A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

Neighborhood socioeconomic disadvantage and access to health care

Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an "emergent characteristic " of those areas that predicts the ability of residents to obtain health care.     

Welfare brokers and European Union migrants' access to social protection

In spite of the existence of an extensive national and supranational legal framework, European Union (EU) citizens who exercise their right to freedom of movement to work in another Member State face numerous hurdles in accessing social protection. While recent scholarship on street-level bureaucracy and on migration and welfare has shed light on the role of discretion and stereotypes in access to rights, little is known about the processes through which such hurdles are overcome. In this article, we focus on a specific strategy which is the recourse to what we call “welfare brokers”. These actors offer assistance to EU migrants to overcome specific cross-border administrative challenges in the area of social protection that derive from their use of the right to freedom of movement. Relying on qualitative data collected with brokers and Romanian migrants working in Germany, the article also demonstrates that welfare brokers attempt to transform the norms, bureaucratic practices and representations that condition access to these entitlements. The article concludes by underlining how the existence of a brokerage industry is a sign of existing inequalities in the exercise of freedom of movement within the EU.     

Outreach social work: from managing access to practices of accessibility

A recurring feature of outreach work is that outreach tries to reach people who are left without care and not effectively reached by existing services. In this article, we discuss the importance of outreach practices in the context of changes in society. We suggest that the pressure on the managing of access to social services is increasing along with the demand to avoid an unnecessary inflow, and make a distinction between a residual and structural approach to social work and social service delivery. In a residual approach, outreach social work can be seen as a strategy to manage access or as a strategy to link clients with appropriate services. In this sense, they ensure that people meet predefined criteria of social services. From a structural approach, however, the focus lies on how practices possibly contribute to the realization of human dignity in social interactions and might lead to a socio-political analysis of those situations in which social work intervenes. On a conceptual level, outreach practices thus appear as practices of accessibility. From this perspective, existing problem constructions and dynamics of inclusion and exclusion in social services but also more broadly in society might be questioned and ultimately changed.     

A critical theory of medical discourse: ideology, social control, and the processing of social context in medical encounters

The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.     

A model of social work classification in health care

Abstract

The introduction of casemix funding for Australian acute health care services has challenged Social Work to demonstrate clear reporting mechanisms, demonstrate effective practice and to justify interventions provided. The term ‘casemix’ is used to describe the mix and type of patients treated by a hospital or other health care services. There is wide acknowledgement that the procedure-based system of Diagnosis Related Groupings (DRGs) is grounded in a medical/illness perspective and is unsatisfactory in describing and predicting the activity of Social Work and other allied health professions in health care service delivery. The National Allied Health Casemix Committee was established in 1991 as the peak body to represent allied health professions in matters related to casemix classification. This Committee has pioneered a nationally consistent, patient-centred information system for allied health. This paper describes the classification systems and codes developed for Social Work, which includes a minimum data set, a classification hierarchy, the set of activity (input) codes and ‘indicator for intervention’ codes. The advantages and limitations of the system are also discussed.     

Disabled people's access to social work education--ways and means of promoting environmental change

Disabled people are under-represented among social workers. It is argued that this results in lack of diversity in the workforce and in reduced opportunities to make service delivery more inclusive. An audit tool is outlined which can be used to identify barriers and strengths at DipSW programme, university site, agency site and individual student level to disabled people entering social work education. Completed audits could then form the basis of DipSW Programme Development Plans or curriculum plans for individual students, as required. Review mechanisms at the different levels would help ensure that attention to planning and action does not get lost. Assessment issues and aspects of the practice teacher/student/tutor relationships are also discussed. Disability equality training is seen as a central component of audit and provision. The need for proactive, not reactive, policies is made clear.     

Resource effects on access to long-term care for frail older people

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Class inequalities in access to social capital in the metropolitan area of Buenos Aires

this paper analyzes social class inequalities in access to social capital. Quantitative methodology was used with data from the PI-Clases “Reproduction and social mobility in family trajectories and life courses” survey, conducted in the Metropolitan Area of Buenos Aires in 2015 (n = 1065). Social capital measures where derived from the Position Generator (Lin, 2001) to identify the volume, status and range of the respondent’s networks. Results show that there are class inequalities in access to social capital in terms of the number of contacts, mean status of contacts, range of contact’s status and highest status of contacts. Also, the working class is more heterogeneous in its access to social capital, suggesting it has a sector that has network ties with people from the middle class and a sector with lower social capital. The observed trend is of gradational differences between class strata, with more marked inequalities between the service, intermediate and working class, but with fluid class boundaries without social segregation. Also, social capital is conditioned by intergenerational mobility trajectory, showing a trend of elasticity in the class composition of social relationships. The upwardly mobile can increase their access to social capital but don’t reach the same level as the intergenerationally stable, while the downwardly mobile retain some social capital from their class origins.     

Seven strategies for facilitating access of nontraditional students to graduate education in social work

Undergraduate academic performance as a principal criterion guiding admission to graduate social work education may result in the exclusion of otherwise strong candidates for involvement in graduate education. This paper presents seven strategies for strengthening the admission status of nontraditional students, that is, those students who do not possess adequate undergraduate grade point averages to justify admission. These strategies are particularly important in the United States given the elimination or substantial limitation of affirmative action policies in higher education. Schools of social work, like other educational institutions, must become more creative and proactive to ensure that candidates for graduate education who can make important and substantive contributions to the profession gain entry. Using adult learning theory, the authors offer a rationale that underscores the need to look at an individual's vocational background and professional experience as well as professional commitment to serving vulnerable populations in order to assess readiness for admission. And, the authors identify the importance of offering opportunities to these individuals to strengthen their post-undergraduate academic records in order to be more competitive in the applicant pool. Each of the seven strategies is discussed in terms of its key processes and outcomes in relationship to developing these individuals as viable candidates who can compete in the admission process. The strategies are based on the logic of empowerment theory and they underscore the necessity of building on the strengths and assets that these individuals bring to graduate social work education. The authors illustrate the inclusion of these strategies into the admissions process of a school of social work in the United States and suggest that the use of these strategies can facilitate 'affirmative access' to social work education.     

A multiple indicator approach to blockmodeling signed networks

Regardless of whether the focus is on algebraic structures, elaborating role structures or the simple delineation of concrete social structures, generalized blockmodeling faces a pair of vulnerabilities. One is sensitivity to poor quality of the relational data and the other is a risk of over fitting blockmodels to the details of specific networks. Over fitting blockmodels can lead to multiple equally well fitting partitions where choices cannot be made between them on a principled basis. This paper presents a method of tackling these problems by viewing (when possible) observed social relations as multiple indicators of an underlying affect dimension. Quadratic assignment methods using matching coefficients, product moment correlations and Goodman and Kruskal's gamma are used to assess the appropriateness of using the sum of observed relations as input for applying generalized blockmodeling. Data for four groups are used to show the value of this approach within which multiple equally well fitting blockmodels for single relations are replaced by unique (or near-unique) partitions of the summed data. This strategy is located also within a broader problem of blockmodeling three-dimensional networks data and suggestions are made for future work.