The Evolution of the System of Care for the Aged in Denmark

In Denmark, formal services are viewed as a right to be used by any member of hat society who is in need of assistance, premised upon a societal model of mutual self-help. The focus here is on the dual themes of philosophical consistency and of transition in the formal system of services and delivery of care in Denmark. Denmark's system centers on meeting the basic needs of the elderly while enabling individuals to retain control over decisions regarding their own lives. It was effective during the economically expansive period of the 1960s and 1970s, but became less effective during the 1980s. Because of the economic necessity of cutting back on budgels, the national government has in fact attempted to define and redirect available choices in service delivery. The dual themes of consistency and dynamism are demonstrated through the case of a rural municipality northwest Jutland during the prosperous period into the more economically limited period of the last decade and the present. Implications for informal social support and relationships between the aged and their families, friends, and neighbors in Denmark are explored.     

Mothers and deployment: Understanding the experiences and support needs of deploying mothers of children birth to five

ABSTRACT

Military deployments can demand long separations of service members and their families. The strain of separation is particularly acute for mothers of very young children. This study aimed to better understand the deployment and reintegration experiences of service members who are mothers of young children. Focus groups and interviews were conducted with 12 service member mothers who deployed to Iraq and/or Afghanistan when one or more of their children was younger than age 6. Discussions explored experiences before, during, and after deployment; needs and challenges at each stage; available support resources and gaps in support. Thematic data analysis was conducted, drawing on principles of grounded theory. Disruption and continuity were central themes as participants illuminated the challenges they faced and their profound dedication to sustaining strong family relationships across the deployment cycle. Relinquishing, reassuming, and balancing multiple roles and responsibilities are additional themes that were frequently evoked. Participants noted a lack of formal resources responsive to their needs and circumstances and highlighted a need for services tailored to mothers who are deploying. Military mothers, particularly mothers of young children, face distinct challenges surrounding deployment. Better understanding their experiences and support needs can inform tailored services to meet their needs.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

The caring child: an evaluative case study of the Cornwall Young Carers project

This paper reports on an evaluation of the Cornwall Young Carers project (jointly funded by social services and the Cornwall and Isles of Scilly Health Action Zone), conducted during the period 2000–2002. A diverse range of methodological approaches were adopted (comparative national statistics, local pilot study, monthly and quarterly data capturing instruments, and a service user focus group) in monitoring and evaluating the project's high level statements/outcomes. Four evaluative themes are discussed, namely: identification of young carers; assessment of young carers' needs; direct service provision; and partnership working. Recommendations and action steps are proposed with a view of informing future planning and service delivery, as well as developing an ethos of integrating evaluation into everyday practice for the Cornwall Young Carers Project. Overall, the project has made significant progress in meeting and exceeding its original targets. The fact that the project has been able to identify 202 new young carers over this period is a key milestone in demonstrating the critical need for the project's services. It is suggested that existing referrals are only the ‘tip of the iceberg’ for work with young carers in Cornwall.     

Parent–Caregiver Experiences With the Autism Spectrum Disorder Service Delivery System

Autism spectrum disorder (ASD) diagnoses are increasing, leading to growing demands on the service delivery system to meet the needs of children and families. Further understanding individual enabling components such as perceptions of parents/caregivers and personnel, as well as community-level enabling components such as the availability of and quality of services, may help inform system improvements. In this qualitative study, 19 parents/caregivers of children with ASD in one state in the United States were interviewed regarding their experiences with the ASD service delivery system, as well as their individual responses in relation to these experiences. Emergent themes point to the importance of individual coping strategies such as social support, collaboration with service providers, advocacy and empowerment, determination, and luck. Characteristics of the service delivery system, positive and negative, also were described. Findings can inform the design of future programs, services, and policies to support parent/caregiver coping and improved service delivery.     

Beliefs and Behaviors of Pregnant Women with Addictions Awaiting Treatment Initiation

Substance use during pregnancy poses clear risks to children’s healthy development. However, women with addictions face unique barriers to accessing substance abuse treatment and often delay or avoid treatment seeking. The objective of this study was to examine women’s beliefs about the impact of use on the developing baby and to examine the protective behaviors that women with addictions engage in during the period of time between when they first find out they are pregnant and when they begin substance abuse treatment. Semi-structured interviews were conducted with 15 women who were either pregnant or postpartum and who had used illicit substances during pregnancy. All participants were currently receiving inpatient substance abuse treatment services to address their addiction and were asked to retrospectively report on their experiences. Interviews were transcribed, imported into a qualitative data analysis software, and iteratively coded for themes. Women reported being concerned about the impact of substance use on the developing baby, in particular, about the physical and long-term developmental consequences of prenatal exposure. Given these concerns, women described trying to protect the baby from harm on their own, outside of accessing traditional treatment services. They sought information anonymously, increased their engagement in health-promoting behaviors, and decreased their use of alcohol and other drugs. The results suggest that women who use alcohol and other drugs during pregnancy are often motivated to protect their baby from harm and are engaging in harm reduction behaviors prior to accessing treatment services.     

