Understanding care for the poor in rural Russia

The issues surrounding care and care-provision have been key themes in social scientific research, yet the intersections between care and poverty, particularly in rural contexts, have not been sufficiently explored. This paper addresses this gap by studying care for the poor in rural Russia. It argues that isolated, disengaged and decontextualised caring interventions often ignore situated possibilities and traditions of care and overlook what matters to poor people. To overcome this problem, the paper uses 20 and 22 dwelling approach to prioritise a relational framework that focuses on care as concern, solicitude and possibilities for supportive action in the context of rural Russia. Using examples from fieldwork in two Russian villages, the paper stresses the constitutive role of non-representable practices of care which provide the ontological basis for recognising and understanding the worldviews and coping practices of the poor. It concludes with conceptual observations about alternative approaches to care, relations to others and responsibility for the rural poor.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec

BackgroundThe evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach.MethodInspired by empowerment evaluation, the transformative–participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation.ResultsThe knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.     

Children with Special Health Care Needs

Abstract

The health care model presented in this paper is a non-linear, systems approach to service delivery. The model was a by-product of three ethnic-specific conferences that were convened to discuss strategies for improving access to care and the quality of services provided to children with special health care needs (CSHCN) from diverse cultural backgrounds. The model evolved as insights regarding the common values and norms held by parents, health care providers, and cultural representatives were shared. Content analysis was used to identify core themes identified by participants. These themes were incorporated into a model that included the following elements: community-based, culturally competent, health-oriented, resiliency-focused, and family-centered care. At the fourth Consensus Conference, selected participants from the previous ethnic specific conferences reviewed the proposed model and deemed it a vehicle for facilitating health care service utilization by culturally and linguistically diverse CSHCN and their families.     

Development and application of a rubric to compare strategies for improving access to health care in rural communities in the United States

Rural areas are underserved in terms of the availability of and access to health care services. According to Healthy People 2020, access to health care continues to be the most frequently identified rural health priority in the United States.PurposeThe purpose was to develop an efficient approach for standardizing and prioritizing strategies to improve access to health care in rural areas across the United States. The rubric provides a quantitative metric of the effectiveness of each strategy in terms of impact and feasibility and allows community health departments and other access to care groups to compare strategies and facilitate discussion of various strategies’ ability to meet the needs of diverse communities.FrameworkThe Plan, Do, Check, Act (PDCA) cycle was used to create the rubric. The research team constructed a plan for creating a rubric to measure each strategy’s impact and feasibility. We checked the rubric by applying it to selected access to care improvement strategies evaluated by the Robert Wood Johnson Foundation (RWJF). Members of a rural community Access to Care Workgroup applied the rubric to several RWJF What Works for Health strategies. The final step was to compare the results of the application phase through facilitated conversations with the goal of determining which strategy or strategies would best meet the needs of the rural community.DiscussionA rubric is a valuable tool to facilitate assessment and discussion and for assisting community members in determining access to care priorities. After applying the rubric in a community setting, we identified two important tactics: 1) the rubric is best applied to strategies when they are summarized consistently and cohesively; and 2) it is important to involve community stakeholders early in the process of identifying strategies for evaluation. The next step is to apply the rubric to similar strategies in other rural communities to further validate the rubric’s effectiveness.     

Transitional compass: anti-capitalist pathways in the interstitial spaces of capitalism*

ABSTRACT

The focus of the special issue explores the forms of power used, engendered, and (re)produced to challenge structures of economic, social and political power that produce inequality as well as concrete empirical examples of movements, workers’ struggles, and initiatives in challenging inequality. The idea of ‘transitional compass’ looks beyond protest politics to what we call ‘generative’ politics that builds the alternatives in the interstitial spaces of capitalism. Resistance to power emerges through engendering counter-hegemonic projects that are intertwined with alternative everyday practices. To concretize the conceptual framing, we focus on the emancipatory possibilities of a universal basic income, the use of law in tackling inequality in health and education, creative initiatives to establish a people-centred food system, new forms of organizing by precarious workers, democratic possibilities in local state delivery, and reconceptualizing the good life by looking at issues of happiness and ecosocialism.     

Charity Care in Crisis: Reclaiming a Lost Professional Ethic

Abstract

The concept of “charity care” is a fundamental principle in the practice of medicine. This paper examines the origins of the construct charity, the expansion of charitable care during the Middle Ages, and its gradual secularization throughout the Renaissance and the Enlightenment. The paper then highlights the transformation of Almshouses, Infirmaries and Dispensaries into charitable institutions of medical science in the nineteenth century with the birth of progressivism during the early twentieth century. A conceptual model is then presented that depicts the erosion and qualitative changes in charity care as a result ofthe corporatization of health care over the course of the last century. The construct of charity care is now in crisis. The medical profession has gradually disassociated from its obligation of charitable care as an ethical precept for the practice of medicine. The paper ends with a challenge to reclaim and renew the importance of charity in the provision of health services.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

What are the characteristics of the champion that influence the implementation of quality improvement programs?

