Mental health and educational difficulties in children in contact with Children's Social Services

The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, selected at random from the child benefit register. At 2 and 3 years, all those with a psychiatric disorder and a random third without were followed up with further detailed interviews about the services contacted if parents reported service contact or if parents expressed concern about their child's mental health at baseline and follow‐up, but reported no service use. We compared children in contact with Children's Social Services with children in contact with Child and Adolescent Mental Health Services (CAMHS) or no services. The children in contact with Children's Social Services had a high level of psychopathology and considerable educational difficulties. Despite this, they often had no contact with CAMHS or access to provision for special educational needs. It also became clear that parents were often using Children's Social Services as a first‐line service, i.e. a way of trying to access help. The results provide us with an interesting insight into the level of need of those children in contact with Children's Social Services and we hope to stimulate discussion about how liaison between all the services children access can better provide for their needs.     

The SESS multisite collaborative research initiative: establishing common ground

Multidisciplinary intervention approaches are needed for meeting service needs for families in which substance abuse and mental health disorders may be interfering with child‐rearing. Experiences from the Starting Early Starting Smart (SESS) initiative, a 12‐site national collaborative investigation of integrating behavioural health services in early childhood and primary health care service settings for children aged 0–5 years and their families and caregivers, are described. This 4‐year applied research initiative was co‐funded by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services and Casey Family Programs, a private operating foundation. SESS, which was developed and implemented in 12 geographically and culturally diverse cities in the USA during 1997–2001, encouraged federal, state, and local public/private partnerships. Opportunities and challenges in using an inclusive, consensus‐based, stakeholder model to maximize study relevance and utility for researchers, practitioners, and fiscal sponsors are discussed, and lessons for multidisciplinary, multisite research collaborations are identified.     

Patterns of entry to community‐based services for families with children with developmental disabilities: implications for social work practice

The purpose of the present study was to understand, from parents' perspectives, the process of entry to community‐based services for children with developmental disabilities and to explore the relationship between patterns of entry and parent‐reported needs and priorities for service. Qualitative interviews were conducted with 43 mothers and 29 fathers of children with developmental disabilities approximately 6 months after the families entered community‐based childhood disability support services in Manitoba, Canada. Analysis of the coded interview data resulted in the identification of three process factors influential in the entry of families to community‐based support services: recognition of problems in child development, formal diagnosis of child disability and linkage between diagnostic services and the community‐based support system. Analysis of these processes identified four patterns of service entry associated with differing family needs for service: early entry, prompt entry, delayed entry and atypical entry. The results can be understood as a typology useful for social workers in the assessment of family needs and priorities at the point of entry to community‐based services.     

Patterns of family service needs and caregiver–child relationships among families at risk of child welfare involvement

Caregivers at risk of involvement in the child welfare system report high levels of need for multiple types of services, and their children have high levels of mental health need. Caregivers from families with more service needs, as well as unmet needs, are less likely to be engaged with child welfare services and may have diminished capacity to care for their child. This study takes a family‐centered approach by using latent class analysis to identify patterns of both caregiver and child service needs among families at risk of child welfare involvement. Using data from the LONGSCAN consortium (N = 957), we identified 4 classes of service needs among child welfare‐involved families. We then examined differences between the 4 classes based on demographics, maltreatment histories, unmet service needs, and caregiver–child relationship. The caregivers were split fairly evenly among the 4 classes: low needs, medical needs, poverty support, and high needs. There were significant differences between classes on assessed variables, with higher levels of needs associated with diminished caregiver–child relationships.     

Older People and Access to Care

Correspondence to Denise Tanner, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: d.tanner{at}coventry.ac.uk Summary At the heart of a number of New Labour health and social policyinitiatives are stated concerns with supporting independence,preventing deterioration and extending access to services. Thisarticle examines the potential impact of these initiatives,including Prevention Grants (Department of Health, 2000b), theNational Service Framework for Older People (Department of Health,2001a), the Fair Access to Care Services Guidance (Departmentof Health, 2002a), and the Single Assessment Process (Departmentof Health, 2002b), on older people with ‘low level’needs who have increasingly been excluded from services targetedat those in high risk categories. Key standpoints for this analysisare research findings indicating what older people themselveswant from preventive services. Central messages, consistentwith those from other service user ‘groups’, arethe need for support services that enable older people to continueto exercise choice and control over their lives. New preventivemeasures are evaluated in the light of these findings and foundwanting. It is argued that recent policy initiatives are likelyto do little to widen access to support services for those withlow intensity needs, and, moreover, that the processes involvedin identifying those at future high risk will detract from ratherthan enhance citizenship. A more diffuse approach to preventionis advocated, based on mutuality, community development, andcapacity-building.     

Service users as gatekeepers in Children's Centres

Children's Centres are the latest in a line of initiatives designed to provide neighbourhood‐based family support. These are part of a spectrum of preventive services from Universalist (primary prevention) to permanence and rehabilitative work (quaternary). High levels of need confronted by tertiary Child Care Social Work and Child and Adolescent Mental Health Services, mean that the contribution of these centres at secondary level and responsiveness to its higher‐level needs, have become particularly important. At the same time, the involvement and perspectives of service users have become equally important in the evaluation and development of centres. Users, though, can help create the culture and expectations in centres just through the processes of interaction developed over time. However, although users have evaluated services for their openness, we know little about the part played by service users themselves – particularly through their informal interactions and culture – in the responsiveness of centres to higher‐need families for whom secondary level prevention is appropriate. This paper focuses on the part played by service users as gatekeepers showing they can play an important, and sometimes limiting, part in the responsiveness of centres. The theoretical and practical implications of this for prevention are discussed.     

Study on a resource allocation formula for social services in Finland

This article considers how a specific need-based resource allocation formula for children's day care, income support, child welfare and other social services was developed. The formula is needed for the municipal allocation of state subsidies for social services, and the work was performed for the Ministry of Social Welfare and Health. Cross-sectional data were collected from the 436 Finnish municipalities and 37 small areas within the six largest cities. Because of the simultaneous relationship between supply and demand of services, two-stage least-square estimation and structural equations models were used in the analysis. After the effect of supply was removed from the service utilisation data, group-need factors (municipal variables) were found for these services. The new formula is financially and administratively feasible, transparent and reasonably simple.     

Family support services delivered using a restorative approach: A framework for relationship and strengths‐based whole‐family practice

Family support services, an integral part of many welfare systems across the developed world, have witnessed a growing demand for the use of relationship and strengths‐based whole‐family approaches in the belief that this increases service engagement and effect. Despite this, knowledge that delivering services using such approaches can be challenging and calls for the identification and exploration of methods likely to promote and sustain their use. Restorative approach is an ethos and method centred on building and sustaining positive relationships, which is increasingly being adopted in family and children's services in the United Kingdom. Despite this, the scarcity of research conducted in this area as yet, means little is known of its use and effect in this context. This article draws on empirical data collected in a wider study exploring the efficacy of different family service delivery models to describe the use of restorative approach in family service provision and determine whether its adoption promotes sustained use of strengths and relationship‐based whole‐family approaches when working with families. Furthermore, it explores whether the process incorporates wider evidence‐based methods of change.     

Implementation of Child Rights in the Children's Homes in Malaysia

The objective of this study was to examine the implementation of the Convention on the Rights of the Child (CRC) in the Children Homes under the Social Welfare Department (SWD) in Malaysia. Data was collected from 402 registered children who were staying in six Children Homes across the country. This study employed self‐report surveys where multiple data collection methods, such as face‐to‐face structured interviews, key informant interviews (KIIs), and documentation survey, were used. The study found that the SWD failed to comply with most of the commitments of CRC in Children Homes at its implementation level, and it is still needs based. The findings of this study present important guidelines for government and policy makers in improving child welfare services in the Children Homes in Malaysia.     

Notional defined-contribution schemes: Old wine in new bottles?

Until recently, most pension benefit formulae in social security schemes resembled each other. They were all defined-benefit formulae that were either generous or mean, while defined-contribution formulae were exclusively used in private and occupational pension schemes and some national provident funds. Then came the mandatory retirement savings model, introduced in Chile and subsequently in other Latin American countries. It did not seem possible that such a formula could be used on any large scale in the pay-as-you-go environment of OECD pension schemes. In the early 1990s, however, Swedish social security experts devised the notional defined-contribution (NDC) system: individual social insurance pension contribution records are converted into a fictitious savings amount at retirement, whereupon the defined-contribution approach is followed. This article analyses how much of this approach is new. The conclusion is that it is a novel pension policy instrument rather than a new type of pension formula, and most of its potential financial and distributive effects could also be achieved by a classical, linear defined-benefit formula. It is the packaging that differs and, in politics, that often is what matters.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

The use of intensive family preservation services with adoptive families

With the increase in special needs adoption, there is growing concern about the adjustment of these children and families beyond legalization. The purpose of this study was to explore in greater depth the use of intensive family preservation services with adoptive families and the factors related to the family’s ability to stay intact beyond services. Multiple regression analyses were used to determine factors that were predictive of the family’s ability to remain intact at 6 and 12 months post services. Potential predictors of family intactness included child characteristics, family characteristics, previous placement history and service characteristics. Results at 6 months found no significance in the full model; however, the individual factors of ethnic origin of the child, full‐time employment of the primary parent and initial placement reason were significant predictors of family intactness. At 12 months post services, the full model was highly significant, with service characteristics being the greatest predictor of the family’s ability to remain intact.     

