Social Work,Knowledge and Social Responsibility

A beginning has been made in regarding the mentally retarded as people of worth and dignity in our society. As the social work profession endeavors to find ways to bring significant service to the retarded, social work education must respond and prepare practitioners for this specialization. The student's preparation must include substantial cognitive background, as well as emotional maturity and the ability to objectify and quantify case movement in extremely small steps. Basic concepts and principles of helping people are briefly reviewed as they relate to work with the mentally retarded.     

Large-scale changes in the German residential care system during the 1980s

In West Germany during the 1980s extensive and encompassing reforms took place in residential care. These reforms involved completely new approaches such as non-institutional individual care. This paper examines the question of how non-institutional individual care was able to establish itself on a national basis in the West German youth services while, at the same time, other innovations failed to take hold. The reasons presented here involve: specific historical contextual conditions; certain qualities of agents' actions; and changing education and labour market policies, particularly the rapid increase in the professional workers in the youth service during the 1970s and 1980s. These and other factors led to an alteration of collectively shared interpretation schemes within residential care that called into question the closed forms of prison-like residential care of children and young people. These changes, however, led to problems in areas where youth services encountered other professional and societal systems, which continued to expect that youth services deal with youth delinquency in a custodial manner. New forms of treatment were needed which would be accepted by other services and wider society, while at the same time being compatible with changing ideas in the youth services. Non-institutional individual care was able to assert itself in this situation, in contrast to other innovations, because of the key abilities of the agents involved in its development, primarily as a result of their ability to create strategic alliances to support change.     

Mental Retardation: Social Construction or Clinical Reality?

In this paper issues relating to the social construction of mental retardation are raised. The writings of a group of six people, diagnosed as moderately mentally retarded, are used to highlight several areas of debate. It is argued that labelling people as mentally retarded, particularly those deemed mildly or moderately retarded, is not necessarily of benefit to those individuals. Furthermore, this process establishes and perpetuates the notion that people so-called are incapable of acting in their own best interests. The work of the six people used in this paper challenges these notions, and suggests that many people who are labelled as mentally retarded are aware of their needs and are able to express these coherently.     

On the margin? Residential child care in Scotland and Finland

Situated on the margins of Europe, Scotland and Finland are small countries which share similar demographic and economic profiles. In many European countries, residential child care can also be considered to be ‘on the margin’ of child care provision; there is ambivalence about residential care and a view that it should be used as a last resort. This paper examines systems and practices of residential care in Scotland and Finland, locating these in the context of wider child welfare policy in both countries. The underpinning principles of child welfare provision in both countries are similar—based on children's rights and primarily family-focused. In both countries there are also similar concerns about the fragmentation of child care provision and the cost of residential services. However, there are also important differences relating to child welfare provision and the use of residential care. In Finland, overall numbers of children in residential care are much greater than in Scotland; the age profile of these children and young people is very different; and the two countries vary markedly in the use of secure accommodation and custody. This comparative analysis suggests new ways of understanding the similarities and difference in the use of residential care in the two countries. It highlights the continuing challenge to develop residential care as a positive and integral part of a continuum of care services.     

Psychopathology and behavioral problems in mental retardation

1. The lack of psychiatric services for the mentally retarded is of particular concern for advanced practice nurses in psychiatry. 2. Prevalence of psychopathology and behavioral problems in the mentally retarded appears to be significant. 3. For purposes of diagnostic clarity, a thorough mental status and neurological examination specifically devised for the mentally retarded population must be utilized.     

Voices of 65 Young People Leaving Care in Sweden: “There Is So Much I Need to Know!”

Abstract

The purpose of this study is to examine young care leavers’ experiences of supportive and nonsupportive factors after leaving care. Telephone interviews were conducted with 65 young people, between 18 and 26 years old, who had left care in Sweden within the previous 3 months to 3 years. The care-leaving process was in many cases described by the young people as badly planned and compressed. Some interviewees received support from the formal network (social services, foster carers, residential homes, contact persons) for housing (37) and financial matters (36), but few received support from the formal network concerning employment (14) and education (11). Emotional support was mainly provided by partners and friends. Altogether, the results suggest that access to support is a helpful factor for young people leaving care, but also that many of our interviewees had no such access, from neither formal nor informal networks.     

