Provider and care workforce influences on quality of home-care services in England

A key trend in home care in recent years in England has been movement away from "in-house" service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users' views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Perspectives of college students and their primary health care providers on substance abuse screening and intervention

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.     

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.     

Working with Homeless Populations to Increase Access to Services: A Social Service Providers’ Perspective Through the Lens of Stereotyping and Stigma

Through the lens of stereotyping and stigma, this article examines discrimination and prejudice toward homeless families from the perspective of social service providers. Semi-structured qualitative interviews were conducted with practitioners. A critical social work practice perspective is used to provide a framework for understanding how social worker knowledge about discrimination and prejudice informs the ways in which the workers engage with clients, build capacities, and advocate for clients in an anti-oppressive manner. The themes found in this study include: a) providers’ awareness of bias, stereotyping, prejudice, and discrimination; b) providers’ use of a range of strategies to work with people experiencing homelessness; c) providers’ ideas about strategies that organizations can implement for service provision; and) providers’ belief that additional advocacy and policy are needed in relationship to people experiencing homelessness.     

Health Care Reform and the Behavioral Health Workforce

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field.     

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.     

Insights into the black box of child care supply: Predictors of provider participation in the Massachusetts child care subsidy system

The United States child care subsidy system relies on the voluntary participation of private providers in the market in order for low-income families to access otherwise unaffordable care. However, with few states able to pay child care providers subsidy payment rates at market value (National Women's Law Center, 2015) and increasing pressure for providers to improve their quality of care (Child Care and Development Fund [CCDF] Program, 2016), there is concern at the federal level regarding the supply of providers willing to participate in the subsidy system (CCDF Program, 2016; Schumacher, 2015). Using administrative data from Massachusetts, this study examines the factors associated with provider participation in the child care subsidy system. Findings from logistic regression analyses indicate that lower administrative capacity, higher private pay prices (in comparison to the subsidy payment rate), and higher local market household income may limit or reduce opportunities for participation in the subsidy system. Results also suggest that for-profit providers are not avoiding participating in the subsidy system, but may find participation challenging if subsidy payment rates are too low (compared to private pay prices). Additionally, although the total pool of accredited providers is small, accredited providers have greater odds of participation compared to non-accredited providers, indicating that families may have some access to quality care. These findings suggest that states should focus on identifying 1) ways to ease administrative impediments to entry into the subsidy system, 2) effective provider recruitment tactics, and 3) monetary/non-monetary incentive structures that can build a large and diverse supply of high quality subsidized care.     

Improving Primary Care for Persons with Disabilities: the nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.     

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Spirituality and Faith-Based Social Services

Abstract

Spiritual aspects of faith-based social services are rarely addressed in discussions of policy initiatives encouraging greater involvement of faith-based providers in service delivery. This article reports findings of a qualitative study of the values, beliefs, and practices of non-congregational faith-based service providers. Twenty-two providers in Midwestern and northwestern regions of the U.S. were asked about the spiritual bases of their programs, spiritual dimensions of service relationships, distinctions between service communities and programs, and distinctions between service ministries and social work. Implications for collaborations among providers with different beliefs are discussed.     

Professional Responses to Government-Endorsed Premarital Counseling

Abstract

This paper presents preliminary findings about the manner in which public policies that promote premarital counseling impact professionals who conduct premarital counseling. The purpose of this paper is to describe findings from a survey of premarital counseling providers in a state in which the government endorses premarital counseling. A total of 194 premarital counseling providers described their responses to their state government's endorsement of premarital counseling. Results indicated that a majority of providers held a favorable opinion of this policy, although a number of providers held either unfavorable opinions of the policy or were uncertain about the policy's effectiveness. Implications for practice and future research are discussed.     

