Results of a nationwide hospice and palliative care social work job analysis

The role of the hospice and palliative social worker is often ambiguous and misunderstood by colleagues and fellow team members. One reason for this is the lack of identified, clearly delineated roles, skills, and tasks employed by these specialty social workers in their daily work. This article summarizes the first nationwide job analysis of hospice and palliative social workers. A contextual, cross-sectional survey design was used to identify current and relevant job tasks from practicing hospice and palliative social workers. A sample of 482 social workers representing 46 states responded to a survey that included demographic questions and ranking of 152 tasks and importance to the position. Tasks were categorized into four broad categories: assessment and reevaluation; planning and intervention; death, grief, and bereavement; and professionalism; which includes subcategories consisting of multiple tasks and skills. Respondents identified performing a psychosocial assessment from a patient/family centered care perspective, assessment of the patient’s current and desired quality of life and of coping skills as the tasks most important to their role. This outline of the role of the hospice and palliative social worker was then used in the development of an evidence-based certification exam that may be required of those who want to receive specialty certification in the field.     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

Elderly chinese and their family caregivers' perceptions of good care: a qualitative study in shandong, china

This study aims to understand what older Chinese people with chronic illness and their family caregivers perceive to be good care, and to compare perspectives of those living in rural and urban areas. We conducted semistructured interviews with 24 care recipients and 23 caregivers in Shandong, China. Two major themes were identified: (a) filial piety as the standard, and (b) modifying cultural ideals to meet reality. There was overall consistency in perceptions of study participants. Variations between rural and urban elders' perceptions appear to reflect differences in socioeconomic development and institutional structures.     

Home care development in Korea and Germany: The interplay of long-term care and professionalization policies

The aim of the study was to compare the effects of long-term care and professionalization policies on the development of home care infrastructure and the care workforce in reference to long-term care insurance systems adopted in Germany and Korea. A comparative analysis of the effects of the two policy systems allowed us to examine distinct forms of marketized home care service expansion. In both countries, the opening-up of care markets has brought about a significant expansion of home care services through the active participation of mainly for-profit providers. However, a trade-off between the rate of expansion, the quality of care services, and the stability of care infrastructure has emerged. The market-based expansion of home care services has resulted in difficult employment and working conditions for care workers in both countries. The country-specific organization of home care and related professionalization approaches has led to the development of a well-trained care workforce with less precarious conditions in Germany but not in Korea. Despite this difference, less well-trained care workers experience precarious employment in both countries.     

Adult self-sufficiency and social adjustment in care leavers from children's homes: a long-term assessment

This paper presents a study carried out in Spain that followed up 260 young people, the majority of them adults, who had been in residential care for significant periods. The follow‐up takes place between 1 and 9 years after participants had left residential care, and assesses their level of social and work integration, as well as considering the incidence of problems related to marginalization and social exclusion. Furthermore, it analyses the reasons for the child being taken into care, the socio‐family context, length of stay, changes in placement and other features or incidents in relation to the residential care. The data show that close to 15% have serious problems (drug dependence, delinquency, etc.), 25% receive help from the social services and the rest manage independently to a greater or lesser extent. We discuss the significance of these data, especially the relationship between the final result and the initial and process variables.     

The significance of a secure base: a psychosocial model of long-term foster care

ABSTRACT Long‐term foster care has been a much neglected area of social work practice and research. Yet there are obvious challenges that need to be understood when building a family for life in foster care. Is it possible for foster families, where there are no biological or legal ties between carers and children, to provide care, concern and family membership not only through childhood but also into adult life? The study on which this paper is based set out to explore that question by investigating the experiences of 40 adults, aged 18–30, who grew up in foster families. Qualitative interviews were conducted, transcribed and analysed. Theoretical frameworks from attachment and resilience were brought together with concepts such as ‘belonging’ and ‘family membership’ to make sense of the narratives provided. An integrated and dynamic psychosocial model of long‐term foster care was developed, which emphasizes the significance of a secure base and has some important implications for practice.     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands

Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.     

Exploring the care effects of multiple factors on the educational achievement of children looked after at home and away from home: an investigation of two Scottish local authorities

This paper reports the findings of a research project which explored the care factors that influence the educational achievement of looked‐after children. The project was innovative because it focused on children looked after at home and away from home. A mixed‐methods strategy was adopted to analyse data from two large Scottish local authorities. The project developed, what is to date, the largest dataset which includes variables for one‐fifth of children discharged from care in Scotland over a 5‐year period. The qualitative element of the project collected in‐depth data on the care and education experiences of looked‐after children and care leavers. The overall finding was that looked‐after children perform less well academically than their counterparts in the general school population. The empirical data indicated that factors such as placement type, reason for becoming looked after and age on becoming looked after were significant in determining educational achievement. Empirical results further indicated that looked‐after children suffered from discrimination and social exclusion in many areas of their lives, including school and where they lived.     

