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.     

The experience of smoking in recovery settings: an ecological momentary assessment pilot study

ABSTRACT

Smoking continues to be the leading cause of preventable death in the United States, and people with substance use disorders (SUD) smoke at higher rates compared to their non-using counterparts. Individuals with SUDs may have different emotional experiences and expectancies than those without. The current study explored the relationship between smoking and emotional experiences among residents in recovery homes, a population that little is known about regarding their tobacco addiction. Using ecological momentary assessment (EMA), significant emotional differences were found between nicotine users and nonusers. Implications of these findings could help in the development of interventions directed toward reducing smoking cessation.     

The Physical Housing Environment and Subjective Well-Being Among Older People Using Long-Term Care Services in Japan

Abstract

For older people using long-term care services, the conditions of their life-space may be critical. The relationships between the physical housing environment and aspects of health were examined among older people in Japan (aged 65+ years, N?=?1,928) by multivariable logistic regression analysis, adjusting for sociodemographic characteristics. Lack of safety, low access to emergency assistance, low or high indoor temperature, poor sanitary conditions, and state of home disrepair were significantly associated with negative aspects of health among people with low activities of daily living (ADL) independence. Home care service providers and policymakers need to consider the importance of appropriate environmental conditions for the most vulnerable groups.     

Utilizing social media for social work: insights from clients in online youth services

ABSTRACT

This study explored and conceptualised service users’ experiences in online outreach projects supported by the Hong Kong SAR government. Fifteen active users were interviewed. The study used thematic analysis to explore service users’ experiences that might not have been possible without technology. Participant utterances were non-mutually-exclusively tagged with a specific theme. Each utterance reflected an aspect of user experience which combined a technical component with a service-need component. Six themes were identified, including: (i) Personalised newsfeeds help identify service information and news, (ii) Online status indicators improve service accessibility, (iii) Online communications enable a disinhibition effect, (iv) Asynchronous communications facilitate continual feedback loops, (v) Incomplete communicative modalities may cause misunderstanding and (vi) Asynchronous communication may disrupt conversations. The findings reveal that there are middle-level concepts between broad social work concepts and ever-changing technology. Implications for research and practice are discussed.     

Sexual Orientation Bias Experiences and Service Needs of Gay,Lesbian, Bisexual,Transgendered, and Two-Spirited American Indians

Summary

Employing both quantitative and qualitative methodologies, this study examined: sexual orientation bias experiences among American Indians (AIs) who were gay, lesbian, bisexual, transgend-ered, or two-spirited (GLBTT-S); service provider attitudes toward AI GLBTT-S; and service barriers and needs with respect to AI GLBTT-S at one AI community-based organization. Among the 14 AI GLBTT-S surveyed, the percentages reporting various bias-related experiences were comparable or greater to those reported for non-AI GLBTT-S in other studies (e.g., 36% had been physically assaulted because of their sexual orientation). The 22 service providers surveyed revealed generally low levels of heterosexism, which was inversely related to contact and comfort with AI GLBTT-S as well as understanding of AI GLBTT-S terms. Data from 8 focus groups (7 with service providers and 1 with AI two-spirited men) yielded four main themes related to problems and barriers to service utilization for AI GLBTT-S (i.e., invisibility, discrimination, trauma, and identity) as well as ideas for community-based program planning with this population.     

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

ObjectiveNon-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes.MethodSeventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline.ResultsPersonal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health.ConclusionsThis study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.     

Predictors of Divorcing Women's Use of Divorce Mediation

Abstract

This study examined the relations between perceived usefulness of mediation, problem susceptibility, mental health conditions, availability of social support, and the likelihood of using divorce mediation service. The sample comprised 124 divorcing women in Hong Kong who sought legal aid to settle matrimonial issues. A large proportion of participants indicated their willingness to use mediation. Logistic regression showed that likely users have higher appreciation of the helpfulness of the service, have poorer mental health, and to some extent, receive lower levels of social support from informal sources. Susceptibility to housing, finance, and child-care problems is not a significant predictor. The results strongly suggest the importance of promoting mediation services to the people in need.     

