Lessons from introducing a livelihood project for unaccompanied children into an existing child protection programme in the Dadaab refugee camps in Kenya

Evidence shows that displacement, family separation and economic status are risk factors for child protection concerns and children's mental health, and that violence and economic status are risk factors for children's physical, emotional and social development. Family based care, community social support and economic strengthening have been shown to moderate such risk factors. This article explores the introduction of a livelihood project for unaccompanied children into an existing child protection programme in the Dadaab refugee camp complex in Kenya, with the primary objective of strengthening the household economy of foster families and improving the care of the fostered children. In this article the authors reflect on the programme's work in recognising and building on existing traditional clan-based family tracing and care mechanisms for unaccompanied and separated children, as well as the importance of understanding the particular needs of specific groups of children such as those without appropriate care. They discuss issues of insecurity and lack of funding affecting programme quality and programme monitoring, and discus challenges of project design. Consideration of how such challenges can impact on existing traditional care mechanisms is shared. The authors argue for greater acknowledgement and efforts to build on traditional child protection mechanisms within wider debates on child protection systems; greater understanding and consideration of the needs of unaccompanied children in particular contexts; better monitoring of the outcomes of child protection programmes on the children they serve; and adequate and sustained funding for child protection in emergencies.     

How was a national moving and handling people guideline intended to work? The underlying programme theory

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their ‘programme theory’, how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP – the intended outcome.     

Queues and care: how medical residents organize their work in a busy clinic

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.     

The incidence of metabolic risk factors in an inpatient psychiatric setting

Our study examines risk factors for metabolic syndrome on admission to an acute psychiatric facility and the incidence of medical referrals at discharge. Data on demographics, risk factors for metabolic syndrome, other health risk factors, medications, related diagnoses, and primary care providers and referrals were collected from 125 psychiatric patient charts. Comparison analysis was done for two groups: those with two or more risk factors for metabolic syndrome and those with less than two risk factors. Differences between groups were statistically significant for age, waist circumference, body mass index, high-density lipoprotein, triglycerides, and fasting glucose levels. Few patients were referred to their primary care provider for follow-up care. This study has clinical implications for improving assessment of psychiatric patients at risk for developing metabolic syndrome, for designing interventions to help patients adopt lifestyle changes to mitigate these risks, and for working toward fuller integration of psychiatric and primary care.     

Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.     

Healthcare Use in the Heartland: How Health Care Selection Varies Between Rural,Retirement‐Age Migrants and Long‐Term Residents

One increasingly important problem affecting rural health care selection is the tendency of older residents to bypass local health care providers. This research investigates how the effects of community characteristics and attachment on health care bypass behavior vary between rural retirement‐age migrants and retirement‐age long‐term residents. Non‐health‐related behaviors, such as purchasing goods and services outside one's community during a health care trip, that is, “outshopping,” could influence bypass if individuals combine trips for their medical care with other consumer needs. Basing our work on the outshopping theory, we argue that bypass behavior is one facet of consumer consumption patterns for both rural retirement‐age migrants and long‐term residents. In addition, dissatisfaction with local health care and services like shopping can “push” rural residents to bypass local health care and travel greater distances for primary health care. We further contend that strong community attachment has an opposite “pull” effect that can help to negate the push of outshopping and reduce the likelihood of bypass. Our results reveal retirement‐age migrants are significantly more likely to bypass local primary health care providers than retirement‐age long‐term residents. Furthermore, our analysis bridges the rural health care and retirement community development literature to suggest that outshopping theory can now be applied to rural primary health care bypass behavior.     

Working with neglected children and their families

Child neglect has proved a particularly difficult area for social work to address. In the first part of the paper a number of reasons for this are discussed. We go on to suggest that chronic child neglect characteristically involves the breakdown or absence of a relationship of care. Therefore, the social work response needs to include a focus on the relationship difficulties between parent and child which manifest as either an unwillingness or inability on the part of the primary carer to offer reliable, adequate care, and on broader relationship difficulties within the family. In arguing for an approach that pays attention to the intra-personal and relational dynamics of neglect, we draw specifically on attachment theory and consider how Ainsworth's (1978) typology of attachment patterns can shed light on parenting styles and patterns of family functioning associated with chronic neglect. We use the concept of the 'internal working model' to develop an understanding of the ways in which family members understand and live out their relationships—with each other and with the worker. We conclude by suggesting that this relational approach requires an ability on the part of the social worker to work both with and within relationships, and look at the contribution that a critically informed relationship-based approach can make to work with families where child neglect occurs.     

