Social Work Resources Research Articles

Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument.

The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital system's IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.

Personalisation through Individual Budgets: Does It Work and for Whom?

In England, ‘personal budgets’ are being implemented at a time of financial austerity. They are part of a growing trend internationally to give users of publicly funded social care and support more choice and control. In the individual budgets' (IB) pilot, people were allocated and had control over the way their IB was managed and spent, offering the opportunity to explore the potential of IBs to deliver better outcomes for people than conventional services and support. We describe the way we measured outcomes, the effects we found and how they varied between and within service user groups. For some groups, there were clear benefits from IBs. However, it should not be a ‘one-size-fits-all’ approach, and, in taking personal budgets forward, it is important to consider how best to address the particular challenges for older people, effects on social work practice and resource implications if the potential benefits are to be achieved. Social workers may find themselves implementing a policy with considerable potential, but which may prove very difficult to achieve in the current financial climate.

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support.

BackgroundIncreasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.MethodsDrawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.DiscussionThe translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

Locked Out of Prevention? The Identity of Child and Family-Oriented Social Work in Scottish Post-Devolution Policy

The post-devolution settlement in 1999 created the environment for major national policy and legislative reform across all dimensions of Scottish life. This paper seeks to understand better the place of child and family-oriented social work in post-devolution Scotland. Scottish social work policy in general and children's services policy in particular are analysed to consider where policy makers appear to locate social work resources. An alternative reading of these post-devolution policies suggests that a policy ‘effect’ is being produced that appears to lock social work out of early intervention and prevention. Ambiguities and hidden elements reveal an identity for social work in policy that primarily aligns it with control functions where balancing care and control and the use of involuntary measures is to the fore—the ‘hard cases’. This analysis points to the importance of social work taking a critical distance to policy formation and what it may mean for its identity and contribution to meeting the needs of the most vulnerable children growing up in Scotland today.

Cancer Patients' Use of Social Work Services in Canada: Prevalence, Profile, and Predictors of Use

This study examines the demographic and physical and mental health characteristics of social work clients among cancer patients in Canada as compared with nonusers of social work services, and factors that affect use of social work services among cancer patients. On the basis of data from two cycles of the Canadian Community Health Survey, the study's samples include 2,703 and 2,821 Canadians living with cancer in 2000-01 and 2003, respectively. The number of Canadians with cancer who consulted social workers about their physical, emotional, or mental health increased from 31,005 to 36,427 over the study period. Results indicate that cancer patients who used social work services were in need of social support or were members of vulnerable populations. Patient's age, living arrangement, income, depression status, and physical limitations were significant predictors of service use. Findings of this study, never reported before, offer information important for identifying barriers to service use and for future planning of social work services and resources.

Clinical Priorities: Strengthening Social Work Practice in Health*

In the context of health services, decisions regarding priorities for social work intervention and, hence, the allocation of social work expertise and resources have traditionally been based on an interaction between social work knowledge, principles and skills, historical precedence, health policy, multidisciplinary team requirements, and manager opinion. In the current context of health services, traditional practices are questioned and it has become essential for social work as a profession to clarify its role, its choice of interventions, and to state clearly and strongly, on the basis of social work knowledge, its core priorities for practice and, hence, the allocation of resources. This paper presents the findings of an exploratory study, undertaken by joint university and practice collaboration, designed to develop a set of priorities for social work practice in health. The study was undertaken in the Hunter Health region of New South Wales, Australia, where social workers are employed across a range of hospital, mental health, specialist, and community services. The resulting set of clinical priorities for social work practice in health has implications for the allocation of social work resources and expertise to the social issues central in individual family and community health status, and for the profession's capacity to strengthen the role of social work in health.

A National Review of Health Services for People with Intellectual Disabilities in Scotland

*Dr Martin Campbell, BA, TFQE, PhD Senior Teaching Fellow, School of Psychology, University of St. Andrews, St Andrews KY16 9JP, UK Tel: +44 (0)1334 462084 Fax: +44 (0)1334 463042 Email: mc1@st-andrews.ac.uk Dr Margaret Whoriskey, MBE, BA, M.Phil., C.Psychol., PhD Asst. Director, Joint Improvement Team, Scottish Executive, Edinburgh, UK Dr Ros Lyall MBChB, MPhil, MBA, MRCPsych. Consultant Psychiatrist, NHS Lothian, Edinburgh, UK Mr Alex Davidson BA Head of Adult Services, Social Work Resources, South Lanarkshire Council, UK Mr Michael McCue BA Complex Needs Services Manager Glasgow Learning Disability Partnership, Glasgow, UK * For Correspondence Introduction

