Social Care Workers Research Articles

Planetary health benefits from strengthening health workforce education on the social determinants of health.

Social inequalities are perpetuating unhealthy living and working conditions and behaviours. These causes are commonly called ‘the social determinants of health’. Social inequalities are also impacting climate change and vice-versa, which, is causing profound negative impacts on planetary health. Achieving greater sustainability for human and planetary health demands that the health sector assumes a greater leadership role in addressing social inequalities. This requires equipping health and social care workers to better understand how the social determinants of health impact patients and communities.Integration of the social determinants of health into education and training will prepare the workforce to adjust clinical practice, define appropriate public health programmes and leverage cross-sector policies and mechanisms being put in place to address climate change. Educators should guide health and social workforce learners using competency-based approaches to explore critical pathways of social determinants of health, and what measurements and interventions may apply according to the structural and intermediary determinants of health and health equity.Key institutional and instructional reforms by decision-makers are also needed to ensure that the progressive integration and strengthening of education and training on the social determinants of health is delivered equitably, including by ensuring the leadership and participation of marginalized and minority groups. Training on the social determinants of health should apply broadly to three categories of health and social workforce learners, namely, those acting on global or national policies; those working in districts and communities; and those providing clinical services to individual families and patients.

Moral injury, depression, and anxiety symptoms among health and social care workers during the COVID-19 pandemic: The moderating role of belongingness.

The COVID-19 pandemic can affect health and social care workers' (HSCWs') mental health in their role as frontline workers in this crisis. The pandemic poses unique challenges to HSCWs as they face morally daunting decisions while working with limited knowledge and resources. This study primary objective was to examine the moderating role of thwarted belongingness in the relationships between HSCWs' exposure to potentially morally injurious events (PMIEs) and moral injury symptoms, depression, and anxiety. A sample of 296 Israeli HSCWs completed validated self-report questionnaires that include measures of depression, anxiety, PMIE exposure, moral injury symptoms, and a sense of thwarted belongingness. About one-third (33.6%) of the sample met the criteria for major depression and 21.5% for generalized anxiety. Beyond demographic and work-related characteristics, PMIEs contributed to depression and anxiety levels. The indirect effect of PMIE exposure on anxiety/depression symptoms through MI symptoms was significant only at high levels of thwarted belongingness among HSCWs. Thus, greater PMIE exposure contributes to more MI symptoms, which, in turn, is linked to higher levels of anxiety/depression symptoms among HSCWs with high levels of thwarted belongingness. Cross-sectional design, self-report questionnaires, sample limited to Israeli HSCWs. The study's findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the critical contribution of PMIE exposure and thwarted belongingness to this burden. Clinicians treating HSCWs coping with depression and anxiety following the COVID-19 should also attend to moral injury symptoms as well to the belongingness experience.

Testing an Extended Social Cognitive Model of Occupational Turnover Intentions

Workforce shortages in the health and social care sectors are a relevant issue worldwide. One measure to mitigate workforce shortages is to improve working conditions and workers’ future prospects in order to encourage worker retention. Although studies have examined factors related to organizational turnover, less is known about the factors that lead to occupational turnover intentions. Drawing upon social cognitive career theory, this study examines the reasons behind health and social care workers’ occupational turnover intentions considering emotional exhaustion as an explanatory variable. The participants were 403 health and social care workers who responded to a questionnaire about 4 years after completing their vocational education and training at the upper-secondary level. Structural equation analyses revealed that affective occupational commitment showed the highest negative correlation with occupational turnover intentions. Furthermore, the results suggest that career-related outcome expectations, wellbeing, and supportive working conditions are crucial for designing effective interventions.

Working With Refugees' Health During COVID-19-The Experience of Health- and Social Care Workers in Sweden.

