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.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Prayer and Charitable Behavior

Abstract

I propose a theoretical framework to understand how prayer influences charitable volunteering and financial giving. Drawing on work from symbolic interaction and cognitive psychology, I argue that individuals’ concepts of divine others become more cognitively accessible during the act of prayer. Because most people attribute the characteristics of omniscience and the desire for humans to help others to divine others, people are more likely to help known and unknown others the more cognitively accessible divine other concepts are to them. This lead to the prediction that frequency of prayer will be positively and linearly association with the frequency of volunteering, frequency of giving money to charity, and amount of money given to charity in a year. Using data from the General Social Survey, I find evidence for my argument. Frequency of prayer is positively and linearly associated with these charitable behaviors, even after controlling for other religiosity and sociodemographic variables.     

From pipeline to practice: Utilizing tracking mechanisms for longitudinal evaluation of physician recruitment across the health workforce continuum

PurposeArea Health Education Centers work with community partners to prepare a diverse, primary care workforce particularly among rural and underserved communities. We set out to assess our impact on the physician workforce across a multitude of short-term, intermediate, and long-term benchmarksMethodWe used a comprehensive evaluation scaffolding to assess benchmarks of success across the workforce pipeline including short-term (i.e. pre-medical intent to pursue a health career or medical students’ intent to practice in primary care), intermediate (college matriculation and primary care residency match rates) and longterm measures (licensure and medical practice location of program participants).ResultsWe identified significant findings in each part of the AHEC program continuum. Among our alumni, we found a significant increase in the pre-medical learner’s intent to pursue a health care career. Among medical students, we found a significant increase in intent to practice in primary care, rural areas, and medically underserved communities and a high rate of primary care residency match (compared to peers). Approximately one-third of licensed physicians are now practicing medicine serve in an underserved communityConclusionsOur findings confirm the value of longitudinal evaluation on confirming that participation in an AHEC supported program strengthen the physician workforce development.     

高校是培育与传播慈善文化的重要基地

为促进慈善事业的发展,需要构建适应现代慈善事业发展需要的慈善文化,而慈善文化的培育与高校有着紧密的联系。高校具有培育与传播慈善文化的责任,面对我国高校慈善文化发展过程中所出现的种种困境,比如,重视慈善文化建设的高校数量较少、高校慈善教育缺乏协调机制、高校慈善文化教育体系缺失等,因此,完善教育管理制度、增强师资队伍、加强教材建设、完善慈善课程、增加慈善实践有利于来加强慈善文化建设,促进慈善事业的发展。     

From communal charity to national welfare: Jewish orphanages in Eastern Europe before and after World War I

This article examines Jewish institutions for the care of orphans in an attempt to understand several aspects of Jewish life in Eastern Europe: (1) attitudes towards orphans on the part of communal leaders, intellectuals, and political activists; (2) the transition of Jewish charitable and (in the modern period) philanthropic institutions from the pre‐modern communal charity of the early nineteenth century to modern “scientific philanthropy” at the fin de siècle to national welfare in the interwar period; (3) and, to a lesser extent, the experiences of orphans themselves, as far as is possible to ascertain from documents relating to the institutions that cared for them. Marginal figures such as orphans were of growing concern to the organised Jewish community in its increasingly complex encounter with modernity in the Russian Empire, and traditional patterns of charity, family life, and relations between socioeconomic classes were cast into doubt by new government policies and modern scientific attitudes arriving from Western and Central Europe. The religiously mandated charity of the pre‐modern kehillah gave way to a paternalistic philanthropy that aimed to mould a generation of “productive” working‐class Jews. However, the upheavals of World War I and the mass politicisation of East European Jewry brought about a transformation in attitudes towards orphans and other marginal groups, whose care was made a centrepiece of national, and nationally minded, Jewish communal life in the interwar Polish Republic.     

