Welfare Professionals Research Articles

Usability of information systems: Experiences of outpatient physicians, outpatient nurses, and open care social welfare professionals from three large cross-sectional surveys in Finland

BackgroundMany European countries are integrating healthcare and social welfare services; some also include joint information systems (ISs) in this process. Despite this, large national survey studies examining and comparing the experiences of the major professional groups regarding the usability of their health (HISs) and client information systems (CISs) are lacking. MethodsWe combined the responses from three national cross-sectional surveys conducted among physicians and nurses in 2017, and social welfare professionals (SWPs) in 2019 in Finland. We selected the responses of 1,826 physicians and 774 nurses working in outpatient clinics in specialized and primary care, and 669 social workers and other SWPs working in open services. The questionnaires were adjusted from a validated instrument. In this study, we analyzed 11 usability-related statements. ResultsThe healthcare professionals (HPs) were more critical of the stability and responsiveness of their ISs than the SWPs (27–48% vs 58–65% agreed). The physicians were most dissatisfied with IS support for routine tasks (24–26% agreed). Less than half of all respondents agreed with statements concerning the ease of documentation, arrangement of fields, and terminology. While the HPs were satisfied with IS support for collaboration and information exchange between professionals in the same organization, all professional groups were dissatisfied with cross-organizational support and communication with patients and clients. Almost half of the HPs considered that HISs improve the quality of care, but 80% of the SWPs disagreed that CISs help improve the quality of services. ConclusionsOverall, the physicians, nurses, and SWPs were dissatisfied with the usability of their HISs and CISs. Based on our findings, ISs should be further developed to support routine tasks, inter- and cross-organizational collaboration, and information exchange. ISs for the integration of care and services should be designed to accommodate various professional groups’ different work contexts and needs.

Comparing conservation and animal welfare professionals' perspectives on domestic cat management

Debates about managing roaming and hunting behaviours in domestic cats often appear to fracture along lines of biodiversity conservation and animal welfare. In practice, however, there may be no inherent opposition between these interests. We carried out a series of Q methodological studies with people in the UK who were professionally engaged either with wildlife conservation or with animal welfare, and who had key individual stakeholder roles as cat owners. Participants arranged a set of statements according to their perspectives on roaming and hunting behaviours and on cat husbandry practices. Analysing the two professional groups together, we found three distinct perspectives: ‘Conservationist’, concerned about cat impacts on wildlife populations; ‘Welfarist’, focused on ensuring cat safety and wellbeing, and ‘Liberationist’, prioritising cat behavioural freedom. Analysing responses within the professional groups, however, we found that cat owners from both conservation and welfare organisations held perspectives that had much in common, and either (a) supported active management of roaming and hunting behaviour, (b) tolerated hunting behaviour as either desirable or unavoidable, or (c) were conflicted, supporting outdoor access for cats but expressing concern about hunting behaviour and cat safety. While their priorities may differ, cat owners working as conservation professionals were cognisant of cat welfare considerations, and animal welfare professionals were often also concerned about wildlife, particularly wild animal welfare. We also identified important areas of agreement on night-time confinement and regulation of cat breeding. This research highlights valuable opportunities for constructive dialogue and greater collaborative working among conservation and animal welfare organisations.

Opinions and Experiences of National Iranian Oil Company Retirees on Psychological Wellbeing: A Grounded Theory Approach

Objective: Mental health refers to emotional balance and social adjustment, feeling comfortable, the absence of mental illness, the integration of personality, and the knowledge of self and the environment. This study aimed to investigate the opinions and experiences of Iranian Oil Company retirees about psychological wellbeing. Methods: This qualitative study was conducted using the grounded theory approach. The participants in this study were 15 retired senior managers of the National Iranian Oil Company in Tehran who were selected through purposive sampling based on the theoretical saturation criterion in 2021. The data were collected through semi-structured interviews and were analyzed using Corbin and Strauss method (1998). Results: Data analysis revealed three selective codes, 11 axial codes, and 67 open codes. The selective codes include self-coherence and the balance between life needs and satisfaction with the current situation, contextual factors promoting psychological health in older adults, and the process of achieving psychological health and wellbeing in older adults. Conclusion: The insights from present research can be used for developing and implementing therapeutic and educational models for elders and recognizing retirement concerns. In addition, understanding the opinions and experiences of the psychological wellbeing of elders helps the healthcare system and social welfare professionals to realize the retirees’ psychological needs.

