‘Recovery work’ and ‘magic’ among long‐term mental health service‐users

Based on an extended period of qualitative research with mental health service‐users in north‐east England, this article considers the various forms of ‘magical work’ and ‘recovery work’ that emerge in the lives of people living with severe mental health problems. Given the now sizeable body of literature which seeks to problematize traditional conceptual boundaries of work, the article asks to what extent these hidden and unusual work‐forms might also be considered legitimate members of the category. Rather than argue for the expansion of the construct to accommodate these activities, the paper attempts simply to problematize the extent to which so‐called ‘mad’ forms of work are irresolvably different to more conventional forms of occupation. In challenging notions of the psychiatric patient as inevitably inactive, new vocabularies for service‐user work are explored. Concluding remarks are also directed to recent policy debates concerning ‘back‐to‐work’ welfare reform for long‐term out of work service‐users.     

Reimagining social work case studies: a social work—creative writing collaboration

This paper describes a joint social work and creative writing project which analysed case studies from textbooks on reading lists for the Bachelor of Social Work course at Edith Cowan University. The textbook case studies were analysed from the perspectives of both social work and literary craft and it was found that they presented simplified scenarios which were limited in terms of diversity and rarely portrayed depth or complexity. The case studies were also often bereft of information about social workers’ or service users’ human qualities and frequently portrayed service users in terms of the problems they presented to the social worker. The authors argue that depicting social workers and service users in this way can create the impression that social work is a distanced procedural activity and can also serve to distance service users’ lives and experiences from social work students. Drawing on research in creative writing craft, as well as analysis of the textbook case studies, principles for writing engaging text-book case studies were developed and the paper concludes by arguing for the use of these principles when crafting social work case studies.     

State discretion and medicaid program variation in long-term care: when is enough, enough?

Although federal statutes and regulations establish the broad parameters within which state Medicaid programs operate, the federal government grants states substantial discretion over Medicaid and Medicaid-funded long-term care. An appreciation of resulting cross-state variation in Medicaid program characteristics, however, has been lacking in the ongoing debate over whether the federal government should further devolve responsibility for caring for the poor and disabled elderly to the states. To better inform this discussion, therefore, this article documents considerable variation, not only in terms of Medicaid program spending and recipients, but also in terms of strategies chosen to reform long-term care services and financing. Since there is little doubt that states take full advantage of current levels of discretion, advocates of devolution may want to reassess their views to consider whether existing variation has resulted in inequities addressable only through more, not less, federal involvement.     

An Examination of the Woodwork Effect Using National Medicaid Long-Term Services and Supports Data

A common concern in long-term services and supports (LTSS) policy is the “woodwork effect,” which has two components: (1) more people will use publicly funded services if access to home- and community-based services (HCBS) is expanded; and (2) the additional beneficiaries will increase the growth rate of LTSS expenditures. Medicaid LTSS beneficiary and utilization data starting in 1999 indicate modest growth in beneficiaries and expenditures, after adjusting for inflation and the number of people with functional impairments. The data do not provide strong evidence that the shift in Medicaid funding toward HCBS significantly increased or decreased overall Medicaid LTSS spending.     

State Discretion and Medicaid Program Variation in Long-Term Care

Summary

Although federal statutes and regulations establish the broad parameters within which state Medicaid programs operate, the federal government grants states substantial discretion over Medicaid and Medicaid-funded long-term care. An appreciation of resulting cross-state variation in Medicaid program characteristics, however, has been lacking in the ongoing debate over whether the federal government should further devolve responsibility for caring for the poor and disabled elderly to the states. To better inform this discussion, therefore, this article documents considerable variation, not only in terms of Medicaid program spending and recipients, but also in terms of strategies chosen to reform long-term care services and financing. Since there is little doubt that states take full advantage of current levels of discretion, advocates of devolution may want to reassess their views to consider whether existing variation has resulted in inequities addressable only through more, not less, federal involvement.     