Towards Customized Deliberations

ABSTRACT

The profession of social work has important contributions to make in the rapidly developing dialog about medical care decision making and to the evolution of hospitals as systems that engage with people as patients, for whom illnesses create increased vulnerability (Gruber, 1998). Professional ethics clearly states that the individual professional social worker has a responsibility to influence processes involving vulnerable populations. Articulating social work's responsibility and potential contributions in the area of medical care decision making begins with an application of social work's mission and values, and then continues with consideration of the profession's evolving role in hospitals. Pertinent aspects of the health care industry, including current models for continuum of care and for provider-patient relationships, are discussed in terms of opportunities to modify the models used to guide interactions with patients. Finally, the impact of a growing number of distinct treatment options is also considered. The objective of the article is to offer social workers in health care settings a conceptual framework for considering professional ethical obligations and for participating in the contemporary dialog regarding medical care decision-making.     

Meaning as outcome: Understanding the complexity of decision-making around residential placement in aged care

Abstract

Changes in aged care and health policy have introduced an increasingly complex assessment, resource option, and economic and regulatory context for decision-making regarding relocation to residential care. This paper reports on a study exploring residential placement from the perspective of spouses who place a long-term partner in an aged care facility. It highlights the importance of understanding the meaning of such decision-making for the spouse who remains at home and explores the ways in which the placement is constructed as either a continuation of, or a refusal to, care for a long-term partner. The paper draws out the implications for social work practice and identifies the challenge to merge knowledge of resource packages, care options and financial arrangements with a concern with the processes of decision-making and the emotional and symbolic aspects of such decisions.     

An Editorial Planning for Health Services

Abstract

The field of administration and management has undergone a steady evolution since its origin at the turn of the century. A perspective regarding that development is useful to the health service administrator. This paper examines and interprets selected writings in administration and management. The appropriateness of this open-communication model to medical settings is demonstrated and the application of this model to a specific student health service is described and discussed.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

Letters

Abstract

Approximately 500,000 children were institutionalised in Australian orphanages and other forms of children's Homes over the course of the 20th century. However, growing up in care is not just a part of childhood; it can have ongoing impact across a person's life. Access to records can be a very important way in which people who grew up in institutional care construct the story of their lives, contributing to their self-identity, and also find out practical information, such as their exact date of birth and medical history. The present article takes as its starting point a recommendation of the third of the Australian Government reports concerned with the institutionalisation of Australian children—Forgotten Australians—and draws on interviews with former residents of children's Homes aged between 42 and 76 years to examine their access to records in Australia. We discuss a case study, the unique Heritage Information Service at MacKillop Family Services, which supports former residents to access their records, and consider the implications for good practice of agencies working in this area.     

Recovery,Managed Care,and the Reflective Practitioner

ABSTRACT

Conflicting priorities between the recovery movement among consumers of mental health services and managed behavioral health care planners result in turbulence and ambiguity in the service delivery system. Based upon information from both published and unpublished written sources, areas of strain are described. The utility of a reflective practice model, as conceptualized by Schon (1983), for addressing a recovery vision within a managed care environment is explored.     

A Concealed Wrongdoing of Corporate Philanthropy: Evidence from China

The paper is trying to examine the changes between rational and irrational charitable donation of Chinese listed corporations under the background that an increasing number of Chinese listed corporations register charity foundations in recent years. Considering corporate income tax ratio as a proxy for tax preference, whether products are exposed to consumers directly or indirectly, as well as gross profit margin, debt financing scale and debt maturity structure as proxies for the reputation effect and strategic advantage, the indicators of rational charitable donation consist of the five factors mentioned above; The indicator of irrational charitable donation is disposal accrued profits calculated by Extended Jones Model. By the regression of data of charitable donations from Chinese A listed corporations during the year from 2008 to 2013, findings show that the behavior of rational charitable donation is weakened gradually, while, in contrast, the irrational charitable donation is strengthened. The listed corporations have strong motivation to transfer profits through registering and establishing charity foundations, which is a new tendency of transferring interests.     

