A survey of occupational therapy in Australian work practice

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.     

Can a Family Therapist do Statutory Work?

Despite a clear interest in problems such as child abuse it appears that family therapists could work more extensively and constructively with statutory presentations. This paper proposes three reasons as partial explanation for the difficulty many therapists have in working with statutory cases. These reasons are: (i) a belief that social control is not the business of therapy, (ii) a belief in a particular and restrictive notion of neutrality, and (iii) a practice habit of talking less than directly to clients. The existence and persistence of these constraints to the effective provision of statutory services is related to the historical tradition which largely structures professional/client relationships. It is argued that this pattern is highly implicit in our work and can therefore act to restrict our practice and our ability to envisage alternatives.     

Functional capacity evaluation: An essential component of South African occupational therapy work practice services

South African occupational therapists have been involved in the delivery of work practice services since the inception of the profession in this country. Initial development in this area of practice appeared slow but following the acceptance of South Africa's first democratic Constitution in 1996, many opportunities for service delivery were facilitated by the implementation of disability equity legislation. One of the key services offered by practitioners is Functional Capacity Evaluation (FCE). Although the outcomes of FCE are many, the process in essentially the same. This entails: referral, the initial interview, evaluation of performance components and ADL, vocational evaluation, obtaining collateral and the closure interview, the work visit, hypothesis testing and reporting. This article reports on the Functional Capacity Evaluation process as followed by South African occupational therapists in various contexts.     

Voluntary work in the Norwegian long-term care sector: complementing or substituting formal services?

ABSTRACT

Across Europe, governments call for increased involvement of volunteers to shoulder some of the welfare burden. Nevertheless, there is little research into what kind of work and how much volunteers currently contribute in the long-term care services and whether this has the potential to substitute formal services. Drawing on findings from a survey of employees in Norwegian nursing homes and home care districts, we examine the nature and volume of voluntary, unpaid work in the long-term care services in Norway. Our data suggest that volunteers to a very limited degree carry out work that has traditionally been considered the formal system’s domain: personal care and practical help. Nearly all the voluntary, unpaid contributions in our data takes place within cultural, social and other activities aimed at promoting mental stimulation and well-being, indicating a classic specialisation of tasks between volunteers and professionals. However, there has been an expansion of the formal care system to include activities aimed at promoting well-being in recent decades. This may indicate that there is a certain level of task sharing between voluntary and formal care. Thus, social workers need to consider voluntary service provision when assessing the needs of clients.     

Clinical social work practice in the private sector: A survey

Although a great deal is known about mental health services provided by the public sector, few systematic data exist on service provision in the private sector. Despite this, the relative roles and merits of private-versus public-sector practice are issues of considerable contention within the social work profession. This survey, based on the responses of 253 social workers providing clinical services in the private sector in Colorado, sheds new light on this debate. Information reported includes the personal characteristics of providers, characteristics of clients seen, and other characteristics of practice.     

The caring child: an evaluative case study of the Cornwall Young Carers project

This paper reports on an evaluation of the Cornwall Young Carers project (jointly funded by social services and the Cornwall and Isles of Scilly Health Action Zone), conducted during the period 2000–2002. A diverse range of methodological approaches were adopted (comparative national statistics, local pilot study, monthly and quarterly data capturing instruments, and a service user focus group) in monitoring and evaluating the project's high level statements/outcomes. Four evaluative themes are discussed, namely: identification of young carers; assessment of young carers' needs; direct service provision; and partnership working. Recommendations and action steps are proposed with a view of informing future planning and service delivery, as well as developing an ethos of integrating evaluation into everyday practice for the Cornwall Young Carers Project. Overall, the project has made significant progress in meeting and exceeding its original targets. The fact that the project has been able to identify 202 new young carers over this period is a key milestone in demonstrating the critical need for the project's services. It is suggested that existing referrals are only the ‘tip of the iceberg’ for work with young carers in Cornwall.     

The Theory Circle: A Tool for Learning and for Practice

Social workers have grappled for many years now with the tension between theory and practice. The struggle may be to bridge a perceived gap between the academic knowledge base of social work and the complex realities of practice. Equally, it may be to move from common‐sense interpretations of human need and professional responses, towards a more informed and accountable approach to practice. In recognition of the challenges faced by social work academics, practitioners and students, in relation to applying theory to practice, two of the authors of this paper developed a model, which aimed to facilitate productive discussions between practice teachers and students about the nature of theory and its link to practice. In addition, the model was designed to promote partnership approaches where service users participate fully in identifying their own issues and in shaping the services they receive. This paper describes the model—The Theory Circle—and reflects upon its effectiveness, based on the views of 19 practice teachers from central Scotland. The findings suggest that the pictorial model is one that practice teachers and students find accessible and valuable; it helps them to build a theoretical understanding of service users' situations and to work alongside service users to agree the most appropriate methods of intervention.     