Lessons learned from children who have experienced homelessness: what services need to know

Children who accompany their parents or guardians during a period of homelessness make up 37% (more than one in three) of all people accessing the Supported Accommodation Assistance Program (SAAP) services. This paper describes an Australian qualitative study that explored the experiences of children who accompanied their families during periods of homelessness. It focuses particularly on what children and young people say they want from the services that they come in contact with; particularly specialised homelessness services such as housing support services and refuges. Key themes that emerged from the research include: the need for services to engage with children as individuals in their own right, to listen to and acknowledge their stories, to have services that meet their individual needs, to act and respond when children feel unsafe and for workers who can provide support to children to talk to parents about what is going on. Children and young people wanted workers to know that they felt their parents were doing their best to keep them safe. They focused on what their parents could do and did do rather than what they were not able to provide. They called on the human service system to do the same.     

Child protection: a new approach in South Australia

This paper argues the case for an integrated approach to child protection services, embracing children's safety, risk and needs and incorporating formal assessment instruments. It then provides a brief overview of the new child protection system in South Australia. The steady rise in child abuse/neglect reports raises questions about how best to provide child protection services. Analysis of South Australian data suggests that much of the rise can be attributed to an increase in reports of neglect and emotional abuse and an increase in re‐notifications. This in turn raises questions about the traditional investigative approach. In 1995 Messages from Research advocated that agencies re‐focus on children's needs and concentrate less on investigations into safety and risk. The critical question is how to distinguish families requiring investigation from those needing support. The latest research suggests that such decision‐making in child protection is generally inconsistent and unreliable. This paper argues that statutory agencies should use formal assessment tools to determine the level and nature of their interventions. These arguments have been critical in the development of the new child protection model in SA, which relies on a centralized intake, differential response to reports and the structured decision‐making system. Initial evaluation of the new model indicates improvements in consistency of initial screening and responses to children in danger. Copyright © 1999 John Wiley & Sons, Ltd.     

Older Lesbians and Gays Accessing Health and Aged-Care Services

Abstract

The present paper examines older lesbian and gay people's experiences of and expectations for the delivery of health and aged-care services. In-depth narrative interviews were conducted with older gays and lesbians in the Blue Mountains, west of Sydney (NSW, Australia). Data were analysed by identifying evaluative statements within specific narratives and grouping these statements into themes. Participants reflected on the meaning of their sexual identity and how they would like it to be acknowledged when in contact with health and aged-care service providers. In addition to direct discrimination, participants reported a more indirect form of discrimination in providers’ assumption of heterosexuality among clients and their failure to provide lesbian- or gay friendly services. The findings highlight the need for health and aged-care services to better understand and acknowledge older gay and lesbian people's sexual identities to enable improved access to services in the future.     

Mental illness and help-seeking behavior among Mariel Cuban and Haitian refugees in south Florida.

Differences in psychopathology and use of the mental health system by recent refugee groups are explored in light of competing hypotheses stemming from theories of immigrant adaptation and minority mental health. Results show that would-be Haitian refugees arriving in South Florida during the early 1980s had relatively small needs for mental health care, but whatever needs they had were largely unattended by the health services system. Mariel Cubans had far greater needs that were mostly met satisfactorily by virtue of their familiarity with service facilities prior to departure and their incorporation into a favorable social environment. These contextual factors are added and compared with the individual-level predictor variables suggested by Andersen and others. The results' implications for theories of immigrant mental health and help-seeking and for the implementation of effective delivery programs are discussed.     

Learning About the Lived Experiences of Women with Autism from an Online Community

The experience of being an adult female with an autism spectrum disorder (ASD) has been understudied in social work literature. The purpose of this study was to develop an understanding of females with ASD, from their perspective, by examining content from an online autism community Web site. Using a phenomenological approach, data analysis on content obtained from the forum revealed several themes about the women’s experiences concerning the diagnostic process, managing and understanding symptoms, and the impact of ASD on their personal and work relationships. Implications for social work practice, including creating more effective services for females with ASD, are discussed.     

Social work and technology: Challenges for social workers in practice: A case study

Abstract

Social Work is just beginning to consider the full impact of technology on practice. In this paper the experience of social workers working in Centrelink, the Australian Government's service delivery organisation, is explored in the context of Centrelink's increased reliance on technology to deliver its services to six million Australians. The results of a survey that indicated nearly one half of Centrelink's social workers have received no formal training in how to use the technologies they rely so heavily on in their work are considered, as is the role of the social workers who are working as a part of Centrelink's call centre network. It is argued that social workers need to be careful not to confuse means and ends when it comes to utilising technology as a part of their practice.     

Child protection systems within the Danish,Finnish and Norwegian welfare states—time for a child centric approach?