A limited entitlement for community care: how members use services

The goal of this paper is to show how members of three Social HMOs use a limited entitlement for community-based long-term care to meet their needs and solve their problems. The paper is based on in-home interviews with 48 aged Medicare beneficiaries who joined Social HMOs and are eligible for the entitlement. Members' experiences with case management (called service coordination), benefits for covered services, and cost-sharing requirements are explored. Members (and their informal caregivers) are found to have complex lives, into which community care fits (or does not fit) in varied ways, depending on preferences, experiences with providers, informal care, financial resources, and other factors. The paper provides insights into what kinds of problems people want to solve and how community care systems can be better designed to empower service users to solve them.     

Drinking Patterns,Problems, and Motivations Among Collegiate Bisexual Women

Objective and Participants: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). Methods: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. Results: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. Conclusions: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.     

An Evaluation of Mental Health Services for the Culturally Diverse

ABSTRACT

The purpose of this project was to examine the needs of multicultural populations in the mental health system, and see how these needs get addressed in current policies. As a social worker in the mental health system, I wanted to investigate the strengths and weaknesses of service providers in their ability to meet the needs of diverse populations. In doing this research, I hoped to make a space for people whose families have had to deal with mental health services, and explore the experiences of those who have not had the opportunity to discuss them. In addition, the purpose of this paper is to contribute to a body of increased knowledge on how the mental health system treats people who belong to a cultural minority.     

Prevalence of Problem Gambling Among Adolescents: A Comparison Across Modes of Access,Gambling Activities,and Levels of Severity

The high availability and accessibility of online gambling have recently caused public concern regarding the potential increase of gambling-related problems among young people. Nonetheless, few studies among adults and none among adolescents have explored specific characteristics of gamblers as a function of gambling venues to date. This study sought to analyze the prevalence of gambling among a sample of adolescents in the last year, as well as sociodemographic and gambling-related characteristics as possible predictors of at-risk and problem gambling. The sample comprised 1313 adolescents aged 14–18 years. Participants were asked to respond to several questions regarding their gambling behavior. Chi square and ANOVA tests were performed in order to explore differences between groups, and a set of multinomial regressions established significant severity predictors. The prevalence of at-risk and problem gambling was 4 and 1.2 %, respectively. Regression analyses showed that having a relative with gambling problems predicted at-risk gambling. Both living with only one parent or not living with parents at all, and the prevalence of Electronic Gambling Machines in the last year were associated with problem gambling. Mixed-mode gambling was a predictor of both at-risk and problem gambling. Our findings extend previous research on gambling among adolescents by exploring gambling behavior according to different modes of access. Although the prevalence of exclusive online gambling among the total sample was low, these results support the need to consider specific subgroups of gamblers and their concrete related features when conducting both indicated prevention and treatment protocols for adolescents.     

The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work

ABSTRACT

Peer adviser roles are becoming an increasingly common—and celebrated—aspect of agencies where social workers are located. This article reports on a qualitative research study exploring the experiences of staff within a homelessness outreach service in which three peer advisers (people with a lived experience of homelessness) commenced employment. Drawing on action research principles, the study explored the experiences of the peer advisers and the broader team following the introduction of the peer adviser roles. Themes identified include, realising the skills of peer advisers, defining the role, taking a “whole of team” approach, and reflecting on power. This study demonstrates that the introduction of peer adviser roles into human service organisations is a promising strategy for creating services that are more likely to respond effectively to the needs of service users. However, social workers need to be aware of the pitfalls of tokenism and the devaluing of experiential knowledge.

IMPLICATIONS

• Peer advisers in health and welfare agencies add significant benefits to an agency’s capacity to respond to the needs of service users.

• The introduction of the peer workforce is aligned to social work values of service user empowerment and the valuing of experiential knowledge.

• In order to avoid tokenism, the introduction of peer adviser roles should be supported by both the attitudes and actions of other staff members, as well as organisational support structures.

