Social Service Personnel Research Articles

A New Era in Mental Health Care in Vanuatu

Inequity in health-care delivery for those with mental illness is widespread throughout low- and middle-income countries. In the Pacific Island countries there are many barriers to addressing the growing mental health burden. In an effort to address this problem, the WHO is coordinating the Pacific Islands Mental Health Network involving 18 countries in the Pacific region with the financial support of New Zealand Aid (NZAid). JB and DP have developed and presented mental health training to health professionals, community leaders, and social service personnel in an environment in Vanuatu that is very different from that of their usual Australian-based general practices. They discuss evidence for their work, an outline of the programme, some difficulties working across different cultures, and the enthusiasm with which the training has been greeted. Vanuatu is now well on its way to addressing the inequity of access to mental health care with a culturally appropriate and self-sustaining mental health workforce.

Characteristics of Young Children Exposed to Violence: The Safe Start Demonstration Project

The Safe Start demonstration projects, funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) under the first phase of the Safe Start initiative, are primarily designed to influence change at the systems or macrolevels to reduce the incidence of and impact of exposure to violence for children aged birth to 6 years; direct services are also provided to young children and their families who were exposed to violence. The data presented in this article come from 10 communities that submitted data regarding the characteristics of young children exposed to violence to OJJDP. These data represent families who are typically not represented in the databases of state child protective services programs but instead have been identified by domestic violence advocates, early care and education providers, family members, court personnel, police, and other social service personnel as families with young children in need of intervention due to violence exposure.The purpose of this article is to describe the characteristics of young children and their parents who seek help for psychosocial problems related to exposure to family and community violence. Results indicate that one quarter of the children and nearly half of their parents evidenced clinical levels of stress, suggesting the need to intervene at the family level as well as at the individual level when working with young children exposed to violence. The information presented, including the extent of exposure to violence, the multiple types of violence to which children are exposed, the impact of this exposure on young children and their families, and the multiple ways in which families exposed to violence come to the attention of service providers is useful for policy makers and service providers who are interested in breaking the cycle of violence by meeting the needs of the children exposed to violence and their families.

An Organizational Self-Care Model: Practical Suggestions for Development and Implementation

Research has documented the negative effects of secondary exposure to trauma across a spectrum of professional and nonprofessional caregivers, including spouses of combat veterans, disaster first responders, mental health professionals, and other medical and social service personnel. Investigators have documented organizational factors that may contribute to these negative effects and have called for organizations to address the self-care needs of their staff. However, implementation of an organizational self-care model has not been described previously in the literature. This article describes a qualitative practice experience related to the implementation of a self-care model within a large social services organization. The goal is to stimulate further research in refining theory and interventions from a scientist-practitioner perspective.

Children with disabilities: victimization, sexuality and communication

Studies have long established that children with disabilities are disproportionately criminally victimised. According to research children with intellectual disabilities are almost four times as likely to be neglected or emotionally...

A 14-year retrospective maternal report of alcohol consumption in pregnancy predicts pregnancy and teen outcomes

Detecting patterns of maternal drinking that place fetuses at risk for fetal alcohol spectrum disorders (FASDs) is critical to diagnosis, treatment, and prevention but is challenging because information on antenatal drinking collected during pregnancy is often insufficient or lacking. Although retrospective assessments have been considered less favored by many researchers due to presumed poor reliability, this perception may be inaccurate because of reduced maternal denial and/or distortion. The present study hypothesized that fetal alcohol exposure, as assessed retrospectively during child adolescence, would be related significantly to prior measures of maternal drinking and would predict alcohol-related behavioral problems in teens better than antenatal measures of maternal alcohol consumption. Drinking was assessed during pregnancy, and retrospectively about the same pregnancy, at a 14-year follow-up in 288 African-American women using well-validated semistructured interviews. Regression analysis examined the predictive validity of both drinking assessments on pregnancy outcomes and on teacher-reported teen behavior outcomes. Retrospective maternal self-reported drinking assessed 14 years postpartum was significantly higher than antenatal reports of consumption. Retrospective report identified 10.8 times more women as risk drinkers (≥ one drink per day) than the antenatal report. Antenatal and retrospective reports were moderately correlated and both were correlated with the Michigan Alcoholism Screening Test. Self-reported alcohol consumption during pregnancy based on retrospective report identified significantly more teens exposed prenatally to at-risk alcohol levels than antenatal, in-pregnancy reports. Retrospective report predicted more teen behavior problems (e.g., attention problems and externalizing behaviors) than the antenatal report. Antenatal report predicted younger gestational age at birth and retrospective report predicted smaller birth size; neither predicted teen IQ. These results suggest that if only antenatal, in-pregnancy maternal report is used, then a substantial proportion of children exposed prenatally to risk levels of alcohol might be misclassified. The validity of retrospective assessment of prior drinking during pregnancy as a more effective indicator of prenatal exposure was established by predicting more behavioral problems in teens than antenatal report. Retrospective report can provide valid information about drinking during a prior pregnancy and may facilitate diagnosis and subsequent interventions by educators, social service personnel, and health-care providers, thereby reducing the life-long impact of FASDs.

