Discharge Planning Process on a General Psychiatry Unit

Abstract

This study investigates the discharge-planning process and short-term outcomes for 100 patients discharged from a general psychiatry unit. The contributions of functional/illness factors, personal factors, and family factors to communication of the plan, length of stay, and satisfaction with discharge-planning process were investigated. Findings indicate that both the process and short-term outcomes of discharge planning are affected by factors that can be addressed in interventions with patients, families and the social environment. This research suggests that discharge planning without attention to psychosocial factors will fail to address issues relevant to patient well-being.     

Benefits of psychosocial rehabilitation programming in a treatment mall

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals. Treatment malls provide psychoeducation and skill-building activities in a centralized, school-like setting for participants from all patient care units. It differs from traditional strategies that use decentralized one-on-one or unit-based models. Treatment malls provide a self-directed learning experience that meets the person-centered needs of participants. Evidence is increasing that this psychosocial educational model can provide lasting benefits for psychiatric patients, including symptom management, reduced psychiatric hospital readmission rates, and improved quality of life.     

Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review

The current health care system is discharging elderly patients "quicker" and "sicker" from acute care facilities. Consequently, hospital readmission is common; however, readmission may be only one aspect of adverse outcomes of importance to social work discharge planners. The early recognition of risk factors might ensure a successful transition from the hospital to the home. A systematic review was conducted to identify factors associated with adverse outcomes in older patients discharged from hospital to home. Using a content analysis, factors were characterized in five domains: demographic factors, patient characteristics, medical and biological factors, social factors, and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. A systematic search identified four discharge assessment tools for use with the general population of elderly patients. Practice and research implications are offered.     

Social Care Work in the Recent Past: Revisiting the Professional/Amateur Dichotomy

Abstract

The present article challenges the received wisdom of the distinctiveness of professional social work in Australia and its dichotomous juxtapositioning against work undertaken by those without formal social work qualifications. Findings are presented from a qualitative study of Australian Catholic sisters’ experiences of social care work in the recent past, based on indepth interviews with sisters who collectively worked in a variety of fields from the 1950s to the time of writing. Sisters’ accounts of work with marginalised people reveal many similarities with the values and principles of social work. This suggests a blurred line between “professional” social work and “amateur” social care work. In an era of reconsideration of many certainties, Australian social work could profitably reflect on its commonalities with, and differences from, practice domains outside professional social work.     

The first three years after foster care: A longitudinal look at the adaptation of 16 youth to emerging adulthood

Sixteen former foster youth were followed for 3 years to examine their adaptation to emerging adulthood. Youth were classified on their adaptation according to 2 concepts, Connectedness and Risks. Connectedness refers to engagement with the adult world through work, schooling, marriage, and parenthood. Risks refer to problems with substance abuse, financial difficulties, and mental health problems that would hinder engagement with the adult world. All of the youth maintained at least one adult connection, but only 6 youth did not have a risk at the final interview. Three years after discharge 50% of the respondents had a drug and/or alcohol problem, and had neither savings nor health insurance. Despite many problems the post foster care period was marked by much resilience as most struggled to remain independent, and continue their schooling. Factors which facilitated successful adaptations were: a period of transitional residence after foster care, good support systems including family and former social workers, and a commitment to further education.     

Parental substance misuse and statutory child protection in England: Risk factors and outcomes

Parental substance misuse is a significant child welfare issue and associated with increased risk of child maltreatment. The aim of the present study was to understand what social care outcomes children who live with parental substance misuse have, and to assess factors associated with those social care outcomes over a two-year period. The paper reports on a retrospective longitudinal study of 299 children all living with parental substance misuse and referred to one local authority in England. Data were collected from children's social work case files about procedural social care outcomes and factors which may be associated with those outcomes. Using cluster analysis, a new typology of children's longitudinal trajectories through the children's social care system was developed, consisting of five distinct types. Analysis indicated that some children received too little intervention from children's social care despite ongoing concerns, while other children were potentially unnecessarily caught up in the social care system. Factors associated with children having the poorest outcomes were: caregiver instability resulting from substance misuse, parenting capacity and household instability. The study's findings indicate that some children who live with parental substance misuse are at significant risk of harm, but others are not and may be better supported through non-statutory services such as early help.     

Of the Soul and Suffering: Mindfulness-Based Interventions and Bereavement

There has been increased interest in, and evidence for, mindfulness-based interventions (MBIs) as integrative approaches for a wide variety of psychosocial issues. However, there is very little research on the use of MBIs in bereavement care and only one proposed model existing in the literature. This article presents an overview of the mindfulness-based literature and uses a case study of a bereaved parent to illustrate a mindfulness-based model of bereavement care that is consistent with social work values. Such a model may provide a future direction for care of the bereaved as well as interesting opportunities for further development and research.     