Effect of Professional Attitude and Welfare on Job Satisfaction and Performance of Early Childhood Education Teachers in Paringin District, Balangan Regency

This study aims to determine and analyze the effect of professional attitudes and welfare on teacher satisfaction and performance. This research was a correlational quantitative approach research. The study population was 141. The sampling in this study was carried out using the Proportionate Random Sampling technique so that a sample of 104 teachers was obtained. Professional instruments (34 items), welfare (35 items), teacher work (60 items) and teacher performance (48 items). The instruments that have been tested for validity and reliability using correlation analysis of moment products. This data analysis used path analysis. The results of the study showed that there was an effect of professional attitudes and welfare, the effect of not on job satisfaction and the performance of early childhood teachers. There is an indirect effect of the effect of professional attitudes and welfare on job satisfaction and the performance of early childhood teachers.

‘You say you are a TB doctor, but actually, you do not have any power’: health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China

BackgroundIn China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into ‘designated’ public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB ‘designated’ hospitals in Zhejiang province, we explored factors influencing hospital-based health workers’ motivation in the context of integrated TB service delivery.MethodsWe conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation.ResultsHealth workers tasked with TB care in ‘designated’ hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems.ConclusionsInadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.

States of Intimacy: Refugee Parents, Anxiety, and the Spectral State in Denmark

This article examines the ways in which parenting practices of refugee parents are the object of concern for the Danish welfare state. Emphasis is placed on how interventions of daycare institutions and other welfare professionals have been experienced by refugee families who live in a context of radical uncertainty since they hold temporary residence permits in Denmark. Based on ethnographic fieldwork and in-depth interviews with families spanning several years, I analyze the experiences of a number of refugee families from Syria and Iran. Drawing on what has been called “the spectral turn” or “hauntology” in anthropology, I argue that welfare state belonging causes ambiguity for families who appreciate protection and sometimes family-like care from state agents but also fear its repercussions. As a result, I argue that relationships between refugee parents and agents of the welfare state are characterized not only by “fear of proximity” but also by “intimate distance”, since refugee parents experience “the system” as being nowhere in particular but potentially everywhere.

Proceduralisation of decision-making processes: a case study of child welfare practice

ABSTRACT This article examines the use of a standardized assessment framework (the Kvello Assessment Framework (KF)), and how it guides assessment work, professional discretion and the knowledge base in child welfare practice. The KF is explored as an example of a standardized tool; it is a non-manual based assessment tool commonly used in Norway. The data stem from fieldwork in two child welfare offices and client documents from one of these offices, which were analysed using thematic analysis. The findings show that the use of the assessment tool led to proceduralisation of assessment work in two areas. First, through requirements for focus and for activities to obtain information. Second, the tool included procedural requirements of form-filling, which in turn placed interpretive demands on the professionals that turned interpretations into conclusions. The findings also identified gaps in their chain of argument. Based on these findings, I argue that use of this tool influences professionals’ discretionary activity as it leads to standardization of decision-making and a narrow knowledge base. The tool may increase the level of transparency of decision-making, and thus function as an instrument of control in association with accountability. However, the use of a standardized assessment tool does not seem to enhance child welfare professionals’ analytical skills and thus does not solve the challenges of child welfare practice. The article discusses how these shortcomings may lead to biased assessments, and emphasizes the importance of a transparent decision-making process.

Rapid and Deferred Help Seeking Among African American Parents of Children With Emotional and Behavioral Difficulties.

Little is known about the factors African American parents consider when seeking care for their child after emotional and behavioral difficulties emerge. This study aimed to examine factors associated with seeking professional care within 30 days after identifying a child's need (i.e., rapid care seeking) and with deferring care for ≥1 year. This cross-sectional study surveyed African American parents raising a child with emotional or developmental challenges (N=289). Logistic regression was used to examine associations of parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care and deferring care seeking. About 22% of parents rapidly sought care, and 49% deferred care for 1 year or longer. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. Community-based pediatric and child welfare professionals should be informed about facilitators and barriers to mental health care seeking as part of efforts to develop interventions that support African American families.

Moral injury experienced by emerging adults with child welfare histories in developmental and sociocultural contexts: “I knew the system was broken.”