Two Roles Exist for Social Services Personnel

Caring for the Ages is the official newspaper of AMDA and provides long-term care professionals with timely and relevant news and commentary about clinical developments and about the impact of health care policy on long-term care medicine.

The Response of Custodial Care Networks to the Needs of Custodial Grandparents and their Adult Children: A Framework Based on Four Caregiving Situations

ABSTRACT The quality of the relationship between custodial grandparents or kin caregivers and the biological parent may have an affect on the ability of kin care or, “grandfamilies,” to obtain help from social and educational services, including child welfare, and to provide a safe living arrangement for the child. The custodial care network consists of the biological parent, custodial grandparent(s), friends, other relatives, educational institutions, and social service organizations. The authors of this paper present a theoretical framework for assessing and addressing the ability of the custodial care network to help children in custodial care homes. Using questions that have been posed by custodial grandparents in a statewide, “relatives as parents program,” in West Virginia, as evidence of need for information and assistance, the framework addresses four custodial care situations and makes suggestions for family preparation as well as resource development by social service and educational personnel. The underlying assumption is that the stronger the relationship between the biological parent/adult child and the custodial grandparent, the more likely it is that other members of the custodial care network can assist the family in raising the child without the child entering the formal child welfare system.

Supporting children and families facing the death of a parent: part 1

To present findings from a review of key literature and from a scoping of current provision of support for children facing the death of a parent. A summary of the findings from these is reported here. To set out the background and context to the evaluation of a new service aimed at supporting children and families facing the loss of a parent from cancer, key literature was reviewed and a scoping of current bereavement support for children and families was conducted using online searching, telephone and face-to-face communications. The review processes uncovered a range of national and local bereavement services. Bereavement was reported as a normal life event and part of human experience. Health, education and social services personnel need to respond to individual needs, accepting that not all bereaved children require complex, long-term interventions. At national and global levels there was recognition that the needs of bereaved children require careful assessment. A complex range of initiatives have been developed across the UK aimed at supporting children facing the death of a family member. The fragmented nature of provision makes it difficult to be comprehensive or all-inclusive when describing service provision in this area.

Functional Problems and Arthrofibrosis Following Total Knee Arthroplasty

Improved surgical techniques and multidisciplinary rehabilitation protocols that involve coordination among surgeons, physical therapists, anesthesiologists, and social services personnel have led to excellent knee function and range of motion in a large percentage of patients following total knee arthroplasty. Nevertheless, there remains a small number of patients with persistent dysfunction that is difficult to treat1-4. Functional problems following total knee arthroplasty may be incapacitating as a result of persistent pain5, instability6, and a limited range of motion7. It has been shown recently that there is a direct correlation between a decreased range of motion following surgery and a lower perceived quality of life as evaluated with use of the Short Form-36 health survey questionnaire8. Continued dysfunction for any reason ultimately leads to decreased patient satisfaction. There is controversy about treatment methods for patients for whom initial rehabilitation efforts are unsuccessful following total knee arthroplasty. The reported efficacy of both noninvasive and invasive treatment modalities has been variable, with the percentage of patients obtaining improvement ranging from 0% to 90%3,9-12. Patients who have continued dysfunction despite initial rehabilitation efforts may require revision surgery. However, patients who have well-aligned, well-fixed prosthetic components will likely not benefit from a complete revision. Treatment of arthrofibrosis, scarring, soft-tissue contractures, and/or other soft-tissue dysfunction should involve less invasive treatment protocols before surgical options are considered. Nonoperative treatment modalities for restoring the range of motion include intensive rehabilitation protocols, static or dynamic splinting, injections, and application of serial casts13. Manipulation with the patient under anesthesia and invasive procedures, including arthroscopic debridement, open debridement with or without polyethylene exchange, and complete component revision, have been utilized when initial nonoperative rehabilitation efforts have failed. As a result of the …

