Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.     

‘If I was a different ethnicity,would she treat me the same?’: Latino parents’ experiences obtaining autism services

This article reports on an ethnographic study with 12 Latino families of children on the autism spectrum related to obtaining autism services in Los Angeles County. Using critical discourse analysis of interviews, observations, and records, we consider the experiences of the Latino families in relation to: a discursively constructed ‘autism parent’ subject position that mandates ‘fighting’ service systems to ‘win’ autism services for children, originating from White middle-class parents’ socioeconomic resources and social capital; a neoliberal social services climate that assumes scarcity of available resources and prioritizes austerity in their authorization; and a media and institutional ‘cultural deficit’ discourse that attributes disparities in autism services for Latino children to their parents’ presumed culturally-based ‘passivity.’ We argue that parental discourse about fighting, or not fighting, for autism services is engendered by a tension between a parental logic of care, and the logic of competition of the economic market.     

The system-of-care for homeless youth: perceptions of service providers

Service providers' perceptions of the system of care for homeless youth are described. Face-to-face structured interviews were conducted with staff at homeless youth agencies in Los Angeles County (L.A. County) regarding organizational and staff characteristics, issues affecting youth, types of available services, gaps in services, and barriers to service delivery.Overall, agencies were large, well established, and provided multiple services. Most agencies (62%) were concentrated in Hollywood, a cruise area of L.A. County. Clear distinctions emerged between large and small agencies; large agencies had more resources, more professional staff, were established longer, and were policy advocates. Typical of other US metropolitan areas, services for homeless youth in L.A. County are located in cruise areas, and are not as readily available in other geographic areas. Such geographic barriers to providing a comprehensive and coordinated system of care can affect youth's pathways out of homelessness.     

The Relationship Between Sexual Minority Verbal Harassment and Utilization of Health Services: Results from Countywide Risk Assessment Survey (CRAS) 2004

In this article we examine the prevalence of and associations between sexual orientation–based verbal harassment and reported utilization of health services across levels of sexual orientation in a diverse sample of adult recipients of Los Angeles County–funded HIV-related health and social services. Thirty-two percent reported they had experienced verbal harassment, the majority (80.3%) of whom identified as lesbian, gay, or bisexual (LGB). Those who reported being verbally harassed received significantly more services overall than those who were not verbally harassed, and service utilization varied by sexual orientation. These findings inform future efforts to identify and assess social discrimination in health and social service settings.     

Drug use,prostitution and the prevalence of AIDS: An analysis using census tracts

This paper reports on preliminary efforts to study at the census tract level the reciprocal relationships between AIDS and street crime, particularly prostitution and drug offenses and the prevalence of AIDS. The Los Angeles County Department of Public Health provided the number of reported AIDS cases by census tract. The data on reported crimes and arrests, organized by reporting districts, came primarily from the Los Angeles County Sheriff's Department and the Los Angeles City Police Department. Although this strategy needs replication and extension, the present findings suggest that sexual orientation, drug use and prostitution are useful risk variables at the census track level.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Quality of care for youths in group homes

This paper analyzes findings pertaining to quality of care issues concerning group home care for adolescents in the greater Los Angeles County area during 1978-1979. The issues include normalization, institutionalization, treatment goals, continuity of care, and qualifications of child welfare staff, particularly child care workers. Recommendations for improvement are offered.     

Child abuse and neglect in Cambodian refugee families: characteristics and implications for practice

This study examines the characteristics and patterns of child maltreatment among Cambodian refugee families in Los Angeles and assesses the implications for child welfare practice with Cambodian refugee families. Data were extracted from 243 active Cambodian case files maintained by the Los Angeles County Department of Children and Family Services (LAC-DCFS). Some of the major findings include (1) Cambodian child maltreatment cases were most frequently reported to the LAC-DCFS among various Asian Pacific ethnic groups; (2) Cambodian refugee families were more likely to be charged with neglect, while their Asian Pacific counterparts were more likely charged with physical abuse; (3) the circumstances under which maltreatment occurred most frequently were parental substance abuse and mental illness; and (4) while fathers who maltreated their child were likely to use alcohol, mothers were also more likely to have a mental health problem such as depression. This study suggests the importance of collaboration between Child Protective Service agencies, substance abuse programs, traditional healers, mental health services, and other social service agencies for effective child abuse prevention and intervention efforts.     

How Do They Fit?

Abstract

Despite public policies that promote an increased role for faith-based organizations in the delivery of publicly supported services, insufficient attention has been paid to assessing how service delivery by faith-based and secular providers might differ. This study considers the issues involved in evaluating the role of faith-based organizations within the broad context of a community's social service offerings. Criteria are developed for assessing role differences by comparing the types of services, delivery approaches, and service locations offered by different types of providers. The approach is then illustrated using a large sample of social service providers in Los Angeles County. Important role differences are revealed. Faith-based organizations offer fewer and different types of services than their secular counterparts. The results suggest a modest and focused role for faith-based organizations in social service delivery, but one that is complementary to the efforts of secular providers. The methodological issues raised by such analyses are highlighted.     

