Transferring HIV/AIDS Related Healthcare from Non‐governmental Organizations to the Public Healthcare System in South Africa: Opportunities and Challenges

Almost two decades after the transition to a post‐apartheid regime, South Africa is still high‐ranking in the incidence of chronic diseases like tuberculosis, HIV/AIDS, diabetes and hypertension. This article explores the transition from HIV/AIDS related healthcare offered by internationally supported non‐governmental organizations (NGOs) in rural areas to the inclusion of this healthcare into the public healthcare system. This transition is part of a wider process that represents the exact reverse of healthcare reforms in Western industrialized countries. Instead of a transition from public healthcare to privatized or marketized healthcare, the transition in South Africa is from partly private healthcare to a public healthcare system in which the private commercial health sector as well as all services provided by NGOs will be integrated. In that process, many obstacles obscure intended outcomes, such as equal access to healthcare. Some obstacles are evident in the case studies of two internationally supported NGOs in the field of HIV/AIDS healthcare. We will conclude that governance structures of public and private NGO‐based healthcare are often difficult to integrate; implementation timelines and priorities do not always coincide; and the public healthcare system is still too weak to deliver good quality healthcare in rural areas without continued NGO support.     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

Finding the right connections: Peer support within a community‐based mental health service

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community‐based mental health service This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community‐based mental health service. Interviews with 19 peer and non‐peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non‐judgemental way. However, peer support workers tended to ‘fill service gaps’ within intensive, administrative case‐management environments. These findings highlight the importance of an organisational‐wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: ? Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; ? The roles of peer support workers were poorly understood by team members; ? Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.     

Labour Force Participation,Social Inclusion and the Fair Work Act: Current and Carbon‐Constrained Contexts

The notion that employment is a precondition for personal wellbeing and social inclusion is almost sacrosanct in Australian culture. Yet, the working and living conditions of Australia's low paid workers tells a different story. While labour market participation is a cornerstone of the Federal Government's Social Inclusion Agenda, it is recognized that low pay and poor job quality often derail this key objective. Indeed, the difficulty of ‘making work pay’ at the bottom end of the labour market is a social inclusion challenge that has yet to receive the policy or public attention that it warrants. This article considers what the Fair Work Act means for the social inclusion of disadvantaged workers, in the context of wider‐ranging strategies to address low pay. It concludes with some considerations of the challenges that a carbon‐constrained economy is likely to present for labour force participation as a remedy for social exclusion.     

Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service‐users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services – a setting where conflicting objectives to manage risk and meet need are apparent. Media‐driven pressure to ward against the ‘risk’ represented by service‐users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service‐user engagement and hinder risk management. Drawing on qualitative data from interviews with service‐users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter‐productive, trust plays a significant role in service‐users' initial and ongoing engagement, communication and co‐operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in‐patient care.     

Healthcare in India: Changing the Financing Strategy

The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one‐fifth of health expenditure being publicly financed. India has large‐scale poverty and yet the main source of financing healthcare is out‐of‐pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to over‐emphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.     

Garbage‐can Policy‐making Meets Neo‐liberal Ideology: Twenty Five Years of Redundant Reform of the English National Health Service

The garbage‐can theory of decision‐making (Cohen et al. 1972), has been adapted into a perspective on policy‐making, with adaptations of the approach placing notable emphasis upon the health sector (Kingdon 2006; Paton 2006). This article creates an adapted ‘garbage‐can’ framework to help explain each stage of the reform of the English National Health Service (NHS) over the last 25 years. The emergence of the key idea and resultant policy at each stage of reform of the English NHS has been arational and indeed sometimes irrational. Policy has reflected advocacy by policy‐salesmen (Kingdon 2002), proffering ‘solutions’ to ill‐defined problems and answers to unasked questions, and politicians' short‐termist responses at each decision‐point. Yet the garbage‐can alone is not enough: if arationality rules in policy‐making day to day, this does not mean that there is not an overall ideological context, trend or bias in reform. The article also posits that ‘market reform’ has derived from the ideological hegemony of a naive anti‐statism (hostility to a misleadingly defined and often mythological ‘centralist state’) in public services and enthusiasm for market competition rather than any evidence‐based application of pro‐market ideas to health policy. A question arises: how are these two approaches (short‐term arationality and longer‐term ideological bias) combined in explanation of how policy over time is biased in a particular direction while seemingly arbitrary and directionless at each messy decision‐point. The article attempts to combine the insights of a garbage‐can approach with wider explanations of ideological hegemony.     

