State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

Planning Australia's Health and Welfare Services

The report of the Health-Welfare Task Force to the Royal Commission on Australian Government Administration brings together for the first time a great deal of useful information about health and welfare services in this country. However, restricted definitions of health and welfare compounded by strict adherence to a structuralist model of society leads to a predictable set of proposals for the planning, delivery and financing of services in a federal structure. It is to be hoped that the recommendations for greater research efforts and for increased community participation will be given enthusiastic support at all levels of welfare organization.     

The impact of welfare reform for families with children: Evidence from New York: A report of the New York city social indicators center,Columbia university school of social work

Abstract

This paper uses data from the Current Population Survey and administrative data from New York to simulate the poverty impact of the recent federal and state welfare reforms. We find that the federal welfare reforms would in the absence of additional state or local aid raise the poverty rate of families with children and the poverty gap (the amount needed to raise poor families’ incomes up to the poverty line). Although New York state and local welfare programs will offset much of this impact, we find that even with state and local aid, 16,000 families with children will move into poverty and 63,000 families with children, most of them already poor, will move into severe poverty, while the aggregate poverty gap will increase by nearly 25%.     

Hospice Use by Older Adults Knocking on the Door of the Nursing Facility

Abstract

Since 1983, federal funding has been available for hospice services. However, research studies have found that hospice is underutilized by people with terminal illnesses and their families. Low-income older adults are particularly at risk for underutilization. This study examined utilization of hospice services by nursing home applicants in one Midwestern state. Characteristics of users and non-users, and potential barriers to hospice use were examined. Findings further document that hospice is underutilized, especially by the Medicaid population, and point to barriers to hospice utilization. Specific recommendations are made to help practitioners increase hospice access.     

Of peasants and publics in colonial India: Daduram's story

ABSTRACT

This article uses an exceptionally well-documented law case from the 1650s to offer a fresh perspective on the English experience of Atlantic settlement during its early years. It argues for the centrality of the Essex county quarter sessions court in the building of neighbourhood on the geographic and cultural margins of the Massachusetts Bay colony. By focusing on the north-eastern margin at Cape Ann, the analysis reveals aspects of state building through a common law judicial process which was just as important, but less readily apparent, in other settings. The article addresses three major historiographic areas, engaging with the historical literature on English neighbourhoods and English adaptation to the American environment, on the significance of witchcraft or maleficium in English societies, and on the nature and meanings of law, law courts and judicial process in the building of communities. Case documents also enable the use of some concepts and techniques of literary analysis related to the study of narrative, arguing that judicial verdicts selected and suppressed aspects of local stories elicited during the course of the investigation in order to craft an account of local neighbourhood that suited a broader cultural narrative of Massachusetts Bay’s political consolidation during the 1650s.     

Economic Survival Strategies and Food Insecurity

Abstract

This article reports on a study of 67 Hurricane Katrina survivors who were evacuated to one Texas community. The authors examine the economic survival strategies employed by Katrina evacuees to feed their families during the approximately one week time frame beginning the day before the storm and ending when they were ultimately evacuated from New Orleans. An analysis of their strategies and actions provides insight both into the nature of households and sharing networks under the pressure of this disaster and the shortages that ensue when federal and state systems cannot meet basic needs beyond the resources of the local community.     

Toward increased public representation on bioethics committees: Lessons from Judging the cold war human radiation experiments∗

The process of judging the Cold War Human Radiation Experiments illuminates a need to develop a model for an appropriate public role on bioethics committees. A citizen representative was appointed to the President's Advisory Committee on Human Radiation Experiments, and the Committee solicited broad public participation in their investigation. However, many members of the affected and interested public desired further representation on the Committee, as they tended towards stronger ethical condemnations of the experiments than the Committee expressed. I offer an account of a testimony before the Committee by a radiation experiment subject's survivor to illustrate this contrast in moral perspective. I consider some the contributions that “non‐expert”; public members can add to committee deliberations, and suggest that concerns about public representatives may be overcome with the guidance of clearer principles for selecting public members. Further efforts to increase membership by the general and affected public on bioethics committees will enhance deliberations and help realize the democratic ideals of bioethics.     

A little too much of the buchenwald touch? Military radiation research at the university of Cincinnati, 1960–1972

From 1960 through 1972, Dr. Eugene Saenger oversaw the experimental administration of lethal and near‐lethal doses of radiation to hospital patients at the University of Cincinnati. These experiments were funded by the US Department of Defense, and were specifically designed to acquire military information on the effects of radiation in combat soldiers. Although Saenger's research was terminated after public exposure in 1971, a full and detailed account has not been available until now. The account provided by the President's Advisory Committee on Human Radiation Experiments (ACHRE) in their Final Report of 1995 was incomplete. Our account is based on a reanalysis of all the material available to ACHRE, including highly critical peer reviews by U.C. faculty members. We also present, for the first time, several case histories taken from the medical records of Dr. Saenger's subjects.     

Disaster preparedness networks in rural Midwest communities: Organizational roles,collaborations, and support for older residents

ABSTRACT

This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.     

The Coordination of Welfare and Health Services in Australia

The report of the Task Force on Coordination in Welfare and Health (Bailey Report) is the most important single report on the organization of health and welfare services since the first Medibank Green Paper. It provides for the collapsing of a plethora of categorical grants into four broad ‘programme grants’. The effects of this report will be felt by most health and welfare organizations. It is the purpose of the article to review the main recommendations of the Task Force and of the related Report from the Committee on the Aged and the Infirm.     