South African social workers' knowledge of attachment theory and their perceptions of attachment relationships in foster care supervision

Despite the prominence of attachment theory in international foster care literature and the importance of attachment relationships in successful foster care, attachment theory and practices do not feature prominently in South African foster care research. Against this backdrop, we interviewed twenty South African social workers' about their knowledge of attachment theory and their perceptions of attachment relationships in their own foster care work. Thematic analysis was used to analyse the interviews. We found that the social workers had limited knowledge of attachment theory and interventions; experienced most biological parents as unmotivated to improve their circumstances and attachment relationships with children; indicated that family reunifications were rare occurrences; reported foster parents were mostly kin; and experienced constraining contextual factors that hindered optimal consideration of attachment relationships in foster care supervision.     

Selling social work education (2) credit when credit is due: A “three year” framework for social work education

Three year training courses are the ultimate goal for social work education. But changes in the funding of higher education will require more aggressive marketing strategies. It is necessary to consider alternatives to the full-time model beyond the conventional part-time approach. Three schemes for credit exemption are described. Educational opportunity with potential appropriate for social work education exists outside formal course provision. A proposal is made for the incorporation of agency inservice training provision and part-time adult education study into basic qualifying courses, adapting existing precedents and extending the programme provider model. It is suggested that although political obstruction will prevent an early move to a three year model, some of the mechanisms proposed could be incorporated into current planning to safeguard intellectual standards.     

Transmen's Health Care Experiences: Ethical Social Work Practice Beyond the Binary

Informed by institutional ethnography approaches, this study includes interviews with 3 young transmen (21–29) about their experiences regarding Canadian health care and the work they perform to access care. Semistructured interviews were used to gather data that were then analyzed to identify key aspects of participants’ experiences and perceptions. Findings describe the extra work transmen perform to compensate for a lack of provider competence in transgender health care. Influences of the dominant gender binary ideology as it shapes the health care experiences of transmen are discussed. This article calls for social workers to challenge the gender binary and use practice frameworks informed by transgender theory.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention

This article is based on qualitative research with fathers who attended Mellow Dads, an intensive ‘dads only’ group-based intervention underpinned by attachment theory for fathers of at-risk children. Specifically the article draws on data from a process evaluation of the programme in order to explore the challenges of engaging men in effective family work. The methods used to undertake the process evaluation included participant observation of one complete Mellow Dads course, interviews with fathers and facilitators, interviews with the intervention author and a study of programme documentation. The article focuses on the theoretical underpinning of the programme, its acceptability to the fathers and the challenges faced by facilitators in delivering the programme as intended. The fathers appreciated the efforts of facilitators to make the group work, valued the advice on play and parenting style as well as the opportunity to meet other fathers in similar circumstances. However, there were obstacles that impacted on the effectiveness of the programme. These included the considerable time required to get the men to attend in the first place and then to keep them coming, the lack of practice of parenting skills when fathers were not living with their children, and the difficulties of sharing personal information. The challenges identified raise questions about how much change can be expected from vulnerable fathers and whether programmes designed for mothers can be applied to fathers with little adaptation. The article aims to contribute to ongoing dialogue about the best way to successfully engage fathers in children's well-being, and raises the question as to whether working with fathers requires different skill-sets and approaches from the more familiar social work territory of working with mothers.     

Attachment to Volunteering

We propose that volunteers' attachment to their work is determined by the level of resources they bring to it, the rewards they derive from it, and the context in which the work is carried out. We test this theory using two waves of the Americans' Changing Lives panel study (1986–1989). The resources part of the theory is supported: the likelihood of remaining in the volunteer labor force across the two waves is greater for the more highly educated, those who report higher rates of formal and informal social interaction, and those who have children in the household—the last effect is stronger for women. Respondents reporting an increase in regular working hours across the two waves are more likely to cease volunteering. However, declining functional ability has no effect on attachment. The reward part of the theory is not consistently supported. Commitment to volunteer work in the first wave (measured by hours volunteered) predicts being a volunteer in the second, but enjoying the work has no effect, and being satisfied with the results of the work decreases attachment. Compared to a number of other work contexts, church-related volunteering in the first wave is the strongest predictor of being a volunteer in the second.     

Record keeping practices: Consequences of accounting demands in a public clinic

This observational study explores the tensions and negative consequences of record construction for patients and front-line staff in a public clinic providing services to poor women and children. For emphasis, it is possible to say that the routine of the clinic is record driven, not service driven. More is accomplished in clinic work than producing records; patients certainly do receive needed health care. However, tight regulations filtered through heavy paperwork requirements stifle the effective delivery of comprehensive, flexible services especially needed by disadvantaged families. Clinic staff may be motivated to attend to individual patient concerns, but accounting demands generally circumscribe their work and create barriers for patients. The record has a life of its own as a socially constructed artifact in the process of caregiving in bureaucratic settings, where actual services often respond not to the client, but to the countable, accountable mandates of management.     

