Social Work Practices for Young People with Complex Needs: An Integrative Review

The aim of this integrative review is to investigate research of social work practices for adolescents and young adults with complex needs. The research questions are: What are the major themes in studies of practices for young people with complex needs? How do studies suggest that complex needs can be met in ways that are beneficial for young people? A young person with complex needs is in this review defined as an adolescent or young adult who, due to mental ill-health in combination with different types of social vulnerabilities, is receiving assistance from multiple welfare services. Searches were conducted in seven databases. These searches resulted in a sample of 1677 records, published 2007–2016, which in the screening process were reduced to 24 publications, all peer-reviewed articles. The participants in the studies in the articles consisted of young people, parents and professionals from mainly Anglo-Saxon countries. The articles were analyzed with qualitative summative content analysis. Three empirically generated themes were found in studies of work practices targeting young people with complex needs: collaboration-, relationship- and empowerment-oriented practices. In conclusion, the practices contain a wide variety of features, but with the joint aim of acknowledging young people’s needs. The results can be used by practitioners and policymakers to further the development of services for youth with mental ill-health and social vulnerabilities, who use multiple welfare services.     

Transgender youth homelessness: Understanding programmatic barriers through the lens of cisgenderism

Service access and acquisition are often complex and sometimes dangerous for transgender and gender expansive young people, who frequently experience stigma and discrimination and face systemic barriers including sex segregated programs and institutional practices that deny their own understanding and articulation of their gender. A common theme in the literature is recognition of the need for affirming services specifically designed to meet the needs of transgender young people experiencing homelessness, as this population may not utilize or have access to much needed services due to systemic barriers and fear of rejection and harassment. The current study investigates the lived experiences of transgender and gender expansive young people with histories of homelessness. This phenomenological qualitative investigation explores aspects of transgender and gender expansive youth's experiences, both at home and on the street. A recurring theme emerged in the participants' narratives — the seemingly insurmountable barriers constructed by systems that were not designed with their unique needs in mind. When understood through the lens of cisgenderism, the findings illuminate the structural barriers that exist for transgender and gender expansive young people and the systemic challenges service providers must address.     

Evidence-based practice in real-world services for young people with complex needs: New opportunities suggested by recent implementation science

There is growing agreement that child and youth services have been slow to implement evidence-based practice (EBP). A variety of interrelated barriers and facilitators of EBP implementation have been recognized and investigated. Key categories include the attitudes of providers, the characteristics of client populations, the characteristics of usual practice, organizational factors, and resource availability. Implementation scientists are investigating these factors, seeking to bridge the gap between clinical science and practice. Much of this work has been conducted in the context of behavioral health services for children and young people. This paper provides a purposeful review of this research from the perspective of decision-makers in agencies serving young people with multiple and complex psychosocial needs. It is argued that major barriers to EBP may be mitigated if ways can be found to transcend the oppositional construction that has characterized the discourses of EBP versus practice wisdom. A conceptual approach to such integration is offered. New lines of implementation research are offering opportunities for practical action by decision-makers consistent with this integrative approach.     

Developing Family-Centered Models of Genetic Services

Abstract

This article reports the findings of an exploratory, multi-method study conducted for a state health authority to examine stakeholder perceptions of existing genetic services and service ideals using survey and focus group methodologies. A web-based survey of medical providers and allied health professionals (N = 567) examined the knowledge needed by service providers to deliver competent genetic care. A second web-based survey of programs (N = 15) viewed as potential partners in the delivery of genetic services was conducted to explore the potential for interagency coordination, the family-centered nature of these services, existing training, and general agency ideals and values. Focus groups were also conducted with 4 groups of families and 3 groups of service providers to explore their perceptions of current and ideal services. The strategies yielded important information around service needs, resource issues, barriers to service, psychological issues, and education and information needs related to the delivery of genetic services. Implications for professional education, especially social work education, are also covered.     