BackgroundQuality improvement in Healthcare is the new fashion actually. Rich countries and developing countries alike are trying to implement quality improvement initiatives to improve their performance and the quality of care. There is evidence in the scientific literature that the existence of a “champion” can play an important role in the successful implementation of quality improvement strategies. Most of the time, people get stuck at the implementation level: they know what to do but they fail to execute it in the organizational setting. That’s where a champion can be useful to facilitate the success of the change. There is a paucity of research on the link between the champion and the implementation of quality improvement programs. The aim of the study was to investigate the perceptions of stakeholders about the characteristics and qualities of the champion that could facilitate the successful implementation of quality improvement programs in health care settings in Haiti.MethodsTwenty semi-structured individual interviews and one small group discussion (n = 4) with providers, administrators, directors, and NGO representatives were conducted during a six months period. The total sample size was twenty-four (n = 24). The methods were informed by grounded theory and the data were analyzed using the constant comparative method and thematic content analysis approach.ResultsThe analysis resulted in eleven themes describing the characteristics and qualities of a successful champion: Communication and persuasion, proactivity, humility, horizontal and collective leadership style, sense of responsibility and accountability, go-ahead type, empathy, dedication and motivation, ability to inspire and motivate people, have a vision, and encourage learning.ConclusionsIt is important to support and encourage champions in the health care systems in developing countries to master and exhibit those qualities and characteristics in order to lead a team for the successful implementation of quality improvement initiatives in the health facilities. More research is needed to understand how to better articulate those qualities in the context of the Haitian health care system.     

A Review of: “Dattilio,Frank M. (2010). Cognitive-Behavioral Therapy with Couples and Families: A Comprehensive Guide for Clinicians.”

This conceptual study focuses on health disparities among African Americans in the Arkansas Delta. The author uses an ecosocial perspective to explore several social and individual-level influences upon patients' perceptions of health care quality, including health beliefs and life experiences of discrimination that can lead to not accessing health care systems. The study findings identify community-based strengths that can inform the development of strategies and programs to reduce rural health disparities. The discussion includes the potential implications of the Patient Protection and Affordable Care Act for progress in health care quality and health equality, especially for rural racial/ethnic minorities.     

Towards Customized Deliberations

ABSTRACT

The profession of social work has important contributions to make in the rapidly developing dialog about medical care decision making and to the evolution of hospitals as systems that engage with people as patients, for whom illnesses create increased vulnerability (Gruber, 1998). Professional ethics clearly states that the individual professional social worker has a responsibility to influence processes involving vulnerable populations. Articulating social work's responsibility and potential contributions in the area of medical care decision making begins with an application of social work's mission and values, and then continues with consideration of the profession's evolving role in hospitals. Pertinent aspects of the health care industry, including current models for continuum of care and for provider-patient relationships, are discussed in terms of opportunities to modify the models used to guide interactions with patients. Finally, the impact of a growing number of distinct treatment options is also considered. The objective of the article is to offer social workers in health care settings a conceptual framework for considering professional ethical obligations and for participating in the contemporary dialog regarding medical care decision-making.     

Visual accountability

In this article, we draw attention to the way in which accountability relations are manifested in and through the use of visual evidence. Through their status as representations of what is the case, evidentiary visual images frequently provide a basis for giving accounts and for raising questions regarding distributions of accountability. At the same time, and in a similar manner to numbers (Munro, 2001), such images become part of organized relations of accountability that can be noted as having ‘hailing’ effects: they call for and prefigure a certain kind of response and dispersing of responsibility. Here we examine how the use of visual evidence is embedded in discursive and material practices that variously create or inhibit possibilities for questioning, or interrogating, this evidence. Drawing on elements of ethnomethodology and actor‐network theory, we use ‘interrogation’ as the basis for depicting a three‐part analytical schema focused on opening up, closing down and temporality to explore how visual accountability is worked out in surveillance, traffic management and breast screening images.     

Teaching Note—Asserting Social Work’s Role in Developing an Interprofessional Education Project

ABSTRACT

Interprofessional (IP) education is an essential component of today’s health care education. IP education has been recognized and supported for its potential to educate workforce-ready health care clinicians with the knowledge and skills, necessary to collaboratively deliver high-quality, client-centered care. While social work’s reflective, patient-centered, and holistic approach to care is invaluable in addressing healthcare challenges at all levels, social work’s lack of involvement in IP health care team practice is evident in the development of IP education curriculum with other health care disciplines. This article describes how one School of Social Work at a regional public university became part of a longitudinal IP education project in collaboration with a large R-1 research university, creating an IP opportunity for Master’s in Social Work (MSW) students. It also discusses the process taken for social work inclusion in the IP project, an experiential elective course designed to supplement the project, as well as Transformative Learning Theory, the conceptual framework used.     

