The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

Barriers to healthcare for American Indians experiencing homelessness

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.     

Leaning Out: Exploring Organizational Advocacy Activities From an Open Systems Perspective

This article explores the effect of organizational culture on engagement with advocacy activities, both traditional and electronic. The Competing Values Framework offers a model for understanding how organizations’ culture influences behavior. Using a sample of nonprofit providers from across the country, the author hypothesized that organizations that use electronic advocacy tools are more involved with advocacy activities of all types. A paper and pencil survey was used to collect data on organizational culture, advocacy tools and techniques, perceived effectiveness of the advocacy tools, policy goals, organizational sustainability goals as well as barriers and facilitators of electronic advocacy. The study used path modeling to describe the connections between organizational culture and engagement in advocacy activities. The article examines the barriers and facilitators of electronic advocacy, the penetration of electronic advocacy use in this sample of agencies and the perceptions of effectiveness associated with using these strategies; lastly, the implications of these findings for managers and organizational leaders are discussed.     

MSM's Versus Health Care Providers’ Perceptions of Barriers to Uptake of HIV/AIDS-Related Interventions: Systematic Review and Meta-Synthesis of Qualitative and Quantitative Evidence

ABSTRACT

To compare the perceptions of men who have sex with men (MSM) and health care providers (HCPs) on barriers to uptake of HIV/AIDS-related interventions using existing quantitative and qualitative data. Systematic review and meta-synthesis was employed to combine data from both groups. Based on studies focusing on MSM and HCPs, knowledge about the intervention and intervention's cost emerged as major barriers to uptake whereas HIV- or homosexuality-related stigma/discrimination was a barrier in studies focusing on MSM alone. Lack of practice guidelines was barrier among HCPs only. Few studies exist that focus on perceptions of barriers by HCPs.     

“A Very Steep Climb”: Therapists’ Perspectives on Barriers to Disclosure of Child Sexual Abuse Experiences for Men

ABSTRACT

Recent studies indicate that men experience unique barriers to disclosure of child sexual abuse. Blind spots held by mental health providers and social service agencies may inadvertently help produce and sustain these barriers. However, therapists who specialize in treating this population may also hold important insights into the barriers clients face. Because delayed and nondisclosure of child sexual abuse have been associated with negative mental health outcomes for adult survivors, understanding these barriers is critical to improve clinical practice and facilitate help-seeking. Using conventional content analysis, this study examined the perceptions of nine therapists who specialize in the treatment of men who were sexually abused in childhood, many of whom are considered pioneers in the field. Analyses identified nine types of barriers, which were organized into three categories: intrapersonal experience (difficult feelings, lack of language, and self-engagement), social milieu (internalized social stigma, negative responses, social loss or judgment, and masculine identity dissonance), and health care environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies). Implications for future research, clinical training, and clinical practice are discussed.     

Prevalence,people and processes: a consideration of the implications of Lord Laming's progress report on the protection of children in England

Media coverage of the death of Baby P revived national concerns about the standard of child safeguarding practice in England following the implementation of widespread structural changes in response to the Victoria Climbié Inquiry chaired by Lord Laming in 2003. This paper discusses the recommendations of Lord Laming's recent Progress Report. It questions whether the scale of the challenge in improving child protection is fully recognised and considers briefly the culture of social care in the UK and the barriers to effective reform. Copyright © 2009 John Wiley & Sons, Ltd.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

Promoting sexual well-being in social work education and practice

This paper explores the importance of including sexual well-being within social work practice and education. Social workers often work with individuals for whom opportunities for sexual expression are limited and who face discriminatory attitudes. Sexual well-being is a global concern, and is particularly relevant considering international interest in the influence of notions of well-being on mental and physical health. Implementation of new social care policy in England, underpinned by the well-being principle, provides practitioners with the opportunity to explore what is meaningful to individual’s well-being through person-centred approaches to practice. There is currently little coverage of sexual well-being within social work education, this means students and practitioners lack the knowledge and skills to challenge barriers. Promotion of the concept of sexual citizenship, with its associated rights and responsibilities, enables social workers to engage in rights focused practice. Sexual well-being is a sensitive subject and the social and personal barriers practitioners may experience in addressing this topic are explored.     

Comparing local and national service systems in social care Europe: framework and findings from the STEPS anti-discrimination learning disability project

This paper outlines the methodology and findings of a cross-national comparison of social care services for people with learning disabilities in Europe, developed from the EU funded STEPS anti-discrimination project. The comparative framework developed for the project is profiled and summary findings are organised into thematic dimensions. Wide variations in service organisation were evident, providing particular challenges for those involved in cross-national research or social work practice. Key variation was evident between local and national systems, the varying impact of generic and specialist community care and the degree of individualisation in services, with various structural, funding and policy barriers to integrated social work and ongoing de-institutionalisation evident. Development priorities for inclusive and anti-discriminatory practice included individual funding and planning, self-advocacy and user involvement in quality management.     

