Working with Homeless Populations to Increase Access to Services: A Social Service Providers’ Perspective Through the Lens of Stereotyping and Stigma

Through the lens of stereotyping and stigma, this article examines discrimination and prejudice toward homeless families from the perspective of social service providers. Semi-structured qualitative interviews were conducted with practitioners. A critical social work practice perspective is used to provide a framework for understanding how social worker knowledge about discrimination and prejudice informs the ways in which the workers engage with clients, build capacities, and advocate for clients in an anti-oppressive manner. The themes found in this study include: a) providers’ awareness of bias, stereotyping, prejudice, and discrimination; b) providers’ use of a range of strategies to work with people experiencing homelessness; c) providers’ ideas about strategies that organizations can implement for service provision; and) providers’ belief that additional advocacy and policy are needed in relationship to people experiencing homelessness.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

BRINGING CLIENTS BACK IN:

Using qualitative data from a cohort sample of 76 current or former Wall Street professionals, I argue that the perception that clients prefer homophily with their service providers shapes Wall Street careers and contributes to gender inequality. I also reveal how some women on Wall Street partially insulate themselves from biases against them by deliberately avoiding positions that are most dependent on client relationships. I hypothesize that the strength of client preferences for homophily in service providers in the Wall Street context is related to the high status of this service profession and its clients.     

How Heterosexism Plagues Practitioners in Services for Lesbians and Their Families

Barriers to services for lesbians and their families have been well documented in the literature (DeCrescenzo, 1984; Harris, Schatz, & O'Hanlan, 1994; Nightengale, & Owen, 1995; Mallon, 1998), especially among medical professionals and social service providers. This study seeks to explore the prevalence of heterosexism and homophobia among mental health practitioners who identify as qualified providers for lesbians and the recipients' perspectives regarding the services they have received. Of the twenty-five practitioners who responded, 48% of them “knew personally of incidences of professional bias against lesbian clients.” Interestingly, only 26% of the 98 families reported heterosexual bias from their providers.     

Domestic Violence Service Providers’ Needs and Perceptions of Technology: A Qualitative Study

There is growing recognition of the need to better understand the intersections between the work of domestic violence service providers and technology. Professionals who work with clients impacted by domestic violence are increasingly using technologies across different aspects of their work, including communicating with other professionals and seeking information and resources via the Internet. The current study used qualitative data from two sources—individual interviews and two focus groups—to learn about domestic violence service providers’ needs and perceptions related to technology use. The results provide insights about technologies used currently, expected benefits of future technological advances, barriers to using technology, and participants’ self-rated levels of comfort with technology.     

Service providers' modes of interacting with frail elders and their families: Understanding the context for caregiving decisions

The purpose of this study was to explore the professional context within which frail elderly individuals and their families operate as they make decisions regarding caregiving. The findings serve to improve our understanding of the nature of the interface between the informal structures of families and the formal structures of the service-provider network. Designed as an exploratory qualitative study, the research process involved one-on-one interviews with providers from 9 areas of service related to elder caregiving. Specifically, analysis of the data revealed 4 provider styles or modes of interacting with elders and their families: Listener, Educator, Encourager, and Advocate. The most frequent mode was Educator, with 7 of the 9 providers referencing it more often than any other mode. The least frequent mode was Listener, with 5 of the service providers referencing it the least often. Implications of these findings for service providers lie in better understanding of how preferences for one style or another may affect their communication with clients. For families, the implications lie in understanding ways to more effectively interact with the formal network of providers in order to have their needs adequately addressed. Further, educators or counselors may be able to use these results in helping families improve their access to resources and services, and in helping providers better serve the needs of clients.     

Overconfident health workers provide lower quality healthcare

While a growing body of evidence suggests that healthcare workers in low and middle-income countries often provide poor quality of care, the reasons behind such low performance remain unclear. The literature on medical decision-making suggests that cognitive biases, or failures related to the way healthcare providers think, explain many diagnostic errors. This study investigates whether one cognitive bias, overconfidence, defined as the tendency to overestimate one’s performance relative to others, is associated with the low quality of care provided in Senegal. We link survey data on the overconfidence of health workers to objective measures of the quality of care they provide to standardised patients – enumerators who pose as real patients and record details of the consultation. We find that about a third of providers are overconfident – meaning that they overestimate their own abilities relative to their peers. We then show that overconfident providers are 26% less likely to manage patients correctly and exert less effort in clinical practice. These results suggest that the low levels of quality of care observed in some settings could be partly explained by the cognitive biases of providers, such as overconfidence. Policies that encourage adequate supervision and feedback to healthcare workers might reduce such failures in clinical decision-making.     

