Working U.S. Adults without Paid Sick Leave Report more Worries about Finances

Using the National Health Interview Survey 2015 data release, an analytic sample of 17,897 working U.S. adults in current paid employment were examined to determine if there was a relationship between not having paid sick leave and worry about finances. A series of nine indicators of financial worry were regressed on paid sick leave status with ten control variables. U.S. workers who lack paid sick leave are more likely to report worry about: medical bills from a potential future sickness or accident, retirement, current medical costs from an illness or accident, maintenance of standard of living, medical costs for normal health care, normal monthly bills, rent, mortgage, or other housing costs, and credit card payments. Based on this set of nine multinomial multivariable regressions equations, findings indicate a positive association between not having paid sick leave and reporting financial worry after controlling for gender, age, marital status, education level, race and ethnicity, personal health status, full time work status, insurance coverage, family size, and annual family income. Implications for policy, practice, and future research are set forth.     

Using the Internet and Email for Health Purposes: The Impact of Health Status*

Objective. Increasingly, people use the Internet and email for health purposes; however, we know little about whether this varies by health status. This study examines whether sick or healthy people are more likely to access the Internet, conduct online health searches, and exchange emails regarding health issues. Methods. We conduct multivariate analysis on a random sample of 2,038 adults. Results. Despite greater Internet access, respondents in excellent/good health are less likely to say they conduct online health searches because they have no health concerns or are satisfied with other health sources. In contrast, sick and disabled respondents are more likely to seek medical information online, and do so more frequently. They are also more likely to exchange health emails with friends and physicians. Conclusions. Practitioners especially need to educate their sicker patients about the uneven quality of online health information since they are more likely than healthier patients to conduct online health searches.     

Disciplining Disability under Danish Active Labour Market Policy

This article explores how caseworkers are re‐constructing disability in the Danish welfare system and disciplining themselves and clients according to the active labour policy paradigm. Combining Foucault's ideas about discipline with Maynard‐Moody and Musheno's method of interpreting street‐level bureaucrats' stories ( Foucault 1977 ; Maynard‐Moody and Musheno 2003 ), we analyze caseworkers' stories about their clients, fellow caseworkers and themselves to understand how they practice the ideology behind active labour policy. Our analysis uses Møller's (2009 ) interviews with 24 Danish caseworkers who administer social welfare and sick leave benefits based on disability as the primary eligibility criterion. We selected stories told by caseworkers that exemplify archetypes of good and bad citizens, good and bad clients, and good and bad caseworkers. Through interpretative analysis, we elucidate how caseworkers make sense of active labour policy and internalize the pressures of managerial reforms to discipline both citizens and each other.     

Institutionalized strategies in face-to-face encounters: focus on immigrant clients

The aim of this article is to explore how officials' institutionalized patterns of acting can be useful for understanding encounters between immigrant clients and representatives of a welfare organization. The data indicate that there are two fundamental social mechanisms at work: the materialization of the organizational ideology, and the cultural filter. Both have an impact on the type of action strategy chosen by an official in handling client problems. An analysis of the strategy outcomes according to the social mechanisms shows that: 1) The outcome will depend on the client's consent to the organizational ideology. Immigrant clients more often than other clients are assumed to have different views on, for example, sickness, work capability and retirement age; 2) Comparing clients to the image of an ideal-typical long-term sick person can lead to the definition of clients with different cultural backgrounds or those of immigrant status as deviant, and therefore problematic to deal with; 3) The cultural filter through which the officials interpret their clients' situation can be an important obstacle in understanding the responses of immigrant clients.
The study was conducted at a local social insurance office in a suburban area of a major Swedish city. Immigrants represented approximately 60% of the long-term sick people. The empirical material consists of observations of encounters and interviews with the officials working with rehabilitation of the long-term sick.     

The client interview and the context

Based on analysis of 60 tape-recorded or observed interviews from a Danish social welfare office the article examines the Lipssky-like question: How and to what extent are macro structures such as social legislation and local municipal rules brought into real live existence in the meeting between case workers and clients? To what extent do the case workers show rule-conforming practice? Illustrated by several extracts, it is shown that the legislation is not a simple governing instance and that the case workers do not serve as simple tools for fulfilling decisions made as formal rules at a macro level. On the contrary, the case workers made use of those rules and official client or benefit categories that seemed helpful to them for their own professional purposes, and so did the clients in order to secure their interests. All in all, the case workers showed a considerable distance to social security office which was presented for the clients as distant and partly hostile towards the clients.     

