The international migration of nurses in long-term care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.     

Social Work and Interprofessional Education in Health Care: A Call for Continued Leadership

A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and facilitators of this practice. Educators will learn how to help students discover the knowledge, skills, and attitudes for successful interprofessional work. Specifically, this article has the following objectives:

1. Discuss essential elements of effective interprofessional practice;

2. Present exemplars of interprofessional education involving social work;

3. Identify the roles for social work in leadership, education, and practice in interprofessional education.

     

Minimising Coerciveness in Coercion: A Case Study of Social Work Powers under the Victorian Mental Health Act

The balance between care and control in mental health social work is one of constant tension. In the State of Victoria, Australia, the Mental Health Act 2014 gives coercive powers to social workers employed by public mental health services. These include the power to decide if a person needs to be assessed by a psychiatrist, to “take” a person using bodily restraint, to enter premises, and to search and seize a person’s belongings. This paper applies a doctrinal analysis to examine the law, then argues that the use of these powers by social workers, where safe, may be less restrictive than when they are used by police or paramedics. The exercise of these powers may be less traumatic and stigmatising to the people who are subject to them, and social workers may be both legally and ethically obligated to use coercion when appropriate.

IMPLICATIONS

• More social work literature on the coercive powers under mental health legislation is needed as well as more guidance on using these powers for social workers in practice.

• In some circumstances, these coercive powers may be better exercised by social workers than by other professionals.

• Social workers should carefully consider their legal and ethical obligations to use these powers in some circumstances.

     

Family Experiences of Caring for Relatives Who Have Received Electroconvulsive Therapy (ECT)

The research literature on family members’ experiences of the use of electroconvulsive therapy (ECT) is limited. This article explores the perspectives of family members whose relatives had received ECT. Drawing on a social constructionist perspective, this qualitative study collected data using in-depth interviews with nine families in South Australia, to examine how family members constructed the supports and challenges they experienced. The research found that families experienced a range of social and service system barriers, including social stigma and isolation, and limited support from health professionals. They had to negotiate caring expectations within a social context that stigmatised both mental illness and ECT. A need for ECT-specific mental health support groups was identified.

IMPLICATIONS

• Social workers’ roles in Australian hospitals could be further expanded to accommodate supporting families whose relatives have received ECT, referring families to community support, and advocating for specialist support post-ECT treatment.

• Social workers can further articulate their unique contribution to community care post-ECT treatment and advocate for supporting families.

• Increased focus on ongoing and preventative care for supporting families is a potential growth area for social workers in mental health.

     

Critical Reflection on the Ethics of Mindfulness

Mindfulness is a way to achieve mental wellbeing that has been widely adopted as part of counselling and mental health treatment. However, there is a distinct lack of critical reflection about the origins of this technique, how it is used, and the implications it has for the beliefs of clients. The purpose of this paper is to provide a carefully considered response to the use of humanistic mindfulness. Social workers need to explain why they recommend mindfulness, and explore culturally consistent and sensitive practice, so that they are abiding by the Australian Association of Social Workers Code of ethics.

IMPLICATIONS

• The use of mindfulness in social work practice requires careful consideration as to its impact and relevance to clients’ needs.

• Mindfulness originates in philosophical traditions distinct from mental health treatment.

• In choosing to use mindfulness social workers require consistent and sensitive understanding of clients’ needs, world views, and culture.

     

Descriptive Analysis of Foster Care Adoptions in New South Wales,Australia

This paper describes the population of children in care in New South Wales, Australia, who were adopted by their foster families (N?=?372) from 2003 to 2014. Data pertaining to 370 of these adoptees were available and obtained from administrative records accompanying adoption applications. Most of these children had been placed with their subsequent adoptive family during infancy. However, adoption orders occurred much later in their lives. According to the available information at the time of adoption, these children did not suffer the high levels of mental health problems typically identified in populations of children in foster care. Though the data do not include follow-up to determine if the contact agreed upon at the time of adoption orders translated into practice, the most frequently postadoption arrangement recorded was face-to-face contact, four times a year with mother and siblings. The high levels of openness and face-to-face contact in Australian adoptions from care are a significant point of difference with other adoption models, and presents a need for research in the area.

IMPLICATIONS

• Following the change of legislation in New South Wales, Australia, that prioritises open adoption over foster care, social workers in the field of child protection are well placed to assist in this process.

• Social workers can assess children entering care to identify those who will benefit from adoption in a timely manner; undertake casework and administrative aspects of the adoption process; work closely with the child, and birth and adoptive families by delivering pre- and post-adoption supports; and conduct longitudinal research on the outcomes for children adopted from care.