WEB SITES

Abstract

It would be useful to better understand the personal determinants of successful interventions in the community, especially those interventions already recognized for their efficacy and efficiency, such as elder home care telesurveillance. This is a modality of health care services that transmits, via a call center on a 24/7 basis, the clinical information necessary to follow elders outside medical centers. Community health workers refer elders to this service. A qualitative research design was realized to understand why so much difference in the implementation of this service had arisen in two comparable sites previously judged receptive. The research objectives were as follows: (1) to document the personal determinants associated with telesurveillance adoption by community health workers, in two sites previously judged receptive; and (2) to point out the personal determinants that can explain successful adoption of telesurveillance. According to the Theory of Interpersonal Behavior, the results showed that habits (e.g., community health workers' knowledge of new information technologies) and perceived barriers in clinical practice were fundamental determinants in the adoption of telesurveillance.     

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series–Depression (CBS-D) Project

Abstract

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to identify, treat, and track depressed students for 12 weeks to monitor predetermined process and clinical outcomes. Results: Of all students receiving primary medical care services between January 2007 and May 2008, 69% (n = 71,908) were screened for depression. A total of 801 depressed students were treated and tracked; most predetermined treatment process and clinical outcome targets were achieved. Conclusion: The CCM for depression shows promise for improving depression identification and care for college students.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Medical rationalization, cultural lag, and the malpractice crisis

The theses of this paper are that (1) the practice of medicine has become more formally rationalized in the past century; (2) this rationalization process has been retarded by the professional aspects of medical practice, e.g., the service ethic and the medical profession's exclusive jurisdiction over medicine; (3) this retardation is evident in cultural lag between the development of medical knowledge and how medicine is practiced; and (4) the "malpractice crisis" is a particular force which is accelerating the rationalization process and is overcoming lag. Data from physician surveys and interviews are presented which show the utility of a rationalization-cultural lag model in generating a number of substantive questions pertinent to the quality of rationalized medical care.     

Children with Special Health Care Needs

Abstract

The health care model presented in this paper is a non-linear, systems approach to service delivery. The model was a by-product of three ethnic-specific conferences that were convened to discuss strategies for improving access to care and the quality of services provided to children with special health care needs (CSHCN) from diverse cultural backgrounds. The model evolved as insights regarding the common values and norms held by parents, health care providers, and cultural representatives were shared. Content analysis was used to identify core themes identified by participants. These themes were incorporated into a model that included the following elements: community-based, culturally competent, health-oriented, resiliency-focused, and family-centered care. At the fourth Consensus Conference, selected participants from the previous ethnic specific conferences reviewed the proposed model and deemed it a vehicle for facilitating health care service utilization by culturally and linguistically diverse CSHCN and their families.     

Consumer Participation: Case Study of the College Health Services Setting

Abstract

Nurses, functioning in expanded roles, have created uneasiness in some circles, particularly medicine. Will these new roles for nurses be competitive or collaborative? It is the thesis of the author that the nurse's new expanded role, which is fast becoming the norm, will be collaborative if there is 1) adequate understanding between the disciplines of nursing and medicine of their respective characteristics and range of activities, and if there is clarification of organizational, financial and certification issues; 2) adequate differentiation between the definitions of health and medical needs; 3) adequate attention and resources are given to prevention of disease and disability and promotion of health in a world dominated by medicine and episodic care; 4) organization and financing of health services that accommodate the utilization of nurses in expanded roles; 5) nurses who prepare themselves scientifically, humanistically, and politically for the type and kind of practitioner that society needs; and if 6) certification of individuals and accreditation of educational programs are controlled by the respective professional group.

However, if the expansion of nursing practice is not recognized, reimbursed, and rewarded appropriately, there will be interprofessional competition for patients or clients, for funds, and for political power.