Caregiver involvement in behavioural health services in the context of child welfare service referrals: a qualitative study

Human service agencies serve a growing number of adults with behavioural health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioural health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioural health services. Researchers reviewed agencies' case records and conducted in‐depth interviews with 16 caregivers, 9 child welfare caseworkers and 12 behavioural health treatment counsellors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioural health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioural healthcare needs. Implications for managers and practitioners are discussed.     

The impacts of accessible service delivery on front‐line helping relationships in child welfare

This paper presents the results of a study comparing the impacts on helping relationships of locating front‐line child protection service providers in central locations or in accessible school and neighbourhood service delivery sites. Creating easier access to front‐line child protection service providers, fostering more positive community perceptions of child welfare services, improving client and service provider satisfaction with helping relationships and services, and increasing families' willingness to ask for help were core objectives at the accessible sites. Using a quasi‐experimental outcome design, file reviews and qualitative interviews with service providers and parents, this study presents evidence that accessible sites had substantial success in achieving these objectives when compared with central service delivery locations.     

Enhancing Social Support for Migrant Families: A Case Study of Community Services in a Shanghai Urban Village and Implications for Intervention

Recent years have witnessed the growing emphasis of the Chinese central government to develop community services as a method of building communities and strengthening social solidarity. With the increased involvement of multi‐generation households in China's internal rural‐to‐urban migration, however, little is known about what community services are available for migrant families. Nor do we know much about how such services can enhance social support for migrants, which is crucial for their psychological well‐being in managing the ongoing challenges that arise from migration and further integration into cities. This article presents a case study conducted in Shanghai where social services are emerging in a few urban villages. We begin with a brief background on China's rural‐to‐urban migration and the emergence of urban villages, followed by a discussion of community services and social support for Chinese migrant families. We then document existing services in an urban village to explore how they can influence migrant families' social support. Drawing on the perspective of service providers, we highlight the effects social work interventions can have on improving social support for migrant families. Finally, we propose an intervention framework based on multi‐dimensions of social support, emphasizing an integration of formal and informal social support through community services for migrant populations.     

Thrown back: Reintegration experiences of National Guard/Reserve mothers of young children

Few studies have examined the experiences and perceptions of servicewoman mothers and their children, even as an increasing number of them have experienced deployment and combat exposure. The present paper describes a qualitative study that explored National Guard/Reserve (NG/R) mothers' experiences with mothering and co‐parenting during reintegration and their perceived priorities, supports, challenges and needs. Interpretive phenomenological analysis of seven in‐depth qualitative interviews produced themes including reunion and loneliness, the importance of time, help seeking and gendered experiences. Notably, all participants transitioned immediately back into primary caregiver roles upon homecoming, and several described how difficult it was to readjust while privately dealing with unmet mental health needs. Findings underscore the importance of a flexible suite of service options that meet key needs, most importantly, child care, social–emotional support for children and peer‐based parenting support specific to servicewoman mothers. For NG/R mothers, who may live far from base, community‐based services are essential, but as participants described, civilian social workers and other professionals must develop specialized knowledge, skills and experience to provide appropriate support.     

Connecting and engaging with health and social care: Exploring the core components of a telephone and web-mediated family navigation prevention service

Early engagement with health care, mental health care, and social services can promote the well-being of children and families. How practitioners can best support family engagement with these services however remains largely unknown. To address this gap in knowledge, data from a voluntary 12-week telephone and web-mediated family navigation preventive intervention called Navigate Your Way were subject to mixed-methods analysis. Twenty-nine caregivers and five family navigators contributed data to the study. Thematic analysis of weekly navigator check-ins, participant closing interviews, navigator discharge notes, and lab meeting notes was conducted and followed by quantitative analysis of navigator effort across project activities. Results were then mixed to illuminate the essential conditions for supporting family connection to health care, mental health care, and social services. Qualitative analysis identified themes related to empathic engagement and person-centred navigation as central to connecting families to needed services. Quantitative analysis of navigator effort identified participant outreach, weekly check-ins, service identification, and ongoing supervision as essential navigation activities. Together, providing an environment that is supportive, consistent, flexible, person-centred and tailored to families' specific needs are important for connecting to health and social care.     

Promoting family well‐being and social cohesion: The networking and relational approach of an innovative welfare service in the Italian context

This evaluation study examined a Family Services Centre (FSC) operating in a socio‐culturally deprived suburban area of Southern Italy to explore how promoting innovative practices to meet increasingly complex family needs. The research used a case study approach and a mixed‐methods design: the service's documents underwent a documentary analysis; users' trends and satisfaction levels were examined using quantitative data; service's identity and changes in the perceptions of professionals were analysed by qualitative techniques. Overall, the data highlighted the fact that the FSC can be considered an effective prevention instrument: its family support practices, oriented to the ASPIRE model, ensure accessibility, empowerment and a strengths‐based approach. Thanks to its strengthened mediator role, client participation and caseworkers' ideas, it represents an environment conducive to the development of innovation in social practices, influencing local social policies regarding child and family welfare. Despite its changes, the FSC still promotes family well‐being and social cohesion within the community with its innovative multilevel and multimethod approach. Considerations and lessons learned by this case study could stimulate decision makers and social practitioners to reflect on innovative models to meet families' needs.     