The economic value of psychology in Australia: 2001

The purpose of this paper was to update the Guldberg & Sivaciyan (1995) estimates of the value of psychology based on 1991 figures. In addition, this paper expands the scope of their work by including comparisons of other related professional groups (those with tertiary training in psychiatry, mental health nursing, social work, counselling, occupational therapy and human resources). Economic modelling indicated that psychology contributes $8.6 billion to the National economy – some 500% more than in 1991, and more than all other related professional groups combined. However, psychology incomes in most sectors have marginally decreased in real terms, and still lag 9.2% behind related professionals. The number of individuals trained in psychology has also risen dramatically to at least 37 978. Many of these individuals (17 364) have only a bachelor degree, and experience a higher rate of unemployment than both their higher qualified peers in psychology, and the national average for individuals with the same level of qualification. The ongoing lack of Federal funding for professional higher degrees, and the training guidelines of the Australian Psychological Society are likely to lead to rises in the cost of postgraduate education in the coming years. There is nonetheless a substantial economic advantage to students undertaking professional higher degrees in psychology. The implications for the profession of psychology are discussed.

The Future of Social Work in Aging: “Everything Old is New Again”

With the aging of the baby boom generation, the number of older adults in the US will increase substantially. Using a biopsychosocial framework, this article presents cutting-edge of older adulthood and considers emerging roles of social workers with older adults and their families. Research, education, and policy perspectives that will advance social work knowledge, skills and resources in aging are proposed. Social work as a profession is challenged to lead the way in making “everything old new again.”

Motivational Interviewing and Social Work Practice

• Summary: Motivational interviewing was proposed as an alternative model to direct persuasion for facilitating behavior change. Social work behavior change interventions have traditionally focused on increasing skills and reducing barriers. More recent recommendations tend to encourage practitioners to explore a broad range of issues, including but not limited to skills and barriers. The article defines and explains motivational interviewing by presenting its essential spirit and techniques, and provides a brief case example within a domestic violence context. • Findings: This article proposes motivational interviewing as an intervention appropriate for social work practice concerned with behavior change by arguing that motivational interviewing is an exciting intervention model for numerous social work settings due to its consistency with core social work values, ethics, resources, and evidence-based practice. • Applications: Social workers may strive to practice and test motivational interviewing in addictions settings, as well as within other critical social work arenas including but not limited to health, domestic violence, batterer treatment, gambling, HIV/AIDS prevention, dual disorders, eating disorders, and child welfare.

Successful ways to increase retention in a longitudinal study of lead-exposed children.

