Record keeping practices: Consequences of accounting demands in a public clinic

This observational study explores the tensions and negative consequences of record construction for patients and front-line staff in a public clinic providing services to poor women and children. For emphasis, it is possible to say that the routine of the clinic is record driven, not service driven. More is accomplished in clinic work than producing records; patients certainly do receive needed health care. However, tight regulations filtered through heavy paperwork requirements stifle the effective delivery of comprehensive, flexible services especially needed by disadvantaged families. Clinic staff may be motivated to attend to individual patient concerns, but accounting demands generally circumscribe their work and create barriers for patients. The record has a life of its own as a socially constructed artifact in the process of caregiving in bureaucratic settings, where actual services often respond not to the client, but to the countable, accountable mandates of management.     

Commentary on 'Managing the process of change in residential child care: A consultancy approach'

This paper draws on a ten month British study completed in April 2001 investigating service responses to women of South Asian background who had attempted suicide or who self-harmed. The scope of the study is briefly outlined and an analysis of perspectives documented in the study is presented, drawing on research interviews with 18 staff from a variety of health and social care disciplines and with seven survivors of attempted suicide/self-harm. The implications of this analysis for improving practice are considered. Attitudes surrounding attempted suicide and self-harm are discussed. The issue of ‘race anxiety’ is also discussed. The factors seen by workers as contributing to South Asian women's attempted suicide are considered, with a particular focus on the difficulties caused in the delivery of services by common-sense accounts of cultural issues. Current approaches to the delivery of services to South Asian women are identified and analysed, showing how their current organisation can lead to circularity in referral systems and consequent non-intentional neglect of the needs of this client group. It is urged that proper consideration be given to the support and professional supervision of staff in this complex area of work.     

Broadening the Intersectional Path: Revealing Organizational Practices through ‘Working Mothers’ Narratives about Time

This article is concerned with the complex inequality experienced by mothers in employment, and applies ‘strong intersectionality’ to women's narratives about time to reveal the intersecting inequalities women experience and gendered organizational practices. Drawing on empirical research with 30 Irish ‘working mothers’, this article explores the way time is ordered and managed to create gendered inequalities for women at the intersection of maternity with paid work. By conceptualizing gender, maternity and class as simultaneous processes of identity practice, institutional practice and social practice, following Holvino, women's narratives reveal that organizations manage and order time to fit with notions of ‘ideal workers’, which perpetrate older hierarchies and gendered inequalities, and which create regimes of inequality for women at the intersection of maternity with paid work.     

Experiences of health service providers establishing an Aboriginal-Mainstream partnership to improve maternity care for Aboriginal and Torres Strait Islander families in an urban setting

Australian policy encourages multiagency partnerships between hospitals and Aboriginal Community Controlled Health Organisations to improve the health of Aboriginal and Torres Strait Islander people. Service planners remain unsure about how to implement such partnerships in maternity care, and there is a lack of appropriate tools designed to gauge the state of such partnerships for the Australian Indigenous context. In 2013, two Aboriginal health services and a major tertiary hospital partnered to deliver best practice maternity care to Indigenous families in Brisbane, Australia. A participatory action research approach underpinned this study. Semi-structured qualitative interviews and focus groups were conducted with 21 of the partnership staff. All interviewees emphasized the partnership’s commitment to improving long-term health and wellbeing for Indigenous families. Strategic planners were more likely to report a positive partnership than staff involved in service delivery who had diverse views. This highlights the challenges of change management when conducting such a significant service redesign in this cross-cultural context. We detail changes made within the partnership in response to the findings and provide suggestions for future development of an evaluation tool to review the state of Aboriginal-Mainstream Partnerships.     

Professionals' and parents' perceptions of A&E use in a children's hospital

Helpful keywords in accessing literature on the use made of hospital accident and emergency (A&E) departments are ‘misuse’ ‘abuse’ and ‘inappropriate’. While the medical literature is inclined to present patients (and, in the case of children, their parents) as irresponsible, or misguided, social scientists looking at similar data have tended to act as apologists for patients, explaining A&E attendance in terms of poor access to GPs, mistaken beliefs about the relative skills of hospital-based doctors and GPs and ‘lay’ health beliefs. Both of these approaches see the patient (or parent) as passive recipients of health care, rather than active caretakers of their own or their children's health. On the basis of a study of minor ailments presenting at a children's A&E department, this paper explores the differing views of health workers and parents. It suggests that a view of patients (parents) as largely passive custodians of their own or their children's health is inadequate. Patients (parents) can and do play an active part as providers of primary health care and their decisions to use A&E are not as irrational as health providers sometimes suppose. In this light, attempts to ‘re-educate’ parents to use A&E in a way which would be more acceptable to health providers is unlikely to succeed.     