Assessing the value of family safety networks in child protective services: Early findings from Minnesota

The considerable number of families served continues to place systemic challenges on the child welfare system. Jurisdictions are turning to new strategies to increase family engagement in services and to leverage taxed or limited resources. Signs of Safety® is a strengths‐based and safety‐focused approach to child protection work that is grounded in partnership and collaboration. This exploratory pilot study with a referred participant sample used interviews with 26 parents and 32 safety network members to explore respondents' perceptions and use of a safety plan and safety network, core components of the Signs of Safety framework. Findings from this pilot investigation include insights about how safety plans and safety networks are established, how they function, and opportunities for enhancing their use with families with the goal of providing supports that increase the likelihood of continued safety for children after case closure. Preliminary results also suggest these tools may contribute to reduced re‐reports to child protection.     

South Asian immigrants' experience of child protection services: are we recognizing strengths and resilience?

Ethno‐racial minority families who come in contact with child protection services face unique challenges that include different ideas about appropriate child rearing practices, possibly different definitions of child maltreatment, the possibility of racial biases and service provision that does not address their particular needs. Ethno‐racial minority immigrants encounter additional barriers to services associated with the challenges of settlement in a new cultural environment. Although considerable research has explored these issues, knowledge of the experiences of ethno‐racial families who have been in contact with child protection is limited. The current paper provides insights from a qualitative study that explored the experiences of one ethno‐racial group (South Asians) in Canada. Findings suggest a variety of reasons that families come into contact with the child protection system, and the characteristics of the sample highlight their difficult financial and employment circumstances. Themes include participants' desire to be better informed about the reasons for child protection involvement and about what they can expect from the worker and the agency. They also identified a wish for services that not only recognize their cultural diversity but also respond to the needs of the whole family. In‐home services were especially appreciated. The findings reveal the resilience and personal agency among participants that can be enhanced through strength‐based approaches to practice. Helping others, establishing community networks and developing needed services were avenues of resilience identified.     

Planned telephone support for disadvantaged parents in North Wales: perceptions of service users

This paper draws on the findings of a qualitative evaluation to examine user perceptions of a planned telephone support intervention based in a disadvantaged area in North Wales. Telephone support services are tailored differentially to offer information, advice and/or counselling on a crisis‐led or planned‐intervention basis. Research focusing on telephone support, for the most part (and particularly in the UK) has examined crisis‐led as opposed to planned support services. The findings of our study resonate with earlier research findings about telephone support that suggest provision of non‐visual support in social care can overcome some practical and financial difficulties for users with little discernible loss to their experience of satisfaction with the service. In addition, the paper suggests that planned support may provide a valuable service to users who are most disadvantaged and marginalized and who have found traditional forms of support unsatisfactory. For such users, planned telephone support can offer one‐to‐one communication tailored to specific client needs. Moreover, it can enable the development of user trust in the service which empowers users to operationalize strategies in the context of a reliable, sustained, unthreatening (and thus minimal risk) relationship.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

The Influence of Service Factors on Spousal Caregivers' Perceptions of Community Services

The literature clearly denotes that spouses differ from other family members in their reactions to caregiving, their patterns of service use and their assessment of specific services. Yet, despite their prevalence as caregivers, little is known about their unique perceptions of community services and the factors that impact their experiences with the service system. The purpose of this study was to explore the relative influence of (a) spouses' personal factors (e.g., gender, family support) and (b) service factors (e.g., one-on-one professional support), on spousal caregivers' perceptions of community services. The study employed a survey design with a sample of 73 spousal caregivers caring for their partners with dementia at home.

This study found that spousal caregivers have more negative perceptions of the service system when their in-home workers are not informed about their spouses' likes, dislikes and routines. This service factor was the most significant predictor of caregivers' service perceptions. The study further found that most spousal caregivers receive fewer than five consultations from a non-medical professional over a one year period. While spouses longed for more professional support, this service factor was not uniquely associated with service related stress. The policy and practice implications of these findings are discussed.     

Strengthening kinship families: scoping the provision of respite care in Australia

Kinship care is the fastest growing form of out‐of‐home care in Australia, as it is in many other countries. The Victorian Government's response has been to establish 18 programmes across the state to provide support to kinship families. The scoping project described here, based on interviews with key programme staff, explores the experiences of the new programmes in providing support, specifically respite care, to kinship families. It has produced a picture, based on qualitative and quantitative data, of how respite care is understood, the perceived respite needs of kinship families, how services are organized and provided, identified barriers to families accessing support, the effect of respite provision and what constitutes optimal practice. The findings establish a basis for a best practice model of service provision for this increasingly significant family type.     

Australia's Individualised Disability Funding Packages: When Do They Provide Greater Choice and Opportunity?

