Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

The Effect of Social Work Education and Self-Esteem on Students' Social Discrimination of People with Disabilities

Social work education on disability content has become more important due to political changes in the last two decades. The United States protected people with disabilities from discrimination in community and employment settings with the enactment of the Americans with Disabilities Act of 1990. These changes have empowered people with disabilities to become more independent; however, social workers primarily fulfill roles as case managers, and often make decisions for people with disabilities. This is not consistent with the empowerment perspective embedded in the disability movement. Most social work schools have minimal courses covering disability content. Previous research and the Self-Esteem Hypothesis indicate that social work education, social proximity to people with disabilities, self-esteem and other demographic characteristics are associated with social discrimination, or attitudes, toward people with disabilities. Social work students (n = 73) participated in a survey in the last semester of their program to assess how these characteristics were associated with their attitudes towards people with disabilities. A multiple linear regression revealed that social work education preparedness to work with people with disabilities, an MSW education, self-esteem, and having a friend with a disability were significantly associated with students' social discrimination towards people with disabilities.     

Predictors of Nursing Home Admission: A Social Work Perspective

Abstract

Institutionalisation of geriatric patients is a growing trend in ageing societies, such as Singapore. Earlier studies focused on the sociodemographic profile and attributes of nursing home residents and applications, but neglected to address the predictors of nursing home admission from a social work perspective. The present retrospective study identifies independent risk factors that predispose a patient to a nursing home discharge from a general rehabilitation ward in a community hospital in Singapore, with a multidisciplinary emphasis on clinical intervention. Factor analysis results reinforced findings that functional impairment and dementia are consistent predictors of nursing home admission. Multivariate logistic regression analysis showed that positive predictors of nursing home admission include older age, length of hospital stay, low socioeconomic status, dementia, and functional disability. Social work interventions include early referrals to the medical social worker, so that options for social and family support can be explored prior to deciding to place patients in a nursing home. Other interventions include suitable family therapy and counselling for patients and their families.     

Using Q-sort methodology as an educational tool in post-qualifying education whilst simultaneously gathering research data about views on parenting

Post-qualifying courses for social workers offer unique access to large numbers of practising social workers. Therefore, they present an opportunity to gather research data about current practice concerns. Asking students on post-qualifying courses to take part in research activity can also enable reflections upon the links between research and practice. However, ideally, any research activity should also contain an educational element so that students will directly gain from taking part. This paper describes a study in which Q-sort methodology was used as a method of both gathering data and as an educational tool. The study was an exploration of the links between views about both 'good enough' parenting and decision-making in child care and protection work. Subjects were students attending post-qualifying child protection courses. The methodology was successful both in gathering meaningful data and in stimulating lively debate about the issue. This paper will describe the study, briefly set out the research findings and discuss the advantages of the methodology as an educational tool.     

Investigating the Readiness of Hospital Social Workers to Respond to Domestic and Family Violence

ABSTRACT

Domestic and family violence (DFV) is recognised as a health care priority. Women experiencing DFV use health services at a higher rate than the general population. Hospital social workers are an important component of a public hospital response to domestic and family violence but how prepared are they for this role? This research study explored the readiness of social workers in a Melbourne metropolitan hospital setting to respond to DFV. Results indicated that although the social workers had a knowledge base highly relevant for responding to DFV, many lacked specific knowledge of risk assessment, safety planning, legislative responsibilities, and referral pathways for support, including legal support. As a result, it was likely that they were not adequately responding, either by not recognising when they needed to, or with knowledge and confidence when they did. They also identified a range of organisational enablers, including policy, time, and safe conversation spaces.

IMPLICATIONS

• Hospital social workers have a central role to play in responding to domestic and family violence.

• Hospital social workers need to be better prepared for domestic and family violence responses.

• Social workers require ongoing training and organisational support including practice protocols and guidelines, and the provision of time and private, safe spaces for sensitive conversations to occur.

• Universities should ensure that the role of hospital social workers is considered within curriculum addressing the area of domestic and family violence (DFV).