Confronting Cruelty

Abstract

The present article reports on a study of the attitudes and behaviour of young people towards help-seeking during times of emotional distress and, in particular, when contemplating suicide. Twent- one young people aged between 16 and 24 years, as well as six parents and 14 youth service providers who lived in ‘Subcity’, a metropolitan community, were interviewed about their understandings of youth suicide and effective interventions. Nearly all the young people, service providers and parents identified a range of barriers that impede or prevent young people from asking for help when they need it most, including issues related to trust and confidentiality, parental support and fear, stigma and perceived loss of esteem. Implications for social work practice include an emphasis on developing parenting skills and community development related to education about suicide and the provision of appropriate support services.     

Adolescents’ experiences of therapeutic relationships at high and low levels of risk and resilience

Abstract

Engaging adolescents in treatment requires professionals to negotiate relationship boundaries in ways that young people experience as therapeutic. For this study, we used qualitative data from a mixed methods investigation of 85 young people ages 12-19 who were either clients of two or more human services (n=61) or selected from a convenience sample of young people attending school in the same communities as the service users (n=24). By sorting participants into four groups based on their risk and resilience scores calculated during the quantitative phase of the research, patterns emerged in the quality of the relationships young people reported as the most therapeutic. Findings show that youth at higher levels of risk exposure preferred looser professional boundaries (a real relationship) in their interactions with their workers while those with higher resilience scores described positive relationships with professionals that included more structure, greater expectations and firmer boundaries. Findings suggest that the quality of adolescent client-professional relationships should vary depending on the risk and resilience profiles of the youth.     

Mitigating Harm: Considering Harm Reduction Principles in Work with Sexually Exploited Young People

A growing awareness of child sexual exploitation (CSE) in the United Kingdom and throughout the world has prompted human service and legal/policy professionals to seek ways of engaging young people experiencing sexual exploitation, although much remains unknown regarding effective practice, and whether or not current knowledge regarding best practices with young people can be expanded to address CSE. This paper considers how principles of harm reduction, a public health approach widely used to engage adults and young people in help‐seeking behaviours, can be considered as part of a children's rights‐centred approach to policy and practice with young people experiencing CSE.     

You’re Deaf? Breaking through Myths for Effective Therapeutic Practice

ABSTRACT

Most mental health practitioners provide services to hearing clients and might be unprepared when a deaf individual requests services. The purpose of this article is to explore commonly held stereotypes and myths about deaf people and to provide guidance to clinicians who encounter deaf clients in their practices. Myths and stereotypes can affect the way clinicians perceive their clients’ needs. This can lead to miscommunication, misunderstanding, and misinformation, which can harm the therapeutic relationship, thus making effective therapy unattainable. Clinicians should reframe these beliefs and overcome barriers to make way for the therapeutic process to begin.     

Homelessness in Ottawa County Michigan: The “Gap” Population

Abstract

Homelessness has gained increasing attention since the 1980s in the United States. And the numbers of individuals and families experiencing homelessness are growing, with a 20,000 person, or 3% increase, from 2008 through 2009 (“State of Homelessness,” 2011). In spite of persistent investigation and activism on how to prevent and end homelessness, there is not agreement on what causes homelessness or how to stop it (McNamara, 2009). What is apparent, however, is that the homeless population is not homogenous. Therefore, the standard models of service, whether from governmental or non-governmental organizations (NGOs), end up neglecting the needs of portions of the population of people who face homelessness. Governmental and non-governmental service providers have recognized the existence of the unique sub-populations of people who are homeless and are attempting to understand and meet the needs of people outside the prevailing understanding of homelessness. This project works with a collaborative of such service providers through a multiple methodological approach to generate better understanding on the two key areas necessary to create models of service for people who are in the “gap” subsector of the homeless population. First, investigation was undertake to learn systematically who is included in the “gap” population among the homeless community, or, in other words, what traits those who continue to cycle in and out of homelessness, and thus are part of this “gap” population, share. Secondly, the project explores what organizations are currently serving these people, and how are they doing so. In other words, this project also ask what are the trends or practices that exist nationally and locally for serving people who fall into this category of homelessness? Findings suggest central traits including mental illness, substance abuse and a history of incarceration as factors spanning members of the “gap” population. Though there are caveats and practices to be avoided, these people are surviving or even thriving through the service primarily of faith-based non-governmental organizations, unfettered by the policy and funding constraints of governmental entities.     

