Transgender and Gender Diverse Children: Considerations for Affirmative Social Work Practice

Given growing public awareness about transgender and gender diverse identities, it is expected that greater numbers of children and families will seek mental health and social services, including transition-related services, from social workers and other mental health professionals. Transgender and gender diverse children have a range of transition-related needs which require the support of informed practitioners with transgender and gender diverse-specific knowledge and skills. Moreover, the needs and experiences of families and caregivers of transgender and gender diverse children will vary greatly. To date, research suggests a paucity of transgender and gender diverse-specific expertise among social workers and other mental health providers; this seems particularly evident with respect to the needs of transgender and gender diverse children. An affirmative practice framework to guide therapeutic work with transgender and gender diverse children and families is presented. In addition, key clinical practice considerations associated with engagement, assessment, psychoeducation, support and referral are provided. Finally, clinical examples illustrating use of the affirmative practice approach with transgender and gender diverse children are provided.     

Building a Social Movement for America's Children

Americans are concerned with the conditions of children and young people, and this concern has proven to be pervasive, intense, and enduring. But it has also largely proven to be politically anemic. Beyond the consensus that children's well-being is threatened, there is little public agreement over who bears responsibility for these problems or what we should do about them. As a result, public unease has failed to translate into a coherent and widespread demand for political change. What explains this gap between public concern and political action when it comes to children's well-being? This paper addresses four aspects of this question: First, in what ways is the public concerned for the well-being of children? Second, why has this concern failed to lead to political mobilization? Third, what factors helped to translate public concern with children in earlier eras into political movements, and why were those movements able to contribute to the policy-making process? Fourth, what might contemporary children's advocacy—reconfigured in light of these insights—look like? Answering these questions sheds light on how collective public will develops and how and when it translates into collective political action benefiting children.     

Future of Long-Term Care Financing for the Elderly in Korea

ABSTRACT

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Aging,Health, and Social Policy:

Seven major turning points in the evolution of U.S. aging policy are identified and reviewed: (1) the Social Security Act (2) the Great Society (3) the federalization of Old Age Assistance (4) the enactment of comprehensive social services (5) Social Security improvements (6) New Federalism, and (7) medical cost-containment policies under Medicare and Medicaid. In the 1980s, significant and growing problems of uninsurance and underinsurance for health care have re-emerged. Simultaneously, state Medicaid programs are characterized by their increasing variation and inequities, while there has been a decline in access for the poor. The future of aging policy will be decided in the context of four socio-demographic realities: (1) population aging (2) trends in mortality and morbidity (3) the relationship between income and health, and (4) aging as a woman's issue. The article concludes with a call for a recommitment to the public interest and to public solutions which affirm that health care is an inalienable right.     

Future of long-term care financing for the elderly in Korea

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly longterm care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Appropriate Therapeutic Care for Families with Pre-Pubescent Transgender/Gender-Dissonant Children

In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.     

Kinship Care for Children of a Parent With a Mental Illness

Little is known about “hidden” kinship caregivers of children of a parent with a mental illness (COPMI). An exploratory study surveyed 56 COPMI caregiver members of a kinship center administered by a school of social work in a large public university. The COPMI sample was a subset of a larger kinship caregiver study. Nearly one in four caregivers was providing COPMI kinship care. The COPMI caregivers reported numerous child behavioral crises and decreased caregiver physical and emotional health since they began providing care. Practice, policy, and research require development to increase support for COPMI caregivers and their families.     

Life after Growing Up in Care: Informing Policy and Practice through Research

Abstract

Existing research on the impact of growing up in care focuses upon either the care experience itself or the period of transition from care to independence. Our knowledge of outcomes largely ceases when former residents of the care system reach their early twenties. There are strong social justice reasons for extending research into the older adult lives of such young people. We know a great deal about the multiple disadvantages that such individuals face as children. But research is largely silent about their subsequent adult lives. While we must be cautious in drawing causal links to the childhood care experience as the time period since life in care extends, we know that early experiences can affect care-leavers across their life course—just as childhood experience affects all adults in a variety of ways. In this review, we highlight evidence drawn from research in Australia, the United Kingdom, Canada, Ireland, and the United States, with particular attention paid to the first two of those countries. We use a wide range of sources and identify areas for further consideration, including access to personal records, mental health, education, and parenting. By doing so, we seek to open up this area for further research with the hope that such research will lead to an increasing recognition of care-leavers' needs and thus to improvements in social policy and service provision.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Interventions that Foster Healing Among Sexually Exploited Children and Adolescents: A Systematic Review

Sexual exploitation of children and adolescents is a pressing, yet largely under-recognized form of child abuse. The goals of this review were to identify interventions that have been implemented with sexually exploited children and adolescents and to better understand their effectiveness for fostering healing with this population. Our systematic search generated 4,358 publications of which 21 met our inclusion criteria. Based on their objectives and delivery, we organized the interventions into five categories: (a) focused health and/or social services, (b) intensive case management models, (c) psychoeducational therapy groups, (d) residential programs, and (e) other. Most programs were gender-specific, targeting girls and young women with just one being for boys and young men only. Studies reported on a range of outcomes including psychosocial outcomes, risky behaviors, trauma responses, mental health, protective factors, and public health outcomes. Despite differences in delivery, most of the interventions did, to some degree, appear to foster healing among sexually exploited children and adolescents. Findings from this review have implications for researchers, policy and program developers, and frontline practitioners who, through partnerships with one another, can advocate for the creation of evidence-informed, purpose-built, and thoughtfully delivered interventions.     

