Schools as workplaces: Intersectional regimes of inequality

Joan Acker extended her 1990 brilliant and path‐breaking article, ‘Hierarchies, Jobs, Bodies', to address the intersectional effects of gender, race and class as ‘inequality regimes' in her 2006 article of that name. This research picks up her challenge to see embodied workers holding jobs in organizations structured simultaneously and interactively by gender, race and class processes. Rather than studying a corporate regime in which the actors are managers, supervisors and workers, this study looks at the organizational interactions among teachers and paraprofessionals in one large, urban and unionized school district in the United States. We look at skill, care and respect as three dimensions of interaction embedded in the occupational demands and specific job requirements of teachers and paraprofessionals, and some of the tensions this regime produces between the largely White teachers and the women of colour who are the paraprofessionals. By highlighting the largely invisible racialized work of supporting the moral worth of students and staff, we extend the understanding of skill and care beyond a binary model.     

Treatment of late-life mental disorders in primary care: we can do a better job

Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.     

Working together as culture brokers by building trusting alliances with bilingual and bicultural newcomer paraprofessionals

The authors' reflect on the challenges and rewards of partnering as casework supervisors with bilingual and bicultural newcomer paraprofessionals in resettlement work with refugee youth. Such individuals are generally recruited for their linguistic abilities and cultural knowledge, but they can lack formal clinical training or licensing credentials. Drawing on their own experience as supervisors of bilingual and bicultural newcomer paraprofessionals from Cambodia, Laos, and Vietnam, the authors compare their early attempts to establish trust and communication with insights gained in more recent supervisory experiences. Recommendations are offered that promote mutual understanding between newcomer paraprofessionals and their Western-trained supervisors.     

The association between aging inmate housing management models and non-geriatric health services in state correctional institutions

One of the current debates in the literature on aging inmates asks, what is the most efficient housing/health care model for this "special needs" population? State and federal correctional systems place elderly inmates either in specialized segregated housing units away from the general inmate population, consolidate elderly inmates in housing units within the prison, or provide a combination of both models. In general, proponents of the segregated housing model argue that aging inmates will receive specialized medical services in geriatric units. However, proponents of consolidated housing model argue that aging inmates will have the benefit of both geriatric and non-geriatric health services. This paper examines the association between the type of housing management model for aging inmates and the availability of non-geriatric physical and mental health services. Data for the analysis come from the 2000 Bureau of Justice Statistics Census of State and Federal Adult Correctional Facilities. The results suggest that institutions offering consolidated geriatric care provide more mental health services and that these effects are independent of the characteristics of prison facility.     

The politics of aging: the geriatric imperative of the Department of Veterans Affairs

Committed "to care for him who shall have borne the battle and for his widow and his orphans," the federal government through its veterans' programs has long been a pacesetter in meeting some of the income-security and health-care needs of older Americans. But the Department of Veterans Affairs is short of funds. Key policymakers are genuinely divided over how much more they want to invest in the care of aging veterans. This paper assesses four options and concludes that it makes sense to strengthen DVA's internal capacity to meet its geriatric imperative.     

Paraprofessionals in Refugee Resettlement

The increased demands of refugee resettlement have directed attention to the role and function of indigenous paraprofessionals, who share a common background experience with the client population. With training and supervision, such paraprofessionals can bridge cultural and linguistic barriers, and serve as role models. This article examines this topic from the experience of the recent Soviet Jewish refugee resettlement program in Boston.     

The Politics of Aging

Committed "to care for him who shall have borne the battle and for his widow and his orphans," the federal government through its veterans' programs has long been a pacesetter in meeting some of the income-security and health-care needs of older Americans. But the Department of Veterans Affairs is short of funds. Key policymakers are genuinely divided over how much more they want to invest in the care of aging veterans. This paper assesses four options and concludes that it makes sense to strengthen DVA's internal capacity to meet its geriatric imperative.     

