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.     

Challenges for Studying Care After AFDC

Mandatory work and low wages after the end of AFDC may propel changes in the caregiving of children and dependent elders in single-mother families. This article suggests some challenges facing researchers who will examine care in single-mother families. Drawing on a qualitative study of care in the last years of welfare, and on social network analysis, it suggests how changes in resources, networks, and norms may affect practices of care and also make it difficult to discover the changes.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Conversations of Care: A Narrative Review of Collaborative Care Systems for Foster and Kinship Care

This paper reviews the literature on human relational factors and their impact on complex care systems for a highly vulnerable population of children and young people in out‐of‐home care (OOHC). Factors contributing to the functioning of collaborative OOHC systems are reviewed from theoretical and contextual perspectives. The authors posit that secondary traumatic stress and vicarious trauma are central to understanding the impact of relational trauma and the experience of individuals, families, teams, and the wider ecology of collaborative care systems. Given the challenges of working collaboratively across interpersonal, family, and systems boundaries to support traumatised children in OOHC, further research is required.     

Sustaining Low Pay in Aged Care Work

This article examines the ways in which employers in the Australian aged care sector justify and sustain low pay for work that is both highly skilled and in high demand. We build on a large body of feminist research that analyses why care work is devalued by showing how such devaluing is produced at the level of the organization. To do so we examine some of the specific discursive mechanisms that sustain low pay. We show that aged care employers actively reproduce a familial logic of care that represents paid aged care work as unskilled and natural for women and therefore not deserving of higher pay. We argue that in order to achieve their goals employers must develop and sustain an opposition between care as love‐centred and work as money‐centred, while upholding the notion that they provide quality care for care recipients.     

Ageing Siblings: Supporting New Care Partnerships

Through the lens of a case study of a sibling caring for an unmarried sister affected by dementia, the article explores a phenomenon of growing social importance, late life care for those ageing without a spouse, partner or adult children. The purpose of the article is to describe the experience of sibling care partnering, to highlight the needs of sibling care partnerships and discuss how the support group model can address some of the challenges faced by this population. This article addresses the caregiving sibling's experience of participating in a support group of adult children caregivers of parents with Alzheimer's. Ultimately, the article argues for the development of services geared specifically for older adult siblings caring for each other for the first time in later life.     

Chapter 3 Residential Care Facilities for the Elderly

Abstract

Residential Care Facilities for the Elderly (RCFEs), known as board and care homes, are licensed in California and many other states for non-medical care in the community. RCFEs are examined here to provide illustrative issues in the definition of types of long-term residential care. The research examines physical functioning, social supports, and course of residential placement for 109 RCFE residents (mean age 84 years). A significant portion of the residents had personal assistance needs not usually provided at the RCFE level (75% assistance with medication, 52% used walking aids, 29% assistance in bathing). Additionally, a third of the residents had restricted social supports and social activity. Residents report declines in functioning and support as reasons for moving to residential care. Length of residence in the facility (range less than a year to 15 years) was not related to physical functioning or social activity. These findings do not support “aging in place,” within the facility, as the rationale for increased need for assistance in residential care. Implications include the need to maintain the social model of residential care ample for the majority of residents while assuring the availability of a higher need for assistance of a significant portion of the residential care population.     

Building Bridges into the Community: Social Capital in a Volunteering Project for Care Leavers

Volunteering to address poor life outcomes often experienced by care leavers is emphasised in UK policy. Although volunteering is credited with the ability to generate social capital, there is limited research on the impact of volunteering on the social capital of care leavers. This article re‐examines data from an evaluation of a volunteering project for care leavers. It explores in what ways young people's participation in the project constitutes social capital. The findings support the importance of regular face‐to‐face contact and co‐production for young people to become creators of their own social capital.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Ascertaining the Perspectives of Young Children in Care: Case Studies in the Use of Reality Boxes

This article describes the use of an innovative method, reality boxes, to elicit the perspectives of children, ages four to seven years, in state care. Using examples from a broader research project based on children in Northern Ireland, which was concerned with their participation rights, the article considers how the children used the boxes to express their views. Informed by a child rights‐based approach, the article highlights the processes and practices involved and concludes by stressing the potential importance of this method, used in the context of this framework, in social work practice with young children.     

