Parenting groups for parents whose children are in care

Excluding very severe child abuse cases, biological parents are usually encouraged to maintain contact with their children in care. Parent‐child contact is often considered important because it can maintain the child's psychological identity and well‐being. It can also maintain parent‐child attachment and in some cases facilitate reunification. Improving parenting skills is viewed as an important method by which contact between children and their biological parents can be enhanced. However, mainstream parenting groups are often unsuitable for parents whose children are in care for a number of reasons. There is stigma involved with having children in care, such parents have very complex lives and there are reduced opportunities to practise skills learnt with their children. Groups designed specifically for parents whose children are in care appear to be a promising approach to improving the quality of contact between these parents and their children. This paper will review group‐based approaches to working with biological parents whose pre‐school‐aged children have been placed in care. The paper will also report the findings of a research project designed to identify key facilitators and barriers to parental involvement in a group‐based programme which includes contact between parents and their children who have been placed in care. Copyright © 2009 John Wiley & Sons, Ltd.     

Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

In between formal and informal: Staff and youth relationships in care and after leaving care

This paper deals with the contact and relationship youth have with staff while in care and after emancipation and examines the young adults' needs in contacting staff after leaving care. The study was conducted through 60 interviews with young adults ages 21–26 who emancipated from residential settings in Israel. Results showed that most youth report having had a meaningful staff member in care and that 62% were in contact with staff after their transition to independent living for both emotional and practical needs that could not always be answered by staff. One of the study's conclusions is that despite their departure staff's relationship with these young adults continues informally years after. However, without formal recognition of the place staff have in the lives of aged-out youth, no resources are invested in training them to properly meet the young adults' needs. The discussion highlights the need for an integrative approach that sees residential settings and staff as a meaningful part in the continuity from care to independent living by supporting aged-out youth's gradual transition to adult life.     

Maintaining contact between parents and children in the public care

Children looked after by local authorities are at risk of losing contact with parents and significant others despite emphasis in the Children Act 1989 on partnership and promoting contact. Work to maintain contact should address losses before as well as during care. Contact declines over time with lower rates for children in foster care and as social work support for families diminishes. Contact after adoption is increasing; methods of indirect contact developed by adoption agencies may help to maintain contact for looked after children. Lost contact can be restored with social work support.     

Child Abuse on the Internet: Ending the Silence

The Melbourne Health (MH) Social Work Residential Care Team (RCT) was established in 2002 as a new and innovative approach to aged care. The service employs three full-time social workers and an Allied Health assistant with previous experience in aged care. The RCT works across the MH continuum of care with inpatients recommended for residential care. The service is predominantly patient- and family-focused, but is also consultative to meet the education needs of MH staff and the community. This paper discusses the MH Social Work Residential Care model, reviews data collected since RCT implementation and the benefits shown for patients, their families and interdisciplinary staff. This paper discusses pressures and factors that impinge on the ability to discharge patients to residential care and explores recommendations for ongoing clinical practice as well as recommendations that the RCT has submitted to management for further consideration.     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.     

Contact networks in the emergency department: Effects of time,environment, patient characteristics,and staff role

Emergency departments play a critical role in the public health system, particularly in times of pandemic. Infectious patients presenting to emergency departments bring a risk of cross-infection to other patients and staff through close proximity interactions or contacts. To understand factors associated with cross-infection risk, we measured close proximity interactions of emergency department staff and patients by radiofrequency identification in a working emergency department. The number of contacts (degree) is not related to patient demographic characteristics. However, the amount of time in close proximity (weighted degree) of patients with ED personnel did differ, with black patients having approximately 15 min more contact with staff than non-white patients. Patients arriving by EMS had fewer contacts with other patients than patients arriving by other means. There are differences in the number of contacts based on staff role and arrival mode. When crowding is low, providers have the most contact time with patients, while administrative staff have the least. However, when crowding is high, this differential is reversed. The effect of arrival mode is modified by the extent of crowding. When crowding is low, patients arriving by EMS had longer contact with administrative staff, compared to patients arriving by other means. However, when crowding is high, patients arriving by EMS had less contact with administrative staff compared to patients arriving by other means. Our findings should help designers of emergency care focus on higher risk situations for transmission of dangerous pathogens in an emergency department. For instance, the effects of arrival and crowding should be considered as targets for engineering or architectural interventions that could artificially increase social distances.     

Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Addressing intimate partner violence in primary care: lessons from chronic illness management

Though many studies have documented the high prevalence, morbidity, mortality and costs attributable to intimate partner violence (IPV), it is still unclear how our health care system should address this major public health problem. Many have advocated for routine screening, yet there is still insufficient evidence that routine IPV screening can lead to improved outcomes. Though recognition of IPV is very important, a screening paradigm may not be the optimal way to approach IPV within the health care system. For many patients, exposure to violence is a chronic condition, characterized by long-term abusive relationships, histories of childhood and community violence, multiple associated chronic symptoms, and extra barriers to addressing their other chronic illnesses. Thus, there may be important lessons to be learned from work being done in the area of chronic care. We explore how Wagner's Chronic Care model may guide efforts to improve health care for IPV survivors and may serve as a framework for future research studies.     