Health care as a social security benefit: Institutional approaches to extending coverage

Reaching universal health‐care coverage requires an appropriate mix of compulsory contributory social insurance schemes, with mechanisms to include the informal‐economy population, and tax‐based social assistance for those whose incomes preclude their own contributions. This article urges a reversal of the trend that favours the separate development of social health insurance by separate health authorities and makes the case for the extension of health‐care coverage using existing formal‐sector social security schemes, not least because they have the necessary political backing and institutional structures. The article reviews reasons for the slow pace of coverage extension to date, and stresses the added value of incorporating health care as a social security benefit while also acknowledging the importance of retaining linkages between statutory and well‐regulated community‐based or micro health‐insurance schemes.     

Long-term care reform in Korea: lessons from the introduction of Asia's second long-term care insurance system

Korea was the second Asian country to introduce universal long-term care insurance in an attempt to meet the challenges posed by its ageing population. This article presents an overview of the key issues that were involved in designing and implementing the new Korean system and the lessons that have been learned. Although the government reformed the long-term care system, a number of new challenges have emerged, such as its limited coverage and the unethical behavior of service providers. These problems appear to be closely associated with the scheme's initial design flaws and the government's passive responses to these problems.     

Developing a Palliative Radiation Oncology Service Line: The Integration of Advance Care Planning in Subspecialty Oncologic Care

Within radiation oncology, there is often minimal attention on radiotherapy with palliative benefits due to the overlying focus on curative treatments. Historically at the University of Pennsylvania, advanced-stage patients are cared for by cancer site-specific teams rather than a more rapid treatment service model that focuses on patients’ symptom needs and larger clinical issues within a palliative framework. Thus, the University of Pennsylvania created a designated palliative radiation oncology team to focus on the complex medical and relational issues of metastatic cancer patients. Social workers play a critical role in patient and family conversations about advance directives, care needs, and end-of-life goals and fears as treatment regimens and outcomes continue to unfold. The palliative radiation oncology social worker developed and instituted a new, formalized assessment tool called the “palliative radiation oncology psychosocial care plan” in the electronic medical record. A retrospective analysis of 26 palliative radiation oncology patients under treatment between February and August 2016 was conducted. Of these patients treated with palliative radiation, 19% completed an advance directive after the social work intervention. This model highlights advance care planning as a best practice and encourages end-of-life discussions as a routine part of the oncology workflow.     

Barriers to collaboration on behalf of children with challenging behaviours: a large qualitative study of five constituent groups

Inter‐agency collaboration is seen as an effective way to support children and families with multiple and complex needs. Children in out‐of‐home care, especially those exhibiting challenging and disruptive behaviour, often require the services of multiple agencies. Ninety‐two South Australian stakeholders experienced in supporting children in out‐of‐home care were interviewed about their experience of collaborative practice, using the specific example of supporting children with extremely challenging behaviour. Participants were teachers, foster parents, child welfare workers, child mental health professionals and residential care workers. Thematic analysis revealed several tensions inherent in such collaboration. Results are discussed in terms of their unique implications for managing challenging behaviour, and suggestions are made for improving collaborative approaches to behaviour and multi‐agency practice.     

Fostering educational prosperity: A randomized controlled trial of home tutoring in foster care

The educational gap between children in out-of-home care and their non-placed peers is well-documented. However, tutoring stands out as a promising intervention to raise children's educational attainment in out-of-home care. This study randomized 105 children in foster care (62% girls, aged 7–15 years [M = 10.3, SD = 2.0]) to the home tutoring program Foster Caregivers as Tutors (FCT) or regular public school services (treatment as usual [TAU]). In the FCT group, the foster caregivers tutored the children for 2.5 h/week for 40 weeks. The program effect is measured in learning and developmental outcomes, including reading and math ability, learning skills, IQ, executive function, and psychosocial function. Follow-up was 17.5 months after baseline. The results show a significant effect over time in both groups on IQ (effect size [ES] = 0.40, P < 0.001), verbal comprehension (ES = 0.29 P = 0.02) and perceptual reasoning (ES = 0.60, P < 0.001) measured by WISC IV. Neither the FCT nor TAU provided any significant academic recovery in reading and math nor progression in executive function, learning skills or psychosocial function. These findings, implications for practice and future efforts to support the schooling of children in out-of-home care are discussed.     