Care Diamonds and Welfare Regimes in East and South-East Asian Societies: Bridging Family and Welfare Sociology

This paper tries to bridge the micro-level analyses of social networks for "care" provision which have been conducted in the field of family sociology, and the macro-level framework on welfare mix which has been developed in the area of welfare sociology, because the options for creating social networks are given to individuals by society. A group of Asian researchers including the author have conducted comparative research on social networks for childcare and elderly care in six Asian societies, namely Korea, China, Taiwan, Thailand, Singapore, and Japan. To reexamine the results, the author draws diagrams of the care diamonds in each society for each type of care (childcare or elderly care) to show the balance between four sectors (the state, market, family and relatives, and the community) which determines the pattern of welfare mix. The most prevalent pattern in Asian societies today is the pattern with a large family and relatives sector and a large market sector. We can interpret it as a familistic welfare regime combined with liberalism. However, Japan alone shows a pattern close to pure familism because the development of the market sector is restricted by immigration policies prohibiting the employment of foreign domestic workers. Unlike other Asian societies which were exposed to the global market before the family could become a closed organization and marketization of care work took place easily, in Japan, where the modern family system had been established, both socialization and marketization of care work have stagnated.     

‘If I Had a Family,There Is No Way That I Could Afford to Work Here’: Juggling Paid and Unpaid Care Work in Social Services

Drawing on three case studies in each of Australia, New Zealand and Scotland, this article explores how care workers employed in the social services sector negotiate their unpaid care responsibilities in the context of lean work organization and low pay. For younger workers, the unrelenting demands of service provision and low pay made any long‐term commitment to working in social services unrealistic, while many female workers experienced significant stress as they bent their unpaid care responsibilities to the demands of their paid work. However, male workers, less likely to have primary caring responsibilities, appeared less troubled by the prioritizing of paid over unpaid care work and less likely to self‐exploit for the job. At the same time, there is a widespread acceptance across different national and organizational contexts that the work/family juggle is a personal responsibility rather than a structural problem caused by the demands of underfunded and overstretched organizations.     

Health care,social care or both? A qualitative explorative study of different focuses in long-term care of older people in France,Portugal and Sweden

Challenges with an ageing population are increasingly becoming a reality in the Western world. Since cognitive impairment increases with age, we can expect an increasing number of older people in need of care. The aim of this article is to describe, analyse and compare different focuses on care of older people with dementia, using examples from France, Portugal and Sweden. The questions are principally focused on the participants’ view about their tasks, the organisation of work, the professional role and cooperation with other professions. Everyday care was studied through observations and participant observations and the staff's opinion was explored by means of interviews. Twenty-two care settings for older people were included. The findings showed that France provided mainly ‘health care’, Sweden ‘social care’ and Portugal an integrated ‘health care and social care’. In a comparative perspective the Portuguese general care of older people, which focuses on integration of health care, social care and social work, also seems to provide care for older people suffering from dementia which best corresponds to the previously developed group living model.     

A Leadership Role for Social Work in the Mental Health Transition to Local Care

Current philosophy, policy, and practice involving care of persons with serious mental illnesses are reviewed, with a focus on the movement that is usually called deinstitutionalization. Past efforts and future trends are discussed within the context of public mental health systems at the state level. The paper argues for a greater leadership role for social work in providing mental health care in local communities because of the social work tradition of client empowerment, family involvement, and systems intervention.     

The Hidden Costs of Informal Elder Care

Demographic, socio-economic, and political trends throughout the developed world have contrived to make elder care an issue of utmost policy importance. They also have led to sharp reductions in health and social program expenditures. Policymakers are looking to communities to help meet growing care needs because community care is believed to be better and cheaper than institutional care. However, these beliefs become untenable when costs beyond public sector costs are considered. In fact, informal care carries a number of hidden costs that seldom are considered in health and social policy discussions. This article introduces a taxonomy of the costs of informal elder care, which can be categorized as out-of-pocket expenditures, foregone employment opportunities, unpaid labor, and emotional, physical and social well-being costs. Then, an illustration is provided regarding how the taxonomy can be applied to understanding the incidence, magnitude, and distribution of these costs among stakeholder groups. This taxonomy can help inform ongoing debate about health and social policy reform.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

Informed Consent Agreements: Standards of Care for Digital Social Work Practices

The inclusion of remote digital practices (e-mail, texting, blogging, social media) to deliver social work services raises unique ethical and legal challenges for client and practitioner. Competent care necessitates providing clients with information that would materially affect clients’ decisions whether to assume the risks, benefits, and conditions associated with e-practices. As standards of care for distance service provision have not been firmly established, social workers are duty bound to be well-informed about current laws, duties, and obligations including specific rules governing the practice of social work in the states where they deliver remote services. This article identifies distinct threats to privacy and confidentiality associated with e-practices and offers suggested content for a comprehensive informed consent policy.     

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.     

Long-Term Care Insurance in Japan

Abstract

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan? This article presents answers to these questions.