Service providers to the homeless mentally Ill: Their thoughts,perceptions, and recommendations for the homeless

A qualitative research study was conducted to obtain an understanding of the people who provide services to persons who are homeless and mentally ill. Service providers were asked about the kinds of services they provide, what they consider beneficial to this population, the kinds of services they would like to provide, and what is needed to alleviate the homeless problem. Services found in the study included, those that meet basic needs, psychiatric/medical services, social services, and activities. Service providers indicated the major service priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social services, (c) day programs, and (d) health care. It is recommended that service providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Recognizing Abuse and Neglect in People with Severe Cognitive and/or Communication Impairments

ABSTRACT

It is widely acknowledged that physical abuse of persons with severe developmental disabilities is prevalent, usually perpetrated by a residential care provider and is rarely reported. However, no solid research on the topic has been reported. This article notes the lack of information about protective services directed to the developmentally disabled population and lack of coordination between agencies serving people with developmental disabilities and those providing protective services. The signs and symptoms of abuse in the developmentally disabled population, the alternative communication strategies required when interviewing, and the special skills needed for case assessment are presented. The author ends with a series of federal, state, and community level policy recommendations.     

Conceptualizing psychosocial nursing in the jail setting

1. The deinstitutionalization movement led to the release of thousands of mentally ill patients, many of whom were incarcerated as a way of dealing with their disturbed behavior. More restrictive civil commitment laws have also contributed to the number of mentally ill who are incarcerated. 2. Health care and security can be perceived as competing interests in the correctional institution. These competing interests may also be perceived as sources of conflict because each interest aims towards divergent goals that interfere with the other. 3. A problem central to the inadequate services for the mentally ill offender is that few people are aware of the poor conditions for this population. Correctional and mental health organizations must educate the public about the plight of the mentally ill offender.     

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.     

The integration of child care services in Scotland

This paper describes the development of integrated child care services in Scotland with a particular focus on the role of residential child care provision. It discusses changes in Social Work Department policies and the impact this has had on their relationship with the Children's Hearings system. Recent research shows the pattern of use of residential and foster care in three Social Work Departments and issues in the development of residential services are identified. Three particular examples of service integration are described: residential outreach work; a centre for young people under an integrated management; and multi-agency youth strategies. Social work and education services in Scotland are in the process of radical change. In the context of the integration of child care services, the paper discusses the impact of local government reorganisation and changes in child care legislation.     

Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

Service Providers to the Homeless Mentally Ill: Their Thoughts,Perceptions, and Recommendations for the Homeless

A qualitative research study was conducted to obtain an understanding of the people who provide senvices to persons who are homeless and mentally ill. Selvice providers were asked about the kinds of selvices they provide, what they consider beneficial to this population, the kinds of selvices they would like to provide, and what is needed to allevwte the homeless problem. Selvices found in the study included, those that meet basic needs, psychiatric/medical selvices, social setvices, and activities. Service providers indicated the major selvice priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social selvices, (c) day programs, and (d) health care. It is recommended that selvice providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

Delivery of dental care to persons with disabilities and other special populations

Although humankind has long suffered from dental ills, and despite progressive efforts by the field of dentistry to provide dental healthcare in a compassionate and anxiety-free manner, the profession of dentistry has suffered a tarnished reputation. Going to the dentist is considered painful and induces fear among most people; however, this mindset is changing. Dentists of today are beginning to take their rightful place as integral members of the health care team, including disability management initiatives. The public and other health care providers are beginning to recognize the importance of oral health to the overall health of the body. Dental care is a vital component to rehabilitation planning. Unfortunately, some government agencies, insurance companies, and other policy making bodies have failed to grasp the importance of this concept. Also, professionals within the field of dentistry have not fully grasped the important of continued dental care for persons with disabilities, geriatric patients, the deinstitutionalized, and others in need of rehabilitation services. Problems associated with the delivery of dental care to patients with disabilities are discussed.     

