Parenting children with autism spectrum disorders: a crucible for couple relationships

As the incidence of autism spectrum disorders (ASDs) continues to rise, there is a growing need to understand how ASDs impact family life. This qualitative study explored the ways in which parenting a child with ASD impacts marriages. Using modified grounded theory, nine couples and one wife (n= 19) were interviewed. The dominant finding that emerged is that parenting a child with ASD acts as a crucible for couple relationships, exerting extraordinary pressure on partners that forces qualitative adaptations in their relationship. Two relationship phases emerged from the analysis: tag team and deeper intimacy and commitment. The resulting theoretical model can help clinicians tailor assessment and intervention for couples who are parenting a child with ASD.     

The small ministry with the large reach: Using relationships to extend organisational capacity

Abstract

The Ministry of Pacific Island Affairs is charged with identifying the aspirations and needs of Pacific people residing in Aotearoa/New Zealand, providing high quality policy advice to governments and their ministries, and with advising ministries on how these might be achieved. With a large, dispersed client population, a small staff and limited resources, this represents a major task for the Ministry. However, the Ministry has been able to deliver these by forming a network of co‐operative relationships with both its communities and the other ministries and agencies charged with formulating policy and delivering services to the communities. But limited resources prevent the Ministry mediating each of these relationships on a continuing basis.

This paper focuses on the ways in which the Ministry of Pacific Island Affairs went about forming and using a web of “partnerships” with Pacific communities, social policy agencies, and service providers to overcome some of the challenges which a small ministry with limited resources faces. This paper attempts to show how a larger web of relationships became central to the Ministry's community development mission.

The Ministry formed and nurtured a series of local partnerships between communities’ representatives and the ministries which deliver local programs. The arrangements free the Ministry to monitor the relationships and the performance of the ministries and agencies. Previously, we have described the organisational model as an apogāleveleve, or spider web, in which the web is a series of defined relationships created and maintained by the “centre” for a specific purpose: obtaining the best possible outcomes for constituent communities. Each operative relationship is connected via the centre, and mediated by the centre, which also monitors the performance of the system as a whole and moves to repair damage anywhere it occurs to ensure that the web as a whole continues to deliver outcomes. The network of co‐operative relationships, or partnerships, has made it possible for the Ministry to achieve significant results relatively quickly with limited resources.     

Partnership and the limits of procedure: prospects for relationships between parents and professionals under the new Public Law Outline

April 2008 saw the introduction of a new Public Law Outline (PLO) that aims to improve judicial case management of Public Law Children Act cases. The PLO is a response to concerns about the rising number of care proceedings, associated costs, and the difficulties of achieving case resolution given this volume. Based on an ethos that care proceedings should be avoided wherever possible, the new approach to case management, which places significant emphasis on pre-proceedings work and the effective engagement of parents, can be seen to reinforce the 'no order principle' enshrined in the Children Act (CA) 1989. Focusing specifically on relationships between parents and professionals, this paper provides a critical discussion of the potential of the PLO to further promote consensual practices with parents. Discussion traces the introduction of the concept of partnership within the CA 1989, provides a review of the evidence to-date of effective partnership working, before considering the prospects for the PLO with respect to parental engagement. A number of key contextual obstacles are highlighted that will inevitably undermine the aspirations of the new outline, and a more general observation is drawn about the limits of procedure in effecting change in complex social issues.     

From policy to practice: the implementation of a new framework for social work assessments of children and families

This paper describes a two‐year study conducted in 24 English councils to evaluate the implementation of the Framework for the Assessment of Children in Need and their Families. The Framework promotes a holistic, multi‐agency approach towards the assessment of children in need. The study was carried out in two phases. Phase one explored how councils implemented the Framework and accompanying assessment records. Phase two used a variety of methods to assess the impact of the Framework on practice, including an audit of completed assessment records, postal questionnaires to practitioners and managers in social services and partner agencies, and a qualitative study of 52 cases which included interviews with parents, children over 10 and social workers. A time record was used to gather information on the time social workers spent on the various elements of the core assessment process. The study suggests that councils had to overcome a number of organizational and other barriers in order to implement the Framework. However, the Framework and supporting materials appear to have provided the foundations to improve the quality of social work recording and promote interagency working, and have strengthened the involvement of children and families in the assessment process.     

Spouse Liability for a Partner's Long–term Care Costs: Local Variations in Policy and Practice in the UK

Under the 1948 National Assistance Act a husband and a wife are liable to maintain each other and so can be required to contribute towards a spouse's care home costs. A national postal survey of social services finance officers showed that only a minority of local authorities pursue liable spouses. These authorities have often developed individual policies with widely different treatment of capital and income. Discretion is being exercised in the pursuit of liable spouses within these authorities. Social workers do not necessarily bring liable spouses to the attention of finance officers and articulate and knowledgeable spouses can either decline to pay or pay only token amounts. Only the unlucky and ill–informed spouses end up contributing. Such variation in the treatment of spouses is at odds with the development of fairer policies to meet the costs of long–term care.     

