Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

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.     

A qualitative look at child care selection among rural welfare-to-work participants

The welfare reforms of 1996 changed the administration of public assistance to children and families. One of the key provisions, requiring parents to join the workforce, resulted in an expanded need for child care. Prior research demonstrates that welfare recipients, particularly in rural areas, utilize informal child care arrangements. Further, recipients in rural communities face greater challenges due to a lack of transportation, geographic spread, and less access to services. This qualitative study examined the child care selection experiences of 33 welfare recipients in six rural Northern California counties. More families selected home-based than center-based child care. During their search processes, welfare recipients utilized both formal and informal routes to locate child care providers. Parents took advantage of their connections with the social service system, but also accessed their social networks for recommendations. Rural families also reported that their choices were constrained by the available programs, transportation, and by the quality of the programs they were able to access. Given the high rate of utilization of home-based arrangements among families in welfare-to-work programs, quality of care in such programs should be improved. Recommendations for increasing quality and access, as well as supports for welfare to work participants, are discussed.     

Teachers and health workers: partners in primary health care. Experiences from Papua New Guinea

Primary health care (PHC) involves community health education. When health priorities in rural communities are focused on the vulnerable under-5-years-of-age group then one has to examine who actually cares for this age group and what are the most appropriate means of reaching them through health education programs. In the context of rural communities in Papua New Guinea the linking of school and community health programs has been taking place. Examples and insights from programs where teachers and health workers attempted to find appropriate channels for integrating child and adult education in order to improve the health status of the very young child are described. The school programs used a child to child approach to develop in children a sense of shared responsibility with adults towards better health for themselves, younger children in their care and the environment of the community. The goal was a health program that applied to the whole community, where division between child and adult learning activities was not so sharply drawn, and where formal school programs and nonformal community education programs were to complement and contribute to each other. A campaign against infant diarrhea and death through dehydration was implemented. As a result of a 3-day planning workshop a program was drawn up for schools and communities. The workshop covered causes of diarrhea, fluid loss and dehydration, simple preventive and curative measures, essential hygiene habits and current community practices. Teachers, health workers and community leaders fashioned a program of activities for school children and adults. It was discovered that adults often feel a barrier between themselves and the child's school learning. Also, a gap often exists between what is taught in school and what is needed and can be applied to community health priorities. Thus, an effective community health education program that includes both children and adults in an integrated program will need to cover the varying ages and groups of community members who, with different degrees of responsibility, take care of themselves and others.     

Innovations in child protective services inservice training: commitment to excellence

The overwhelming obstacles to effective CPS intervention created by increasing reports of abuse and neglect, funding shortfalls, and the lack of qualified workers have prompted national efforts to reform the public child welfare system in the United States. Organizations such as the American Public Welfare Association, the Children's Defense Fund, the Child Welfare League of America, and the National Association of Social Workers are currently working closely with other national organizations to develop legislative proposals that will enable child welfare agencies to be more responsive to the needs of children and families. A critical component of this reform is the need to recruit, train, and retain qualified and competent CPS workers. The four training programs described in this article are examples of innovative programs seeking to enhance service delivery by enhancing the knowledge and skills of their staff members. Although the four programs were developed in very different political and social climates and within diverse organizational structures, they all provide useful lessons in how to develop efficient and effective training for workers delivering protective services for children. Any national, state, or local efforts to design and develop new CPS training programs should take into account the significant strides made by these agencies.     

Neighborhood Experiences and Community Integration

Abstract

This exploratory study examines the social interactional aspect of community integration among persons with psychiatric disabilities. Six focus groups were conducted with 18 mental health consumers in three publicly sponsored community residential programs and 11 staff members providing services to these consumers. Mental health consumers reported both positive and negative experiences in their interactions with community residents. Despite perceived differences between persons with psychiatric disabilities and their neighbors, consumers considered reciprocity and mutual accommodation to be critical for building social relationships in their communities. Mental health providers suggested that social integration can be facilitated by developing independent living and social skills, by overcoming self-stigma and institutional and homeless mindsets, and by having a supportive community of consumers.     