Hospital social work in Sweden and the UK: Access to chances of physical health and well-being

In Swedish and UK practice, interest is developing in social work's contribution to tackling service users' unequal chances and experience of physical health. This is through alleviating disadvantaged social conditions such as relative poverty which service users face and which are associated with health inequalities. Ready access to social work services is an essential preliminary if service users are to gain the material and social resources services can provide, to alleviate their adverse social circumstances and thereby improve their health prospects. However, despite hospital social work's well-established position, its significance as an access point for services has tended to be marginalized. Drawing on a comparative account of Swedish and UK practice featuring two action research projects, we explore how hospital social work is a key point of access to services for service users experiencing profound disadvantage. We analyse major barriers to such access, notably the underfunded nature of hospital social work, discriminatory procedures, and unequal professional service user power relations. Nevertheless, the action research projects show how these barriers may be breached to some degree, enabling service users as patients and carers to access resources which contribute to more equal chances of health and well-being in ill-health.     

Medicaid nursing facility reimbursement in flux: effects of federal regulatory changes and prevailing fiscal conditions, 1978-1998

Basic concepts and trends are examined in Medicaid nursing facility reimbursements between 1978 and 1998, because Medicaid payment reform is a common budget reduction strategy pursued by state officials. Non-incremental changes in state rate-setting methods, as well as incremental changes in per diem rates and expenditures per recipient, are analyzed. In addition to substantial cross-state variation, results reveal clear trends in reimbursement policy characteristics over time. Not only do these track closely with changes in the federal regulatory environment, but they also track closely with prevailing fiscal and economic conditions. Given the serious ramifications reimbursement policy changes can have for nursing home residents and providers, it is imperative that the impact of federal disengagement from this policy area be understood.     

Technology,social services and organizational innovation or how great expectations in London and Cardiff are dashed in Lowestoft and Cymtyrch

The purpose of this paper is to illuminate important aspects of the policy implementation process in UK welfare organizations. We draw on two evaluations in which we were each involved — those of the Integrated Children's System and the Children's Fund. Our interpretive frameworks share a concern to foreground the significance of the local, informal, and ground level, but do so in ways that acknowledge the encompassing governmental and policy contexts. We illustrate and assess the significance of multiple policy aspirations, the significance of local implementation contexts, the diverse ways in which practitioners gain and subsequently develop knowledge of how policy works, and how such knowledge moves about in organizations. We indicate the kinds of expertise that social service workers bring to and achieve as actors within policy innovations, and how they may manage and in some cases seek to control knowledge shifts between providers and users of services. We infer the inadequacy of conventional top-down models of implementing policy innovations.     

Service user involvement in social work education: experiences from Germany and implications for a European perspective

ABSTRACT

Service user involvement (SUI) in social work education has gained widespread attention in Europe and other continents. Nevertheless, experiences on including service users in social work education have not been reported from Germany or other German-speaking countries to date. This paper reports preliminary experiences with implementing SUI in a bachelor’s programme of social work in a German University of Applied Sciences. The main goals of the current paper are (1) to provide a background for implementing service user approaches in Germany by introducing the structure of social work education in Germany; (2) to report experiences from a weekend seminar where service users worked together with students of social work in the framework of a curriculum of a German University of Applied Sciences and (3) to formulate some implications of these experiences for SUI across Europe. The main results were that introducing service user involvement into a German curriculum of social work is possible but needs careful reflection and planning. Experiences gathered in the weekend seminar with service users were encouraging for service users, students and teachers. We conclude that systematically implementing SUI into German curricula of social work is important.     

Outcomes focused user involvement in social work education: applying knowledge to practice

Abstract

This paper discusses an innovative approach connecting service user and carer involvement (SUCI) in social work education to social work practice. The research team, comprised service users, carers, social work students and module leader, worked collaboratively democratising the research process. At the University of Dundee, a core social work module facilitates students to spend 15 h with a service user and/or carer (host) gaining a unique insight into their everyday lives. During this time, hosts and students discuss two policy practice questions, responses to these questions are generating annual qualitative data, with study findings being disseminated at local and national level. The experiential learning students acquire from spending time with their host becomes the site of knowledge creation through involvement that is applied to practice. This paper reports on the narratives emerging from the longitudinal data (2012–2015, n = 90) on the changing landscape of social care in Scotland and the dissemination of project findings. We explore the intersection where the voices of service users and carers, student learning and social work practice coalesce. A model of outcomes focused SUCI is introduced as a template for meaningful, sustainable and outcomes-focused SUCI in social work education.     