Spiralling up and spiralling down: implications of a long‐term study of temperament and conduct disorder for social work with children

A model of social work grounded in the integration of the social sciences is presented. In social work with children this is exemplified by the importance of difficult childhood temperament and the goodness of fit between parenting practices in the evolution of conduct disorders. A professional model in which the social worker is an equal status member of a cooperative team of professionals engaged in treatment and research is stressed. The basis for this model of social work is that of the person‐in‐environment in which loopbacks from the child’s environment reinforce or diminish the evolution of conduct disorder in the process of spiralling down or spiralling up. This process is illustrated by two extensive case histories. In one the spiralling down process has been checked through intensive social work inputs. Nevertheless, in a longitudinal study it is shown that without such interventions difficult temperament observed at age 3 has significant links to conduct disorders, and movement into care or institutional life at age 17. Severe conduct disorders which lead to permanent school exclusion are likely to be expensive.     

Enhancing the rights and well‐being of people with acquired brain injuries in the criminal justice system: Some findings from a qualitative study

This article focuses on the issues currently facing people with an acquired brain injury (ABI) in the criminal justice system in the state of Victoria, Australia and, in particular, the impact of this condition on people suffering various forms of social disadvantage. This qualitative study involved in‐depth interviews with key stakeholders, such as service providers working in the system, court personnel including Magistrates and Judges, legal practitioners and persons living with an ABI and their carers. The aim was to determine the advantages and limitations of current policy and practices, and to identify possible actions which could lead to improved outcomes for this cohort. This paper responds to our research findings in relation to two key areas: first, the awareness of ABI amongst legal practitioners and service providers, prompting the need for better education, training and professional development; and second, the requirement to improve processes for identification, assessment and support, for people involved in the criminal justice system with ABI. A number of systemic modifications and educational initiatives are recommended to address the unreasonable and unacceptable impacts on persons living with an ABI in the criminal justice system.     

An elder abuse shelter program: build it and they will come, a long term care based program to address elder abuse in the community

This article describes how The Hebrew Home for the Aged at Riverdale (the Hebrew Home), a non-profit geriatric care center, has established one of the nation's first long term care based elder abuse prevention and intervention programs for elderly living in the community. This program, known as the Weinberg Center for Prevention, Intervention and Research in Elder Abuse (the "Weinberg Center"), received start-up funding in the form of a matching grant challenge from the Weinberg Foundation of Baltimore, which has a history of funding innovative geriatric programs throughout the United States. Utilizing the Hebrew Home's extensive integrated service model, a multidisciplinary team works with a network of private and governmental agencies. This model was designed based upon the needs of this population as described in the nascent research, evaluation of the few programs in existence, and the emerging state of elder abuse as a matter of public policy. The goals are to increase public awareness, intervene to make the home safe, and provide a secure and fulfilling short or long term shelter. Research in prevalence and efficacious use of the shelter is being conducted.     

Precautionary behavior and willingness to pay for a mortality risk reduction: Searching for the expected relationship

This paper examines within-sample correlation between six different precautionary behaviors and stated willingness to pay for a mortality risk reduction. The paper also shows estimates of the value of a statistical life based on seat belt and bicycle helmet use as well as based on the stated willingness to pay for a risk reduction in traffic mortality. Contrary to the theoretical expectations, no correlation is found between precautionary behavior and stated willingness to pay. One major explanation is that females and the elderly take more precaution, but state a lower WTP for a risk reduction. The estimates of VSL from the different approaches are $11.0 million, $5.0 million and $2.8 million from stated WTP, bicycle helmet use and seat belt use, respectively.

Continuing to Pay: the Consequences for Family Caregivers of an Older Person's Admission to a Care Home

This paper aims to discuss the reasons why caregiving in the community had ended for a sample of dependent older people, two-thirds of whom had dementia. Comparisons are made between the situation of a spouse caring for a partner and a daughter or son caring for a parent in a separate household. Spouses in the study had often sustained a greater burden before caregiving collapsedthan had daughters or sons. They were less likely, however, to have had support from the home care service. When caregiving in the community ended and the dependent older person entered a care home, family caregivers themselves often had a financial price to pay. Currently spouses have a legalliability to contribute to a partner's care costs. The implementation of this liability depended on individual local authority policies and the views of the individual social worker doing the financial assessment. Because of the UK's means-testing rules, daughters and sons were often penalizedbecause a parent's assets that they might have inherited had to be used to meet the care home costs. Resentment at being disinherited was related to the daughter's or son's family situation. Those with children or grandchildren themselves were far more likely to be angry than those without children.     

