Dementia Patients’ Transition to Residential Aged Care: Carers’ and Social Workers’ Experiences

Many people with dementia eventually require residential aged care, frequently preceded by a hospital admission. Family carers often find the process challenging and disempowering, as they are expected to move their family member to residential aged care quickly. This article reports on findings from a small Australian qualitative study focusing on the provision of information, support and resources, and discusses the findings in relation to person-centred care and critical social work. Social workers completed an online survey and participated in focus groups, and carers were interviewed. The research found that carers valued the information, support, and resources provided by social workers and other hospital staff. They needed time to adjust to the dementia diagnosis and wanted a supportive person to talk to about the written information. The social workers wanted an improved approach to the preparation and communication of information, and a more consistent approach to family meetings.     

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.     

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.     

Social Work in the Emergency Department—Implementation of a Domestic and Family Violence Screening Program

Abstract

Women who have experienced domestic and family violence use health services more frequently than women who have not. Early identification and intervention by the health system may reduce health problems associated with domestic and family violence and lead to savings for the health sector. This study aimed to evaluate the impact of a new domestic and family violence screening program, which was based on an ecological model and introduced by a social work team in the Emergency Department of a major metropolitan hospital. The evaluation method included an audit of social work case files to assess the effect on referral rates and a survey of Emergency Department staff to obtain perceptions of the impact of the program on the staff and clients. In the 3-month period following the introduction of the program, the rate of referral to social work increased by 213%. Staff agreed that the Emergency Department is an appropriate place to ask about domestic and family violence, under certain conditions. Findings suggest that an ecological social work model provides an approach to screening for domestic and family violence that not only contributes to increased identification and supportive client interventions but may also contribute to more sustainable systemic change.     

Emergency department social work in the UK and Sweden: evaluation by older frequent emergency department attenders Kuratorsarbete på akutmottagning i förenade kungadömet Storbritannien och Sverige: en utvärdering utifrån brukarperspektivet hos äldre mångbesökare på akutmottagningen

Social work based in hospital emergency departments (EDs) in Sweden and the UK reflects a wider European social/health care policy trend. A key focus is on diverting older frequent ED attenders from ‘inappropriate’ hospital re-attendance or emergency admission, because of social care problems. However, previously there has been no evaluation of the significance of ED social work for health and well-being, from the standpoint of older frequent ED attenders themselves. In a preliminary way, our paper provides this through drawing on a small scale Swedish/UK study. Its comparative account of service user feedback underscores the importance of ED social work as a facet of European social work. It indicates that ED social work contributes to the quality of care within emergency departments, acts as a key access point to social services, and can promote both short and longer-term health. At the same time, some serious shortcomings emerge. These include under-developed referral systems, and limitations to community based services following ED social work assessment, which reflect the under-resourcing of social care provision in both countries. Moreover, service users’ experience in both Sweden and the UK reveals the risk of ED social work with older frequent ED attenders being used as a substitute for follow-up medical/nursing care when that is also required.     

Building Indigenous Australian Social Work

Abstract

An Indigenous social work guided by Indigenous Australians’ participation and experience that has, at its heart, human rights and social justice is in its infancy in Australia. The present paper continues a discussion on Indigenous Australian social work theory and practice developments being generated by those working in this field. Aspects of this “praxis” include recognition of the effects of invasion, colonialism, and paternalistic social policies upon social work practice with Indigenous communities; recognition of the importance of self-determination; contemporary Indigenous and non-Indigenous colleagues working in partnership; the impact of contemporary racist and neocolonialist values; and rethinking contemporary social work values and practices. There is discussion of appropriation and reinterpretation of social work concepts, incorporation of international and local Indigenous theory, and the framing of social work by Indigenous Australians’ views and values.     

Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia

Purpose: To describe factors influencing decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Design and Methods: Individual interviews were used to collect data with 30 Chinese family caregivers of older adults with dementia in Taiwan. Data were analyzed using thematic analysis. Results: Factors influencing caregivers' decisional conflict included the Chinese value of filial piety, limited financial resources and information, placement willingness of the older adult, family disagreement, distrust of nursing home care quality, and limited nursing home availability. Factors influencing caregivers' decisional conflict post placement included disappointment with nursing home care quality and self-blame for the placement decision. Implications: Findings resulting from this study indicate that Chinese family caregivers experience decisional conflict during the nursing home decision making process as well as after the placement decision. It is important to provide appropriate decision support beginning before admission and across the trajectory of the older person's nursing home stay in order to decrease decisional conflict and facilitate a more positive decision making process for caregivers, family members, and older adults with dementia.     