     

African-American Women in the Workplace:

This article looks at the perceptions and professional perspectives of African-American female EAPs who work with African-American women in various industries. It provides an exploration into the attitudes of African-American women about several workplace and personal issues including:

• sexual harassment and discrimination

• racial discrimination

• career opportunities

• work assignment disparity

• organization culture and sensitivity

• organizational supports

These concerns have been examined against a backdrop of actual demographic changes that have occurred for minority and all women over the last decade. The author has used her own experiences as an EAP professional for the last ten years, in addition to those of other African-American women EAPs, in order to highlight and identify the central issues of concern for Afiican-American female clients. The data were gathered through indepth, face-twface interviews with six African-American female Employee Assistance professionals. Their experiences illustrated the difficulty that EAPs are still having in effecting the problems of sexual discrimination and harassment, racial discrimination, and general career barriers that African-American women face in the workplace. As our current cadre of intervention strategies are not yet successful, new approaches are called for as we move toward ihe next century, especially if EAPs are to enhance our effectiveness in helping clients confront some of the most significant problems they face.     

The Experiences of Human Service Managers in Contexts of Change and Uncertainty

Against a background of rapid and widespread changes to the delivery of human services and social welfare, this paper reports on a study into the experiences of managers of human services organisations. Within an interpretive methodology, the research utilised focus group and interview methods to examine the relevance and need for business, finance, and management skills from the perspective of managers in the human services. Results indicate that managers of human service organisations need advanced business, management, and finance skills to deal with change and uncertainty in contemporary and competitive service environments.

IMPLICATIONS

• Human service organisations in Australia are subject to change and uncertainty with new models of funding and increased accountability.

• Social workers employed as managers are under pressure to lead sustainable and accountable services, while still holding to social work principles.

• Social workers who manage organisations face a challenge of how to integrate business, management, and finance skills with the values and mission of social work.

     

Developing Anti‐oppressive Ethics in the New Curriculum

This paper describes the development of an anti‐oppressive ethics and values module appropriate for the new social work degree. It is contended that there has been insufficient attention paid to ethics teaching in social work education generally in the UK, and in particular there has been:

• ?failure to develop discrete modules on ethics and values in social work;

• ?minimal critique of conventional ethics with social work values that take oppression and diversity seriously;

• ?insufficient use of recent feminist ethical contributions relevant to social work;

• ?limited development of interprofessional ethics teaching that take service user and social work values seriously; and

• ?neglect of ethical decision‐making guides that can encompass legal, ethical and social work values.

The paper proposes a rationale for an anti‐oppressive ethics module that will enable traditional ethical theories to be placed within an anti‐oppressive social work values context, and aim to provide students with a more adequate guide for decision‐making. The module will be developed in consultation with service users and interprofessional colleagues. It will take into account the British legal and policy framework, the General Social Care Council code of practice, as well as the Quality Assurance Agency for Higher Education requirements, but placing them within an anti‐oppressive framework drawn from the authors' current and previous work in this area, and will have special reference to recent feminist moral philosophy. The authors have recently been re‐located into a Faculty of Health and Applied Social Studies and will be developing the new module on ethics in consultation with health lecturer colleagues specialising in ethics with the aim of developing interprofessional co‐operation and sharing of perspectives between staff and students. They write with long experience of both practising and teaching social work, and with diverse experiences of ‘race’, gender, class, and also being both service users and providers.     

Social Work Registration: What’s the Contention?

In the face of consistent lobbying for the national registration of social workers by the Australian Association of Social Workers (AASW), the Council of Health Minsters maintains the view that registration is not required, placing it at odds with comparable countries around the world. One factor that shapes this current decision is the view that social work does not pose a significant risk to the health of individuals to warrant the need for this level of regulation. In light of this ongoing debate, the following article provides an overview of the discussion to date, summarising the risks, harms, and the associated costs. Additional evidence of harm and cost are then posited, followed by suggestions for further steps that can be taken to support the Council of Health Ministers making an informed decision on whether or not to include the social work profession in the National Registration and Accreditation Scheme (NRAS).

IMPLICATIONS

• Registration of social work is an under-researched topic. Research will provide much needed evidence to help understand the impact and efficacy of registration in protecting the public.

• Research will inform the Australian Association of Social Workers strategy in pursuing mandatory registration and also support the federal government in its decision making.

• Research in this area may have broader implications for other professions and government policy both nationally and internationally.

     

Acceptability of an Aboriginal Wellbeing Intervention for Supporters of People Using Methamphetamines

Families and workers often suffer significant stress while supporting people who are experiencing problems related to methamphetamine use yet there is little evidence on how best to help. Small pilot studies can provide valuable information about potential ways to intervene. This paper presents a pilot study of an Aboriginal family wellbeing intervention with workers in an Aboriginal health service. The pilot indicated that participation in the intervention improved the psychosocial empowerment and wellbeing of workers, that these workers perceived the program as relevant to families, and that this was an intervention they felt they could deliver to clients themselves.

IMPLICATIONS

• An Aboriginal family wellbeing intervention was piloted and found to improve the empowerment and wellbeing of workers. Participants regarded it as highly relevant for families supporting people using methamphetamines and other drugs.

• This research has added to our knowledge about how to assist those supporting Aboriginal people using methamphetamines and other drugs.

     

Social Work and the Natural Environment: Embedding Content Across Curricula

Social work is a profession focused on people within their environments. This is reflected in codes of ethics, where our shared mandate is to work towards individual wellbeing and social change. Recently, social work literature has promoted green and eco-social work, drawing on climate change science, notions of expanded and future justice, knowledge of the link between health and the environment, and principles of deep ecology. However, if social workers are to take up their place in a rapidly changing, globalised world, rife with environmental concerns, their education must prepare them to do this. One way of doing this is to embed curriculum on social work in relation to the natural environment in already existing units. This paper describes two examples of how this could be done based on the authors’ experiences from their respective universities.

IMPLICATIONS

• It is incumbent on social work to respond to the mounting evidence related to the environmental crisis.

• Social work is well placed in terms of theory, values, and skills to lead the way in developing an eco-social paradigm of potential relevance across disciplines.

• Social work educators need to educate students about emerging issues, such as environmental degradation. Embedding material in already existing courses, as per examples provided in this paper, provides one way of doing this.

     

Evaluation and assessment

The current debate about the balance between child protection and family support, informed by the publication of a sequence of government sponsored research studies, tends to focus on the investigative stage of child protection relating to Section 47 of the Children Act 1989 and contrasts this with the less stigmatising approach of assessment and support to the families of children in need under Section 17 of the Act. Little attention has so far been paid in Government documents and guidance to the child protection process after the initial investigative stage. The work of the core group, set up by the child protection conference when a child's name is placed on the register, is, however, the main vehicle for the implementation of the plan to protect the child(ren) at risk in a family and marries the twin strands of protection and support.

Because of the pressures on training and staff development sections of Social Services Departments, as well as on academic institutions offering social work courses to meet the mandatory requirements of CCETSW and of the Training Support Programme, training and education relating to core groups have been afforded low priority in most authorities and universities.

Research suggests that there is great potential for prevention, for family support and for positive work with children and their families in this area of work. A recent national conference suggested models for progressing good practice. A pre-conference questionnaire was completed by conference participants and is to be extended to all local authority Social Services Departments to collect information on current practice and procedures.

Training Issues include the following:

• 1. partnership practice with both family members and professionals;

• 2. communication with children and young people and other family members;

• 3. power and issues of difference;

• 4. clear and detailed planning, monitoring and review;

• 5. user perspectives.

Some examples of professionals' and service users' views will be given as well as suggestions for a framework and strategy for training in this area.     

Who Makes Decisions for Vulnerable Young People? Shifting Sands and Murky Waters

This paper discusses the existing guidance in Australian legislative and regulatory frameworks to inform the process of young people moving through varying stages of maturity towards independent decision-making. In the context of exploratory research to develop a stable online repository of personal documents for young people in out-of-home care, the researchers envisioned in-built, age-appropriate levels of decision-making authority, associated with what was stored, who had access, and who owned these records. They sought guidance to protect young people themselves and to support workers and other mentors. Little unqualified guidance emerged from the documentary search. Supporting any young people in the journey towards independent decision-making relies on individual judgements about the type of decision and risks involved, and the age, maturity, and experience of the young person. Above all, a supportive trusting relationship with an adult allows young people to learn through their own mistakes.

IMPLICATIONS

• Young people's competence in decision-making depends on a range of individual, familial, and social factors, and individualised guidance is necessary to support their participation.

• A supportive, trusting relationship with an adult provides the best environment for balancing vulnerable young peoples’ participation rights with their continuing needs for protection.

• The policy and practice challenge is to harness digital technologies without being distracted from the importance of relationship-based work.

     

NEW LABOUR'S TEENAGE PREGNANCY POLICY

This chapter explores the changing governmental approach to the problem of teenage pregnancy in the UK. It argues that there has been a shift from moral traditionalism towards individualized approaches based on promoting responsibility, agency and prudent choice-making. New Labour's approach to teenage pregnancy marks a decisive turning point in governmental regulation, documenting the failure of previous approaches and establishing three distinctive discursive strategies:

1. risk management through knowledge acquisition;

2. constituting active knowing welfare citizens;

3. reconstituting blame.

The paper ends by examining how this approach forms part of New Labour's combined and contradictory project of ‘modernizing the social’ and ‘remoralizing welfare’.     

Role of Relational Case Management in Transitioning from Poverty

One-off financial assistance through emergency relief provides a short-term intervention to immediate material crisis. However, recurrent instances of clients accessing this type of assistance points to the ineffectiveness of managing financial hardship without addressing the causes of long-term poverty. This article presents findings from an external process evaluation of the Salvation Army relational case management model known as Doorways. A mixed-method design was implemented, consisting of semistructured interviews, observations, and document analysis, as well as Client Satisfaction and Wellbeing Survey. Across the seven research sites semistructured interviews were conducted with 45 clients and nine case managers, and 30 client surveys were completed. Three themes will be discussed: the Doorways philosophy; the flexible service delivery approach; and client capacity building and continuity of care. Findings illustrated the effectiveness of a relational case management approach and reaffirm the central role of relationships in transforming the lives of people experiencing poverty.

IMPLICATIONS

• The quality of relationship between case managers and their clients plays an integral role in transforming the lives of people experiencing long-term or situational financial disadvantage.

• Service delivery requires a relational and flexible approach to adequately tailor support to the individual and contextual needs of clients.

     

Implications for Practice: Exploring the Impacts of Government Contracts on Refugee Settlement Services in Rural and Urban Australia

This article presents the findings from a small qualitative study of Refugee Settlement Service (RSS) workers under Australia’s Humanitarian Settlement Services and Settlement Grants Program. Managers and front-line workers from five Refugee Settlement Services in rural and urban New South Wales were interviewed to examine the impact of new Government funding structures and contracts on the delivery of services and supports to newly arrived refugees. The comparative findings show that the Government’s contractual arrangements impact Refugee Settlement Services in different ways; ultimately prioritising market-like structures and undermining their core service roles. We argue that improving the relationship between Government and Refugee Settlement Services is critical to successful refugee settlement.

IMPLICATIONS

• Successful refugee settlement requires greater flexibility and responsiveness in rural and urban Refugee Settlement Service (RSSs).

• RSSs require increased autonomy and control over funding to enable locally responsive service provision for newly arrived refugees.

     

“We Live and Breathe Through Culture”: Conceptualising Cultural Connection for Indigenous Australian Children in Out-of-home Care

Indigenous Australian children are overrepresented in the out-of-home care (OOHC) system, with numbers and rates on an upward trajectory. There is now serious concern that this overrepresentation is creating a second Stolen Generations in Australia, noted within policy campaigns such as Family Matters—Kids Safe in Culture, not in Care, and Grandmothers Against Removals. While placement in OOHC is designed to protect children’s long-term safety and wellbeing, it threatens cultural connection, which is fundamental to Indigenous identity and wellbeing. Some government policies that aim to foster cultural connection have not been effective, while others, such as the 2014 permanency legislation in Victoria, arguably threaten cultural connection. This article highlights the vital importance of cultural connection for Indigenous child development, arguing that for Indigenous children, family connection strengthens cultural connection. We argue that family needs to be recognised as a critical component of cultural connection that is equally as important as placement stability in OOHC. Consequently, statutory and community organisations responsible for Indigenous children in OOHC must focus on facilitating and strengthening family relationships, not only to foster cultural connection, but also to explore reunification possibilities.

IMPLICATIONS

• Cultural connection is fundamental to Indigenous identity and wellbeing, but requires family connection if it is to be fostered and strengthened.

• When Indigenous children live in out-of-home care, social workers in child and family welfare need to ensure that children are connected to culture.

     

The Kids Say Project: Supporting Children to Talk about their Experiences and to Engage in Decision-making

Research and policy calls for hearing the voices of children and youth in out-of-home care and involving them in decisions about their own lives. The “Kids Say” cards were designed to facilitate this engagement, particularly with Indigenous children and youth. A feasibility study explored the extent to which the Kids Say cards were acceptable to young people, and prompted discussion about their lives and what is important to them. The study involved 47 participants, aged 7 to 18 years, from three cultural groups: Aboriginal n?=?20; culturally and linguistically diverse (CALD) n?=?10; non-Indigenous English-speaking n?=?17. The cards were found to be appealing to all three groups, and to facilitate child and youth voice. Findings also did not differ significantly according to gender or age. These preliminary findings indicate the potential value of appropriate practice tools to support children and youth to share their experiences and participate in decision-making.

IMPLICATIONS

• Engaging resources, such as the Kids Say resource, are potentially valuable in supporting practitioners to encourage children and young people to share their experiences and participate in decision-making about their own care and service needs.

• Training in creating safe sharing contexts for children and young people is essential. While emphasis is often given to gathering child voices, there is a need for at least equal emphasis on respectful adult listening.