Lesbian Survivors of Intimate Partner Violence

Abstract

Service barriers of lesbian domestic violence survivors were identified from the perspectives of six service providers using qualitative interviews. Constant comparative methods identified service barriers including: Systemic barriers (laws and policies of criminal/justice system, social and cultural attitudes, and theories regarding domestic violence dynamics), institutional barriers (ambiguous and inconsistent policy, assigning lesbian clients to specific staff members, lack of commitment to serving lesbians, and using heterosexist language), and individual barriers (attitudes/actions of lesbian survivors, heterosexual female clients, staff members, and police/court officers). Participants expressed motivation to serve lesbian survivors and indicated the potential to influence institutional policies and practices.     

Applying marketing management and communication management theories to increase client retention in the short-term insurance industry

Businesses must retain their clients to remain profitable. The academic field of marketing management considers customer relationship management (CRM) as most appropriate to achieve this, while communication management focuses instead on public relations (PR). The purpose of this research was to analyse theories in these two disciplines and derive an integrated theoretical framework of CRM and PR client retention. The framework was then tested through in-depth interviews with short-term insurance clients and short-term insurance providers (brokers and direct insurers) in South Africa to gain perspectives from both sides. The importance of some fundamental elements found in literature were affirmed, two elements’ importance were questioned and it was established that three inconsistencies existed between what providers regard as essential to retain clients and what clients regard necessary for them to stay in a relationship with an insurance provider. This may explain the many unsuccessful client retention efforts of South African brokers and direct insurers. Six new CRM and/or PR elements, not found in literature, are presented in the article for exploration in future research. In order to assist client retention in the very competitive short-term insurance industry, results were applied to the core tenets of Niemann's (2005) SA model for the implementation of strategic integrated communication (IC). Finally, the authors present an integrated approach to client retention strategies in the South African short-term insurance industry, incorporating both marketing and communication theories.     

Funneling Child Welfare Consumers into and through the Mental Health System: Assessment, Referral, and Quality Issues

This qualitative study explores how consumers of child welfare services reach nonpsychiatric mental health providers and the perceived quality of these services. It relies on iterative interviews with individuals and groups, as well as on court observations from one metropolitan area. Results suggest that, consistent with theories of street-level bureaucracy, efficiency issues drive mental health service use, as clients are routinely subjected to psychological evaluations and funneled into mental health services as a matter of course. Referral practices are shaped by child welfare professionals' routines, discretion, and desire to meet such system objectives as providing short turnaround times for reports. The results suggest that, despite stakeholders' best intentions, maltreated children are not benefiting from thoughtful processes geared to screen for, assess, and provide targeted treatment for unmet mental health needs.     

Cost effectiveness of an integrated service delivery model as measured by worker retention

This study sought to examine the impact of housing child welfare ongoing teams in the community, near client neighborhoods, and in a setting that also co-locates other service providers that serve the same clients. The focus was the impact of location and service integration on perceptions of worker stress and actual worker turnover. Thirty four workers from this type of setting and from a more traditional setting in two urban cities in a Southern state were interviewed. In addition turnover rates were calculated and compared. It was found that those located near clients and with staff from other agencies had better morale, lower stress levels, more positive attitudes toward clients and client contexts, knew more about the communities the clients lived in and had more chances to collaborate to solve client problems than those in a more traditional setting with co-location only with family support staff. The turnover rate was lower in the integrated service delivery setting than in either the traditional setting or the state overall. Thus, integration of service delivery benefits not only the child welfare workforce participants, but also the clients who have greater access to other service providers and to the bottom line of the agency through the retention of workers. Implications are described.     

The Compact of Free Association: An Impact Analysis for Hawaii

Abstract

Available evidence suggests that homelessness in Hawaii is a substantial problem. Among this population, migrants under the 1986 Compact for Free Association have been especially susceptible to homelessness. The three major objectives of this study were to (1) determine the characteristics of COFA migrants who utilize homeless shelter services in Hawaii (2) assess the impact of COFA on Hawaii (3) identify unique features of the COFA migrant population in Hawaii that lead to recommendations as to how better serve them.

This study targets homeless service providers and community stakeholders most burdened by the problem of COFA migrant homelessness in Hawaii. Drawn from the 2003 supplemental census, intake data at the Institute for Human Service and community meetings with stakeholders, general demographic characteristics of COFA shelter users were collected and analyzed. Further, qualitative data was collected through a series of interviews with shelter staff and clients through a series of open-ended interviews and participant observation.     

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.     