Women with disabilities making the transition back to work: Psychosocial barriers and interventions

The economic impact of disability on employment, earnings, and education appears to be more devastating for women than for men. Women with disabilities who are making the transition either back into the workforce or into the workforce for the first time often face barriers that are unique to this population. Many researchers have described women with disabilities as having a "double disadvantage" that results in social and psychological barriers to their transition back to work. The purpose of this article is to help vocational and career development programs better address the psychosocial needs of women with disabilities by (a) describing key psychosocial barriers faced by women with disabilities in their transition back to work and (b) providing career development strategies designed to ease this transition process for women with disabilities and enhance their employment outcomes.     

Women in corrections: A call to social work

As governments continue to spend more money on law enforcement and prison construction, social workers will be increasingly faced with clients who have connections with the criminal justice and correctional systems. Despite the increasing numbers of women entering the criminal justice system, they continue to be one of the most marginalised groups in Australian society. This article reviews the social work literature concerning this population and proceeds to argue that social work has a significant role to play with women in corrections. Using a conceptual model based on an ecological systems framework, the author examines the mutuality of various social work practice principles at different levels of intervention and the roles that social workers may engage in to enhance the lives of women in corrections.     

Accompaniment in a Mexican immigrant community: Conceptualization and identification of biopsychosocial outcomes

Taller de Jose (TDJ) offers accompaniment in a Mexican neighborhood in Chicago, helping service participants navigate health, judicial, and social service systems. Using a community-based participatory approach, the current study conceptualizes the accompaniment service and identifies psychosocial outcomes. Focus groups with service participants and staff were conducted, using a grounded theory approach. The data provides support for a conceptual model of accompaniment based on interdisciplinary knowledge in ministry, social work, and public health; and a consideration of social context, values, and outcomes such as increased social support, knowledge of community resources, and improved self-efficacy.     

Social Work Doctoral Education in Australia: The Case for Further Development

ABSTRACT

Social work education in Australia has been based in universities since the 1940s. There are now 32 higher education providers offering social work programs across Australia. The significant growth in master’s level qualifying programs in Australia, along with recent higher education policy changes, has increased the need for social work academic faculty members with doctoral qualifications. This paper presents the findings of a scoping review of literature on social work doctoral education. Despite a growing literature on social work doctoral education in international contexts, the review found that there is a lack of Australian research and evidence on social work doctoral pedagogy, the number and diversity of doctoral students, the doctoral student experience, and doctoral graduate employment intentions and outcomes. Addressing the lack of Australian research in this area would be an important step to enabling Australian social work to address future research training and capacity needs and directions.

IMPLICATIONS

• There is a lack of research on Australian social work doctoral education and this is a neglected aspect of social work scholarship of teaching and learning (SOTL) research.

• Research into social work doctoral education would provide baseline information on the number and diversity of students, doctoral student experiences, graduate outcomes, and employment intentions.

• Development of social work SOTL about doctoral education would support future research capacity and enable the advancement of social work research knowledge and skills.

     

The Longitudinal Discharge Planning and Treatment Model (LDPTM)

Abstract

A longitudinally based discharge planning and treatment model that integrates essential components of other successful approaches (PACT, PACED, and Bridge to Discharge) is described. The development of linkages between the inpatient and community mental health providers during the early stages of hospitalization could improve the continuity of care and establish an aftercare plan rooted in existing community resources. Placing the client's need first will ensure a smoother transition from the structure of the inpatient ward to the community while maintaining continuity of care and reducing potential re-admissions to the hospital. Potential barriers that may prevent the adoption and implementation of such a system are discussed. Belcher and DeForge (2005) in Part 1 provided a review of case management and discharge planning, as well as a critique of case management models. In Part 2, DeForge and Belcher (2005) present and describe the components of the longitudinally based discharge planning and treatment model (LDPTM).     

Transition within transition: How young people learn to leave behind institutional care whilst their carers are stuck in neutral

This paper discusses findings from a qualitative longitudinal study which explored the process of leaving long-stay institutional state care in Romania during 2002-4, a period at the heart of accelerated EU-enforced childcare reform. 28 young people were interviewed before leaving care and 17 were tracked up to 8 months after discharge. 18 practitioners were also interviewed.The findings confirmed Pinkerton's (2006) emphasis on the impact of global and national factors on the individual experience of leaving care. This study took place in a country undergoing widespread change. The care leavers' irreversible transition took place within the simultaneous professional transition of their carers and that of the community with which they needed to integrate. This insight is widely relevant in the current context of public funding cuts and changes in welfare policy in many countries, including the Central and Eastern European (CEE) countries.Bridges (2009) was used to understand the experiences of care leavers and their carers. Bridges stresses the role of the leader in creating protective conditions for traversing three unavoidable transition stages: 1. ending old identity/behaviour; 2. a neutral zone of deconstruction and transformation; and 3. a new beginning. Preparation for leaving care can be viewed as learning to end care, followed by the neutral zone which begins at discharge. When lacking family support, formal carers are the young people's main transition guides. However, their professional transition also needs management. Because of top-down, accelerated childcare reforms, the Romanian carers' transitions appeared stuck in the neutral zone, affecting preparation for leaving care. Yet, the availability of learning opportunities after discharge changed the nature of the neutral zone for most of the sample who did better than expected at follow-up. This, supported by Bridges' proposal that learning during transition influences future coping, offers a foundation for new theory.     

