Raising the Titanic: Rescuing Social Work Documentation from the Sea of Ethical Risk

Abstract

One of the most contentious issues in social work practice concerns what should be written about people who access social work services, how comprehensively, and in what format social work assessments, interventions, and outcomes should be documented. The present paper describes a structured approach linked to an action research project that was undertaken by hospital-based social workers to identify and minimise problems associated with documentation in the medical record. The Social Work Ethics Audit provided social work staff with a risk-management tool that highlighted documentation as a key area of ethical risk. Through a process of evaluating existing recording practices, social workers were able to meet the challenge of improving social work recording in medical records, returning it to its proper place as a vital component of clinical and ethical practice rather than an administrative task submerged beneath competing priorities. It was anticipated that the social work documentation proforma that resulted from the ethics audit process would have applicability in other health care settings.     

Making Records Meaningful: Creating an Identity Resource for Young People in Care

Abstract

The Who Am I? research was an interdisciplinary, action research project focused on the past and present record-keeping practices for people growing up in out-of-home care in Australia. This paper reports on two of the nested projects directed at current record-keeping practices. For the 100+ Points of Identity study, a tool was developed (the Document Accessibility Exercise or “Daesy”) to determine the number of personal records critical to identity that could be accessed by practitioners prior to a young person leaving a placement. The Backpack of Identity project developed a further iteration of the action research cycle, as the first project identified the vulnerability of the record when placements for the young person changed. A number of implications for practice arose, including the need for greater attention to the development of personal records (as against an administrative record) and the need for practitioners to understand their responsibilities for the story “of the record” as well as the story “in the record”.     

Measurement Issues in Human Behaviour Theory

Abstract

This paper provides a brief introduction to the use of standardized measurement scales in behavioural theory, discusses some of the limitations of the domain sampling model of measurement for behavioural scientists and practitioners, and identifies central measurement issues in behavioural theory that are germane to all measurement tools. The ever popular and useful behavioural checklist is used to introduce the domain sampling model of measurement and to describe how it can be treated as a standardized measurement tool.     

Text,competence and logic: An exercise

Professional medical practice, like other organizational conduct, relies upon records which document transactions between members and their clientele. Medical practitioners employ a set of conventions providing for the systematic recording and interpretation of medical record cards that forms a social organization underlying the records cards' ordinary usage. In this paper we examine these conventions and develop a computer program which captures elements of their structure and use. By doing so we illustrate one way in which sociological analysis can contribute to the design of intelligent systems. We also suggest that the emerging discipline of Artificial Intelligence might find recent developments in sociology pertinent to its concerns.     

Self-Care Practices and the Professional Self

ABSTRACT

Consistently and actively engaging in self-care has been shown to improve the performance of mental health practitioners by reducing burnout, vicarious trauma, compassion fatigue, and other stress-related psychological problems. Not only is this important to the individual practitioner’s well-being, but ethical standards also mandate the recognition and remediation of any physical, mental, or emotional self-impairment to maintain high standards of care for clients. Professionals in small communities, like the Deaf community, however, confront unique challenges in attending to their self-care. This article investigates these challenges—as well as the rewards—experienced by Deaf and hearing counselors working in mental health care with deaf clients.     

The Limits of Working with Children Cards in Protecting Children

Abstract

In 2006 Western Australia passed legislation that introduced a system to check criminal records and issue permits to those who wish to work with children. In 2007, the legislation was described by the minister responsible as a “powerful system that would prevent harm to children”. This paper explores that system and identifies limits to its effectiveness. The paper concluded that unless the system's limits are fully appreciated there is a possibility of a paradoxical outcome, whereby children's lives will be less safe. It also raises the question of whether in the area of record checking a national approach is not preferable to each state and territory developing its own system.     

The Response of Social Work to the Depression,by Jacob Fisher. Schenkman Publishing Co., Cambridge,Mass., and G. K. Hall and Co., Boston, 1980. $23.95.266 Pp.

Abstract

This article presents an innovative refinement in the use of group process records for educational purposes, reviews the history of Rothman's Committee for the Preparation of Teaching Materials, and discusses the Committee's development of a comprehensive framework for teaching records. The teaching record fosters student attentiveness to practice context and complexities, regard for ongoing self-evaluation, and interest in cooperative learning. Teaching records also provide a structure for integrative learning through the identification, elucidation, linkage, and illustration of practice concepts and principles. The five key parts of the teaching record—major teaching themes, overview of group characteristics, group process record, teaching points, and teaching strategies—are described, and excerpts from an illustrative teaching record of a session with nursing home residents are presented.     

The Role of the American Nurses' Association in Maintaining Professional Accountability

Abstract

A professional association has been defined as a group of practitioners who organize to perform functions they cannot perform as separate individuals and to judge one another as professionally competent. History reveals that when a profession becomes clearly defined, the responsible practitioners form an association in order to establish standards of practice and enforce rules of conduct.

As the professional association for nurses, the American Nurses' Association is inextricably involved in the development of mechanisms that guarantee professional accountability. A standing priority of the association is to improve the quality of care provided to the public by such means as 1) setting a timetable for establishing qualifications for entry into nursing practice; 2) evolving a coherent credentialing system; 3) establishing systems to assure the profession's accountability for practice and for the delivery of services; and 4) providing for expansion, accessibility, and improvements in continuing education in nursing.

If nurses are to assume greater responsibility, the profession must be in a position to assure the public of quality nursing care. Since the public holds the profession (as a whole) accountable for the competence of its practitioners, the professional association has a responsibility to establish mechanisms by which to judge the competence of its practitioners and to evaluate the quality of care.     

The Staff-Designed Medical Audit

Abstract

The presentation describes a cyclic process of patient-care evaluation especially suited for use in ambulatory care settings. The cycle is discussed in detail, beginning with topic selection and moving through all steps to the final activity, reevaluation. Rather than assessment of a single individual's competence, the development of a composite profile of performance for the group is made possible through examination of the four perspectives of prevention, investigation, management, and outcome. The standards, or criteria, are developed by those whose performance is to be evaluated, thus assuring a high degree of commitment to the process.

In the 2 1/2 years' experience with the use of such staff-designed audit at one health service, 10 of 11 re-audits, performed after intervals of 6 to 12 months, have demonstrated improvement in performance when measured against the same criteria. Each of 13 new topics considered during this period has provided subject matter for staff meetings, either through general discussions, review of pertinent literature, or presentations by invited speakers. Such data provide supporting evidence for the concept that a nonpersonalized, internally-developed assessment process can elicit significant commitment to improved patient care and to ongoing education.     

Further notes on record taking and making in maternity care: The case of South Asian descent women

This paper draws on data from a small-scale ethnographic study of the delivery of maternity care to South Asian descent women in a hospital in Southern England during 1988. Stereotyped views of these women which related to their customs and culture as well as their typification as patients were commonly expressed by staff, particularly midwives. The paper examines the role of medical records and record making in stereotyping Asian women: the ways in which stereotyped views of women may affect the record making process; and how that process itself may reinforce and create stereotypes. The utility of records for ‘rate production’ purposes is also discussed. The focus of the paper is the creation of a woman's maternity records which occurs in the antenatal clinic. The transformation of stigmatised views of a client into ‘facts’ about a client is common among bureaucrats, in this setting health service staff. This process affects the client's future encounters with the bureaucracy. In medical settings records (ie the case notes) help to create, transmit and reify negative stereotypes of health service users. These stereotypes can affect the kind of care given to individual patients.     

HIV/AIDS and Home Based Care in Botswana

SUMMARY

The extent of the AIDS pandemic in Africa (and specifically in Botswana), and the lack of institutional frameworks to address concomitant issues, have necessitated the adoption of home based care for sufferers as national policy. The practice is beset by problems, given the severe symptomatic nature of the disease and the general lack of human and material resources to address the needs of patients and care-givers.

A study of one such programme in the Kweneng District of Botswana highlighted gender imbalances, poverty, lack of appropriate skills, over-involvement of the elderly, deficient specialised facilities, need for volunteer capacity building, inadequate income generating activities, insufficient counseling services, and culturally determined cognitive processes as areas requiring urgent attention. It is apparent that the programme needs strengthening through appropriate support mechanisms and that alternative strategies should be devised for those whose circumstances demand them.

The international hospice movement, represented in Botswana, exemplifies a philosophical and service model for multisectoral consideration and implementation on a nationwide scale. The article discusses, inter alia, day care centres and residential units for the terminally ill; a system of highly trained volunteers to work with patients and their families; consistent, skilled nursing services in home based care situations; and halfway houses for training of care-givers as possible solutions to the problem.

The contextualization of such measures will undoubtedly assist in bolstering Botswana's unchallenged record of high standards in governance and social development.     

The Incidence of Sexual Dysfunction in Patients Attending Dutch General Practitioners

ABSTRACT

Data on patients with a sexual dysfunction were collected in 45 Dutch general practices between 2003 and 2008. The aim of the study was to determine the incidence of patients with a sexual dysfunction, associated health problems, and related interventions performed by their general practitioners (GPs). The study design was a dynamic cohort study comparing 6 years of data on patients with a sexual dysfunction. Participating GPs were asked to record weekly all consulting patients who presented with a sexual dysfunction. In an additional questionnaire, these problems and associated interventions were specified. Incidence of sexual dysfunctions varied between 132 per 100,000 per year for male patients and 60 per 100,000 per year for female patients. Men mainly consulted a GP for erectile dysfunction, and women mainly consulted a GP for hypoactive sexual desire disorder and dyspareunia. Sexual desire problems were more often associated with comorbid problems such as psychological and relationship problems and medication use than other sexual dysfunctions. Female patients showed more co-occurrence of sexual dysfunction and were more often referred to secondary care services than were male patients. During the period of 2003 to 2008, the help-seeking pattern of men and women consulting their GP for a sexual dysfunction appears to be stable. The presence of comorbid problems indicates that GPs are often dealing with complex multifactorial dynamics. Co-occurrence of sexual dysfunction among women probably resulted in a higher referral rate to secondary care services. Therefore, a gender-sensitive approach and an open mind to differences in sexual identity are needed for counseling in and treatment of sexual dysfunction.     

Improving mental health assessments in child protection through audit

Existing agency records, together with questionnaires completed by social services referrers and mental health providers, were used to identify problems in current arrangements for obtaining specialist mental health assessments in child protection cases. Standards were set and implemented through a multi‐agency steering group. The practice of referrers and providers was then reaudited. Sixty‐nine social workers, six mental health specialists and 27 child protection initial case conferences (involving 31 children) were involved in the reaudit over a 4‐month period. Initially, main problems concerned communications, unclear referral and access arrangements, waiting times and disagreements over prioritization. Standards concerned consultation and decision‐making arrangements within the child mental health service, the format of referral and reply letters, the sharing of information and the attendance of mental health professionals at child protection case conferences. There appeared to be improvements in all these areas at reaudit. In conclusion, some shared views of problems, additional support funding and the audit process appear to have helped to improve inter‐agency collaboration and develop more efficient referral and care arrangements. There is a need to maintain and further develop this work, and audit would again be a useful means. Copyright © 1999 John Wiley & Sons, Ltd.     

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.     

Alcohol-Related Problems Seen at the Student Health Services

Abstract

The number and types of alcohol-related problems seen by medical, nursing, and mental health professionals at the University of Massachusetts Health Services has been assessed since 1975 as part of a Demonstration Alcohol Education Project.