Evaluating a community based mental health programme in West Bengal,India: Description of the methodology and lessons learned

Mental disorders impose an enormous burden on society. In developing countries like India, there is a lack of adequate number of trained mental health professionals to provide specialized care and 75–85 % of affected individuals do not have access to appropriate mental health services. The National Mental Health Programme (NMHP) is being implemented by the Government of India to support state governments in providing mental health services in the country. The Urban Mental Health Programme (UMHP) is a pilot initiative that has attempted the integration of mental health services in primary health care settings in two municipal wards in Kolkata, West Bengal, India. The overarching aim of this paper is to describe the methodology used for the evaluation of the community based mental health programme and to understand the processes of the programme in terms of barriers and facilitators. The current evaluation is based on a concurrent nested design, where qualitative and quantitative data are both collected at the same time but analysed separately and priority was given to qualitative data. This experience will contribute in helping other researchers to make some evaluations more effective, useful and manageable. Ethics approval was obtained from an institutional ethics committee of an organization (Ekjut) based in Ranchi, Jharkhand, India. The evaluation was undertaken by the George Institute for Global Health, New Delhi from February- June 2016.     

Mandated benefits for a new provider class: LICSW's

The purpose of this study is to assess the initial impact of Licensed Independent Clinical Social Workers (LICSW's) as a new reimbursable provider class in an insured population with mandated nervous and mental benefits. History of nervous and mental therapy, previous provider type, age, and sex are examined. Data were obtained from Blue Shield of Massachusetts' nervous and mental claim information from 1979 through 1982 for all patients who saw a social worker during the year of LICSW certification. Results show (1) a large majority of the 1982 social worker patients had no billable psychiatric experience for the three years prior to 1982; (2) the longer a patient is in treatment, the less likely is a provider type switch; and (3) psychologists' patients are more likely to switch to a social worker than psychiatrists' patients. A concern remains for this insurer over the increase in the total number of psychiatric services concomitant with a new provider class introduction.     

Family experiences of children’s social care involvement following a social work change programme

Abstract

Social work change programmes rooted in a particular practice theory and design are increasingly a fixture of UK local authority social work and the focus of a small but developing body of research. However, in this research to date, there has been a lack of engagement with the perspectives of families. In this article, we detail findings from 23 family interviews undertaken as part of an independent evaluation of a social work change programme in a single local authority. These findings afford insight into the positive influence change programmes can have on engaging families and re-routing practitioners to work in a relationship-based way. They also illustrate the limitations for reshaping practice in the context of rising levels of need, a paucity of supportive provision, and administrative burdens remaining the same as before the introduction of a change programme. As part of the article, we offer some brief reflections on the recruitment of families for evaluative study to assist other researchers and local authority professionals who may be involved in comparable evaluations in future.     

Adoption for adaptation: A theory-based approach for monitoring a complex policy initiative

This paper explores some of the challenges involved in designing a monitoring framework for a complex policy initiative designed to support climate change adaptation in a highly varied and dynamic implementation environment. It looks specifically at the UK’s Department for International Development (DFID) initiative called Action on Climate Today, a five-year programme that aims to support the mainstreaming of climate change adaptation into policy systems in five countries and ten locations in South Asia.This paper presents a theory-based approach to designing a monitoring system for the ACT programme that seeks to account for the programme’s design and implementation complexities. It does so by providing an example for monitoring the causal processes and mechanisms that underpin the programme’s theory of change. The paper highlights a systematic approach to context monitoring through periodic context assessments and evaluative indicators; the use of categorical indicators to capture a diverse portfolio of support; and a flexible results framework structured around the adoption and implementation of programme outputs into the targeted policy systems.     

Writing a Book Review for JFSW

ABSTRACT

For children in foster care, continued contact with biological parents may have significant implications. This article seeks to synthesize literature examining attachment theory and visitation between children in foster care and their parents. The results of the research synthesis indicate that although the exploration of attachment theory began over 40 years ago, the questions regarding the implications of foster care visitation and attachment continuation surprisingly remain unanswered.     

Looking beneath the surface of a preceptor-training programme through a realist evaluation

South Africa’s department of health devoted themselves to the clinical nursing education and training model, which indorses preceptors as essential stakeholders to promote competence in students. A preceptor-training programme was developed that build on this model and implemented through an intervention. The initial programme theory hypothesised that trained preceptors would promote support and develop competence in students in comparison to untrained preceptors. Results showed a poor outcome because few preceptors participated and a high student attrition rates. The authors then posed the question “Why did the preceptorship training programme not work?” This article offers insight into the context, mechanism, and outcome of the preceptor-training programme through a realist evaluation. Reflective field notes, gathered during the intervention, were used and gave insight regarding how, for whom, and under which circumstances the programme could work and offered a refined programme theory for preceptorship. The main conclusion drawn showed that a preceptor-training programme alone is not the sole determining factor to ensure preceptors’ motivation to transfer their learning; a systems approach, ensuring the effectiveness of the programme, should be followed. Reflection on findings indicated the implementation context as a major determining factor of the training programme.