Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers’ Perspective

ABSTRACT

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers’ perspective of gaps in services for male CSA survivors. “Limited Male CSA Programs”, “Institutional Barriers”, “Attitudinal Barriers”, and “Systemic Gaps” emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.     

The impacts of accessible child protection services on services, jobs, and families

This multi-faceted study assessed the differences between accessible and central child protection service delivery sites in Ontario on: (1) family functioning; (2) front-line child protection service providers' satisfaction with services; (3) parents' satisfaction with services; (4) the services and supports available to families; (5) front-line service job satisfaction; and (6) front-line helping relationships in child welfare. A quasi-experimental outcome design gathered data from parents at case-opening and approximately 10 months later. Semi-structured individual or group qualitative interviews were conducted with parents, front-line service providers, and supervisors/managers. Information also was gathered from agency files. Front-line service providers completed an employment questionnaire. Findings indicated that the accessible sites were able to foster a greater proportion of cooperative helping relationships with families and to create more service partnerships. Parents at the accessible sites were more positive about their service involvements and more willing to ask for help again in the future. Front-line child protection service providers at both service delivery models described positive aspects of their jobs as well as frustrations with the expectations of the formal child protection system.     

Third party buying: the trend and the consequences

The trend toward more buying of health insurance, life insurance, and pension or annuity plans through employers brings up problems of consumer sovereignty , problems of the incentives of service providers, and problems of availability of the services of insurance which are only available through group buying. In order to specify what social indicators would be useful in this area, this paper analyzes the incentive systems for consumers, for service providers, and for employers as they are affected by the trend toward third party buying. It assesses the indicators that are available on the trend, and the literature in health economics which tried to analyze the impact of the trend on the provision of health services and health costs. On this basis, needed social indicators for policy assessment in the area of third party buying are suggested.     

Standards,Regulation and Development of School-age Day Care and ‘Open Door’ Services1

The subject is play and day-care services for school-age children. The paper draws on research carried out by the author and colleagues at Thomas Coram Research Unit (TCRU). It reports a survey of 120 services, randomly sampled, from 20 local authorities in England and Wales. This provides data about the standards to be found in such services when they became subject to registration and inspection under the Children Act 1989, and identifies shortcomings with regard to material resources and practice. The paper then draws on two case studies, and reports and discusses the problems met by local authorities in carrying out their new duties under the Act. These included their inexperience of services for over fives, the lack of resources available to improve services and the transient nature of holiday play schemes. It covers ways in which registration personnel used the Act to raise standards, eg ‘counselling out’, making requirements and conditions, and advising and resourcing service providers. The concluding discussion points to the need for further policy development in this area.     

Community-Based Participatory Research (CBPR) needs assessment of parenting support programs for fathers

This study reports the results of a Community-Based Participatory Research (CBPR) needs assessment of programs, services, and support systems for fathers in the City of Detroit, Michigan. The goal of this needs assessment was to assess the availability of parenting support services to men through multiple perspectives. To enact a CBPR approach, the research team collected qualitative data through interviews with service providers and community dialogues with fathers and consulted a community advisory board for further guidance on the research efforts. The research team engaged in member checking to improve the accuracy and credibility of study findings. Results indicated that both service providers and fathers agreed that very few parenting support services are available to fathers, particularly young African American fathers, and they also largely agreed in establishing priorities to address community fathers' parenting needs. Practice implications include the need for greater collaboration across service sectors and for greater outreach, possibly through technology, to young fathers.     

Evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) in Western Australia: barriers to better service provision

This paper details a 2009-2010 evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) commissioned by the Disability Services Commission (DSC) in Western Australia (WA). The program, run by the Multiple Sclerosis Society of WA (Inc.) provides in-home care and supports and respite for people who are under the age of sixty-five and diagnosed with a rapidly degenerative neurological condition. In 2009, the identified barriers to the better provision of services included: shortage of quality out-of-home respite providers, and convoluted paperwork requirements to qualify for the program. Some service providers were unaware of the program and so were not referring them into the NCCCP, a number of service providers were unwilling to refer their clients into the program, neurologists were unwilling to give a final diagnosis for a client, that would enable them to qualify for the service, there was a general lack of knowledge about what services were available in the general community, and existing equipment pools were under-resourced. In 2010, the study found that most of the issues had been addressed however, out-of-home respite services were still very limited especially in rural areas, and the eligibility criteria for entry to the program is confined to those 65 years and under. This paper discusses the issues that still remain with the program as examples of barriers to better provision of services.     

Disentangling system contact and services: A key pathway to evidence-based children's policy

There is often a disconnect between the best available research and the policy decisions governing the functioning of large child-serving systems. This paper argues that this is, in part, due to conflating system contact with actual service provision. When outcomes are understood in terms of contacts as compared to services, this can lead to inappropriate or inadequate policy responses. Empirical data on contact and services for four large child-serving systems (child welfare, education, juvenile court, and mental health) are presented to illustrate this dilemma. Multi-sector services and need for collaboration are also briefly reviewed. Recommendations are made for improving data infrastructure and research to help bridge the gap between what policy makers see and actual system functioning. This is presented as a key step on the path to achieving evidence-based policy to support children's well-being.     

Health Care Reform and the Behavioral Health Workforce

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field.     