How Do the Professional Lives of Family Therapists Affect their Private Relationships: A Qualitative Study

This article is based on a qualitative research project about how the professional lives of family therapists affect their private relationships. The overarching research question was: How does your professional work as a family therapist affect your private relationships? To answer this question, semi‐structured qualitative interviews were conducted with four therapists from two different Family Counseling Services. Through the use of interpretative phenomenological analysis, three main findings were identified: (1) family therapists’ knowledge and values are a basis for interpersonal encounters; (2) participants describe resonance in relation to clients’ stories; and (3) therapists can be challenged in managing confidential knowledge particularly where they belong to the same communities as clients. The study also explores societal expectations and discourses that accompany the role of therapist, which can affect therapists’ freedom of movement in their private lives. These issues are discussed in relation to family therapy theory and relevant research.     

Cultural and religious influences in maternal response to intrafamilial child sexual abuse:charting new territory for research and treatment

The role of culture when providing services for families in the wake of child sexual abuse disclosure is a charged issue although surprisingly little attention has been given in the research literature to this. This article reports the findings of a grounded theory study exploring facets of maternal response, and aspects of more and less supportive responses, to children who were sexually abused by the mother's intimate partner. Ten mothers, chosen on the basis of theoretical sampling, provided information through in-depth interviews to understand how they responded emotionally and behaviourally to their child's disclosure. As well, three service providers were interviewed as key informants. The research revealed cultural and religious influences as affecting how mothers made meaning of the sexual abuse and the actions they took. Mothers from cultural backgrounds that adhere to rigid patriarchal norms identified themes of intense value conflicts regarding family preservation, loyalty binds between the perpetrating partner and child victim, and anxieties around being alienated from their extended family and ethnic community. They also reported that their cultural belief systems were not well understood by service providers. In parallel, helping professionals identified cultural issues as presenting barriers for engaging with some clients. Practice implications and research directions are discussed.     

‘We are Hungry but We Won’t Eat the Food’: Schoolchildren’s ‘Thin’ agency and its impacts on the implementation of Ghana’s School Feeding Programme

Following the introduction of the concept of agency by the New Sociology of Childhood, the concept has dominated discourses about children's everyday lives. Nevertheless, little is known about schoolchildren's agency in their daily interactions with the service providers of Ghana's school feeding programme. Through this qualitative study, the paper provides empirical evidence to show how children in restrictive contexts exercise ‘thin’ agency in their interactions with frontline service providers, leading to significant improvements in the quality of services delivered to them. Consequently, the article questions Michael Lipsky's assumption that clients have minimal effect on the services delivered to them.     

The Impact of Hopelessness and Hope on the Social Work Profession

Abstract

Burnout and turnover are detrimental to social service organizations, social service providers and clients. Very often organizational characteristics are part of the cause for burnout. Burnout in a job can lead to hopelessness for social service providers and begin a vicious cycle of continued burnout and increased hopelessness. Knowing the characteristics of hopelessness can help social welfare institutions nurture their employee's level of hope thus impacting the way the social service providers work with their clients.     

Perceived Needs of Therapeutic Service Providers in Their Work with Families in the Child Welfare System

Each year approximately half a million children are identified as victims of abuse or neglect in the United States. Referrals to therapeutic service providers are a primary means to help alleviate risks leading to child maltreatment and promote child and family well-being, yet it is not clear how well therapeutic service providers are prepared to meet the specialized needs of a child welfare client population and/or navigate the contextual characteristics of child welfare practice. The purpose of this study was to assess the gaps in knowledge and skill among therapeutic service providers working in this specific service setting. Five focus groups were conducted with 40 current therapeutic service providers working with clients involved with state child protective services. Data were analyzed using conventional content analysis methods. Fifteen themes emerged and were organized into three primary categories of needed knowledge and skill development: (1) cross-system, (2) therapeutic, and (3) functional. Implications for training and practice are discussed, as well as directions for future research.     

Immigrant Therapists’ Unresolved Identity Problems and Countertransference

The difficult task of identify formation is greatly complicated by immigration in childhood or adolescence. This paper shows how the unresolved identity problems stemming from their immigration to Israel in childhood or early adolescence of three young therapists, two from Ethiopia and one from Russia, affected their countertransference in their treatment of their adolescent clients from their own countries of origin. The three examples are based on art works produced by the therapists and their clients in the framework of workshops on the integration of art therapy techniques into verbally based diagnosis and treatment. The paper highlights the need to help immigrant therapists recognize their own identity conflicts and resulting countertransference, as well as the identity issues of their immigrant clients.