A different kind of holding environment: a case study of group work with pediatric staff

This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups-the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

The Mentoring FAN: A Promising Approach to Enhancing Attunement within the Mentoring System

ABSTRACT

Youth mentoring is a popular tool in positive youth development, with most programs utilizing a model through which youth and non-parental adults are “matched.” Using an adaptation of the Facilitating Attuned Interactions framework, this study sought to explore the effectiveness of the Mentoring FAN in enhancing interpersonal attunement among mentoring staff at two youth mentoring programs in the U.S. Upon completion of the Mentoring FAN training, quantitative (n = 28) and qualitative (n = 15) data were collected from program staff at both sites. Open-ended data from a subset of mentors (n = 27) was also gathered. Results revealed that mentoring staff experienced significant increases in empathy following the Mentoring FAN intervention. Participant interviews revealed increased attunement, increased listening ability, and increased collaboration in the supervisory relationship. Findings support the continued delivery and rigorous testing of Mentoring FAN training, with great promise for enhancing attunement across the mentoring system as a means of strengthening the relationships so critical to this intervention. The study also has important implications for the development of mentor support practices within mentoring organizations, as well as policies designed to meet the needs of youth served by mentoring programs in the U.S.     

A family-centred practice supervision project conducted for a child welfare agency

ABSTRACT

This paper reports on a supervision project that aimed to enhance a child welfare agency staff’s professional competence in family-centred practice through a strength-based approach. A qualitative study was designed to explore the effectiveness and the change agents of the supervision. Purposive sampling was used. Two agency supervisors and two social workers participated the study voluntarily. The findings indicated that after the period of supervision, the staff had changed in three respects: their conceptualisation of the meaning of family work in the care context; their understanding of the importance of relationship-based interventions with families; and their development of alternative ways of practice. The agents of change from the supervision were the consultants’ modelling effect and the co-worker experience of the consultants and the social workers. This supervision approach can discern the synergistic effect of supervision on an agency’s routine supervision and balance the cultural beliefs in qing, yuan and ‘face’ embedded in the supervisory process.     

Hoarding in the Community: A Code Enforcement and Social Service Perspective

ABSTRACT

Hoarding behaviors endanger individuals and their communities. Although there is a growing literature on clinically referred and elderly hoarders, there is limited information about hoarding behaviors beyond these contexts. This study examines the frequency, characteristics, and outcomes of cases involving hoarding encountered by code enforcement officials and social service staff. Prior to an in-service training, 236 social service staff members completed a 43-item survey about their experiences with cases involving hoarding. Respondents reported encountering between two and three cases per year. Although these hoarding cases were estimated to cost more than $3,700 in cleaning fees, 83% of respondents reported having received no prior training on dealing with hoarding. Survey responses suggested that hoarding situations were difficult to resolve and involved multiple community agencies. Collectively, hoarding behaviors appear to be a problem regularly encountered by social service members, who often serve as the initial point of contact. Along with increased training, future research is needed to develop and evaluate collaborative interagency protocols to manage this multifaceted problem. Empirically informed interagency protocols may facilitate the timely referral of community hoarders to mental health professionals and may lead to improved outcomes.     

Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility

ABSTRACT

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.     

A Study Exploring Risk Management Issues Among Volunteers in an Oncology Support Program

ABSTRACT. Risk management and challenges of volunteer roles in an oncology support program in Montreal, Canada, were explored using a phenomenological approach involving 65 service volunteers. Fourteen focus groups were held representing oncology services in the hospital and the wellness center. Self-reported questions were administered to assess the risks perceived by the volunteers. Findings revealed 4 major themes: comfort level, daily frustrations, risk and environmental issues, and suggestions. Suggestions included: better communication with staff, a safer health-related environment, and improved role-specific training to mitigate the risks. Additionally, for each group, 1 specific change was implemented during a 6-month period. Health care professionals should focus on job-training issues to address safety, comfort level, and role capacity. Future research should investigate an enhanced training curriculum with strategies to address concerns about risk management. Volunteers who are better equipped to perform their roles will be able to offer a higher quality of service to patients and families.     

Utilizing a Continuing Education Workshop to Increase Knowledge of Documentation Among Hospital Psychosocial Staff

ABSTRACT

Hospital-based psychosocial staff including social workers, mental health counselors, and marriage and family therapists utilize documentation skills to assess, treat, and manage patients admitted to inpatient settings. Little research exists that examines the impact of continuing education on documentation skills. This study examined changes in hospital-based psychosocial staff perceptions of their documentation skills after attending a two-part continuing education documentation workshop. The quantitative, pretest–posttest design utilized a convenience sample that included 32 staff members at pretest and 30 staff members completing the posttest. Results from the 51-item pretest and posttest survey indicate that the continuing education workshop statistically increased participants’ knowledge of progress notes and termination summaries. Findings did not indicate any differences when comparing knowledge, at the start of the workshop, for employees with prior documentation training, longer work experience, or different license groups. The authors discuss implications for practice, continuing education, and future research.     