A study of 185 foster children 5 years after placement

This study's findings are similar to those of other studies. The majority of children who enter foster care return to their families within a relatively short time. A small group, because of the severity of their problems or those of their parents, need extended care. This group of children, over time, form the hard core of foster care placements. Our findings also bear out those of others that the foster care experience is a relatively stable one for children, with the majority having one or two placements while in care. Clearly, the need for and use of foster care is frequently misunderstood. The methodology used in research studies has gradually improved, adding to objective knowledge about this aspect of the child welfare system. Longitudinal studies, such as Jenkins [1967], Fanshel and Shinn [1978], and the one reported here, point to the need for deeper, more refined studies that examine not only the going and coming of children in foster care but the professional service component that can make foster care a constructive experience for children placed in it. Meyer issued an intelligent and timely challenge to the field of child welfare to give up "debates about permanency" and, if it is not too late, to "retrieve child welfare from the control of lawyers and MBAs" [1984: 499]. If the profession of social work can more clearly define the components of foster care service and can differentiate among the children needing care those who can best be served by this type of placement, then the field will be well on its way to offering an appropriate service for certain children. Attempts to denigrate a potentially helpful service for needy children simply destroy one aspect of a complex system. A wide range of services is necessary to serve all children appropriately. Without this kind of continuum, children are more likely to receive inappropriate services and to be placed at risk.     

基于社会服务项目的儿童福利资源整合

当前,我国儿童福利资源存在资源匮乏、供给分散、可获得性弱等问题,而社会服务项目则是解决这些问题的一种路径。以福利治理为理论视角,尝试以一个留守儿童社会服务项目为例的研究发现,该项目通过不同形式的合作整合了来自政府、军队、群团组织、社会组织、企业、社区等资源,提高了福利资源的供给效率,满足了留守儿童多元化的福利需求,但是,由于项目本身的周期性、制度保障的缺乏等限制,导致了项目难以持续发挥作用。因此,基于社会服务项目的福利资源整合只是一种基于实践基础上的暂时的整合,而最根本的还需要在福利制度上进行整合。     

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.     

Child Abuse Prevention: The Community as Co-Worker

Much of the literature on community organization describes the efforts of a worker to enable a community to coalesce arouund an external enemy in order to resolve systemic service delivery problems. Based on the mid-point of a federally-funded child abuse prevention project, this article describes the roles of worker and community as colleagues in an effort to enhance the community's capacity to shape its own values and behaviors to reduce child abuse and neglect. This article poses a challenge to the social work education community to be more responsive to the potential of becoming a co-worker with the community, and to enhance the social worker's skills in defining strenghts rather than weakness of communities.     

Community Differences in the Association Between Parenting Practices and Child Conduct Problems

Various hypotheses were identified regarding the manner in which community context might influence the association between two dimensions of parenting—control and corporal punishment—on child conduct problems. The authors used hierarchical linear modeling with a sample of 841 African American families to test these hypotheses. Consistent with the evaporation hypothesis, the results indicated that the deterrent effect of caretaker control on conduct problems becomes smaller as deviant behavior becomes more widespread within a community. The findings for corporal punishment supported the normative parenting argument. Although there was a positive relationship between caretaker corporal punishment and child conduct problems in communities where physical discipline was rare, there was no association between the two variables in communities where physical discipline was widely prevalent. These results suggest that a particular parenting strategy may be more effective in some neighborhood environments than others. The theoretical implications of this view are discussed.     

Integrated Substance Abuse and Child Welfare Services for Women: A Progress Review

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

Are the voices of parents heard? A scoping review of satisfaction in parenting programs

Parenting programs are an effective approach to promote positive parenting. In evidence-based practice, client’s values and preferences contribute to promoting quality, and are a crucial component of service evaluation. The current scoping review summarizes quantitative research that examines parental satisfaction with parent training for families with child conduct problems. We aimed to know how much research had been undertaken; what measures have been used; and what were the findings related to parental satisfaction. A scoping review was conducted to retrieve peer-reviewed original articles.Out of 420 papers 5.5 % obtained data on parental satisfaction. Seven different measures were used, mainly Therapy Attitude Inventory and Client Satisfaction Questionnaire. Out of 23 papers, ten studies reported Cronbach's alpha coefficients on the assessment that was used to evaluate parental satisfaction. All of the 23 included studies found that parents are very satisfied with the parenting program they have received.The findings indicate that only a few studies included parents’ values and preferences in quantitative evaluation studies on parental programs. In addition, there is a limited arsenal of assessment tools to measure what matters to parents. There is a need to develop measures with high psychometric quality, which will promote more quality in service evaluation.     

