Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations

Cortis N. Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations Social service providers strive to meet the needs of those most marginalised from society and from service systems. Yet many people who might benefit from available help consistently miss out. Using qualitative data, this study developed a repertoire of actions that organisations and service personnel can employ to improve participation and outcomes for groups who may be eligible for and may benefit from services, but whom service providers find difficult to identify, reach and engage. Semi‐structured interviews with service managers and coordinators of child, family and youth services in Australia attest to the diversity and context specificity of those who are deemed to be ‘hard‐to‐reach’. The research data highlight ways to improve reach and engagement in a managerialist context by refining organisational action in four strategic domains: overcoming access barriers, building client relationships, utilising networks and partnerships, and ensuring staff capacity and sustainability.     

Can Quasi‐market and Multi‐level Governance Co‐exist? Insights from the Case of Lombardy's Employment Services System

This article explores the functioning of Lombardy's networked employment services system, inspired by quasi‐market and horizontal subsidiarity principles, and specifically addresses a gap in the quasi‐market literature, where little attention is devoted to the role played by institutions at lower levels of government. A qualitative study of the Lombardy system, with a focus on the municipality of Milan, is relied upon in order to explore the extent to which the principles of quasi‐market and multi‐level governance pursued by the regional government are allowed to co‐exist in practice. Here, sub‐regional levels of government are directly involved in services provision, but enjoy a more privileged condition relative to the private providers, thereby jeopardizing the implementation of an effective quasi‐market. The article contributes to existing theories by suggesting that horizontal subsidiarity and marketization cannot neglect multi‐level governance in those sectors where public bodies at various levels of government are directly involved in implementation.     

‘A Common Sense of the Times’? Neo‐liberalism and Changing Public Opinion in New Zealand and the UK

Neo‐liberalism represents a significant and enduring shift in the politics shaping social policy. Although frequently ascribed a hegemonic, all‐powerful status that focuses our attention on the coherence found in neo‐liberal policies, this article builds on scholarly work highlighting variegation in the neo‐liberal project across different policy areas, national settings and time periods. Specifically, it employs Peck's and Tickell's (2002) view that neo‐liberalism has gone through multiple phases in response to both external and internal crises as an entry point for studying neo‐liberalism's impact on public support for the welfare state. Drawing upon New Zealand and British attitudinal data, the article argues that public reactions to an early period of retrenchment (‘roll‐back’ neo‐liberalism) differ from those reported in the ‘roll‐out’ or embedding phase of neo‐liberalism implemented by Third Way Labour Governments in both countries. Indeed, continuing public support in many policy areas arguably contributed to the internal crisis that provoked an adaptation to the neo‐liberal project. The article further explores public support for the welfare state following the external crisis provoked by the financial meltdown of 2008–09 asking whether New Zealand and British attitudes showed signs of resisting austerity measures or whether they, instead, indicated a third, ‘roll‐over’ period of neo‐liberalism where the public accepted not only a neo‐liberal economic agenda but also the need for further retrenchment of the welfare state. Conclusions about the politics of social policy at the level of public opinion offer both good and bad news for welfare state advocates.     

Capitalizing the Crisis? Explanatory Factors for the Design of Short‐time Work across Organisation for Economic Co‐operation and Development Countries

This article looks at the financial and economic crisis 2008–10 in 18 Organisation for Economic Co‐operation and Development states and seeks to investigate explanatory paths for the subsidization of further education within short‐time work programmes. Several hypotheses are put to the test: first, a classical partisan difference argument; second, a varieties of capitalism approach proposing a successful joint rallying of employers and employees for subsidization in coordinated market economies; and, lastly, the merged hypothesis that right‐wing parties in a coordinated economic context might subsidize feeling the pressure to overcompensate an ‘issue ownership’ of left parties in the field of employee‐friendly policies. We identify four explanatory paths: coordinated economies in the sample subsidized when they were economically closed or highly indebted. The results also support our combined hypothesis, that New Zealand – a left‐governed liberal market economy – and right‐governed coordinated market economies of the non‐Scandinavian type subsidized.     

Is Personalization the Right Plan at the Wrong Time? Re‐thinking Cash‐for‐Care in an Age of Austerity

As personalization has dominated the policy agenda for reform in social care, its roll‐out as a mainstream option has coincided with global programmes of austerity which have targeted services for disabled people. Was this simply bad timing or was its implementation always part of the agenda for reform? Whilst the principle of cash‐for‐care schemes drew strongly on promoting the independence and autonomy of disabled people, early incarnations of direct payments policy in the UK were initially at least in part rolled out in light of potential cost savings to social care budgets. This article explores these and other issues in light of evaluations of the Scottish government's self‐directed support (SDS) test sites (2009–11) and implementation of subsequent legislation enforcing models of SDS in Scotland from April 2014. Discussion draws on the authors’ recent book (Pearson et al. 2014) to reflect on what the evidence can tell us about radically transforming social care at a time of global austerity.     