Inside co‐production: Stakeholder meaning and situated practice

Co‐production has risen to the fore of contemporary policymaking, with the intention of placing citizens at the heart of public service design and production. Although this may lead to more democratic and legitimate decision‐making, achieving “meaningful” co‐production can be difficult. In this qualitative study, we examine what constitutes meaningful co‐production, in particular asking whether there is a disconnect between the elite policy narrative that legitimizes co‐production and stakeholder experiences of this approach. Our research adopts a decentred approach to examine the different ways that actors understand and participate in co‐production, both as a methodology and as an interactive social practice. We conclude that a lack of synergy between local narratives may undermine the potential success of co‐production.     

A green social work perspective on social work during the time of COVID‐19

COVID‐19 has challenged social workers to engage with health pandemics and provide essential services in conditions of uncertainty and high risk. They have safeguarded children, older adults and diverse adults in ‘at risk’ groups under tough conditions mediated by digital technologies, adhered to government injunctions, maintained social and physical distancing under lockdown and worked from home remotely. Social workers and social care workers have risen to the challenges, providing services with inadequate personal protective equipment and limited supervision and support. This article highlights the degraded physical environments, socio‐economic and political contexts that intensify precariousness and constraints that neoliberalism imposed on professional capacity before and during this health pandemic. It provides guidelines to protect practitioners and service users. It concludes that practitioners ought to understand zoonotic diseases, environmental concerns, acquire disaster expertise and training, widen their practice portfolio and value their contributions to this pandemic. Key Practitioner Message: ? Develop technological skills and innovate to support stressed individuals, safeguard children, adolescents and elders and deal with poverty and unemployment; ? Use digital technologies involving peers to explore tricky situations, examine ethical dilemmas through scenario building exercises, and tips for self‐care; ? Contribute to environmental protections that prevent the spread of zoonotic diseases like COVID‐19; ? Seek supervision and support for disaster‐based training from your line manager.     

Living in the red zone: the experience of child‐to‐mother violence

Child‐to‐mother violence is an area of family violence that has received limited attention over the past 20 years but is a problem for many families. It is poorly understood in the community and this lack of understanding creates a basis for families and service providers to minimize the abused mothers' experience. This paper is drawn from a larger study that aimed to explore child‐to‐mother violence in a high‐risk geographical area and describes a qualitative theme developed from 185 participating women's narratives, ‘Living in the red zone’: the experience of child‐to‐mother violence. The red zone refers to danger and was an element throughout women's narratives. It is clear from the reflections of these women that child‐to‐mother violence is a significant and complex issue. Mothers were predominantly struggling in silence with their experiences of a child or children whose behaviour was threatening and/or abusive. Their experiences were most often minimized and/or devalued by family and community members, which may prevent affected women from seeking support. Mothers generally had limited concepts of the possibilities open to them to improve their situation, or limited access to appropriate and empathic individuals or services.     

Microcredit for rural poverty alleviation and social well‐being: A study of Sabah,Malaysia

Microcredit is an influential intervention used to alleviate poverty and improve social well‐being in rural communities in Sabah, Malaysia. This study examined the effects of a microcredit scheme, Amanah Ikhtiar Malaysia (AIM), on the well‐being of these communities. Using a survey method, a pre‐tested interview schedule was administered to 277 AIM recipients in Sabah, Malaysia. Social well‐being was examined based on the three indicators of Midgley's social development approach: the management of problems, the fulfillment of basic needs, and social opportunities provided. AIM microcredit schemes were successful in improving the well‐being of AIM recipients, although the recipients faced a number of problems, including unemployment, lack of education, and access to public services and healthcare facilities. The findings of this study represent a useful guideline to the AIM authority, development practitioners, policymakers, and governmental organization and non‐governmental organization workers.     

‘We Don't Have to Take This’: Zero Tolerance of Violence against Health Care Workers in a Time of Insecurity

Doctors, nurses and other health care workers in the UK are said to be increasingly aware of the ‘risks of the job’ as a result of mounting verbal abuse, threats and assaults from patients and their relatives. In the late 1990s the UK government introduced a policy of ‘zero tolerance’, which it claimed was designed to minimize the risk of such violence. Current policy refers to the need to be tough on offenders and encourage a culture of respect. In this article we review this strategy and the reasons for its introduction and consider some of the potential consequences. The article starts with an account of the policy, the definition of violence that underpins it and how it has been measured, and assesses the evidence regarding prevalence. This is then interpreted in the context of wider policies of zero tolerance to crime, and debates about risk, anxiety and insecurity.     