Much has been written about low retention rates in longitudinal studies of children (Bender, Ilke, DuHamel, & Tinkelman, 1997; Hartsough, Babinski, & Lambert, 1996). Although no reports on retention rates in studies of lead-exposed children were found, other clinical trial studies reported varied retention rates. In a review of clinical studies following children with ADHD into adulthood, Klein and Mannuzza (1991) reported retention rates of 51 percent to 88 percent. Other authors reported retention rates ranging from 75 percent (Tinkelman, Reed, Nelson, & Offord, 1993) to 81 percent (Hartsough et al., 1996). Reasons given for these retention rates include the length of the commitment required, participants' distrust of research programs, and family stresses (Bender et al., 1997). Loss of any subject can affect the statistical power of the findings, possibly leading to erroneous conclusions. Thus, it is important to retain as much of the original cohort as possible. The Treatment of Lead-Exposed Children (TLC) study, was a multiyear National Institute of Environmental Health Sciences contract carried out in four urban sites: Newark, NJ; Baltimore, MD; Philadelphia, PA; and Cincinnati, OH. Its purpose was to study the effects of oral chelation on the neurobehavioral sequelae of lead exposure in children with low to moderate lead levels (20-44ug/dl). The study enrolled 780 children ages 12 to 33 months. It consisted of a randomized, placebo-controlled, double-blind trial of up to three courses of treatment with succimer (a lead chelating agent) and required frequent visits over a period of three years. The Newark TLC site, located at the University of Medicine and Dentistry of New Jersey (UMDNJ), enrolled 208 children, of whom 71 percent were African American, and 22 percent were Latino/Hispanic. Of the enrolled children, 101 were girls and 107 were boys. Almost all were residents of urban areas with deteriorating housing. The Newark TLC site maintained a 97 percent retention rate (attrition rate of 3 percent) over a five-year period. Retention rates for the other three TLC sites ranged from 84 percent to 95 percent. This article describes the four primary factors that contributed to Newark TLC's high retention rate: program structure, social work resources, family care, and tangible supports. FACTORS IN HIGH RETENTION RATE Program Structure Staffing made a significant contribution to the low attrition rate at the Newark site. On the basis of decades of experience working with urban lead-exposed children, one of the principal investigators decided to hire personnel dedicated to the project rather than use staff from other hospital departments. Clinical staff consisted of one pediatric advanced practice nurse, one registered nurse, two pediatricians, a bilingual social worker, a bilingual social work aide, a supervising psychologist, and a bilingual psychologist. Using University Hospital in Newark as home base, TLC Newark also operated clinics in a nearby city's health department and at a satellite outpatient clinic 40 miles away. TLC Newark staff traveled to all three sites, so that families were assured that the same staff would always greet them, know their history, and care for their needs on each visit. All TLC staff were hired three to six months before recruitment of study participants. Regardless of prior experience and training in working with lead-exposed children, all staff received at least three months of training in the UMDNJ Pediatric Lead program. Social Work Resources The presence of a dedicated bilingual social worker was a key component of Newark's retention success and was unique to the Newark TLC site. The social worker provided a vital link between the study and the enrolled families. The most critical elements of this role were home visits, missed appointment follow-ups, referrals to ancillary services, hands-on assistance, and managing and providing transportation to and from clinic visits. …

Social Work in Primary Health Care Settings

Boosting access to social/health care through the creation of 'one stop' services in primary care settings is a distinctive feature of current Government policy. The Quality Strategy for Social Care sets out how: 'In future, social services will . .. need to be routinely delivered in a variety of new settings such as GP surgeries' (Department of Health, 2000, p. 5). As the articles considered here reflect, accessing social work services and resources is of critical importance to a more equal chance of maintaining physical health, and sustaining well-being in the face of acute and long-term illness. However, the issue of the potential benefits as well as limitations of social work based in primary health care centres has tended to be marginalized within analysis of social work practice. In this way it suffers from the more general lack of recognition within social work discourse, of the significant impact social work in its own right can have on physical health (McLeod and Bywaters, 2000). It is therefore particularly important to spotlight the few examples of evidence on social work in primary care settings which do exist. The articles discussed here do not document the work of Healthy Living Centres or Health Improvement Programmes, which are multifaceted organizational initiat ives in primary care, with an explicit brief to address deprivation on a neighbourhood basis, in the interests of health (Department of Health, 1998). Instead they make their point about the health promoting potential of social work, through practice that is lower profile. The first two papers assess the significance for older peoples' uptake of services, of individual local authority social workers being located in GP surger ies. The final paper assesses the degree and nature of discernible improvements to older service users' health, resulting from benefits advice being routinely available at a surgery. The argument may be raised against its inclusion here, that benefits advice does not constitute 'mainstream' social work practice. In response, there is powerful evidence that to meet service users' requirements, such 'poverty-aware'

Denial of Pregnancy: A Case Study and Literature Review

A case is presented of a young active duty woman who experienced nonpsychotic denial of pregnancy until she precipitously delivered a healthy full-term infant. Despite the lack of prenatal care and the requirement for neonatal resuscitation, the child has apparently developed normally. The woman had no ongoing psychiatric illness. She was able to make appropriate use of medical, nursing, and social work resources to function well with her child at home. The recent literature on denial of pregnancy is reviewed, and the clinical differences between nonpsychotic and psychotic denial of pregnancy are described. Clinical management and mobilization of social support structures can improve the chances of successful clinical outcomes in nonpsychotic denial of pregnancy.

A heavy responsibility: Recruiting residential child care staff

The recruitment of residential child care staff is a complex and difficult task. It present challenges to social work managers and human resource professionals, local politicians and others carrying responsibilities in this area. The recent abuse scandals in residential settings highlight the importance of studying this issue in depth. This paper considers why thorough procedures are needed, evaluates the risks posed by staff to children, and the part played by recruitment procedures in lessening these. It considers which elements should be in place in effective recruitment and selection procedures pre-planning, advertising, application forms, references, vetting, interviewing, testing, and cost. Use is made of the literature to throw light on this, and remaining dilemmas are noted and issues discussed. The necessity of social work and human resource professionals pooling their knowledge and skills is emphasised.