Implementation of Active User Principle: Learning from the Czech Social Services Reform

ABSTRACT

The active user principle introduced in Czech social services by the new Act on Social Services (2007) was expected to induce change of the prevalent paternalistic nature of social service provision. This study examines the relationship between clients and social service workers in social service facilities designed for people without shelter. From 2001 to 2008, instrumental case studies were examined from three different shelter facilities using qualitative interviews (with 17 members of staff) and document analysis. The findings indicated that neither the frontline workers nor the managers could always understand how to implement this principle. Response patterns and the effect it had on recipients are examined. These findings imply that such a profound change needs to be supported with proper explanation, professional training, and practical application skills. Directions for further application and future research are suggested.     

Lessons Learned From the Supporting Father Involvement Study: A Cross-Cultural Preventive Intervention for Low-Income Families With Young Children

ABSTRACT

Despite the proliferation of fatherhood programs designed to promote paternal involvement and positive family outcomes, evaluations of these programs are scarce. The Supporting Father Involvement (SFI) study is a randomized clinical trial comprised of 289 low-income Spanish- and English-speaking families living in California. The evaluation design reflects a partnership stance that promotes empowerment of staff and social service agencies. This article examines lessons learned from the program's first 3 years (2002–2004) from the perspectives of both evaluators and program staff. The lessons cover a broad range of areas, including communication procedures, training, staffing, recruitment/retention, clinical needs, intervention content and process, and maintaining cultural sensitivity.     

Bridge Builders: A Qualitative Study Exploring the Experiences of Former Refugees Working as Caseworkers in the United States

ABSTRACT.

Individuals who come to the United States as refugees and work as resettlement caseworkers offer peer support, modeling, and assistance with integration to newly arriving refugees, despite often having limited training or experience in social service provision. A phenomenological approach was utilized to gain understanding about the experiences of refugee caseworkers. Nine caseworkers who came to the United States as refugees completed in-depth interviews. Thematic analysis was used to identify primary themes, including: a) the caseworker's bridge-building role with clients; b) their role in building bridges with others in the community, including the resettlement agency; and c) the caseworkers’ experience as bridge builders, including motivations, perspectives toward their role, and needed supports. Refugee service providers face unique challenges in negotiating boundaries with clients and meeting the expectations of their ethnolinguistic community members. Their strengths in understanding household experiences and in building agency and community understanding highlight their ability to contribute to positive resettlement outcomes. The findings from this study have implications for agencies serving refugees and for other social services that utilize peer-support strategies, particularly in regards to staff training and support. Findings highlight the need for research examining effective resettlement strategies and the perspectives of refugees toward resettlement approaches.     

Supporting Family Carers Through Telephone-Mediated Group Programs: Opportunities For Gerontological Social Workers

ABSTRACT

Telephone-mediated group programs are an important but under-utilized medium for reaching frail or disabled older persons' family carers who are in need of support. The primary purpose and style of group programs can range across a broad spectrum–encompassing educational, supportive and therapeutic types. Gerontological social workers are the members of the multidisciplinary care team whose training, experience and supervision makes them most suitable for facilitating this broad range of group types. Drawing on the experience of training a number of group facilitators, this article provides suggestions for social workers contemplating the use of telephone-mediated groups and highlights groupwork skills peculiar to conducting group programs via the telephone.     

Using Community-Based Participatory Research to Develop a Series of Core Competency Trainings Within a Developmental Disability Program

ABSTRACT

The New York State Talent Development Consortium at the Office for People with Developmental Disabilities (OPWDD) mandated developmental disability programs to train and evaluate direct service providers (DSPs) on seven core competencies. Utilizing community-based participatory research (CPBR) – an approach where clients, providers, and researchers share their knowledge and experience to identify study areas, formulate research questions, and use results to improve practice – a needs assessment was conducted by a New York-based developmental disability program to inform a training curriculum. Six focus groups were conducted from a purposive sample of 14 DSPs, and 19 managers/supervisors. Staff identified skills that corresponded with six out of seven competencies. Staff recommended hands-on training on: appropriate communication to deal with individuals with severe disabilities; professionalism; person-centered care; and education on terminology in behavioral health plans, medication, and mental health illnesses. Empowering DSPs through CBPR allows for a training curriculum catered toward staff needs, which may be well-received and utilized. The CBPR process employed may be beneficial to other agencies within the intellectual and developmental disabilities field, particularly at a time when the demand for nonlicensure providers such as DSPs is increasing, and there is a need to train them to render quality and effective services.     

Grief and Intellectual Disability

Abstract

People with intellectual disabilities are living longer, which in turn leads to a higher probability that they will experience significant loss due to the death of someone they know. This paper describes a systemic therapeutic model, ROC, which combines bereavement therapy with training and support for staff. On reporting the effects of the ROC model, it is noted that changes over time in the type and nature of referrals has shown the ther apeutic value of the program. The author makes a case that the best way to detect and possibly prevent serious emotional problems in this population is to provide training and support in dealing with death and related issues for the service network surrounding these individuals.     

