Capability Traps Impeding Homeless Services: A Community-Based System Dynamics Evaluation

Continuums of Care (CoCs) are the primary coordinating bodies for homeless services in the United States. However, the complexities involved in delivering homeless services across interagency networks challenges coordination and system improvement. CoC governance, planning, and service provision have received little attention in academic literature, and thus, Continuums attempt to manage complex systems with little guidance. This evaluation applied community-based system dynamics with homeless consumers and service providers to (1) identify capability traps that impede services delivery and to (2) engage stakeholders in a structured system improvement process. Results revealed organizational structures for governance and planning that inhibit system outcomes. Insights led to policy and practice recommendations for the homeless system.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

An integrated system of engaging social workers and community volunteers in social care for the elderly: case studies in Taiwan

Integrating volunteers into social care is widely expected but rarely successful in practice. This paper discusses how the Community Care Centre Plan organising community volunteers to provide services to the elderly in Taiwan. This plan successfully integrated social workers and volunteers in a national system to offer service in local communities, showing a systemic practice of community care and a unique case of community-based and volunteer-based service. The purposes of this paper are to introduce the programme design and to understand how to integrate the mission of social workers and volunteers’ performance. The governmental policy and requirements, the role of social workers and the provision of voluntary community service which contributed to form the system were examined in this paper.     

Community care for adults with severe mental disorders in rural China: A case study

In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community‐care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community‐care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Building a partnership for social service delivery in Indonesia: state and faith‐based organisations

Contrary to the secularisation processes in modernisation theory, religions and faith‐based organisations (FBOs) are thriving in contemporary Indonesia. Strongly supported by community members, religious organisations have begun to extend their services beyond the traditional areas of education and health to operate in disaster relief and poverty alleviation programmes. These FBOs have been offering assistance to the disadvantaged whose needs have not been adequately met by the state. Social programmes run by the FBOs are an important safety net at the grass‐roots level in Indonesia; how to effectively coordinate and offer such services are important social policy issues. This paper will show that the Indonesian Government is keen to remain the key provider of social services and often perceives the services of FBOs as a threat. Some recent state policies to regulate the funding sources of Islamic organisations have posed a significant logistical challenge for their future operation. In addition, theological differences across various religious groups have made it difficult to form inclusive and extensive partnerships among the FBOs, who tend to compete with each another resulting in rivalry. These socio‐political contexts have limited the formation of effective partnerships for offering coordinated social services.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

The impact of declining resources and purchase of service contracting on private, nonprofit agencies

The increasingly precarious and vulnerable position of the private, nonprofit social service agency in an environment of government contracting and declining funding has been the subject of a number of articles over the past few years. Nonprofit agencies have been characterized as being controlled by powerful government agencies that dictate the terms and conditions of contracts, the types of services to be provided, the methods of delivery, and the price to be paid for services. One would expect to find nonprofits anxious to terminate their relationships with various units of government, and return to a more independent status. That is not happening. If anything, purchase of service contracting (POSC) with nonprofit agencies is increasing. This national study of nonprofit agencies explores the impact of declining funding from all sources (including POSC), and seeks to determine its impact on clients, staff, and organization.     

Learning to love (the state) again? Money,legitimacy and community sector politics

The erosion and dismantling of the post‐war welfare settlement has entailed an expanded role for the community sector, as a complex ‘mixed economy of service provision’ has developed. Critiques from both right and left have undermined the legitimacy of a statist model of welfare; state funding of non‐government community organisations is one aspect of the move away from centralised delivery. Despite their important role in this process, the distinctive perspectives of community sector organisations are rarely considered in broader theoretical and political debates. These organisations face significant dilemmas in struggling to maintain their viability and independence. Analysis of three major arguments for funding shows how organisations challenge the state's legitimacy by insisting on their own independent role but precariously rely on traditional sources of welfare state funding. This analysis draws into question the possibility of satisfactory non‐statist theories of welfare. It also suggests that the community sector might need to reposition itself as part of a broader public system of welfare, rather than in opposition to government, but that this strategy entails obvious risks for organisations' independence.     

Practitioners preferences of care coordination for older people: A discrete choice experiment

These findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences.

This study explored practitioner preferences about the relative value of attributes of care coordination services for older people. A Discrete Choice Experiment (DCE) survey was used to identify the views of 120 practitioners from 17 services in England in 2015. The survey design was informed by an analysis of standards of care coordination, a postal survey and a consultation with carers of older people. Results of the DCE survey were supplemented by a content analysis of qualitative comments and fieldwork notes. Most respondents were over 30 years of age, female and almost half worked part-time. Continuity of care (care provided by the same care coordinator) and the ability to access the range of services outlined in the care plan were the most important service attributes. Service setting influenced practitioner preferences. Those in specialist services for people with dementia identified the length of time a service was provided as another important attribute. The DCE methodology has provided the opportunity to systematically canvas practitioner preferences.     

Trust, risk and control within an indigenous–non-indigenous social service partnership

Partnerships between organisations are seen as one of the building blocks of the 'third way' approach to welfare provision in both Europe and New Zealand. While there is much discussion on building social capital and partnership working, such partnerships are usually perceived as being between government and community or private organisations. There is a gap in the literature in two specific areas: partnerships formed between two community-based social service organisations and partnerships formed between indigenous, or immigrant peoples, and non-indigenous organisations. This article explores such a partnership – that between the Ngai Tahu Maori Law Centre (an indigenous organisation) and the Dunedin Community Law Centre (a non-indigenous organisation). The article analyses this relationship and strategies employed by both organisations to develop trust, diminish risk and equalise control. Lastly, the article suggests that the model of interaction articulated here could be promulgated to other sites within the social services in New Zealand and the Americas, and within the European context.     

