Information Technology in the Care of the Mentally Handicapped

Summary

The use of information technology has reached the professional care for mentally handicapped. Students in schools of social work in the Netherlands will use a prototype of a care information system, learning to appreciate these applications for planning and evaluating the care process. Curriculum material will be developed according to the Dutch ‘National’ Curriculum Computer Applications for schools of social work.     

Home Is Where the Help Is

Abstract

Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skævinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.     

The New Orleans Patient Tracking System (PTS)

SUMMARY

The New Orleans Patient Tracking System is a software system on an INFORMIX platform which operates in a UNIX environment on dual Data General file servers. The system networks 15 alcohol and drag treatment service delivery units and four central intake units, two of which are located in criminal justice agencies. These agencies are linked through a wide area network based on primary rate interface and integrated system digital network communications technology. This management information system supports centralized intake, standardized assessment, slot management, patient-program matching, patient tracking and self-corrective program evaluation for the network of drug treatment providers. These system features are discussed in detail.     

The Patient Transit Assistance Scheme: A case for social work advocacy!

Abstract

The Patient Transit Assistance Scheme is one of Queensland Health's initiatives designed to facilitate equity of access for Queensland residents to essential health care services. The purpose of the scheme is to help all Queenslanders, irrespective of where they live, to have access to specialist medical services. It provides direct financial assistance to patients and in some cases their carers, to facilitate access to specialist medical services irrespective of geographic location.

The findings of recent research conducted on social worker involvement with PTAS for patients diagnosed with leukaemia and associated haematological disorders will be used to argue that the problems in relation to the administration of this scheme require serious attention at the level of patient care and health policy.     

Care Coordination of Services for People Living with HIV: A Case Study of a Rural Clinic

Abstract

The healthcare landscape is changing with the development of integrated health care models across the country. Counseling is uniquely positioned to add to the continuum of services of integrated health by providing counseling and case management services through advocacy for clients. One particular chronic illness that remains highly stigmatized is HIV, which is slowly becoming more integrated into the larger healthcare system. This pilot study documents the process and experience of a hospital-based midwestern AIDS service organization in the development of innovative and unique services to address the needs of the HIV population in a rural midwestern state.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

Integrating Services for Older People in Aging Communities in The Netherlands: A Comparison of Urban and Rural Approaches

ABSTRACT

The aim of this article is to discuss approaches to services integration for older people in urban and rural aging environments in The Netherlands, and the preliminary effects of these approaches on local aging conditions. In urban areas, services integration revolves around the creation of functional spatial hierarchy. In rural areas, the emphasis is on forging links between service providers. Outcomes for health and use of professional care services are similar. Out-comes for housing, informal care, and accessibility of services differ between urban and rural areas in ways that can be traced back to local aging conditions and elements of the specific approach to services integration used. In both urban and rural areas, much more could be done to connect formal programs to the lifeworlds of older dwellers.     

Teaching Information Technology to Human Service Students

Summary

This article specifies the knowledge and skills needed by human service professionals in order to utilize the potential of information technology for better care delivery. The conceptual foundation proposes an integrative approach that views management, case management and treatment as one integrated process in the human service agencies and which must be reflected in the information system design. A course for graduate students that incorporates this concept was developed in two schools of social work during a three-year period and is presented in details.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Structuring Home-Based Therapy: Four Phases to Effective Treatment

ABSTRACT

Home-based services are gaining more popularity than in years past. Therapists going into the home are exposed to various treatment issues that differ from those in a clinic or office setting. One of these issues is that of structuring the therapeutic process. Much has been written about the structure and stages of clinic-based therapy; however, little is known about the process of home-based therapy. This paper will delineate four phases of home-based therapy which the in-home therapist can use as a guide to provide faster and more effective services.     

The impact of para-professional social workers and community health care workers in Côte d'Ivoire: Contributions to the protection and social support of vulnerable children in a resource poor country

BackgroundResearch indicates a disproportionate impact of HIV and AIDS in sub-Saharan African countries, leading to many vulnerable families and children. Many of these communities have limited resources to support these vulnerable families, especially orphans and vulnerable children (OVC).Study aims and objectiveThis study set out to investigate how para-professional social workers and community health workers (PSWCHW) impact the provision of services and the psychosocial wellbeing and protection of vulnerable children in the community.MethodsThis quasi-experimental research study used data from an independent Save the Children program evaluation study in Côte d'Ivoire. We compared the health and psychosocial wellbeing of identified vulnerable children supported by para-professionals (n = 334) and children not receiving para-professional support (n = 213).FindingsSupport services and activities provided by PSWCHW included encouraging the children to be part of psychosocial support groups. Many of the children reported legal issues that ranged from getting a birth certificate issued to fighting or quarrelling with adults, disputes, public insults, beatings, and refusing to go to school. We found that the engagement of PSWCHW helped three out of four children go to school (compared to only one in four of the children without PSWCHW). PSWCHW also helped the children improve access to health care services.ConclusionsCommunities in sub-Saharan Africa should continue to consider the integrated utilization of para-professional social workers and community health care workers to support and improve psychosocial wellbeing of orphaned and vulnerable children which, in turn, enhances child protection services and access to healthcare.     

