Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Community Service Use by Older Adults: The Roles of Sociocultural Factors in Rural–Urban Differences

ABSTRACT

This study examined the influence of sociocultural factors in explaining the rural–urban differences in home and community-based service (HCBS) use among older adults. Survey data of 228 older adults living in Alabama were analyzed. Sociocultural factors included participants’ perceptions of service availability, attitudes toward seeking formal help, informal support, and religious behaviors. Rural older adults were less likely to use HCBS than their urban counterparts (p < .05). An interaction effect between perceived service availability and church attendance was found. These findings suggest a need for collaborations between community aging services with religious organizations to ensure existing programs are accessible to older adults living in rural areas. Future research based upon large probability samples is needed to shed more light on the relation between church attendance and service use.     

Mental Health Service Utilization Among Frail,Low-Income Elders

Abstract

This study was conducted to determine the extent to which service providers in a community-based care program accurately identified and referred elders with symptoms of depression. Interviews were conducted with 79 frail, low-income elders, with the CES-D used to gauge depressive symptomatology. Reviews of their case files were then conducted to determine first, the extent to which case managers recognized depressive symptoms and second, the extent to which respondents who screened with significant symptoms were referred for mental health services. Results suggest an imperfect association between CES-D scores and case managers' perceptions and referrals. Less than 1/3 (31%) of those who screened for depression received counseling.     

Trajectories of Community-Based Service Use: The Importance of Poverty and Living Arrangements

ABSTRACT

This study examined how older adults’ living arrangements and poverty status affected their use of in-home health, functional, and out-of-home services over time. Using eight waves of data from the Korea Welfare Panel Study, we employed a logistic mixed-effect model to analyze how poverty and living arrangements affect community-based service use. Living-alone older adults and elder-only couples were more likely than co-residing households to use services. Elder-only couples, when poor, were more likely to use in-home and out-of-home services over time. Understanding predictors of community-based service use over time enables researchers and policymakers to better understand the process of aging-in-place.     

Personal networks and employment: a study on landless farmers in Yunnan province of China

Abstract

Drastic urbanisation has produced a new marginalised group of landless farmers in China. Using representative survey data (N = 620) collected in the communities of landless farmers in Yunnan Province, this study examined the effects of active personal networks on employment status of landless farmers in the transition from rural to urban living. Our findings suggested that landless farmers more active in personal networks (receiving more support through the networks) were more likely to obtain employment in cities. This positive effect was much stronger for male landless farmers than for their female counterparts. While active personal networks significantly improved the opportunity of employment of older landless farmers, they had an insignificant effect on the younger ones. Social policies and service programmes aimed to facilitate landless farmers’ urban adjustment need to pay more attention to the community-based approach, and take into consideration the different service needs of different groups within this marginalised population.     

Life Satisfaction of Rural Migrant Workers in Urban China: The Roles of Community Service Participation and Identity Integration

Abstract

China is home to approximately 245 million rural-to-urban migrant workers. The influx of migrants into urban areas has posed various challenges for local social service systems. Recently, increasing number of community services have been developed to meet the growing service demands from the migrant population. However, whether increase in community service use results in improved wellbeing among migrant workers remains critically unexplored. As such, this study examines the role of community service use in migrant workers’ life satisfaction and the potential mediating effect of identity integration in Shenzhen, China. Bootstrapped models were adopted to examine relationship among variables. Drawing from a sample of 1,087 rural-to-urban migrant workers, we found that community service use is positively correlated with both identity integration and migrant workers’ life satisfaction. Moreover, identity integration served as a partial mediator between community service use and life satisfaction. The mediating effect of identity integration was found to increase with age. This study highlights that diverse services should be implemented to address divergent needs of migrants in different age groups. Community service can also serve as a vehicle to foster integration among migrant workers in host communities, especially for older age groups. Future studies may further investigate the relationships between community social capital, community social support, quality of community-based organization and frequency of service use so as to optimize the life satisfaction of migrant workers.     

Needs and Supports in Transitional Housing for People Living with HIV/AIDS in Ontario,Canada

ABSTRACT

There is a paucity of research on transitional housing for people living with HIV/AIDS (PHA) and even less so within the Canadian context. The present work addresses that gap and reports on the results from the Transitional Housing Study, a province wide community-based research collaboration involving PHA, service providers, and university researchers in Ontario Canada. This article answers the following research questions: What supports do residents in transitional housing for PHA access and what needs do these supports address? Developing from a thematic analysis of in-depth qualitative interviews with 25 residents in one of three transitional housing agencies in Ontario for PHA, the findings reveal that participants benefited from four key supports while in transitional housing: the provision of a safe environment, co-coordination and management of HIV (and other) drug therapies, assistance with appointments, and referrals to health and social services. Until more resources are available to increase availability of transitional housing for PHA, the nonprofit housing sector must fill the gap that exists by offering the types of supports identified in this study in order to address the needs of PHA. Future research may link these supports efficiently with concrete health improvements and permanent housing stability among PHA.     

