Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Older Adults Navigating Medicare: When Benefits Are Denied

Guided by Bourdieu's theory of practice and symbolic violence, this qualitative study explored experiences and perceptions of elderly beneficiaries who had been denied rehabilitation services by Medicare. In semistructured interviews, 12 beneficiaries or family members told of the physical, psychological, and financial consequences of service denial/termination. The resulting perception of Medicare was as a cumbersome, difficult to negotiate system. Findings have implications for future research on service denial and indicate the need for better communication with, and support of, consumers by health care professionals when this occurs.     

论灾后学校康复社会工作的基本原则：基于汉旺经验

汉旺学校社工站于2009年2月成立,致力于服务震后有康复需要的学生及其家长。本文是工作站康复工作的经验呈现。介绍了工作站从社会包容理念出发,以社工、康复治疗师跨专业合作为策略,以整体视角看待学生的多层面需要,并开展个别化的全人康复服务。工作站关注康复学生的环境,开展以家庭为本的支持性服务及有效的资源链接。为了巩固服务效果并让增加受益人群,工作站将服务拓展至社区,运用社区资源并开展社区教育,力求营造一个接纳、包容的社区氛围。作者期望本文可以为灾后重建社会工作有关的理论和实践问题的探索有所助益。     

Safeguarding young people through confidential advocacy services

The political agency of children and young people is gaining ascendancy as government agendas prioritize the need to listen to children. Recent guidance on inter-agency working to safeguard and promote the welfare of children and young people takes account of new research, experience, and legislation concerning abuse. In the past, children and young people have been failed by the services designed to help them, and many have been silenced through the lack of a safe space where they will be listened to and taken seriously. The development of advocacy services for children and young people has been actively encouraged by recent legislation, but many existing services tend to remain at the passive end of the advocacy continuum – advocating on behalf of rather than enabling them. This is inevitable as children continue to be marginalized in a powerful adult world. This paper examines the need for advocacy services to have clear policies of confidentiality if they are to be a credible option to young people, when services to safeguard them emphasize the importance of agencies working together and sharing information.     

The Effects of Neighborhood Variables on Needs of Social Care: A Hierarchical Multiple Regression of Senior Residents in China

Community-based elder care has become a dominant model in the world. However, the role of community-level factors in helping or hindering the individuals concerned in obtaining the needed care has not received much attention. This research aims to investigate how community-level factors, including neighborhood disadvantage, residential instability, and social service environment affect the need for instrumental, medical, and emotional services of Chinese senior residents. Employing the hierarchical multiple regression analysis, the results show that instrumental activities of daily living impairment contributed significantly to the need for instrumental, medical and emotional services. Living alone was found to be associated with the need for medical and emotional services. Objective socioeconomic status was only significantly related to the need for medical care. The type of urban community was positively associated with the need for instrumental services and was negatively related to the need for medical care. Residential instability was positively associated with of the need for instrumental services and medical care. Social service environments had heterogeneous effects on the need for social services. However, neighborhood disadvantage had no significant impact on the need for social services. Implications for future research and policy reform were also discussed.     

Different problems – same treatment. Swedish juvenile offenders in community‐based rehabilitative programmes

Ginner Hau H, Smedler A‐C. Different problems – same treatment. Swedish juvenile offenders in community‐based rehabilitative programmes Int J Soc Welfare 2011: 20: 87–96 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. Young delinquents may be regarded as children in need of rehabilitation or as offenders deserving of consequences proportional to the committed crime. The focus has increasingly been on the latter, while research shows that individual risk assessment is essential for effective rehabilitation. This study explored self‐reported history of antisocial behaviour among Swedish male offenders 15–17 years of age (n= 189) who were sentenced to participate in rehabilitative programmes conducted by local social services. Antisocial behaviour was extensive and, according to a principal component analysis, consisted of three dimensions: (i) adolescent delinquency; (ii) violence and theft; (iii) drug‐related crimes. Using cluster analysis, the participants were divided into four subgroups representing different levels and characteristics of delinquency, which explained 73 per cent of the variance in antisocial behaviour. The conclusion is that assignment to rehabilitative programmes appeared unrelated to subgroups, i.e. to risk level. Organisational obstacles to an evidence‐based practice are discussed.     