Task force on Medicaid in Missouri: a community collaboration in gerontological social work education

Master's level social work gerontology students formed a Task Force on Missouri Medicaid as the primary course project of the Social Policy and Aging class at George Warren Brown School of Social Work, Washington University in St. Louis. Led by students, the Task Force collaborated with community leaders to address issues with the escalating enrollment and cost of Missouri's Medicaid program, resulting in a widely disseminated policy brief. Students identified multiple professional skills gained through this assignment and community leaders determined the issue brief to be a significant contribution to Missouri's Medicaid policy debate.     

A grass roots approach to influencing child welfare policy

This paper provides a brief review of child welfare issues identified by a Canadian Task Force convened for the 1979 Year of the Child. Project experience with the use of Looking After Children is linked to the issues identified in 1979. A fairly extensive discussion of legal considerations is presented to provide a context for the challenge of influencing policy. Finally, the possibility of influencing policy from a grass roots approach that can transcend jurisdictional boundaries is presented as offering hope for change in a child‐centred direction.     

Trust in Government: Personal Ties that Bind?

Objective . This research note compares the views of the federal government held by federal government workers, their family members, their close friends, and state and local government workers to the views held by other U.S. citizens. Methods . We analyze data from a 2000 survey of Washington, D.C. metropolitan-area residents. Results . Respondents employed at any level of government—not only federal but also state and local—trust the federal government more than respondents with no ties to government. Being the family member or friend of a federal government employee has no impact on trust in government. Conclusions . A confidence gap divides government employees from the rest of the public.     

Engaging the public in policy development: The national bioethics advisory commission report on research involving persons with mental disorders that may affect decisionmaking capacity

U.S. bioethics commissions have used a variety of methods to involve the public. All share a common requirement: as federal advisory committees they are required to comply with the Federal Advisory Committee Act, the federal law established during the Nixon administration which provides the public with an assurance that groups established by the government to advise the government should be publicly accountable. This paper will describe some of the ways the National Bioethics Advisory Commission (NBAC) sought to involve the public in its report on Research Involving Persons with Mental Disorders that May Affect Decisionmaking Capacity.     

Tangible and Spiritual Relief After the Storm

Abstract

This study assessed the types of social services and spiritual messages that were provided by Baton Rouge area churches following Hurricane Katrina. Church representatives (n = 157) completed a 26-item survey which consisted of open and closed ended questions. The most common resources provided by churches included food, clothing, and financial assistance. Nearly 75% of churches attempted to connect evacuees with outside state and federal resources. The greatest unmet needs reported by churches included evacuee shelter and housing, and on-site computer and internet access. Churches recommend preparedness, triage care, and leadership for other churches that find themselves the first responders following a disaster. Because of their responsiveness to the needs of communities, clergy need to be trained in disaster management. Moreover, government monies could be well-spent in supporting faith-based disaster initiatives .     

IX. Children referred by the schools to the Worcester child guidance clinic 1

Abstract

The level of job rewards for social workers has been correlated with the quality of service to clients. A purposive quota sample of 127 Licensed Independent Clinical Social Workers in Massachusetts employed in three settings completed the Job Role Quality Scale. Respondents found Decision Authority, Flexibility, and Impact (sense of helping others) most rewarding. Private practitioners reported a significantly higher level of reward than respondents in public and private agencies. Administrative interventions directed toward increasing job rewards and decreasing job concerns, may reduce social work staff turnover and enhance the quality of service to clients.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

The market for (Ir)reproducible econometrics

Context: As the volume and complexity of research have increased, the amount of time spent on Institutional Review Board (IRB) review has decreased. The complexity of research has expanded, requiring increasingly specialized knowledge to review it. Dilemma: Under the current system, increasing numbers of research studies requiring expertise in ethics, new technologies or diverse study designs place a substantial burden upon local IRBs and often result in substantial variability among their reviews. This lack of uniformity in the review process creates uneven human subjects’ protection thus undermining the intent of the Common Rule. Objectives: To outline a scenario for expert centralized IRB review via implementation of a national virtual IRB review system overseen by the Office for Human Research Protections (OHRP). Conclusions: The complicated ethical issues and science involved in much of current research warrant an expert review panel. Centralized review would enable expert review specific to the research at hand, ensure consistency in human subjects protection, reduce the burden on local IRBs, and may reduce time spent obtaining approval. A centralized virtual system would allow IRB members to remain at their institutions while providing unprecedented expert review through currently available technology, and make information regarding monitoring and adverse event reporting available online in real-time.     

Central Ethical Dilemmas in Research Involving Children

We are obligated to protect individual child subjects of research, yet it is also necessary to investigate the safety and efficacy of medical treatments that benefit children as a class. The federal regulations on research with children have provided ethical guidance since 1983, but divergent interpretations persist. Since varying interpretations can lead to confusion and abuses, efforts are underway to clarify the criteria. Clarity is needed to protect individual child subjects from harm while enabling ethical research to proceed. The "pediatric rule" and the "pediatric exclusivity" incentive are important policy initiatives for promoting sound research on the medical treatment of children.