Assessment as the Site of Power: A Bourdieusian Interrogation of Service User and Carer Involvement in the Assessments of Social Work Students

The centrality of service user and carer involvement in social work education in England is now well established, both in policy and practice. However, research evidence suggests their involvement in student assessments is underdeveloped and under researched. This study focused on the positioning of service users and carers in relation to other stakeholders involved in the assessments of social work students in England. Using narrative research methodology, 21 participants, including service users, carers, social work students, social work employers and social work educators, were offered a semi-structured individual interview. Participants’ narratives revealed different power relations among those involved in social work students’ assessments and a lack of confidence among service users and carers in making failed assessment recommendations. The paper concludes by arguing the case for social work educators and service user organisations to provide joint training to support service users and carers in their role as assessors of social work students.     

Service-user participation in developing social services: applying the experiment-driven approach

ABSTRACT

Participatory approaches are needed in Finland for service users to participate in designing and developing social services. New collaborative methods are the focus of this research, as this pilot case-study analyses the experiment-driven design approach and its consequences on service users’ agency and participation. This practitioner research belongs to the pragmatist research tradition. The data comprises transcribed focus group and individual interviews of service users and social workers in group operations in a Finnish municipal adult social service organisation. The data are evaluated by content analysis. The experiments with service prototypes allowed the service users to observe the consequences of their actions in practice. Instead of only being heard and consulted, the service users found they could influence the practice in concrete ways. The professionals and organisation shaped the service users’ participation and agency by operating as gatekeepers in sharing power. The service users reported that collaboration with professionals and participation in the group gave them a sense of renewed citizenship, improved social skills and helped to manage with personal illnesses or daily struggles. The research concludes that experimentation can provide a way to utilise experiential knowledge in developing social work collaboratively.     

Clarifying the role of belief-motive explanations in multi-stakeholder realist evaluation

In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders’ belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders’ belief-motive explanations (‘we believe the program works’) in realist evaluation is clarified and discussed.     

Controlling the supply of long-term care providers in thirteen states

Many states have responded to growing Medicaid long-term care expenditures by limiting the number of long-term care providers through certificate-of-need (CON) programs and moratoriums on new construction or certification for participation in the Medicaid program. This article focuses on the use of these policies in 13 states. Most of the 13 states control the supply of nursing home beds and hospital conversions with CONs or moratoriums, but they are struggling to adapt the role of supply policy to the growth of home health and residential care. As an increasing proportion of Medicaid long-term care spending goes to these nursing home alternatives, supply policy needs to keep pace with the changing provider market and the changing demographics of the consumer market if it hopes to ensure access to long-term care and control Medicaid expenditures.     

Service user or service provider? How social work and human services students integrate dual identities

Students studying undergraduate social work and human services (SWHS) degrees may have used health and human service agencies, before and during their university education. Using services provides them with insights that are useful for professional practice. However, this article identifies that they experience a fear of shame and stigma revealing this during their studies. In examining interview data from 15 undergraduate SWHS students they recounted how they integrated their experience of being a service user into their professional development. It is argued that insider knowledge of services can provide them with valuable insights for practice. Students spoke about how positive experiences motivated them to study and provided models of effective practice, exemplifying its potential power to assist those in need. Negative experiences of service use can also be beneficial for learning what ‘not to do’. Although students found the experience of service use invaluable, they felt it was never acknowledged within the curriculum. Consequently, students interviewed in this study identified service users as ‘others’. They feared disclosing their own use of services due to perceived shame and stigma. Failing to provide opportunity for students to integrate their service user experience into their professional development creates a false dichotomy which does not acknowledge the intersection of these dual identities.     

