A Community's Perceptions of Pediatric Social Outcomes in a Downsized Urban Hospital System

This article describes parental perceptions of pediatric services at Los Angeles County King/Drew Hospital and Medical Center after the hospital and its community clinics were restructured in the 1990s. Qualitative and quantitative measures are used to capture parental perceptions of service utilization, service convenience, and quality of care. The results are compared to hospital institutional operational data from patient flow analysis reports, appointment delay reports, and improving organizational performance committee reports. A comparison of parental perceptions of pediatric care is also made with findings from other post-devolution studies on access and quality of care at the Los Angeles County Department of Health Services. The implications of the findings for hospital quality assurance processes and health services outcomes research are discussed.     

Provider and care workforce influences on quality of home-care services in England

A key trend in home care in recent years in England has been movement away from "in-house" service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users' views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Child care improvement on a shoestring: evaluating a low-cost approach to improving the availability of quality child care

The Philadelphia Early Childhood Collaborative (the Collaborative) was designed to improve the quality of child care by increasing coordination among organizations that locally deliver professional resources to child care providers. The evaluation examined the implementation of the Collaborative, utilization of its services, and the impact of service use on child care quality. Child care providers reported gains in their professional knowledge and behavior from using Collaborative resources and rated the resources highly. No long-term effects on provider behavior, knowledge, or attitudes were observed. Although the original organizations were able to function collaboratively and Collaborative services were widely used, more intensive interventions may be required to change the availability of quality child care.     

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.     

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.     

Insights into the black box of child care supply: Predictors of provider participation in the Massachusetts child care subsidy system

The United States child care subsidy system relies on the voluntary participation of private providers in the market in order for low-income families to access otherwise unaffordable care. However, with few states able to pay child care providers subsidy payment rates at market value (National Women's Law Center, 2015) and increasing pressure for providers to improve their quality of care (Child Care and Development Fund [CCDF] Program, 2016), there is concern at the federal level regarding the supply of providers willing to participate in the subsidy system (CCDF Program, 2016; Schumacher, 2015). Using administrative data from Massachusetts, this study examines the factors associated with provider participation in the child care subsidy system. Findings from logistic regression analyses indicate that lower administrative capacity, higher private pay prices (in comparison to the subsidy payment rate), and higher local market household income may limit or reduce opportunities for participation in the subsidy system. Results also suggest that for-profit providers are not avoiding participating in the subsidy system, but may find participation challenging if subsidy payment rates are too low (compared to private pay prices). Additionally, although the total pool of accredited providers is small, accredited providers have greater odds of participation compared to non-accredited providers, indicating that families may have some access to quality care. These findings suggest that states should focus on identifying 1) ways to ease administrative impediments to entry into the subsidy system, 2) effective provider recruitment tactics, and 3) monetary/non-monetary incentive structures that can build a large and diverse supply of high quality subsidized care.     

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.     

Institutional responsibilities: providing placement for international students

ABSTRACT

Recent years have seen a rapid increase in the number of international students studying health professional degrees such as social work in Australia and internationally. Research indicates that placement educators perceive that extra time and effort is required to support international students on placement due to, for example, language barriers and cultural and educational differences. This paper reports on findings from a nationwide study investigating the experiences and support needs of placement educators who supervise international social work students. The data consists of 15 in-depth interviews and 66 survey responses from placement educators across Australia. Findings reveal that placement educators feel pressure from education providers to supervise international students, yet they also feel they lack support from the education provider to do so adequately. Placement educators cite a need to increase contact and coordination between agencies and education providers, including clarity around the education providers’ expectations of their supervision. Placement educators want closer working relationships between agencies and education providers to ensure rewarding and enriching experiences for both students and placement educators. Such findings suggest that increased institutional support for, and collaboration with, placement educators is required to sustainably maintain quality placements for international students.     

Preference for same-race health care providers and perceptions of interpersonal discrimination in health care

This article examines black Americans' preference for black health care providers. Using data from a national survey, we assess how blacks 'perceptions of discrimination are related to preference for same-race health care providers. Overall, the belief that discrimination is frequent in different-race doctor-patient dyads is associated with greater preference for a same-race provider However; the belief that discrimination occurs regardless of a doctor's race reduces preference for a same-race provider Finally, general perceptions of discrimination are distinct from concerns about personally being treated unfairly, and low personal concern about unfair treatment reduces preference for a same-race provider among those who believe that interpersonal discrimination occurs frequently. These results suggest a complex picture of how perceptions of discrimination influence preferred race of health care provider among blacks in the United States.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

Making Continuing Professional Development Relevant and Accessible in Regional Social Work

ABSTRACT

Continuing professional development (CPD) is an integral component of quality social work practice (Australian Association of Social Workers, 2013). Despite this, there is a lack of knowledge around the perceived needs and challenges of accessing CPD for rural and regional social work practitioners. This research explored professional development education needs and challenges for rural social work practitioners. The findings revealed an increase in complex cases in practice leading to the need for more training in mental health, legal aspects, and therapeutic interventions. Strong demand for CPD was evident, with a preference for face-to-face training instead of online modules. In the face of persistent challenges some innovative solutions were possible from a partnership between service providers, higher education providers, and the professional body to better meet the needs of the rural social work practitioners.

