Social Work and Complex Care Systems: The Case of People Hospitalised with a Disability

Health and hospital system reforms prioritise efficiency. However, initiatives can impact on people with new or existing disabilities who require time to maximise functional independence. With greater demands for shorter hospital stays social workers face increasing pressure to facilitate discharge. This paper reports findings from research identifying factors contributing to extended stays for adults with disabilities. We sought to better understand patient characteristics and discharge planning challenges by analysing a clinical dataset of 80 patients and qualitative interviews with five experienced hospital social workers. Three key factors are identified: issues around rehabilitation services; assessment and planning for community care; and availability of and access to discharge options. Strategies to reduce length of stay are reported. We argue that building collaborative partnerships and working across multiple, complex systems and disciplines are vital to ensure these patients access appropriate community-based resources within the current health reform environment.     

Workforce Issues in Residential Care Facilities in Rural China

This study examined contemporary frontline workforce issues related to residential care for elders in rural China. Residential facilities in rural China are in transition from exclusively providing shelter to childless elders to providing long-term care for frail elders. These facilities are also under pressure to improve the quality of services that they provide. The study is based on in-depth interviews with administrators and field observations of facilities. The study focused on the following issues related to the workforce: recruitment and retention, training, work environment, workforce organization, regulations, compensation, and career ladders. The implications of resident characteristics for demands on the work force were examined. The study found that lack of skilled personnel is one of the major reasons that the overwhelming majority of facilities deny admission to frail and demented elders. Improving workers’ skill is critical if these facilities are to meet the increasing demand for institutional long-term care needs.     

The implications of disability protests for social work practice

This article examines the demands which have been made in the over 800 US protests this author has analyzed. Some demands are cross-disability, meaning they could apply to people with all types of impairments; these include demands for rights and accessibility in all domains. Other demands are disability-specific: they apply to people with specific types of impairments, ranging from mobility impairments to developmental disabilities. Many demands have been related to services, which can be either cross-disability or disability-specific. The paper examines the implications of these demands for social work practice. These include that disability be de-stigmatized by practitioners, that people with disabilities have choices, that they have control over their services, and that all aspects of social work practice be accessible to people with any type of disability.     

The Implications of Disability Protests for Social Work Practice

Abstract

This article examines the demands which have been made in the over 800 US protests this author has analyzed. Some demands are cross-disability, meaning they could apply to people with all types of impairments; these include demands for rights and accessibility in all domains. Other demands are disability-specific: they apply to people with specific types of impairments, ranging from mobility impairments to developmental disabilities. Many demands have been related to services, which can be either cross-disability or disability-specific. The paper examines the implications of these demands for social work practice. These include that disability be de-stigmatized by practitioners, that people with disabilities have choices, that they have control over their services, and that all aspects of social work practice be accessible to people with any type of disability.     

Perceived barriers to accessing health services among people with disabilities in rural northern Namibia

People living with disabilities (PWD) face unique problems in dealing with conventional healthcare facilities. We investigate the experiences of PWD as they access healthcare facilities in rural Namibia. More specifically, we investigate structural–environmental and process barriers to accessing health facilities. The study relied on semi-structured interviews and purposive sampling. The results showed PWD find it difficult to walk to health centers for treatment due to lack of transport, money to pay for treatment and toilet facilities and the distance is too far for people with lower-limb disabilities. There is a need to consider the unique issues affecting access to healthcare for people living with disabilities to achieve equitable access to healthcare services.     