The impact of globalization on social work in the UK

Since the late 1980s social work in the UK has undergone a period of unremitting change affecting its organizational structure, value-base, and service users. There has been a regrettable narrowness of scope in the social work literature on such changes, as analysis has been limited to policy and service delivery issues, which treat such changes as if they were simply new technical responses to the problems of reorganizing social services. We argue that such analyses do not engage sufficiently with the complex dynamics driving these changes and that there is a need to contextualize change in social work against the wider political and economic context. The transformative nature of the contemporary period is posited with reference to the impact of global macro-level forces and the ways that these interact with national and political variables on micro-level forms of social work practice. This paper reviews selective literature on globalization and draws linkages with changes in social services at the agency and practitioner level in the UK.     

Rural Social Service Disparities and Creative Social Work Solutions for Rural Families Across the Life Span

The provision of social services in rural areas has historically presented a challenge for social workers. Rural social service disparities are presented in relation to key challenges surrounding the provision of social work services in the rural United States. Barriers that define rurality and hinder the provision of social work to rural families, a multicultural examination of rural community strengths and resiliency, and creative solutions for rural social work delivery are discussed. A case study utilizing collaborative partnerships between rural churches, schools, and community leaders to combat rural homelessness and streamline service delivery for rural families across the life cycle is presented.     

Parent-Professional Power Relations: parent and professional perspectives

This paper reflects on a small-scale qualitative research study around the establishment of a conductive education centre in a city in the north of England. From the outset, the centre's existence presented a challenge to existing services because the monopoly control of existing professional practice and policy was under question. The research does not offer an evaluation of the effectiveness of conductive education. The task was to examine the centre's provision in relation to existing statutory services, and provide a forum for informed discussion relating to the provision and organisation of multi-professional services for disabled children. The paper suggests that, although there was a mutual tension between the centre and professionals, a number of pointers could become a starting point for a more equitable partnership between parents and existing service providers. We also argue, however, that such a notion of partnership is limited without the voices of disabled people.     

A Survey of Online Practitioners: Implications for Education and Practice

In the last decade the helping professions have seen a growing interest in the provision of online counseling and therapeutic services for individuals. Like most fields of work, social work also has experienced a growth in the creative use of technology in various areas of professional work. Based on this growing interest and the need for such services and research on its efficacy, a study was conducted to learn from e-therapists across the United States on their experiences with this mode of service delivery. This paper elicits results from the online survey and provides recommendations to better serve our clients in the tech savvy world and future research endeavors. The main findings of this preliminary study include: (a) Many theoretical perspectives and models are being used to ground online practice, (b) e-therapists are beginning to use videoconferencing for online practice supplementing their face-to-face sessions, and (c) e-therapists believe that online interventions benefit their clients.     

Impact of hearing loss in the workplace: raising questions about partnerships with professionals

The number of adults with hearing loss who continue to work later in life is growing. Persons with hearing loss are generally unaware of the role that audiologists, occupational therapists, and vocational rehabilitation counsellors might play in the assessment of the workplace environment and appropriate accommodations. Three narratives of adults with hearing loss are used to demonstrate the gaps in accessing information, technology and services needed to maintain optimal work performance and productivity. The lack of recognition of the multidimensional needs of older workers with hearing loss and the lack of timely coordination of services led to all three persons acting alone in trying to access services and supports. In two of the three cases the impact of the hearing loss resulted in further unexpected losses such as the loss of employment and the loss of a worker-identity. There is an urgent need for partnering with persons who are hard of hearing to develop new strategies for knowledge exchange, more thorough assessment of hearing demands and modifications in the workplace, and interdisciplinary approaches to service specific to the needs of hard of hearing persons.     

What do we really know about usual care child protective services?

The term “usual care” is often used in clinical research to refer to a comparison or control group that is receiving whatever normal services an organization may provide. In the US child protection system, “usual care” is the practice from the point of screening in a report, to assessment and possible in-home services or a decision to place a child in out of home care. Policy and practice variations across states and counties, as well as changes in policy over time, make research on normative child welfare practice services challenging but necessary. The service delivery mechanism in child protection is understudied, limiting our ability to inform decision-making at the local, state and federal levels. Gaps in knowledge also confound intervention research because a clear understanding of a given service platform is key when interpreting effect sizes against usual care controls. This article overviews what is known about “usual care” in child protective services and seeks to encourage more research in this area by reviewing six key factors related to measuring the impact of usual care from the point of initial report through the provision of services.     