Gendered,Invisible Work in Non‐profit Social Service Organizations: Implications for Worker Health and Safety

Nonprofit organizations (NPOs) play an important role in the provision of health and social services. In Canada the nonprofit sector includes 7.5 million volunteers and employs over 1.6 million paid workers. The sector is overwhelmingly female‐dominated — women make up over 80 per cent of workers in these nonprofit services. Work performed by women has traditionally been undervalued and invisible. It has often been considered safe by researchers, employers, policymakers and sometimes even workers themselves. Although there is some indication that jobs in the restructuring social services sector can be characterized by constant demand, high stress and violence, research into the working conditions and health hazards of these types of jobs has not been a priority. Using data from a qualitative study examining work in NPOs, we trace the ways that work performed in these workplaces is both gendered and invisible. We identify three types of invisible labour. ‘Background work’ facilitates and supports more visible and recognized organizational activities. Certain organizational language obscures the full spectrum of work that takes place in the organizations and the risks it may involve. ‘Empathy work’ includes the relationship building, counselling and crisis intervention that comprise key components of social service delivery. ‘Emotional labour’ involves the management of client emotions and workers' own emotions in the process of working with clients and delivering care under conditions of scarcity and contraction. The invisibility of these activities means that much of the day‐to‐day work done in the organizations, while particularly important in the context of social service restructuring, is taken‐for‐granted and undervalued by organizational outsiders. As a result, many of the hazards present in the jobs are hidden from view and workers' health may be compromised. We argue that the invisibility and taken‐for‐grantedness of certain types of work in NPOs is reflected in, and constitutive of, particular exclusions and shortcomings of current occupational health and safety systems designed to protect the health of workers.     

Understanding the role of Australian Aboriginal maternal infant care workers: bringing a cultural dimension to a critique of the ideal worker concept

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform.     

Continuity of Midwifery Care in England: A New Professional Project?

Over the last decade, an increasing amount of research has examined the relationship between gender and professionalization using female professional projects to illustrate how the generic notion of a profession has been a gendered one. This paper develops Witz's (1990) theory of professional strategies in female-dominated occupations particularly regarding midwives in Britain in the twentieth century and suggests that an important dimension that also needs to be critically examined in midwifery history is the interaction of gender and social class within midwifery. Furthermore it documents the traditional emphasis in midwifery on the single woman's career path. This historical analysis has resonance today as midwifery in Britain is undergoing a renaissance. The role of the midwife and the current organization of the maternity services are being reviewed with the intention of providing increased choice and control over the reproductive process for women and increased continuity of care with a midwife. These changes are viewed as midwives' new professional project and the implications for midwives and women discussed. The aim of this paper is to explore the explanatory power of these approaches to current developments in maternity care and by drawing historical parallels, consider the impact that this professionalizing strategy may have for those who are excluded from this process of ‘dual closure’. Furthermore, this paper asks whether this new way of working empowers midwives, women, both or neither?     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

NO ROOM FOR ABUSE

In Canada, media reports on health care tend to focus on the high costs of the health care system; reporting privileges the economic aspects of this social service. In the Canadian system, long-term care or chronic care is a type of service that is situated within the health care system. Long-term care institutions typically house older individuals who have lost a significant amount of autonomy and require constant care. Until recently, the services dispensed within these institutions were unseen by the media, and thus the public did not reflect much on these services. The publication of the Report of the Royal Commission on the Future on Health Care in Canada in 2002 has fostered a growing public awareness of the vulnerability of older individuals and those with chronic illnesses, and their relationship with their care-givers. Although it may be the case that the typical care for such persons in these situations is now emerging from a zone of invisibility, it is uncertain that the media coverage accurately portrays the realities of institutionalized care-giving. This essay examines the care practices in long-term care institutions in order to understand the processes at work in an environment in which care is commodified. The ‘area’ in which this caring labour is located is an area where constant moral compromise can create a climate where abuse can become endemic. This paper considers these environments and the potential for abuse in them in relation to the concept of ‘grey zone’, first formulated by Primo Levi and later adapted by Giorgio Agamben and Claudia Card, as well as in relation to the related concept ‘bare life’, also formulated by Agamben. The author argues that the ‘greyness’ produced by care practices that are bound to a cost-effective and task-oriented framework create an environment that is not conducive to proper moral behaviour.     