Levels of Death Anxiety: A Comparison of American and Lithuanian Health and Social Service Personnel

Globalization, coupled with increased attention to issues surrounding death, highlights the need to explore cultural influences on the social, personal, and psychological consequences of death. This study compared the responses of 82 American and 119 Lithuanian health and social service personnel on seven subscales of the Multidimensional Fear of Death Scale. Lithuanian participants were more likely to express fear of the dying process and fear of the unknown and were less likely to fear the dead than were Americans. The findings suggest that different historical and environmental experiences with death may influence anxiety about various dimensions of death. Cultural differences in the dimensions of death anxiety among health and social service providers in the two nations suggest the importance of differential training based on specific cultural knowledge to improve the quality of care.

Cirrhosis-associated mortality: Frankly, Scarlet, do we really make a damn?

Cirrhosis-associated mortality: Frankly, Scarlet, do we really make a damn?

A Comparison of Family Functioning, Life and Marital Satisfaction, and Mental Health of Women in Polygamous and Monogamous Marriages

A considerable body of research concludes that the polygamous family structure has an impact on children's and wives' psychological, social and family functioning. The present study is among the first to consider within the same ethno-racial community such essential factors as family functioning, life satisfaction, marital satisfaction and mental health functioning among women who are in polygamous marriages and women who are in monogamous marriages. A sample of 352 Bedouin-Arab women participated in this study: 235 (67%) were in a monogamous marriage and 117 (33%) were in a polygamous marriage. Findings reveal differences between women in polygamous and monogamous marriages. Women in polygamous marriages showed significantly higher psychological distress, and higher levels of somatisation, phobia and other psychological problems. They also had significantly more problems in family functioning, marital relationships and life satisfaction. The article calls on public policy and social service personnel to increase public awareness of the significance of polygamous family structures for women's wellbeing.

Internet Poses Multiple Risks to Children and Adolescents

Computers and Internet usage, whether by children at home or at public places such as schools and libraries, are here to stay. Tremendous benefits in terms of educational opportunities, communication, and recreation can be expected. With all the benefits that such information technology provides, however, there is an element of risk that should not inhibit its use but must be attended to and managed. The methods child sexual offenders use to pursue their criminal interests will continue to evolve as technology evolves. The first and most important line of defense calls for parents and other caregivers to remain directly responsible for the safety of the children in their care. Parents, teachers, healthcare providers, and other caregivers need to learn continually about the Internet and remain aware of how best to protect children who use the computer and the Internet. Law enforcement agencies must also continue to prepare for advances in computer technology, to better anticipate the behavior of child sexual offenders, and to investigate and prosecute offenders. All law enforcement, medical, and social services personnel who have contact with children on a regular basis must continue to educate children and their parents or guardians about the dangers posed by the Internet. After a child is victimized, law enforcement, medical, and social services personnel also must remain cognizant that the victim's computer may contain evidence that may help identify and prosecute the offender. In short, all those charged with the protection of children and the prosecution of child sexual offenders must continue to adapt to our ever-evolving computer technology.

Awareness, Acceptance, and Action: An Emerging Framework for Understanding AIDS Stigmatizing Attitudes among Community Leaders in Barbados

AIDS stigma must be acknowledged and reduced to advance HIV prevention and HIV/AIDS care in a variety of settings worldwide, including in the West Indies where national epidemics are thought to be growing rapidly. Regarded by international health organizations as a formidable barrier to service delivery and receipt, AIDS stigma refers to prejudice and discrimination directed toward people living with HIV/AIDS (PLHA), persons perceived as being at risk for HIV infection, and the informal and formal service providers who care for PLHA. However, there is little evidence of successful antistigma interventions in the literature. Furthermore, beyond studies of willingness in various professions to serve clients or patients with HIV/AIDS, the stigmatizing attitudes and behaviors of service delivery personnel, paraprofessionals and volunteers have been inadequately studied. This paper uses data obtained during an AIDS awareness workshop with sports coaches in Barbados to illustrate principles of an antistigma intervention framework being developed for social service and health personnel. The Awareness/Acceptance/Action Model (AAAM) draws on principles of mindfulness, rooted in ancient Asian traditions, and recently adapted to a range of physical and mental health interventions in Western contexts. Mindfulness techniques encourage awareness of one's current state and environment, acceptance of the implications of one's attitudes and behaviors, and the development of intentional responses rather than habitually patterned reactions. In this initial effort, community leaders were guided through a series of self-reflective exercises focusing AAAM principles on their tendencies toward AIDS stigma, and exploring more compassionate and functional alternatives.