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.     

Responding to People Sleeping Rough: Dilemmas and Opportunities for Social Work

Abstract

Rough sleeping refers to the state of being literally without shelter or residing in shelter not fit for human habitation. People who sleep rough are thought to be a group who experience a range of complex problems in addition to their homelessness. Despite their small numbers relative to the broader homeless population, rough sleepers have been identified as a target group for policy and practice intervention. This article critically examines outreach responses directed toward people sleeping rough. Moving beyond traditional charity approaches or interventions that “move people on”, emerging models of “assertive outreach” have been implemented in Australia as part of broader strategies to reduce homelessness. Challenging the idea that assertive outreach is a shift from a social work approach, it is argued that interventions to actively end rough sleeping are consistent with social work principles. Indeed, this article takes it that social work must advocate for the provision of affordable housing as central to rough sleeping interventions. Housing not only enables people to achieve human dignity and worth, but the linking of housing with outreach responses to rough sleepers will facilitate a trusting and effective working relationship.     

Making Social Policy “Sexy”: Evaluating a Teaching Innovation

Abstract

How to stimulate student interest in social policy, while reinforcing its professional significance for social work, remains an understudied topic. This paper reports an evaluation of a teaching intervention that sought to enhance student interest in social policy by: more explicitly connecting social policy with professional social work practice; introducing an assessment exercise that involved visiting Parliament House; and undertaking weekly “hot policy topic” small group discussions. Social work students were found to be quite aware of the importance of social policy to professional practice. The intervention did not measurably increase interest in social policy, but heightened student awareness of their capacity to contribute to policy processes.     

Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents

We conducted a qualitative content analysis of barriers to nursing home admission for rural residents. Data came from semi-structured interviews with 23 rural hospital discharge planners across five states (Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin). From those, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions across four themes: loosen bureaucratic requirements, improve communication between facilities, increase rural long-term care capacity, and address underlying social determinants of health.     

Limiting relationships through sousveillance video based digital advocacy: multi-modal analysis of The Nervous CPS Worker

ABSTRACT

Digital media technology and Internet-based/social media sharing are shifting the contexts and processes of social work, including the relationships emerging in practice. The Nervous CPS Worker, a digital video shared via YouTube, provides a concrete practice-based example of the use of social media self-advocacy by professional foster parents. This case-study demonstrates the fragmented and shifting power-relations brought to bear within contemporary social work. Multi-modal analysis facilitates the development of a layered qualitative understanding of this video, shaped by the researcher’s inter-textual relationship with the material. Supplemental online texts are applied to the Nervous CPS Worker and relevant scholarship, including discipline specific knowledge, reveals the layered and convergent meaning making processes present in this video through the use of auditory communication, visual representations and genre. Analysis demonstrates how contemporary social work contexts, such as neoliberalism, and standardisation are implicated in practice and how identity and context compete for recognition and space within the home visit depicted in this video.     

Research Articles in Australian Social Work from 1998–2007: A Content Analysis

Abstract

With the rise of evidence-based practice, there have been calls in social work for practice research that examines the efficacy of its interventions. For the present paper, the authors conducted a content analysis of all articles published in Australian Social Work in the period from 1998 to 2007 to examine the nature of published research and evaluation. Of the 313 articles, 138 (45%) reported on research findings. Of these, only six articles involved practice evaluation or testing of an instrument, but there were positive signs of a developing empirical research culture primarily utilising a qualitative approach or mixed methods studies. The authors suggest that there is a need for more research on social work interventions, a more conscious decision by the profession about its attitude to evidence-based practice (EBP), specific directions for research education, and greater rigour in reporting all types of research studies, but particularly qualitative studies.     

Social Constructivist Practice with Youth

Social constructivism is an important and creative perspective for helping social workers in their work with adolescents. This paper demonstrates how theoretical orientations and clinical techniques that adhere to a social constructivist perspective can be integrated with the developmental realities of adolescence to provide effective social work interventions. Fundamental assumptions are discussed and are related to problems of practice. Case studies are utilized to demonstrate social constructivist principles in clinical work with adolescents.     

