Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

The Efficacy of a Community-Based Project in a Chinese Context

In this paper, the authors report the results of an exploratory study which assessed the service efficacy of a collaborative service initiative developed by a university academic department and a community-based social service agency in a socially deprived and remote community in Hong Kong. The project aimed to foster mutual help and self-help of low-income families and deepen their social connection with the community. Service efficacy was assessed using a structured questionnaire and a focus group interview. After participating in the service project, the well-being of the participants has become better and their family relationships have improved. They have developed a stronger sense of belonging toward the community. The preliminary findings support the importance of creating social network in social work practice for low-income families residing in a deprived and remote neighborhood.     

Factors affecting nonmedical participants' allocation of scarce medical resources

This study was designed to determine the factors that affect nonmedical participants' judgments in constructing a ranked waiting list for kidney patients requiring dialysis. Participants (N=167) were given a questionnaire that provided minimal demographic data about 16 hypothetical patients. Participants were requested to rank patients in order of priority for treatment. Each participant's personal demographic details were also obtained. Patients differed on four dimensions: gender, income, alcohol consumption, and religious beliefs, yielding a 2x2x2x2 design. The participants favoured for treatment included females over males, "poor" over "rich," nondrinkers over drinkers, and Christians over atheists. Results are discussed in terms of establishing democratic criteria and informing medical personnel on explicit factors which may affect their decision making, thus guarding against biases in judgment.     

Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n?=?11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.     

Lower-Status Participation and Influence:Task Structure Matters

Status hierarchies readily form in groups and , once established , limit lower-status group members' opportunities for contributing to and influencing group decisions . Recent findings , however , suggest that the type of task on which a group works may allow lower-status individuals to break through power and prestige orders in a cooperative way while conflicting with ideas of their higher-status group members . In this article , we review a research program that investigates how task structure relates to status and influence in small groups . In one experiment, using groups of three female students as participants , we found that open-structured tasks allow lower-status group members to participate , receive positive evaluations , and improve their status more than closed-structured tasks . In a second experiment, using groups of two female students and a female experimenter as participants , we found that open-structured tasks and lower-status confederates foster more divergent thinking and indirect influence than closed-structured tasks and higher-status sources . Our findings contribute to the understanding of how immediate problem-solving environments contribute to status change and influence in small groups.     

Decision‐making in child welfare services: Professional discretion versus standardized templates

The article explores differences in the assessment and decision‐making processes, in child welfare services where a standardized template is implemented and in services where it is not. Child welfare services in several countries use different approaches to assess children's and families' need for intervention. In Norway, as in other European countries, there is a shortage of knowledge about decision‐making strategies. The article examines how 36 child welfare caseworkers in 6 different teams in Norway investigate, assess, and make decisions at the phase of an incoming referral. The analysed data were collected by focus group interviews. We use decision theory as a theoretical frame of reference. The analysis shows variation in the assessment procedure at different points of the process, depending on which approach was used. Despite such differences, the final decisions made were almost identical. Even though the data has its limitations because of the small number of informants, the results indicate that choice of approach is not decisive for decision‐making in the child welfare services.     

Double or nothing?! Small groups making decisions under risk in “Quiz Taxi”

This paper investigates the behavior of contestants in the game show “Quiz Taxi” when faced with the decision whether to bet the winnings they have acquired on a final “double or nothing” question. The decision in this natural experiment is made by groups of two or three persons. This setup enables the decision-making process to be studied with regard to group and communication characteristics. The contestants show fairly risk averse behavior. There is also a significant heterogeneity in attitude to risk. In particular, all-female groups are much less likely to go for the risky option. Furthermore, decision-making behavior appears to vary across differently composed groups and prior performance. The study also documents the importance of discussions: The propensity to gamble increases with discussion length, and the correlation between communication content and the final choice is strong, indicating that time and subjective context are important features of decisions made under risk.     

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.     

Self-Esteem,Life Satisfaction,and Positive Future Perception among at-Risk and Comparison Group Participants in National Civic Service

ABSTRACT

This study focuses on a program designed to engage at-risk youth in the National Civic Service (NCS) in Israel with the goal of enabling them to better integrate into normative adult lives. This exploratory study employed a cross-sectional design and compared groups of at-risk female volunteers (N = 426) with comparison groups of not at-risk participants in the NCS (N = 456). For both of them, three sub-groups were examined at different stages of their service: the beginning, near the end, and about one year after finishing the service. In both the at-risk and comparison groups, self-esteem was higher among the alumni compared to those at earlier stages of the program. Life satisfaction was generally much lower among the at-risk group, but after service completion, both groups reported higher life satisfaction. There were no significant differences between the groups in their future perceptions. The implications of these findings for policy and practice are discussed.     

My life in care: experiences of non-participation in decision-making processes

The extent to which young people are involved in legal decision‐making depends on assumptions and perceptions about their ability to participate in decision‐making in general. This paper draws on research with four young people, looking at their experiences of involvement in a variety of decision‐making processes whilst in the care of the local authority. Through narratives, games and other activities, the thoughts and emotions of the four young people are explored, identifying the development of feelings of helplessness, low self‐esteem and poor confidence that have followed the lack of opportunities made available to them to make decisions about their own lives. The efficacy and tension of corporate parenting is also explored with suggestions from the participants on how the care system could be constructed differently to facilitate their voice and that of much younger children than themselves. Thus, the debate becomes one of adult ability and preparedness to involve young people in decisions about their own lives, rather than whether they are able to participate effectively.     