Direct work with children – the practitioner's perspective

Direct work with children is a social work technique widely used by practitioners involved with children who have experienced trauma and abuse. Whilst there is an abundance of literature about how to do direct work and ‘successful’ pieces of work there is little written about practitioners experiences of the work. This article seeks to identify some of the difficulties and dilemmas practitioners, including the author, face undertaking direct work. It makes recommendations of ways in which social work structures and resources might be altered to ensure that direct work is of benefit to the children it seeks to help and that practitioners are able to maintain their commitment to it.

An evaluation of pre-admission assessment for elective surgery

Abstract Increased pressures on hospitals to minimise the hospital stays of patients can limit effective planning for patient discharge. In an attempt to maximise social work resource use while providing quality patient care, a major Sydney teaching hospital evaluated pre-admission screening and early social work intervention as an alternative strategy to hospital-based social work provision and discharge planning for patients on a waiting list for elective surgery. Of 243 patients admitted during a two-month period to an elective surgery program, 74 pre-admission screenings were conducted. This process resulted in over 48 per cent of all social work services being provided prior to hospital admission. While information and education were the most common services provided, 22 per cent of interventions to the subject group involved the use of more complex social work skills. The findings support pre-admission screening and the provision of social work intervention prior to admission once specific 'at risk'...

Maintaining links: Resource demands and social work attitudes in respect to parent–child access in a statutory child welfare agency

This paper investigates the demands on social work resources in the north east region of the Department For Family and Community Services in South Australia, and examines the attitudes of workers to the question of access. Twenty three social workers, working predominantly in Child and Family Teams, were interviewed. A two part questionnaire was devised. The initial data covered information relating to the frequency, duration and supervision of access visits. The second part of the questionnaire used a semi-structured, open-ended format in order to explore social workers' knowledge and values in respect to access. The results of these interviews are presented and the implications for policy and practice in relation to statutory social work are discussed.

Gerontological social work: an annotated bibliography

Foreword by Erdman B. Palmore Introduction Gerontological Social Work: General Works Gerontological Social Work: Clinical Practice Issues Gerontological Social Work: Educational Issues Geriatric Health Services in Social Work Resource Information and Materials Author Index Subject Index Biographical Sketches

A Controlled Evaluation of Comprehensive Social Services Provided to Teenage Mothers Receiving AFDC

This article reports the evaluation of a community-based program designed to assist teenage mothers receiving Aid to Families With Dependent Children to become self-sufficient. The program began with 204 young mothers randomly assigned to a control (N = 100) or an experimental group (N = 104). At the completion of the demonstration period, total sample size had been reduced to 144, with 83 in the experimental group and 61 in the control group. The results suggest that with labor-intensive casework services, conscientious case management, and systematic linkages to a network of critical supportive social work services and resources, it is possible to align adolescent welfare mothers on the path toward self-sufficiency in a number of critical life areas. However, the benefits of the community intervention were not realized within the first year of involvement in the program; the desired outcomes emerged after nearly 2 years of intensive services.

The Resource Worker Project: Evaluating a Specialist Social Work Service for Severely Disabled Children and their Families

Accumulated research evidence revealed the continued fragmentation of support services for families caring for a severely disabled child; while parents themselves repeatedly reported the lack of a comprehensive source of information and advice. The resource worker project was designed to assess whether the levels and coherence of services to the families of severely disabled children could be improved through the intervention of specialist social workers. The activities of the social workers were extensively documented and multiple methods of data collection were used to evaluate their intervention, in comparison with a matched group of families who continued to receive the normal generic services. According to a number of ‘outcome’ measures—for example families' use of services, facilities and professional expertise; the incidence and severity of stress among parents; the mental and physical well-being of various family members—changes occurring as a result of the intervention were, apparently, neither large scale nor consistent. Nevertheless parents were virtually unanimous in their positive and enthusiastic appreciation of the help and support they had received. The implications of these findings for the evaluation of social work intervention are discussed; and attention is drawn to the importance of evaluating intervention of this kind, as the long term support of families with severely dependent members is likely to place increasing demands on social work and social services resources in the future.