IntroductionIn Sweden, often seen as one of the most egalitarian countries, the COVID-19 pandemic exposed high levels of health inequality, especially harming people with a refugee background. This is also despite Sweden's image as a refugee-friendly country. In this context, the aim of this paper is to better understand how Swedish health- and social workers have reacted to the health- and social needs of refugees during the pandemic. The Swedish case is particularly interesting because, as seen in the paper, health- and social workers had the task of communicating health guidance to refugees who were sometimes more reliant on information from abroad where the consensus on COVID-19 restrictions ran contrary to the approach recommended by the Swedish public health authority.MethodThe study utilizes a qualitative content analysis of 13 in-depth interviews with health- and social workers in Sweden, active in the care of refugees within different kinds of health- and social care settings.ResultsThe analysis showed that healthcare services have remained open during the pandemic but with new precautions at reception areas impacting how refugees access healthcare. As discussed in the article, the shift to digital tools has particularly impacted refugees, worsening already existing barriers to healthcare services faced by those with refugee status. Public health recommendations were poorly designed to the needs of refugees whose living conditions often prevented them from self-isolation and social distancing. Furthermore, Sweden's initially non-restrictive approach to the pandemic instructed health- and social-workers to encourage refugees to take far fewer precautions (e.g., self-isolation, home-schooling, pregnant women to avoid virus hotspots) compared both with European neighbors and the international media typically used by refugees. When Sweden shifted toward a more restrictive approach, health- and social-workers had to revise their guidance in relation to the new recommendations around precautions.ConclusionRefugees have faced increased barriers to maintaining their health and wellbeing during the pandemic that exceed those experienced by the rest of the Swedish population. Refugees have, in general, taken precautions in regard to social distancing and followed recommendations but faced challenges with social distancing due to isolation and crowded living. Public health authorities have often failed to acknowledge that individuals use increasingly diverse sources of knowledge when trying to protect their health, and that not everyone has access to the knowledge needed to access healthcare and social systems. At the same time, there is a need to acknowledge that refugees are sometimes a source of expertise that was ignored by the Swedish health and social system during the pandemic. There is a need for urgent efforts to halt the worsening health conditions for this specific group, but also to counter knock-on societal effects and rising health inequity.

National heroes, disposable workers. How collective action in the health and social care sector during the pandemic negotiated with the self-sacrificing worker ideal.

During the pandemic, the ideal of the self‐sacrificing health and social care worker became both more powerful and more unsustainable than ever. This article explores the manner and extent to which health and social care workers collectively challenged this ideal. Drawing on ethnographic fieldwork in Italy, this paper discusses mobilizations organized within three occupations: doctors in training, nurses, and social care workers. The study finds that collective action partially rejected and partially reproduced the self‐sacrificing worker ideal. Moreover, it shows how inequality regimes, imposing this ideal through classist, gendered, ageist, and racist‐nationalist processes in a pattern specific to each occupation, fundamentally shape the ways in which the ideal is challenged, as does the political culture of the groups organizing the mobilizations.

Morally injurious events and post-traumatic embitterment disorder in UK health and social care professionals during COVID-19: a cross-sectional web survey

ObjectiveTo estimate the prevalence and predictors of morally injurious events (MIEs) and post-traumatic embitterment disorder (PTED) in UK health and social care professionals during the COVID-19 pandemic.DesignCross-sectional study.SettingSeptember–October 2020 in...

Non-reimbursable Workload in Pediatric Diabetes Care – the Providers’ Perspective

Objective: In this study, we quantified the amount of time that pediatric diabetes care providers spend in non-reimbursable activities and evaluated the predictors related to clinic structure and educational and behavioral care diabetes support. Methods: We distributed an anonymous electronic survey via email to Pediatric Endocrine Society (PES) members and requested information about their practice and about non-reimbursable time spent during an average week not on call. Results: A total of 96 diabetes providers completed the survey. Most providers spent 1-2 hours a day on non-billable activities and 60% of them worked on weekends. Providers from medium sized programs and those without fellowships saw more patients than providers from small and large programs and those with fellowships. The same groups had the least assistance from certified diabetes care and education specialists (CDCES) and social workers. Providers from practices allowing CDCES to review blood glucose data and adjust insulin spent significantly less time on this activity themselves. Conclusions: We call for the development of new reimbursement models, noting increasing demands of technology, need for longitudinal care between visits and ensuring sustainability and equity of pediatric diabetes care.

Excess mortality among essential workers in England and Wales during the COVID-19 pandemic

BackgroundExposure to SARS-CoV-2, subsequent development of COVID-19 and death from COVID-19 may vary by occupation, and the risks may be higher for those categorised as ‘essential workers’.MethodsWe estimated excess mortality...