Moral distress among social workers: The role of insufficient resources

The present study examined moral distress among Finnish social workers and the role of perceived resource insufficiencies in explaining it. The aim was to shed light on this understudied phenomenon in the field of social welfare. The study focused on work‐related moral distress, defined as impaired wellbeing that is connected to the continual inability to implement actions that one considers morally appropriate. The survey data were collected with an electronic questionnaire between the years 2011 and 2012. The respondents (n = 817) were social workers in the public social welfare services and the overall response rate was 46.5 per cent. Nearly 11 per cent of the respondents reported experiencing moral distress and perceived resource insufficiencies strongly explained this experience. Moreover, social workers with moral distress reported that they were less willing to continue in their post, were more frequently on sick leave and had positive work‐related experiences less often than their colleagues who did not experience moral distress. Key Practitioner Message: ● The concept of moral distress is useful in describing the experiences of social welfare workers when they are unable to practise their profession according to their moral code and the emotional burden related to this inability; ● Perceived resource insufficiencies are strongly associated with experiences of moral distress among frontline social workers; ● Social workers experiencing moral distress are less willing to continue in their work, take sick leave more often and less frequently have positive experiences related to their work.     

Adaptation and Evaluation of a Group Curriculum for Latino Clients in a Driving Under the Influence Program

The purpose of this study was to describe the process of culturally adapting group curriculum modules for Spanish speaking clients in a Driving Under the Influence Program as well as to test the acceptability of these modules. Using the Group Topics Evaluation Scale (English and Spanish version), 90 clients rated six modules that were presented in 30 different group sessions. Spanish speaking clients were significantly more likely to rate all six modules much higher than their English speaking counterparts, indicating acceptability. This is important as driving-under-the-influence programs may provide access to Latino clients not seen elsewhere. Possible further research is discussed.     

German family policy at the crossroads: analysing the impact of parental leave reform through simulation

Comparative studies of welfare reforms encounter two problems. First, the counterfactual problem is that in the real world schemes and their reforms do not coexist simultaneously and are hard to compare. Second, the contextual problem derives from the absence of comparable measures for change. Microsimulation helps to overcome these problems. It compares policy options – actual reforms or reform plans – simultaneously and provides a comparable measure: the disposable income of model families. This article uses a type–case approach to investigate recent reforms of the German parental leave benefit. Simulation makes those reforms comparable over time and across countries. Results show that the profile of the German scheme is changing from 'general family' towards 'dual-earner' support. Furthermore, the recent reforms make the German scheme converge towards the Swedish leave scheme. The recent reforms introduce a new concept of fairness and a focus on gender equality to German family policies.     

German family policy at the crossroads: analysing the impact of parental leave reform through simulation

Comparative studies of welfare reforms encounter two problems. First, the counterfactual problem is that in the real world schemes and their reforms do not coexist simultaneously and are hard to compare. Second, the contextual problem derives from the absence of comparable measures for change. Microsimulation helps to overcome these problems. It compares policy options – actual reforms or reform plans – simultaneously and provides a comparable measure: the disposable income of model families. This article uses a type–case approach to investigate recent reforms of the German parental leave benefit. Simulation makes those reforms comparable over time and across countries. Results show that the profile of the German scheme is changing from 'general family' towards 'dual-earner' support. Furthermore, the recent reforms make the German scheme converge towards the Swedish leave scheme. The recent reforms introduce a new concept of fairness and a focus on gender equality to German family policies.     

Short-term and long-term effects of an outpatient rehabilitation program for patients with musculoskeletal disorders

The objective of the study was to investigate whether intensified rehabilitation efforts in primary health care may produce any short-term or long-term reduction of sick leave. The resources at the health care center were fortified with a coordinator from the local insurance office and a specialist group from the hospital. In one primary health care district, a prospective study was performed among 100 patients with a musculoskeletal disorder, having caused at least 21 consecutive days of full-time sick leave (patients). Serving as a control group were individually matched patients from any other health care center in the surrounding municipality of Kristianstad (controls). The number of sick leave days was assessed during year one (short-term) and year three (long-term) after rehabilitation was initiated. The median number of days with sickness benefits for men in the short-term was lower for patients than for controls (34.5 vs 48.5). No difference was found among women. No differences were found in the long-term between patients and controls, either for men or women. We conclude that rehabilitation in primary health care was made more efficient through collaboration with the local insurance office and the specialists, but the effects were not maintained after the collaboration ended.     