Co‐producing innovation or innovating co‐production? Responding to the contact needs of non‐resident parents in the Republic of Ireland

The empowerment and participation of children and families in both the design and the delivery of services oriented towards them is now an accepted norm, if not always the accepted practice. Yet, challenges still remain, particularly where parents are separated and contact issues are problematic. Although contact centres are common in some Western countries including Australia, New Zealand, the UK, France, and the USA, this is not the case in the Republic of Ireland. The relatively recent introduction of divorce, increases in separation and childbirth outside of marriage have led to the need for service planners to respond to the growing issue of non‐resident contact with children. Using Bovaird's co‐production framework, the purpose of this paper is to outline and discuss specific findings relating to service user involvement emanating from a formative evaluation of an innovative supported contact service in Ireland. What emerges from the findings is a picture of co‐production where the broad parameters of the service are professionally defined and where the specifics of service user involvement in delivery vary from family to family but within the bounds of professional control.     

Academic performance and peer relations among rural‐to‐urban migrant children in Beijing: Do social identity and self‐efficacy matter?

Due to the household registration system, millions of rural‐to‐urban migrant children in China are ineligible to receive urban social welfare benefits. These children potentially suffer from the evolving awareness of their perceived inferior social identity and experiences of inequalities at an early stage of life. This study examined whether self‐perceived social identity is related to academic performance and peer relations among rural‐to‐urban migrant children in Beijing. Data were collected from 136 children during 2013 and 2014 in three schools for migrant children in Beijing. Path analysis showed that children who identified as a Beijinger, compared with those who self‐identified with their rural hometown, had better self‐efficacy, which in turn was associated with better academic performance and better peer relations. Enlightened by Western theories, these findings suggest that migrant children’s performance in school could be enhanced by cultivating positive perceptions of their social identity through teachers’ practice and community‐ and policy‐level social support.     

Migrant Care Work Going Dutch? The Emergence of a Live‐in Migrant Care Market and the Restructuring of the Dutch Long‐term Care System

In recent years, a live‐in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long‐term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live‐in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash‐for‐care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. Our findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change.     

Being counted? Examining the prevalence of looked‐after disabled children and young people across the UK

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step.     

Coexisting principles and logics of elder care: Help to self‐help and consumer‐oriented service?

Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self‐help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer‐oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people? Using neo‐institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self‐help is the dominant principle, that it is deeply entrenched in the identity of the professional care worker and that it coexists with consumer‐oriented service and without major tensions in the logics identified in their practices.     

Risk assessment and domestic violence – how do child welfare workers in three countries assess and substantiate the risk level of a 5‐year‐old girl?

This paper examine how a sample of 301 child welfare workers in Norway, England and California, USA assess risk in cases of domestic violence. Decisions in child welfare cases are made under a high degree of uncertainty, and by using the vignette method, we explore whether child welfare systems and risk assessment approaches result in different assessment of risk level and substantiations. We find both cross‐country differences and similarities: Norwegian workers consider the risk level to be significantly higher than their peers in England and USA. However, workers' justifications for and identification of decisive factors in the case are strikingly similar across countries. These similarities are observed for both high‐risk and low‐risk assessors, and they may exist due to widespread knowledge about domestic violence and its negative consequences. We argue that the international differences in risk level assessments are due to system differences in the countries studied.     

Do depressive symptoms in justice‐involved girls reduce the effects of a cognitive‐behavioral program on their disruptive and delinquent behaviors?

The present study evaluated the effects of a cognitive‐behavioral program on disruptive and delinquent behaviors among a sample of adolescent girls placed in a residential center in Quebec (Canada). This study also investigated the moderating impact of depressive symptoms on program effectiveness. The study used a quasi‐experimental design to allow comparisons between 104 girls in the treatment group and 78 girls in the comparison group over 18 months. Findings showed that the program contributed significantly, albeit modestly, to a decline in some forms of disruptive/delinquent behaviors. Results also indicated that girls with a higher level of depressive symptoms at admission also reported higher involvement in a myriad of disruptive/delinquent behaviors and that for some types of problem behaviors, this higher involvement persisted over time. In general, however, the seriousness of the depressive symptoms that the girls reported at admission did not interfere with the effectiveness of the cognitive‐behavioral program.     

(A‐)typical and (in‐)secure? Social protection and “non‐standard” forms of employment in Europe

Atypical forms of employment (part‐time work, mini‐jobs, fixed‐term contracts and solo self‐employment) have gained in importance overall in recent years in many European countries. They are often part of an irregular career pattern and carry a high risk of unemployment. In a 6‐country comparison (Germany, the United Kingdom, the Netherlands, Italy, Denmark and Poland) we consider whether and in what way national social protection laws cover the various forms of non‐standard employment and the specific risks these entail. Significant variations were found in coverage standards and practices between countries as well as substantial variability within countries in their responses to different types of non‐standard employment. A need for further and improved coordination of both social legislation and tax law is identified.     

Does the unification of health financing affect the distribution pattern of out‐of‐pocket health expenses in Turkey?