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.     

Can a Munro-Inspired Approach Transform the Lives of Looked after Children in England?

This discussion paper will examine the lessons from the Munro Review relevant for looked after children. Although the Munro Review focuses on child protection, we will argue that some of its key principles have relevance for understanding looked after childhoods. The Munro Review provides an analysis of the current state of the child protection system, challenging bureaucratised practice and arguing for a reclaiming of professional social work identity, knowledge and understanding. There are three key principles of the Munro Review that this paper will focus upon. The first two are the recognition that risk cannot be eradicated and the bureaucratisation of practice is an inadequate response to the demand for public accountability. The third principle is that ethical integrity lies at the heart of services for children in public care. The key message of this paper is that a Munro approach can transform looked after childhoods. However, the current ‘child protection’ model of social work in England may prevent this shift in social work practice.     

Creating Happier Children and More Fulfilled Social Workers: Neoliberalism,Privatization and the Reframing of Leftist Critiques in Britain

To differing degrees, governments in Europe, North America, and Australasia have, over recent years, given particular attention to the reform of services for children and families. However, the aim of this article is to focus on Britain and to examine plans to transform social-work services for children and young people who are “looked after,” that is to say, in public care. It is argued that these plans, focused on the introduction of what are termed social work practices, are best grounded and interpreted within an analytical framework that recognizes the centrality of neoliberalism. Furthermore, social workers and others working in related areas of human services provision should take account of how the plan to install social work practices is being discursively constructed and organized. Important here, it is maintained, is how this strategy seeks to deploy selectively leftist critiques of social work that have emerged over the past two decades.     

Short Break and Respite Services for Disabled Children in England: Comparing Children's and Parents' Perspectives of Their Impact on Children

Researchers, health and social care workers often seek to understand the perspectives of children; but gathering views directly from children can present difficulties. Parents are often asked to provide accounts of children's feelings or opinions on the assumption that their proxy reports are accurate and unproblematic. This qualitative thematic analysis of open‐question responses from 352 parents and 73 disabled children examines their accounts of the impact of short break services on disabled children. Participants' perspectives differed; children tended to describe immediate outcomes such as enjoying activities and participation; parents acknowledged these, but focused on longer term developmental outcomes for children.     

残疾儿童心理健康内涵及结构初探

心理健康是儿童生活和健康成长的保障,相较于普通儿童,在某些方面具有障碍或缺陷的残疾儿童更容易出现情绪和行为问题,其心理健康状况堪忧,迫切需要得到更多的关注和有效的干预.本文基于心理健康的概念和标准,结合残疾儿童的身心发展特点,厘清了残疾儿童心理健康的内涵,其实质是努力达成残疾儿童与外界环境的适度平衡和内心的和谐,即良好的社会适应.在此基础上,从社会适应心理机能的活动领域和特质内容两个维度入手,初步构建出残疾儿童心理健康的五领域(自我意识、人际交往、学习适应、生活适应、社会支持)与三内容(认知、情绪情感、意志行为)相交叉的二维结构模型,为进一步开展残疾儿童心理健康教育的实践工作奠定理论基础.     

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.     

Access to Mental Health Services: The Struggle of Poverty Affected Urban Children of Color

It is estimated that, in the United States, one in ten children and adolescents suffer from illness severe enough to cause some level of psychosocial dysfunction. Urban children, and in particular low-income children of color, are at greater risk of developing mental health problems, and are less likely to receive effective child mental health services. Prompt and effective access to mental health services by urban children of color is a critical direct practice and social policy concern. This article provides an overview of significant barriers to mental health care experienced by poverty affected urban children of color and their families. It also addresses a broad range of practice and policy issues that need to be raised in order to ensure competent delivery of mental health services for children living in urban environments. The role of social work in assisting poor urban children of color to access and benefit from mental health services is stressed. Manny John González, D.S.W., is an Assistant Professor of Social Work at Fordham University Graduate School of Social Service.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

Supporting and Encouraging Father Involvement in Families of Children Who Have a Disability

Although researchers have studied families of children with disabilities for many decades, most of this work has been focused on the mothers. Very little information is available to help social workers and other family professionals understand the importance and benefits of father involvement. Such involvement can be deterred if fathers feel overwhelmed by the transitions the child and family will inevitably face. By identifying the developmental and historical stage of the father, mother, couple, and child, social workers can help the family prepare for impending transitions. Such preparation can avoid likely distress and provide the family with sufficient information and support to change a potential crisis into a positive, affirming turning point. To assist social workers in planning appropriate interventions, a list of potential resources is also provided.     

Coordinating co-production in complex network settings

This article draws together the concepts of network management and co-production with complexity sciences. So far, these approaches have rarely been connected in research literature. We suggest that this conceptual framework offers new insights for analyzing the challenges of co-production in complex network settings in the local public services. The aim of the article is to find out how complex network structures meet the co-production process in the context of social and health care services. The empirical part of the article presents a Finnish case study of a multiprofessional service network producing social and health care services for youth. Here, the clients, in this case children and young people with a need for social services, often need multiple services from different service providers simultaneously. Our research findings suggest that the outcomes of the service process are not only dependent on the client's needs, but rather on organizational and professional interests. Our research gives new insights for the discussion on co-production; when it is applied as an intended policy to improve and deliver public services, the complexity of interaction among the street-level workers and the detached professional frameworks should be kept in mind.