Met needs and unmet needs, and satisfaction among Social HMO members

This article reports on a survey of 800 members of four Social HMO demonstration sites, who were receiving home-based, community-based, and short-term institutional services under the demonstration's expanded community care benefits. The survey asked whether members needed help in 11 areas, whether they received help in each area from an informal caregiver, whether they wanted more help from the Social HMO, and whether help provided by both was adequate. Satisfaction with the program and with service coordination was also assessed. The adequacy of informal care differed by problem area, as did the help desired from the Social HMO and its responsiveness. Members were less satisfied when they had weaker informal care, were African American, and when they received inadequate help from the plan with ADLs, transportation, medical access, and managing money. Members were more satisfied when they were professionals, home owners, knew their service coordinator's name (or how to contact her), and received help with their problems. The findings point to the importance of clarifying divisions of labor with informal caregivers, as well as possible expansions in responsibilities for service coordinators and benefits beyond traditional boundaries.     

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

This article aims to present the lived experiences of psychiatric service users/survivors who have experienced the transition from institutional care in the 1970s and 1980s to community care services in the 1990s and post-2000s. By using a biographical narrative approach the study compares service users’ historical experiences with their contemporary experiences of community and residential care. Sixteen biographical narratives were analysed to explore how mental health services have changed over time, from the perspective of service users/survivors, their families and mental health practitioners. The study examines how the closure of NHS mental hospitals in the 1980s, which were replaced in the 1990s with new types of community and residential care services, has changed the lives of service users/survivors. Thus, the article presents these lived biographical experiences which, for the majority of service users/survivors, were defined by the process of trans-institutionalisation rather than de-institutionalisation, within a neoliberal context.     

Community responsibility for the self-neglectful client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

The distribution of a federal entitlement: The case of adoption assistance

Adoption assistance entitlements support children whose birth parents cannot care for them. The entitlements are meant to offset the extra cost to adoptive families of raising children whose early adverse experiences leave them with special needs. Unlike other Social Security Act programs, adoption assistance is not federally administered but is administered by states or localities. State-to-state variation in administration of this federal entitlement leads to unequal treatment of similar children. Moreover, although adoption assistance is an entitlement for children, payments made by many states are systematically correlated with the characteristics of adoptive families.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

Parents' Perceptions of Services for Children and Youth with Emotional and Behavioral Disorders

Increased concern about the pervasive problems children and youth with emotional or behavioral disorders (EBD) experience has led to the planning and development of alternative approaches to serving these individuals and their families. One alternative approach includes the development of a comprehensive, community- based system of care. This study encouraged parent participation in a county-wide needs assessment designed to facilitate the development of a system of care. Parents were surveyed to gather their views regarding their experiences with various service agencies as well as their input into how comprehensive services could best be developed and implemented. The survey focused on (a) family needs, (b) existing barriers to comprehensive individualized care, and (c) specific service priorities for system development. Suggestions for future research and implications for developing such services are discussed.     

Child Abuse on the Internet: Ending the Silence

The Melbourne Health (MH) Social Work Residential Care Team (RCT) was established in 2002 as a new and innovative approach to aged care. The service employs three full-time social workers and an Allied Health assistant with previous experience in aged care. The RCT works across the MH continuum of care with inpatients recommended for residential care. The service is predominantly patient- and family-focused, but is also consultative to meet the education needs of MH staff and the community. This paper discusses the MH Social Work Residential Care model, reviews data collected since RCT implementation and the benefits shown for patients, their families and interdisciplinary staff. This paper discusses pressures and factors that impinge on the ability to discharge patients to residential care and explores recommendations for ongoing clinical practice as well as recommendations that the RCT has submitted to management for further consideration.     

Social Capital and Participation in Community Improvement Activities by Elderly Residents in Small Towns and Rural Communities*

Abstract This study critically reviews theoretical concepts and measurements of social capital and tests hypotheses that elaborate how four dimensions of social capital (informal social ties, formal social ties, trust, and norms of collective action) and sense of community are related to participation in community improvement activities for elderly residents in small towns and rural communities. Mail surveys of 2,802 elders in 99 small towns and rural communities in Iowa reveal that many elders are actively involved in their community. Social capital and sense of community are very important in predicting elderly participation in community improvement activities, but they relate differently to elderly community involvement. Formal ties and sense of community have much stronger relationships with community involvement than informal ties and norms of collective action. Generalized trust is not significantly related to elderly community involvement.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.     

