The Life Course: A Sociological Introduction

Abstract

Recognition of the deleterious effects of domestic violence on women's mental health has highlighted the potential benefits for women of collaboration between mental health and domestic violence services. Yet the different histories, knowledge bases, and organisational cultures of the mental health and domestic violence sectors present formidable challenges to the development of effective collaborative work. This article draws on a large research enquiry, involving four separate but related studies, which explored aspects of collaboration between these two service sectors. It focuses particularly on data collected in interviews with practitioners from mental health and domestic violence services who were participants in an action research study (one of the four studies), which was aimed at discovering the factors that contributed to enhanced collaboration and the benefits of this for women who experience both domestic violence and mental health issues.     

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.     

Collaboration for the Provision of Services

Abstract

This paper conducts a review of the extant literature to examine community collaboration in the provision of human services. The authors conducted a systematic research synthesis to organize literature around how community organizations should position themselves in order to maximize the benefits of collaborative relationships while enhancing service provision. Evaluation of the literature reveals 30% of the articles could be classified as empirical. Due to limitations of the studies no definitive statements could be made regarding the nature of collaboration and what works in the collaborative process; however, some generalizations are suggested. Gaps in the literature include lack of rigorous empirical studies that identify best practices, the type of training needed to prepare staff and members of organizations for participation in the collaborative process, and differing management models and practices to determine which forms of governance system achieve the best results.     

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.     

Developing an educational workshop on teen depression and suicide: a proactive community intervention

Eight years into the YES emergency services collaboration, a comprehensive Youth Emergency Services model has emerged, one that incorporates a proactive approach to clinical and prevention strategies. In addition to direct service provision, these strategies include: (1) workshop training of school and community professionals so that they can identify young persons at highest risk for suicidal thoughts, threats, and attempts; (2) prevention education for both adolescents and parents about suicide, risk factors, and interventions; (3) a partnership with the local hotline to facilitate community screening and referral to appropriate crisis services for families and youths; (4) collaboration with a large primary care provider network to streamline the after-hours crisis referral process, using the hotline; and (5) the use of a website to inform individuals about services and resources. It is proposed that this is a contemporary model that can meet the present primary and secondary intervention needs for children, adolescents, and their families.     

Why Are Some People's Needs Unmet?

Australia has legislation that states that 'people with disabilities have the same rights as other members of society to services', yet nearly one-third of all people with spinal injuries have their need for community services unmet. If all people have the same rights, why are some people's needs unmet? How equitable is the distribution of services? This study challenges service providers' beliefs that decisions about the provision and distribution of services are made objectively and equitably. To obtain needed services, people had to demonstrate their worthiness by conforming to providers' stereotype-based expectations of the disabled, based in entrenched philosophies. Service structures reinforce these disabling ideologies Service provision must thus undergo fundamental philosophical and structural change in order to meet community service needs.     

The role of interagency collaboration for substance-abusing families involved with child welfare

Meeting the needs of families involved with the child welfare system because of a substance abuse issue remains a challenge for child welfare practitioners. In order to improve services to these families, there has been an increasing focus on improving collaboration between child welfare, treatment providers, and the court systems. This paper presents the results from qualitative interviews with 104 representatives of these three systems that explore how the collaborative process works to benefit families, as well as the barriers and supports for building successful collaborations. Results indicate that collaboration has at least three major functions: building shared value systems, improving communication, and providing a "team" of support. Each of these leads to different kinds of benefits for families as well as providers and has different implications for building successful collaborative interventions. Despite these putative benefits, providers within each system, however, continue to struggle to build effective collaborations, and they face such issues as deeply ingrained mistrust and continued lack of understanding of other systems' values, goals, and perspectives. Challenges that remain for successful collaborations are discussed.     

Give your child and adolescent mental health service a health economics makeover

Specialist child and adolescent mental health services (CAMHS) must make decisions about what treatments to provide to whom, when, where and how, within limited budgets. This raises questions about how services make such decisions, to best meet the mental health needs of their catchment. The methods and practices of Health Economics, a field with considerable expertise in measuring performance in health systems, can help CAMHS make better informed decisions regarding service provision. This paper identifies a process through a set of focused questions to help CAMHS examine and improve their performance. The aspects covered are service profile, costs, conceptualisation of outcomes and identification of value for money. The recommended approach should help CAMHS redirect resources to maximise benefits for their catchment population.     