Autism and Learning Disabilities: A relational-intersectional perspective

In this article, I develop a relational-intersectional perspective in my work with autistics with learning disabilities and their paid care staff in social care in England. I propose and illustrate a shift from normalisation to depathologisation in autism as it has already occurred with “homosexuality” classified as a mental disorder in the 70s. I also explore the performativity of “being LGBTQ+” and “being autistic” in a neurotypical-heteronormative-ableist-led society. I point out a possible confluence of intersectionality and the social graces model. I also dig into what research tells us about the lives of people with learning disabilities and autism and the lives of care workers in social care. Finally, I emphasise the benefits of working from a relational-intersectional perspective in a relational approach that has social justice at the heart of its values.

Supporting All Students: Teacher Education and the Realities of Trauma

This article addresses the potential for preparing teachers to instruct students who are living in contexts of trauma as well as the implications of excluding such preparation. Literature in education, social work, and health care are drawn from to highlight important concepts related to trauma. These include types of trauma, effects of trauma on learning, trauma-informed teaching strategies, and the secondary trauma often experienced by bystanders such as teachers. The current state of trauma training in U.S. teacher educational programs is considered generally as well as within the authors’ specific institutions. Against this backdrop, case study research was conducted of novice and experienced teachers in the United States teaching in contexts in which their students with immigrant and refugee backgrounds were experiencing the impacts of political trauma. Interviews took place immediately after executive orders imposing immigration limits intended to stop or reduce refugee resettlement and asylum applications were signed. Interviews were analyzed using a qualitative theoretical analysis methodology to identify how teachers supported their students, each other, and themselves during this time of trauma. The findings included both promising teaching approaches as well as a glaring absence of explicit support given to teachers directly and a lack of teacher self-care. The authors suggest a re-envisioning of teacher preparation responsive to the impact of trauma that can lead to the well-being of both students and their teachers.

Religious-based negative attitudes towards LGBTQ people among healthcare, social care and social work students and professionals: A review of the international literature.

There is a dearth of research on how negative religious attitudes towards LGBTQ people inform professional practice. This paper reports on a scoping review of 70 selected studies from 25 different countries. It explores key issues and knowledge gaps regarding the delivery of services to LGBTQ adults by religious healthcare, social care and social work organisations and/or practitioners with faith‐based objections to LGBTQ people and their lives. The review identified four main themes: (1) a close connection between religious affiliation and negative attitudes towards LGBTQ people, among both students and professionals; (2) a heightening effect of religiosity, particularly among Christian and Muslim practitioners/students; (3) educators’ religious attitudes informing curriculum design and delivery, and some highly religious students resisting and/or feeling oppressed by LGBTQ‐inclusivity, if present; (4) examples of practice concerns raised by professionals and lay LGBTQ people. The article considers the ethical, practical, educational and professional standards implications, highlighting the need for further research in this area.

Decent work in care homes: lessons and implications of the pandemic experience from Scotland

PurposeThe purpose of this paper is to identify lessons and implications on the theme of decent work in social care. This has long been highlighted as integral to improving social care for the elderly. The COVID-19 pandemic experience reveals lessons and implications about the systemic absence of decent work in one place, Scotland, in care homes. The main lesson and implication is a need for change beyond the focus on levels of pay and systemic advocacy of decent work as it is conventionally understood.Design/methodology/approachData was collected using qualitative, semi-structured interviews with 20 care workers in care homes.[AQ4] A range of care system institutional stakeholders was also interviewed. A range of care system institutional stakeholders was also interviewed.FindingsDecent work in social care may only be progressed to the extent that a culture change is achieved, transcending the institutional stasis about who owns and engages with progressing decent work.Research limitations/implicationsThis is a study in one place, Scotland, with a small sample of frontline care workers in care homes and representatives from a range of institutions.Practical implicationsEffective culture change for decent work in care homes needs to be a higher research priority. More explicit culture policies can be a mechanism by which overall decent work and system change may be catalysed and sustainably secured together. Explicit culture change is here set out with respect to operational, institutional and national domains.Social implicationsThere needs to be social policy and political support for situating decent work to be part of a broader culture change around care work with the elderly. A culture-oriented change plan as well as new resourcing and structures can together ensure that the nadir of the pandemic experience was a historical turning point towards transformation rather than being just another low point in a recurring cycle.Originality/valueThe situating of systemic decent work progress within a broader culture change, and modelling that culture change, are original contributions.