Online Peer Support Programs for Young People with a Parent Who has a Mental Illness: Service Providers’ Perspectives

Young people with a parent or parents who have mental illness are at a higher-than-average risk of experiencing emotional and behavioural difficulties. Notwithstanding the difficulties experienced by these young people, opportunities to interact with and obtain support from peers living in similar families can be beneficial. While young people face several barriers to participating in face-to-face peer support programs, online approaches potentially provide a different way of obtaining peer support. This paper aims to explore service providers’ perspectives on current Victorian peer support programs, as well as the strengths and weaknesses of online approaches to peer support. Semistructured interviews were conducted with 17 mental health professionals who work with families affected by parental mental illness. Participants recognised that many young people miss out on face-to-face peer support programs, and were highly supportive of the idea of online programs. This study suggests that online peer support programs for young people could occupy an important position in the evolving suite of services for Australian families affected by mental illness.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

Youth outside the labour force — Perceived barriers by service providers and service users: A mixed method approach

BackgroundYoung people who are neither in employment nor in education or training (NEET) have received increasing attention in Western countries. While some young people in the labour force are unemployed because of a shortage of jobs, others would be without employment even in periods of economic growth, when more jobs are available. The latter group is referred to as neither in the labour force nor in education or training (NLFET), and such people need intervention to improve their chances of work participation. However, this group is poorly understood, and more knowledge is needed to develop efficient measures. The purpose of the study is to investigate the NLFET population and to identify barriers to education or employment.MethodInterviews were conducted at all labour and welfare offices in a representative county in Norway, and an internet-based survey among 586 persons aged 18–29 years who met the NLFET criteria was conducted. Sixty case managers of young service users and 30 managers/assistant managers were interviewed at the 25 offices in the county.ResultsThe local labour and welfare offices prioritize young clients, and some have designated follow-up teams for young service users. Three main barriers to education or employment were identified through the interviews at the offices: client motivation, the sense of lack of achievement/defeat, and unrealistic expectations about working life. A survey of the young people revealed other barriers, such as health problems (60%), low education (55%), lack of work experience (41%), the feeling of being exhausted (38%), low self-esteem (36%), feeling depressed (35%), sleeping problems (35%), and very often a combination of these barriers.ConclusionsHealth problems, social and other problems are highly prevalent among the NLFET population. The majority of the population wanted to find a job or to complete their education. We conclude that mental health problems often camouflage social problems. Treatment of complex problems should not be left to mental health services. Given the nature of the barriers identified, follow-up by strong multi-professional teams, including social work and health professions, should be part of the measures allocated to the NLFET population.     

Social workers and intercultural mediators: challenges for collaboration and intercultural awareness

ABSTRACT

Social work in Europe is facing numerous challenges in terms of promoting the participation of migrants and their descendants in super-diverse societies. This study investigates collaboration between social workers and intercultural mediators based on international debate and fieldwork in Italy. Does social work require collaboration with other professions specialised in intercultural relations? What are the characteristics of intercultural professionals? What are the pros and cons of collaboration between social workers and intercultural mediators? This study shows that local social services need to work with intercultural mediators, allowing local social services to implement various strategies for tackling cultural and linguistic barriers with their clients and rely on professionals inside or outside their own. Furthermore, intercultural mediators tend to have weak and heterogeneous training backgrounds and working conditions. This article aims to contribute to the debate on the welfare reform process to support migrants and their descendants’ equal rights and participation in society, highlighting the need for collaboration between interculturally aware social workers and intercultural mediators to tackle institutional structural weaknesses in such professions as part of an organisational innovation process in social-welfare institutions.     

Constructing the sick child: the cultural politics of children's hospitals

Drawing on an ESRC funded study of children's experiences of hospital space this article explores the cultural politics of contemporary English childhood. Using the words and commentaries provided by both children and young people, the article argues that although, as patients, children and young people share the same hospital spaces, their experiences of them are quite different. Through mundane material and symbolic practices, a number of experiential continuities are created for the youngest children between life in hospital and life at home, continuities that work to downplay their identities as children who are sick. For young people, however, these practices are more problematic since the discourses of childhood that are recreated have little resonance with young people's own experiences and sense of self and identity. Thus this article provides evidence of the need for a more nuanced understanding of not only young people's needs in relation to hospital services, but also of the significance of understanding the ways in which particular constructions of ‘the child’ and ‘childhood’ are threaded through public discourses and come to be realized in institutional settings.     

