Social Care Arrangements Research Articles

“Care process into a cash transaction”: medical neoliberalism, Afloat and graphic medicine

ABSTRACT Medical neoliberalism has precipitated a significant shift away from the patient-centric approach to a profit-driven paradigm that prioritises the interests of corporations and shareholders over the well-being of patients. Consequently, there is a shortage of funding for adult social care resulting in compromised service quality. Taking these cues, the article close-reads some sections of Nigel Baines’s Afloat: A Memoir about Mum, Dementia, and Trying Not to Drown (2019) in order to demonstrate how graphic medicine offers multifaceted critique of the NHS and social care arrangements in the UK through nuanced visualisations. Baines deploys a series of visual metaphors to concretise his challenges in quest of an appropriate care arrangement for his dementia-afflicted mother. In particular, Baines deploys thought-provoking board game metaphors (such as the snake and ladder board) and the Yeatsian symbol of gyre to introspect the fine-grained workings of medical neoliberalism and its impact on social care. The article concludes by discussing how Afloat operates as a critical lens exposing the intricacies emblematic of healthcare environments and the deeply rooted vulnerabilities enmeshed within the system.

The outcome of children placed in a welfare center or foster care before the age of 4: Prognostic factors

BackgroundIn child and adolescent psychiatry, many patients are placed in welfare institutions or foster care. ObjectiveIt is important to study their progress in the long term and to examine the psychological and social care arrangements as well as their impacts. Population and methodsThis qualitative study designed to identify potential prognostic factors relating to the outcome of children placed in a welfare center or foster care before the age of 4 years was based on the analysis of 34 case histories of children placed in a welfare center or foster care in Angers. These records involved 129 cases collected for the “Saint Ex” study, a quantitative case study conducted from 1994 to 2001 designed to assess the outcome of children placed in a welfare center or foster care in Angers before the age of 4. The population sampling was purposive and was based on eight subgroups defined by three clinical criteria: Parent–Infant Relationship Global Scale assessment (PIR-GAS) at T1 (admission into welfare center or foster care), the status of a “infant at risk” at T1, and GAF (Global Assessment of Functioning) at T2 (exit from the welfare center or foster care). ResultsThe study population included 11 girls and 23 boys. Factors contributing to adverse progression included problems with interactions at a very early age, failure to listen or respond to a child's request regarding his or her placement, long delays between establishing facts and implementing social measures, discontinuity and/or inconsistency regarding the placement arrangements, and sexual abuse. On the other hand, factors contributing to positive progress included the diagnosis and adapted treatment of a mental disorder in the case of one or both parents, early placement in a foster family, considering the child's requests regarding the placement, responsiveness of social services, and psychological or psychiatric follow-up. ConclusionThe analysis of these 34 cases sheds light on several prognostic elements, with the combination of all these factors as the background. Care based on prevention seems essential to protect early interactions and shorten the time that children are exposed to danger.

Complex care needs and devolution in Greater Manchester: a pilot study to explore social care innovation in newly integrated service arrangements for older people.

Objective The aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. Methods A case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. Results Six case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. Conclusion Components of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. What is known about the topic? The devolution of health and social care arrangements in Greater Manchester has aroused considerable interest in much wider arenas. Necessarily much of the focus in available material has been upon strategic development, analysis of broader trends and mechanisms and a concern with changes in the healthcare system. What does this paper add? The findings from this study will enable emerging approaches to be described and codified, and permit the specific social care contribution to the new arrangements to be discerned. The findings are relevant beyond the immediate context of Greater Manchester to wider integrated care. The evidence can be used by commissioners and services, providing a sound basis for further work as service systems develop. What are the implications for practitioners? This research is important because it is one of the first pieces of work to examine the new integrated care arrangements in Greater Manchester. By providing guidance to promote evidence-based practice, this study contributes to service development in Greater Manchester and the achievement of the broad national service objectives of improving user and carer experiences and ensuring value for money.