‘It's People's Whole Lives’: Gender,Class and the Emotion Work of User Involvement in Mental Health Services

The concept of emotion work has been widely applied to the study of service work. Yet its use in understanding the social dynamics of user involvement in public services remains under explored. Drawing on a study of user involvement in mental health service development, I show its utility for understanding this social and political realm. The article discusses findings from a critical discursive and contextual emotional labour perspective, taking into account organizational and institutional factors as well as social structural dimensions of gender and social class. It shows how discourses on emotion, constructed through articulation of personal experiences of service usage both reflected and constructed the ideological and structural positionings of women service users, while emotional discourse — displays of anger in user involvement forums — worked to constitute traditionally male and ideologically masculine elements of the field, as well as the working‐class identities of some participants. These forms of emotion work, and the ways in which they elicited further emotion management from service users and workers alike, are located in relation to the rules of engagement of user involvement and the bureaucratic institutional forms within which this took place. The article concludes that the emotion work of user involvement ultimately helped to reproduce the dominant institutional and social order, including its gender and class dimensions. Implications for policies and practices of user involvement in mental health services are provided.     

Service user research in social work and disability studies in the United Kingdom

In recent years, there has been growing interest in the involvement of service users in research as well as in research studies that are led by service users. Although this interest in service users’ roles in research has been evident in both social work and disability studies, the two research disciplines have remained remarkably separate in the United Kingdom. This paper examines the epistemological underpinnings of social work research and disability studies research and explores the tensions, possibilities and power dynamics of collaboration between the two research disciplines in the United Kingdom. It concludes by outlining possibilities for social model approaches to social work research.     

Using primary and secondary stakeholders to define facility-to-community transition needs for adjudicated youth with disabilities

Stakeholder participation, specifically the primary beneficiary, enhances evaluation results by increasing the overall validity of the evaluative measure. This article provides an example of how the addition of adjudicated youth, the primary beneficiary, as a stakeholder group in a needs assessment provided additional information important for program development of a multi-agency transition program. The needs assessment consisted of five regional community forums comprised of youth correctional facility and community-based service providers (n=127), as secondary stakeholders. A nominal group process was completed defining both supports and barriers to the development of the service delivery model. Additionally, qualitative in-depth interviews were conducted on adjudicated youth (n=33) to describe their perception of the barriers and supports necessary for a successful transition from either a youth correctional facility or off of probation. Both groups identified and ranked the top 12 supports and barriers. Common themes emerged from both groups with substantive differences providing information that helped shape the program service delivery model to accommodate needs of both the adjudicated youth and secondary stakeholder participants. Implications for the development of the service delivery model are described.     

Mending the gaps in social work education and research: two examples from a Swedish context

ABSTRACT

The gap-mending concept is an analytical tool that helps teachers and researchers in social work to reflect upon what, in their practice, increases, maintains or mends gaps between professionals and service user groups. The article suggests a theoretical background on how gaps in social work practice can be challenged. This includes theories about power and recognition. It then moves on to describe the development of gap-mending strategies in research and education at the School of Social Work at Lund University. Lund University was one of three partners that took the initiative to the international network PowerUs that has focused on gap-mending strategies in social work education. The authors have been working over 10 years in collaboration with service user participation in the education of social workers and in different research projects. In the article, they give examples of gap-mending practices and of challenges that they have faced. The first example is an experimental course that has been given since 2005 where social work students study together with students from service user organizations in a university course. The second example is an attempt to combat homelessness in several Swedish municipalities. Supported by researchers, the development project has been a collaboration between homeless groups, politicians and social workers.     

NJ governor approves medical cannabis for OUD

Last week, Gov. Phil Murphy announced that New Jersey would remove prior authorization for Medicaid for medication‐assisted treatment (MAT) and would approve opioid use disorder as an eligible indication for medical marijuana. The moves, among several announced Jan. 23 in the state's efforts to combat the opioid epidemic, would increase access to treatment. Last year, more than 3,000 individuals in the state died from overdoses. “The opioid epidemic continues to devastate families and communities across our state,” said Gov. Murphy. “As we combat this crisis, it is critical that we use data‐driven, evidence‐based strategies to support individuals suffering from addiction and help them get on the path to recovery.”