Health Maintenance Organizations

Health maintenance organizations and similar pre-paid health plans are an alternative form of health care available to Medicare beneficiaries in some areas of the country. While proponents of HMOs have argued that these plans may be better suited than fee-for-service medicine to provide care to an older population, HMOs have played a relatively small role in health care of the elderly. This paper traces federal health policy relating to HMOs and Medicare and describes obstacles to HMO Medicare programs stemming from those policies. It then examines the Massachusetts experience in HMO program development as a case study of how state policy can play a critical role in implementation of policy objectives at a local level. The paper demonstrates how an active state policy involving the executive and legislative branches, elder advocacy groups, and the private sector created a public-private partnership to develop HMO programs for the Medicare population. When this paper was completed, however, Medicare HMO development in Massachusetts was at a standstill, waiting for several critical problems of federal policy to be resolved.     

Community Responsibility for the Self-Neglectful Client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and in normal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

Physician Resistance to Innovations: The Case of Contract Medicine

Abstract

Physicians' assessments of contract medicine arrangements such as health maintenance organizations (HMOs) are considered in light of innovation diffusion theory and changing professional relations in medical care. Data from a national sample of physicians reveal that physicians practicing in HMOs differed from others in that they were more likely to be primary-care practitioners and politically liberal; they were also more likely to have thought that a physician surplus was emerging and that HMOs offered better working conditions. They did not differ from other physicians in job satisfaction. After considering differences between the two groups, the research examines how physicians, who did not practice in HMOs, viewed such contract medicine arrangements. Findings indicate that physicians in fee-for-service (FFS) practices felt that working conditions and service quality in HMOs are highly related and are better in FFS practices than in HMOs. In addition, physicians who anticipated heightened competition from HMO development were more likely to favorably evaluate HMO service delivery. The findings suggest accommodation to an organizational innovation if it is seen as preserving practice autonomy, but limited acceptance otherwise.     

Carers of People with Mental Illness from Culturally and Linguistically Diverse Communities

Australia is a multicultural country and it is common for families from culturally and linguistically diverse (CALD) communities to care for their relatives with mental illness. However, there are limited Australian studies examining the experiences of informal carers of people with mental illness from CALD communities. A scoping review was conducted to search for peer-reviewed articles reporting the perception of carers regarding their caregiving experiences, wellbeing, and needs. Using cultural responsiveness as a conceptual framework, this study analysed the findings of the identified studies to generate themes. Findings show that carers experience severe caregiving challenges and face considerably poor culturally oriented services in mental health. Social work implications concerning the need to provide culturally responsive practice in mental health services are discussed.     

Social Rights and Disability: the language of 'rights' in community care policies

Social rights and disability: the language of 'rights' in community care policies. The paper argues that what disabled people mean when they speak of 'rights' is relatively under-developed with regard to health and social services. Furthermore, while a claim of 'rights' is typically presented as a fairer alternative to the needs-based character of welfare policies, how such an approach would change the delivery of health and social care is unclear. The paper draws on a landmark test case in community care to explore the problems of a rights-based approach to social justice for disabled people. It demonstrates the weaknesses of rights, especially the more problematic 'social rights', and urges caution in seeking solutions to social problems through the courts. It ends by suggesting that, given the anecdotal evidence about local authorities' tightening their eligibility criteria in the light of the 'Gloucestershire case', that limits on coverage may be the trade-off for implementing rights.     

Community involvement in land regularization for informal settlements in Tanzania: A strategy for enhancing security of tenure in residential neighborhoods

This paper documents and analyzes how landholders managed to uplift status of their neighborhood from hazard land as designated by the 1978 master plan to a regularized residential settlement through land regularization in Dar es Salaam city. Specifically, explores policy framework governing land regularization and how the local community explored the opportunities it offers. Documents the local community planning and land regularization processes undertaken focusing on land use planning, drainage construction, and cadastral survey and discuses how financial resources were raised, trust was built as well as factors which sustained community involvement towards meeting their interests of securing tenure. The paper also, draws challenges facing land regularization policy and recommends areas for further interventions commensurate with the human dimension challenges in securing tenure.Underlying community involvement, those aspects of community, which have been connected to the idea of social capital namely existence of committed leadership in land development matters, embracing mechanism for participatory decision making process and educational background to local leaders were particularly important in determining success for the case. Others include economic ability to contribute, high proportion of landholder settlers, land conflict task force formulation, local consensus to solve commonly felt problems, existence of strong community organization, and unwritten norms put in place to regulate individual behavior in building construction. Weak legal recognition of informal settlement, lengthy and bureaucratic procedures in planning and approval of regularization plans, weak knowledge on land management matters, short-term title deeds with low financial betterments, political popularity are identified critical challenges.Some of recommendations put forward include formalization of the grass-roots role in decision-making, decentralizing some of land development control functions to sub-ward leaders and training the same in basic land management matters. Others include definition of norms; by-laws and government facilitation of informal land parceling. Besides community support should be sought so as to create partnership in the promotion of security of tenure in informal areas. The study concludes that, unless land development activities ongoing in informal settlements are closely monitored and regulated as the settlement grow, it will be too costly socially and economically to retrofit once the settlement have identified.     