Toward a More Data-Driven Supervision of Collegiate Counseling Centers

Abstract

Hearing the national call for higher education accountability, the author of this tripartite article urges university administrators to move towards a more data-driven approach to counseling center supervision. Toward that end, the author first examines a key factor—perceived increase in student pathology—that appears to shape budget and staffing decisions in many university centers. Second, she reviews the emerging but conflicting research of clinician-scholars who are trying to empirically verify or refute that perception; their conflicting results suggest that no study alone should be used as the “final word” in evidence-based decision-making. Third, the author delineates the campus-specific data that should be gathered to guide staffing and budgeting decisions on each campus. She concludes by reminding readers that data-driven decisions can and should foster high-quality care that is concurrently efficient, effective, and in sync with the needs of a particular university and student body.     

Organizational Change-Too Much,Too Soon?

ABSTRACT

Recent changes in government policies and practices, especially managed care, have led many nonprofit organizations to embrace collaboration as a competitive strategy. This article presents a case study of a large human service agency that has adopted a management service organization (MSO) model, a type of collaboration particularly suited to handling third-party contracts, at the urging of the founding CEO. A new governance model was also adopted. Using chronology as an analytical approach, the case examines key decisions made by professional and lay leaders during four distinct stages of organizational development. The actions taken by the board of directors to restore financial stability and protect the organization's reputation after learning from the CEO of the existence of a significant deficit demonstrate the need for strategic planning and better communication among all relevant parties involved in a collaboration.     

Care and community revalued during the COVID‐19 pandemic: A feminist couple perspective

The COVID‐19 pandemic led us to understand and revalue care ethics within our daily lives and communities based on the feminist theory of care ethics. This article is a personal reflection of an academic couple living in Japan as we reflect on our experiences and the challenges encountered in caring for ourselves and our community. We discuss the ideas of care theory mainly: caring‐about and caring‐for, interchangeably in our discussion across the three‐stage categories: Home — A Commonplace; Care Ethics in Community; and Care Ethics for Self. Through these personal narratives, we strive to recognize the struggles of living through the pandemic in a virtually connected world that often disconnects us from self. We foster the idea of embracing care ethics as a starting point at an individual level.     

Conceptual Framework for Integrating Holistic Perspectives and Approaches to Problems of Safe Motherhood

ABSTRACT

This article provides a conceptual framework for incorporating the array of variables defined in maternal health research in order to explicate their influence on problems of safe motherhood. Focusing an overview of the articles in this collection, in addition to strategies and policies needed from practitioners' perspectives and finding from case studies, research findings from a variety of countries are provided. Factors influencing positive outcomes such as age of mother, skilled attendants at delivery, and prenatal care are considered. The importance of the political and economic structure and stability of the country which plays an important role is discussed.     

Health and Well-Being for Late Middle-Aged and Old Lesbians in a Rural Area

Abstract

Previous research on lesbian health care has drawn primarily from samples of young lesbians living in metropolitan areas. Through face-to-face interviews with twenty-one lesbians aged 54 or older and living in rural communities, this exploratory, naturalistic inquiry begins to fill a gap in the literature by examining the health care experiences of older, rural lesbians. Five themes emerged from the narrative data: issues of access; good health/good care; open to her own diversity; family and community; and visions-ideals and fears. We present these themes through informant quotes and discuss implications for policy and practice.     

Interprofessional collaboration between residential child care and mental care practitioners: a cross-country study in six European countries

ABSTRACT

The severe mental health problems of many of the young people living in residential settings pose a great challenge and demand on child protection and mental care (MC) services. Drawing on comparative research and debates from six European countries, this study examines demands for integrated care and interprofessional collaboration practices between residential child care (RCC) and MC. In this article, research data will be brought together from Denmark, Finland, Germany, Lithuania, the UK (Scotland) and Spain. In total, 61 practitioners from RCC and MC were interviewed. Given the complexity of the residential care service context and service system differences across national contexts, the original hypothesis was that this would differentiate the collaboration practices. However, the similarity between the countries is greater than anticipated. The concluding findings are organised by matrix technique into a content-analytic summary table. The main finding was that in spite of encouragement for integrated RCC, obstacles for collaboration and lack of coordination between systems remain, often related to understanding the professional role and tasks, lack of shared knowledge, attitudes and ways of communication. One significant finding in the cross-country comparison was the evident and unrealistic expectations for the ‘other’ provider to help and care.