Exploring Formal Service Use by Older Chinese: A Case Study on a Naturally Occurring Retirement Community

ABSTRACT

This study examined secondary data from a naturally occurring retirement community in which 296 older Chinese were interviewed to understand and identify the factors related to formal service usage. Regression analysis found that the importance of perception of formal services impacts predicting service use. The results also indicated older female Chinese participants were more likely to use services. Implications for practice and policy to improve access to services by older Chinese were presented and the development of culturally sensitive services for this group is encouraged.     

虚拟社区是否增进社区在线参与？一个基于日常观测数据的社会网络分析案例

对互联网技术的使用是否会增进公民的社区参与一直是一个具有争议性的问题,对于网络社区在其中如何发挥作用的相关研究却寥寥无几。本文利用大数据,采用一个案例,从社会网络分析的视角对此进行研究。通过区分不同性质的讨论网后发现,网络社区对业主的网络公民参与存在正效应,不同议题的讨论网关系可以相互转化,从而促进网络参与。     

THE GROPE FOR GROUP

There has been an apparent increase in the use of social work groups for clinical purposes. This trend has neglected the more traditional and important use of groups for community change goals. Even when working with clinical groups, community goals can be impacted. This article suggests a specific methodology for integrating group treatment goals with community action. It suggests that group workers view their role as instigators in broadening community support and action around clinical group work issues; that agencies need to make time to do this; that how group workers connect group work to community action needs to be empirically demonstrated with each service act.     

Partnerships, Power and the "New" Politics of Community Participation in British Health Care

Multi–sectoral approaches to health improvement in its broadest sense have entailed an emphasis by the British government upon partnership working in and around community involvement in planning processes. New service planning and delivery organizations in the health service—primary care groups and primary care trusts—thus have to ensure that public and patient involvement strategies reflect a coordinated, if not integrated, multi–sectoral approach to such involvement. But how are these enforced partnership arrangements shaping the approach taken by primary care groups and trusts to the issue of public and patient involvement? More particularly, is the traditional dominance of health service managers and the medical profession in decision–making processes under challenge? This article draws on a study of primary care groups and trusts in three districts in order to gauge perceptions and calculations with regard to partnerships for involvement. Results appear to suggest that health service managers and practitioners continue to exercise considerable influence in comparison to that of patients and citizens. But, if the findings are viewed in the broader contexts of government managerialist strategies of surveillance and accountability and the growth of service–user and advocacy organizations, partnerships may offer significant scope for “lay” challenges to managerial and medical power.     

Preferences and Expectations for Delivering Bad News Among Korean Older Adults

ABSTRACT

 The purpose of this study was to explore Korean older adults’ perspectives toward physicians’ disclosure of serious illness to patients. Seventy Korean older adults residing in the community were interviewed in person using a semistructured interview guide. Major themes included conflicting desires among participants to: 1) inform the patient directly, 2) inform the patient indirectly, and 3) inform only the family. Subthemes under the first theme included: a) decision making about treatment, b) planning and preparation for the future, c) need for use of an ethical standard, d) consideration of patient coping responses, and e) disclosure of serious illness as a relational process. Disclosure of bad news is more than revealing or concealing information. Needs and preferences regarding to what extent and how information is delivered differ by culture. Thus, understanding preferred communication pathways for advanced care planning in specific cultural frameworks is important. Future studies using clear concepts and measures about serious illness disclosure can better prepare health care professionals in interacting with those from minority cultures. In addition, studies of those with poor health status from diverse cultural groups may further assist social workers to tailor interventions to accommodate cultural needs and expectations in end-of-life settings.     

Life Satisfaction of Rural Migrant Workers in Urban China: The Roles of Community Service Participation and Identity Integration

Abstract

China is home to approximately 245 million rural-to-urban migrant workers. The influx of migrants into urban areas has posed various challenges for local social service systems. Recently, increasing number of community services have been developed to meet the growing service demands from the migrant population. However, whether increase in community service use results in improved wellbeing among migrant workers remains critically unexplored. As such, this study examines the role of community service use in migrant workers’ life satisfaction and the potential mediating effect of identity integration in Shenzhen, China. Bootstrapped models were adopted to examine relationship among variables. Drawing from a sample of 1,087 rural-to-urban migrant workers, we found that community service use is positively correlated with both identity integration and migrant workers’ life satisfaction. Moreover, identity integration served as a partial mediator between community service use and life satisfaction. The mediating effect of identity integration was found to increase with age. This study highlights that diverse services should be implemented to address divergent needs of migrants in different age groups. Community service can also serve as a vehicle to foster integration among migrant workers in host communities, especially for older age groups. Future studies may further investigate the relationships between community social capital, community social support, quality of community-based organization and frequency of service use so as to optimize the life satisfaction of migrant workers.