Previous sickness presence among long‐term sick‐listed in Norway and Sweden: A retrospective study of prevalence and self‐reported reasons

The aim of the present study was to analyse previous sickness presence among long‐term sick‐listed individuals in Norway and Sweden and the reasons given for sickness presence. The study was based on survey data for 3,312 persons in Norway and Sweden who had been sick‐listed for at least 30 days. Two questions were used. One measured prevalence: During the last 12 months prior to your current sick leave, did you go to work even when feeling so ill that you should have taken sick leave? The second question concerned reasons for sickness presence. Large differences were found between Norway and Sweden in the prevalence of sickness presence. More long‐term sick‐listed Norwegians than Swedes reported sickness presence [adjusted odds ratio (OR) for Sweden 0.65 (0.53–0.80)]. The Swedes more often reported financial reasons for sickness presence [adjusted OR 2.77 (2.1 to ?3.54)], while the Norwegians more often gave positive reasons related to work. The national differences may be related to differences in sickness insurance strategies.     

Less social health insurance, more private supplementary insurance? Empirical evidence from Germany

Based on individual level data from Germany, we analyze the effect of changes in the compulsory benefit package of the social health insurance on the demand for supplementary private insurance, employing a difference-in-differences approach. The focus is on the exclusion of dental prostheses from the benefit package in 1997 and its re-inclusion in 1999. Individuals born prior to 1979 serve as control group because only the young were affected by the reform. No significant effect on the demand for supplementary health insurance is found. Thus, the notion of clients making informed choices about their health insurances’ coverage is not supported.     

Sick but at work: Graded sick leave in a comparative perspective

Measures to activate sick‐listed workers and to combine work with sickness benefits are a growing but little‐studied policy field. This article investigates graded sick leave benefits in Sweden, Finland and Germany. The analysis reveals some commonalities between countries, as well as substantial differences in terms of institutional background, benefit design and governance. The schemes range from models in which grading has become an integral component of the regular sickness certification process, to models in which the graded‐work option is targeted at a much smaller category of workers and has a stronger therapeutic character. The variation in design and governance of the models is reflected in large differences in terms of their diffusion. All schemes face a common set of obstacles and challenges. They relate in particular to the distribution of stakeholders' roles and responsibilities, the involvement of employers and the assessment of residual work ability.     

Using work, health and sick leave to predict work disability

In the Netherlands, a situation has developed in which there is one permanently disabled person for every seven to eight people active in the workforce. This is an economic emergency, for which countermeasures have been taken. The employer is made in large part financially responsible for employees' sickness absence and work disability and, at the same time, is obliged to use the professional support of a Health and Safety Service (HSS). It stands to reason that in this situation, making use of the HSS, the employer is motivated to prevent sickness absence and disablement of employees as effectively as possible. Preventing work disability critically depends on being able to predict disability through early identification of the future disabled. In order to develop a prediction procedure at the individual level, the present prospective study was conducted. Some 3,500 employees were followed for up to five years. Predictors of disability were sought among employees'opinions on their health, work, and working conditions as measured by the Questionnaire on Work and Health (QWH), and sick leave data. The QWH items are concerned with health, work and job circumstances. As expected, most (two thirds) cases of disability occur in male employees aged 50 and over. Disability in this group is strongly predicted by complaints about work strain, health, and illness behaviour, with the odds being in the 4 to 6 range. The odds can be raised to over 10 by including sick leave data. These predictions warrant individual preventive interventions. The results, taken together, speak for the predictive validity of the questionnaire and its usefulness to occupational health services in combating disability.     

