Partnership and Performance of Community-Based Organizations: A Social Network Study of Taiwan

ABSTRACT

Community-based organizations (CBOs) generally face challenges of meeting clients’ complex needs with limited resources. Partnership development can be a strategy for the CBOs to expand capacity and improve performance. However, relevant evidence is scant and tends to lack a theoretical base. This study examines the relation between networking and performance of a CBO from the perspective of social network analysis. The sample consists of 15 CBOs relying on volunteers to provide primary care services for older adults in a suburban area of Taiwan. Data analyzed include an expert evaluation record, a sociomatrix data set denoting the CBOs’ relationships, and a focus group of the social workers supporting the CBOs’ services. The breadth, brokerage, and embeddedness of networking are measured by centrality indicators and are hypothesized as being beneficial for service performance in terms of effectiveness and innovation. The study reveals that brokerage and embeddedness of networking are positively associated with effectiveness. A CBO may enhance its performance by bridging less connected organizations that need the relationship or by partnering with other organizations that bring in information from many others, but a wide social network is not necessarily helpful. Future studies can strengthen the findings by employing large samples and advanced statistical methods.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

Networks for Welfare Provision: Getting a Grip on Processes of Social Exclusion by Evaluating Network Effectiveness

It has been repeatedly stated that the topic of network effectiveness has often been neglected. This has led to a situation of ‘network euphoria’ amongst practitioners and policymakers with regard to the creation of networks as a means to (re‐)organize welfare provision. Starting from a case study of networks for welfare provision in two Belgian cities, this article focuses on the effectiveness of service delivering networks at the client level, which is understood as the contribution of the network in improving the conditions of life of those being served or targeted by the network. Therefore, we focused on the collective efforts via these networks (e.g. by creating a night shelter or by conducting case consultations) to look after a population of homeless people who face multiple problems and are not able yet to benefit from welfare provision. Our findings revealed that these networks were able to realize a ‘collaborative advantage’ by filling in service gaps and by overcoming fragmentation of care. Nevertheless, these networks equally maintained criteria that restricted the accessibility or usefulness of welfare services provided to homeless people. In the concluding section, we highlight some of the factors that could help us to explain our findings and highlight the tension between the effectiveness of networks at the client level and the effectiveness at the organizational level.     

‘Meeting them where they are at’: A practice note on implementation of the Child and Family Traumatic Stress Intervention in an emergency family homeless shelter

Families experiencing homelessness report higher rates of traumatic exposure than the general population, and traumatic experiences can often be precipitating factors for entrance into a homeless shelter. Emergency shelter is meant to be a brief, temporary housing intervention to support families toward more stable and permanent living arrangements. Beyond this ecological intervention, there is a frequently unmet need for trauma-specific mental health services. Further still, psychosocial interventions to support sheltered families should be sensitive to both the trauma-specific needs of this population and the constraints of the shelter setting. The Child and Family Traumatic Stress Intervention (CFTSI) is a brief, secondary prevention protocol that aims to prevent PTSD after exposure to a traumatic event, with research demonstrating its effectiveness in acute care settings such as child advocacy centres and emergency departments. This case study illustrates the implementation of CFTSI in an emergency family shelter in a large urban area, highlighting the appropriateness of the intervention for the setting, its adaptability to client needs and its generalizability to other non-traditional intervention settings.     

Veterans’ Use of Programs and Services as They Transition to Civilian Life: Baseline Assessment for the Veteran Metrics Initiative

Abstract

A substantial minority of veterans struggle as they reintegrate into civilian life, reporting problems with vocational attainment, legal/financial/housing challenges, physical and mental health conditions, and social/interpersonal issues. While there are thousands of programs and services offered to veterans, little is known about which ones they use. In the current exploratory study, veterans separated from active duty in the prior three-months (48,965) were invited to complete a survey. Two primary questions were addressed: What programs/services did veterans use to assist in their reintegration to civilian life? What specific components/attributes of those programs did veterans report using? A total of 9566 veterans completed the survey. Approximately, two-thirds of veterans used at least one program to enhance their well-being, while one-third reported using multiple programs across multiple domains. Veterans primarily sought assistance for employment and educational advancement. Fewer veterans sought assistance for legal/financial/housing, health, and social functioning challenges. Social service providers and policy makers should be aware of the resources veterans use as they reintegrate into civilian life. Future research should examine factors that predict the use and nonuse of veteran reintegration programs, how use changes over time, and what factors predict program/service use, particularly among veterans at risk for poor transition outcomes.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Performance measurement: the new accountability

