INTENSIVE ASSESSMENT FOR “INTENSIVE ASSISTANCE”: UNEMPLOYMENT,MENTAL HEALTH AND THE NEED FOR HOLISTIC ASSESSMENT OF LONG‐TERM UNEMPLOYED PEOPLE

This article will comment on recently announced changes to the Intensive Assistance (IA) program and to the Community Support Program (CSP) as they relate to the assessment of mental health and similar issues in recipients of unemployment benefits. It will be argued that proposed resources to be spent on assessment of IA clients and increased funding and numbers for the CSP are much needed alterations and should be welcomed. It will be argued that agencies assisting IA clients risk significant underestimation of mental‐health and related issues in their clients if they rely only on Centrelink's Job Seeker Classification Instrument (JSCI) as a screening tool and do not expend resources on additional professional assessment. The reasons behind failure of such issues to be easily identified in the current system include difficulty in administration of the JSCI, fear of disclosure by the client, client ignorance of their condition and its relevance to work‐ability, the lack of mental‐health expertise in private sector employment agencies and the current high cost. of purchasing professional assessment. Recently announced changes to IA and the CSP appear to allow for considerable improvements in identifying and managing these issues.     

The importance of clinician courtroom testimony for children exposed to domestic violence

Children exposed to domestic violence account for as many as a third of all children in the United States. Many of these children will seek mental health treatment for symptoms of trauma. The clinicians who provide their treatment are often called as witnesses in family law proceedings, especially child protection and custody cases. Clinicians are often anxious when they receive subpoenas to testify and prefer to avoid testimony. Training about court proceedings, subpoenas and how to prepare for testimony would be beneficial for clinicians and will help clinicians be more confident in the courtroom. Additionally, becoming designated as expert witnesses can only help mental health clinicians provide a greater understanding of the issues encountered by children experiencing domestic violence, and these clinicians can provide recommendations that will take into account child safety without exacerbating trauma symptoms.     

Increasing Client Voice within Involuntary Groups

Partners for Change Outcome Management System (PCOMS) is a client-driven outcome management system that has been proven effective with engaging voluntary mental health client populations through several randomized clinical trials. Little is known, however, about PCOMS application to clients who are court ordered or pressured to attend group programs. This study (N = 10) interviewed group facilitators who use PCOMS with involuntary groups. Participants strongly endorsed the use of the instruments to increase client voice, respond supportively to client incongruence, and focus on client responsibility for change. Guidelines for application to involuntary groups and research and practice implications are discussed.     

Practices of activation in frontline interactions: Coercion,persuasion, and the role of trust in activation policies in Germany

Following Michael Lipsky's well‐known argument that policy is made in the daily encounters between street‐level bureaucracy and citizens, a growing body of research emphasizes that actors and organizations delivering social and labor‐market policy play a crucial role in welfare‐state politics. Using qualitative data collected at three local employment agencies in Germany, this article explores worker‐client relations as a crucial mechanism through which activation policies are translated into practice. The analysis investigates how caseworkers define their role and their relationships with clients. The findings show that it is essential for caseworkers to achieve client compliance. In such a context, building relationships of trust is a strategic instrument in overcoming possible barriers to co‐operation in the caseworker‐client interaction. Caseworkers develop strategies to create the impression of trustworthiness and to motivate both unemployed clients and employers to become trust‐givers in the caseworker‐client relation. While research has often stressed the dichotomy between disciplining and enabling elements of activation policies, our explorative study shows that persuasion and trust‐building are a further important dimension of the frontline delivery of activation policies. These strategies reflect the importance of emotional aspects of frontline work.     

To disclose or not to disclose: Political conflicts in the countertransference

Self‐disclosure is a frequent topic in the relational psychotherapy literature. However, there are few psychoanalytic writings or empirical studies that concern self‐disclosure in the context of cross‐cultural treatment; specifically treatment between Israeli therapists and Palestinian clients. This particular subject broadens the investigation of cross‐cultural treatment beyond race and color into the domain of religious and political differences between client and clinician. An Israeli‐American therapist's counter‐transference reflections around self‐disclosure and its impact on her Palestinian client will be the subject of investigation in the following paper.

Self‐disclosure has been increasingly examined in the relational literature over the past ten years in the context of the therapist's subjectivity within the therapeutic encounter (Aron, 1991; Renik, 1995). Few psychoanalytic writings, however, have focused on self‐disclosure as embedded within race and culture, and fewer still address the impact of religious and political differences between client and therapist, differences that, in the case of a Palestinian client and an Israeli therapist, reflect larger social and political conflicts. The transference‐countertransference dynamics around self‐disclosure and the way these shape the therapeutic encounter between a Palestinian client and an Israeli therapist will be the subject of investigation in this paper.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.     

Performance measurement: the new accountability

Over the years, "accountability" in the human services has focused upon issues such as the legal framework, organizational management, financial responsibility, political concerns, and client inputs and expectations. Within the past decade, the meaning of "accountability" has been extended to the more dynamic organizational functions of "efficiency" and " effectiveness." Efficiency and effectiveness increasingly must be put to the tests of performance measurement and outcome evaluation. Forces outside the social work profession, including, among others, federal expectations and initiatives and the increased implementation of the concept of managed care, will ensure that efficiency and effectiveness will be central and highlighted concerns far into the future. This "new accountability" is demanded by the stakeholders in the nonprofit sector and by federal requirements built into the planning, funding, and implementation processes for nonprofits and for-profits alike.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

The Fieldwork Team Response: An Investigation into the Relationship between Client Categories, Referred Problems and Outcome

Correspondence to Peter C. Burke, Lecturer in Social Work, Department of Social Policy and Professional Studies, The University of Hull, Hull HU6 7RX. Summary This paper concerns a study of the outcome achieved followingfieldwork responses to referred client problems within particularclient categories. The evidence from the study demonstratesthat while referred client problems initiate the social workresponse, administratively assigned client groups were a betterdeterminant of outcome. It is shown that the category of a caseis more directly related to outcome than is the problem referred.If social work is to be predominantly based on client categorizationthen polarization will result, represented by an increasinglyprofessional child care practice and a more basic servicingrole for the worker with elderly and handicapped people. Thispresents dangers for the organization of teams, the allocationof resources, and the training of social workers. Taking accountof client problems as part of caseload management should reducethis effect.     