Assessing the Barriers to Achieving Genuine Housing Choice for Adults with a Learning Disability: The Views of Family Carers and Professionals

It has been reported that the capability of adults with a learningdisability to choose their housing is too often impeded by theviews and actions of their family carers and involved professionals(McGlaughlin and Gorfin, with Saul, in press). This study furtherexplores these apparent barriers to providing genuine housingchoice for adults with learning disabilities. It discusses findingsfrom a series of focus groups which explored family and professionalviews about housing and choice. The views expressed indicatethat risk is a fundamental concern for both professionals andfamilies when considering more independent housing for thisgroup. Although opportunities for choice were generally supported,many argued for the need to assess the ability to make informeddecisions. There were also examples of problematic relationshipsbetween professionals and carers, creating a barrier to choice.Carers need involvement, information and support during thedevelopment of housing plans if the needs of the primary serviceusersare to be met. The barriers identified have to be removed ifservice-users are to truly become the focus of decisions andbe enabled to make genuine informed choices.     

Recurrent grief in mothering a child with an intellectual disability to adulthood: grieving is the healing

Much of the literature on mothering a child with a disability focuses on grief in the context of diagnosis, with a paucity of longitudinal studies focusing on ongoing grief as the child moves through the life stages. This qualitative study explores the existence of recurrent grief within the lived experience of six women, in mothering their children with intellectual disability through to young adulthood. Informed by the differing theories of grief and disability, the study considers mothers' perception of the experience of recurrent grief as influenced by personal and societal factors, with a focus on its triggers, its manifestation and its amelioration. The findings have relevance to social work practice, policy and research in revealing the necessity for ongoing support and advocacy for mothers of children and young adults with intellectual disabilities.     

Retesting the income inequality hypothesis: Pooled time‐series–cross‐section regression with a new statistical case selection method

The Wilkinson hypothesis, which posits that it is income inequality, rather than economic growth, that determines population health in wealthy societies has been widely debated over decades. This article, with an original case selection process, retests the controversial hypothesis with the time‐series–cross‐section (TSCS) regression model. The main findings are that disposable income inequality is not statistically significantly associated with life expectancy, and its influences on the health of the elderly population are counterintuitively beneficial. Infant mortality rate is the only health indicator that both has the statistically significant association with income inequality and corresponds with the Wilkinson hypothesis. Finally, the relationship between income inequality and population health is not as simple as the hypothesis suggests and found to be dynamic and complex depending on what health indicator is used for the test.     

‘She was like a mother and a father to me’: searching for the ideal mentor for youth in care

Recent studies of youth in out‐of‐home placements have indicated that a successful mentoring relationship in care is associated with better emotional, educational and behavioural outcomes in adulthood. The goal of this exploratory qualitative study is to describe the profile of a staff member who is able to establish a meaningful relationship with youth in care through the perspectives of 20 young adults aged 21–26 who left care in Israel. Findings revealed that the staff member who formed meaningful relationships with youth was the staff member who was available to the youth and familiar with their personal backgrounds, who was able to see them as positive and trustworthy and to provide guidance and support from a non‐judgmental approach. One of the study's conclusions is that staff members who were able to transform their connection with the youth into mentoring relationships were those who were able to make the youth feel as if they were the staff member's own children, and as a result feel cared for deeply and loved. The discussion addresses the barriers in forming a mentoring relationship with a formal professional and the ways to utilize these mentoring relationship components more effectively within the care system.     

Patients with Minor Mental Disorders Leading to Sickness Absence: A Feasibility Study for Social Workers' Participation in a Treatment Programme

Minor mental disorders are common among patients who visit theirgeneral practitioner. In the Netherlands, they are associatedwith high costs due to absenteeism, disability benefits andmedical consumption (consumption of drugs as well as expenditureof medical staff’s time). In the Netherlands, a protocolwas developed for the treatment of minor mental disorders, basedon the principles of brief cognitive behaviour therapy. Thecost-effectiveness of this protocol was tested in a group ofpatients whose minor mental disorders had lead to sickness absence.The protocol was completed by Dutch social workers, one of whosecore tasks normally is to provide psychosocial care. The mainaims of the protocol are for the patient to regain functionalityand to prevent long-term disability. The protocol emphasizespatients’ own responsibility and active role in the recoveryprocess, includes homework assignments and stresses the importanceof early work resumption. This article focuses on a discussionof the feasibility of this treatment for minor mental disorders.The evidence for or against the protocol’s cost-effectivenesswill be discussed in future papers. The results show that patients,social workers and general practitioners were motivated to participateand that the protocol was well received by all three groups.If the treatment also proves to be cost-effective, it wouldappear to be a promising intervention for a frequently encounteredproblem in primary care.     

The Reaction of the Family to the Institutionalization of an Elderly Member: Factors Influencing Adjustment and Suggestions for Easing the Transition to a New Life Phase

The institutionalization of an elderly person is a crisis for the family. Using case illustrations, this article presents three major factors affecting family reactions and adjustment (the expectations of society, family roles and expectations, and the impact of the move upon daily family life), suggests that nursing home placement be viewed as a step in the normal family life cycle, and discusses ways in which rituals could be used to ease the tradition to the post-placement phase of the family.