'Your friends don't understand': Invisibility and unmet need in the lives of 'young carers'

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

Lessons learned implementing community‐based comprehensive case management for families surviving homicide

Family members of homicide victims often experience a wide range of adverse reactions to the homicide. This study reports on the Traumatic Loss Response Team, a project conducted by a community‐based, mental‐health agency to provide comprehensive case‐management services to meet homicide survivors' complex needs. To conduct the study, we abstracted service/process data from open client cases in 2013 (most recent year with available data) and conducted interviews with the project's implementing agencies. Interviews revealed both initial challenges and factors facilitating successful implementation. Main challenges to overcome included gaining credibility and trust from police and issues around overlap of services provided to families by numerous agencies that may become involved in a homicide. Partners view the project providing a range of important services to families, including intermediary/buffer between families and police. Concerning service data, of the 131 cases open in 2013, most were referred directly by police and involved community violence, an adult victim and a firearm. Most of the 164 clients receiving services were female, adult, African‐American and parents of the deceased. Grief support was the most common of numerous services provided. We hope that this study will catalyse sharing of similar data and experiences among organizations providing services to homicide survivors.     

Social Context of Service Use Among Homeless Youth in Los Angeles,California

ABSTRACT

Little is known about rates and correlates of service use or the role that social context plays in service engagement among homeless youth. This study compares two distinct service areas and uses a social network approach to examine how environmental factors (e.g., neighborhood), social factors (e.g., social capital and network engagement) and individual level factors that relate to service use patterns among homeless youth in Los Angeles, California. A sample of 938 youth was recruited from three drop-in centers in two distinct service sites. Individuals were surveyed about their individual and social network attributes. Univariable and multivariable analyses were utilized to understand the influence of social-contextual variables on service use. Service use behaviors varied across site and service type with youth in Hollywood showing greater engagement than youth at the Beach site. Across both sites and several service types, staff emotional support was positively correlated with levels of service use. The site comparisons also point to the fact that even within a single geographic area, like Los Angeles County, client profiles and rates of service use can significantly vary. Future research needs are presented with specific emphasis on understanding the needs of non-service-seeking youth.     

Caregiver involvement in behavioural health services in the context of child welfare service referrals: a qualitative study

Human service agencies serve a growing number of adults with behavioural health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioural health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioural health services. Researchers reviewed agencies' case records and conducted in‐depth interviews with 16 caregivers, 9 child welfare caseworkers and 12 behavioural health treatment counsellors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioural health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioural healthcare needs. Implications for managers and practitioners are discussed.     

Stilling the tremors: Resurrecting HIV services in Haiti's post‐earthquake tent cities

The January 12, 2010 earthquake in Haiti severely undermined HIV service provision in the country. Almost 10 percent of Haitians were displaced and now live in temporary tent communities. Little is known about how HIV services are being provided to Haitians with HIV in these encampments. This study addresses this lacuna by conducting a process evaluation of the manner in which a collaboration among Haitian community‐based HIV service providers, a US‐based HIV service provider, and a US‐based academic research team resurrected HIV services in the encampments. Efforts to set up HIV services in the encampments proceeded through three stages: (i) an initial crisis response that activated established networks and identified feasible goals; (ii) the development of services by building research capacity, conducting needs assessments, addressing logistical challenges, and establishing community‐based services; and (iii) the sustaining of the initiative by targeting resources and negotiating in the political arena. Implications of the protocol for future efforts are discussed. Key Practitioner Message: ● Resurrecting HIV services in post‐disaster zones; ● Utilizing cross‐country, provider–academic partnerships to develop service capacity; ● Targeting structural barriers to establish HIV services in resource‐poor settings.     

Towards a Multi‐level Approach on Frontline Interactions in the Public Sector: Institutional Transformations and the Dynamics of Real‐time Interactions

This study develops a multi‐level approach on frontline interactions in the public sector. Previous research suggests that detailed analyses of frontline interactions are essential to our understanding of how welfare services take shape when policies and rules are applied and negotiated in individual cases. The dynamics and performances of real‐time interactions have, however, rarely been analyzed as such. This study shows how the methods developed in the field of Conversation Analysis can contribute to this research. Our multi‐level approach integrates analyses of the policy‐ and institutional transformations that shape conditions for frontline interactions; and analyses of how policies and rules are evoked, negotiated and reshaped in the turn‐by‐turn organization and performances of interaction. The approach is applied on an analysis of how rules regarding financial aid are applied in an authority highly affected by changes in welfare policy towards standardization and detailed regulations. The empirical case is the Swedish Board for Study Support. The empirical study includes analyses of documents, interviews and analyses of taped telephone conversations. The study shows how institutional arrangements of standardization, detailed regulations, monitoring and depersonalization, structure the frontline work and shape narrow frames for officials' discretion in interactions with clients. The study also shows how rules are invoked and negotiated in recurrent practices in the interaction: in the careful design of decisions; in the investigations of alternatives and exceptions from the rules in order to find solutions to the client's problems. The analyses of concrete interactional practices clearly indicate that also a rule‐governed work dominated by task discretion involves recurrent negotiations, flexibility and local policy‐making.     

The Group versus the Individual as the Unit of Analysis in Small Group Research

It is common for social work researchers to use the individual as the unit of analysis in small group research. This paper examines the discrepancies that may exist between analyses that incorporate the individual and those that incorpo- rate the group as the unit of analysis. An example is presented with data collected from 331 members of 53 workgroups in 22 different human service organizations. Researchers are cau- tioned against drawing conclusions about groups from data based on the individual as the unit of analysis.