From Enlightened Self‐interest to Welfare Coalitions: Overcoming Identity‐based Tensions in the Israeli Welfare State

A common argument in the social policy literature is that ethnic and identity‐based heterogeneity undermines the welfare state. In part, this happens because of difficulties in the generation of broad social solidarity in diverse societies: solidarity which is allegedly necessary for sustaining public support for the welfare state. This study explores this argument's logic in the context of welfare state politics in Israel. Israel would appear to be a near‐perfect example of how heterogeneity strains social solidarity and, in turn, undermines the welfare state. Quite differently from most studies, however, this work's emphasis is not on public attitudes or voting, but on the political interaction between economically disadvantaged identity‐based minorities – specifically Arabs on the one hand and religious Jews on the other – in the welfare field. It is argued that shared interests enable extensive co‐operation among political elites in the welfare field despite religiously‐ and nationally‐based antagonism.     

Stability and change – a 7‐ to 8‐year follow‐up study of mental health problems in Norwegian children in long‐term out‐of‐home care

The aim of the study was to explore stability and change in mental health problems in Norwegian children aged 6–12 years old (n = 70) in long‐term out‐of‐home care. The children's mental health problems were assessed shortly after the placement and 7–8 years later by the caregivers and the teachers on the Revised Rutter Scales. Information on pre‐placement and placement factors were collected from the child welfare workers. At a group level the children's mental health problems had improved significantly over time according to the teachers' reports. According to the caregivers' reports, however, the children's problems were high and stable across time. Analyses aimed at detecting individual changes revealed a great variability in development according to both informants, indicating that treating the placed children as a homogenous group could be misleading. Several pre‐placement and placement variables were associated with the change in the children's mental health problems from the time of placement to the follow‐up time according to both informants' reports. However, all the predictors were accounted for by the strong effect of the children's problem scores when entering care.     

Poverty‐aware social work in the child protection system: A critical reflection on two single‐case studies

In recent years, scholarly writing that calls for the development of a new child protection framework that contextualizes risk and links it to poverty and social marginalization has increased. Nonetheless, there is a lack of research on the challenges of implementing such a framework in frontline practice. Based on the ongoing, rigorous documentation of the author's experience, as a social work practitioner in a community child protection centre, this article presents two single‐case studies that describe and conceptualize the potential contribution of the poverty‐aware paradigm to the creation of a social framework for child protection practice. Utilizing critical reflection as a method of analysis, the findings reveal two major tensions entwined in poverty‐aware child protection practice: the tension between focusing child protection interventions on parenting and focusing them on poverty and the tension between framing risk within a social context and framing it within the concept of the best interest of the child. Based on the case studies, seven poverty‐aware practices to cope with these tensions are identified.     

Practices of activation in frontline interactions: Coercion,persuasion, and the role of trust in activation policies in Germany

Following Michael Lipsky's well‐known argument that policy is made in the daily encounters between street‐level bureaucracy and citizens, a growing body of research emphasizes that actors and organizations delivering social and labor‐market policy play a crucial role in welfare‐state politics. Using qualitative data collected at three local employment agencies in Germany, this article explores worker‐client relations as a crucial mechanism through which activation policies are translated into practice. The analysis investigates how caseworkers define their role and their relationships with clients. The findings show that it is essential for caseworkers to achieve client compliance. In such a context, building relationships of trust is a strategic instrument in overcoming possible barriers to co‐operation in the caseworker‐client interaction. Caseworkers develop strategies to create the impression of trustworthiness and to motivate both unemployed clients and employers to become trust‐givers in the caseworker‐client relation. While research has often stressed the dichotomy between disciplining and enabling elements of activation policies, our explorative study shows that persuasion and trust‐building are a further important dimension of the frontline delivery of activation policies. These strategies reflect the importance of emotional aspects of frontline work.     

What do children think about their social worker? A Q‐method study of children's services

Understanding how children experience social work interventions is an important part of gauging whether what is provided is genuinely helpful. In this paper, we describe the findings from a research project using Q‐method, aimed at understanding what children involved with statutory services think about their social workers and how they experience the time they spend together. Using a pre‐existing practice framework, we explored skills including empathy, collaboration, and purposefulness from the point of view of children and young people. The participants in our study (n = 22) were insightful observers of social work practice, able to describe not only how they experienced time spent with their workers but also inferring differences in motivation and approach. In addition, workers who were described in similar terms by different young people were nevertheless experienced differently. This suggests not an archetypal “good social worker”—instead, there are skills that are good for specific children at specific times within the context of specific relationships.