Meeting the needs of adolescents living with HIV through home based care: Lessons learned from Tanzania

PurposeHome based care is central to HIV care and support throughout Africa. Most programs have not addressed the unique needs of adolescents living with HIV, who display lower retention in HIV care and treatment adherence. This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs.MethodsWe conducted a qualitative study in Dar es Salaam and Tanga Region consisting of in-depth interviews with 14 adolescents living with HIV, 10 primary caregivers, and 12 providers assigned to their households. Interviews examined adolescents' experiences of growing up with HIV, perceptions of current home based care, and challenges in increasing acceptability of services.ResultsWe found the program did not align well with adolescents' expectations. Adolescents felt home based care to be more relevant to their caregivers and did not form independent relationships with providers. They expressed anxiety that participation might lead to inadvertent disclosure of their status and consequent discrimination. Both adolescents and their caregivers felt disappointment that no material or financial support was available despite widespread poverty, although they appreciated receiving psychosocial support and practical referrals. Providers demonstrated motivation to work with adolescents but acknowledged lacking requisite skills such as ways to communicate with young people and key messages to deliver.ConclusionsDespite challenges, we identified feasible adaptations to make home based care more adolescent-centered. These include actively engaging adolescents in program design, improving provider training in communication with adolescents, and proactively addressing unrealistic expectations. Finally, increasing referral links to a wider range of services could improve program effectiveness by integrating it into a broader development approach.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Social services,social work,and information management: Some european perspectives

Social services are entering the information society. Over the past decades, information technology applications have slowly permeated service agencies. Although originally the domain of administrative and management staff, now core operational staff are also confronted with making increased use of technology. The way information management in human services is shaped is not only dependent upon technology, but increasingly seems to result from an interaction between social policy developments and information technology opportunities. Similarly, social policy developments are shaped by the existing information management infrastructure. One of the purposes of this paper is to explore–taking social services and social work as the exemplar, and mainly drawing upon experiences from the UK and the Netherlands–the relationship between new technology and the policy environment. We also reflect on whether or not this relationship is more complex than indicated by globalization and related post-Fordist theories.     

Vertical Axes on the Long-Term Care Continuum

Abstract

As the continuum of long-term care has expanded, public funding has not accompanied new care options. I detail access, provider profits and resources, and care quality in two types of residential care that fall in the center of the continuum, assisted living and board and care. These two options provide examples of how limited public funding leads to vertical axes, which represent access to services, the resources providers draw on to give care, and the quality of long-term care services, at each service point on the long-term care continuum.     

Belgium and the Netherlands: Two Different Ways of Coping with the Housing Crisis, 1945–70

ABSTRACT

Belgium and the Netherlands are very different in their spatial outlook and in the way housing is organized. In Belgium individual private dwellings predominate whereas in the Netherlands social housing and planned neighborhoods are much more common. This article aims at unraveling the histories and sensibilities that led to this situation. It argues that the well-known diverging histories of architecture and urbanism make up only one explanation, which needs to be complemented by understanding the different processes of mediation between producers and consumers adopted by both countries. In tackling the postwar housing crisis, Belgium chose to stimulate private initiative by providing tax incentives for home builders. The Netherlands, on the other, hand mitigated the housing crisis by planning new estates of social housing, using new techniques of prefabrication that led to standardized flats. In the Netherlands the process of mediation, oriented towards “correct living,” was dominated by a national organization, which resolutely advocated modernist design as the most rational way to organize the home. In Belgium the task of mediation was taken up by “pillarized” social organizations rather than by a national institution. This resulted in a much stronger bottom-up influence from ordinary dwellers, who convinced their organizations to soften the modernist approach in favor of more traditionally inspired homes and interiors. The Belgian way of organizing home cultures thus came to resemble much more an “American way of living” than its Dutch counterpart—contradicting the prevailing literature that tends to stress the Americanization of Dutch culture while ignoring such patterns in Belgium.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

The intersection of home study assessments and child specific recruitment: the performance of home studies in practice

Child specific recruitment efforts are designed to facilitate permanent placements for children in foster care by finding them potential adoptive families among people already known to the child. This process relies heavily on gathering thorough and accurate information about prospective families, and much of this information is often contained in families’ home study assessments. Yet, little is known in the research literature about the way that home studies operate in conjunction with the recruitment of adoptive families. The purpose of this study is to explore how home studies are perceived and used in the context of child specific recruitment. Findings suggest that home studies perform best in gathering general family information, but poorly in capturing sensitive information, which may be one of the most critical dimensions to capture. These findings highlight important practice changes needed in current adoption practice.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.