This mixed methods research examines moral injury in childhood and adolescence as described by emerging adults with histories of child welfare involvement. Twenty-eight emerging adults (18–25 years) with foster care histories participated in life story interviews, and assessments of exposure to potentially morally injurious events (Moral Injury Events Scale, MIES; Nash et al., 2013). Participants reported on the MIES exposure to potentially morally injurious events during their involvement in the child welfare system as children and adolescents. The most common events described by participants were child maltreatment (82%), adults’ failure to protect them (75%), and injury to their identities as individuals worthy of respect, and as members of particular groups (families, ethnic communities) (39%). In addition, most participants reported multiple moral injuries, and moral injuries that were sustained across months or years. Participants’ reported responses to these events included: rage, shame, guilt, and feelings of betrayal, vulnerability, confusion and worthlessness. Longer term responses included relationship problems, mental health and substance abuse disorders. Perpetrators of moral injury included parents, substitute caregivers, and child welfare professionals. Events occurred in birth homes, but also in out-of-home placements and social service settings. This study contributes to child welfare by highlighting the voices of young people, and identifying moral as an issue for practice and policy intervention. In so doing, this research also contributes to the literature on moral injury by examining the lived experiences of individuals reporting moral injury, by extending the concept to emerging adults with child welfare histories, and by considering moral injury in developmental and sociocultural contexts.

Child welfare system inequities experienced by disabled parents: towards a conceptual framework

Parents with disabilities and their families experience pervasive inequities within the child welfare system. However, existing conceptual frameworks do not adequately explain or address the unique needs and experiences of parents with disabilities and their families involved with the child welfare system. Accordingly, we present a conceptual framework that incorporates empirical findings from existing literature while integrating and expanding extant frameworks and models. The conceptual framework, which is aimed at being a starting point from which to investigate child welfare system inequities experienced by disabled parents, includes interrelated factors measured at the contextual, institutional, and individual levels. The paper discusses areas for further research, challenges for researchers, and implications for reducing child welfare system inequities. Points of interest Parents with disabilities are more likely to be involved with the child welfare system, have their parental rights terminated, and receive inadequate services and supports from the child welfare system, compared to other parents. This paper offers a conceptual framework that identifies factors that impact the inequities experienced by disabled parents who are involved with the child welfare system. Researchers can use the conceptual framework to study the reasons that parents with disabilities have worse child welfare system outcomes than other parents. Policymakers and child welfare professionals can use the conceptual framework to identify ways to prevent parents with disabilities from being unnecessarily involved with the child welfare system and ensure that parents with disabilities who are involved with the child welfare system are treated fairly.

Have the Welfare Professions Lost Autonomy? A Comparative Study of Doctors and Teachers

AbstractThis article investigates the impact of NPM reforms on two prominent welfare state professions; medical doctors and teachers. The case study context is Sweden, where the impact of NPM led to a series of reforms in health care and education after 1990. The focus in the paper is on professional autonomy, which can be seen as a core trait in professional work. The findings in the article point to both medical doctors and teachers having lost professional autonomy as a result of NPM-reforms, particularly with regards to the dimensions of work organization and evaluation. Autonomy in individual decision-making seems to have been least affected, even if there are indications of this being infringed upon as well. Despite these broad similarities, the loss of autonomy is found to be more pronounced in the case of teachers. One reason behind this difference, which manifests itself in teachers having become subject to higher level of direct administrative control by school managers while at the same time experiencing a more distinct loss of autonomy to evaluate their work, appears to be that medical doctors have been more successful in establishing themselves as experts in relation to new public audit agencies.

Resilience of Families Involved in Child Welfare: A Mixed-Methods Study

Abstract Efforts to prevent child abuse and neglect have primarily focused on family deficits, including poverty and parental psychopathology. Models of resiliency, which are focused instead on family adaptation and strengths, offer an alternative to deficit-based practices. Although child-focused resilience studies are common in the field of child welfare, few focus on parents. The authors employed a mixed-methods study to understand how mothers involved in child welfare use resiliency strategies—including belief systems, organizational patterns, and open communication—to overcome adversities. Mothers (N = 129) at risk for child welfare involvement completed a quantitative survey, with 38 completing a follow-up qualitative phone interview. Both survey and interview asked a variety of questions on everyday adversities and coping. Two mothers were assessed as nonresilient. However, a majority of mothers exhibited resiliency, including consistent daily routines, peaceful homes, and family mealtimes. A strong aspirational belief system, not necessarily stemming from a faith tradition or community, provided both parents and children hope in times of trouble. Further, open communication with children about stressors was common. The authors’ results showed that resiliency strategies are being utilized by families typically defined as “at-risk,” and that child welfare professionals should consider focusing prevention efforts more on family strengths than on shortcomings.

