The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

The Crisis in Retiree Health Benefits

Over 7 million retirees currently are covered by employer-sponsored health benefits plans in which the employer contributes all or a portion of the premium cost. Almost one-third of these retirees are under age 65 and therefore lack Medicare coverage. The annual cost to employers for this coverage is now $9 billion and is expected to be $22 billion in 20 years. However, inflation in health care costs, recent court decisions, the aging of America, and a major proposed accounting rule change by the Financial Accounting Standards Board have combined to produce a "crisis in retiree health benefits" in the business sector. As a result, employers are rapidly redesigning retiree benefit plans to shift future health care cost increases to their retirees. Until now, the aging network has been largely oblivious to this transformation in financing. Yet, this "crisis" begs for public/private sector dialogue and partnership, and the White House Conference on Aging could be a major forum for this dialogue.     

When to Work for Pay,When Not to: A Comparative Study of Australian and Danish Volunteer Care Workers

This paper explores the links between volunteers care workers’ current unpaid work and their own present or former paid work with the objective of analysing the ways welfare states influence volunteer care work. Data were collected between August 2012 and May 2013 through 41 face-to-face interviews with Danish and Australian volunteers working with the frail elderly, very sick and terminally ill. Three related arguments are made. One, paid and unpaid care work are so intertwined that it is not possible to understand volunteers’ unpaid working lives without simultaneously understanding their paid work lives. Two, many volunteer care workers are attracted to care work, not volunteering per se. Three, volunteering must be understood in relation to men’s and women’s ‘access to work’ in the welfare state, access that ultimately depends on the design and developments of these two contrasting welfare states.     

The history and metamorphosis of the National Registry of Health Care Providers in Clinical Social Work

This paper traces the history and metamorphosis of the National Registry of Health Care Providers in Clinical social Work. It was created in 1975 to credential qualified clinical social workers, and to identify them through a published directory. In 1987 it became the National Institute for Clinical Social Work Advancement. Its objectives and purposes moved from credentialling to advancing the speciality of clinical social work through research, education and marketing.     

Older Lesbians and Work in the Australian Health and Aged Care Sector

While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace.     

城市更新中的“公共利益”：界定标准与实现路径

界定公共利益,划清公共利益与私人利益的边界,是解决城市更新合法性问题的关键和基础。而目前公共利益的判定存在着无法明晰界定内涵与外延的困境。因此必须打破思维定势,将“什么是公共利益”转化为“由谁来界定公共利益”这样一个问题,以“公众受益性”和“受益人的不特定性和多数性”为标准,遵循法律保留、比例与正当程序原则;由人民代表大会及其常务委员会对“公共利益”的内涵与外延界定．并引入司法机构裁判．以听证、补偿、监督和救济程序为保障．     

Social Work in Health Care: A Guide to Professional Practice

Abstract

This article describes the evolution of a research program across 18 PhD dissertations over a period of eleven years. Included in this paper is a discussion of the advantages and disadvantages of student and field participation in thematic experimental research. The essential steps in the development of a set of related dissertations also are described. The guidelines for constructing the true experiment as dissertation are outlined. Attention is paid to the resources required to carry out thematic research and the specific ways in which such dissertations have been funded. Characteristics of those students who can best avoid such an approach to a dissertation are examined. Finally the author looks at the product of these dissertations and dissertators in terms of contribution to knowledge, the creation of practitioner manuals for practice interventions, the formation of practice-research faculty, research productivity of these faculty, and the development of the dissertator's clinical skills.     

When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda

Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well‐informed public backed up by a participatory political culture.     

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.      

When Social Work and Psychoanalysis Meet

In this paper I share my personal journey from agency social worker to psychoanalyst. I show how I have brought to my psychoanalytic work the teachings of such well known social workers as Mary Richmond, Bertha Reynolds, Gordon Hamilton, and Florence Hollis as well those of such contemporary social workers as the late Gertrude and Rubin Blanck, Nancy Bridges, and Eda Goldstein, among others. In the presentation, I also consider how social work values, social work ethics and social work attitudes have influenced my approach to the practice of psychoanalysis. The attitudes which I refer to, include flexibility, beginning where the client is; an appreciation of the importance of understanding a patient’s cultural background and a recognition of the importance of the relationship in the therapeutic encounter. These were not standard for psychoanalysts at the time I began to practice. Today however psychoanalysis has largely caught up with social work, and this paper affirms how those of us who have had a social work background are well prepared for psychoanalysis in the 21st century.

Teaching Reflective Social Work Practice in Health Care: Promoting Best Practices

Reflection on case material is traditionally believed to promote better clinical practice; recent neurobiological understandings explain why reflection consolidates learning and allows professional heuristics to develop. Here, we describe a practice in context (PIC) framework that requires reflection on the contextual and decisional aspects of a case and further reflection on potential changes for use in similar cases in the future. We analyze cases using the PIC framework to identify themes related to the use of self to identify potential best practices. The framework is shown to function to promote reflection at all levels of practice; published cases provide “role-modeling” for students, while also creating data for analysis of best practices.     