Addressing the needs crossover youth: What key professionals are saying

Crossover youth have complex needs and can create difficulty for service providers who have to both provide effective services to the youth but also work with and navigate a system outside of their own. Professionals from the child welfare system and the juvenile justice system have recognized the need to work together to help crossover youth. A successful collaboration can be extremely beneficial to all those involved but certain barriers must be overcome. This study uses secondary qualitative analysis to examine the opinions of key professionals in both systems as they came together to create action plans to address issues facing crossover youth in their individual counties. Researchers identify common themes and discuss the importance of collaboration among systems and recognizing individual county's stages of change.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.     

Visibility,Immobility and Stigma: Young People's Use of Sexual Health Services in Rural Areas†

Teenage pregnancy has become a major policy issue, for which young people are often publicly held solely responsible. However, a combination of factors substantially increases the risks of conception faced by young people engaging in early sexual activity. This article reports the main findings of a study of teenage pregnancy in linked seaside and rural areas, focusing on the experiences and perceptions of young people living in rural localities. They identify the issues of immobility, visibility and attitudes of stigma as affecting their ability to access sexual health services. The young people highlighted issues for service and policy development and the behaviour of professionals, both within schools and from sexual health services. Education, social and health services and the voluntary sector have important roles to play in responding to their needs.     

What mental health professionals in Israel know and think about adolescent problem gambling

Mental health professionals are well versed in addressing multiple adolescent risky behaviours and play a primary role in the identification of and referral process and service provision for young people who engage in such behaviours. Given their ‘person-in-environment’ approach, training in multi-sectoral collaboration, and awareness of social policies, social workers are especially equipped to provide needed mental health services to young people. The aim of the current study was to examine Israeli mental health professionals’ awareness of and attitudes towards adolescent high-risk behaviours, including gambling. Child psychologists, social workers and school counsellors (N = 273) completed an online survey addressing concerns related to high-risk behaviours. Findings revealed that social workers perceived gambling as being among one of the least concerning adolescent mental health issues and reported feeling the least confident in their abilities to provide services to young people with gambling problems. The results suggest the importance of youth gambling addictions being incorporated into social work training curricula.     

Social Service Needs of Hispanic Immigrants

Abstract

Large numbers of poor Hispanic immigrants have come to the U.S. in recent years with many social service needs. This qualitative, pilot study of Hispanic immigrants in the Washington Heights community in New York City identifies their perceived needs and barriers for accessing services. Seven face-to-face interviews with community-based professionals and four focus group interviews with thirty Hispanic immigrants provide the data. Both groups of informants report many unmet service needs, especially in the areas of health care and housing. Data support the view that Hispanic immigrants often require micro-and macro-level advocacy that can best be performed by Spanish speaking social workers.     

Young people's views of children's rights and advocacy services: a case for ‘caring’ advocacy?

This paper looks at some preliminary findings from research with young people in foster and residential care in the UK who have received advocacy services from a range of local authority and voluntary agencies. The study also includes the views of professionals, from both children's rights and social services. The initial findings highlight the importance to young people of their relationship with rights professionals. They speak about the value to them of care and respect, aspects not always seen as fundamental to rights work. Caring, in its various guises is seen by young people as a vital component of their relationship with children's rights workers. They also see this as important within advocacy work itself since caring about the outcome is often key. A pure individual rights focus with an emphasis on challenge and ‘being heard’ may not take account of the complexity of their situation and may pose difficult dilemmas for young people, especially in dealings with their carers. This ‘caring’ advocacy is not the paternalistic approach of a professional who ‘knows what's best for you’ but is a model based on a strong awareness of ways that young people are excluded and oppressed. It is also about placing a positive value on their contribution as citizens and links to a view of society that gives importance to an ethic of inter‐relationship and care as well as an ethic of individual rights. Copyright © 2007 John Wiley & Sons, Ltd.