Cost-utility analysis in educational needs assessment

Educational needs assessments (hereafter NAs) are inattentive to cost considerations and are frequently dominated by elite stakeholder groups. In this article I make a case for adopting a cost–utility approach, illustrating the argument with data generated in a NA of central library services in a Canadian school district. Using survey data from eight stakeholder groups, I found that (1) NAs based on the service preferences of a single stakeholder group can be misleading; (2) service preferences can be integrated into a single set of priorities, even when there are disagreements, by using the stakeholder group as the unit of analysis and assigning weights that privilege input from knowledgeable respondents; and (3) that the ranking of service operations produced by user preferences was not significantly correlated with the ranking produced by integrating preferences with costs. Cost–utility analysis would be more helpful if the utilities represented rigorously determined benefits of the services assessed, as well as stakeholder perceptions of the value of these benefits. Cost–utility analysis in NA will not reach its potential until cost considerations are routinely included in educational program evaluations.     

Service Provision for Men with Eating Issues in Australia: An Analysis of Organisations', Practitioners', and Men's Experiences

Abstract

Research was undertaken to explore issues surrounding service provision for men with eating issues in Australia. Qualitative and quantitative data were gathered from key stakeholders—organisations that provide treatment (n=15), practitioners that have worked with men with eating issues (n=10), and individual men with eating issues (n=5). Four key areas were explored: rates of access to services, the expression and development of eating issues in men, factors inhibiting or facilitating the recovery process, and recommendations to improve service provision. Results highlighted the need for increased awareness about men's eating issues within society generally, but for health professionals specifically, the need for better recognition of the expression of eating issues in men, and the expansion of existing services to be more “male friendly”. It is anticipated that service providers will benefit from these findings by identifying ways to reduce barriers and encourage help-seeking behaviour in men. Future research should seek to replicate and expand these findings using a larger sample size.     

Does Attitudinal Consensus Lead to Neighborhood Collaboration? An Exploratory Analysis of an Urban Community

This article examines whether high levels of attitudinal consensus on community needs and civic responsibilities among a community's residents are associated with effective collaborative efforts among that community's neighborhood associations. Drawing upon both quantitative and qualitative data from an evaluation of an umbrella organization in an urban community, the authors found only a weak connection between attitudinal consensus, which was strong to moderate on most issues, and effective neighborhood association collaboration. The authors conclude that attitudinal consensus may be a necessary first step toward building effective collaboration but is far from sufficient to foster meaningful and stable partnerships. The authors explore the reasons for the lack of effective collaboration, offer suggestions for addressing barriers to collaboration, and discuss the implications of the findings for community building initiatives that aim to build social capital, particularly across “difference,” in distressed and diverse urban communities.     

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.     

What Changes for Young Carers? A Qualitative Evaluation of the Impact of Dedicated Support Provision for Young Carers

In 2016, the Children’s Commissioner for England reported that the most frequent provision for young carers (YCs) comes from dedicated YC services. This study formed one part of a three-year evaluation of support for YCs and their families provided by the Hampshire YCs Alliance (HYCA), a county-wide collaboration of ten YC services in the UK. It set out to explore the following primary questions; (a) what are the most important changes that the YC services made to YCs and their families? (b) what is it about the services that creates those changes? Semi-structured interviews were carried out in 2017, with YCs aged 9–17 (n = 8), their parents (n = 5), HYCA staff (n = 6) and professionals from other stakeholder organisations (n = 5) and a thematic analysis was undertaken. Reflecting previous research that YCs and their families have a broad range of needs, findings also reveal how YC services support them through a diverse range of interventions. Support led to a diverse range of positive changes for YCs and their families. A number of service features that facilitate change for YCs, as well as ‘key dynamics’ important in facilitating change were identified. These findings have led to a conceptual framework of how YC services facilitate change for YCs and are important for understanding the impact these dedicated services can make to the lives of YCs and how they facilitate change. Together they have implications for the development and commissioning of interventions for YCs and families and how service providers promote their support provision.