The art and science of teamwork: enacting a transdisciplinary approach in work rehabilitation

Teamwork, collaboration and interprofessional care are becoming the new standard in health care, and service delivery in work practice is no exception. Most rehabilitation professionals believe that they intuitively know how to work collaboratively with others such as workers, employers, insurers and other professionals. However, little information is available that can assist rehabilitation professionals in enacting authentic transdisciplinary approaches in work practice contexts. A qualitative study was designed using a grounded theory approach, comprised of observations and interviews, to understand the social processes among team members in enacting a transdisciplinary approach in a work rehabilitation clinic. Findings suggest that team members consciously attended to a team approach through nurturing consensus, nurturing professional synergy, and nurturing a learning culture. These processes enabled this team to work in concert with clients who had chronic disabilities in achieving solution focused goals for returning to work and improving functioning. Implications for achieving greater collaborative synergies among stakeholders in return to work settings and in the training of new rehabilitation professionals are explored.     

Field Note—Integrating Policy and Political Content in BSW and MSW Field Placements

Practice incorporating policy and political social work is a key component of the social work profession and an area in which students would benefit from exposure during social work education. Field education presents a significant opportunity for students to develop policy and political practice skills; however, individual and structural barriers may prevent students from developing practice experience in this area. Based on a survey of bachelor of social work and master of social work field directors in the United States, this field note examines the current state of policy and political practice field opportunities and examines barriers to offering such opportunities more widely. Ideas to facilitate these field opportunities, including curriculum-wide education about policy practice, relationship building, creativity, and identifying diverse placement sites, are presented.     

Oppression and Barriers to Service for Black,Lesbian Survivors of Intimate Partner Violence

This narrative study identified service barriers from the perspectives of 16 Black lesbian survivors of intimate partner violence (IPV). Qualitative analysis revealed diverse interrelated barriers similar to those identified by service providers in a previous study by the authors, including societal barriers such as heterosexism, and institutional barriers such as ambiguous policy. Results indicate that the theory of intersectionality is best poised to frame an investigation of the complex barriers encountered by these survivors. Results also demonstrate that although these women desire to receive services, current inequities prevent them from accessing support and further endanger, victimize, and isolate them. Strategies for improving services and reaching culturally diverse survivors are also discussed.     

Economic and social implications of aging in Singapore

The economic and social impacts of population aging in Singapore are examined, particularly their impact on labor supply and the extent to which traditional family and community care providers can meet the challenges of an aged population. The adequacy of public policy responses, such as the new employment policy and the Central Provider Fund, are explored. Government strategy to shift the burden of care to the family and other community providers is challenged.     

Barriers to substance use disorder treatment in a sub-acute setting

ABSTRACT

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to substance use and mental health diagnosis. With the current opioid epidemic there is a need to address substance use disorders when treating patients in different health care settings. Despite the necessity of integrated care, there are barriers to addressing addiction in sub-acute care settings. With the lack of buy-in from the patients and health care providers and the stigma surrounding addiction it is time to address the barriers that prevents integration of care where it is most needed.     

Issues in African-American family preservation

This article is concerned with African-American family preservation. The authors' assumptions are that (1) child welfare service takes place in a cultural context; (2) effective work with African-American families requires a culturally relative "nondeficit" perspective on African-American culture; (3) this begins with helping service providers to acquire an analytical approach to culture and factual knowledge about the cultural behavior of clients; and (4) staff members must be prepared through training to implement a cultural knowledge base in transactions with African-American families and must have the supervisory and policy supports to do this. The several practice issues central to African-American family preservation are highlighted.     

Variations in provider capacity to offer accessible health care for people with disabilities

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.     

The First Hit: a case study of the physical abuse of people with learning disabilities and challenging behaviours in a residential service

This paper describes the circumstances surrounding the physical abuse of persons with learning disabilities and challenging behaviours in a residential service and the general findings of a related inquiry. Evidence is interpreted in relation to wider policy and practice intelligence on the abuse of people with learning disabilities, with lessons for the recognition, reporting and management of abuse identified. The discussion is designed to help those charged with responsibility for the support and protection of people with learning disabilities understand the complex circumstances and conditions which may be associated with an abusive service culture, with the culture of abuse itself examined at four levels. Suggestions for reviewing the development and implementation of adult protection policies and procedures are offered, along with priorities for action and implementation for purchasers and providers.     

The circumstances surrounding the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes

Resident-to-resident incidents in dementia in long-term care homes resulting in deaths represent a growing concern among residents, family members, care providers, care advocacy organizations, and policy makers. Despite these concerns and experts’ predictions by which injurious and fatal incidents will increase in the coming years due to the projected growth in the number of people with dementia, no studies have been conducted in North America on these fatal incidents. This exploratory pilot study makes first steps towards bridging this major gap in research and practice. Using publicly available information (primarily newspaper articles and death review reports), practically useful patterns were identified pertaining to the circumstances surrounding the death of 105 elders as a result of these incidents. The findings could inform various efforts to prevent future deaths in similar circumstances, keep vulnerable and frail residents safe, and encourage researchers to examine risk and protective factors for these incidents.