Patterns of Provision in Respite Care and the Children Act

Summary This article presents the findings of a three-year study intorespite care services to disabled children and discusses thesein the light of the 1989 Children Act. The aims and methodsof the research are first outlined and the various servicesincluded in the study are described. Access to services was found to be uneven, with families fromlow socio-economic groups and from black and ethnic minoritycommunities apparently having less choice. The characteristicsof users are identified: some of these varied according to typeof facility used or amount to care received. Agency records and registers were often found to be inaccurate:the Children Act will require authorities to maintain updatedregisters. New powers to charge for services may create furtherbarriers to access although requirements to take account ofchildren's racial and cultural background should extend it.The Act will help authorities regulate the amount of respitecare children receive and introduces certain safeguards. Itsemphasis on consulting young people is to be welcomed. Overall,the new legislation has the potential to improve many aspectsof respite care; its ability to do so will depend on havingadequate resources.     

Developing a Palliative Radiation Oncology Service Line: The Integration of Advance Care Planning in Subspecialty Oncologic Care

Within radiation oncology, there is often minimal attention on radiotherapy with palliative benefits due to the overlying focus on curative treatments. Historically at the University of Pennsylvania, advanced-stage patients are cared for by cancer site-specific teams rather than a more rapid treatment service model that focuses on patients’ symptom needs and larger clinical issues within a palliative framework. Thus, the University of Pennsylvania created a designated palliative radiation oncology team to focus on the complex medical and relational issues of metastatic cancer patients. Social workers play a critical role in patient and family conversations about advance directives, care needs, and end-of-life goals and fears as treatment regimens and outcomes continue to unfold. The palliative radiation oncology social worker developed and instituted a new, formalized assessment tool called the “palliative radiation oncology psychosocial care plan” in the electronic medical record. A retrospective analysis of 26 palliative radiation oncology patients under treatment between February and August 2016 was conducted. Of these patients treated with palliative radiation, 19% completed an advance directive after the social work intervention. This model highlights advance care planning as a best practice and encourages end-of-life discussions as a routine part of the oncology workflow.     

Service Utilization Patterns Among Adolescent Mothers Residing in Three-Generational Households

ABSTRACT

This qualitative study used in-depth interviews to better understand the social service experiences and identified needs of 26 demographically diverse adolescent mothers and their mothers, who resided together in three-generational households. Most dyads accessed community services, particularly parenting and emotional supports, financial and material assistance, and medical care, and desired short-term assistance related to their circumstances and newly expanded families, rather than long-term support. The most commonly identified barrier to service utilization involved income eligibility guidelines. In light of welfare reform policies and the current economic climate, this research underscores the need for transitional supports for families, including assistance with basic needs. In terms of implications for social work practice and future research, adolescent mothers may need formal supports as they pursue independence after they leave their mothers’ care. Future research could further explore, within other communities and longitudinally, whether these preliminary trends hold true.     

Developing Practice Tools for Social Workers in End-of-Life Care

Abstract

This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers.     

Research Note: Developing Outcome Measures in Child Care

Correpondence to Dr Harriet Ward. Research Associate, University of Bristol, Social Policy and Social Planning. The Alfred Marshall Building, 40 Berkeley Square, Bristol BS8 1HY. Summary The complexity of the concept of outcome has discouraged researchinto the impact of the care experience on the child. This Notesummarizes the conceptual thinking behind a comprehensive systemof assessment which is being piloted in four local authorities,and reports on the preliminary results.     

居家养老:城市养老模式的选择

家庭养老在中国既是一种悠久的传统 ,也是一个古老的制度。直到２０世纪９０年代 ,其依然是中国目前主要的养老形式。但是 ,我们不得不注意到 ,在社会经济现代化和现代人口结构转变的过程中 ,传统的家庭养老开始面临许多挑战 ,它无法解决全部的老年生活保障问题。因此 ,必须对家庭养老制度进行创新 ,推行居家养老。传统家庭养老面临挑战家庭养老在我国养老制度中占有重要地位。但是 ,必须清楚地看到 ,传统的家庭养老制度正在面临着越来越多的挑战。首先是家庭趋向小型化 ,家庭户的平均规模缩小 ,核心家庭增多。１９８２年和１９９０年两次人…     

Emerging Patterns of Care Management: Arrangements for Older People in England

One of the key objectives of the community care legislation, implemented in the UK in 1993, was the development of care management systems. Subsequent studies based on limited samples of local authorities have indicated that there is much variation in the forms and types of arrangements being developed. This paper explores whether typologies of care management arrangements for older people can be discerned through the analysis of a series of key indicators. Data were drawn from a survey of all English local authorities, undertaken as part of the PSSRU study: Mapping and Evaluation of Care Management Arrangements for Older People and Those with Mental Health Problems. Care management arrangements were categorized using a limited number of key indicators chosen on an empirical and an a priori basis. This resulted in the formulation of six categories of care management arrangements for older people, within which approximately 80 per cent of local authorities could be included.     