Community resilience for youth and families: Facilitative physical and social capital in contexts of adversity

Studies that focus on community-level factors associated with the resilience of youth and families reflect a shift in perspective from community deficits to the potential of communities to facilitate the mobilization of human and physical resources. Physical and social capital (both informal relationships and formal service provision) give communities the potential to recover from dramatic change, sustain their adaptability, and support new growth. This paper reviews key concepts such as these as they relate to how young people access informal supports and formal services that promote resilience. A discussion of the relevant research highlights the way protective processes function when children, youth and families are exposed to catastrophic human-made and natural events. Five principles are suggested to help promote community resilience. Implications for the design and implementation of interventions are discussed with a focus on making informal supports more available and formal services coordinated, continuous, co-located, negotiated, culturally relevant and effective.     

Granny as Nanny: Positive Outcomes for Grandparents providing Childcare for Dual-Income Families. Fact or Myth?

The proliferation of dual-income families has led to the prevalence of grandparents providing child care in Singapore. The Chinese culture and values have tasked grandparents to fill the role of providing child care while mothers seek employment. Literature on grandparents providing informal care posits this situation to be a rewarding experience and a protective factor for grandparents’ stability in old age. This study uses the Social Relational Theory framework to examine the experiences of Chinese grandparents who provide care for dual-income families in Singapore. In-depth interviews were conducted to understand the experiences of the grandparents and common themes guided by the framework. Through the exploration of the narratives of grandparents, this study sieves out the issues they face in the Singaporean context and analyzes the motivations that spur grandparents to provide care for their grandchildren. Despite informal caregiving being positively framed in many studies, this study found that grandparents also faced a variety of challenges. Chinese grandparents were bound to the caregiving roles by cultural and familial obligations despite the high costs associated with providing care.     

Studying the particular, illuminating the general: community studies and community in Wales

This article is inspired by Frankenberg's (1990 ) claim that the best way to understand general social processes is through the study of their manifestation in the details of social life. We look at how studies of community that have been carried out in Wales, particularly Village on the Border and The Family and Social Change (Rosser and Harris, 1965), have accomplished this link between the particular and the general. We then consider the findings of our own research, which is a restudy of Rosser and Harris, showing how they provide a counterbalance to grand theoretical claims about the transformations that are affecting community and family life. We find that although factors such as increasing geographical mobility and women's greater participation in paid work affect people's experiences of community, people continue to place a high value on what they call communities. Such communities are spoken about and defined in different ways but all are based on local social networks of kin, neighbours and friends and/or locally‐based associations. They are also gendered, with women playing a key role at both informal and formal levels of community. We suggest that the apparent resilience of local social relations evident in our research may help to explain the continued cultural and political resonance of community in Wales.     

“A Bad Combination”: Lived Experiences of Youth Involved in the Foster Care and Juvenile Justice Systems

Youth with involvement in foster care and the juvenile justice system, often called dual-status youth, are at increased risk for negative outcomes as they transition into adulthood, including homelessness, and involvement in the adult criminal justice system. Increase of interest in the phenomenon of youth dual involvement within the last decade, reveals focus on challenges associated with the dual-status population, the importance of multi-system collaboration, and foster care factors contributing to juvenile delinquency. This study aims to build on the current literature, through exploration of how dually-involved youth make sense of their experiences in the juvenile justice and foster care systems; and what youth believe are their unique challenges of being in two systems? This phenomenological study engaged ten individuals in Houston, Texas, between the ages of 18 and 24 years old, and previously involved in the juvenile justice and foster care systems. Research subjects participated in-depth, semi-structured, and audio-recorded interviews, disclosing their experiences in two systems. Interviews were transcribed and entered in the qualitative analytical program, Atlas.ti, where common themes of participant responses were extracted. Accounts from participants highlighted three key experiences: (1) experiences of and leading to dual involvement, (2) traumatic experiences, and (3) absence of normalcy. Study results are categorized based on their pathways to dual-involvement. This current study offers rich insights into how dually-involved youth make sense of their experiences in the foster care and juvenile justice systems. Implications for enhanced service provision among child welfare and juvenile justice professionals are offered.