More Nuanced Universal Services for New Parents: Avoiding Assumptions of Homogeneity

Abstract

Universal services focus on prevention and providing the support to parents that will help them meet the challenges of parenthood and deal with problems before they become entrenched. Many countries now have good universal services available for new families, and significant advances have been made in recent years to recognize the importance of the early years in the optimal development of the child. This article is based on a qualitative study of transition to parenthood. The study explored the experience of 25 first-time mothers in socioeconomically diverse circumstances in New Zealand. Eleven partners of these women also participated. Mothers were interviewed three times, first in late pregnancy, then 3 and 12?months after giving birth. Partners were interviewed once, mid-way through the baby’s first year. The article focuses on how participants experienced service support. It illustrates some of the diverse needs of new parents, and explains ways in which prevention services might become more responsive to parents’ expressed needs. The authors offer a case for stronger interplay between universal services and informal systems of support, and the development of a new generation of universal services that act as enablers of natural support hubs for new families within their own communities.     

Intimate Partner Violence Survivors’ Unmet Social Service Needs

ABSTRACT

Women who have experienced intimate partner violence (IPV) victimization are at risk for physical and mental health problems, as well as social and economic challenges. In this cross-sectional study, 173 adult, English-speaking women who had experienced police response to IPV completed a self-report questionnaire about their use of, interest in, and need for various social services and whether or not each type of service helped (or would help) them to feel safer. More than three quarters of the participants reported a current need for health and economic support services. There was less interest in traditional IPV resources: law enforcement and domestic violence counseling or shelter. Expanding services to meet survivors’ needs for health care and economic independence may facilitate long-term safety. Recommendations for further research in this area are provided.     

Quality attributes of home help services in Sweden and Canada – a consumer view

The ranking pattern of quality attributes among the respondents of the sample from Canada was very different from those comprising the sample from Sweden. Both samples were drawn from city populations and some similarities were expected. In Sweden, continuity and personal suitability (personal qualities and professional competence) were the most important general quality attributes followed by personal relationship, times/availability and influence. The Canadian sample ranked personal suitability and the time/availability variables as the most important quality attributes followed by influence, continuity and personal relationship. Background factors linked to each sample appeared to affect the ranking pattern. In the Swedish sample, the ranking pattern was affected mainly by the same independent background variable, while in the Canadian sample the ranking pattern was a little more diversified. There were also differences in the satisfaction arising from home help services received by the two samples. The Swedish sample generally experienced a higher level of satisfaction for individual attributes of home help, but overall satisfaction with the home helper and the home services were similar, with both groups being "rather to very satisfied". Good subjective health in the Swedish group was significantly related to positive overall judgment of the home help. In the Canadian population, high age and low charge for the home help services were significantly related to positive evaluation of the home help. The policy implications of the results for the future are discussed.     

Challenges to and Strategies for Formal Service Utilization among Caregivers in an Underserved Community

Family caregivers face enormous challenges when attempting to oversee the medical, legal, financial, and daily affairs of loved ones with chronic or life-limiting illness. While formal services and agencies exist to assist caregivers with some of these tasks, caregivers in underserved communities do not utilize these services, or utilize them with unsatisfactory results. This study used focus groups (N = 5 groups) with underserved, minority caregivers (N = 22) to explore their experiences related to care provision, including barriers to support service use and challenges navigating systems related to the broad spectrum of caregiving demands. Thematic content analysis revealed three main themes: (1) prior difficulties with formal service use, (2) difficulties navigating financial, legal, and medical systems, and (3) caregivers’ personal strategies to address challenges associated with formal service use and systems navigation. Findings from this study identify underserved caregivers’ challenges in utilizing formal services, as well as caregiver-identified strategies for supporting their caregiving activities.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences

The sexual health problems experienced by homeless youth bring into question their use of available sexual health services. Using a qualitative typological analysis, this study aims to identify sexual health services utilization profiles for homeless youth, and to understand the role of the homeless experience on the utilization of sexual health services. Individual interviews were conducted with 33 homeless youth (17 men, 16 women) between 18 and 25?years of age. Typological analysis identified four profiles: (1) a targeted use of sexual health services to determine one’s serological status following a relational change during the homeless experience; (2) a limited use of sexual health services to manage sexual emergencies that arise during the homeless experience; (3) a regular use of sexual health services to avoid the risks associated with the homeless experience; (4) a frequent use of sexual health services to obtain support when engaging in prostitution during the homeless experience. This study shows that the precarious and unstable conditions within the homeless experience incite youth to utilize sexual health services in different ways. These findings point to the importance of rethinking sexual health services to better adapt them to the different utilization profiles of homeless youth.     

A Comparative Discussion of the Gendered Implications of Cash-for-Care Schemes: Markets, Independence and Social Citizenship in Crisis?