Transmen's Health Care Experiences: Ethical Social Work Practice Beyond the Binary

Informed by institutional ethnography approaches, this study includes interviews with 3 young transmen (21–29) about their experiences regarding Canadian health care and the work they perform to access care. Semistructured interviews were used to gather data that were then analyzed to identify key aspects of participants’ experiences and perceptions. Findings describe the extra work transmen perform to compensate for a lack of provider competence in transgender health care. Influences of the dominant gender binary ideology as it shapes the health care experiences of transmen are discussed. This article calls for social workers to challenge the gender binary and use practice frameworks informed by transgender theory.     

Social Work and Interprofessional Education in Health Care: A Call for Continued Leadership

A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and facilitators of this practice. Educators will learn how to help students discover the knowledge, skills, and attitudes for successful interprofessional work. Specifically, this article has the following objectives:

1. Discuss essential elements of effective interprofessional practice;

2. Present exemplars of interprofessional education involving social work;

3. Identify the roles for social work in leadership, education, and practice in interprofessional education.

     

The Problem-Oriented Method of Health Care Administration

Abstract

In 1968, Dr. Lawrence Weed^1,2 described the problem-oriented medical record as a basic tool in medical education. The authors attempted to adapt the “Weed System” for use in health care administration. The aims of the modification were to facilitate participative management in problem solving, and to formulate quality decisions by the consensus of an interdisciplinary group of managers.

Thirteen Department Heads were introduced to the Problem-Oriented System as described by Weed.^1,2 The Problem-Oriented Method of Health Care Administration (POM/HCA) was described by the Director as an extension of Weed's system.³

Weed's categories of Subjective, Objective, Assessment, and Plan (SOAP), were given for each problem presented at Department Heads' Meetings. The subjective information for the particular problem was derived from the felt or perceived needs, or the immediate pressures that so often arise in a multidisciplinary health care setting. Objective data came from identification and analysis of information about the problem. The assessment section was used by the Director to outline his thinking on the issue. The plan-for-decision section indicated the desired level of staff involvement in the decision-making process, by giving a numerical value to the area of freedom for the staff (adapted from Tannenbaum and Schmidt).⁴

Each Department Head was interviewed by the Management Consultant to find out how he or she experienced POM/HCA, their reactions to the numerical system for designating staff involvement in the decision-making process, and what he or she saw as the impact, advantages, and limitations of this method.

“Blood Doping:* An Update,” M.H. WILLIAMS. The purpose of this paper is to review the literature relating to the use of blood doping* in an attempt to improve the performance of an aerobic endurance athlete such as a five or ten km. runner or a marathoner. An earlier review of the literature by the author in 1975 concluded that there was not sufficient objective evidence to support the use of blood doping to increase endurance capacity. However, contemporary research demonstrates that when properly done, blood doping does significantly increase endurance performance in sports that are dependent on sustained, high levels of oxygen. The author also calls attention to the medical, legal, and ethical problems related to the practical application of blood doping. (The Physician and Sports Medicine 1981, July;9(7)59–64.)

* Blood doping is the process of removing blood from an athlete, usually an endurance-related sports participant, saving the blood and then about two weeks later, prior to competition, retransfusing into the system, to increase the oxygen capacity.

Contributed by John M. Miller, M.D.     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

Health Benefits of Pets for Families

During the last decade, the common belief that pets are good for their owners has gained concrete scientific support. In this paper we review the evidence for the health benefits of pets, discuss the importance of pets in the family system, and explore the implications of this information for therapists. Pets play a variety of health promoting roles which are particularly important for individuals lacking support from family members or close friends. We present research evidence supporting the health benefits of pets ranging from the facilitation of social interaction while walking dogs to the physiological effects of the presence of animals on cardiovascular responses to mild stressors.     

The Families and Democracy and Citizen Health Care Project

This article describes and updates the work of the Families and Democracy and Citizen Health Care Project, which engages with community concerns in order to effect change on many system levels. The project draws on family therapy's tradition of interest in larger social issues and adds democratic public theory and community organizing strategies. Since 1999 we have developed 14 citizen initiatives with a wide range of groups on a diverse set of problem areas. We describe the overall project and several of its initiatives, we address research and evaluation issues, and we outline opportunities for marriage and family therapists to learn how to do this work in their own communities.     

Preparing Social Work Students for Integrated Health Care: Results From a National Study

ABSTRACT

Integrated health care serves a vital role in addressing interrelated physical and behavioral health conditions, but social work graduates often lack sufficient training to work on integrated teams. We surveyed 94 deans of master’s of social work programs to assess the current and planned integrated health care curricula and the aptitude of schools to teach this material. We applied chi-square analyses to evaluate differences among programs that reported already teaching integrated health content and programs not yet delivering this curriculum. Findings suggest that deans of schools not yet teaching this material not only felt less prepared but also reported a lower capacity to do so. Implications and next steps to increasing integrated health curricula are presented and discussed.