Child Welfare in England: Problems, Promises and Prospects

This paper discusses developments in child welfare services in England in recent years and, particularly, the role and contribution of research. It is shown that a more significant and coherent body of child welfare research has been developed, which has linked formally to the policy process. Research programmes in England have highlighted specific problems in three areas: first, moving away from a narrow focus on child protection to an approach that provides broader family support for children in need; second, the absence of policies relating to services for adolescents; and, lastly, problems in the delivery of residential care for young people. A major programme of reform has been introduced by the new Labour government, consistent with research messages. It is concluded that research has had an impact on the development of child welfare services in England, although influencing the structure of services, social work practice and outcomes for young people are highly complex issues.     

The role of research in drug policy in Hong Kong: highlighting life satisfaction from two longitudinal studies of drug abusers

ABSTRACT

This paper examines the role of research in the development of drug policy in Hong Kong. The upsurge of the prevalence of psychoactive drug abuse in young people since the mid-1990s had brought about a great demand for medical and social science research on psychoactive drugs and users. Among a large number of Beat Drugs Fund-funded projects, two longitudinal studies, conducted between 2000 and 2002 and between 2009 and 2011, respectively, were used to illustrate the possible contributions of research findings to treatment and rehabilitation services. The most salient finding present in both studies was the significant and negative relationship between life satisfaction and continuation of drug use. The finding suggested that subjective well-being should be incorporated into treatment programmes, and there is a need to provide post-treatment services to young rehabilitated psychoactive drug abusers in the form of life planning programmes and organisation of sustainable social activities in the community.     

The Role of the Private Market in Day-care Provision for Children in Need

This article examines the role that the private day-care market plays within the range of day-care services offered by 12 local authorities for children in need. It examines how local authorities have developed their use of private day-care services generally, and goes on to discuss three models of sponsored childminding practice which were identified in the study. Although authorities have generally been innovative in developing their work with independent day-care providers, if they are to continue to purchase good quality services for children in need they need to ensure that private day-care providers receive adequate levels of training and support, and that steps are taken to address existing gaps in both private and local authority day-care services.     

The Utilization of Social Services by the Mexican-American Elderly

One of the knowledge gaps in empirical research on utilization of service is that little attention has been given to testing causal models of use among the various ethnic elderly groups. The purpose of this study is to analyze the pattern of determinants of social service use among the Mexican-American elderly. A causal model of social service use was tested using a subsample of data obtained from a national needs assessment interview of 1,805 randomly selected noninstitutionalized elderly Hispanics. The findings, indicate that knowledge of social services, need for social services, perceived health status and income have direct effects on the use of social services. The major findings are discussed in relationship to past empirical research.     

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

A Brave New World of Personalized Care? Historical Perspectives on Social Care and Older People in England

Social care policy for older people in England continues to generate extensive discussion around the need to break with the past and to deliver a personalized response to need. This article explores the extent to which this represents a complete break with the past by looking at four key reports from the past, namely the Rucker Report (1946 ) on the break up of the Poor Law, the Seebohm Report (1968 ) on the personal social services, the Griffiths Report (1988 ) on community care and The Royal Commission on Long Term Care ( Sutherland Report, 1999 ). Each is interrogated in terms of how social care is defined, how services are to be delivered, how quality is understood and the assumptions made about who will be able to access services. This analysis is used to draw out key continuities in policy assumptions such as the primacy of family and the ongoing debate about ‘What is social care?’ and how it can be distinguished from health care. The article also argues that the voluntary sector has always been seen as a ‘key player’ in social care. Finally, the analysis of the four reports is used to trace the ever changing role of local authorities in the planning, purchase and provision of social care services for older people.     

Overcoming barriers: Effects of entering vocational rehabilitation on labour market outcomes

Vocational rehabilitation aims at getting people with health problems or disabilities back into work. In Germany, the Public Employment Service is a central provider of vocational rehabilitation services targeted at unemployed people. Against this background, the study examined the labour market effects of vocational rehabilitation for people registered as unemployed with the Public Employment Service. A comparison of the accepted and the rejected applicants for vocational rehabilitation using inverse probability weighting based on propensity scores provides an insight into its effects. The results suggest that the employment prospects of persons who were accepted in the programme improved modestly after the third‐year following application. A subgroup analysis identified stronger re‐employment effects of acceptance into vocational rehabilitation in eastern Germany as well as for men and older individuals.     