Research Review: Parents' service experience – a missing element in research on foster care case outcomes

A large body of child protection literature focuses on termination of parental rights, family reunification, and children's re‐entry into care as outcomes for children in foster care. Studies have investigated child, placement, family, and parent variables as predictors of case outcome. However, one important group of variables remains largely unstudied: factors related to parents’ service experience. Parents’ service experience includes parents’ perceptions of and involvement in the various services in which they must participate in order to recover their children from foster care (e.g. mandated treatment programmes such as substance abuse rehabilitation, parenting skills classes, etc.). The parental perspective on the foster care process is a critical element in the life of a child protection case, and its influence on case outcome must be explored. A brief review of the current literature on case outcome predictors is provided and parents’ service experience is highlighted as an area in need of investigation. Suggestions for the measurement of parents’ service experience are also offered.     

Informal care in Sweden: a typology of care and caregivers

This study describes and analyses the types of informal care provided in Sweden and whether it is possible to distinguish different types of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61 per cent. The results showed that there were large differences in the numbers of male and female carers when the data were divided into a typology of care categories based on different caring tasks. Women were much more likely than men to be involved at the 'heavy end' of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely to provide some kind of practical help for a mother or a neighbour/friend. Even though the Swedish welfare state has been described as universal and characterised by an extensive system of benefits and services intended to cover the entire population, the results here indicate that informal care plays an important role and that the gender role patterns are similar to those observed in other types of welfare state. When discussing support systems it is important for social policy to develop programmes that take into account the support needs of both caregivers and care recipients, and not to see their needs in isolation from the social care system as a whole.     

Suicidal behaviour in transition‐aged youth with out‐of‐home care experience: Reviewing risk,assessment, and intervention

The rates of suicidal behaviours in youth with out‐of‐home care experience, particularly those who are on the verge of emancipation, appear to be alarmingly high. The purpose of the current study is to highlight the rates of suicidal ideation and behaviour in these youth, illuminating the empirical risk factors that may increase their vulnerability. We offer a review of screening measures and suicide interventions that may hold promise for administrators, practitioners, and researchers who wish to provide comprehensive assessment for transition‐aged youth with out‐of‐home care experiences and effectively treat those who may be at the highest risk.     

Making a connection: school engagement of young people in care

Intervention to improve educational attainment for children in out‐of‐home care is increasingly being recognized as important for their well‐being and future opportunities. This paper reports on a mixed method study of the school engagement or connectedness of young people in care. The study comprised a survey of 202 young people in care in Queensland, Australia, and a matched comparison group of young people not in care, plus interviews with a subset of 65 young people in care who were surveyed. Both the school environment and the perceived levels of support influenced school engagement, with those who were assisted by carers and caseworkers more likely to be positively connected with school. These young people perceived education as a pathway to achieving work and life goals. The findings suggest that active and focused attention on young people's school engagement should be part of case planning and monitoring as it offers an additional strategy for improving their educational experience.     

Policy learning and cross-national diffusion in social long-term care insurance: Germany, Japan, and the Republic of Korea

Recently, many developed countries have moved toward comprehensive Long-Term Care (LTC) systems. Along with the conventional explanations of these policy changes based on domestic factors, learning from abroad should be considered. We focus on the social insurance model of LTC, particularly how Japan learned from Germany and the Republic of Korea learned from Japan. Some approaches for how to think about policy learning in general as well as cross-border learning are suggested.     

Evaluating community care in Scotland: critical reflections on a study of policy implementation

The paper describes the reality of evaluating the implementation of the reforms in community care in Scotland in 1993. In doing so it reports a trajectory familiar to evaluative researchers: the presentation of problems at the design stage, and their imperfect solutions; the emergence of delays in implementation, causing modifications to plans and timetable; discoveries made during the research which affected the hopes invested in the original design, and the adoption of pragmatic solutions; the outcome of the research and its reception. The paper ends with some critical reflections on the study and on evaluative research in general. It is suggested that evaluative research occupies a middle ground which results in the inevitability of compromise, queries whether there is truly an audience for uncompromised evaluation, and argues for the continuation of dialogue after completion as a guard against the ephemerality to which evaluation is often prone.