‘Our young people are worse’: family backgrounds,educational progression and placement options in public care systems

Introducing continental European approaches to UK child welfare practice raises a problem of comparison: to what extent are the problems and issues similar to or different from one country compared to another. Social pedagogues trained in continental Europe and working in English residential care services often encountered the phrase ‘our young people are worse’ from their English colleagues, with the implication that the social pedagogic approach was not suitable for the client group. This paper examines two propositions: (1) that in the context of introducing the continental European approach of social pedagogy into children's residential care services in England, young people are ‘different’ in England compared to other European countries and (2) that the placement options and practices for young people living away from their birth parents in continental European countries differ from those in England. Using data from a five nation study of young people from public care backgrounds, the paper argues that while family backgrounds are remarkably similar there are marked differences in the child welfare systems that might account for the perception that young people in care are ‘worse’ in England.     

The normalization of social interaction: When shared assumptions cannot be assumed

This article presents data gathered during a participant-observation study of an educational program for adults identified as mentally retarded. The difficulties inherent in trying to make retarded people appear normal (normalization) and the implications of these for the study of social interaction are examined. “Normal” social interaction is shown to depend upon a huge body of tacit knowledge as well as an assumption by the participants that they share a common understanding of the situation at hand.     

The use of institutional care for children across europe

This article describes the use and prevalence of institutional or residential care of children in Europe. It looks at systems in Western European countries and in countries of Central and Eastern Europe and discusses some of the difficulties in making comparisons across and within Europe. The author takes a wide view of the available literature, government and non-governmental statistics and case studies across the continent of Europe. Taking account of regional and national variations, he describes two broadly different approaches for children and their families and identifies trends in institutional and non-institutional care in the continent of Europe.

In Western Europe there has been a marked reduction in the use of residential care, accompanied by the development of non-institutional family based care and support services. Whilst there are good child-centred reasons for this shift in provision, some countries have gone too far in reducing residential care and are facing a shortfall in suitable foster carers. The financial costs of both residential and family based services remain high at a time of resource restraints. In the countries of Central and Eastern Europe some family based alternatives to institutional care are emerging, usually within the international non-governmental sector. However, children in out-of-home placements throughout the region continue to enter, and remain in, the same kinds of large, isolated and impersonal institutions that existed before the economic and political changes of the late 1980s.

The writer uses his teaching experience in Romania over the past four years to illustrate the development of small-scale social work initiatives in that country and calls for further developments in legislation and policy to support the practice of the emerging profession of social work.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

Young people's views of children's rights and advocacy services: a case for ‘caring’ advocacy?

This paper looks at some preliminary findings from research with young people in foster and residential care in the UK who have received advocacy services from a range of local authority and voluntary agencies. The study also includes the views of professionals, from both children's rights and social services. The initial findings highlight the importance to young people of their relationship with rights professionals. They speak about the value to them of care and respect, aspects not always seen as fundamental to rights work. Caring, in its various guises is seen by young people as a vital component of their relationship with children's rights workers. They also see this as important within advocacy work itself since caring about the outcome is often key. A pure individual rights focus with an emphasis on challenge and ‘being heard’ may not take account of the complexity of their situation and may pose difficult dilemmas for young people, especially in dealings with their carers. This ‘caring’ advocacy is not the paternalistic approach of a professional who ‘knows what's best for you’ but is a model based on a strong awareness of ways that young people are excluded and oppressed. It is also about placing a positive value on their contribution as citizens and links to a view of society that gives importance to an ethic of inter‐relationship and care as well as an ethic of individual rights. Copyright © 2007 John Wiley & Sons, Ltd.