A Tale of Two Cultures: Cross-Disciplinary Perspectives in the Care of Older Adults with Combined Visual and Medical Disabilities

A comparison of the vision rehabilitation and medical rehabilitation systems suggests that, despite the distinct professional cultures that have evolved around them over the past 50 years, their commonalities are more notable than their differences. The older adult, who frequently develops simultaneous visual and medical disabilities, demands a greater degree of cooperation between these systems, than that required for the younger client who was the primary focus of the rehabilitation paradigm in the years following World War II. This article includes guidelines for practitioners that should help them achieve a more comprehensive approach to their elderly visually impaired clients.     

A Cross-Sectional Examination of the Association Between Dyspnea and Distress as Experienced by Palliative Home Care Clients and Their Informal Caregivers

This study examined the association between dyspnea and distress as experienced by both palliative home care clients and their informal caregivers as a unit of care. Cross-sectional analysis was conducted using the interRAI Palliative Care Assessment database. Responses from 6,655 individual palliative home care clients across six regional jurisdictions in Ontario, Canada were included. This study found that clients experiencing dyspnea were more likely to show overall signs of distress; report one or more signs of self-reported distress; and be at risk for depression when compared to clients who do not experience dyspnea. Caregivers of clients experiencing dyspnea were more likely to exhibit distress than caregivers of clients not reporting dyspnea. When indicators of caregiver distress and client distress were combined, 53% of the caregiver-client units exhibited distress. Social work practitioners should include a focus on distress within the care unit as a priority when care planning to meet the needs of persons nearing the end of life. Members of the care team should consider available treatment and management options tailored to meet both the client and their informal caregiver’s needs.     

Risk for a Price: Sexual Activity Solicitations in Online Male Sex Worker Profiles

ABSTRACT

The use of social- and sexual networking-based Web sites designed to provide easy and more anonymous access to sexual partners is rising. The popularity of the use of Web sites by male sex workers to promote their services and find clients is also rising. To date, very little inquiry has been devoted to studying the sexual behaviors solicited within online advertisement profiles of male sex workers and men who have sex with men. This study utilized a widely used popular Internet site designed to advertise to clients and gathered demographic, advertised sexual and nonsexual behaviors, pricing, and safety risk category data from profiles within the state of Florida (n = 163). Pearson chi-square analyses indicated that location and several sexual behaviors were significantly related to how often the men reported the degree to which they had safer sex with clients. These findings suggest some male sex workers do not consistently maintain safer-sex behaviors and that some of these men are engaging in sexual activity while under the influence of drugs. Future recommendations support the need for effective public health outreach that emphasizes the importance of safer sexual decision making.     

Open Records: The Client's Right to Partnership

Summary Many Social Services Departments have opened their files totheir clients or intend to do so. This reflects the incomingtide of concern about citizens' rights and client participation,but what effect might the opening of records have on the practiceof social work? The paper summarizes the findings of a small scale study inwhich a team of social workers opened their case recording toa selected number of clients. The workers’ and clients‘views of this process are described, along with the implicationsfor practice. The study suggests that a focus on shared recordingcan begin to alter the kind of work done by the social worker,helping to promote a partnership between the worker and theclient. Finally, the paper argues that a policy of client access enforcedonly as a right is prone to sabotage or a fall into disuse.A seven point training programme is outlined in order to helpsocial workers use Open Records as an opportunity to promotea partnership in their work with clients.     

SWEDEN

During the 1990s many changes have been carried out in Sweden in terms of forms of insurance for sickness and work-related injury. The need to carry out these measures has its background in developments that took place over the course of the 1980s. In that decade, instances of both short- and long-term sick leave, including periods covered by payment of disability pensions, increased substantially. This resulted in a sizeable increase in insurance costs. To counteract this negative trend, a number of measures were implemented over the first half of the 1990s. The task of change is not complete, but discussions on new measures continue. The Committee for Sickness and Work Injury has put forward a number of proposals in its final report.     

ANALYSIS OF CLIENT CAREERS FOR PROGRAM EVALUATION

The present study analyzes the careers of clients, both within and between agencies. Several phases of the careers of 316 adolescent clients are examined as part of a process evaluation of Professional Youth Services (PYS). Clients' movement within PYS is described to provide on understanding of when and why clients leave a helping agency and to describe some of the characteristics of clients who are most likely to have their treatment interrupted. In addition, clients' "between agency" movement is analyzed by exploring the other human service agency involvements) of clients; in this way the role of PYS in the larger service delivery network is clarified.