Difficulties in Shifting from Individualistic to Socio-political Policy Regarding Disability in Canada

An individualistic conception of disability has been replaced by a socio-political definition. The socio-political model implies that disability stems from the failure of the social environment to adjust to the needs of people with disabilities rather than from the inability of disabled individuals to adapt to societal demands. This paper will examine the extent to which Canadian policies have changed to embrace this new definition. There has been some progress in policies related to shelter, transportation and recreation. However, policies related to income and employment are still individualistic in nature because policy change in these areas requires a major shift in governmental approach to unemployment and fundamental reform of the Social Assistance system. In a period of high unemployment, people with disabilities are viewed as surplus labour, and the Canadian government has found that high unemployment is politically tolerable. Obstacles to an increase in income support include a strong work ethic, the philosophy that social assistance benefits should be less than could be earned in the work-force, and the private insurance and litigation industries which benefit from the current income system. Other barriers to change are the lack of power of disabled groups and the dominance of professionals.     

New settlements and community benefits: Public and private responsibilities

This paper aims to develop a framework for approaching the negotiation of planning gains — private sector contributions towards public facilities — from the perspectives of both planning authorities and developers. Previous assessments of planning gain have located it within corporatist modes of intervention, which demands various assumptions about the relationship between planners and developers. A comparison of the arguments used to define the bounds of legitimate gain suggests an alternative model of competing professional cultures. A case study of proposals for new settlements in the countryside is used, in order that the specific way in which the rural local state tackles the issue of developer contributors may be assessed.     

Knowledge,Tasks and Strategies for Teaching About Persons with Disabilities

Abstract

Persons with disabilities are a distinct and insular minority group within the United States. Given the fact that social workers offer critical social services to this group, it is important for social work programs to offer meaningful curriculum content on persons with disabilities. This article presents key issues that social work educators should find useful for teaching about persons with disabilities. Specifically, a discussion is offered on the disability civil rights movement, the culture of disability, models for defining disability, knowledge areas on disability issues, teaching tasks and strategies for focusing on persons with disabilities.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Transition from school for youths with a disability: issues and challenges

Australian research has demonstrated that students with a disability are more likely to remain out of the full‐time workforce. These research findings have been the catalyst for a call for a comprehensive career development and transition planning approach for all students with disabilities in schools as well as for employers to rethink the role of people with disabilities in the workforce. In the Australian context the transition from school for individuals with a disability is complicated by a disparate and fragmented group of service agencies providing a range of services, including employment, supported accommodation, recreation and leisure pursuits, as well as training and placement, along with, at times, a deep‐seated prejudice towards people with disabilities in the market place. This paper reviews a number of issues and challenges confronting individuals with a disability making the transition from school to the post‐school environment.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Order of selection in vocational rehabilitation: implications for the transition from school to adult outcomes for youths with learning disabilities

Interagency cooperation between special education and vocational rehabilitation (VR) is central to ensuring the continuity of services to young adults with disabilities who are in transition from school to adult living. However, the interface between special education and VR may be complicated by order of selection, an equally binding mandate in federal VR policy to provide priority services to individuals with the most severe disabilities. Because students with learning disabilities are typically perceived as having mild rather than severe disabilities, these youths are most at risk for falling through the cracks in the service landscape once they leave the school setting in states where the VR agency is implementing an order of selection procedure. This article identifies and discusses common impediments to collaborative transition planning for students with learning disabilities that may be intensified when the state VR agency is operating under an order of selection plan. Recommendations are provided to facilitate greater interagency cooperation among schools and VR agencies so that transition planning and implementation for students with learning disabilities is not subverted as a result of the order of selection mandate.     

残疾人创业的信任环境重构——基于团队特征的视角

推动残疾人成功创业已成为各国促进残疾人就业率提升的一个有效手段,但创业成功并非易事,残疾人创业所面临的信息沟通不畅、信任环境缺失等问题直接影响创业的成功率。本文通过构建相关变量的有调节效应的回归模型,深入探讨了影响残疾人创业的情景因素,研究结果显示,残疾人创业团队的外部信任环境重构和创业团队自信心的建立对创业成功有显著的正向影响。     

Child Abuse and Children with Disabilities

Children with disabilities experience a significantly increased risk of abuse. This paper explores the cultural context that values body perfection and tolerates violence, so that abuse of children with disabilities, in response to normal frustrations and pressures, becomes a legitimate response. These pressures are analysed as to how they affect parents and siblings. The medical model as it affects hospital organisation and the health care system and rehabilitation is analysed. The objectification of parts of the disabled child is discussed in terms of its effect on lowering the natural modesty boundaries of the child. The child with disabilities as it relates to the family is also a creator of frustration and rage. The structural issues as they apply to the external environment are presented. The paper proposes a new understanding of the child with disabilities within the family, and within the external environment, most particularly the medical system.     