     

Raising the Titanic: Rescuing Social Work Documentation from the Sea of Ethical Risk

Abstract

One of the most contentious issues in social work practice concerns what should be written about people who access social work services, how comprehensively, and in what format social work assessments, interventions, and outcomes should be documented. The present paper describes a structured approach linked to an action research project that was undertaken by hospital-based social workers to identify and minimise problems associated with documentation in the medical record. The Social Work Ethics Audit provided social work staff with a risk-management tool that highlighted documentation as a key area of ethical risk. Through a process of evaluating existing recording practices, social workers were able to meet the challenge of improving social work recording in medical records, returning it to its proper place as a vital component of clinical and ethical practice rather than an administrative task submerged beneath competing priorities. It was anticipated that the social work documentation proforma that resulted from the ethics audit process would have applicability in other health care settings.     

An Empowerment Approach in Teaching a Class about Autism for Social Work Students

Social workers are being asked to respond to the rapidly increasing number of individuals and families affected by Autism Spectrum Disorders (ASD). However, the curricula in schools of social work have limited content on disabilities. This article describes a course which prepares social work students for work with individuals with ASD through an empowerment approach in an ever-changing socio-cultural and political environment. This approach changes the focus of disabilities from a narrow perspective on particular services and rehabilitation to a broader concern with human rights, social inclusion and quality of life. The article describes the development of the course in collaboration with a university disability program, the areas of emphasis for the course (family focused, interdisciplinary, lifespan) and the multiple modes of delivery. The implications of teaching the course as an elective or as integrating it further into the curriculum are discussed.     

Responses to Homelessness in Australian Cities: Social Worker Perspectives

Abstract

Responses to homelessness in Australia are provided by a range of government and nongovernment services. The present study examined the experiences of social workers within these diverse services. The article discusses how social workers make meaning of their professional identity and responses to homelessness in contemporary practice and policy settings. The findings of a qualitative study of 39 social workers employed in Adelaide, Melbourne, and Sydney are analysed from a social constructionist perspective. The practice dilemmas for social workers interviewed related to the dominating influence of the contemporary political and economic climate, the managerial requirement of organisations, and the personal and professional tensions these political and organisational contexts created.     

A Report on the Use of Open Access Podcasting in the Promotion of Social Work

Open access podcasting or podcasts on the internet on specific disciplinary topics are gaining prominence but are not well researched. This paper explores the usefulness of a new podcast series for social workers freely available on the internet that aims to: promote the profession of social work and contribute to a social work identity; make connections between theory, research, and practice; introduce students to real-life practice issues much earlier than often occurs in undergraduate degrees; and provide practitioners with opportunities for ongoing professional development. The evaluation was based on social media and website statistics, a survey of 22 students and nine educators, and a content analysis of listener feedback. While the evaluation provided limited evidence that all the aims had been met, the findings revealed very positive attitudes towards the initiative.     

Employers' Experiences and Views of Grow Your Own Social Work Programmes: A Qualitative Interview Study

In the light of expressed support for Grow Your Own or employer sponsored schemes for social work training, this article explores why they are not so frequently adopted. It draws on findings from a multi-method study of GYO activities and outcomes in England, in particular interviews with 27 participants from 20 organisations employing social workers and funding GYO activity. These interviews revealed that GYO was seen as a means to recruit and retain new social workers, specifically to recruit workers who were able to start practice immediately and needed minimal support, but also to widen access to the profession and to demonstrate evidence of the employers' wider commitment to its non-qualified staff by providing a career pathway. Not all those interviewed were able to provide firm data as evidence of their belief in the value of GYO schemes. The article concludes that the reasons for the decline in GYO schemes lie in the sizeable investment required to develop and sustain them. It identifies some mismatch between the need for immediate solutions to workforce shortages and the longer-term investment in students and in workforce development staff who are necessary to reap the benefits of such schemes.     

Addressing Psychosocial Barriers to Hospital Discharge: A Social Work Led Model of Care

Australian hospitals regularly care for patients who cannot be discharged routinely due to complex psychosocial needs that manifest as barriers to discharge. These long-stay or “stranded” patients are at risk of detrimental health outcomes resulting from their extended stay while also potentially delaying admission for those who need acute care. This article discusses a new social work led model of care developed at an Australian metropolitan hospital that targets long-stay patients with psychosocial barriers to discharge. The model of care, overseen by a specialist social worker and assistant, demonstrates how the social work profession can take leadership within the psychosocial realm to improve both organisational and patient outcomes.     