Social work guanxi: a reflexive account of the social work relationship in the Chinese context

ABSTRACT

In a guanxi-driven acquaintanceship, the worker, the client, and the community are tied together more closely than they are in mutually agreed-upon service contracts. This paper re-examines the contemporary boundaries in the social work relationship, especially in Asian nations such as China, where ‘relationships’ are generally translated and perceived as ‘guanxi’. The indigenisation of social work must be managed with care when translating from West to East. Drawing from the experiences of community development projects in rural Hong Kong, this paper discusses how guanxi among social workers, clients and other stakeholders in Chinese communities might challenge the professionalism of social work and breach the boundaries of social work relationships.     

The Parent Concerns Questionnaire: evaluation of a mothers' self report instrument for the identification of problems and needs in child and family social work

The measurement of problems and needs is a major issue for policy and practice in social work and social service provision. There has, furthermore, in recent years, been an increasing emphasis on gaining an understanding of users or clients' views of needs and service provision. However, there have been few attempts to develop practitioner and ‘client friendly’ ways of gaining information on problems and needs, either on an individual basis, or through the collection of aggregated data which can be used by local authorities as a whole. Where these have taken place there has been little attempt to assess their reliability or validity. This paper reports on the design and development of the Parent Concerns Questionnaire, an instrument designed to obtain the views of mothers in general, and depressed mothers in particular, in families subject to child and family care intervention. The paper reports on the reliability and validity of this instrument, which is presented as appropriate for use, both with families containing depressed mothers and other families subject to child and family care intervention. It may be used to examine problems and needs both on an individual family‐by‐family basis, and through the aggregation of data, on an authority‐wide basis. Copyright © 2000 John Wiley & Sons, Ltd.     

Ethnicity and Health Service Use in a Women's Prison

ABSTRACT

This paper highlights the findings in relation to health need, ethnicity, and health service use among a sample of women in prison. Medical records review for 129 women and interviews with 15 women were conducted to determine factors associated with differential service use. Statistical analyses reveal that ethnicity and an interaction between ethnicity and whether one is on medication at prison admission (a health need variable) significantly predict extent of service use. Women of color use fewer services overall, with the exception of those on medication. Qualitative analyses reveal that women of color view the quality of medical care and the ways they are treated less positively than White women. Implications for equitable service provision are explored.     

Partnering for Mental Health Promotion: Implementing Evidence Based Mental Health Services Within a Maternal and Child Home Health Visiting Program

This article details the clinical foundations of a social work focused community-based participatory research project promoting women’s mental health during and around the time of pregnancy. Specifically, we discuss the theoretical, empirical and organizational implementation of an enhanced engagement model of mental health service delivery that integrates evidenced based practices into the structure and services of an existing non-profit maternal and child health home visiting agency. The model is grounded in literature addressing barriers to accessing mental health care among minority women living in low-income communities. We discuss informing the intervention through direct consumer involvement, as well the rationale supporting the inclusion of Interpersonal Psychotherapy and Cognitive Behavioral Therapy into the design and implementation of the model which emphasizes adequate training of staff with varying levels of mental health experience. Finally, we describe typical client situations and responses reflected by the Enhanced Engagement model and discuss future implications of this approach as a way to offer meaningful intervention to women and families who may not have access or eligibility to utilize specialty mental health services.     

Matching needs and services: an assessment tool for community-based service systems

This article presents results from an outcomes-based needs assessment in an urban service district, using case record data to profile service needs in different communities. The methodology emphasizes consistent collection of data from actual case records and explicitly includes line staff and clients in the planning process. Such reviews could benefit a variety of community-based child welfare, health, and education systems, although implementing identified service strategies can be challenging.     