Introduction: social policies and social inequalities in contemporary Turkey

Turkey undertook a series of social policy reforms in the 2000s, including a large-scale transformation in health care, recalibration of its pension system, the introduction of a new industrial relations regime, reconstruction of its labour market, the launch of a wide range of social assistance programs and alterations in social care arrangements. This wide range of social policy changes and their impact on the patterns of social inequalities in Turkey has created a highly fruitful research agenda that has attracted the considerable interest of academics from different social science disciplines. This special issue contributes to this literature by offering a critical analysis of recent social policy changes and the changing patterns of social inequalities covering an impressive range of issues: social care, child labour, youth unemployment, young women's employment, the role of faith-based organizations in social welfare and the pension reform. This introduction to this special issue briefly reviews the history of social policy development in Turkey and scholarly debates on the direction of social policy changes in the last decade. Then the article examines contemporary policy trends and the patterns of social inequalities in three policy areas, namely, employment and income generation, education, and housing, which are also selected to reveal the changing character of social policy arrangements and to complement the comprehensive picture that this special issue sketches.

Telecare, obtrusiveness, acceptance and use: An empirical exploration

Introduction Telecare is increasingly part of the United Kingdom (UK)’s health and social care arrangements, and therefore occupational therapists’ practice. Understanding factors which influence telecare’s acceptance and usage is important to ensure optimal outcomes, both for service users and health and social care systems. Method This paper uses data collected by a qualitative, multi-method, longitudinal research study ( n = 60) to explore whether an American model of ‘obtrusiveness’ is applicable to the UK context by examining what factors influence older adults’ acceptance and use of telecare. Findings The obtrusiveness model is broadly applicable to the UK context, but there are also two further issues which affected the acceptance and use of telecare: the degree of control a service user feels they have and the information and support they receive in using their devices. Conclusion The obtrusiveness model, plus the two additions (control and information), highlight important issues which could assist professionals working with telecare, including occupational therapists, in ensuring telecare is both accepted and well used.

Developing the knowledge base about carers and personalisation: contributions made by an exploration of carers' perspectives on personal budgets and the carer-service user relationship.

This qualitative study aimed to explore an under-researched issue within the emerging body of research about carers and personalisation - the carer-service user relationship. It was carried out across 11 English local authorities between 2011 and 2012 and focused on the impact of a change in the service user's social care arrangements to a personal budget on this relationship. Using purposive sampling and explicit inclusion criteria, data were gathered through semi-structured in-depth interviews with 23 carers in long-term dyadic relationships with an adult in receipt of social care who had changed to a personal budget. The interviews explored carers' perceptions of the carer-service user relationship before and after the advent of the personal budget and changes that had occurred. The findings were thematically analysed and reflect the fact that in addition to the effects of the move to a personal budget on the carer-service user relationship, the interviewees talked at length about a range of other effects of this move. Just over half of those interviewed felt that the personal budget had enhanced the carer-service user relationship. The other effects were both positive and negative. Three quarters reported positive outcomes, such as feeling happier, healthier and having more control over their lives. Although two thirds experienced negative feelings about having less involvement in the service user's care, these feelings eased over time and if they had confidence in the quality of the care. Over half found administering the personal budget stressful. Further analysis of these findings showed the study contributes not only to existing knowledge about the carer-service user relationship within personalisation but also to knowledge about the effects of personalisation on carers more generally. It therefore simultaneously develops the emergent knowledge base about carers and personalisation. Recommendations based on this analysis are made about future practice and research.