     

Work and Work Alternatives for Disabled Young People

This paper presents results from a population based action research study in East Devon of the needs of 383 young people aged 16-25 years with a whole range of impairments and disabilities, and 152 able-bodied controls. A comparison between these two groups is made of their current and past experiences of work and work alternatives. The aspirations and expectations of the disabled young people are also compared with those of their families and service providers, and the preferred occupations of the young people, with various profiles of disability, are explored. Although the analysis pinpoints groups of disabled young people with particularly high levels of employment handicap, there is, throughout the study group, a need for progress out of static or unstable occupational paths. The handicapping features of employment services that impede this progress are discussed together with an examination of society's response to high levels of unemployment among disabled people. The research findings, set within this context, provide a basis for action research now being undertaken in local communities within East Devon to improve employment opportunities.     

A Passion for Gambling: A Generation-Specific Conceptual Analysis and Review of Gambling Among Older Adults in Canada

The proliferation of gambling opportunities in Canada, coupled with an aging population, has led to an increased prevalence of gambling among older adults. Encouraged by this trend, gambling industries have modified their activities to attract and market to this group. Yet, older adults are not a homogeneous group. The life experiences, values, and attitudes shared by generations make a cohort-specific analysis of gambling among older adults a worthwhile pursuit. Drawing from the Dualistic Model of Passion (Vallerand et al. in J Pers Soc Psychol 85(4):756–767, 2003), we discuss the role of passion in shaping gambling behaviours, and the implications of a harmonious or obsessive passion on the benefits and risks to two distinct generations of older adults. Based on their generational attributes, we posit that members of the Silent Generation (those born between 1925 and 1942) stand to gain more from the benefits of recreational gambling, but also stand lose more from problem gambling, than their children’s generation, the Baby Boomers (those born between 1942 and 1964). Preventative strategies to assist problem gambling seniors, along with recommendations for further research, are discussed.     

Excessive Gambling and Online Gambling Communities

The Internet provides an accessible context for online gambling and gambling-related online communities, such as discussion forums for gamblers. These communities may be particularly attractive to young gamblers who are active Internet users. The aim of this study was to examine the use of gambling-related online communities and their relevance to excessive gambling among 15–25-year-old Finnish Internet users (N?=?1200). Excessive gambling was assessed by using the South Oaks Gambling Screen. Respondents were asked in a survey about their use of various kinds of gambling-related online communities, and sociodemographic and behavioral factors were adjusted. The results of the study revealed that over half (54.33%) of respondents who had visited gambling-related online communities were either at-risk gamblers or probable pathological gamblers. Discussion in these communities was mainly based on sharing gambling tips and experiences, and very few respondents said that they related to gambling problems and recovery. In three different regression models, visiting gambling-related online communities was a significant predictor for excessive gambling (with 95% confidence level) even after adjusting confounding factors. The association of visiting such sites was even stronger among probable pathological gamblers than among at-risk gamblers. Health professionals working with young people should be aware of the role of online communities in terms of development and persistence of excessive gambling. Monitoring the use of online gambling communities as well as utilizing recovery-oriented support both offline and online would be important in preventing further problems. Gambling platforms should also include warnings about excessive gambling and provide links to helpful sources.     

Practising partnership--participative inquiry with older people

This paper examines the importance of approaching research with minority groups of older people in an inclusive way. For older people, ageism is a key feature of the discrimination and marginalisation they experience, but some are excluded and marginalised further on the basis of their ethnicity and sexuality. The 'invisibility' of these groups poses a challenge to social workers and social work educators, as assumptions about their experiences and needs may be made which do not reflect the subjective experiences of these older people. The use of Participatory Action Research as a method of including service users in knowledge and theory development will be analysed, and a research proposal undertaken in partnership with a local voluntary agency will be explored. The importance for social work education of pursuing 'inclusive' methods of research so that service users have more power over knowledge produced about their lives, will be discussed.     

