Exploratory study of the use of community treatment orders with clients of an Ontario ACT team

ABSTRACT

Community Treatment Orders (CTOs) have raised questions about coercion, lack of autonomy, and effectiveness in reducing hospitalizations and improving service users’ quality of life. This study examined the experiences of clients and clinicians when CTOs are used in combination with Assertive Community Treatment (ACT) in a recovery oriented approach. Eleven clients who were or had previously been on a CTO and eight ACT clinicians were interviewed. Although most clients had negative feelings about CTOs, some acknowledged their lives had improved. Clinicians reported that the decision to employ a CTO is sometimes debated within the team but they agreed that combining CTOs and ACT resulted in regular access to mental health supports, fewer hospitalizations and overall improvement of quality of life for their clients.     

Implementation Issues for Consumer-Directed Programs

Summary

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs “closer to the people.” Consumer-direction goes even further by placing resources directly in the hands of consumers.

Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective “dialogue” that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

Neighborhood Experiences and Community Integration

Abstract

This exploratory study examines the social interactional aspect of community integration among persons with psychiatric disabilities. Six focus groups were conducted with 18 mental health consumers in three publicly sponsored community residential programs and 11 staff members providing services to these consumers. Mental health consumers reported both positive and negative experiences in their interactions with community residents. Despite perceived differences between persons with psychiatric disabilities and their neighbors, consumers considered reciprocity and mutual accommodation to be critical for building social relationships in their communities. Mental health providers suggested that social integration can be facilitated by developing independent living and social skills, by overcoming self-stigma and institutional and homeless mindsets, and by having a supportive community of consumers.     

An Evaluation of a Community Collaboration Approach to Psychosocial Rehabilitation

ABSTRACT

This article reports on the results of a multiagency collaboration demonstration project that was designed to replicate the salient features of an exemplary practice, single-agency program of psychosocial rehabilitation for persons with serious mental illness (SMI). The community collaboration extended over two phases for 2 years and involved over 20 mental health service providers. The demonstration project itself was designed to be a replication of the Village Integrated Services Agency (Village ISA) of Long Beach, California. Additionally, this article reports the results of a rigorous evaluation of the project. The treatment group outcomes were substantially superior to all control group measures at or beyond the 0.05 level of significance. With due regard for limitations imposed by a small sample size (n = 50), the project demonstrates that the replicated model of intervention can be effectively implemented through a collaborative organizational structure involving a coalition of agency service providers.     

Confronting Cruelty

Abstract

The present article reports on a study of the attitudes and behaviour of young people towards help-seeking during times of emotional distress and, in particular, when contemplating suicide. Twent- one young people aged between 16 and 24 years, as well as six parents and 14 youth service providers who lived in ‘Subcity’, a metropolitan community, were interviewed about their understandings of youth suicide and effective interventions. Nearly all the young people, service providers and parents identified a range of barriers that impede or prevent young people from asking for help when they need it most, including issues related to trust and confidentiality, parental support and fear, stigma and perceived loss of esteem. Implications for social work practice include an emphasis on developing parenting skills and community development related to education about suicide and the provision of appropriate support services.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Implications of Welfare Reform on the Elderly

Abstract

Whereas many studies of welfare reform have focused on effects on children and families, little research has examined the implications of welfare reform for the elderly. This case study incorporates interviews with service providers for the aging, members of advocacy organizations, and two focus groups of older consumers conducted in the multi-ethnic urban community of San Francisco. Study findings suggest that welfare reform has had both direct and indirect effects on the elderly and their services in the study community. Direct effects derive primarily from changes in the welfare reform legislation that had the effect of undermining both immigrants' eligibility for and claiming of public assistance benefits. Indirect effects on older persons include increased child-care demands upon grandparents. The case study data bear on a significant policy change within the broader trend of devolution at a historical point when anti-immigrant sentiment in the United States was running high.     

The Role of Theory in the Assessment of Sex Offenders

SUMMARY

No generally accepted theory of sex offender behavior exists at this point. As clinical experience and research findings interact within an evolving theoretical framework, the picture of what is important, as well as what is possible to know about a sex offender, is rapidly changing. It is vital that mental health professionals, the legal system, social service agencies, and other consumers and providers of sex offender assessments be aware of both what is possible to learn about an offender as well as the limitations on that knowledge and its application. Prominent theories that influence the assessment of offenders in North America and Europe are presented and examined. Uses and limitations of each theory are discussed. Several trends emerge which could influence the future of sex offender assessment, treatment, management, and policy.     

Transcending Boundaries

SUMMARY

This paper presents a participatory research and planned change effort to develop a coordinated community response system to domestic violence in a United States culturally diverse community with a large immigrant population. This work grew out of an international, interdisciplinary project that was designed to establish ongoing collaborative relationships between university and community practitioners in the United States, Honduras, and Costa Rica around the theme of intra-familial violence, particularly gender-based violence against women. The paper analytically describes the international collaborative project, the local community-based participatory research and community development project, and lessons learned from both the local and international interdisciplinary collaboration. Examination of differences across disciplinary and cultural contexts generated critical reflection on the need to consider reframing domestic violence in the context of fundamental human rights, as is the case in Central America. At the same time, challenges around developing a coordinated community response, addressing inadequacies in the legal system, and implementing education and training were echoed across boundaries, demonstrating the need for continued international collaboration.     