There are moves across many countries away from state-led provision of services for disabled people towards cash-based systems, which have been welcomed by disabled people as increasing choice and control over services and support, and increasing independence and social participation. However, feminist scholars have long warned about the implications of commodifying care for women, and the possible consequences of substituting cash for services for social citizenship have remained underexplored, for both disabled people generally, disabled women and mothers more particularly, and for personal assistants/care workers. This article will attempt to address that gap by carrying out a comparative literature review and policy analysis of the role of policy development and outcomes in cash-for-care schemes, looking comparatively across policy developments in several countries, as well as developed welfare states beyond Europe to examine: (a) the impact of the tensions between various governance levels, particularly local and national government; (b) the gendered impact of such policies on (for example) gendered divisions of paid and unpaid work, citizenship and social participation; (c) the impact such policies have, or are likely to have, on different groups of men and women across the life course and across different social and economic groups; and (d) how such policies can contribute to the well-being and/or detriment of different groups of women (and men) within different social, political, economic and historical contexts.     

The Older Woman:

Interviews were conducted with 302 elderly persons residing in two ethnic urban communities to determine their problems as well as their needs for diverse community services. Sex and living arrangements were found to be critical mediators of the demand for and use of various services. A greater proportion of women than men (particularly women living alone) reported needs for household, self-maintenance, and community services. Older women living alone were also more likely to report that they had experienced neighborhood problems. Implications for designing community-based services to better meet the needs of older persons in diverse living situations are discussed.     

Treatment Barriers to Social and Health Care Services from the Standpoint of Female Substance Users in Finland

Abstract

This qualitative study discusses barriers affecting female substance user’s treatment access to welfare services. The study consisted of seven group discussions and three individual meetings with 13 women in Helsinki, Finland. Institutional ethnography was used as the theoretical framework for the study. The research questions are: (a) What treatment barriers do women face?, (b) What reasons are there for them not receiving services?, and (c) How do the ruling relations coordinate women’s experiences? Women faced multiple barriers affecting their access to services. They could be interpreted as being: determined by the service system, such as a difficulty in meeting the various criteria in order to be granted access to services; determined by the lack of trust; or determined by personal choices. The study suggests that the service system should be organized according to the needs of the service users. Future research is needed to address the questions such as how social and health care services could better co-operate, and how the different sectors of the service system could break down the institutional barriers.     

Informal care in farming families in Northern Ireland: some considerations for social work

Summary This paper is the result of a study of the dynamics of care-givingwithin farming families in Northern Ireland. It is argued thatwhilst much is known about informal care, existing knowledgeis largely urban based and quantitative, and therefore limited.Following in-depth interviews with 'farm wives' it is concludedthat for these women care-giving patterns are dependent on aparticular set of cultural expectations and norms. Within farmingfamilies there is much resistance to becoming involved withformal social services. Outside help with the care of one'selderly relatives is often seen as an admission of failure,as there is a pride in being able to look after one's familymembers. Users of social services, which still evoke associationswith the Poor Law, are highly stigmatized. It is claimed thatfor these women the concept of 'carer' has no bearing on theirlives and is not something to which they can relate. The paperchallenges the depiction of caring as a one-sided difficultrelationship where the person being cared for is a passive recipient.It is suggested that caring is not necessarily oppressive butmay be rewarding and positive. It concludes that if social workersare to support and facilitate informal care they must be awareof and fully understand the diversity of care provision andthe different contexts in which care is undertaken. If interventionis to take place then it must be sensitive to the deeply embeddedideas and perceptions that exist within farming families.     

In Their Own Words: Elders' Reactions to Vision Loss

Understanding how persons over 70 years of age cope with the stresses of living is of central interest to gerontologists, service providers and policy makers. Their family life has been studied as an indicator of quality of life. Frequently there has been an implicit assumption that the family is, or should be, a sufficient informal resource system. In 1987-88, 520 elderly persons living in Vancouver were interviewed in their homes regarding their general and dental health and support systems. Information was obtained on interaction with family, friends, neighbors and formal caregivers. To determine respondents' appraisal of her/his social resources, they were asked to whom respondents' would turn if she had problems. To establish reciprocity, they were asked who would turn to them for help with the same problems. Significant differences by gender and marital status are found as to whom one perceives to be available to meet personal care, instrumental and emotional needs. Expected reciprocity is low except for instrumental needs with neighbors and emotional needs with friends.     