IMPLICATIONS

• Increasing complexity in rural, regional, and remote social work practice has placed extra demands on the knowledge resources of social workers.

• Continuing professional development (CPD) must be relevant and readily accessible to meet the needs of those who practice in these areas.

• Partnerships between agencies, higher education providers, and professional bodies, along with the use of technology can increase accessibility for rural, regional, and remote social workers.

     

Perceptions of child abuse: a comparison of three professional groups in Japan

Japan passed its Child Abuse Prevention Act on 20 November 2000. In these early years following the passage of this Act, it is especially important to attempt to define what constitutes child abuse. Definitions and practical responses may be coloured by perceptions of service providers, and since professional culture is believed to influence individuals, this study compared the perceptions of (a) social workers, (b) physicians, (c) lawyers, and (d) the general public. Results suggested less disagreement in perceptions than was anticipated. When differences were observed, they were correlated more frequently with age and gender rather than with profession.     

Improving student knowledge and perceptions of primary care providers at campus health centers

ABSTRACT

Objective: To examine current knowledge and perceptions toward primary care providers commonly staffed at student health centers (PAs and NPs), and also assess the effectiveness of information-rich provider biographies to improve knowledge and perceptions. Participants: One thousand six hundred forty six students from 2 universities in 2 states participated in this study from February to November, 2016. Methods: An online survey. Students were exposed to an improved biography of an NP discussing how she can perform many of the same duties as primary care physicians. Changes in knowledge and perceptions were assessed pre- and post-biography exposure. Results: More than half of students are unaware NPs and PAs can prescribe medications and diagnose illnesses. Students exposed to the biography increased their knowledge of NPs, and perceptions of their expertise. Conclusions: Results suggest improved provider biographies on student health centers' websites can help reduce the knowledge deficit that exists among students regarding common primary care providers.     

An examination of student and provider perceptions of voluntary sector social work placements in Northern Ireland

Practice based learning in Northern Ireland is a core element of social work education and comprising 50% of the degree programme for undergraduate and postgraduate students. This article presents evidence about the perceptions of practice learning from voluntary sector/non-government organisation (NGO) placement providers and final year social work students on social work degree programmes in Northern Ireland in 2011. It draws on data from 121 respondents from189 final year students and focus group interviews with voluntary sector providers offering 16% (85) of the total placements available to students. The agencies who participated in the research study provide a total of 55 PLOs to social work students, and are therefore fairly representative in terms of voluntary sector (NGO) provision. The article locates these data in the context of practice learning pedagogy and the changes introduced by the Regional Strategy for Practice Learning Provision in Northern Ireland 2010–2015. Several themes emerged including; induction, support and guidance, practice educator/student relationship, professional identity and confidence in risk assessment and decision-making. Social work educators, placement providers and employers must be cognisant of newly qualified social workers’ needs in terms of consolidating knowledge within the formative stages of their professional development.     

Caregiver perceptions of children in their care and motivations for the care work in children's homes in Ghana: Children of God or children of white men?

The perceptions and motivations that workers have in their work and work environment are important determinants of the quality of work they do. For people who work in residential institutions where children who have lost the care of their parents receive care, these perceptions and motivations become a crucial part in determining the quality of services or care the children are given. This study set out to explore the perceptions and motivations of caregivers in the institutional context in Ghana. Adopting a qualitative, phenomenological approach, data were collected from 35 caregivers in two children's homes in Ghana through participant observations, focus group discussions and in-depth interviews. It emerged that caregivers perceived the children in their care first as children of God and then as children of white men and were predominantly motivated by their religious convictions to keep doing ‘the work of God’. Other motivations included personal life situations and economic aspects of the job. Implications for the workers and children in this environment are discussed.     

儿科医护人员职业压力分析

目的调查儿科医护人员工作的主要压力。方法采用问卷调查法,对川北医学院附属医院儿科20名医生和50名护士进行工作压力方面的调查。结果⑴护士平均压力值高于医生压力平均值;⑵医生的压力来源主要是家长及病人亲属,护士的压力来源主要是儿科专业压力;⑶压力最大的三个因素是风险大,待遇低,工作负荷重和家长要求高,期望值高,过度维权。结论儿科医疗护理是压力较高的行业,儿科医生和护士的压力有所不同。     

Ethical assessment and moral reasoning in child therapy

Social workers find it hard to operationalize the profession's Code of Ethics, and few professionals even rely on the Code, as a point of reference in making judgments when faced with ethical dilemmas. Children and adolescents hold a special position in clinical practice. Issues requiring ethical judgments are more complex, because any intervention involves people other than the child. How the professional meets the interests of the parents and those of the child, is frequently a cause for conflict. This article presents philosophical models of moral reasoning, and ethical assessment, to assist clinicians in identifying and resolving frequently faced practice dilemmas, with the goal of improving the quality of patient care, in terms of both the process and the outcome. Emphasis is not only on the ethics of the actual decision but also on the ethics of the decision-making process itself.This article is based on the author's unpublished dissertation, seminars, and grand rounds presentations on applied ethics in clinical social work. Additionally, this author has had consultative and collaborative contact with the Hastings Center, Institute of Society, Ethics and Life Science.