The Perception of Organizational Issues of Social Work Practitioners in Saudi Hospitals

ABSTRACT

Health care has evolved rapidly in Saudi Arabia, based upon a Western model of service that incorporates multidisciplinary professional teams. Social work practice forms part of patient care. This study explores how Saudi social workers perceive their role and how they describe their practice within the hospital context. A quantitative methodology was employed using a self-administered questionnaire. Analysis revealed that 219 social workers perceived formidable limitations to their daily work practice. The study identified factors relating to the hospital's organizational circumstances where a) organizational structural aspects, b) organizational resources, and c) hospital management and interprofessional teamwork impacted best practice. Future research and recommendations for further study are outlined.     

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Abstract

Social work practice in a psychiatric emergency department presents a unique set of professional and personal challenges for the clinician. This article presents an individual account of practice within this setting and within a larger system of mental health care which is overwhelmed by individual and societal needs and limited provider options. The personal and professional challenges which arise in response to crisis work with chronic populations is discussed.     

Is “humane managed care” an oxymoron? (Essay Review)

Abstract

Though the impact of managed care on clinical social work practice and education has been widely acknowledged and critiqued, Humane Managed Care? edited by Schamess and Lightburn, represents a compendium of papers addressing all aspects of the recent phenomena and its impact on practitioners, educators, and most especially our clients. In reviewing this impressive and comprehensive volume, this paper addresses many of the most controversial and painful aspects of the “Managed Care Revolution,” including its impact on the level of clinical practice and its economic and political ramifications. It is suggested that the editors and some of the authors are less hopeful about the possibility of providing “humane” treatment in the managed care environment than they were only a few years earlier, as indicated by a comparison of this volume with the 1996 special edition of Smith College Studies in Social Work. This article also critiques some of the anthology's chapters, which suggest that the changes in health care delivery will ultimately be beneficial to clinical social workers.

Essay Review: Humane Managed Care? Gerald Schamess, M.S.S. & Anita Lightburn, Ph.D. (Eds.). (Washington, DC: NASW Press, 1998.)     

Professional Dissonance

Abstract

Social workers in mental health face a complex climate where they encounter value-laden intervention choices daily. Examples of these choices may include deciding to initiate treatment in spite of a client's wishes to the contrary, making a decision to break confidentiality, feeling pressured to diagnose a client with a reimbursable condition despite a treatment philosophy that may be to the contrary, or feeling the need to “pick and choose” therapy topics in light of severe shortages in benefit coverage. These and other scenarios put social work clinicians at risk for professional dissonance or what has been called a feeling of discomfort arising from the conflict between professional values and expected or required job tasks. The current article explores professional dissonance as a pertinent concept for social work in general, and mental health social work in particular. The theory base of the concept is explored as well as its utility for understanding burn-out in a deeper way.     

Differences by Race in Social Work Students’ Social Distancing,Treatment Options,and Perceptions of Causes of Mental Illness

ABSTRACT

Research has shown that racial and cultural differences are related to the degree of social distancing associated with mental illness, beliefs about what causes mental illness, and what treatment options are best; however, there is little information on how this may manifest in social workers’ perceptions of these issues. This cross-sectional survey analyzed the differences in perceptions by race of 835 students enrolled in social work classes in the United States. Results indicated that individuals who self-identify as African American/Black expressed the greatest social distance concerning mental illness. Whites were most likely to endorse the use of medication and were least likely to normalize mental illness. The most frequently endorsed mental health provider varied according to racial/ethnic groups. Our findings show that future research may be needed to further investigate the conceptualization of the role of social work among different groups. The need for self-reflection and keeping biases in check are discussed as implications for social work practice and education. Suggestions for working with diverse clients, including religious diversity, are offered as well.     

On the Value and Meaning of Trauma-Informed Practice: Honoring Safety,Complexity, and Relationship

ABSTRACT

In social work, as in other mental health fields, there has been a surge of literature regarding trauma-informed practice. Even so, the value and meaning of being a trauma-informed practitioner still call for further explication and analysis, especially in the realm of clinical social work practice. Approaching and engaging traumatized clients with a trauma-informed lens carry profound implications in the assessment, diagnostic, and intervention stages of treatment, and these implications warrant further unpacking. Additionally, it is critical to explore, through real-world case examples, the significance of working with a trauma-informed lens. This article develops a stage-based, relational definition of trauma-informed practice and argues that trauma-informed practice prioritizes client complexity, social context, and the therapeutic relationship throughout the assessment, diagnostic, and treatment process. In addition, it prioritizes the nuanced experiences and needs of the client, in particular the need for safety, above specific treatment modalities. In this way, it has vital importance to the field of social work. The significance of being trauma informed is considered at all stages of treatment and will be illuminated through practice examples and a longer clinical vignette.     

Pre–Post Release Health in US Adult Male Convicts

Abstract

This study sought to determine whether need for healthcare and reported health status among adult men (N?=?1,113) in US Federal prisons (in 12 states) changed from pre-release to 15?months after release by analyzing data collected by the Serious and Violent Offender Reentry Initiative (SVORI). Specifically, the study was guided by three questions: (1) were there changes in treatment for specific diseases; (2) were there changes in health status, need for care, and access to and satisfaction with healthcare; and (3) did various social determinants of health predict any of the health outcomes at 15-month follow-up. The analysis of SVORI data found that men reported lower physical and mental health status and declines in receiving treatment following release, but greater satisfaction with healthcare. Further, analysis found the best predictors of health status as being satisfied with access to health care as well as employment. The greatest declines were in mental health treatment, however those ceasing treatment did not report worse physical health status, mental health scores, housing, employment, or recidivism. Future research is needed to determine the significance of the link between employment, satisfaction with access to health care, and health status among ex-prisoners.     