Harm reduction readiness for illicit IV drug use among safety-net primary care practices in the San Fernando Valley

BackgroundHarm reduction is an accumulation of strategies aimed at preventing adverse health outcomes associated with illicit substance use. Several harm reduction programs and services exist within Los Angeles County (LAC), however their success relies in part on the application of harm reduction principles by local primary care providers serving patients with substance use disorders. This study aims to assess the readiness of patient-centered medical homes in the San Fernando Valley to provide effective harm reduction to patients who use injection drugs and identify barriers to doing so.MethodsAn online survey was distributed to primary care providers and social workers via email at federally qualified health centers and LAC Department of Health Services clinics in the San Fernando Valley between May and June 2019. It consisted of 22 multiple-choice, Likert scale, and short answer questions. The survey assessed knowledge of injection drug use (IDU), familiarity and utilization of harm-reduction and resources, and self-evaluation of attitudes and skills.ResultsThere were a total of 41 survey respondents across all clinics. Of respondents, 98% correctly identified heroin as a drug typically injected, and 93% identified Hepatitis C as an infectious risk of IDU. 63% of respondents use harm reduction strategies every few months or less. 34% prescribe buprenorphine routinely, and 76% prescribe pre-exposure prophylaxis to those at risk for Human Immunodeficiency Virus (HIV). 76% are comfortable discussing IDU with their patients, but 59% indicate that they lack the necessary skills, and 42% agree that they lack the time to address it.ConclusionKnowledge of IDU was adequate among those surveyed, although overall utilization of harm reduction was infrequent. There is a perceived deficit in skills and time to effectively provide harm reduction to primary care patients in the San Fernando Valley.

Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial.

BackgroundHealth and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time.ObjectiveThis study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic.MethodsNHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6).ResultsRetention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI –0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI –0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI –0.11 to 0.46), and mental well-being (vs MPS: Cohen d=–0.04, 95% CI –0.62 to –0.08; vs NHSWBP: Cohen d=–0.15, 95% CI –0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group.ConclusionsOur analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments.Trial RegistrationISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122

Anchoring social care and social work practice in structured reflection: introducing a model of group reflective practice

ABSTRACT This paper explores the provision of a psychoanalytically informed reflective practice space to a multi-disciplinary social care and social work team in Ireland. The reflective model is closely aligned to the Tavistock’s Work Discussion Group (WDG). The authors explore the selection and preparation of a case and case presentation by one of the authors. This paper examines this process, what it looks and feels like, showing with supporting theory, how refined engagement with case material offers an opportunity for deep thought and reflection. The paper draws on Bion’s concept of ‘attacks on linking’ referring to a phenomenon that occurs when intolerable experiences sever the capacity to think. Facilitated group reflection offered emotional containment to the worker and supported a deeper understanding of his complex connection with and understanding of one foster family. This experiential paper is written in support of the potential for reflective practice spaces.

The challenges of integrating signposting into general practice: qualitative stakeholder perspectives on care navigation and social prescribing in primary care

BackgroundA national policy focus in England to address general practice workforce issues has led to a commitment to employ significant numbers of non-general practitioner (GP) roles to redistribute workload. This paper focuses on two such roles: the care navigation (CN) and social prescribing link worker (SPLW) roles, which both aim to introduce ‘active signposting’ into primary care, to direct patients to the right professional/services at the right time and free up GP time. There is a lack of research exploring staff views of how these roles are being planned and operationalised into general practice and how signposting is being integrated into primary care.MethodsThe design uses in-depth qualitative methods to explore a wide range of stakeholder staff views. We generated a purposive sample of 34 respondents who took part in 17 semi-structured interviews and one focus group (service leads, role holders and host general practice staff). We analysed data using a Template Analysis approach.ResultsThree key themes highlight the challenges of operationalising signposting into general practice: 1) role perception – signposting was made challenging by the way both roles were perceived by others (e.g. among the public, patients and general practice staff) and highlighted inherent tensions in the expressed aims of the policy of active signposting; 2) role preparedness – a lack of training meant that some receptionist staff felt unprepared to take on the CN role as expected and raised patient safety issues; for SPLW staff, training affected the consistency of service offer across an area; 3) integration and co-ordination of roles – a lack of planning and co-ordination across components of the health and care system challenged the success of integrating signposting into general practice.ConclusionsThis study provides new insights from staff stakeholder perspectives into the challenges of integrating signposting into general practice, and highlights key factors affecting the success of signposting in practice. Clarity of role purpose and remit (including resolving tensions inherent the dual aims of ‘active signposting’), appropriate training and skill development for role holders and adequate communication and engagement between stakeholders/partnership working across services, are required to enable successful integration of signposting into general practice.

