Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway

This article aims to contribute to the understanding of shared decision making as an important aspect of user involvement in mental health care from the perspectives of service users. A thematic analysis of interviews with 25 individual service users in three different community mental health centers in Norway identified different understandings of shared decision making. Shared decision making was identified as essential in four contexts: 1) during admission, 2) in individualized treatment, 3) in different treatment contexts, and 4) in user-professional relationships. We consider shared decision making to be intertwined with treatment from the service user perspective.     

Inheritance Law in an Aging Society

An exploratory analysis of states' inheritance law changes between 1961 and 1990 was conducted in order to discern major trends and their implications for older families. Results suggested that states were modifying their laws in ways similar to suggestions of the law community's Uniform Probate Code, with about one third of the states adopting the Code itself. Consequently, inheritance law has become less traditional and paternalistic and more like "facilitative law," that is, flexible, accommodating, and supportive of family autonomy and decisionmaking authority. These changes and new laws that simplify procedures, protect the dependent and vulnerable, treat marital property more like community property, recognize variant family forms, and enable extrafamilial bequests, may serve to minimize family disruption, conserve resources, and allow families to tailor property divisions and procedures to particular needs and wishes. An impact study is proposed for disclosing the actual effects of inheritance law reforms. Also, while trends observed in this study were fairly evident, states' adoption of new laws was uneven and selective, inviting continuing trend analyses and further research into the reasons for interstate variation.     

Is There a Woodwork Effect? Addressing a 200-Year Debate on the Impacts of Expanding Community-Based Services

In U.S. social welfare history, many have suggested that if benefits were too attractive, consumers would come out of the woodwork to take advantage of the opportunity. Clinical trials have provided evidence of the woodwork effect’s existence, suggesting caution when expanding home- and community-based services (HCBS). However, it is unclear whether these studies are best suited to assess whether a system-level effect occurs. Using state and federal data tracking Ohio’s long-term services and support (LTSS) system from 1995 to 2015, this paper examines changes in the utilization rates and expenditures of Medicaid LTSS to explore whether a woodwork effect occurred as Ohio moved to improve its LTSS system balance (80% Nursing Home [NH], 20% HCBS) to (49% Nursing Home [NH], 51% HCBS). After accounting for population growth of individuals older than 60 and those with two or more impairments in activities of daily living, there was no change in utilization rates of older people with severe disability (1995: 491 per 1000 population, 2015: 495 per 1000 population) or overall LTSS expenditures (1997: $2.7 million [in 2013 dollars], 2013: $2.9 million). Our results suggest that states can make significant strides in HCBS expansion without increasing the overall long-term services utilization rate.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Quality of Web-based Information on Pathological Gambling

The present study aims to evaluate the quality of web-based information on gambling and to investigate potential content quality indicators. The following key words: gambling, pathological gambling, excessive gambling, gambling problem and gambling addiction were entered into two popular search engines: Google and Yahoo. Websites were assessed with a standardized proforma designed to rate sites on the basis of “accountability”, “presentation”, “interactivity”, “readability” and “content quality”. “Health on the Net” (HON) quality label, and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. Of the 200 links identified, 75 websites were included. The results of the study indicate low scores on each of the measures. A composite global score appeared as a good content quality indicator. While gambling-related education websites for patients are common, their global quality is poor. There is a need for useful evidence-based information about gambling on the web. As the phenomenon has greatly increased, it could be relevant for Internet sites to improve their content by using global score as a quality indicator.     

Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004–2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.     

Experience,Knowledge, and Concerns About Long-Term Services and Supports: Implications for Financing Reform

Using the 2014 Survey of Long-Term Care Awareness and Planning, this article examines Americans’ experiences, knowledge, and concerns about long-term services and supports (LTSS) and actions they are willing to take if they become disabled. The survey included 15,298 non-institutionalized respondents aged 40 to 70 years drawn from a nationally representative sample. Although many reported some experience with LTSS, knowledge of how LTSS worked was low. Respondents reported widespread concerns about becoming disabled. They preferred informal care over paid care, with a strong desire to remain in their homes. These results can be used to design reform initiatives and to motivate political support.     

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.     

Student and faculty perceptions about mandatory influenza vaccinations on a health sciences campus

Objective: To examine the perceptions among faculty and health professional students regarding mandatory vaccination policies on a health sciences campus. Participants: A total of 296 faculty and 244 students completed surveys during Fall 2015. Methods: The online survey administered to individuals who received the influenza vaccine during the fall 2015 influenza vaccination clinic season included five items evaluating perceptions of employer mandatory vaccination requirements. Results: Chi-square analysis indicated that although faculty and students agree mandatory vaccinations in a health care environment are appropriate, faculty are more likely than students to get vaccinated in the absence of a mandate. Additionally, a small fraction of faculty would consider employment elsewhere when facing this mandate. Conclusions: Overall, faculty and students had favorable perceptions about mandatory influenza vaccine policies. Since students were less likely to be vaccinated in the absence of a mandate, education of students should be improved to support the importance of vaccinations in a health care environment.     