Barriers to the Use of Mental Health Services by African-American and Hispanic Elderly Persons

Abstract

This study discusses barriers to the utilization of community-based mental health services by African-American and Hispanic elderly persons. The study sample consists of “key Informants,” chosen because they were knowledgeable about the mental health needs and use of mental health services by African-American or Hispanic elderly persons. Principal component analysis using orthogonal rotation was conducted on the 23 item barrier scale and identified three levels of service barriers for the entire sample and for each subsample of African-American and Hispanic informants. Based upon the study findings, a number of strategies are offered to improve Utilization and overcome service delivery barriers.     

Intention to Leave the Profession: Welfare Social Workers Compared to Health Care and Community Social Workers in Israel

ABSTRACT

This study aimed to compare specific work related-factors (personal factor: length of work experience; structural factors: personal subjection to violence and fear of being subjected to violence; and psychological factors: professional quality of life—compassion satisfaction, burnout, and compassion fatigue) between welfare social workers (SWs) (n = 200) and health care and community SWs (n = 173). Furthermore, since the issue of turnover among SWs has important implications for the provision and programming of social services, the study also aimed to assess the relationship between these factors and SW intention to leave the profession. For the purpose of this study, online questionnaires were distributed to SWs working at social agencies and services. The findings suggest that the two categories of SWs showed a similarity with regard to the association between the personal and structural factors and intention to leave the profession. However, with regard to the psychological factors, the components of professional quality of life were found to operate differently in each category of SWs. It is suggested that future research examine other work-related factors and explore the intention to leave the profession among other social work specializations and employment sectors.     

Utilization of Community-Based Social and Health Services Among Foreign Born Hispanic American Elderly

ABSTRACT

This study examined factors associated with the utilization of community-based social and health services among foreign born elderly Hispanic Americans. The data came from a nationwide probability sample of Hispanic Americans age 65 and older including 296 Mexico-born Mexican Americans, 571 Cuba-born Cuban Americans, and 247 respondents from other Hispanic countries. Being a Cuba-born Cuban American, living alone, having poorer self-rated health and living below poverty level were positively related with the utilization of community-based social services. Cuban Americans with more limitations in activities of daily living (ADL) used more community-based health services. Among Mexico-born Mexican Americans, those who lived alone used more social as well as health services while those who were married used more social services. Those with greater limitations in ADL used more health services. Among other foreign born Hispanic Americans, going to church, living alone and living below poverty status, were positively correlated with the utilization of social services. Respondents with better English language ability were less likely to use community based health services. Elderly men and people who rated their health as poorer or had more ADL limitations were more likely to use these services. Implications of these findings for health and social services are discussed.     

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-Based Nonprofit Organizations

ABSTRACT

Promotores are community lay health workers who provide outreach and services to Latinos. Little research on the promotores programs exists, and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program, telephone interviews were conducted with 10 promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations made in the article highlight promotores recruitment and retention strategies and the development of a clearinghouse of programmatic implementation information for community-based nonprofits.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Job Satisfaction Among Volunteers With Personal Cancer Experience

ABSTRACT

This study explored job satisfaction among 753 cancer-experienced volunteers from hospital, palliative care, and community-based oncology settings in nine provinces across Canada. Based on a conceptual framework including three components of volunteering—antecedents, experiences, and consequences—a mixed-methods design to explore job satisfaction was used. Findings from the quantitative and qualitative inquiries indicated that the level of job satisfaction was high and stress was not reported as a major concern. The four themes related to job satisfaction from the volunteers’ responses included learning, personal growth, challenge, and giving back related to their own experience with cancer. Future research should further investigate the important role of job satisfaction for social service professionals for training, marketing, and recruiting, plus the need to explore supports to sustain oncology volunteers in this most challenging environment.     

Treatment Barriers to Social and Health Care Services from the Standpoint of Female Substance Users in Finland

Abstract

This qualitative study discusses barriers affecting female substance user’s treatment access to welfare services. The study consisted of seven group discussions and three individual meetings with 13 women in Helsinki, Finland. Institutional ethnography was used as the theoretical framework for the study. The research questions are: (a) What treatment barriers do women face?, (b) What reasons are there for them not receiving services?, and (c) How do the ruling relations coordinate women’s experiences? Women faced multiple barriers affecting their access to services. They could be interpreted as being: determined by the service system, such as a difficulty in meeting the various criteria in order to be granted access to services; determined by the lack of trust; or determined by personal choices. The study suggests that the service system should be organized according to the needs of the service users. Future research is needed to address the questions such as how social and health care services could better co-operate, and how the different sectors of the service system could break down the institutional barriers.     

Restructuring Long-Term Care in Spain: The Impact of The Economic Crisis on Social Policies and Social Work Practice

ABSTRACT

Care needs of the aging population are increasing in Southern European countries. The purpose of this article is to explore the implications of meeting these needs while taking into account the recent economic crisis, which has deeply affected countries such as Spain. This study is part of a European project (ISCH COST Action IS1102) and is based mainly on qualitative information that focuses on in-depth interviews with social service workers (n = 19) who provide the service and program recipients or their caregivers (n = 14). In addition, two discussion groups were conducted with professionals (n = 9) and program volunteers (n = 5), as well as a workshop/discussion group (n = 28) with politicians, service providers, and participants. Six thematic premises were identified with differing views being highlighted relevant to the participants' roles in the program. Future research should explore social service strategies to deal with the increase in care needs as well as community-based responses.     

Gender Identity and Social Services: Barriers to Care

ABSTRACT

Transgender people seek social services for a variety of reasons. This literature review highlights needs assessments and social science research articles (N = 30) from the last 16 years that demonstrate the many ways in which social services are further revictimizing transgender people. Studies indicate that transgender people often encounter ignorance, hostility, and transphobic environments while attempting to access social services, and these environments can dissuade transgender people from gaining needed care. Suggestions are made to address these inequalities and include simple measures that social service agencies can begin with to make their services more transinclusive. Future research should address the bias in social services more directly and also develop a clear plan of action and best practices to help agencies remove discrimination from social service settings.     

Living Arrangements,Depression, and Health Status Among Elderly Russian-Speaking Immigrants

Abstract

This study examines the relationship between living arrangements, depression, and health status in a community-based sample of 300 elderly Russian-speaking immigrants. Data were collected via a self-administered questionnaire survey method. The questionnaire was designed to investigate various aspects of health, mental health, health services utilization, and health behaviors. A team of bilingual professionals was involved in the construction and translation of the survey instrument. The sample consists of 150 females and 150 males. The respondents' average age was 73.2 years. The regression analysis reveals that elderly Russian-speaking immigrants who live alone are more likely to experience a higher level of depression than those living with others. This relationship remains statistically significant after controlling for age, education, income, ability to speak English, years residing in the United States, gender, and health status. Since health status appears to influence depression, we performed further regression analyses and found that living arrangements had no statistically significant relationship with health status. Health status serves as an intermediate variable between the block of demographic variables and depression. Implications for future research are discussed.     

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

ABSTRACT

Use of private social care services among older people is increasing in Finland. This study aims to understand why older people choose private care in a comprehensive tax-subsidized social care system and examines whether people choose private service as a free choice or a forced choice as well as what factors contribute toward making these choices. Data for this study (N = 1,436) were gathered in 2010 from people aged 75 and above living independently at home in two Finnish cities: Tampere and Jyväskylä. Data were analyzed with several quantitative tests: chi-squared tests, multinomial regression analysis, and qualitative content analysis (for the open-ended responses from the survey questionnaire). Findings reveal that people chose private services mostly because of the effortlessness involved in its use and of the need for additional services that are unavailable through municipality; for example, cleaning. Majority of the respondents performed a free choice to use private services. People who lived in a city center with a higher level of income and who needed more services were more likely to be constrained toward using private support. Major concern, due to diminishing public service provision, is about service accessibility of economically disadvantaged groups; therefore, more research is required to understand the effects of the growing care market in Finland.     

‘New Wine in Old Wine Skin’: Public Perceptions of NHIS Per-Capita Payment System and Implications for Health-Seeking Behavior in Ghana

Abstract

The article examines public perceptions of capitation payment system and the implications for health-seeking behavior in rural and urban Ghana. Drawing on qualitative approach, the study employed focus groups (n?=?20), in-depth (n?=?20), and key informant (n?=?14) interviews with community-based adult men and women, aged 18–65?years in Ashanti Region. Tape recorded interviews were transcribed and analyzed thematically. Results indicated that majority of respondents have heard about the capitation but only a small proportion of them understood what the whole policy entails and the rationale for its introduction. While general dissatisfaction with and negative perceptions of the capitation still persisted among majority of the study population, this did not translate into nonuse of health services. For subscribers to derive optimal benefits from the capitation, political commitment in continuing public education using the most accessible media modulation is key. More importantly, public and private healthcare providers should increase investments in improving healthcare delivery system. Future studies should employ quantitative approaches with region-wide sample in order to confirm the relationships between capitation enrollment and health-seeking behavior.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.