From conflict to cohesion: Involving stakeholders in policy research

The transitional period in South Africa, coupled with the general societal context of uncertainly, poses several challenges to policy researchers. While policies which address the inequities of apartheid are urgently needed, the time and resources available for policy formulation are limited. These policies often have to accommodate the views of a range of stakeholders who, at best, have had little prior contact with one another or, at worst, are openly hostile. This article describes our experience as health policy researchers in employing research techniques to partially address these problems. The article makes use of examples from several large studies which were conducted over the past 5 years. All of the studies evaluated primary health care services in disadvantaged communities and were unusual in the extent to which they involved community representatives and health authorities at local, regional and national levels in the formulation of recommendations. The first section of the article describes the process we follow in achieving participation, the second highlights the advantages of this approach and the last section describes the difficulties associated with the approach. We conclude by emphasizing the facilitatory role which may be played by independent researchers in times of transition.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Health and mental health services for children in foster care: the central role of foster parents

It is well documented that children enter foster care with special health and mental health needs and, while in care, those conditions are often exacerbated. However, less attention has been given to foster parents who have the most contact with these children. Results are presented from a national study on the developmental, health and mental health care needs of children in foster care that included foster parents' perspectives and observations. Their role in improving child well being is explained and recommendations for policy, practice and advocacy also are included.     

Adding Long-Term Care to Medicare

The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance organization (SHMO). Operating since 1985. the SHMO model integrates community-based, long-term care services into the managed,prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care s stems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.     

Adding long-term care to Medicare: The Social HMO Experience

The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.     

Working with Dave. Application of Peplau's interpersonal nursing theory in the correctional environment.

Achieving therapeutic relationships with forensic patients is dependent upon nurses' awareness of personal needs, reactions to the patient, recognition of their participation in the pattern, the effects of this participation on others, and the changes they needed to make. Nurses have more extensive contact with the forensic patients than other health care professionals. Consequently, the potential exists for nurses--through interpersonal relationship--to have the greatest therapeutic impact or to engage in patterns that replicate pathology-producing situations (Peplau, 1978). The goal is not that nurses be perfect, but that they be aware of imperfections and capable of exploring them.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

Entering into a Collaborative Search for Meaning with Gay and Lesbian Youth in Out-of-Home Care: An Empowerment-Based Model for Training Child Welfare Professionals

Utilizing an empowerment-based approach, which incorporates self-identified gay and lesbian youths and openly gay and lesbian child welfare professionals as collaborative partners in the process, this article offers a model for training child welfare professionals to work more effectively with gay and lesbian youth in out-of-home care. This three hour training model empowers the gay and lesbian youth, whose voices have been subjugated, to emerge as the experts in training child welfare professionals to more competently and responsively address and meet their needs.     

Attachment intervention through peer-based interaction: Working with Istanbul's street boys in a university setting

Street youths are a particularly vulnerable group because of early experiences of emotional and physical neglect and abuse which can make them difficult to approach. Traditional interventions such as 1 h weekly therapy sessions do not meet their needs. This article describes a creative and novel approach to the rehabilitation of street children implemented during the To-Gather with Youth Project (TYP) under the aegis of the Research and Application Center to Support Children/Youth Living and Working in the Streets (SOYAÇ) at Maltepe University in Istanbul, running in collaboration with state-run care institutions for boys since 2010. The approach consists of a peer-based supportive model that provides adolescent boys care with emotional and social security through attachment relationships that they develop with university students. The teaching staff and students of the psychology department constitute the core group running the program, which also includes workshops assisted by teachers and students from humanities departments such as philosophy, drama, and radio. These workshops are organized to promote the psychosocial and cognitive development of the participating street boys as well as to enable their direct access to the public through their art and photography. Based on a qualitative analysis of narrative interviews with boys and detailed observational reports by project volunteers, we identify several mechanisms that we believe contribute to change in the boys, including the development of secure attachment relationships with a trusted adult, a child-centered approach, and a socially safe environment created by peer-support in a university setting. The boys and volunteers also reported incidents and feelings that seem to suggest that the boys' have increased their capacity to regulate their emotions, sense of self-esteem and resilience, and desire to develop their lives in the future. This paper offers this intervention as a feasible service model for the rehabilitation of street boys in other cities.     

Modelling a disease-relevant contact network of people who inject drugs

This study uses social network analysis to model a contact network of people who inject drugs (PWID) relevant for investigating the spread of an infectious disease (hepatitis C). Using snowball sample data, parameters for an exponential random graph model (ERGM) including social circuit dependence and four attributes (location, age, injecting frequency, gender) are estimated using a conditional estimation approach that respects the structure of snowball sample designs. Those network parameter estimates are then used to create a novel, model-dependent estimate of network size. Simulated PWID contact networks are created and compared with Bernoulli graphs. Location, age and injecting frequency are shown to be statistically significant attribute parameters in the ERGM. Simulated ERGM networks are shown to fit the collected data very well across a number of metrics. In comparison with Bernoulli graphs, simulated networks are shown to have longer paths and more clustering. Results from this study make possible simulation of realistic networks for investigating treatment and intervention strategies for reducing hepatitis C prevalence.     

Addressing Psychosocial Barriers to Hospital Discharge: A Social Work Led Model of Care

Australian hospitals regularly care for patients who cannot be discharged routinely due to complex psychosocial needs that manifest as barriers to discharge. These long-stay or “stranded” patients are at risk of detrimental health outcomes resulting from their extended stay while also potentially delaying admission for those who need acute care. This article discusses a new social work led model of care developed at an Australian metropolitan hospital that targets long-stay patients with psychosocial barriers to discharge. The model of care, overseen by a specialist social worker and assistant, demonstrates how the social work profession can take leadership within the psychosocial realm to improve both organisational and patient outcomes.