Medical provider versus social worker screening to detect interpersonal violence

Study objectives: We compare 2 methods of screening emergency department (ED) patients for concordance in detection of intimate partner violence (IPV). Methods: This is an ongoing study occurring in an urban academic ED. In this facility, nurses and physicians, mandated by the Jointre Organizations, screen female patients older than 12 years for IPV. An additional convenience sample was screened by Social Services personnel for IPV. Social worker indications for screening included patients presenting with mood disorder, self-destructive behavior, chest pain, headache, dyspnea not related to asthma, nonmotor vehicular trauma, or chronic pain. These social service personnel were blinded to the result of IPV screening carried out by the nurse or physician. Social Services personnel were asked to record the presenc Commission on Accreditation of Healthcae or absence of IPV on a data collection instrument. Other demographic information is being collected about age and race of patients, providers, and social workers. Concordance and discordance between the social workers and providers was then assessed. If IPV was detected by any method, the presence of IPV was determined to be positive. Results: One hundred seventeen women were screened by social workers. Thirty-four (29%) answered yes to screening by either the social worker or medical provider. Five of these 34 patients responded yes to nurse/physician screening but no to social worker screening. Additionally, 13 patients (38% of those with IPV) denied IPV by nurse/physician screening but responded yes to social worker screening. The sensitivity of nurse/physician screening was 62%. Social worker screening sensitivity was 83%. Conclusion: Standard screening by health care providers seems to be insensitive in identifying IPV victims in the ED. Additionally, screening by Social Services personnel was not perfectly sensitive. The focus of continuing work in this project is to determine whether demographic factors of the patients or questioners play a role in sensitivity of IPV screening.

An experimental introduction of group process support in social services

This paper reports the results of initial trials of a group process support system (GPSS) to aid the training of Norwegian social services personnel in the use of a standardised framework known as Gerix, which is used for the assessment of social services clients. As well as providing the GPSS technology, a degree of structure was introduced to the groups involving feedback, debate, and re-assessment of each client on a number of variables. The availability of initial assessments and re-assessments following discussion has enabled some analysis of the GPSS process, including an analysis of the ranges of assessments and re-assessments, and the influence of the dominant opinion on the assessment of other members. The empirical analyses described in the paper, and the evaluative reports of the consultant charged with implementing training for the Gerix framework, both encourage the approach to group process support described in this paper. Following the trials reported in this paper, the GPSS has been adopted for routine training of social services personnel in the Gerix framework across Norway, and has also been adopted for similar training of social services personnel in Denmark, resulting in over 50 training sessions using the GPSS.

Prevention of falls in older people: the Weymouth and Portland project

Falls are a major cause of disability and mortality in the over-75s: 400,000 people each year attend accident and emergency (A&E) departments in England as a result of accidents, with 14,000 dying annually due to an osteoporotic fracture (DoH 2001). Problems associated with falling include loss of mobility, psychological difficulties, increase in dependency and/or disability, hypothermia, pressure-related injury and infection. The catastrophic consequences of a fall cannot be underestimated. South West Dorset PCT (formerly Dorset Community Trust) was allocated £3,000 up to March 2000 with a further £6,000 per year for the subsequent two years to 2002/03 to promote a prevention of falls programme. Health and social services personnel agreed the specification for a new post to increase local support networks and, in line with national guidelines for managing falls among older people (Simpson et al 1998a), the local Dorset guidelines (Dorset Healthcare Guidelines 2000) and Promoting Independence (DoH 1998), additional funding was secured to run chair-based exercise training for up to 32 people.