After the withdrawal of ‘informed choice’: the meanings and social effects of mothers' choice for HIV prevention in Senegal

To prevent HIV transmission through breastfeeding, African health services in 1998 implemented the World Health Organization's approach of ‘informed choice’ when recommending infant feeding options to HIV-positive mothers. In 2010, ‘informed choice’ was withdrawn in favour of antiretroviral prophylaxis with breastfeeding. A 2010–11 ethnographic study conducted in Senegal among HIV-positive mothers revealed three broad responses to the withdrawal of choice and formula provision: ‘resistance’ from association members claiming the health system was responsible for providing formula to ensure efficient prevention; ‘compliance’ among mothers adopting ‘protected breastfeeding’ without complaints; and ‘self-reliance’ among women trying to obtain formula through other means without mentioning choice. These three responses shed light on the meanings attributed to choice and on the social impact of formula provision during the ‘informed choice era.’ The analysis shows that the top-down introduction of ‘informed choice’ as an ethical and management imperative was appropriated and re-signified locally, making space for new forms of sociality within medical and associative social spaces. These social forms could not easily be maintained after the withdrawal of formula provision; women who continue to exert choice do so silently. By focusing on the upheaval of social care arrangements after the introduction of prophylaxis by pharmaceuticals, this paper sheds light on the understudied local consequences of changes in public health policies and the social framing of ‘choice’ in low-income countries' health systems.

Conservative Familialism Reconsidered: The Case of Belgium

The article aims at de-constructing the myths of a homogenous familialism in conservative welfare regimes and starts with an analytical conception of familialism. Thereafter, it is shown how Belgium — as one of the conservative welfare regimes with high priority for the family — changed its social care arrangements in the field of child care and older persons care over time. Traditionally, Belgium is known for a well-organized system of institutional child care, but during the last two decades, also payments for care and time rights to enable family care were introduced. The article analyses the introduction and reform of care policies and their effects on social care arrangements. In the concluding section, the findings of the Belgian case study will be interpreted within the framework of comparative welfare state research.

The quest for integrated systems of care for frail older persons.

The challenge of an increasing elderly population, particularly with respect to frail older persons in need of long-term care, has coupled with ever-present budget constraints to make the financing, organization and delivery of elder care a major priority in North America, Europe and elsewhere in the developed world. Despite obvious cross-national differences in health and social care arrangements for the frail elderly, evidence of poorly coordinated services, disjointed care, less than optimum outcomes, system inefficiency, inadequate accountability, and uncontrolled costs can be found in all countries. There is a growing belief that more comprehensive approaches are needed to effectively address these problems. One such strategy, so-called integrated systems of care, shows great promise. The author critically examines the concept of integrated systems of care for the frail elderly, including the theoretical benefits and drawbacks of the model. At the policy and practice levels, descriptions are presented of, and evidence and lessons are summarized from a representative sample of such projects in the US (Social HMO and PACE), Canada (SIPA), Italy (Rovereto) and Australia (Coordinated Care Trials). The introduction of prototypes such as these raises a number of significant issues for policymakers, payers, providers, consumers and researchers. These are briefly examined in concluding remarks on the important potential of integrated systems of care for vulnerable older people.

Theorizing Aging in Nepal: Beyond the Biomedical Model

This paper has in part emerged from work recently undertaken by Parker and Pant under a British Academy funded Small Grant examining the phenomenon of aging in Nepal. This has enabled them to work in collaboration with the Nepal School of Social Work in Kathmandu to both generate locally relevant empirical research on aging and to facilitate the creation of spaces for dialogue on the implications of aging in Nepal. As a result of this project a network of key academics, activists, government policy makers and non-government organizations, both national and international, has been formed. The findings of this study reveal a lack of both empirical data and theoretical development on aging in Nepal. Aging in the west is often viewed from a biomedical perspective where the emphasis is on medical treatment and health and social care arrangements. Biomedicine also dominates international health strategies, organizations, and the funding streams for aid, of which Nepal is a recipient. Whilst longevity is clearly a positive outcome of development, it also presents health and social care dilemmas. This paper provides an opportunity to explore some of these key issues and highlights the need for practitioners, policy makers and the research community in Nepal to provide an open dialogue in which local, culturally appropriate decisions can be developed in the best interest of older people in Nepal.