     

Understanding service provision and utilization for vulnerable youth: Evidence from multiple informants

Research has demonstrated that the ability of children to cope well with risk exposure can be partly attributed to the social ecology that surrounds them, including their access to resources. Few studies however have explored the interaction of services that many vulnerable children receive in relation to surrounding risks and available resources. This study reviews data of a paired sample of 166 Canadian multiple service using youth (at least using two of five public service systems) and a youth-nominated person most knowledgeable (PMK) focused on the contextual risk factors, service use variables, and pscychosocial outcomes of youth participants. Despite low to moderate correlations between youth and PMK (the person who is most knowledgeable about youth's lives) reports, findings showed that both PMKs and youth perceive service provision as a mediator between risk and pscychosocial outcomes. For youth however, better quality of service provision is key to improved developmental outcomes. Furthermore, the more risk factors youth face at home and at school, the less likely they are to perceive their services as helpful or appropriate to their needs. Youth data also reflects far more complex interactions between risks, service provision and outcomes than PMK data. Greater sensitivity is needed to both an adult and youth's perceptions of risk and related service needs if service access is to be provided optimally.     

Moving Toward Collaboration

Summary

Traditionally, organizations serving children and families have focused service delivery by available funding stream criteria. Federal funding streams supported fragmented services by tightly channeling monies to specific programs for specific needs. The intensity of providing and improving the delivery of services has overshadowed building connectedness across organizations and systems. Service has been the major goal and intense effort has gone into maximizing opportunities and measuring effects through service frequency. Over the past several years, new funding incentives have provided the opportunity for new collaboratives. This article describes an innovative collaboration between the Idaho Department of Health and Welfare (IDHW) and Eastern Washington University (EWU) and the unique directions and support that a university/agency partnership can provide for both organizations. Key features of this collaboration include shifts in funding and staffing strategies that contributed to more flexible services and increased levels of collaboration between IDHW, EWU and other community and state organizations and institutions. This article describes how funding can be viewed as a tool to increase the level of collaboration between systems, thus potentially leading to a breakdown of the traditional service delivery system. Finally, this article describes how an agency/higher education partnership played a key role in documenting the success of a school based program in meeting the emergency assistance needs of children and families, and how program evaluation, like funding requirements, can provide a supportive role in building collaborative relationships.     

Young people with complex needs meet complex organizations: an interview study with Swedish professionals about sustainable work practices

ABSTRACT

This paper concerns preconditions for the well-being of young people with mental ill-health combined with social vulnerabilities, also referred to as youth with complex needs. Research questions are: What barriers to sustainable work practices for young people labelled as having complex needs do professionals encounter? What do professionals identify as possible ways to overcome these barriers? Sustainable work practices are reflected in three themes: empowerment, relationships and collaboration. The findings are based on semi-structured interviews with 24 professionals, 3 men and 21 women, working in psychiatric care and the social services in two Swedish municipalities in 2016 and 2017. Major barriers are lack of continuity and co-ordination in staff and support, and fragmentation of work practices. As a consequence of the increased specialization of human service organizations, young people have to interact with many different professionals which could cause disparate interventions. Possible ways mentioned to overcome these barriers are supported through good interactional skills, using keyworkers as well therapeutic alliances, wrap-around services and case management. Complexity is linked to organizations and work practices rather than to young people. An often dysfunctional service delivery system in organizations with rigid boundaries may also affect professionals’ aim for sustainable support.     

Better practices in parent engagement: lessons from the USA and England

This paper undertakes an international comparison of parent engagement in the USA and England. Research from both countries is reviewed to establish the extent to which parent engagement is achieving the benefit of an improved fit between need and services and what, if any, differences exist between the experiences of parents in the USA and England. Despite some unique differences, research from both countries identifies similar experiences among parents. Those studies indicate that parent engagement is not yet contributing to the provision of services that are more timely, appropriate, or adequate in meeting parent need. The barriers to achieving a better fit between needs and services are explored and system-wide issues that limit the effectiveness of engagement with parents are discussed. The paper presents the Munro Review of Child Protection in England as a catalyst for change in improving the child welfare system's approach to parent engagement and establishing a better fit between needs and services. Consideration of the applicability of the Munro Review findings to the USA child welfare system or replication of such a review is proposed.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

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.