The economic proposals of Charlotte Perkins Gilman and gender budgeting in Italy

Charlotte Perkins Gilman anticipated Amartya Sen's theories on the economy of wellbeing and the theory of the capabilities by placing humanity at the centre of economic politics, the full development of abilities of the entire population and the participation in all the social, economic and political activities of men and women, as a premise for social progress and genuine democracy. In particular, she highlighted the value of women's competences and female innovative contribution towards the achievement of these goals. Today, the European Union considers these issues as a priority but in Italy they are not fully taken into consideration. Gilman, the American authoritative sociologist and economist, defined in 1993 by the Women's Hall of Fame as one of the 10 most influential women of the twentieth century, thanks to her studies and her in-depth analysis of women's real conditions of life, reached the conclusion that the origins of the traditional sexual roles – and of the female ‘natural’ subordination to man – are not due to nature, but to the economic dependence on man. Consequently, she believed that true freedom and effective citizenship for women are possible only with economic independence. Through the denunciation of the myths and traditional stereotypes that tie women to the so-called ‘natural roles’, Gilman showed the damages that the exclusion of women from socioeconomic activities cause to the progress of human society, and proposed the new woman. The new woman is well-educated – and thus endowed with a critical mind – and professionally prepared, and is aware of the necessity of her full citizenship. Women are also aware of the fundamental social value of maternity. Consequently they are aware that the ‘unpaid caring works’ should not be exclusively assigned to women but rather should be shared by both family and society. Gilman's theories and proposals for the social and economic reorganization, and her criticism of the traditional myths and stereotypes, supply a valid contribution to the present gender politics and in particular to the affirmation of gender budgeting in economics. These policies Gilman had indicated in her study Women and economics, published in 1898!     

Health Care for Older Women:

The issue of health care for older women as it relates to their financial resources and health care reimbursement is the focus of this paper. Federal regulations that affect older women and also the role of the medical establishment are examined. Suggestions are given for policy changes on the federal and local levels and for a redirection of the women's health movement. It is suggested that women tend to be seen as burdens to the health care system and face both age and sex discrimination from many health care providers. This is the disease that needs to be cured.     

“How Do I View My Sister?”

Abstract

Little research to date has focused on what factors interfere with the process of African American women and men developing and maintaining healthy relationships. A better understanding of these factors can help to improve relationships between these individuals and create stronger families within the African American community. Research has documented that prevailing stereotypes of African American women impact the lives of African American women and that stereotypes have the potential to impact interpersonal relationships. The purpose of the current study was to assess whether African American men endorsed stereotypic views of African American women, and to discuss the potential of these views to negatively impact the quality of relationships between African American women and men. Results indicate that 71% of men surveyed endorsed stereotypic views of African American women. Implications of these findings and future directions for research are presented.     

‘Off school sick’: mothers' accounts of school sickness absence

Interview material, collected as part of a wider ethnographic study of sickness absence in an English primary school, is used to examine how mothers accounted for their decisions to keep children ‘off school sick’. Mothers' accounts suggested a process by which they tested their children's claims on sickness against suspicions of feigning illness. The paper describes, from the mothers' point of view, the process of negotiating sickness with children and how children are categorised as ‘pretending’, ‘upset’ or ‘really ill’. These decisions are set within a wider context comprising: a normative discourse of maternal child health care; contradictory demands placed on mothers by the image of children as simultaneously robust and vulnerable; the surveillance and contradictory demands of schooling; and the use by children of sickness as a means of exercising influence on their social situation. It is suggested that locating child health care in relation to childrens' point in their childhood career (for these children the transition to secondary school) and acknowledging the active role that children play in the construction of illness will facilitate a fuller picture of mothers' unpaid health work within the family.     

Patient Rights: An Advocate's Perspective

Abstract

The current growing concern about patients' rights and the delivery of student health care precipitates an environment of fear, distrust, and uneasiness within university health services. This paper addresses several selected clinical, ethical, and legal issues which have come into conflict during recent years. Our examination surveys ethical and legal principles of confidentiality, defines areas in which breaches are most likely to occur, and suggests ways of preventing breaches of confidence between students and health services.

While the fundamental ethical principle underlying confidentiality is the individual's right of privacy, many issues of confidentiality are extremely difficult to resolve. University health services have expanded the concept of health care to encompass all the conditions — medical, emotional, social, economic and environmental — which affect the health of students. As a result, health service administrators should be fully aware of the laws and associated legal complexities in their own state which affect confidentiality. Furthermore, student health physicians, and particularly mental health therapists must be sensitive to needs for protecting the privacy of students.

Legal principles of confidentiality discussed in this paper with respect to specific problem situations which might arise in a student health center include: 1) right to privacy; 2) privileged communications; 3) releasing information from the medical record; 4) releasing information to the student; and 5) treating minors without parental consent. Finally, in addition to the responsibilities which must be assumed by the health professional, certain student responsibilities in the selection and utilization of health professionals are recommended.