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) who had been placed in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9–12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR = 2.50, p = .06) and/or educational (OR = 3.54, p = .04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.     

Los Angeles County Fiduciary Abuse Specialist Team: A Model for Collaboration

ABSTRACT

The Fiduciary Abuse Specialist Team, sponsored by the County of Los Angeles Area Agencies on Aging, provides expert consultation and training to protective services and other practitioners in cases of elder financial abuse. Collaborative teams efforts facilitate prompt and well coordinated interventions.     

Point of engagement: reducing disproportionality and improving child and family outcomes

This paper describes an innovative service delivery model to reduce the number of children entering the child welfare system. Point of Engagement (POE) is a collaborative family- and community-centered approach initiated in Compton, a regional office in Los Angeles County that serves south Los Angeles, a predominantly African American and Hispanic/Latino area. Over the past two years, the POE has been implemented in the Compton area by providing more thorough investigations, engaging families, and delivering needed services to children and families within their homes and communities. POE has demonstrated a reduction in the number of children removed from their families, an increase in the number of children returned to their families within one year, and an increase in the number of children finding legal permanency.     

Strategies for improving child welfare services for families of color: First findings of a community-based initiative in Los Angeles

A disproportionate number of families served in child welfare are families of color. But relatively few strategies for helping families of color have been monitored for their impact. This article reports early findings from a Los Angeles County based public child welfare office that has continuously developed, tracked, and has now begun to assess strategies supporting preservation and reunification of families of color. Some promising trends revealed by a four year data period include the reduction of number of African-American children within the caseload, reductions in substantiated referrals and removals. The most recently developed strategy, which uses specialized four person case management teams, was evaluated through the use of a comparison group. Public agency data revealed that families served by the team, compared with families served through customary agency services, had improved outcomes, including a higher percentage of cases closed with the child remaining in the home, and greater permanency exits from foster care. Additionally the data revealed that the case management team developed to mitigate disproportionality among African-American families also improved outcomes for Hispanic/Latino families.     

Influences on the Size and Scope of Networks for Social Service Delivery

Local social service agencies throughout the world have begunencouraging or requiring social service providers to form community-basednetworks for the delivery of publicly funded social services.Little is known, however, about the nature of the resultingnetworks. In this article we develop a model of organizational,programmatic, and community influences on the size and scopeof interorganizational networks for social service delivery.We then apply this theoretical framework to an empirical studyof service delivery networks in the Family Preservation Programin Los Angeles County. Our findings suggest that the availabilityof potential partners in the community, the scope of requiredservices, and the ethnic homogeneity of the client populationare key determinants of network size. We develop the implicationsof the results for theories of partnership formation and formore effective management of network formation processes.     

'The more things change…': Barriers to community services utilisation in Queensland

Community services are central to the lives of many elderly Australians or Australians with disabilities if they are to remain in the community. Over the past two decades, significant advances have been made in policy and associated programs, significantly improving the standards of service delivery. This research reports on the perceptions of service providers in community services for people with disabilities in six communities in Queensland. It illustrates that significant barriers to service utilisation remain, despite reform. It suggests that continuous efforts to promote service access need to be built in at the program level.     

Factors in the Transition to Homelessness in the Chronically Mentally III

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for the previous year were significantly correlated with TBH Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Introducing Technology in Child Welfare Referrals: A Case Study

Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services, however, varies by caseworker and can be cumbersome and time consuming. The Department of Children and Family Services (DCFS) Needs Portal is an Internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations, and user feedback obtained from the Needs Portal to (a) determine perceived benefits and barriers to adopting the Needs Portal, and (b) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: (a) caseworker apprehension regarding new technology, (b) variation in communication styles by user type, (c) lack of technological infrastructure, and (d) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although Internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

‘Like a fish in a bowl’: parents' perceptions of child protection services

This research involved a small qualitative study focused on family experiences of child protection practice, commissioned as part of a Best Value review of child protection services in a large rural Midlands local authority. Qualitative interviews were undertaken with 18 families who had received child protection services. Findings were mixed in relation to perceived helpfulness of the processes of child protection interventions, with 50% of families reporting some positive bene?t and 22% reporting that such interventions had caused them harm. From the families' perspectives, factors that are associated with positive and negative outcomes are outlined. These include the availability of preventive services, crisis support, respite care, actual provision of services speci?ed in protection plans and an engaging style of practitioners. Conclusions emphasize the value of research focused on family perceptions of services as an important contribution to quality control and service development in child protection service provision. Copyright © 2004 John Wiley & Sons, Ltd.