A Science-Based Framework for Responsible Gambling: The Reno Model

As social observers increasingly identify gambling-related problems as a public health issue, key stakeholders need to join together to reduce both the incidence and prevalence of gambling-related harm in the community. This position paper describes a strategic framework that sets out principles to guide industry operators, health service and other welfare providers, interested community groups, consumers and governments and their related agencies in the adoption and implementation of responsible gambling and harm minimization initiatives.     

Older and Isolated Women and Domestic Violence Project

ABSTRACT

An innovative national research project was undertaken in Australia to identify and explore the needs of older and isolated women who live with domestic violence. Face to face interviews, focus groups, and a national phone-in were conducted, and a wealth of rich information was provided by many women from metropolitan, rural and isolated areas. Older women from indigenous, non-indigenous, and diverse language and cultural communities spoke of their experiences as well as women with varying abilities and those with mental health problems. This paper will identify the significant themes that emerged from the phone-in and will highlight the major issues identified by older women needing attention by government authorities, health professionals, and service providers. Recommendations will be made for policy development, improved service provision, and prevention strategies.     

Service users’ involvement in social work education: focus on social change projects

ABSTRACT

This article presents and analyzes four projects focusing on diverse forms of service users’ involvement in social work training and research in different countries (Israel, Italy, Slovenia and UK). It highlights the value of service user involvement (SUI) to specific social change objectives and to social work education. The conceptual framework focused on the Standpoint Theory, while methodologically participatory action research was applied, and evaluation measures were developed. Key findings, facilitators and limitations to the involvement, students’ views of it and similarities and differences among the four projects are outlined. The challenges embedded in introducing and sustaining social change objectives in a co-production framework within social work education are identified, alongside the added value of meeting them. The differentiated impact the projects had on students is highlighted as well as their significance for health and social care providers were relevant. It is encouraging that in each project SUI was positively valued. The projects indicate the wide range of SUI in the content and format of social work education, as well as its applicability cross-culturally to a range of key issues pertaining to both training and research in social work.     

The complexity of roles in community action projects: The example of the evaluation of ‘alternatives’

Evaluation of community interventions is a special form of evaluation involving many roles that are key to accomplishing both the intervention and the accompanying research. The present paper describes the roles involved in the evaluation of a community intervention (‘Alternatives’) aimed at safer use of alcohol and depressant medications by seniors.The three core roles were the community developer who provided leadership in the implementation of the project, the researcher/evaluator, and the community committee that sanctioned and facilitated the project. Other roles on the project included: the project coordinator, the nurse-interviewers who collected the survey data for the evaluation, volunteers from seniors groups, local health service providers, the media, the funders, and others on the project team who provided specific technical expertise.The paper describes the competing interests among these roles as well as conflicts that arose and how these conflicts were handled. Although specific roles are described, the types of roles and the potential for competing interests and conflict are generally relevant to community level evaluations.     

School and Community Service Providers' Perspectives on Gay,Lesbian and Questioning Bullying

ABSTRACT

Existing literature details many forms of harassment against sexual minority youth, including those behaviors that are present in schools. School and community service providers, such as counselors and psychologists, often witness first-hand the bullying that occurs in schools. Through their direct contact with sexual minority youth, they remain knowledgeable of current school environments facing these youth. Their perspectives on bullying of this population, however, are lacking. Sixteen school and community service providers participated in face-to-face, in-depth interviews regarding their perceptions and observations of general bullying and specific bullying of GLBTQI youth. The principles of grounded theory are used to analyze the data, which resulted in themes on bullying of GLQ youth. Results on these themes are presented in six main categories: Types and Locations of Bullying, Characteristics of Victims, Characteristics of Bullies, Effects of Bullying, Victim Response, and “Non-Targets.” The perspectives of the service providers give support for existing literature on the nature of bullying of sexual minority youth, and provide anecdotal information on victim approaches seen to be effective at combating or preventing sexual minority bullying.     

Reunifying Families Affected by Maternal Substance Abuse: Consumer and Service Provider Perspectives on the Obstacles and the Need for Change

ABSTRACT

This paper presents the findings of a qualitative study which examined the views of chemically dependent mothers, child welfare service providers and substance abuse service providers regarding the obstacles to family reunification and recommendations for change. Implications for practice, policy and research are discussed, with special reference to the mandates of the Adoption and Safe Families Act.     

Black–White Earnings Gap among Restaurant Servers: A Replication,Extension, and Exploration of Consumer Racial Discrimination in Tipping

There is a rich history of social science research centering on racial inequalities that continue to be observed across various markets (e.g., labor, housing, and credit markets) and social milieus. Existing research on racial discrimination in consumer markets is, however, relatively scarce and that which has been done has disproportionately focused on consumers as the victims of race‐based mistreatment. As such, we know relatively little about how consumers contribute to inequalities in their roles as perpetrators of racial discrimination. In response, in this article, we elaborate on a line of research that is only in its infancy stages of development and yet is ripe with opportunities to advance the literature on consumer racial discrimination and racial earnings inequities among tip‐dependent employees in the United States. Specifically, we analyze data derived from an exit survey of restaurant consumers (N = 394) in an attempt to replicate, extend, and further explore the recently documented effect of service providers’ race on restaurant consumers’ tipping decisions. Our results indicate that both white and black restaurant customers discriminate against black servers by tipping them less than their white co‐workers. Importantly, we find no evidence that this black tip penalty is the result of inter‐racial differences in service skills possessed by black and white servers. We conclude by delineating directions for future research in this neglected but salient area of study.