care hours per month; 2) type of care; 3) caregiver peer support group organization; 4) monthly family's cost (in euros), each articulated into three levels. A mixed logit model was applied to analyze the responses using Stata. A total of 93 self-administered questionnaires were collected in January-April 2023. Two-thirds of both caregivers (67.7 %) and care recipients (65.6 %) were female, with a mean age of 59.0 (±12.1) years and 82.2 (±6.5) years, respectively. The experiment showed that increased home care hours, mixed health and social home care, caregiver meetings with professional support and lower monthly costs were mostly valued by caregivers. Some preference heterogeneity was detected in relation to care recipient's characteristics (e.g., age). These results are expected to inform policymakers about caregiver priorities in the field of dementia based on the values placed on hypothetical public home care services.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes.

Research on the long-term effects of treatment for attention deficit hyperactivity disorder (ADHD) on educational and social outcomes is limited. This study aims to evaluate long-term social functioning outcomes in patients with ADHD and the potential effects of pharmacological treatment for ADHD. We used National Patient Registry data from 1995 to 2016 to identify patients diagnosed with ADHD and those collecting ADHD medication. Eligible patients were under 30 years old or had reached 30 between 2005 and 2016, ensuring a minimum 10-year observation period. A case-control design was applied, matching ADHD patients in a ratio of 1:4 with the general population based on age, sex, and residential municipality at the index year. Patients with ADHD experienced substantial socioeconomic difficulties, indicated by increased direct health care costs, higher rates of psychiatric comorbidities, and greater co-medication use compared with controls. No association was found between adherence to ADHD medication and completion of education at age 30 years. Adherence to ADHD medication appeared to negatively impact employment status at age 30, confounded by the severity of psychiatric comorbidity. Despite available treatments, patients with ADHD lag in achieving social functioning outcomes. Further research is needed to better understand how to support patients with ADHD in order to close the gaps in health and socioeconomic status.

Prevalence and Factors Associated With Depression and Depressive Symptoms Among Chinese Older Persons: An Integrative Review.

China is the country with the largest population of older persons. Depression is the most common mental health issue among older adults, a trend expected to increase as societies continue to age. With the global increase in depression and depressive symptoms among this demographic, the resulting disease burden poses a significant challenge to health and social care systems in China. To map, summarise and examine the empirical literature on the prevalence and factors associated with depression and depressive symptoms in Chinese older adults, an integrative literature review was conducted informed by the guidelines of Whittemore and Knafl. The literature search encompassed EMBASE, SCOPUS, CINAHL, Web of Science, PubMed, PsycINFO, SocINDEX, China National Knowledge Infrastructure Database and Wanfang Database. The review included 65 studies, 29 in English and 36 in Chinese. The reported prevalence of depression or depressive symptoms in Chinese older adults was 3.78%-84.3%. Based on the biopsychosocial model, the associated factors were clustered as follows: biological factors (physical health, disability, drug effects, gender, age, diets, physical activities), psychological factors (self-esteem, coping skills, trauma, emotions, beliefs, hobbies, lifestyle) and social factors (family relationships, peers, family circumstances, school, residential areas, social support, social structure). This review synthesised research on depression among older adults in China, highlighting varying prevalence across diverse geographical locations. Given the high prevalence among certain older Chinese cohorts, the early identification and assessment of the factors associated with depression is essential to reducing disease burden. The use of the biopsychosocial model provided a theoretical lens to examine depression in this population in an integrative and holistic way. Thus, furthering understanding of the factors that require close consideration in future research and practice innovations on depression in older persons.

Evaluating Process and Outcomes of Public Involvement in Applied Health and Social Care Research: A Rapid Systematic Review.

Public Involvement (PI) in applied health and social care research has grown exponentially in the UK. This review aims to synthesise published UK evidence that evaluates the process and/or outcome(s) of PI in applied health and social care research to identify key contextual factors, effective strategies, outcomes and public partner experiences underpinning meaningful PI in research. Following a pre-registered protocol, we systematically searched four databases and two key journals for studies conducted within the UK between January 2006 and July 2024. A team of public partners and researchers carried out independent dual screening and data extraction. Included studies were narratively synthesised via Framework Synthesis. Nineteen studies evaluated the PI process with a range of populations including National Health Service (NHS) users, carers, and low-income communities. No specific outcome evaluations were identified. Through their experience, public partners described important components of meaningful PI such as mutual respect and seeing and contributing to change, as well as some unintended harms of involvement. Harms related to 'experiencing negative attitudes', 'emotional burden of involvement', 'frustration and disappointment' and 'further marginalisation'. Meaningful PI was underpinned by structural, organisational, interpersonal and individual factors; as well as practical and principle-based strategies of involvement. Both public partners and researchers reflected on a range of outcomes of meaningful PI including changes to the research process and longer term impacts on organisations, researchers and public partners. PI in research must be facilitated at multiple levels to reduce unintended harm and encourage meaningful and impactful outcomes. Findings are summarised within a model which gives an overview of priorities for individual researchers, organisations and funders to ensure best practice is achievable. From a methodological perspective, researchers should prioritise robust, transparent and co-produced approaches to evaluating PI to increase knowledge in the field. A regional public advisory network provided insight on the relevance and acceptability of the review concept. Our core research team included three public partners. Public partners contributed to the development of the initial review protocol, abstract and full-text screening, reviewing findings and their interpretation and writing the final report.

A Systematic Literature Review of Trauma Systems: An Operations Management Perspective.

Trauma systems provide comprehensive care across various settings, from prehospital services to rehabilitation, integrating clinical and social care aspects. Established in the 1970s, these systems are pivotal yet under-researched in their operational management. This study aims to fill this gap by focussing on the integration of operations management (OM) techniques to enhance the efficiency and effectiveness of trauma systems. By leveraging proven OM strategies from other healthcare sectors, we seek to improve patient outcomes and optimise system performance, addressing a crucial need for innovation in trauma care operations. A systematic literature review was conducted using the PICOTS framework to explore operational aspects of trauma systems across varied settings, from emergency departments to specialised centres. Searches were performed in 5 databases, focussing on articles published from 2006 to 2024. Keywords related to operational research and management targeted both trauma systems and emergency management services. Our method involved identifying, synthesising, and summarising studies to evaluate operational performance, with a specific emphasis on articles that applied operational research/management techniques in trauma care. All eligible articles were critically appraised using 2 quality assessment tools. Employing Donabedian's framework to analyse the quality of trauma systems through structure, process, and outcome dimensions, our systematic review included 160 studies. Of these, 5 studies discussed the application of the Donabedian evaluation framework to trauma systems, and 14 studies examined structural elements, focussing on the location of healthcare facilities, trauma resource management, and EMS logistics. The 63 studies on process indicators primarily assessed triage procedures, with some exploring the timeliness of trauma care. Meanwhile, the 78 outcome-oriented studies predominantly evaluated mortality rates, alongside a smaller number assessing functional outcomes. Existing evaluation metrics primarily focussed on triage accuracy and mortality are inadequate. We propose expanding these metrics to include patient length of stay (LOS) and rehabilitation trajectory analyses. There is a critical gap in understanding patient flow management and long-term outcomes, necessitating focussed research on LOS modelling and improved rehabilitation data collection. Addressing these areas is essential for optimising trauma care and improving patient recovery outcomes.

Rapid Review of Literature Reporting the Experience of Patient and Public Involvement in Prison and Forensic Mental Health Research.

Health research authorities around the world are increasingly committed to embedding public involvement in health and social care research. However, such involvement in internationally published prison and forensic mental health research remains rare. It is therefore particularly important to understand how people are experiencing collaborative research in this field, barriers they may encounter and how these might be overcome. The aim of this review is to explore how academic, practitioner and lived-experience researchers have experienced collaborating on prison and forensic mental health research since a previous review of the topic in 2016. A rapid review of literature was completed by searching three databases (MEDLINE, EMBASE and PsycINFO) between 2016 and July 2023 in addition to Google and Google Scholar searches and hand searching the reference lists of all screened-in documents. We used Reflexive Thematic Analysis to review the screened-in papers. We had lived-experience involvement in this study, which is outlined in our Supporting Information. The database search returned 733 unique articles. Internet searches revealed 10 potentially relevant documents. 20 documents were eligible for inclusion; 15 journal articles, three book chapters, a whole book and a PhD thesis. In the analysis, four overarching themes were developed: the positive psychological impact on lived-experience researchers; it is interpersonally, emotionally and practically challenging; facilitators of the collaborative research process; and positive impact of involvement on the research. Our findings build on the previous review by providing evidence that collaborating on research can have a positive psychological impact on people with lived experience in this setting. It also documents further challenges that are unique to the forensic setting. There was minimal reporting of the experiences of forensic mental health patients involved in research; most included documents focused the experiences of current or former prisoners. Further studies in the topic area are still needed, which utilise a research method to analyse the experiences of conducting collaborative research.

Policy advocacy for inclusive healthcare access from a social work perspective

Access to healthcare is a basic human right, yet systemic barriers like poverty, discrimination, and policy shortcomings continue to create disparities. This paper examines the essential role of social workers in championing healthcare policies that are inclusive and responsive to the needs of vulnerable groups such as low-income families, ethnic minorities, and individuals with disabilities. It explores the limitations of current healthcare frameworks, highlights the methods social workers use to promote equity, and offers evidence-based strategies for reform.

Developing culturally competent models for inclusive social work and healthcare interventions

Cultural competence has become a cornerstone of effective social work and healthcare practices in increasingly diverse societies. This review explores the development of culturally competent models to enhance inclusive interventions in these fields. Drawing on interdisciplinary frameworks and empirical studies, the paper examines key concepts, such as cultural awareness, humility, and intersectionality, while analyzing their practical applications in various settings. Current models, including the Purnell Model for Cultural Competence and the Cultural Competence Continuum, are critically evaluated to highlight their strengths and limitations. Challenges such as implicit bias, resource inequities, and the absence of standardized assessment tools are identified as significant barriers to implementation. The review also discusses innovative strategies, including technology-assisted training and community-driven approaches, as potential solutions to address these gaps.

Life review-based academic service learning to address social work students’ knowledge, ageism and competencies in China: A pilot feasibility trial

ABSTRACT Life review-based academic service learning (LR-ASL) is a comprehensive educational program that addresses social work students’ knowledge, ageism and competencies. This study aimed to examine the acceptability and preliminary effectiveness of the LR-ASL program among undergraduate social work students in China. The study featured a quasiexperimental pretest‒posttest‒follow-up design and collected data from students at a college in China. The intervention group (n = 39) participated in the LR-ASL program, whereas the comparison group (n = 14) completed an aging knowledge examination. Most students (34 out of 39) in the LR-ASL group completed all the intervention sessions and assessments, indicating strong adherence to the LR-ASL program. Repeated-measures ANOVA and a linear mixed effects model were used to analyze the changes. Statistically significant within-group improvements over time in the intervention group were observed for knowledge, anxiety about aging, attitudes toward older adults, competency, and interest in working with older adults. Additionally, the intervention group improved more significantly than did the comparison group in terms of anxiety about aging, attitudes toward older adults, and interest in working with older adults. In conclusion, these findings support the acceptability and possible efficacy of the LR-ASL program among undergraduate social work students in China. LR-ASL may be a viable and promising academic service-learning program that can help inform future research and training related to reducing ageism and increasing gerontology competencies.

Resistance as a coping strategy: an exploration of strategies employed by social work students to manage study and other commitments during placement

ABSTRACT Resilience is widely viewed as integral to social work practice because of the emphasis on strengths-based approaches with clients and their ability to overcome challenges. However, it is crucial to recognize that resilience is not solely an individual issue but is deeply intertwined with broader structural inequalities and disadvantages. As academics working in field education, we understand that social work students often face significant challenges, including the financial and emotional strain of completing long, mostly unpaid placements. This article highlights the strategies employed by social work students to cope with these challenges. Drawing on data from 409 social work students across five universities, students reported relying on support from educators and family, enabling them to problem solve during placement. Despite these efforts, many students admitted to struggling and feeling overwhelmed and had to sacrifice their wellness to meet placement requirements. From a critical social work perspective, the findings underscore the difficulties students face in managing their competing demands whilst on placement in the current economic climate and questions the usefulness of measuring resilience in this context. Social work students instead focused on resistance as a strategy to cope with their study and other commitments during placement which has resulted in collective action and lobbying for change.

Groupwork skills training in social work education: practicing skills training in a Norwegian context

ABSTRACT In research as well as in the field, concerns have been raised that the academization of education in social work contributes to an increased distance from the field of practice. As a core element in the education of social workers, skills training serves an important function in integrating theoretical knowledge and bridging a gap between education and professional practice. Using Vygotsky’s concept of the zone of proximal development, this article takes as its starting point the experiences of BA social work students with skills training and its potential to integrate and activate theoretical knowledge in their training. The students’ evaluations provide a starting point for discussing the importance of their attitudes toward the place of theoretical knowledge in skills training, as well as their own contribution to the integration of theory work. In addition, the teacher’s tasks as a mediator of knowledge about the relationship between theory and practice and how theoretical knowledge can be transferred to, integrated and activated in skills training activities are explored, focusing on dialogue and reflection in the group. Such knowledge might inspire further research on the importance of skills training as a learning arena.

Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial.

Care management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization. To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia. A randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023). Electronic health record screening identified patients with dementia; caregivers confirmed eligibility, including dementia stage. The intervention consisted of monthly calls from a trained nurse or social worker and evidence-based protocols to help caregivers manage patients' neuropsychiatric symptoms, caregiver distress, and palliative care issues (eg, advance care planning, symptoms, and hospice) (n = 99). Usual care caregivers received written dementia resource information and patients received care from usual clinicians (n = 102). The primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range from 0-36, with higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression (Patient Health Questionnaire-8) scores, caregiver distress (NPI-Q distress) scores, and combined ED and hospitalization events. Outcomes were assessed quarterly for 24 months or until patient death. A total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. For the dementia palliative care vs usual care groups, mean NPI-Q severity scores were 9.92 vs 9.41 at baseline and 9.15 vs 9.39 at 24 months, respectively (between-group difference at 24 months, -0.24 [95% CI, -2.33 to 1.84]). There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (P = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, -1.31 [95% CI, -1.93 to -0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]). Among community-dwelling patients with moderate to severe dementia and their caregivers, dementia palliative care, compared with usual care, did not significantly improve patients' neuropsychiatric symptoms through 24 months. ClinicalTrials.gov Identifier: NCT03773757.

Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers: The D-CARE Randomized Clinical Trial.

The effectiveness of different approaches to dementia care is unknown. To determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes. Randomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023). Participants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144). Primary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy). Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29). In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain. ClinicalTrials.gov Identifier: NCT03786471.

Developing an Intervention to Enhance Aging in Place for Older Veterans Living in Permanent Supportive Housing.

The Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program provides rental subsidies, case management, and supportive services to Veterans who are currently or formerly homeless, 77% of whom are ages ≥50. Few interventions have been developed to address the needs of older Veterans in HUD-VASH. We conducted a 2-stage study to inform the development of an intervention to promote aging in place in HUD-VASH. First, we completed qualitative interviews with 21 older Veterans in HUD-VASH and focus groups with 13 staff members to identify unmet needs for supporting aging in place. Second, we used a modified Delphi process with nine staff and one Veteran to prioritize 66 intervention elements based on perceived feasibility and importance. We identified four main themes: need for services to support aging in place; expanding the HUD-VASH workforce; focus on home delivery; importance of trust. The top-rated intervention elements spanned 5 categories: (1) staffing (by social workers, primary care providers, nurses, home health aides); (2) focus (on geriatric needs, mental health needs, dementia care, medication management); (3) modality (in the home or medical center); (4) timing (delivery of the intervention when Veterans have functional impairment, memory impairment, mental health problems, trouble caring for themselves, or are new to HUD-VASH); and (5) duration (regularly scheduled or ongoing as needed). Veterans and staff members identified key intervention elements which can help inform VA efforts to develop and implement interventions to enhance aging in place in HUD-VASH.

Referrals to Peer Support for Families in Pediatric Subspecialty Practices: A Qualitative Study.

Referrals to peer support (PS) can help families of children with special health care needs in providing emotional support, reducing feelings of stress and anxiety, and improving the care experience. This study aimed to gain providers' perspectives about PS referrals for families of children with special health care needs, including their perspectives on logistics of, barriers to, and facilitators of making referrals as well as the perceived impacts of PS referrals. This study builds on a 2022 survey of California pediatric subspecialists about the value and challenges of PS. The study team conducted 20 semistructured interviews with people from pediatric subspecialty practices in California and used a priori themes derived from the interview protocol to develop a codebook, code interview transcripts, conduct a thematic analysis, and summarize findings. Respondents offered a variety of PS referrals inside and outside their institutions, tailoring referrals to each family's needs and preferences. Social workers and family liaisons were most commonly responsible for making PS referrals. Respondents found that care team collaboration and ease of sharing information about PS resources among colleagues facilitated the referral process. Respondents noted a need for more PS resources, including funding, education, and the need for a network where providers can identify PS resources. Encouraging PS program information-sharing within and across organizations could help connect more families to PS services. Future research should assess families' experiences with PS referrals and services to understand approaches that can best meet their needs for information, instrumental, and emotional supports.

The Client in Intrinsic Agency-Based Evaluation: Implications for Social Work Pedagogy

ABSTRACT The author addresses the importance of the evaluation client within evaluation theory and practice and offers a qualitatively derived framework for conceptualizing this role in social work evaluation. Based on an interpretative qualitative analysis of graduate students’ evaluation reports authored over 11 offerings of a specific capstone course on intrinsic agency-based evaluation, the author undertook an analysis of 96 reports selected from 220. Using open coding, the author surfaced four alternative ways of conceiving of the evaluation client, and through interpretation organized those into a typology incorporating two dimensions: the client’s strength of evaluation perspective, and the client’s level of engagement. The author discusses each of the four cells, identifies issues facing social work evaluators when they interact with each type of evaluation client, and draws conclusions for the role of each of the four types of evaluation client in intrinsic agency-based evaluation. The author draws implications for the use of the typology in undertaking client-driven evaluation.

Assessing the feasibility of measuring residents’ quality of life in English care homes and the construct validity and internal consistency of measures completed by staff proxy: a cross-sectional study

ObjectivesTo assess the feasibility of capturing older care home residents’ quality of life (QoL) in digital social care records and the construct validity (hypothesis testing) and internal consistency (Cronbach’s alpha)...