A Preliminary Approach to Defining Social Service Outputs for Auditing Service Distribution

An accurate evaluation ofthe effectiveness of social services requires that the unit of output be clearly defined. The problem, which has never really been solved, has become more important with the passage of Title XX of the Social Security Act. The Title XX Amendments to the Social Security Act decentralize planning for social services to state and local governments. Title XX goals do not easily translate into measures of achievement. This paper describes a standardized framework that discriminates among the elements of service output. Data on the services provided by one social service agency are used to support the feasibility of proposed frameworks. The concept of a unit of service output was used in this study for the purpose of developing standardized categories to measure service provision. Two measures of service activity were developed: One measures service intensity, and the other relates to consumers' need for and utilization of services. The study was conducted at a local social service district in an urbanized county of 400,000. The sample of cases consisted of 120 new applicants accepted for public ossistance during the first 3 months of 1964. A retrospective longitudinal analysis of services provided was performed. All components of service provided to each sample care during the period of 1964-19 71 were coded from agency records in units of service output.     

The gap in social care provision for older people in China

Because of its unprecedented sociodemographic changes, particularly rapid population aging, China faces huge challenges in social care. Using data from the 2012 Chinese Longitudinal Healthy Longevity Survey (n = 9,765), this article examines the need for social care, as well as the major sources of provision. The findings indicate that the majority of older people face some restriction in their daily living activities. From their perspective, however, the most urgent social protection services are related to health care and legal aid rather than services supporting daily living. Although Chinese Government policy since the 1990s has been a strategy of social welfare socialization, the role of government, both as provider and funder, is limited and focuses only on the most deprived and on urban areas. The result is a massive “care gap” between the need for social care and its supply. The primary responsibility for care provision is borne by the family. The direction of social policy in the future should focus on shared care between the family and the state, giving priority to expanding the coverage of social care services, especially in rural areas.     

Specialised Supported Education for Australians with Psychotic Disorders

Australia has a network of Federally funded disability employment and vocational rehabilitation services, including a proportion of outlets that specialise in providing services for persons with psychiatric disabilities. However, neither Federal nor State Governments currently provide or fund disability‐specific education assistance to persons with psychiatric disabilities. To begin considering whether Specialised Supported Education is indicated for persons with psychotic disorders, we examined data collected in a national ‘Survey of Disability, Ageing and Carers Australia, 1998’. International studies of the effectiveness of overseas Supported Education programs were also examined to identify the forms of assistance most likely to warrant consideration in Australia. U.S.A. evidence indicates that Specialised Supported Education is emerging as an effective career development option for persons with psychotic disorders. An example of an innovative Specialised Supported Education program is provided to illustrate how this type of program can be implemented in Australia.     

Psychiatric Non-institutionalisation: Whose Needs are Served?

This article outlines the social problems experienced by persons with a chronic psychiatric disability, and their families. The disabled person's lifestyle is characterised by poor social and vocational skills, poverty, inadequate accommodation and alienation. Many of these problems increase the dependence of the disabled person, emotionally and financially, on their family of origin. The author suggests that these social problems will only be ameliorated if family members are provided with active support and information, and if hospital and community services are integrated and complementary. The disabled person's quality of life can only be improved by accessible intensive social and vocational rehabilitation programs. As these issues are not being comprehensively addressed at the present time family self-help organisations such as the Association of Relatives and Friends of the Mentally III (ARAFMI) will need to politicise their plight.     

Child well-being through different lenses: why concept matters

'Well-being' has entered policy rhetoric in children's services in the UK and other Western developed countries as a companion to other buzzwords of recent years. In order to improve children's well-being, we need not only a better understanding of what it is and how services can improve it, but also the ability to measure child well-being in order to evaluate success. This paper explores conceptually and empirically the 'lenses' through which child well-being is often viewed. It considers the relationships between these perspectives, the added value that each one brings and the implications for services.     

Women's safety service within the Integrated Domestic Abuse Programme: perceptions of service users

This paper draws on the findings of a qualitative evaluation that examines women's perceptions of the services provided to them whilst their abusers attended an Integrated Domestic Violence Programme (IDAP) in one probation area in the UK. Research focusing on domestic violence programmes has mostly concentrated on the experiences of male perpetrators. As a result, less is known about how women feel about such programmes and the parallel safety services they are supposed to receive. This research seeks to address that weakness by exploring the perceptions of 13 women whose abusers are attending one perpetrator programme. The findings of our study suggest that women are generally negative about perpetrator programmes and require more comprehensive and coordinated services than are routinely made available to them. The paper suggests that women value and need direct and assertive support as well as safety services, and this need is especially pronounced in rural contexts where women can be isolated from mainstream services. The implications of the research to practice with victims of domestic violence are discussed to inform further development of IDAP and similar programmes in the UK and beyond.