Revitalizing the Vision in Supervision: Supporting the Supervisor in Home-Based Therapy Programs

Home-based programs provide a growing number of mental health and case-management services to high-risk children, adolescents, and their families. The clinical service providers who work directly with these children and families have varying degrees of education and practice experience as well as a range of different supervisory needs. Because of the daily challenges service providers face, they require support from competent, available supervisors. The professionals who supervise them often assume that responsibility with limited, if any, training in providing supervision. New and experienced supervisors alike often find themselves in positions for which they are ill prepared, without suitable training or administrative support. This article describes a supervision seminar developed for supervisors who supervise the clinicians who provide home-based services. The seminar provides training, support, consultation, and other forms of assistance to help supervisors adapt their clinical skills for use in their supervisory roles.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

Short breaks for families caring for a disabled child with complex health needs

Data from two research studies concerned with disabled children who have complex health needs were analysed in relation to families' experiences of accessing short breaks (respite) services. Many families experience serious problems finding suitable services which can cater for both their child's complex health needs and their own need for significant levels of support. This paper highlights which services families were using and the difficulties of obtaining a coherent and consistent package of support. Regulatory concerns relating to the piece-meal provision of services and use of children's hospices are raised along with recommendations for improving policy and practice.     

Caring for the Elderly Widowed--the Burden on their Supporters

Summary This paper examines how caring for elderly widowed people affectsthe lives of their ‘familiars’. This study is partof a larger national study on widowhood in old age carried outby the Institute for Social Studies in Medical Care. The familiarstended to be the children of the widowed, particularly theirdaughters. Children of the widowed, again often daughters, weremore likely than other familiars to suffer life restrictionsbefore and after the death because of the care and support givento the deceased and the surviving spouse. In addition to theircaring role familiars were often committed to full or part-timeemployment and most also had their own families to support.The care they provide for the elderly is not always withoutcost. The contribution towards community care given by suchinformal helpers deserves greater recognition and the social,psychological and financial costs thus incurred merit greaterrelief. As the help is needed by a minority only of such informalcarers, adoption of a policy relieving them as far as possibleof the costs they incur, would not involve intolerable financialoutlays.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

“We are not weak,we just experience domestic violence”—Immigrant women's experiences of encounters with service providers as a result of domestic violence

Domestic violence continues to be a serious social problem and represents a challenge for those who are exposed to it and those in public services. In Norway, a variety of services are provided to help victims of domestic violence and improve knowledge among professionals who meet with adults and children exposed to domestic violence. Studies in Norway show that families with immigrant backgrounds are overrepresented among social service users as a result of domestic violence. However, contextualized knowledge to provide background information about this overrepresentation is limited. This paper explores women's need for support and their experience with service providers when faced with difficult and unpredictable situations, namely, escaping from violence and leaving home with no financial resources or limited supportive network and turning to service providers for support. Qualitative interviews were conducted with 18 women who were staying in or were in touch with shelters with their children or alone. Five central themes emerged in the analysis of these interviews: (a) help becoming a burden; (b) timely economic measures; (c) economic support and domestic violence; (d) displaced focus; and (e) flexibility and the victim's background.     

Addressing the vision challenges of residents at a retirement community: collaborative research with a community partner

Staff members at a community retirement village were concerned about the demise of a support group for residents with vision loss, and requested help developing effective services for residents with vision challenges. This study explored past barriers to support group participation, as they were perceived by residents, family members, and employees. The community partner worked collaboratively with the researcher in all phases of the study. Questionnaires were designed to elicit demographic data, diagnosed vision problems, level of adjustment to vision loss, well-being, and motivation for attending institutional programs about vision challenges. Residents responded to standardized vision and depression scales; qualitative questions were posed to all 3 groups concerning motivations for resident participation in program activities. Results indicated that, although many residents had diagnosed vision conditions, they were, in general, coping well with vision loss and did not report depressive symptoms. Participants considered ongoing personal contact and follow-up, a group design that offered the choice of educational presentations and/or process discussions, and individualized assistance with practical challenges to be critical to an effective program. This case study, utilizing a collaborative research process, generated requests for expanded social work services and an increased valuing of the social work role.     

Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes.     

The Day-to-Day Reality of Delivering Shelter Services to Women Exposed to Intimate Partner Violence in the Context of System and Policy Demands

ABSTRACT

Intimate partner violence (IPV) is the most common form of gender-based violence affecting Canadian women. Women often seek help from shelters to deal with IPV and its consequences. These shelters function within a broader context that shapes how services are delivered. This study was undertaken to better understand how structural factors including policies shape shelter service delivery and reveal systemic and structural complexities that influence those services and women's ability to rebuild their lives. This feminist qualitative study combined in-depth interviews and focus groups with 37 staff and 4 executive directors from 4 shelters in Ontario, Canada, and included critical discourse analysis of salient policy texts. The findings illuminate the complexity of the structural challenges faced by abused women and the shelters that support them. Systemic impediments were shown to determine how shelters support abused women, the obstacles women face moving forward, and the extent and availability of their options. Future research should include policy evaluation of policy written and enacted, cost analysis examining the actual costs of delivering shelter services and supporting women after leaving, examination of potential alternatives to the identified structural challenges, and investigation of system coordination of services and support for abused women.