A big hole with the wind blowing through it: Aboriginal women's experiences of trauma and problem gambling

Although studies have shown a link between social trauma and problem gambling (PG), there is little research involving Aboriginal women in this area, despite Aboriginal women being potentially at higher risk for both social trauma and problem gambling. This article describes the results of a qualitative phenomenology study asking seven Aboriginal women living in Western Canada to describe their experiences of social trauma and gambling problems. Results suggest four main themes, describing: (1) the Aboriginal women's experiences of social trauma (‘the three tigers’); (2) their use of gambling to cope with these experiences (‘a big hole with the wind blowing through it’); (3) their experience of problem gambling (‘I'm somebody today’); and (4) their process of healing from social trauma and gambling problems (‘a letter to John’). Participants described what they felt was a clear link between social trauma and problems with gambling, and how gambling helped to change their mood and block out the past. The results raise the possibility that Aboriginal women with gambling problems may need support to heal from social trauma – including racism and colonization – and that upstream initiatives to reduce the incidence of social traumas may be an important response to problem gambling among Aboriginal women.     

The Self-Exclusion Experience for Problem Gamblers in South Australia

Abstract

Increased prevalence of problem gambling has accompanied the spread of gaming venues in many parts of the world. One intervention to minimise the impact of harmful patterns of gambling behaviours is self-exclusion, where patrons can elect to ban themselves from a gaming venue or its gaming facilities for a specified time period. While self-exclusion programs are widely available, little research has been conducted into their operations and efficacy, particularly from the self-excluders’ perspective. This paper presents findings from 35 survey responses and 23 interviews with gamblers who had self-excluded through a centralised service in South Australia. They identified key program shortcomings as low publicity, limits on how many venues they could self-bar from, and inadequate venue monitoring for breaches of self-barring orders. Nevertheless, the centralised service, staffed by trained psychologists and located away from gaming venues, which allows multiple venue barring in one application, appeared advantageous over programs that require people to self-exclude directly from individual gaming venues. Most respondents (85%) had ceased or lessened their gambling in the 12 months following self-barring. Nevertheless, some continued to struggle to manage their gambling, reflected in breaches of their orders and gambling in venues from which they were not excluded.     

Gambling Patterns and Problems of Gamblers on Licensed and Unlicensed Sites in France

In 2010 France enacted a law to regulate supply and consumption of online gambling. Its primary aim was to protect citizens from gambling-related harm. This study aims to assess differences in gambling patterns and related harm between online gamblers who use licensed versus unlicensed sites. Participants (N = 3860) completed a self-administered online survey on gambling practices. Pairwise logistic regressions examined the association between the legal statuses of gambling sites people patronized and demographic variables and gambling types. Multivariate logistic regression models explored associations between gambling patterns and related problems according to the legal status of sites people have gambled on. Overall, 53.7 % of online gamblers report gambling exclusively on licensed sites. Those who bet on regulated activities on unlicensed sites, versus licensed sites, are more likely to be female, younger, less educated, inactive in the labor market and are more likely to perceive their financial situation to be difficult. Gambling on unlicensed sites is associated with more intense gambling patterns and more gambling-related problems compared to licensed sites. Findings demonstrate that gambling activities carried out on state licensed sites are associated with less overall harm to gamblers. Implications of these findings on future policy are discussed and prospective research directions are outlined.     

The Mixed-Population Issue in State-Subsidized Elderly Housing: Management Problems Posed by Nonelderly and Elderly Tenants

Abstract

The management experiences of all Local Housing Authorities (LHAs) in Connecticut were investigated concerning younger disabled tenants in state-subsidized elderly housing. While as a group younger disabled tenants were more likely to violate the terms of their lease, including disrupting other tenants' enjoyment of their homes, management problems with younger disabled tenants were not reported by all LHAs. In general, serious, recurrent problems involving younger disabled tenants were concentrated among a relatively small group of LHAs. Emphasizing the diversity that characterizes the experiences of LHAs, the discussion emphasizes the need for caution in drawing conclusions about the issue of a mixed population. It also focuses on examples of how some LHAs have addressed the integration of younger disabled tenants in senior housing and proposes recommendations for viewing the issue in the broader context of public policy.