From service to social control: Implications of welfare reform for professional practice in the United States

In response to the explosive growth and the changing demographic composition of public welfare recipients, this program has undergone four major reforms over the last three decades: the 1962 'Service' amendments, the 1967 Work Incentive program (WIN), the Family Support Act of 1988, and the 1996 program of Temporary Assistance to Needy Families (TANF). These reforms have had a profound impact not only on the scope and purpose of public assistance to needy families, but also on the nature of professional social work practice in this area of public social service. An analysis of the major welfare reforms over the last 35 years reveals how the national entitlement to income maintenance and social services has receded, local responsibility and private delivery of service have increased, and emphases on service functions have shifted from rehabilitative social casework/counselling to work-oriented training, job search activities, and local employment. The provision of public assistance has been transformed from a federal entitlement based on needs to a budget-driven-time-limited benefit enveloped by incentives and sanctions, with welfare clients increasingly subject to mandatory participation in work-related activities. This movement from welfare to workfare has infused the professional role of social workers with a steadily expanding function of social control, which is unlikely to encourage professional participation in the public social services.     

Determining the Need for Social Work Practice in a Public Library

Little is known about social work practice via public libraries. Faced with patron needs, libraries seek creative ways to provide social services. One suburban library carried out community engagement using a community-university partnership. Students reviewed literature, surveyed 32 library patrons, and conducted interviews with five staff members. Patrons identified need for services related to children’s success in school as well as resources needed for health care, food resources, and employment services. They also identified concerns with homelessness, mental illness, and unemployment. Implications support the provision of social work practice at this library to address opportunities to maximize quality of life.     

Using evidence-based accreditation standards to promote continuous quality improvement: the experiences of the San Mateo County Human Services Agency

Following a difficult period of service provision, an agency determined that drastic changes were needed to improve agency-wide capacity and functioning. The agency engaged in an organizational level self-assessment aimed at identifying areas for improvement and beginning work towards determining professional standards for service. Results of this organizational self-assessment paved the way for pursuing accreditation of its services, and the agency became the first public agency in its state to be accredited by the Council on Accreditation in all eligible services. This case study describes this agency's efforts in engaging in an organizational self-assessment, the analysis and codification of their practices, and their eventual development of a systematized process for capturing, evaluating and improving practice.     

Traveller children and the state: Welfare or neglect?

Travellers' historical experience is of persecution. Recent policy in England and Wales reflects assimilation or exclusion, with Travellers facing the paradox of pressure to settle and insufficient sites because of the failure to implement legislation. The conditions for many Travellers are damaging, and undermine access to other rights and services. Children are particularly severely affected, resulting in societally imposed neglect. Traveller children's low health status and the negative effects on their development are documented in practice reports, seminars and research. Policy trends have culminated in the Criminal Justice and Public Order Act 1994 which removes rights and increases penalties for travelling, and is likely to exacerbate an already problematic situation for many Traveller children. Welfare services both have contributed to and can counteract this societal neglect. Problems of access and service delivery are outlined in relation to health, education and social services, and new service developments described. Key criteria for positive practice are found to be common to these areas of welfare provision, and include anti-discrimination and cultural respect, outreach and community-oriented work; hand-held records; specialist provision focused on immediate needs and commitment to mainstream change; flexibility and inter-agency development work; and advocacy and campaigning alongside Travellers.     

A Survey of the First Five Years' Work of a Child Sexual Abuse Team

This paper describes a survey of the first 5 years' work of a specialist NHS child sexual abuse team (CSAT), which provides a post-disclosure treatment service to young people aged between 13 and 19. Information was obtained on the demographic characteristics of young people referred, the nature of their abuse and its perpetrators, and the type, length and outcome of the treatment provided. The survey was also used to ask four questions. Was the team providing a service to its target population, young people whose sexual abuse had been severe? Did the severity of abuse predict the intensity or length of therapy provided? Were there differences in the service provided to boys as opposed to girls? Finally, did experienced therapists achieve different results when compared with non-experienced therapists? It was found that the service was being used by its target group and that severity of abuse was associated with longer or more intensive therapy. The service did not appear to be adequately meeting the needs of boys. There was some indication that experienced therapists achieved the same treatment outcome as inexperienced therapists in a shorter period of time.     

Changes in service provision in rural areas. Part 1: The use of GIS in analysing accessibility to services in rural deprivation research

Previous work has highlighted the importance of public service provision in rural areas particularly for potentially vulnerable groups such as the elderly, unemployed and single parents especially where this coincides with a lack of access to either private or public transport. Disadvantage can often be compounded by limited access to services for such groups with the superior resources of more affluent social groups enabling them to respond and adapt to the increasing centralisation and reduction of services. This paper reviews previous investigations of the implications of changing accessibility to services in rural areas and draws attention to the need for a new research agenda which uses spatial analytical techniques to gauge the current levels of (in)accessibility to key services at the community level. These techniques are illustrated in Part 2 of the paper with reference to changes in post office provision in mid Wales, and the policy significance of incorporating geographical information systems-based measures of provision into traditional area-based indicators of disadvantage is discussed.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.