The development of anti-cancer programs in Canada for the geriatric population: an integrated nursing and medical approach

Cancer control in Canada refers to the development of comprehensive programs utilising modern techniques, tools and approaches that actively prevent, cure or manage cancer. The scope of such programs is quite vast. They range from prevention, early detection and screening, comprehensive treatment both curative and palliative to comprehensive palliative care. Cancer is a disease associated with the aging population, and as the population ages the incidence of cancer would be expected to rise as well. This in itself poses a great challenge. In addition, the aging population demographics with the projected rise in the numbers of senior citizens, especially the over 80 group in the next decade, poses its own creative challenges to health planners. In Canada, health care is centrally administered, and controlled by the provincial governments of Canada, under the Canada Health Act. The challenge of developing comprehensive programs for the geriatric population requires changes in the care models and care pathways. The patient-centred models that have been adapted require a multidisciplinary approach to the clientele and their families that integrates cancer therapy and geriatric care and realities. This requires changes in the nursing and medical approach, as well as education in the subtleties of the two intersecting medical realities.     

An examination of methods in the evaluation of volunteer programs.

Although many volunteer programs have been called "successful" and the use of paraprofessionals urged, few program evaluations with a benefit-cost analysis have been reported. Several major studies of volunteer utilization are reviewed, and particular needs with reference to program evaluation are discussed. Three alternative evaluation methodologies are proposed. The importance of utilizing a comprehensive evaluation incorporating all three methodologies is discussed. An ongoing volunteer program in a community mental health center is used as an illustration.     

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels,evaluated with and without geriatric assessment

Background

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests.

Methods

Prospective, observational cohort study, including 961community dwelling patients aged?≥?70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months).

Results

Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50–79 and <50, and, in the model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI?<?50, receiving home care before admission, higher age, admission with a non-vertebral fracture, and in the geriatric assessment model, cognitive impairment.

Conclusions

Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

     

Delivery of dental care to persons with disabilities and other special populations

Although humankind has long suffered from dental ills, and despite progressive efforts by the field of dentistry to provide dental healthcare in a compassionate and anxiety-free manner, the profession of dentistry has suffered a tarnished reputation. Going to the dentist is considered painful and induces fear among most people; however, this mindset is changing. Dentists of today are beginning to take their rightful place as integral members of the health care team, including disability management initiatives. The public and other health care providers are beginning to recognize the importance of oral health to the overall health of the body. Dental care is a vital component to rehabilitation planning. Unfortunately, some government agencies, insurance companies, and other policy making bodies have failed to grasp the importance of this concept. Also, professionals within the field of dentistry have not fully grasped the important of continued dental care for persons with disabilities, geriatric patients, the deinstitutionalized, and others in need of rehabilitation services. Problems associated with the delivery of dental care to patients with disabilities are discussed.     

Evidence-Based Practice: A Common Definition Matters

The Geriatric Social Work Practicum Partnership Program was funded to attract graduate students to the field of aging and to strengthen field education in geriatric social work. Rotation was selected to achieve the program's goals to provide students with exposure to the spectrum of care in geriatric social work services. This paper describes the program's experience with rotation, which is the planned and systematic movement of students between two or more field practicum sites and supervision from more than one field instructor. Implementing rotation required the establishment of a university–community partnership. Students' positive reaction to rotation indicates that it warrants further implementation and evaluation     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

The Laboratory Evaluation and Enrichment of Couples: Applications and Some Preliminary Results

Data relating to the effects of structured versus unstructured interventions with three couples are presented and compared. Arguments are presented for the standard use of: 1) routine, pre- post-intervention assessment, 2) laboratory procedures in the assessment and treatment of couples, and 3) paraprofessionals in intervention with couples. This report is part of a systematic program of research into the appropriate use of structured and unstructured intervention and into the optimal matching of client family and intervention approach.     

Training Issues in Family Therapy*

Group versus individual supervision, the family therapy training model, videotape as a training method, and training paraprofessionals in a traditional academic setting are discussed from the authors' experience in conducting a family therapy training program. Editor.     

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns.MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained.ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation.ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.     

Geropsychiatric education programs. Providing skills and understanding

1. The treatment of mental health problems is a growing concern in long-term care facilities; up to 80% of nursing home residents suffer from some type of mental illness, but most receive no active treatment. 2. Nursing home staff do not receive sufficient training on mental health issues, the aging process, and assessment and management of psychiatric symptoms in the elderly. 3. Psychiatric nurses can provide a number of quality geriatric mental health programs to increase staff knowledge and promote quality of care.     

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.