Social Work and End-of-Life Care

Abstract

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

Preventive therapy and resilience promotion: an evaluation of social work led skills development group work

Concerns have been expressed for some time about a decline in emphasis on therapeutic work in social work, notably articulated in the Munro Review. Further concerns have been expressed in child care that social workers have increasingly had to focus on child protection work rather than earlier stages of prevention. However, there remain opportunities for social workers through the development of new programmes. One development has been that of Behaviour and Education Support Teams: multi‐professional teams, containing as a key element social workers, and encouraging novel practices designed to help emotional stability and improved behaviour and education performance. This study reports on an evaluation of a social worker delivered school‐based social skills programme, which can contribute to the important area of resilience. This showed significant and sustained improvements in pro‐social behaviour and friendships. The implications of this for the therapeutic potential and professional role of social work are discussed.     

Intention to Leave the Profession: Welfare Social Workers Compared to Health Care and Community Social Workers in Israel

ABSTRACT

This study aimed to compare specific work related-factors (personal factor: length of work experience; structural factors: personal subjection to violence and fear of being subjected to violence; and psychological factors: professional quality of life—compassion satisfaction, burnout, and compassion fatigue) between welfare social workers (SWs) (n = 200) and health care and community SWs (n = 173). Furthermore, since the issue of turnover among SWs has important implications for the provision and programming of social services, the study also aimed to assess the relationship between these factors and SW intention to leave the profession. For the purpose of this study, online questionnaires were distributed to SWs working at social agencies and services. The findings suggest that the two categories of SWs showed a similarity with regard to the association between the personal and structural factors and intention to leave the profession. However, with regard to the psychological factors, the components of professional quality of life were found to operate differently in each category of SWs. It is suggested that future research examine other work-related factors and explore the intention to leave the profession among other social work specializations and employment sectors.     

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

ABSTRACT

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.     

Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit

Saario S, Raitakari S. Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit Int J Soc Welfare 2010: 19: 321–329 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. Mental health NGOs in Western Europe are increasingly managed by contractual audit procedures. This article concerns how contractual audit and its emphasis on effectiveness of care impact on the practices of long‐term mental health rehabilitation. To demonstrate this, a case study of a Finnish NGO that provides supported housing is presented. The study looks at how service purchasing practices, as stated in the contract between the municipality and the NGO, are reflected in the meetings among practitioners. Documentary and meeting data were utilised together with Mitchell Dean's notion of technologies of agency. It was found that practitioners actively sought to show the effectiveness of their everyday work in terms of contractual audit by demonstrating both the economic and progressive aspects of care. Thus, professional competency in mental health rehabilitation appears to entail both the skills of care interventions and the ability to perform these interventions as efficient and financially accountable activities.     

Youth and Provider Perspectives on Social Service Providers' Roles in Mental Health Services

ABSTRACT

In 1994 and 1996, the Youth Services Project interviewed 792 youths from St. Louis City. Although the youths showed a high need for mental health services (20% met diagnostic criteria), less than half of the youths with problems received services. Past contact with a social service provider, but not a teacher, physician, etc., significantly predicted care for mental health problems (odds ratio = 1.5). Social service professionals (largely social workers) served more youths than did any other profession. Of youths with persistent problems, 25% received services from social service professionals, 3% from MD/PhD level psychiatrists or psychologists, 7% from primary care medical doctors, 12% from teachers/coaches, 15% from other helpers, and 37% received no services at all.     

Inter‐agency joint protocols for safeguarding children in social care and adult mental‐health agencies: a cross‐sectional survey of practitioner experiences

Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi‐agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross‐sectional survey of practitioner self‐reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self‐complete questionnaire administered to all professionals in adult mental‐health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter‐agency working between children's social care and adult mental‐health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter‐agency collaboration.     

Cultivating students’ reflective capacity through group-based mindfulness instruction

ABSTRACT

Cultivating critically reflective practitioners is a vital professional competency for social work students. However, few reflective models support undergraduate students to foster nonconceptual skills important to developing reflective capacity. This article presents a group-taught mindfulness teaching intervention applied in a professional practice course to facilitate reflective capacity of social work students preparing for their first placement. Trial data derived from pre–post course administration of the Five Facet Mindfulness Questionnaire show significant gains in awareness were produced on two of the questionnaires’ five mindfulness facets of describe and nonjudgment. A developmental model detailing these shifts and its implications for group-based learning is outlined.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

Social Work and Child Mental Health: Psychosocial Principles in Community Practice

Correspondence to Steven Walker, Senior Lecturer, School of Community Health and Social Studies, Anglia Polytechnic University, 2nd Floor, Ashby House, Brook Street, Chelmsford, Essex CM1 1SQ, UK. E-mail: s.walker{at}apu.ac.uk Summary The increased prevalence, complexity and earlier onset of childand adolescent mental health difficulties, has prompted governmentinitiatives to reconfigure current provision for this clientgroup, their parents and the carers who try to support them.Social workers have an important part to play in respondingto the needs of these individual children and families. A residual,care management role is not adequate in these circumstances.This paper describes the development of social work in childand adolescent mental health, and suggests that a synthesisof psychosocial principles and community practice, offers theoptimum social work model of assessment and intervention. Sucha model embraces the most useful aspects of psychodynamic theoryin the context of practice consistent with anti-discriminatory,children's rights and partnership principles.