Social care stakeholders' perceptions of the recruitment of international practitioners in the United Kingdom—a qualitative study

Mobility of labour is common within Europe and globally, particularly in social and health care. This article examines the findings from a qualitative study of 15 expert or stakeholder views that explored supply and demand factors in international social care staff recruitment to the United Kingdom (UK). Findings are that international social care workers have a better reputation and are perceived as being harder workers, more productive, more reliable, more focused and more likely to stay in a post longer than local workers. However, there is also the perception that employment in social care is a stepping-stone into other forms of employment both in the UK and when returning to home countries, through access to training, experience and improved job opportunities. The impact of migration policies on the composition of international workers is further noted because greater numbers of social care staff are coming to the UK from the European Union and fewer from Commonwealth states. Changes in the profile of international workers are discussed, with a need identified to address cultural and language differences to ensure good outcomes for service users.     

Building School,Family, and Community Partnerships: Developing a Theoretical Framework

School, family, and community partnerships are among the suite of strategies advocated for improved school outcomes in which social workers can play a valuable role. Such partnerships are complex to implement in practice and there is little systematic research to guide the practitioner. This study evaluated an early intervention partnership program involving school, family, community, and philanthropic partners implemented in two primary schools in rural Victoria, Australia. The findings highlighted challenges in the process of evaluation and program implementation and in the opportunities this provided to identify key enabling factors. These involved having: a shared vision and aims; democratic governance; a supportive policy and organisational environment including external funding; workers with skills and clear roles; activities for project momentum; and ongoing review and evaluation. These factors can be used by social workers and others working with schools as a valuable conceptual framework to facilitate school, family, and community partnership processes.     

Developing Wellbeing as a Critical Tool in Social Work Education: An Example from the Field of Learning Disability

This paper will explore how ‘wellbeing’ is used in social work education to develop a critical understanding of the current English personalisation agenda, in relation to people with ‘moderate to severe’ learning disabilities. Drawing upon a short thematic analysis of policy for Learning Disability and Social Work Education, the paper will develop the argument that social wellbeing is an important factor for critical engagement and practice with this service-user group. Based upon teaching – incorporating service user and care views, as well as current research-in-progress, Schalock's (2004) taxonomy of wellbeing is developed to focus upon three themes: friendships and relationships; community engagement and structural factors. The importance for social workers of exploring aspects of community, in its widest sense, is emphasised, contrasting with a narrower view presented in policy implementation. The application of wellbeing as a practice and analytical concept therefore provides a framework for a critically reflective and engaged practice.     

Lessons from American Social Work Education: Caution Ahead

Abstract

Similar trends are occurring in Australian and US social work education, as universities increasingly adopt a rigid market orientation to tertiary education. This marketisation shapes social work education in manifold ways, including the pressure to increase revenues (and effect greater efficiencies) by expanding the size of social work programs. The unregulated growth in social work programs leads to lowered admission standards, as programs are forced to compete for students. An oversupply of social workers will also drive salaries downwards as supply eclipses demand. These issues are examined in the context of a “big” versus a “small” (fewer but more highly trained social workers) model of social work. Emphasis is placed on the lessons that Australian social work educators can learn from the challenges facing US social work education.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

Dressing the Part? The Significance of Dress in Social Work

This paper explores practice educators' views about the significance of dress for social work in the context of UK social work education. The findings, drawn from three focus group discussions, suggest that practice educators regard dress as an important way in which social workers demonstrate values in action. Dress is also seen to play a part in the development and maintenance of a professional social work identity, and is relevant to the physical and bodily experiences of ‘doing’ social work. Social workers should be aware of the significance of dress and self-presentation, and where student social workers fail to demonstrate such awareness, practice educators may have questions about their understanding of the complexity of practice. The paper notes that while participants expressed similar views about the meaning and impact of dress, these are based on the observation and experience of practice, and there is little research evidence specifically concerning dress in social work. The study contributes to an understanding of why practice educators consider that dress may be relevant in the assessment of a student's practice readiness, and suggests areas for further research about this everyday yet significant aspect of a social worker's working life.     

Social work in the public and non-profit sectors in Italy: what are the differences?

Professional social work in non-profit organisations is still little studied, despite the increased number of social workers in such organisations. The article presents the results of a survey conducted on the differences in working conditions between social workers in the public and non-profit sectors in Italy, and shows the factors that influence those working conditions. The article also furnishes empirical indications on how the training of social workers could be reorganised, and the image of social work reconceptualised, in a period when welfare systems are being restructured.