Australia's new National Disability Insurance Scheme (NDIS) uses individualised funding packages instead of traditional block‐funded disability services to support people with disability. The NDIS works with the person and their family to assess the person's needs and develop a plan that determines their funding allocation. Funding can be used to purchase support from a disability service or from the open market. People can purchase support that suits their cultural and personal preferences. This paper examined whether individual funding packages met their aims in Western Australia, where they had been the primary mechanism of disability support for over 25 years. An exploratory case study was conducted consisting of face‐to‐face, in‐depth interviews with 11 key participants: people with disability, senior government administrators, service provider managers, and a support worker. Complex systems theory was used to review the data and findings showed that individualised funding packages did not automatically result in more choice and greater opportunities. People needed information to make informed decisions; supportive and creative support from social workers and other professionals; and welcoming communities. The findings can inform policies and assist social workers facilitate maximum choice and opportunities for people with disability and their families.     

Lessons learned implementing community‐based comprehensive case management for families surviving homicide

Family members of homicide victims often experience a wide range of adverse reactions to the homicide. This study reports on the Traumatic Loss Response Team, a project conducted by a community‐based, mental‐health agency to provide comprehensive case‐management services to meet homicide survivors' complex needs. To conduct the study, we abstracted service/process data from open client cases in 2013 (most recent year with available data) and conducted interviews with the project's implementing agencies. Interviews revealed both initial challenges and factors facilitating successful implementation. Main challenges to overcome included gaining credibility and trust from police and issues around overlap of services provided to families by numerous agencies that may become involved in a homicide. Partners view the project providing a range of important services to families, including intermediary/buffer between families and police. Concerning service data, of the 131 cases open in 2013, most were referred directly by police and involved community violence, an adult victim and a firearm. Most of the 164 clients receiving services were female, adult, African‐American and parents of the deceased. Grief support was the most common of numerous services provided. We hope that this study will catalyse sharing of similar data and experiences among organizations providing services to homicide survivors.     

What do we know about the social networks of single parents who do not use supportive services?

The role that social support and social networks play in mediating isolation and stress experienced by vulnerable families is well established. However, a major issue facing supportive human services is to find and engage families with limited social networks and link them to supports that could improve outcomes for their families. This paper reports on the results of in‐depth interviews with 20 sole parents with children aged under 5 who were not well connected to services. It documents their social networks with the use of a social network map. Using a social capital lens, the analysis attempts to differentiate the different relationships in the participants' lives. Most participants were not satisfied with their informal networks, with conflicted or ambivalent reliance on family, absence of support and community engagement and fragility of informal networks. Although this group of isolated mothers does encounter the formal service system, the opportunities to increase and strengthen their networks do not eventuate. Better understanding of the nature and extent of social networks can inform practitioners and policy‐makers of the critical factors needed to increase service use for parents with limited resources.     

“A game of two halves?” Understanding the process and outcomes of English care home closures: Qualitative and quantitative perspectives

With care services increasingly delivered via a market there is always a risk that care homes could fail financially or struggle in terms of quality, ultimately having to close. When this happens, the received wisdom is that subsequent relocation can be detrimental to the health and well‐being of older residents (possibly even culminating in increased mortality). However, there is very little formal evidence in the United Kingdom (UK) or beyond to guide policymakers and local leaders when undertaking such sensitive work. Against this background, this article reports findings from an independent evaluation of what is believed to be the largest care home closure program in the UK (and possibly beyond). This consisted of qualitative interviews with older people, families, care staff, and social work assessors during the closure process in one case study care home and one linked day center, as well as self‐reported health and quality of life data for older people from 13 homes/linked day centers at initial assessment, 28 days after moving and at 12‐month follow up. The study is significant in presenting public data about such a contested topic from such a large‐scale closure process, in its focus on both process and outcomes, in its mixed‐methods approach, and in its engagement with older people, families, and care staff alongside the use of more formal outcome measures. Despite significant distress part‐way through the process, the article suggests that outcomes either stayed the same or improved for most of our sample up to a year after moving to new services. Care homes closures may thus be a “tale of two halves”, with inevitable distress during the closure but, if done well, with scope for improved outcomes for some people in the longer term. These findings are crucial for current policy and practice given that the risk of major closures seems to be growing and given that there is virtually no prior research on which to base local or national closure processes. While some of this research is specific to England, the underlying issue of care home closures and lessons learned around good practice will also apply to other countries.     

Patterns of entry to community‐based services for families with children with developmental disabilities: implications for social work practice

The purpose of the present study was to understand, from parents' perspectives, the process of entry to community‐based services for children with developmental disabilities and to explore the relationship between patterns of entry and parent‐reported needs and priorities for service. Qualitative interviews were conducted with 43 mothers and 29 fathers of children with developmental disabilities approximately 6 months after the families entered community‐based childhood disability support services in Manitoba, Canada. Analysis of the coded interview data resulted in the identification of three process factors influential in the entry of families to community‐based support services: recognition of problems in child development, formal diagnosis of child disability and linkage between diagnostic services and the community‐based support system. Analysis of these processes identified four patterns of service entry associated with differing family needs for service: early entry, prompt entry, delayed entry and atypical entry. The results can be understood as a typology useful for social workers in the assessment of family needs and priorities at the point of entry to community‐based services.