Family systems functioning,family health roles,and utilization of physical health services

The purpose of the study reported here is to determine the relationship between family systems functioning, family health role, and family utilization of health services. The research is based in the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russel, 1979). Family functioning variables include family level of cohesion, family adaptability, and family type, as measured by FACES II. Family health role (i.e., leadership role and acceptance of sick role) and utilization of health services are measured by scales of the investigator-developed Family Health Questionnaire. The sample consists of 140 parents of 70 families, composed of two parents with children under 25 years of age living at home. Analysis reveals significant relationships between the family level of adaptability and acceptance of the sick role, in conjunction with significant gender and gender interaction effects. There are no significant differences between family cohesion levels or family typologies with the health variables.Su An Arnn Phipps is an Assistant Professor at the University of Oklahoma College of Nursing Graduate Program, Tulsa, 700 N. Greenwood, Tulsa, OK 74106. Her research interests include family systems functioning and family physical health, couples' infertility experience, and fathers' role(s) in family health. She received her Ph.D. from Oklahoma State University in Family Relations and Child Development.     

Maternal child care preferences for infants,toddlers, and preschoolers: the disconnect between policy and preference in the USA

While much research exists looking at parental preferences for child care, much of that research uses child care choice as a proxy for preference. In an effort to examine the types of care mothers prefer if no constraints were placed on their decision, this quantitative study investigated how family demographic factors and family role ideology relate to the types of child care (parental and non-parental forms) mothers prefer ‘in an ideal world’ using a sample of 345 employed mothers of children under 6 years of age in a suburb of a large metropolitan area in the southern USA. Participants completed a questionnaire examining the types of care they viewed as ideal for infants (0–12 months old), toddlers (13–30 months old), and preschoolers (31–72 months old) if no constraints were placed on the decision. Results indicated that the preferences for type of care for mothers in this sample varied according to the child's age, with a large majority of mothers preferring parental care for their children. Ideological and demographic factors predicting preferences for first and second choice of child care were also explored through binary and multinomial logistic regression, revealing the influence of ethnicity, education, and family role ideology to preferences for infant care. These results add to the existing literature by confirming previous findings about the influence of child age to child care preferences, as well as highlighting the disconnect between these preferences and the way family policies are structured in the USA.     

Catering to sex,sexual, and gender diversity: An exploratory study on the effects of LGBTI awareness training on aged care staff in Tasmania,Australia

The Australian National LGBTI Ageing and Aged Care Strategy seeks to address the lack of recognition of older lesbian, gay, bisexual, transgender, and intersex (LGBTI) adults living in aged care. Awareness training for aged care staff forms a crucial part of this strategy, but the impact of such educational programs are yet to be examined. In this article, we examine the effects of LGBTI awareness training on staff working in an Australian aged care facility. These staff perceived the awareness training as valuable, but the outcomes from it were limited. Therefore, we indicate changes that are necessary to support the translation of training into practice.     

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: the development and analysis of a questionnaire

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents’ overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors’ attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents’ satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality.     

Mobilizing Resistance to Privatization: Communication Strategies of Salvadoran Health-Care Activists

In September 2002, unions representing public health-care employees in El Salvador – doctors, nurses, blue-collar workers, and clerical staff – began a strike that would last for over 9 months, in protest of government plans to privatize medical services in the Salvadoran Social Security Institute. This paper focuses on the methods that the unions and their allies used to communicate their policy arguments and the motivations for the strike to the Salvadoran public. Specifically, I examine the endogenous factors that shaped their communication strategy and the movement traits that enabled them to carry this out successfully. Coverage of the lengthy conflict by the country's two leading newspapers is examined in order to sketch a synopsis of counter-movement framing that the activists confronted. Interviews with movement leaders reveal that they relied primarily on direct, nonmediated communication channels to counteract the media's framing, and that the organizational diversity of the movement was an enormous advantage for these methods.     

Healthcare professionals' priorities for child abuse educational programming: A Delphi study

Child abuse reporting and intervening are a complex process. A comprehensive training program with targeted goals and priorities enables professionals to effectively address the needs of abused children and their families. The study purpose was to identify the content and priorities of health professional education in child abuse by integrating expert opinions and achieving consensus. A 3-round Delphi study was conducted with 25 multidisciplinary experts in health care, social welfare, psychology and counseling, and law and jurisdiction. Structured questionnaires collected expert opinion of appropriateness and importance of knowledge, subjective norms, attitudes, skills, team collaboration and teaching strategies. The expert response rates ranged from 96 to 100% for the 3 rounds, and consensus was achieved. Knowledge was regarded as the most important element. Two items on forensic evidence in the skill category received the highest importance score. Results provide a basis to develop educational programs achieving clinical competence in child abuse care.     

Displacement,caregiving, and the ecological system of youth in foster care: a theoretical perspective

Children involved in the child welfare (i.e., foster care) system are at a greater risk for numerous negative outcomes in adolescence and adulthood (e.g., lower educational attainment, higher risk for a criminal record). For children in foster care who experience placement disruption (i.e., removed from a foster home and placed in another nonpermanent placement), the risks significantly increase. Informed by the ecological systems model, the authors propose a theoretical perspective to explain the unique aspects of a foster child’s development and discuss how this framework informs child welfare practice and intervention for foster children at risk for placement disruption. This perspective has the potential to provide a framework that has implications for foster caregivers and child welfare professionals and to inform future policies.     

Exceeding parents’ expectations in Ear–Nose–Throat outpatient facilities: The development and analysis of a questionnaire

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear–Nose–Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents’ overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors’ attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents’ satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality.