An Aging Workforce in an Increasingly Global World

Summary

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Boundary-Spanning

SUMMARY

A boundary-spanning approach to practice traverses barriers to give social workers greater understanding of context, more latitude in interventions, and increased access to systems. This broad-based approach helps social workers work in large, complex systems of care that demand more creativity and advocacy from practitioners in less time with less support. It draws from direct social work practice, program planning and management, social work administration, and business/organizational management. Spanned boundaries include those restricting knowledge bases and definitions of setting, those separating health from mental health, those that isolate systems of service delivery and levels and modalities of practice.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Children with Special Health Care Needs

Abstract

The health care model presented in this paper is a non-linear, systems approach to service delivery. The model was a by-product of three ethnic-specific conferences that were convened to discuss strategies for improving access to care and the quality of services provided to children with special health care needs (CSHCN) from diverse cultural backgrounds. The model evolved as insights regarding the common values and norms held by parents, health care providers, and cultural representatives were shared. Content analysis was used to identify core themes identified by participants. These themes were incorporated into a model that included the following elements: community-based, culturally competent, health-oriented, resiliency-focused, and family-centered care. At the fourth Consensus Conference, selected participants from the previous ethnic specific conferences reviewed the proposed model and deemed it a vehicle for facilitating health care service utilization by culturally and linguistically diverse CSHCN and their families.     

A Critical Analysis of the Social Work Literature on Disabilities

Abstract

The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twenty-five categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.     

Risk and new exclusions in community mental health practice

Abstract

Over the past two decades, mental health practice has become increasingly focused on assessing and managing the risks posed by service users. British researchers have made significant advances in studying the consequences of risk management for community-based health and welfare services, but in Australia this field remains largely undeveloped. Drawing on my experiences as a social worker in a Melbourne-based Crisis Assessment and Treatment Team from 1991 to 2008, the present paper offers a reflective analysis of the shift in practice orientation that has emerged through the growing prominence of risk as a foundation for intervention. Specifically, I argue that this shift has led to a narrowing of service provision and that “low-risk” clients are newly disadvantaged, often excluded from service.     

Marketing Postsecondary Health Services

Abstract

This article reviews the major elements of marketing as applied to college and university health service programs. Changes in the health care industry, institutional debate about the advisability of institutionally based health centers, and the erroneous equation of promotion as marketing are reviewed. The necessity for research data to determine campus health program offerings is articulated as the most important aspect of successful marketing programs for health services. Types of segmentation for user groups are detailed, as well as the basic elements of an environmental analysis. The four fundamental aspects of health care marketing are discussed: the need to define the “core of service” for the health center; the issues associated with the access corridor to care; the task of refining communication channels; and the difficulty of measuring the effect of price on service usage rates. For marketing efforts to have a positive effect, colleges and universities must have an institutional commitment to health services. The article concludes by noting that marketing is a major management task.     

A comprehensive health service evaluation and monitoring framework

ObjectiveTo develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services.MethodA targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders.ResultsThe framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable.ConclusionData collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.     

Providing Medical Information to College Health Center Personnel: A Circuit Librarian Service at the University of Illinois

Abstract

College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at Chicago campus. This partnership led to the adoption of circuit librarianship, a dynamic outreach model, to enhance access to health information for McKinley Health Center personnel. A circuit librarian consults with health center personnel during regularly scheduled on-site visits to the center and its satellite office. Upon returning to the resource library, the circuit librarian conducts research for clinical information on behalf of the center's personnel, then sees that articles, books, and relevant Web sites are identified and delivered to assist in answering questions regarding disease management, drug therapy, wellness, and health administration.     

Facilitating the Welfare-to-Work Transition for Women with a Mental Health Work Barrier

SUMMARY

Since the 1996 PRWORA welfare reform act requiring workforce participation in order to receive services, evidence has emerged that many welfare recipients experience mental health work barriers. Yet, little is known about effective approaches for assisting women with a mental health work barrier in the welfare-to-work transition. This paper addresses this gap by first surveying the empirical research on mental health work barriers among welfare recipients. Second, I propose a comprehensive service provision model to identify and assist welfare recipients with a mental health barrier. Third, I review outcome data from several promising intervention strategies.     

Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

Care Coordination of Services for People Living with HIV: A Case Study of a Rural Clinic

Abstract

The healthcare landscape is changing with the development of integrated health care models across the country. Counseling is uniquely positioned to add to the continuum of services of integrated health by providing counseling and case management services through advocacy for clients. One particular chronic illness that remains highly stigmatized is HIV, which is slowly becoming more integrated into the larger healthcare system. This pilot study documents the process and experience of a hospital-based midwestern AIDS service organization in the development of innovative and unique services to address the needs of the HIV population in a rural midwestern state.     

Deficits in young men's knowledge about accessing sexual and reproductive health services

Objective: The current study aimed to examine (1) gender differences in college students' knowledge of sexual and reproductive health care (K-SRHC) service access points, and (2) the relationship between demographic and psychosocial factors and college students' overall K-SRHC service access points. Methods and Participants: Self-report online surveys were administered to 18- and 19-year-old college students from a northern California public university (N = 183; 39.9% men; 32.2% Latino). Results: Women reported higher overall K-SRHC service access point scores than men. Findings indicated that gender and family planning self-efficacy were the strongest correlates of K-SRHC service access points. Men with a regular source of health care had higher K-SRHC service access points than men without. Conclusions: Results suggest that college men need additional education about how to access sexual and reproductive health services to support their own and their partner's health.     

Predicting job satisfaction of mental health peer support workers (PSWs)

ABSTRACT

The Mental Health Recovery Model is an empowering service philosophy which has been transforming the field of mental health. An important service approach to actualizing this model is hiring peer support workers (PSWs) who are peers advanced in recovery and employed to assist other peers in their recovery process. This study reports on factors hypothesized to affect PSW job satisfaction. Using multiple regression analyses, organizational culture and relationship with peers predicted 29% of job satisfaction. Based on these findings, suggestions are offered to assist social work administrators in effectively integrating and supporting PSWs in the workplace.     

Factors Associated with Depressive Symptoms Among Latino Family Dementia Caregivers

ABSTRACT

Caregiving to a person affected with an irreversible, late onset dementia can be an arduous challenge. Utilizing Pearlin and colleagues' (1990) and Lawton and colleagues' (1989; 1991) stress process model of caregiving, the factors associated with depressive symptoms among Latino¹ family dementia caregivers were examined. Problematic behavior of the dementia-affected person was found to be the most important factor associated with depressive symptoms, followed by poor self-reported health of the caregiver. Human service providers are advised to include depression screening tools at the time of assessment of Latino caregivers and to offer behavioral management interventions and self-care strategies.     

Recovery,Managed Care,and the Reflective Practitioner

ABSTRACT

Conflicting priorities between the recovery movement among consumers of mental health services and managed behavioral health care planners result in turbulence and ambiguity in the service delivery system. Based upon information from both published and unpublished written sources, areas of strain are described. The utility of a reflective practice model, as conceptualized by Schon (1983), for addressing a recovery vision within a managed care environment is explored.     

Internet Technology Makes Clinical Data Systems Technically and Economically Practical: Are They Politically Feasible?

SUMMARY

The creation of data systems capable of tracking health service inputs and outcomes were a major thrust of health reform. It proved neither technically nor politically feasible. Recent advances in software, communication technologies and measurement tools suggest integrated information systems, reliable at the individual case level, are now practical. This paper explores one possible model of a clinical information system for behavioral health services and asks, “Is implementation of such a model now politically feasible?”