The fetus and alcohol – A preventable tragedy

When a pregnant woman drinks alcohol in excess of 14.8 mL per day, she places her unborn child at risk for permanent functional brain damage. If she drinks heavily, either on a regular basis or by binge drinking, the risk of pervasively affecting most of the baby’s other organs, including overall cell size and number, rises to the point that a baby can be born with a predictable and recognizable set of physical characteristics that we call fetal alcohol syndrome. The range of the physical, behavioural and intellectual handicaps that result from the toxic effects of exposing a fetus to alcohol is laid out with stark precision in the position statement by the Canadian Paediatric Society’s Indian and Inuit Health Committee (pages 161–174), “Fetal alcohol syndrome”. The Committee is quite right in drawing our attention once again to the seriousness of this problem among Canada’s First Nations and Inuit communities. Victims of fetal alcohol exposure damage are also found in Canada’s inner city communities, suburban areas and rural areas. Some of these people have parents and grandparents with the same problem. These victims are over-represented among children in care. And when they ‘graduate’ from child welfare responsibility, they often break with their foster parents or group home support systems. They hit the streets. They are the school drop-outs who can’t hold a job. They are at high risk for teenage pregnancy and AIDS. Victims of alcohol-related fetal toxic encephalopathy end up in our society’s prisons, among our homeless and in the sex trade. They are the followers who try to get along with everyone, and they will go along with anybody who shows an interest in them. They are the ones who get caught in petty crime, who enter into high risk partnerships, become unwitting victims of abuse and who use alcohol and drugs in excess as an escape from the reality of hopelessness and despair. Governments have recently become highly sensitized to this public health tragedy. They are beginning to pay serious attention to the preventive and intervention strategies laid out in the position statement. Even while education and social services budgets are being squeezed, new funding has been allocated to children who have been negatively affected by intrauterine exposure to alcohol. School officials and social services agencies have become aggressively active in trying to find out whether children with neurodevelopmental problems can be given the diagnosis of fetal alcohol syndrome or fetal alcohol exposure. Parents are becoming more willing to talk about their drinking habits if they can get help for their children by doing so. Given this element of hope for helping these children, paediatricians can be forgiven for being tempted to err on the side of making the diagnosis of fetal alcohol syndrome or fetal alcohol exposure in times of doubt. In doing so, however, paediatricians need to recognize that the diagnosis carries a life-long sentence of uncertainty. These talkative, friendly, uninhibited children aren’t slow processors who will eventually catch on. Worse, they often seem to learn quickly, but forget it within hours or days. Not only do they have a variety of learning problems, but they can’t remember what they have learned. If our current understanding is correct, many of these children will never be able to function independently in society as adults. Paediatricians must be very sensitive to the impact of this news on the parents, foster families or prospective adoptive parents. The guilt and realistic worry that accompanies this diagnosis can be devastating if the support systems are not in place to help. Paediatricians need to be sensitive and responsive to the questions of teachers and school principals in planning and delivering educational programs. We also need to be effective in our message to family physicians, social services personnel and everyone else in the community team who will be involved with these children. An exciting example of what is involved in effectively using our health care expertise in this field comes from the Department of Pediatrics, University of Manitoba, Winnipeg. The medical staff have brought their renowned experience in northern health service to bear on this challenge through the use of telemedicine. Their message is worthy of careful study, not only for the exciting potential that this technical advance offers, but also for the range of resources brought to bear on a community-based approach to this preventable tragedy.

When Things Go Wrong: Being an Independent Person under the Children Act 1989 Complaints Procedure

The introduction of market principles into public services in the 1990s meant that British local authorities were required to develop complaints procedures. In the case of services for children and families, the Children Act 1989 required the appointment of an “independent person”. This article describes the findings from a research study conducted in 1999. A total of nineteen independent people from a range of London boroughs participated. It was found that young people themselves rarely use this system designed to protect their rights. As “sole traders” in adversarial situations between social services personnel and complainants, the independent people were constantly negotiating their position. Depending upon the issue, they are required to move skilfully between conciliation and formal investigation. The findings will be useful to local authorities using independent people, and to the independent people themselves who are largely unsupported in their roles.

Participation in arranging continuing health care packages: experiences and aspirations of service users

This paper examines patients' and carers' experiences of receiving community health services, and considers the degree of patients' participation in the management of their continuing care. Care management, advocated for many years as a way of ensuring appropriate and coordinated care, emphasizes the involvement of patients and carers in care planning. Evidence suggests that such involvement is unusual. Semi-structured interviews were carried out with 99 continuing health care patients and/or their carers. A few informants had willingly chosen to be active in arranging and coordinating their care, and a few others, who did not take an active role, were very satisfied with the services which they received. The majority, however, were not satisfied, feeling unclear about how their needs had been assessed and how services had been arranged. They were mostly disappointed by the absence of information and by the lack of regular contact with NHS and/or Social Services personnel. Some had felt compelled to become proactive in order to ensure that the care provided was adequate. Community nurses are valued by patients, and are well placed to be care managers. However, less qualified staff are also able to offer the regular support and information which patients want and value.