Over the years, "accountability" in the human services has focused upon issues such as the legal framework, organizational management, financial responsibility, political concerns, and client inputs and expectations. Within the past decade, the meaning of "accountability" has been extended to the more dynamic organizational functions of "efficiency" and " effectiveness." Efficiency and effectiveness increasingly must be put to the tests of performance measurement and outcome evaluation. Forces outside the social work profession, including, among others, federal expectations and initiatives and the increased implementation of the concept of managed care, will ensure that efficiency and effectiveness will be central and highlighted concerns far into the future. This "new accountability" is demanded by the stakeholders in the nonprofit sector and by federal requirements built into the planning, funding, and implementation processes for nonprofits and for-profits alike.     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Assessing families and other client systems in community-based programmes: development of the CALF

Programmes providing services to children and families often face the challenge of assessing not only the child referred, but also the child’s family system and its individual members. Recognizing that household/family members can cause, contribute to or affect a child’s problems requires that human service agencies utilize assessment tools capable of assessing family members across the lifespan. The literature references many assessment tools used by clinical programmes in mental‐health settings that are not well suited to use in social service agencies with multidisciplinary staff at different skill levels. As a response to this dilemma, the authors have developed the Collaborative Assessment of Life Functioning (CALF), a user‐friendly tool that assesses various areas of life functioning. Based on Maslow’s motivation theory, person‐in‐environment and systems theories, the CALF can be used with various client systems. This paper describes the development of the tool, its purpose and use, the importance of assessment tools in the helping process and considerations for agencies wishing to use an assessment tool like the CALF. The authors also discuss the applicability of the CALF in human services and social service agency settings and with diverse client populations.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Network governance among actors involved in the government’s contracting out of foster care services: A case study in China

The government's contracting out of foster care services in Guangzhou, China, introduced the possibility of partnerships between nongovernmental organizations (NGOs) and government-led human services. To understand network governance among actors involved in contracting out foster care services, service funders, service providers, and service users were interviewed. A thematic analysis of interviews combined with a critical review of archival data was conducted. Drawing from the policy network governance analytic framework, we found that network governance conditions in contracting out foster care services were characterized by close interdependence among actors, moderate standardization in work duties, but nonreciprocal patterns of interactions, and low to modest levels of autonomy, along with strong power in the government but limited self-governance among NGOs and foster families. Our findings indicate that network governance was not fully achieved among actors involved in the contracting out of foster care services. Implications for practice and research are discussed.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Service Process and Quality in Therapeutic Foster Care: An Exploratory Study of One County System

ABSTRACT

This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers observed failures in service and in adherence to national program model standards and state regulations. The research indicates the need for consistent monitoring of child-placing agencies and the need for additional research linking service quality with foster care outcomes.     

Service Utilization Patterns Among Adolescent Mothers Residing in Three-Generational Households

ABSTRACT

This qualitative study used in-depth interviews to better understand the social service experiences and identified needs of 26 demographically diverse adolescent mothers and their mothers, who resided together in three-generational households. Most dyads accessed community services, particularly parenting and emotional supports, financial and material assistance, and medical care, and desired short-term assistance related to their circumstances and newly expanded families, rather than long-term support. The most commonly identified barrier to service utilization involved income eligibility guidelines. In light of welfare reform policies and the current economic climate, this research underscores the need for transitional supports for families, including assistance with basic needs. In terms of implications for social work practice and future research, adolescent mothers may need formal supports as they pursue independence after they leave their mothers’ care. Future research could further explore, within other communities and longitudinally, whether these preliminary trends hold true.     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

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.     

What's in a service?

The measurement of ‘service’ in children's services is highly varied. We do not know in a meaningful sense what services children and families get. This paper sets out why it is important to measure services well. It outlines the dimensions of ‘service’, how they have been measured in research, policy and practice contexts, and the strengths and weaknesses of these approaches. It then explores implications for the field and identifies potential applications of a more nuanced and consistent approach to measuring services.     

The VA Caregiver Support Line: A Gateway of Support for Caregivers of Veterans

In passing the Caregivers and Veterans Omnibus Health Services Act of 2010, Congress created a legislative mandate for the Veterans Administration (VA) to strengthen its program of support services for caregivers of veterans. As part of this expansion, the VA implemented a nationwide toll-free telephone Caregiver Support Line (CSL). The CSL is a single point of entry system to link caregivers to national and local services to support care of a veteran. This article describes the CSL and its role in supporting aging veterans and their caregivers, discusses social workers’ contributions to its development and implementation, and reports utilization data.     

The unknown soldiers of foster care: Foster care as loss for the foster parents’ own children

Abstract

This paper explores the effects of the foster care experience on foster parents’ biological children. In spite of having been accepted for over 40 years as the best form of residential care for most children and adolescents requiring alternative living arrangements, very little research has been done into the foster care experience. Almost nothing is known about the effects of foster care on either the foster family as a unit or its individual members, yet one of the major concerns foster parents present is the effect of the foster care experience on their own children. This concern leads many experienced foster families to leave foster care and many potential foster families to decide not to foster. This paper discusses the losses experienced by the children of foster parents.