Medical outpatient clinic alcohol-related contacts using encounter forms completed on every outpatient visit during 1975 and 1976 revealed that 0.08% of approximately 92,500 visits annually were alcohol related, including 0.03% for chronic problems and 0.05% for acute problems (mainly contusions, lacerations, and fractures). Week-long contact surveys conducted in November 1976, and April 1977 recorded a much higher proportion of alcohol-related problems for over 60% of about 2,200 contacts each week. In November 1976, 1.4% of 1,346 reported visits were alcohol related, including 8.0% of contacts which occurred on weekends. In April 1977 2.7% of 1,582 reported visits were alcohol related, including 17.0% of weekend visits. No chronic alcohol problems were reported either week, and most of the acute problems involved traumatic injuries, such as contusions, lacerations, and sprains.

Mental health outpatient clinic alcohol-related contacts self-reported by students at the initial visit revealed that 5.8% of 1,179 initial visits between January 1976, and June 1977 were alcohol related, most involving their own alcohol use. Week-long contact surveys involving all 256 contacts during November 1976 and 192 contacts during April 1977 showed that 13.7% of contacts were for alcohol-related problems, over half due to alcohol abuse by someone else, such as a parent or boy/girlfriend.

The findings suggest that a significant proportion of students seen by student health services have acute rather than chronic alcohol-related problems, especially acute traumatic injuries and relationship problems.     

Setting and maintaining standards in menopause care: audit of current practice in a specialist clinic

Standards are an important way of demonstrating quality of care in any given setting. The British Menopause Society (BMS) has produced guidelines as to what should be recorded at the initial menopause consultation. A retrospective audit of case-notes of women attending Poole Menopause Centre was undertaken using these criteria as audit standards. Although areas of good practice were highlighted, the published criteria were met for only five of the 23 standards. An action plan to improve the documentation to achieve these standards has been formulated.     

Gynecological services utilization by contraceptive clients: a cost analysis

A cost analysis of gynecological service use by students enrolled in a prepaid health plan at the University of Massachusetts revealed that pregnancy and abortion-related services account for almost half of total costs. The medical records of 495 randomly selected students who presented for diaphragm care during 1980-81 were reviewed and 78% of these women were interviewed. 27% had had at least 1 pregnancy; in 15% of these cases, the pregnancy was diaphragm-related, yielding a Pearl Index of 9.75 pregnancies/100 woman-years of use. Overall, 25% of students (33% of seniors) had an abortion while at college. Study subjects made a total of 1483 visits to the gynecological service and saw an average of 3.3 practitioners. 67% of contraception-related visits were for diaphragm fits, checks, or replacements; 24% involved a change to pills. The average cost per visit for diaphragm fit or method change was $31.20 if the provider was a physician ($22.60 for a nurse practitioner); the cost for diaphragm follow up by a physician was $23.60 ($16.60 for a nurse practitioner). For seniors, the average cost to the health plan over 3.4 years of visits was $83.10 for contraception, $47.43 for pregnancy-related care and abortion counseling, and $100.51 for other gynecological problems (e.g., vaginitis, menstrual disorders) and the annual examination. The $231.04 total cost/senior represents half of the $460 paid in direct premiums. Further analysis is recommended to determine whether increased resource allocation to contraceptive counseling would reduce pregnancy-related costs.     

A First Order Markov Model for Use in the Human Services

Summary

Markov processes have found a variety of uses in human services administration, evaluation, program and policy research. The models are concerned with the movement of entities or persons through finite states or conditions, the course of a disease and the movement of persons in various states in population change problems. The possibility of using the computer to link costs factors m levels of psychiatric and medical care as persons move through a system makes the first-order Markov process a potentially powerful tool in the administration of human programs.     

Professionalism in Indian public relations and corporate communications: An empirical analysis

Public relations is evolving in India and the profession is gaining acceptance and recognition. This study is an attempt to measure the extent of professionalism in India and how much consensus, if any, exists regarding professional standards among practitioners in agencies and those in corporations. It also identifies the influence of demographic factors on the standards in the profession.     

The College Student Psychiatric Emergency: A Descriptive Study

Abstract

The authors utilized computerized records of a psychiatric emergency department to study the nature of psychiatric emergencies among college students. The 1156 visits made by students over an eight-year period are described using demographic variables, times of visit, and accompaniment. Implications of the findings for campus administrators and mental health service providers are discussed.