Paid personal assistance services:an exploratory study of working-age consumers' perspectives

This study examined the experiences of individuals who use paid personal assistance services (PAS). Structured interview data were collected from a convenience sample of 24 working-age individuals from diverse backgrounds recruited from Centers for Independent Living in nine states. Respondents described their general satisfaction with current paid PAS, but many reported previous experiences with poor care related to the low wages, lack of training of PAS providers, and an inadequate supply of providers. Respondents reported many unmet needs because of a shortage of hours provided by state programs and the lack of help with daily living activities, transportation, childcare, and social activities. The respondents strongly preferred consumer-directed care.     

The Discreet Charm of the Nonprofit Form: Service Professionals and Nonprofit Organizations (Poland 1989-1993)

This paper examines the role of social proximity (nonprofit) organizations in the process of professional innovation that involved a transfer of human service technologies from Western Europe and the United States to Poland during the 1989 political–economic reform. To explain that role, the paper introduces a theoretical model that posits the existence of elective affinity between the social proximity form and occupational interests of service providers. As the existing system of professions is no longer sufficient to legitimate expert services and curb competition among different types of providers, the social proximity form bestows social legitimacy on novel or controversial types of services, and is thus instrumental in marketing those services. The proposed model is supported by quantitative data and in-depth interviews. Theoretical implications are discussed.     

Communications Technology—empowerment or Disempowerment?

Developments in communication technology can reduce dependence on others and facilitate independent living for disabled people. Recently developed telephone-based services allow users to call up help quickly, as and when they need it. But the dominant model of provision emphasises vulnerability, assumes a need for protection and imposes rules about appropriate use. The article identifies the influence of manufacturers and providers of communication alarms in perpetuating paternalistic approaches to services for older disabled people and limiting the potential for user determination of need. Emergent models which aim to facilitate user-control face low expectations among users, the entrenched attitudes of providers and the dominance of the market in influencing practice. The mixed economy of social care is likely to increase the gap between providers' interests and users' needs.     

Availability of caregiver support services: implications for implementation of the National Family Caregiver Support Program

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAAArea Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.     

Testing Faith

Abstract

The U.S. federal government, through Charitable Choice, has opened public funding for the delivery of social services to faith-based organizations (FBOs) more than ever before. This increased access to governmental funding at all levels has led to a closer examination of the evidence base on the effectiveness of the services provided by FBOs, and the capacity of FBOs to respond to data needs for accountability and program improvement efforts. This paper discusses the current status of evaluation research on FBO services and the emerging data needs among faith-based providers. Promising avenues for enhancing the current understanding of outcomes of FBO services are explored such as (1) adopting outcome measurement practices in use within the current nonprofit sector, and (2) developing more rigorous research designs tailored to the special contexts of faith-based services. The paper suggests an agenda in which FBO operators, funders, and evaluators work together to move forward in improving the evidence base on faith-based services.     

Availability of Caregiver Support Services

Abstract

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAA Area Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.     

What is Important to Young Children Who Have Cancer While in Hospital?

This paper reports on a participatory research project exploring children’s experiences and views of cancer care services. It focusses on findings from interviews conducted with 10 children aged four and five years old. Play and puppets were used to help children express their views. The themes elicited reveal important aspects of hospital care for young children, such as having ‘lots of toys’ available and that ‘mummy and daddy are near’. The use of play and puppets as a data‐collection method is discussed, along with the implications of findings for the care and support of young children who have cancer.     

Latino Immigrants in a New Destination State: A Qualitative Study of Provider Experiences

ABSTRACT

Latino immigrants are settling in new destination states that have fewer culturally and linguistically competent health and social service providers. Social workers are in an ideal position to serve Latino immigrants. Yet, limited literature is available on the strengths and needs of this population specific to new destination states. To help fill this gap, qualitative data were gathered in individual interviews with providers serving Latino immigrants in one new destination state. Key themes emerged from the data, suggesting the importance of family and community, the challenges of immigration-related stressors, and the strengths and gaps in service provision. Implications for practice and social work education are presented.     

Assistive technology outcomes in work settings

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.     

Medicare and the affordable care act

The recently enacted Patient Protection and Affordable Care Act made modest changes to improve Medicare and obtained a substantial share of funding for the Act's broader reforms from future spending reductions in the program. Drug benefits and preventive services were improved. While painful, the spending reductions will have only moderate impacts on beneficiaries and should help achieve the goals of health care reform: encouraging better primary and preventive care, making providers conscious of finding ways to increase the productivity of care delivered and changing the relative levels of payment across certain providers. Additional costs to beneficiaries will arise from changes in private plan payments and increasing income-related premiums.     

Child center closures: Does nonprofit status provide a comparative advantage?

Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30 +) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.     

A Social-Epidemiological Five Year Cohort Study of Homeless Families

Summary

There are significant social investments in families uprooted by homelessness. There are no data clearly delineating types of families helped, and how long help has sustained them. Computer technology was utilized to track eight hundred and seventy-five homeless families who received networked services from both public and private providers in a case managed family shelter from 1983 to 1987. Discussed are secondary data in case files and primary data from field interviews on longitudinal residential history, employment, familial and demographic changes, and service needs.

Policy questions focus on current residential stability and community reintegration.