Mandatory vaccination against COVID-19 for health and social care workers caring for older people.

The COVID-19 pandemic has particularly adversely affected older people with frailty and functional dependency. Essential regular contact with care staff has been evidenced as an important source of infection for this group. Vaccinating care staff can reduce the incidence, duration and severity of infection, preventing onward transmission to older people and minimising the harm associated with discontinuity caused by staff absence. Voluntary vaccination programmes for staff are more likely to be effective when associated with information and education, community engagement and financial incentives but programmes using all of these approaches have failed to establish consistently high vaccination rates in care staff during the pandemic. Mandatory vaccination, proposed as a solution in some countries, can increase vaccination rates. It is only ethical if a vaccine is effective and cost-effective, the risk associated with vaccinating care workers is proportionate to the risk reduction achieved through vaccination, and where all efforts to encourage voluntary vaccination have been exhausted. Even when these conditions have been met, careful attention is required to ensure that the penalties associated with conscientious objection are proportionate, and to ensure that implementation is equitable, in a way that does not disadvantage particular groups of staff.

Heroism and/as injurious speech: Recognition, precarity, and inequality in health and social care work

AbstractThis paper draws on Judith Butler’s (2009, 1997) writing on precarity and the interpellatory power of naming, read through her recent writing on the dynamics of recognition, vulnerability, and resistance, to develop a critique of the discourse of heroism used to position health and social care professionals, and other key workers, during the COVID pandemic. It does so in order to reflect on the insights into workplace inequalities that this example provides, in particular into what, to borrow from Butler, we might think of as the conditions necessary for a “workable life”. It argues that, although it might seem paradoxical, the heroic discourses and symbolism used to recognize health and social care workers throughout the pandemic can be understood as a form of “injurious speech” in Butler's terms, one that served to other key workers by subjecting them to a reified, rhetorical form of recognition. The analysis argues that this had the effect of accentuating health and care workers' precarity and of undermining their capacity to challenge and resist this positioning.

»Teta, s kom si ti lezbijka?«: Z izobraževanjem proti nevidnosti LGBT+ starih ljudi v socialni in zdravstveni oskrbi

The specific characteristics of life course and past experiences of LGBT+ old people require knowledge and awareness on the part of carers. In this paper, an international perspective to shed light on key issues in the field of inclusive care for LGBT+ older people is used, with a particular focus on the Slovenian context, drawing extensively on the findings of the European project “Being me” (2018–2020). In the project, we aimed to explore best practice in the area of education and to develop online learning materials and tools for social and health care workers. Among the principles and approaches that guided our research, the focus was put on intersectionality, resilience, strengths perspective, life stories, and collaboration with LGBT+ old people in all phases of the project.

Public justification, gender, and the family

Social norms regulating carework and social reproduction tend to be inegalitarian. At the same time, such norms often play a crucial role when we plan our lives. How can we criticise objectionable practices while ensuring that people can organise their lives around meaningful and predictable rules? Gerald Gaus argues that only ‘publicly justified’ rules, rules that everyone would prefer over ‘blameless liberty,’ should be followed. In this paper, we uncover the inegalitarian implications of this feature of Gaus's framework. We show that because a society without clear social norms for how social reproduction and care work ought to be organised would be so unattractive, inegalitarian rules would pass Gaus's test. They would pass this test since they would nevertheless be better than ‘blameless liberty.’ Those who are disproportionately burdened by a rule are faced with the daunting task of showing that they would be better off under no rule, instead of merely having to show that they would be better off with a different rule.