Social Services Staff Research Articles

The Discretionary Power of Street‐Level Bureaucrats From the Perspective of Illusio

ABSTRACTInterrogating the tension between care and control in the work of social services staff in Belgian immigration detention centres, this article sheds light on the uses of discretion from the perspective of Bourdieu's concept of illusio. I argue that social services staff's use of discretionary power must be understood at the crossroads of their belief in their professional ethos and the power relations within these centres, which enabled them to frame the element of control as something they had to deal with professionally, rather than something to which they contributed. This sheds light on both the uses of discretion as well as on the articulation of care and control in border humanitarianism.

ENHANCED SUPPORT FOR CHINESE AND KOREAN AMERICAN DEMENTIA CAREGIVERS: INSIGHT FROM SERVICE PROVIDERS

Abstract As members of two large Asian immigrant populations in the U.S., Korean and Chinese American family caregivers of persons with dementia (PWD) have unique challenges impacted by their cultural background. Many of them prefer to and are relying on social services providers who speak the same language as they do for support and assistance. As part of the project to inform the cultural adaptation of NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program for Chinese and Korean American caregivers with multiple chronic conditions, we explored the perspectives of 13 Chinese and 12 Korean services providers (physicians and social service staff). During focus group discussions, services providers shared their perspectives on care challenges facing these populations, including challenges in initiating advanced care planning, family conflict in decision making and caregiving, insufficient community resources, staffing shortage associated with the pandemic and some care aides’ stigmatic beliefs about providing dementia care. We identified nuances in the following aspects: utilization of home health aides’ help, attitudes towards diagnosis and education, approaches to selfcare, preferences for engagement settings, trust-building, and family involvement. For instance, Korean services providers highlighted Korean caregivers’ strong preference for home health aides of the same gender as PWD and having individual rather than group session to learn about dementia. What we found from services providers largely echoed our findings from family caregivers but also provided unique insights from their work experiences. These findings will inform cultural adaptation of the content of the NYUCI to improve its applicability to Chinese and Korean American caregivers.

WE CAN WORK IT OUT: NURSING HOME SOCIAL WORK AND CONFLICT MEDIATION

Abstract Drawing from a nationally representative survey of social service directors (N=922), this presentation will provide an overview of nursing home staffing trends and describe the ways in which social service staff routinely interact with residents, families, and staff. Social workers are involved in many aspects of care, including the admissions process, planning and providing care, care transitions, and general supportive services. As members of the interdisciplinary team, social workers advocate for resident rights, and support decision-making and care planning in times of family crisis and high conflict situations. Summary statistics will be presented to identify the directors’ frustrations with the role – including their perceptions of major barriers to care, and draw attention to the changes that would improve job satisfaction (e.g., higher salary/wage, 51%; lower staff turnover among direct care staff, 47%; and more time to focus on the social and emotional concerns of residents, 45%). The presentation will conclude with an overview of directors’ interest in training topics that may help to mediate conflicts among residents, families, and staff. Specifically, we will share how prepared directors feel to train other staff in conflict-resolution skills (e.g., working with the resident/family and team to balance resident self-determination with the nursing home’s responsibility to minimize risk), and the use of an ethical framework to guide action.

Partnering with social service staff to implement pragmatic clinical trials: an interim analysis of implementation strategies

BackgroundWith recent growth in the conduct of pragmatic clinical trials, the reliance on frontline staff to contribute to trial-related activities has grown as well. Active partnerships with staff members are often critical to pragmatic trial implementation, but rarely do research teams track and evaluate the specific “implementation strategies” used to support staff’s involvement in trial procedures (e.g., participant recruitment). Accordingly, we adapted implementation science methodologies and conducted an interim analysis of the strategies deployed with social service staff involved in one multi-site pragmatic clinical trial.MethodsWe used a naturalistic, observational study design to characterize strategies our research team deployed with staff during monthly, virtual meetings. Data were drawn from meeting notes and recordings from the trial’s 4-month Preparation phase and 8-month Implementation phase. Strategies were mapped to the Expert Recommendations for Implementing Change taxonomy and categorized into nine implementation clusters. Survey data were also collected from staff to identify the most useful strategies the research team should deploy when onboarding new staff members in the trial’s second year.ResultsA total of 287 strategies were deployed. Strategies in the develop stakeholder interrelationships cluster predominated in both the Preparation (35%) and Implementation (31%) phases, followed by strategies in the use iterative and evaluative approaches cluster, though these were more prevalent during trial Preparation (24%) as compared to trial Implementation (18%). When surveyed on strategy usefulness, strategies in the provide interactive assistance, use financial approaches, and support staff clusters were most useful, per staff responses.ConclusionsWhile strategies to develop stakeholder interrelationships were used most frequently during trial Preparation and Implementation, program staff perceived strategies that provided technical assistance, supported clinicians, and used financial approaches to be most useful and should be deployed when onboarding new staff members. Research teams are encouraged to adapt and apply implementation strategy tracking methods when partnering with social service staff and deploy practical strategies that support pragmatic trial success given staff needs and preferences.Trial registrationNCT05357261. May 2, 2022.