Hepatitis C psychoeducation curriculum topics generated by group members

ABSTRACT

Educational programs for hepatitis C (HCV) have been created by professionals. There has not been a focus on whether what clients want to know about HCV differs from what providers want patients to know. This study addresses this gap by examining topics selected by participants in an education/support group model. Data were collected as part of a randomized psychoeducation trial for patients with HCV. Topics were systematically generated by the members uniquely for each group. Topics and rank order for each group were generated and a combined variable was created. Twenty-eight different topics were identified across 12 groups. The total number of topics was 102, averaging 8.5 per group. Topics are divided into three separate conceptual groups, members’ personal relationship to HCV, medical aspects of HCV, and unique concerns. A patient-centered approach that addresses the needs of HCV patients first provides an optimal starting point to discuss HCV disease management.     

Addressing the Vision Challenges of Residents at a Retirement Community: Collaborative Research with a Community Partner

ABSTRACT

Staff members at a community retirement village were concerned about the demise of a support group for residents with vision loss, and requested help developing effective services for residents with vision challenges. This study explored past barriers to support group participation, as they were perceived by residents, family members, and employees. The community partner worked collaboratively with the researcher in all phases of the study. Questionnaires were designed to elicit demographic data, diagnosed vision problems, level of adjustment to vision loss, well-being, and motivation for attending institutional programs about vision challenges. Residents responded to standardized vision and depression scales; qualitative questions were posed to all 3 groups concerning motivations for resident participation in program activities. Results indicated that, although many residents had diagnosed vision conditions, they were, in general, coping well with vision loss and did not report depressive symptoms. Participants considered ongoing personal contact and follow-up, a group design that offered the choice of educational presentations and/or process discussions, and individualized assistance with practical challenges to be critical to an effective program. This case study, utilizing a collaborative research process, generated requests for expanded social work services and an increased valuing of the social work role.     

Organizational Changes and Job Satisfaction among Support Staff

ABSTRACT

The purpose of this study is to identify job satisfaction amongst support staff employed by a nonprofit company undergoing organizational changes. The Job Satisfaction Survey (JSS) scale was used to measure overall job satisfaction and was conducted among 38 workers and the data was analyzed using content analysis. The findings indicate that workers were satisfied with some sections of their job but also dissatisfied with some others, scoring an average job satisfaction amongst the participating groups. Factors such as good relations with colleagues, training opportunities, and work flexibility were identified to assist with increasing worker satisfaction. Further suggestions for enhancing employees’ job satisfaction are provided.     

Toward Empowerment: ReVisioning Family Support Groups

ABSTRACT

Family support groups (FSG) have been recognized as an important and viable means for responding to the needs of family caregivers. How these groups work, however, is not well understood. The purpose of this qualitative exploratory study was to explore the impact of attending a family support group on the caregiving experience from the perspective of the family member. Personal, semi-structured interviews took place with eleven family members who had participated in at least one FSG. Data was analyzed for themes, using a constant comparative categorizing strategy. This analysis suggests that attending a FSG impacts the caregiving experience in four important ways: helping the family member to construct a self-identity as a ‘caregiver’; promoting a sense of personal competence; fostering the use of formal support groups; and creating a community context within which to experience the caregiving role. Cumulatively, these have the potential to contribute to a sense of empowerment for the family member by helping him or her to reposition the caregiving experience as more than a personal issue and promoting the emergence of a more collective voice.     

Risk Factors and Intervention Programs for Depression in Nursing Home Residents: Nursing Home Staff Interview Findings

The in-depth qualitative interviews with 25 nursing home staff members were done to examine (a) their perceptions and experiences of risk factors for residents' depression, (b) current depression intervention programs, and (c) specific needs for staff training. The interviewees identified the residents' sense of loss and grief and feelings of isolation and loneliness as the causes of their depression and in-house activities and contract mental health services as current services aimed at reducing depression. They also pointed out the following barriers to providing effective depression interventions: too much dependence on antidepressant medication, low Medicaid reimbursement rate, staff shortage, residents' attitudes, and nursing home culture. The types of training that the staff members desired were: skills to monitor nonverbal signs and changes and to systematically screen different types of depression; education about antidepressants and their effects, side effects, and interaction effects with other medication; and systematic training in different types of psychosocial and behavioral interventions for late-life depression in residents with various levels of physical disabilities and cognitive impairments.     

The story of Lucy: lessons learned,lessons taught

ABSTRACT

This article provides an extended case example highlighting the value of a supportive approach to practice, in addition to the importance of holding a psychodynamic developmental frame of reference. Concepts of repetition compulsion, the holding environment, and object constancy are applied to the clinical material. The case is underscored for its value as a teaching tool.