The future of child welfare will look toward children’s health: the case of the Kentucky Health Information Data Sharing (KHIDS) project

ABSTRACT The child welfare field in the United States aspires to encompass more than child protection and to move toward the promotion of child and family wellness. Scholars and practitioners have long observed that child wellbeing has been the most elusive of the three-part mandate of the Adoption and Safe Families Act. In response, child welfare agencies have increasingly been asking themselves hard questions and testing new approaches to meet the needs of families. This commentary argues that current developments suggest a future where child welfare workers’ activity in the field actively promotes the health of children and is recognized as an asset to pediatricians and healthcare systems. An example is offered to support this prediction in the form of the Kentucky Health Information Data Sharing (KHIDS) project. KHIDS involved an operational linkage between Kentucky’s child welfare information system and its health information exchange to allow child welfare professionals access to information that allows them to more efficiently perform their duties – especially those related to monitoring health care services for children in out of home care. The KHIDS project is a positive sign of things to come for the future of the field.

‘Offending doesn't happen in a vacuum’: The backgrounds and experiences of children under the age of 14 years who offend

Relative to those who first offend in adolescence, younger children who offend are at increased risk of engaging in serious, persistent, and violent offending. In addition, these children are at risk of a range of adverse psychosocial outcomes across the lifespan. Early intervention with children at risk of offending is therefore critical to support children to thrive and reduce offending and victimisation rates. This study sought to explore the backgrounds and experiences of children who offend prior to the age of 14 years to shed light on the development of child offending and assist early intervention efforts. Interviews with family members (with lived experience of interacting with the child welfare and child offending system) and frontline child welfare and judicial professionals (who directly engage with children who offend) ( n = 33) were conducted. Their experiences show that children who offend have clear, significant, and unaddressed child welfare concerns, including growing up in poverty and experiencing abuse, which cumulatively impacts on children's normative development and can eventually culminate in offending. Participants called for urgent action to address the sociostructural concerns that underlie child welfare concerns and provide prompt and effective assistance to families in need to support children to thrive and prevent future victimisation.

‘If I’m not real, I’m Not Having an Impact’: Relationality and Vicarious Resistance in Complex Trauma Care

Abstract There is growing commitment to trauma-informed practice and increased recognition of risks associated with this work. However, the benefits of working with trauma-affected clients are under-studied. Drawing on interviews with sixty-three welfare, health and legal professionals in Australia, we consider the salutogenic dynamics of work with women with experiences of complex trauma. Participants articulated an ethics of care in which professionals ally with clients against abuse and violence as well as transactional neoliberal service models. We identify this approach to trauma work as a form of vicarious resistance that challenges dichotomies of vicarious trauma and resilience.

Communication Circuits and Inequalities of Health: A Case of Greenlanders in Denmark

Discourses surrounding migration and integration often see language, and in particular the knowledge of the native language, as a crucial barrier to minorities’ access to healthcare and welfare benefits, equal healthcare treatment, social integration, and psychological wellbeing. Using methods of ethnographic and interactional sociolinguistic and conversational analysis our project investigates how healthcare and welfare professionals and Greenlandic patients define, interpret and manage communication and language inequalities in face-to-face encounters. What are the practical, cognitive, psychological and social consequences of “miscommunication” for the Danish Greenlanders? We examine four distinct aspects of communication: conversational strategies, non-verbal behavior, linguistic insecurity, and attitudes. Our aim is to understand the entire communicative circuit (i.e. channels by which information is transmitted), developing on our idea of “affective language economies of health”.