Organizational and community resilience for COVID-19 and beyond: Leveraging a system for health and social services integration.

To examine how a preexisting initiative to align health care, public health, and social services influenced COVID-19 pandemic response. In-depth interviews with administrators and frontline staff in health care, public health, and social services in Contra Costa County, California from October, 2020, to May, 2021. Qualitative, semi-structured interviews examined how COVID-19 response used resources developed for system alignment prior to the pandemic. We interviewed 31 informants including 14 managers in public health, health care, or social services and 17 social needs case managers who coordinated services across these sectors on behalf of patients. An inductive-deductive qualitative coding approach was used to systematically identify recurrent themes. We identified four distinct components of the county's system alignment capabilities that supported COVID-19 response, including (1) an organizational culture of adaptability fostered through earlier system alignment efforts, which included the ability and willingness to rapidly implement new organizational processes, (2) trusting relationships among organizations based on prior, positive experiences of cross-sector collaboration, (3) capacity to monitor population health of historically marginalized community members, including information infrastructures, data analytics, and population monitoring and outreach, and (4) frontline staff with flexible skills to support health and social care who had built relationships with the highest risk community members. Prior investments in aligning systems provided unanticipated benefits for organizational and community resilience during the COVID-19 pandemic. Our results illustrate a pathway for investment in system alignment efforts that build capacity within organizations and relationships between organizations to enhance resilience to crisis. Our findings suggest the usefulness of an integrated concept of organizational and community resilience that understands the resilience of systems of care as a vital resource for community resilience during crisis.

Compassionate interprofessional and interagency community: palliative care

The year 2023 marks palliative care with a global theme of compassionate communities. This short communication concerns an extension project developed by students, professors, and palliative care and social service staff at a Brazilian public hospital.

‘A free position in midfield' – a qualitative study of faith-based social work with people who use drugs in Sweden

ABSTRACT Many faith-based organisations (FBOs) provide social work services to marginalised groups in need of care such as people who use drugs (PWUD), but little is known about how diaconal or faith-based social work with PWUD is carried out and how staff view their work. The aim of this study was to explore how social work with PWUD within FBOs in Sweden is conducted. This study is based on semi-structured qualitative interviews with 14 employees at a range of churches in Sweden. The empirical material was analysed with qualitative textual analysis. FBO staff channeled a personal calling to offer services through their organisations and found PWUD be in need mainly of emergency support. Staff engaged in boundary work such as differentiating between activities conducted at the church premises or on the streets. Staff accompanied clients to meetings with publicly funded welfare services to the benefit of the clients, and they appreciated their free role compared to social services staff. FBOs mainly act as stabilisers in relation to official public welfare services. The role of prophetic diaconal work aiming at social justice was limited and clients’ emergency needs were in focus, which indicates that FBOs in Sweden mainly complement welfare state services.

Examining what factors affect inter-agency working in missing children investigations

Abstract Despite responsibility for missing children belonging to multiple agencies, police perceive this to be falling heavily on their shoulders, placing substantial demand on finite resources. Drawing on thematic analysis of 24 interviews conducted with police, local authority, social service, and care home staff from across three UK boroughs, the following study seeks to identify what factors facilitate and hinder inter-agency working in the prevention and response to missing children and why. Findings highlight that inter-agency working is facilitated by having ‘direct points of contact’ across agencies to facilitate information sharing. Inter-agency working is hindered by ‘inconsistent definitions of missing’, limited ‘understanding of roles and responsibilities’, ‘service demand’, ‘technological issues’, ‘fear’, and ‘discrepancies in responses to missing’. Evidence suggests that partnership working would be facilitated by improving shared understanding of missing, roles and responsibilities, and having direct points of contact across agencies.