Single Parenting in Families of Children with Disabilities

Rearing a child with disabilities is a challenge, per- haps even more so for single parents who most often are women. Stress and negative psychological effects have been considered likely outcomes for parents of children with disabilities. With the increased family focus in the provision of services for children with disabilities, it becomes even more important to understand the sources of stress and the types of adaptations made in these families. The research literature was analyzed and similar results were found. Single mothers of children with disabilities often were younger, had less education, and lower incomes. Few studies included these socio- economic factors. Findings indicate that gross differences betweensingle- and two-parent mothers tended to become nonsignificant when maternal education and income were taken into account. Stress levels and adaptation were not pervasively different for single mothers and mothers who were parenting with a partner, after SES variables were controlled. On a few dimensions-including family harmony, integration, and cohesion-some studies found mothers in single parent families to be at a slight disadvantage relative to two parent families. Research findings indicate that other factors need to be considered in research and in provision of services to understand the interplay between stress and adaptation and to facilitate the fami- lys coping. Further study is needed on factors on two levels; task demands and emotional responses, the diversity among mothers, their life situations, and their task demands must be recognized, and socioeconomic conditions and participation by other adults in care- giving. Positive adaptation by single mothers of children who have disabilities is a reasonable expectation; services should build upon family strengths and competencies.     

Individualized Transition Planning for Students With Learning Disabilities

Many transition plans for students with learning disabilities suffer because (a) they often focus on the employment needs of students with more severe cognitive and physical disabilities and (b) they are not required until as late as 14 years old, sometimes too late for many students with learning disabilities. Lack of effective transition planning may result in inadequate postsecondary adjustment problems (e.g., under‐ or unemployment, restricted participation in community and leisure activities). The authors describe specific problems in transition planning for students with learning disabilities and offer suggestions for designing K‐12 transition plans that are uniquely suited for these students.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Social entrepreneurship as an employment pathway for people with disabilities: exploring political–economic and socio-cultural factors

The current economic climate demands more innovative approaches to increasing labor market participation for people with disabilities. Social entrepreneurship (SE) offers one alternative employment pathway. However, little is known about the broader factors influencing SE for people with disabilities. Using empirical data from focus groups comprised of social entrepreneurs with disabilities and interviews with key stakeholders working in the fields of policy, disability, and business, this research frames its analysis in the intersection of disability studies and entrepreneurship to explore which factors influence the potential for SE to provide equal participation opportunities for people with disabilities in the labor market. Findings suggest that further consideration of political–economic and socio-cultural factors is needed if we are to better understand the potential of SE for people with disabilities.     

Dosvox Usability: recommendations for improving interaction of blind people with the web using the system

At present, it is recognized that the Internet plays key role in universalization of opportunities in society in which we live. For people with disabilities, the content must be accessible in all websites, but the assistive technologies used must be adequate to the specific needs of people with disabilities. Dosvox is a free system developed in the Universidade Federal do Rio de Janeiro (UFRJ) specially designed for blind people and used by them in the performance of their tasks with the use of computers. Previously, through exploratory research based on the observation of the interaction of blind students with the Web, usability problems were identified in the Dosvox interface and in the Webvox, the Web browser included in the system, and these problems were related to the fact that the interface is designed in accordance with the mental model of these Information Technology professionals. This study consolidate the problems in earlier phases of the research, link the results with usability heuristics of Nielsen and propose several improvements to Dosvox and its development process.