Social Justice as Concept and Practice in Australian Social Work: An Analysis of Norma Parker Addresses, 1969–2008

Abstract

Social justice is central to Australian social work. Principles of social justice underpin the definition of social work as a profession, its code of ethics, and its standards of practice and education. However, there is a dearth of empirical research regarding what social justice has meant to social work over time and how it has been enacted in practice, topical as social inequalities continue to escalate. As a first-stage study, this paper examines how social justice was represented within 19 Norma Parker Addresses delivered by Presidents of the Australian Association of Social Workers at national conferences between 1969 and 2008. Two key themes were evident: social justice as a concept and social justice as social work practice. Social justice was represented conceptually throughout the Addresses as an enduring guiding principle and moral responsibility for social work. How social justice was enacted in practice included themes of: standpoint; practices and strategies; educating social workers; and contested and constrained practice. The meanings and practices of social justice were embedded within the changing contexts within which the Addresses were delivered. Further historical studies can inform social work knowledge, practice, and critical reflection as the profession continues to evolve and confront persistent social justice challenges.     

Gender Dynamics in Social Work Practice and Education: A Critical Literature Review

This paper offers a critical analysis of existing literature on historical and contemporary gender dynamics in Australian social work education and practice. Analyses of gender dynamics and inequalities have the potential to illuminate pathways for inclusive social work education and practice, for both practitioners and people who access social work services. This critical review of the literature demonstrates that Australian social work education and practice have been shaped by gendered discourses, structures, and power dynamics since its inception. In a contemporary sense, women constitute the majority of social work educators and practitioners, while men disproportionately dominate positions of power and prestige, although rigorous Australian data on the roles and representation of men and women are not readily available. Our findings point to the need for further engagement with gender as a unit of analysis in Australian social work research, including further engagement with inclusive and intersectional feminisms.

IMPLICATIONS

• Enhanced knowledge of Australian social work history, particularly in relation to gender, allows for a greater understanding of current gendered power relations in social work education and practice.

• Gender dynamics are underresearched in contemporary Australian social work education and practice.

• Up-to-date data on the status and representation of men, women, and nonbinary people in social work are needed as the foundation for transformative and inclusive social work education and practice.

     

“This is Who We are and This is What We Do”: Social Work Education and Self-Efficacy

Abstract

Citing anecdotal evidence about the poor self-efficacy among graduating social work students manifesting in student claims that they lack the skills to practice effectively, the present paper suggests that the cause may lie, in part, in the manner in which social work education is undertaken. Instead of adjusting curriculum content, the author suggests that educators need to moderate the emphasis they place on social work as a professional project, as well as clarify the status and use of practice theory. The paper concludes with three additional recommendations for consideration by educators and suggests a research agenda for assessing student self-efficacy.     

Social work in the development of institutional care for older people in Slovenia

Social work in homes for older people in Slovenia has a special role since we have extremely institutionally-oriented care for older people. Characteristic of the development of Slovenian homes for older people is a shift in the dynamics of the orientation of the homes from a medical to a social one. Different factors influenced the shift towards a social orientation, i.e. the policy of establishing homes, the influence of sociogerontological principles, the development of social work and, recently, by their engagement with residents with dementia. In socially-oriented homes a different model of social work is used than in medically-oriented ones. The difference lies in social work methods as well as in the roles of the social worker in different areas of work with the residents, relatives and staff. By defining a model of social work in a socially-oriented home, a special field of social work with older people in the field of institutional care in Slovenia has been developed.     

Toward Rigor and Relevance in US Social Work Education

Abstract

After reviewing the major changes taking place in American higher education, the present paper discusses a select number of challenges confronting US social work education. These challenges are broadly characterized as those of rigor and relevance. The paper presents the author's reflections on the best ways to meet these challenges and stresses the promotion of research and social innovations as important foci for social work education.     

Mapping the Terrain of Selection for Social Work: A Critical Analysis of Policy,Theory and Research

This paper explores the implications of the changing UK policy and regulatory contexts for the often competing or contradictory interests and agendas operating within the arena of admission decisions in social work education, highlighted by the introduction of the new social work degrees in 2003–04 and the associated care councils. Other contextual factors that impact on admissions to higher education more generally will also be touched upon, including the widening participation agendas; increased requirements for transparency of decision making in the selection process; questioning of the predictive quality of A‐level scores; and, concern regarding recruitment and retention issues. A critical review of relevant research into social work admissions processes and outcomes is reported on. The validity of current selection tools is examined utilising research findings from within social work and allied disciplines. The authors argue that the increased spotlight upon admissions and the ‘front‐loading’ of gate‐keeping into social work education is both unrealistic and irresponsible as it omits the crucial ongoing role of assessment throughout the process of qualifying education.