A Triumph of Hope over Experience? Modernizing Accountability: The Case of Complaints Procedures in Community Care

Complaints procedures are one component of maintaining and improving the quality of community care services. However, how effective are they in providing a means of redress for service users? This article presents the findings from four research projects, which included complaints procedures in their survey of service users’ experiences of community care provision. These findings are compared with the outcomes of similar research projects. The article concludes by evaluating the Department of Health’s consultation proposals on complaints procedures, and other policy documents, in the light of the research findings.     

A Description and Analysis of Multi-Sectoral Fostering Practice in the United Kingdom

Correspondence to Clive Sellick, School of Social Work and Psychosocial Sciences, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TJ, UK. E-mail: c.sellick{at}uea.ac.uk Summary Foster care is the preferred placement option for children andyoung people in the public care system in Britain. In recentyears, fostering has been the subject of extensive policy andresearch review and its practice and services have been widelyexamined. Although still provided principally within the public,local authority sector, there has been a significant growthin the use of independent fostering agencies and a steady useof the fostering services of established voluntary child-careorganizations. This paper reports a recent review of innovativefostering practice in all sectors across the four countriesof the UK, which was commissioned by the Social Care Institutefor Excellence. All British fostering agencies were invitedto submit examples of what they considered to be innovativeor effective in respect of six main categories: foster carerrecruitment and training; retention and job satisfaction; placementprovision; fostering children with complex needs; service provision;and user evaluation. These were examined in the light of relevantresearch knowledge to determine the extent of ‘research-mindedness’amongst fostering agencies. The authors conclude with a critiqueof four key factors which are impacting upon contemporary fosteringpractice in Britain.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

RURAL DISADVANTAGE IN THE DISTRIBUTION OF SOUTH AUSTRALIAN HOME AND COMMUNITY CARE FUNDING

In this paper, the level of HACC funding under the South Australian Dementia Support and Respite Projects and the Community Support Scheme was compared across Domiciliary Care and Human Services and Health regions. Results revealed that metropolitan regions generally received more than their per capita share of HACC funding despite the greater cost of community services in rural areas and the relative paucity of supplementary or alternative rural services. The need for greater planning in the distribution of HACC funds, including moving towards formula funding is identified.     

ANCILLARY AND SPECIALIST HEALTH SERVICES: THE RELATIONSHIP BETWEEN INCOME,USER RATES AND EQUITY OF ACCESS

Australia's public health system currently provides substantial funding to, amongst its other objectives, ensure access to hospital, medical and pharmaceutical services by all families irrespective of income (McClelland, 1991, p. 6). However most ancillary services are not similarly subsidised and there is some evidence that income presents a barrier to the use of these services. There is also evidence that low income might also reduce access to specialist medical practitioner services which, while funded through Medicare, are less likely to be bulk billed than general practitioner services, and which therefore attract higher out-of pocket costs. In this study, the 1989–90 National Health Survey is used to examine whether there are indicators that low income reduces access to a range of ancillary services such as physiotherapy, optician services, chiropractic and dental services and to specialist medical practitioner services.     

The influence of faith‐based organisations on Australian social policy

This historical overview explores the crucial and changing relationships between faith‐based organisations and governments, not only in the implementation of social services but also in the formation of social policy. Historically Australian governments have left large areas of social provision to the non‐government sector. For example, income support for the unemployed was not taken up by governments until World War II and income support for sole parents remained largely a responsibility for non‐government organisations (NGOs) until the 1970s. Prior to governments taking responsibility for income support, most of these NGOs were religious organisations surviving on donations, philanthropic support and limited government funding. It is argued that the dominant, semi‐public role of religious organisations in service delivery and social policy formation is an important but largely overlooked aspect of the Australian historical experience.     

Rethinking The Care‐Market Relationship In Care Provider Organisations

Care provider organisations are under pressure from funding bodies and regulatory procedures to narrowly construct care in ways that preclude its relational, emotional and social characteristics. This process of subjecting care to a managerialist‐market logic, however, creates tensions between the organisation and its key stakeholders: care recipients, care‐workers and unpaid carers. These tensions are significant and are likely to place organisations under pressure to develop a more holistic approach to care. In addressing this issue, this paper draws upon the concept of bounded emotionality to argue that it is feasible for organisations to be both instrumental and caring, and thereby be responsive to the needs of all of their stakeholders. The paper concludes by discussing some of the practical implications of organisations adopting a framework of bounded emotionality, and suggesting some directions for future research.     

Awareness of LGBT Aging Issues Among Aging Services Network Providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Transforming child and family services in urban communities in South Africa: lessons from the South

Post‐apartheid, South African agencies have been required to shift their services in fundamental ways, including offering services in previously un‐resourced areas, honouring the rights of children and families, ensuring that users, staff and governing bodies are representative of the population and providing developmental social welfare services in place of child protection‐oriented interventions only. A study of urban South African child welfare agencies provides insight into the complex task of managing and leading change. In view of overloaded change agenda and resource constraints, managers focused on effecting incremental change and prioritized the most ‘rewarding’ change efforts. Transforming practice towards a developmental approach was less successful. Structural interventions were also not prioritized. Child welfare agencies internationally face demands to transform in response to the effects of local change and globalization. The study's insights might resonate with agencies working for change in other societal contexts.