Service providers' modes of interacting with frail elders and their families: Understanding the context for caregiving decisions

The purpose of this study was to explore the professional context within which frail elderly individuals and their families operate as they make decisions regarding caregiving. The findings serve to improve our understanding of the nature of the interface between the informal structures of families and the formal structures of the service-provider network. Designed as an exploratory qualitative study, the research process involved one-on-one interviews with providers from 9 areas of service related to elder caregiving. Specifically, analysis of the data revealed 4 provider styles or modes of interacting with elders and their families: Listener, Educator, Encourager, and Advocate. The most frequent mode was Educator, with 7 of the 9 providers referencing it more often than any other mode. The least frequent mode was Listener, with 5 of the service providers referencing it the least often. Implications of these findings for service providers lie in better understanding of how preferences for one style or another may affect their communication with clients. For families, the implications lie in understanding ways to more effectively interact with the formal network of providers in order to have their needs adequately addressed. Further, educators or counselors may be able to use these results in helping families improve their access to resources and services, and in helping providers better serve the needs of clients.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Personal and Professional Knowledge of and Experience With Suicide and Suicide Prevention Among Stakeholders in Clinical and Community Practice

Community-dwelling veterans at risk for suicide may be in contact with a variety of providers in agency-based settings that offer health and human services. The study aim is to describe the perspective of agency-based clinical and community providers who may come into contact with veterans in need of suicide prevention services and to examine the nature of their personal and professional relationships to individuals at risk for suicide among this sample.

This study reports on qualitative data from a sample of Veterans’ Affairs (VA) and community providers serving veterans and military families in one Midwestern state (N = 70). Providers completed a survey assessing exposure to suicide, including contact with and relationship to someone suicidal, and organizational characteristics of the providers’ employing agencies. Semi-structured interview questions probed for the nature of how they would react with suicidal individuals. Most providers (94%) had some prior contact with someone who was suicidal, and nearly three quarters (77%) knew someone who had died by suicide. Providers reported powerful emotional responses of sadness and remorse to suicidal experiences. While these providers interact with veterans and military families as part of their jobs, they may have their own history of being exposed to suicide, both professionally and personally.     

What really happened? Incidence and factor assessment of abused children and adolescents

Abuse of children and adolescents is a societal problem. If health-care providers are to intervene adequately in abuse, they must identify the occurrence, elicit all pertinent information surrounding the abuse and the patient's response, and integrate pertinent abuse issues in the overall treatment plan for the patient. This study has conclusively demonstrated the failure of health-care providers to assess and plan treatment based on the comprehensive documentation of sexual and physical abuse factors. Findings clearly indicate a need for education of health-care providers in the development of comprehensive and integrated treatment plans for abused psychiatric patients based on documentation of all factors related to trauma learning and replay. Service agencies must be willing to implement in-service programs that provide nurses and other health-care providers with the cognitive and affective knowledge and skills necessary to feel comfortable in the management of abuse issues.     

Exploring the Hidden Nature of Gambling Problems among People Who Are Homeless

Abstract

Although people with gambling problems are now recognised to be among those groups of people at increased risk of homelessness, little research has explored their experiences. This qualitative interpretive study explored the experiences of people who were homeless and had gambling problems, and the housing and gambling service providers assisting them. In-depth interviews were conducted with 17 service users and 18 service providers. A key finding was that gambling problems among those experiencing homelessness are often hidden; few people presented to housing services admitting to gambling problems. Shame, stigma, and identity issues were described as the main reasons service users did not disclose their gambling activities. The research highlighted that the relationship between service providers and service users was infused with power imbalances and shaped by social discourses and policies that demand self-responsibility and hinder information sharing between service providers and service users.     

Role Conflict among Family Childcare Providers in the Bronx

Family childcare (FCC) providers provide childcare for many low‐income families in the United States, and the literature suggests they take on several other support roles as well. The current study consisted of focus groups and interviews in which FCC providers (N = 22) shared successes and challenges in their profession. Using grounded theory we identified four primary FCC roles: teacher, caregiver, social worker and business owner. Conflict within and between roles was related to considerable stress. Because roles varied across a spectrum from entangled to rigid professional relationship boundaries, many FCC providers struggled with the limits of their daily work. Suggestions are made to limit role conflict, re‐establish boundaries and promote FCC providers’ well‐being.