Community Wise: The Development of an Anti-Oppression Model to Promote Individual and Community Health

Communities with histories of oppression have shown great resilience, yet few health interventions focus on structural oppression as a contributor to health problems in these communities. This article describes the development and active ingredients of Community Wise, a unique behavioral health intervention designed to reduce substance use frequency, related health risk behaviors, and recidivism among individuals with a history of incarceration and substance abuse residing in distressed and predominantly African American communities. Community Wise, developed through the collaborative efforts of a board of service providers, researchers, consumers, and government officials, is a 12-week group intervention that aims to address behavioral health problems by raising critical consciousness in distressed communities.     

The Role of the Economic Sector in the Provision of Care to Trusting Clients

With implications for senior care as well as child care, this article compares for‐profit and nonprofit dependent‐care facilities in areas of service that are not readily visible to consumers. Findings gleaned from the child‐care industry indicate that nonprofit facilities provide a higher quality of service on professionally identified variables than do their for‐profit counterparts. For‐profit directors were more likely to implement cost efficiencies that were not immediately apparent to clients. Despite this, significantly more of the for‐profits were displeased with their financial situation than were their nonprofit counterparts. The study suggests that professional background and training of directors exercises an influence on management satisfaction and decisions, independent of sector.     

The evaluation ranking scale: a new methodology for assessing satisfaction

Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.     

Stopping Child Bullying: Educators' Diverse Approaches for School Improvement

This original case-study research investigates educational professionals' answers to survey questions regarding how to eradicate child bullying. Twenty school professionals from two different schools—one school at the elementary level and the other school at the high school level—detailed their own particular bullying problems they see while serving in their own unique leadership capacity role and learning organization and what proactive initiatives they have modeled or participated in either individually or collectively to stop school bullying. Educational professionals were asked to detail any school-based policies already set in place or any procedural guidelines that will soon become implemented regarding stopping child bullying. Of the study results from participants, findings demonstrate that more critically intensive focus should be placed on school bullying by district wide anti-bully programs and being more frequently assessed. The survey is included at the end of this article (see Appendix).     

A multi-site evaluation of Parents Raising Safe Kids Violence Prevention Program

The Parents Raising Safe Kids Program (PRSK) is a research-based manualized violence prevention curriculum designed to decrease coercive parenting behavior, encourage positive discipline, increase media violence literacy, and increase child development knowledge. This study is a multi-site pre-post comparison evaluation of PRSK's effectiveness with diverse parents, including those who are incarcerated, in drug treatment and both English and Spanish speaking. Results indicate that PRSK was successful at improving media violence literacy, positive parenting behavior, child development knowledge, anger management, and prosocial problem solving. Additionally, PRSK was especially efficacious for Spanish speaking participants, who improved more than English speakers. Due to the need for appropriate and cost-effective programs for underrepresented groups, these results add to the growing evidence base supporting the use of PRSK with diverse parents. PRSK is effective in educating caregivers about nonviolent parenting behavior and child development. It is flexible, focuses on parents of very young children, and is cost effective. The program costs a fraction of other evidence-based practices yet statistical effect sizes for change over time are comparable.     

Factors influencing service coordination in rural South Australia

This paper discusses those factors identified in both the review of literature and from the results of nine focus groups held in rural communities that influence service coordination. The paper shows that the practice wisdom of service coordination is congruent with the findings from research on this topic. It discusses the facilitators, inhibitors and triggers to service coordination within these communities. Informal networking and the support given by management are recognised as important facilitators and the competitive tendering funding process and ‘professional elitism’ are seen to be major inhibitors to service coordination. Important triggers of service coordination were perceived to be the efforts of key individuals in providing leadership of the coordination process and the keenness of human service workers to reduce duplication.