Turkey has implemented health reforms for over a decade and has taken significant steps toward unifying health financing. This study investigated the financial burden associated with out‐of‐pocket (OOP) expenditures under universal health coverage, using national 2003–2015 household budget data from the Turkish Statistical Institute. Progress was evaluated using Kakwani–Suits indices and Lorenz concentration curves. The results indicate that overall, more than a decade after its unification, redistribution of wealth in the Turkish health financing system has benefitted the wealthy but not the poor. Both curve and index approaches (Kakwani index 2003 = ?0.50; 2015 = ?0.44) reveal an increasingly regressive pattern of OOP health expenditures. The effective use of fiscal space and good political leadership are essential for the successful continuation of reforms to combat poverty in Turkey.     

Re B‐S: a glass half full? An exploration of the implications of the Re B‐S judgment on practice in the family courts

The family courts in England and Wales are being significantly reformed in line with the coalition government's aim to speed up the process and increase the numbers of children being adopted from care. In September 2013, the Court of Appeal handed down a judgment, Re B‐S (Children) [2013] EWCA Civ 1146, that has wide‐ranging implications for professional practice and decision making in care proceedings. The judgment challenges the policy direction and provides guidance about what is required before courts can make orders separating children from their birth families, particularly in cases of non‐consensual adoption. In this paper, we outline the changes occurring in the family justice system, some key elements of Re B‐S, and examine the challenges for implementing practice consistent with the requirements of Re B‐S. It is argued that the standards set by Re B‐S are unlikely to be fully implemented without much further attention to the complexities posed by the policy and practice context of social work with children and their families involved in care proceedings.     

Activation and ‘coercion’ among Swedish social assistance claimants with different work barriers and socio‐demographic characteristics: What is the logic?

Nybom J. Activation and ‘coercion’ among Swedish social assistance claimants with different work barriers and socio‐demographic characteristics: What is the logic? The study analysed how the work barriers and socio‐demographic characteristics of both activated and non‐activated social assistance claimants influence their participation in activation and exposure to coercion, measured as two opposite indicators – sanctions and exemptions. The study covered 372 social assistance claimants in four municipalities during a period of 1 year. The results suggest that resource activation, which entails education and/or work practice in regular workplaces, often targets claimants who lack work motivation, whereas job activation, which aims at quick entry into the labour market, targets young claimants and claimants who lack formal skills (education and/or work experience). Swedish men older than 25 years appear to run the highest risk of facing sanctions irrespective of participation in activation. Exemptions vary more than sanctions between activated and non‐activated claimants. The results are discussed in terms of five logics operating in social work.     

Do peer effects mediate the association between family socio‐economic status and educational achievement?

Differences in levels of academic achievement according to socio‐economic status (SES), and parental education in particular, have been a persistent feature of Australian education systems. Young people with highly educated parents are more likely than their peers with low‐educated parents to attain high levels of achievement at school. Students with low levels of achievement are less likely than their high achieving peers to complete Year 12 and are more likely to experience negative post‐school outcomes. The SES of the neighbourhood, and in particular, the school attended, has also been found to have an effect on levels of both academic achievement and attainment. For this paper, we conduct analyses of National Assessment Program – Literacy and Numeracy test scores for four cohorts of secondary school students attending government schools in the Australian Capital Territory to examine the associations between parental education, school attended and levels of educational achievement. Our findings show that students with university‐educated parents achieve at much higher levels than their peers with low‐educated parents and that attending a school with a higher proportion of students from educationally disadvantaged families has a negative effect on educational achievement.     

‘Southern‐style’ National Health Services? Recent Reforms and Trends in Spain and Greece

This article analyses recent changes in the Greek and Spanish national health services. The aim is to assess how the period of austerity and further recovery during the 1990s and early 2000s impacted on them in terms of equity and efficiency. This is of interest because of the closeness in time between the universalizing reform laws and the arrival of the conditions for economic convergence established in the Maastricht Treaty. The analysis is also attractive because it deals with the transformation of already mature health insurance systems into national health services, a transformation that is novel in European welfare history. The article addresses the questions of whether austerity has hindered full implementation of the reform laws enacted in the early to mid‐1980s, examining reform trajectories and financing and expenditure trends. Furthermore, it considers the impact on access, understood in terms of population coverage, the array of services provided, waiting lists, and territorial inequalities. Finally, it discusses the introduction of new managerial formulas and attempts at enhancing efficiency. The concluding section states that divergent trajectories have occurred, thus rendering the definition of a ‘Southern model of health care’ difficult. It also provides explanations of the trajectories followed in both national cases and informs on prospects for the future.     

Treatment‐as‐usual in effectiveness studies: What is it and does it matter?

Andrée Löfholm C, Brännström L, Olsson M, Hansson K. Treatment‐as‐usual in effectiveness studies: What is it and does it matter? A hallmark of an evidence‐based practice (EBP) is the systematic appraisal of research related to the effectiveness of interventions. This study addressed the issue of interpreting results from effectiveness studies that use treatment‐as‐usual (TAU) as a comparator. Using randomised controlled studies that evaluate the effectiveness of multisystemic therapy as an illustrative example, we show that TAU includes a wide variety of treatment alternatives. Estimated treatment effects on recidivism suggest that TAU seems to contain a greater variation in underlying risk than experimental conditions, supporting the hypothesis that the content of TAU could affect outcomes. Implications for the realisation of an EBP are discussed.