The Holodomor and the Building of a Nation

The author traces the evolution of the politics of history in Ukraine with regard to the famine of 1932-33. He examines the role played by this policy in domestic politics and foreign relations and, in particular, the campaign of President Yushchenko and his political allies to impose an interpretation of the famine as genocide against the Ukrainian people and the greatest tragedy of the twentieth century.     

Children's Living Conditions in Sweden. Social Patterns and Trends in Parental Accessibility, Child Care and Economic Resources

In this study, using data from the Swedish level of living surveys in 1981 and 1991 of more than 3,500 children, social patterns and trends in children's living conditions are analysed. The conditions focused on are linked to parental employment, namely, parental accessibility, use of child care and economic resources. The primary statistical method used is logistic regression analysis. The results show differences in children's access to mothers and fathers as parental access is restricted by various aspects of employment. There were also differences in childrenrsquo;s resources by social class and family structure. Of further importance was the combination of these, especially in the way that social class was more decisive for the children of single parents.     

Anger Expression and Persistence in Young Children

This study investigated anger expression during toy removal (TR) in 92 young Chinese children, two to five years of age, and its relations to their persistence in responding to obstacles during two challenging tasks with highly desirable goals [TR and locked box (LB)] and one challenging task with a less desirable goal [impossible perfect circles (IPC)]. Anger expression during TR was positively associated with persistence during TR and LB but not during IPC. The results highlighted the positive effects of anger in the development of persistence.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

“The Persistence of Parent Repayment” and the Anticipation of Filial Obligations of Care in Two Thai Provinces

With an accelerated and sustained decline in fertility and an increase in life expectancy, Thailand has entered its aging phase at a rapid pace. This raises an important question of who should care for the increasing elderly population. Using a survey of adults aged 16–64 years (n = 742) in two provinces in the north‐east (Kalasin) and south (Phang Nga) of Thailand, this paper explores the expectations that individuals have from their children when they become very old. Only one‐third of the respondents expected to live with their children in old age and only one‐fifth anticipated financial assistance. Less than half of them expected personal care and practical care from their children (43% and 38%, respectively). The expectations varied substantially by the number of children and income, with those with higher income reporting lower expectation. Those living in Kalasin, a much poorer province than Phang Nga, had greater expectations from their children in old age. This suggests that, for those with less financial resources, children remain the main care provider for the elderly.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

The Utilization and Training of Volunteers in a Psychiatric Setting

Summary The Volunteer Case Aide Program, which was begun in 1963 atthe Boston State Hospital, Boston, Mass. U.S.A., is ongoingand developing new facets of volunteer intervention in a psychiatricsetting. It is the first program of its kind in the Commonwealthof Massachusetts to utilize the talents of mature communityvolunteers to work in a direct personal, one-to-one relationshipwith the mentally ill and/or emotionally disturbed. The fouroriginal purposes of the program have been carried out. Thecommunity has been brought into closer co-operation with thehospital, and community resources have been utilized in helpingpatients move out of the hospital. Through the creative useof volunteers and part-time psychiatric social workers, theprogram has moved toward diminution of the manpower shortagein the mental health field. The efforts of hundreds of volunteercase aides have contributed to relieving the chronicity of manypatients, and have assisted them to move into community placements. The Associate Leader Training Program, through its weekly trainingmeetings, gives the Associate Leader the responsibility of supervisingnovice case aides. The trained Associate Leader, an experiencedvolunteer, teaches the beginning case aide to understand hisown role with the patient, to relate effectively with the patientand to learn about the hospital operations, treatment modalitiesand pertinent psychiatric and social theories. New volunteergroups under the Associate Leaders' guidance, have proven tobe effective instruments for the expanded teaching and serviceaspects of the Case Aide Program. Given the numerical limitationsof a professional social work staff and with the added resourcesof Associate Leaders, the Program has been able to help manymore patients