PROGRAM BANTUAN ALAT BANTU DENGAR BAGI KAUM LANJUT USIA DI KELURAHAN PANGKALAN BALAI KECAMATAN BANYUASIN III

The aim of this study was to find out the Hearing Aid Assistance Program for the Elderly in Pangkalan Balai Village, Banyuasin III District using qualitative methods. The results of the study show that the Hearing Aid Assistance Program for the Elderly has not been implemented properly due to several obstacles in the distribution of hearing aids for the elderly. The productivity dimension, in terms of service, the attitude of the Banyuasin district social service staff is sometimes not responsive in handling requests for hearing aid assistance for the elderly. The mechanism dimension, in terms of distribution procedures, is basically the main activity carried out by the Banyuasin Regency Social Service in distributing hearing aid aid for the elderly in Pangkalan Balai Village, namely meeting the need for aids for people in need. The responsiveness dimension, in terms of community response, is quite good. The distribution of hearing aids for the elderly in the Pangkalan Balai Village by the Banyuasin Regency Social Service had a positive impact. The targets of the results to be achieved by the Banyuasin District Social Service for the sector of providing and distributing hearing aid assistance to the elderly in Pangkalan Balai Village are that hearing aid assistance services are met evenly for a number of elderly people.

NURSING HOME SOCIAL SERVICES DIRECTORS' ROLE AND RESPONSIBILITIES

Abstract While most of the nursing home literature focuses on residents and nurses, there is a growing literature on social services staff and family members of nursing home residents. Social services staff include social workers as well as non-social workers with responsibility for assessing and care planning for resident psychosocial issues, as well as a host of other responsibilities including working with families. This symposium presents findings from the National Nursing Home Social Services Directors Survey (NNHSSDS), a cross-sectional (2019) nationally representative study (n=924) that collected data on social services staff characteristics, departmental role responsibilities, and training needs. In this session three papers developed from these data are presented to document the extent to which social services staff are involved with family members, their interest in receiving training on how they can support other staff in understanding resident abuse and exploitation (at the hands of family, fellow residents, or staff), and neglect. As demanding as the social services role is, many holding the position of social services director report they are thriving (not just surviving) in the role. A final paper describes which variables help to distinguish those who report they are thriving versus those who do not. Implications to be discussed include what administrators could do to make the social services director’s job more attractive. The RRF Foundation for Aging provided data collection support for the NNHSSDS.

The impact of the pandemic generated by coronavirus on employees in social services for seniors from Romania

Since 2020, senior social services staff have been working under new circumstances resulting from the global spread of COVID-19. The pandemic and the restrictions put in place to control it have affected every area of our lives. Thus, this paper aims to analyze the perception of employees on social services for the elderly in Romania and is based on the indicators: the degree of involvement of employees in social services for seniors, the resilience capacity of employees in social services for seniors and the impact of the pandemic on employees in social services for seniors. In order to assess the impact of the Coronavirus pandemic on social services for seniors, the employees of the service providers were invited to participate in a quantitative research based on the sociological survey based on the questionnaire with the most honest answers to each question. The design of the questionnaire was based on previous research, and adaptations were made where necessary. According to the centralization of the data obtained, the personnel employed in social assistance institutions providing social services to elderly people in our country confirm that access to protective equipment and risk management recommendations have been improved. .