The outcomes of a longitudinal study of non‐organic failure‐to‐thrive

Individuals who had failed‐to‐thrive for non‐organic reasons received psychosocial intervention which was tailor‐made to their particular needs during childhood. Their progress was followed up over 20 years later, including their physical growth and social and cognitive functioning. Not all clients showed the same outcomes. The quality of the parental relationship and the reason for the growth‐faltering were found to be related to the outcomes at 20 years. Unless they experienced a positive and sustained change in their life or circumstances, individuals who had experienced abuse showed poorer outcomes than those whose growth‐faltering had been thought due to neglect, lack of parenting or feeding dif?culties. Abuse tended to be a contributing factor to growth‐faltering more frequently in families where the parents were observed to have a poor relationship with each other. However, a signi?cant change in the quality of care given to the child and the emotional environment experienced by them resulted in positive outcomes 20 years later despite experiencing abuse during childhood. Copyright © 2003 John Wiley & Sons, Ltd.     

Unexpected barriers in return to work: lessons learned from injured worker peer support groups

Some workers who are injured at work have unexpectedly prolonged absences from work. Experiences of workers who constitute a disproportionate cost to the return-to-work system and the systemic and compliance-related barriers they encounter during the process of returning to work are reported. A qualitative interview based study was conducted with 37 members of three injured worker peer support groups in a Canadian province. Four dimensions of peer support were identified: worker experience of being misunderstood by system providers, need for advocates, social support, help with procedural complexities of the workers' compensation, and health care systems. Peer support constitutes a partial return-to-work solution for workers with injuries, but injured workers encounter an uneven playing field. Injured worker peer support group needs and activities show us that sensitivity to structural and social issues may lead to better return-to-work outcomes.     

Associations Between Psychological,Physical, and Sexual Intimate Partner Violence and Health Outcomes Among Women Veteran VA Patients

Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.     

The geriatric social worker and his self-awareness

Abstract

Hospice and palliative care services have become an established part of Australian health care in the last decade. Multi-disciplinary teams are usually a feature of such services and social workers are common members of such teams. Yet the exact extent of their use and role in these programs has not been investigated previously. The author conducted a survey of 53 social workers working in such programs and at the same time, another questionnaire was also sent to service directors in all 134 Australian programs about their utilisation and perception of social workers. This article reports the results of both surveys. The results show that a third of the programs employed social workers, but the social workers themselves reported a number of difficulties: nurses are often the dominant occupational group and role-blurring amongst team members is common. The findings are discussed in terms of their implications for the social work profession.     

Work/Care Regimes: Institutions,Culture and Behaviour and the Australian Case

Increasingly around the industrialized world, labour markets rely upon the paid work of women, many of whom have dependents. Such changing patterns of paid work by women — and by men — are located within work/care regimes that are more or less hostile to the needs of paid workers who care for others. This article sets out a model of work/care regimes and locates the Australian case within international and historical contexts. In Australia, the unchanging normative male worker archetype dominates institutions of work and care, while the cultures of motherhood and fatherhood remain stoically resistant to renovation. In the meantime, the behaviour of working women runs ahead of these unchanging cultures and institutions, creating a policy interest in ‘reconciling’ work and care, but a failure to provide it. The reasons for this failure are outlined.     

Integrating Pharmacotherapy and Psychosocial Interventions in the Treatment of Individuals with Alcohol Problems

Abstract

Both research and clinical experiences suggest that there are separate and overlapping benefits of medications and psychosocial treatments for alcohol problems. Evidence has shown that medication(s) combined with a moderate intensity psychosocial therapy can produce outcomes beyond what each of these approaches can produce alone. Taking medication can be helpful in facilitating longer periods of abstinence that in turn affords practitioners a greater opportunity to enhance patients' individual and social coping resources and to increase their motivation to change. Combining effective pharmacological and psychosocial interventions may provide the impetus to integrate alcoholism treatment into the general health care delivery system, thereby helping to increase the accessibility of care and well-being for individuals seeking or needing help with alcohol problems.