Familial caregivers of older adults

Caregivers of older adults face many obstacles as they balance family, career, and caregiving demands. Caregivers are at an increased risk for burden, stress, depression, and a variety of other mental and physical health complications. It is not uncommon for caregivers to receive some form of pharmacological therapy to treat the physical and mental health changes that may occur throughout their caregiving career. However, while pharmacological forms of treatment are invaluable, medications only may not be sufficient to treat the needs of caregivers. As such, geriatric professionals also have a responsibility to intervene with caregivers through psychosocial interventions. This paper provides an overview of caring, a summary of evidence-based psychosocial interventions for family caregivers of older adults, and recommendations for future interventions.     

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

ABSTRACT

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

The Influence of Client Age on Clinical Judgements of Male and Female Social Workers

Social workers were presented with a clinical vignette in which client age was systematically varied. There were no differences in ratings of older and younger clients on prognosis or pathnology. The older client was not seen as less ideal or more organically impaired, and treatment recommendations did not differ. However, female social workers attached significantly less importance to psychodynamic issues for the older client than the younger.     

Strategic framing to influence clients’ risky decisions

Theory and Decision - This paper develops a model of persuasive demand inducement in the expert–client relationship. The expert frames the decision on whether or not to buy expert services...     

Ethics and research assessing the relative roles of genes and the environment

Research on the interaction of genes and the environment is revealing that many human diseases have both genetic and environmental components. Even traditional "environmental" diseases, such as infections, appear to interact with genetic components in the human host. Environmental genetics research will inevitably increase understanding of individual susceptibilities to toxic exposures in the environment and harmful side effects of medications; therefore, it has great promise for improving the prevention and treatment of human diseases. However, realizing the benefits of this research requires careful attention to ethical issues that are particularly relevant in this context. This article reviews some of the most pressing issues related to research design and methods, as well as from the application of research results (e.g., workplace genetic screening and legal toxic torts, personal medical responsibility, and the relationship between genetics and public health measures).     

Ethics and Research Assessing the Relative Roles of Genes and the Environment*

Research on the interaction of genes and the environment is revealing that many human diseases have both genetic and environmental components. Even traditional “environmental” diseases, such as infections, appear to interact with genetic components in the human host. Environmental genetics research will inevitably increase understanding of individual susceptibilities to toxic exposures in the environment and harmful side effects of medications; therefore, it has great promise for improving the prevention and treatment of human diseases. However, realizing the benefits of this research requires careful attention to ethical issues that are particularly relevant in this context. This article reviews some of the most pressing issues related to research design and methods, as well as from the application of research results (e.g., workplace genetic screening and legal toxic torts, personal medical responsibility, and the relationship between genetics and public health measures).     

Social service systems for vulnerable children and families in low‐ and middle‐income countries: Establishing definitions and key components

Systems strengthening in low‐ and middle‐income countries has long been a topic of concern in global health. By comparison, until very recently, little attention has been paid to the importance of strengthening social service systems to provide a holistic perspective of children's and families' multifaceted strengths and vulnerabilities. This study has reviewed existing literature on the definitions and components of social service systems and provides an analysis of data from key informants in the field of global social welfare. Based on this information, a set of key components is presented and compared, derived from the literature and expert interviews. Existing challenges for the field include establishing consensus on terminology and critical components, implementing and documenting critical components, and linking these components to client outcomes.     

Decentring the NHS: A Case Study of Resource Allocation Decisions within a Health District

The aim of New Labour's health policy is to shift more of the balance of power and responsibility for services to the local level. But, while the government proclaims a new decentralized NHS, doubts exist about the extent to which the reality on the ground matches the tone of policy. This article reports empirical work examining the level of autonomy purchasers have over budgetary allocation. A case study analysis of purchasing within a single district was undertaken for the financial year 2001/2 which included semi‐structured interviews with key officers responsible for budget allocation. Purchasers approach a new financial year with a starting position that matches the previous year's allocation—the “baseline”, this is adjusted for inflation and, as has happened over the last few years, increased further in real terms by “growth funds” for service modernization and government initiatives. The analysis shows a clear dissonance between policy and practice; although purchasers have complete control over their “baseline budgets”, the study found that this does not “ring true” at the local level. Only about a fifth of growth funds were at the discretion of purchasers as most are taken by national priorities and pay and price inflation. Further decentralization is planned, which includes transferring more control of funds to primary care trusts by 2004, the extent to which these measures will change the perceptions of those working in the service remains to be seen—only then will the government be able to claim a truly decentred service.     

Treatment Compliance in Social Work

This paper provides an overview of the area of client compliance with treatment regimens. The definition of compliance and rationale for social work involvement in compliance research are presented. Recommendations for specific topics and methodological procedures for social work research are also discussed.     

Professional Dissonance

Abstract

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