Child welfare experiences with automated medical data sharing for children in protective custody

There are multiple factors contributing to the poor health of children in protective custody, i.e. foster care, including a critical gap in information sharing. A hospital-driven solution was developed in collaboration with child welfare to facilitate automated information sharing between healthcare and child welfare organizations, resulting in a web-based data exchange platform. This study explored the utilization and impact of the data sharing solution by child welfare professionals, learning about the perspectives of child welfare professionals accessing the new health information data sharing platform, and by surveying temporary caregivers about the health information they received from child welfare professionals when children were newly placed with them. Interviews revealed three important themes: (1) The necessity of automated data sharing for child welfare professionals to complete tasks related to managing children’s health and managing child welfare requirements; (2) Recognition that data sharing can reduce work burden and; (3) Even with good automated data sharing, there remained gaps in obtaining the complete picture of children’s health. Temporary caregivers reported no statistically significant increase in health knowledge for new placements before and after the implementation of the data sharing system. This study demonstrated that implementing a data sharing system between the child welfare and healthcare systems is feasible and will be utilized by child welfare professionals who recognize the value both for child health and on their own workload. However, additional research is needed to understand how to best ensure transfer of appropriate health information from child welfare professionals to temporary caregivers.

Hope and resilience as protective factors linked to lower burnout among child welfare workers

Research has established that child welfare professionals regularly face workplace burnout, leading to both high turnover and reduction in service quality. Resilience has been identified as an important factor in coping with workplace burnout. However, a second construct, hope, has also been described as an important buffer to adversity and burnout. To better understand the relative role hope and resilience play in mitigating burnout among child welfare professionals, we conducted a study involving two independent samples of child welfare professionals in Oklahoma (N = 1,272). The two samples were analyzed with structural equation modeling. The model fit the data well (Χ2 = 85.11, p > .001; df = 32, RMSEA = 0.052 [90% CI: 0.039, 0.065]; CFI: 0.983; SRMR = 0.027). Moreover, both hope and resilience were found to be independent protective factors for burnout, but hope was a substantially larger predictor of lower burnout (β = −0.49; p < .001) compared to resilience (β = −0.21; p < .001). The findings suggest that attention to increasing hope in child welfare practice may be a viable intervention to reduce burnout and turnover for child welfare professionals.

African American Adoptions and Expanding Visions of Family

Why do transnational adoption accounts depict adopters as white? Kori Graves delves into this question in A War Born Family: African American Adoption in the Wake of the Korean War. Centering on the obscured history of African American participation in practices of domestic, transracial, and transnational adoptions, Graves tells the story of Korean black children, the African American families that tried to adopt them, and the welfare professionals and nonprofessionals involved in this process of family making. Graves demonstrates that the relatively small number and sporadic nature of Korean black placements in the 1950s and 1960s reflect the impact of segregation and racial inequality upon adoption practices. This history is anchored in the politics of the Cold War and civil rights. After the Korean War, Cold War imperatives shaped narratives around the adoption of Korean children as acts that saved them from communism and disproved U.S. racism, while the ongoing efforts of the Civil Rights Movement brought many African American adoptive families to draw the connections between their struggles to adopt and the broader struggles for civil rights. Building upon the work of historians Brenda Gayle Plummer and Heide Fehrenbach, who examine the adoption of “brown babies” of Germany after World War II, and in conversation with existing studies on Korean transnational adoptions, A War Born Family takes its place as a seminal text on Korean black adoptions after the Korean War. Written in clear and accessible prose, this book will appeal to scholars and non-scholars alike, and will be of particular interest to students of U.S. history and the Cold War, race and civil rights, critical adoption studies, and family and childhood studies.

Whose place? Lessons from a case study of a guardianship determination for an Australian Indigenous child.

Whose values matter when considering which environment is healthier for a child whose guardianship is contested? The biological mother from a remote Australian Aboriginal community, who voluntarily relinquished her but has now requested her return? The foster mother who has cared for her in a metropolitan centre in another State of Australia, thousands of kilometres away? The welfare professionals who also live in that city? Or the child herself, who left her birth home and community five years earlier at the age of two? Drawing on a case study of a seven-year old Aboriginal girl, the authors argue that non-Indigenous values trumped Indigenous values without the realisation of key players who were empowered to make such determinations. The article uses Manuel DeLanda's neo-assemblage theory to consider the range of processes that exert themselves to shape place-values and social identity in colonised nations. It will also draw on Erik Erikson's and Lev Vygotsky's theories of psychosocial development to consider competing sets of values that raised feelings of dissonance within the child. Beliefs about what makes a place health-giving are revealed to be complex in colonised nations. Despite policy and legislative changes to better support Aboriginal people and their right to difference, non-Indigenous professionals can continue to be driven by an unrecognised systemic racism. While place-values are not, of course, the only (or perhaps even the most significant) consideration in guardianship determinations, this article will argue they can play a significant and covert role.