The everyday work of One Welfare in animal sheltering and protection

In animal sheltering and protection, One Welfare initiatives include supporting people who have difficulty providing for their animals because of limitations in their physical or mental health, income or housing. However, little research has focused on the actual work that such initiatives involve for animal shelter staff and animal protection officers. We used institutional ethnography to explore how such work activities occur in frontline practices and to better understand how this work is coordinated. Methods included ethnographic observation of animal protection officers and animal shelter staff, document analysis, plus focus groups and interviews with staff, officers and managers. In cases where an animal’s care was deficient but did not meet the standard for legal intervention, officers provided people with supplies for their animals, referred them to low-cost or free veterinary care, and provided emergency animal boarding. This work was time-consuming and was sometimes done repeatedly without lasting effect. It was often constrained by animal owners’ limited housing, cognitive decline, mental health and other factors. Hence, improving the animal’s welfare in these ways was often difficult and uncertain. Although officers and animal shelter staff are increasingly expected to provide and record supports given to vulnerable owners, standard procedures and criteria for intervention have not yet evolved; hence the work is largely left to the judgement and ingenuity of personnel. In addition, the necessary collaboration between animal welfare workers and human social services staff (e.g. social workers, supportive-housing staff) is made difficult by the different expectations and different institutional processes governing such activities. Further work is needed to assess how meeting the needs of both animals and people could be strengthened in challenging situations. This might include sharing best practices among officers and further ethnographic analysis of animal protection services, how they interact with other services, and how One Welfare initiatives actually affect animal care. Institutional ethnography provides a way to study the organisational processes that shape and constrain care for animals, and its explicit focus on actual work processes provides insights that may be missed by other approaches.

45.2 North Carolina Psychiatry Access Line: Supporting Pediatric Prescribers Caring for Children in Foster Care

The North Carolina Psychiatry Access Line (NC-PAL) is a statewide telephone consultation program for pediatric behavioral health that launched in 2018. Since that time, the program has provided consultation to more than 700 primary care providers (PCPs) and trained more than 150 PCPs. To provide consultation to support providers caring for children in foster care, the NC-PAL program in partnership with the North Carolina State Department of Health and Human Services (NC DHHS) is deploying 4 interventions: 1) child and adolescent psychiatry input on a daily basis for high-needs cases; 2) child and adolescent psychiatry consultation to clinicians and Department of Social Services (DSS) staff members caring for children in foster care; 3) education of clinicians and DSS staff members caring for children in foster care; and 4) review of Medicaid and DSS data to target interventions.

How Community-Based Eldercare Services Adapt in Response to Covid-19 Restrictions: Evidence from Singapore

ABSTRACT This study investigated service adaptation strategies that community-based eldercare services (CES) in Singapore adopted in view of the COVID-19 pandemic restrictions. These strategies were also examined for their strengths and challenges. A qualitative study using semi-structured interviews was conducted individually with 11 social service staff from various CES in Singapore. Findings indicated that two main forms of service adaptation emerged: (1) increased engagement with clients and relevant stakeholders, and (2) increased use of telecommunication modalities. Resulting benefits included (1) perceived enhancement of social connectedness and social engagement for service users, and (2) new opportunities for CES to review operations and tap on increased visibility of service users. However, difficulties using telecommunications, resource constraints, and work stressors remain. It is recommended that CES providers implement supportive workplace practices, complement direct service provision with technology, and leverage on opportunities to improve the social environments of community-dwelling older adults.

Formalist, Specialist, Pragmatist or Idealist—Approaches to Boundary Spanning in Personal Social Services

Abstract The social services generally operate in the very centre of welfare systems marked by organisational specialisation. However, a downside to high levels of specialisation is the risk of service fragmentation, which may particularly affect clients with complex needs. In this context, work over organisational boundaries—boundary spanning—is a crucial challenge for staff when performing their duties for the benefit of both organisation and clients. The aim of this article is to describe and analyse approaches to boundary spanning in the daily work of Swedish personal social services staff, paying particular attention to the often overlooked informal dimensions of work. Findings from a non-participation observation study and a group interview study are presented. Four approaches to boundary spanning are identified and conceptualised: the ‘formalist’, ‘specialist’, ‘pragmatist’ and ‘idealist’ approaches. The article concludes with a discussion of influence of these approaches—and particularly dimensions of informal organisation—on future challenges for a specialised welfare sector.

Training professional caregivers to screen for report of cognitive changes in persons with intellectual disability.