This article explores the relationship between the child protection systems and the Nordic welfare state in Denmark, Finland and Norway. Despite an ideological focus on prevention and provision of a fair amount of universal services and in-home child protection services for families and children, there is, nevertheless, a relatively high number of children in the child protection system, even children placed out of their home. The outcome of child protection seems to be relatively poor. One of the problems in the present child protection systems is related to questionable service provision within the system. Other problems are about the normative foundation for the system, for example, family orientation and the least intrusive principle. Such principles are closely related to the logic of universal services, and may as such ignore the diversity of needs, rights, risks and ages of children needing protection and related services. Consequently, many principles of the present child protection systems are – and will remain – challenged by a child-centric orientation, in which valuing children's needs, rights and voice in situ are central.     

Addressing the needs crossover youth: What key professionals are saying

Crossover youth have complex needs and can create difficulty for service providers who have to both provide effective services to the youth but also work with and navigate a system outside of their own. Professionals from the child welfare system and the juvenile justice system have recognized the need to work together to help crossover youth. A successful collaboration can be extremely beneficial to all those involved but certain barriers must be overcome. This study uses secondary qualitative analysis to examine the opinions of key professionals in both systems as they came together to create action plans to address issues facing crossover youth in their individual counties. Researchers identify common themes and discuss the importance of collaboration among systems and recognizing individual county's stages of change.     

The early days of public relations in British Malaya: Winning the hearts and minds of the Empire

This article traces the early form of public information services during the colonial period to provide new insights into the historical development of Malaysia’s public relations. The first formal information agency created in 1910 was based in London to promote the early practices of public relations for British Malaya and its interests in Britain. British consolidation during the years of economic boom and depression, until the achievement of Malaysian Independence, was aided by the early information services. The article makes an alternative argument about the beginnings of Malaysian public relations based on colonial economic and political interest as against other previously held views     

Danish and Norwegian hospital social workers’ cross-institutional work amidst inter-sectoral restructuring of health and social welfare

Starting in the 2000s, Denmark and Norway have undergone extensive restructuring of their health-related social benefit programmes, including how they are governed. Several reforms have sought to enhance inter-sectoral collaboration. Aiming at ensuring patients’ faster return to work, policy-makers have instituted economic incentives to both individuals and the health and welfare organisations who handle them. Through an institutional logics approach, this paper explores how hospital social workers in these countries are experiencing these changes. The ‘social’ part of post-treatment care and rehabilitation receives more attention in the Norwegian institutional set-up than in the Danish, and whilst challenges are experienced in both countries, in group interviews Danish social workers in particular express concerns about the implications of the accelerated return-to-work focus. In both countries, they report increasing difficulties in ‘making their way through’ the state-municipal bureaucracy. However, by drawing on the formal health knowledge derived from medical settings and the symbolic capital it bestows on them, they often manage to negotiate the work-and-welfare services, thereby transforming the social context for the patients.     

Systemic Practice in the Time of COVID: Conversations Among Culturally Diverse Therapists

The COVID‐19 pandemic has changed the delivery of clinical services and education of health professionals, including family therapists. This paper distils two separate Zoom conversations between myself (as the lead author) and two eminent family therapists, Professors Maurizio Andolfi and Harry Aponte, where challenges and opportunities for the profession during and after the pandemic are discussed. Creativity and resourcefulness are two important elements therapists and educators have needed to access during the pandemic to find alternative ways to continue to provide clinical services and teaching. Most therapists have transitioned using online technology and various platforms such as Zoom and Skype; for some this has been a somewhat familiar experience, for most it has been a novel one. Key themes emerged from the conversations including the personal and professional ‘lived experiences’ of the pandemic; the financial impact on clients and students; the importance of touch for human social connection; the use of ‘self’ as an instrument of change and alternative platforms of service delivery and teaching. We reflected on what has been lost, such as the nuances inherent in face‐to‐face human interactions, and what has been gained, such as observing families in situ in their own environments.     

Medical Utilization and Health Expenditure of the Elderly in Taiwan

The present analysis, based upon data from the 1989 Taiwan Labor Force Survey, includes two parts. First, the determinants of physician visits and hospitalization by the elderly are analyzed according to the behavioral systems approach, and, second, variation in health expenditures among the elderly are examined using the Tobit model with sample selection. Findings show that elderly with good or poor health conditions are less likely to use medical services than the frail elderly and that married elders are less likely than the non-married to use medical care. The higher the educational level, the lower the probability of using formal medical services, and elderly who have health insurance are more likely to use formal health care than those who have no health insurance. The elderly who live with their children are less likely to use formal medical services than those who do not live with their children. Finally, among the elderly who have used formal health care, individual health expenditures are influenced primarily by three factors: health condition, health insurance, and residential location. Implications for Taiwan's relatively newly established national health insurance program (effective April 1, 1995) are discussed based upon the findings of this research.