IntroductionBy age 60, 60% of adults with Down syndrome (DS) have dementia. Detecting dementia in persons with intellectual disability (ID) can be challenging because their underlying cognitive impairment can confound presentation of dementia symptoms and because adults with ID may have difficulty reporting symptoms. The National Task Group Early Detection Screen for Dementia (NTG‐EDSD) was developed to aid detection of report of cognitive impairment in adults with ID. We implemented an educational curriculum using the NTG‐EDSD and evaluated the impact of the intervention on professional caregivers’ self‐assessed capacity to identify persons with ID and dementia.MethodsWe held five in‐person training sessions for professional caregivers of persons with ID, partnering with various managed care organizations and social services agencies. We assessed knowledge and attitudes at baseline; immediately after training; and 1 week, 1 month, and 6 months after training.ResultsA total of 154 direct care workers, case managers, health‐care providers, and other social services staff attended the trainings. Satisfaction with the NTG‐EDSD training was high; 94% of attendees agreed or strongly agreed that they could use the NTG‐EDSD with their clients. After training, attendees reported a marked increase in confidence in their ability to track various health circumstances and detect functional decline in their clients, although some gains were not sustained over time. As a result of the training, one managed care organization made the NTG‐EDSD a standard part of its assessment of adults with DS starting at age 40.DiscussionSocial services and health‐care professionals can learn to document signs of cognitive decline in adults with ID using the NTG‐EDSD. Attendees were highly satisfied with the training, experienced an increase in confidence in their care of persons with ID, and found the NTG‐ EDSD feasible to use. Because not all gains were sustained over time, booster trainings may be necessary.

Facilitators and Barriers to Implementation of the EIT-4-BPSD Intervention

This study aimed to explore the perceptions of stakeholders (site champions, administrators, and front-line, social service, and activity staff) regarding the EIT-4-BPSD implementation strategy, including its utility, and the barriers and facilitators to implementation in real-world settings. A process evaluation included qualitative data from focus groups conducted with 93 stakeholders of 21 nursing homes (NHs) that implemented the EIT-4-BPSD strategy. Data were analyzed using a conventional content analysis. Emerging codes were sorted into categories then organized in meaningful clusters based on the domains of the RE-AIM framework. Challenges, facilitators, and contextual factors explain variability in implementation of EIT-4-BPSD strategy among NHs in six key categories: multi-stakeholder engagement, multi-level outcomes, process adaptations, uptake and utility of EIT resources, adoption barriers and facilitators, and future planning. Overall, stakeholders reported that the EIT-4-BPSD strategy can be successfully implemented in NHs and is helpful in improving staffs’ approach to BPSD.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

“It’s about Living Like Everyone Else”: Dichotomies of Housing Support in Swedish Mental Health Care

The deinstitutionalization of psychiatric care has not only altered the living conditions for people with severe mental illness but has also greatly affected social services staff. In the Mental Health Act launched by the Swedish government in 1995, a new kind of service called ‘housing support’ and a new occupational group, ‘housing support workers,’ was introduced. However, housing support does not currently operate under any specific guidelines regarding the content of the service. This study explores housing support at local level in various municipalities of one Swedish county. The data is based on discussion with three focus groups: care managers, managers for home and community‐based support, and housing supporter workers. The perspective of institutional logics as a specific set of frames that creates a standard for what should or could be done, or alternately what cannot be questioned, is applied to analyze the constructed meaning of housing support. The meaning of housing support is constructed through three dichotomies: process and product, independence and dependence, and flexibility and structure. These dichotomies can be understood as dilemmas inherent in the work and organizing of housing support. With no clear guidelines, the levels of organizational and professional discretion create a space for local flexibility but may also contribute to tremendous differences in defining and implementing housing support. We discuss the potential consequences for housing support users implied by the identified discrepancies.

Social Service Directors’ Roles and Self-Efficacy in Suicide Risk Management in US Nursing Homes

ABSTRACT Nursing home (NH) residents have many risk factors for suicide in later life and transitions into and out of NHs are periods of increased suicide risk. The purpose of this study was to describe NH social service directors (SSDs) roles in managing suicide risk and to identify factors that influence self-efficacy in this area. This study used data from the 2019 National Nursing Home Social Services Directors survey (n = 924). One-fifth (19.7%) of SSDs reported a lack of self-efficacy in suicide risk management, as indicated by either needing significant preparation time or being unable to train others on intervening with residents at risk for suicide. Ordinal logistic regression identified SSDs who were master’s prepared, reported insufficient social service staffing as a minor barrier (versus a major barrier) to psychosocial care, and those most involved in safety planning for suicide risk were more likely to report self-efficacy for training others. Implications include the need for targeted training of NH social service staff on suicide prevention, such as safety planning as an evidence-based practice. Likewise, sufficient staffing of qualified NH social service providers is critically important given the acute and chronic mental health needs of NH residents.