A Qualitative Case Study on Recovery and Personal Growth in Korean Drug Addicts

ABSTRACT

In recent years, crimes related to drug smuggling and production have gradually increased in Korea. This qualitative case study explores the experiences of Koreans recovering from drug addiction and identifies specific details and mechanisms of recovery. For this purpose, participants were selected based on criteria such as engaging in social activities after recovery from addiction for 3 years or more. Next, one-on-one in-depth interviews were conducted with five voluntarily consenting participants. Data were analyzed using the within-/cross-case analysis suggested by Creswell. Substantial personal growth took place in the recovery process for drug addicts. Nineteen themes were identified as manifestations of personal growth through within-case analysis. Four common themes were then derived through cross-case analysis. These four common themes were “reconnection with reality,” “embracing the essence of one's own existence,” “reconstructing oneself in social relations,” and “self-love.” The study's results suggest that a recovery program needs to be developed wherein the program not only enables drug addicts to reflect on their current existence but also allows them to develop their specific coping skills. Future research should be broadened to consider the social support mechanism and viewpoints of people including family and local community members in close contact with drug addicts.     

Improving family planning services to rural adolescents

A longitudinal study conducted among young women and family planning service providers in 3 rural New York counties underscored the need to pay attention to individual differences among the clients served. Barriers to family planning acceptance in these counties included factors such as poor public transportation, long distances to clinic, and no telephone in many households that the urban population does not confront. The 900 young women in the sample were categorized as unserved, underserved, adequately served, or well served with regard to their family planning needs. A comparison of psychometric and survey data from these respondents indicated that clinic clients tended to be unmarried, to have a higher personal income, and have fewer children than their counterparts who were contraceptive nonusers. In addition, nonacceptors who completed the Future Events Test expected more positive events never to happen and made less use of planning for the future than the young women who were clients of the family planning clinic in their county. Although qualitative evaluation and participant-observation revealed significant differences between the 3 counties in terms of their family planning services, the distribution of women in the 4 categories did not differ among counties. Overall, these findings indicate that personality characteristics rather than situational variables are the best predictors of success or failure in taking steps to avoid unwanted pregnancy. For young women who are assessed at intake as lacking sufficient motivation to follow through on contraception, clinic personnel should develop an individualized plan aimed at providing education and raising self-esteem and optimism about control over future events.     

The Significance of Past Abuse to Current Intervention Strategies with Depressed Mothers in Child and Family Care

Correspondence to Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth, Devon, PL6 7EW, UK. Summary There is now considerable evidence that a high proportion offamilies subject to child and family care social work interventioncontain depressed mothers. There is also evidence that the presenceof clinical depression is associated, amongst these clients,with child abuse. Vulnerability to both depression and childabuse have been traced back to the early child-care experiencesof those who are currently parents, expressed in child abusein terms of intergenerational transmission, although it is alsoclear for both that further factors also contribute to thisvulnerability. Despite the link between maternal depressionand child abuse, we have little evidence about the processesand mechanisms, based on social workers judgements about thesituation, by which families with depressed mothers are morelikely than other clients to be involved with intervention forchild abuse. This paper seeks to ‘map’ the pathwaysand the intermediate mechanisms which provide the link betweenthe experience of past abuse and social workers interventionstrategies. Drawing on theoretically significant factors, itfocuses on the following variables: the experience of past abuse,the mother's attributed character, attachment and bonding, childbehavioural problems and intervention strategy. The paper demonstratesa number of significant ‘paths’ through which familiesbecome subject to one or other intervention strategy. It showsthat, while an emphasis on needs assessment is to be welcomed(Department of Health, 1999), they need to be considered (i)within a theoretical framework which helps social workers makesense of, and respond to situations and (ii) through an understandingof longitudinal dimensions (key factors in mothers' earlierlife) which are aspects of this theoretical understanding.     

Independent evaluation of the Triple P Positive Parenting Program in family support service settings

The Triple P Positive Parenting Program is a multilevel system of behaviour‐based parenting training and support. The aim of this study was to determine whether implementation of levels 2 and 3 of the Triple P system, designed for primary care settings, enhances parent, child and family outcomes compared with services‐as‐usual in Alberta, Canada. The study employed a quasi‐experimental, single‐blind and post‐test‐only design. A survey incorporating outcome measures was administered to a sample of 1296 parent‐clients. A total of 923 parents responded, including 172 parents who had received a Triple P (level 2 and/or 3) intervention during the previous 12 weeks. A significant interaction was found between participation in a group‐based parent education programme and receipt of Triple P. Parents who participated in a group‐based parent education programme, and who received a Triple P intervention reported somewhat higher levels of need satisfaction than parents who participated in a group‐based parent education programme but who did not receive a Triple P intervention. No significant difference was found between Triple P and service‐as‐usual groups on any secondary outcome measures including parenting stress, positive interaction, family functioning and child problem behaviours.     

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.     

智障儿童家长服务需求调查

家长在残疾儿童的康复过程中扮演着重要角色。为了解智障儿童家长在家属资源方面的需求,以便社工在工作中更好地为他们提供相关服务。本文以问卷调查的方式对广东省残疾人康复中心智障部32位在训智障儿童的家长进行了研究。结果发现多数家长对于家属资源服务表示感兴趣。他们对家属支援服务的服务内容、形式以及时间安排也表现出不同的需求。该研究将启发社工对现阶段所提供的家属资源服务内容进行反思和调整,并在未来的工作中进一步提供满足服务对象需求的相关服务。     

‘Meeting them where they are at’: A practice note on implementation of the Child and Family Traumatic Stress Intervention in an emergency family homeless shelter

Families experiencing homelessness report higher rates of traumatic exposure than the general population, and traumatic experiences can often be precipitating factors for entrance into a homeless shelter. Emergency shelter is meant to be a brief, temporary housing intervention to support families toward more stable and permanent living arrangements. Beyond this ecological intervention, there is a frequently unmet need for trauma-specific mental health services. Further still, psychosocial interventions to support sheltered families should be sensitive to both the trauma-specific needs of this population and the constraints of the shelter setting. The Child and Family Traumatic Stress Intervention (CFTSI) is a brief, secondary prevention protocol that aims to prevent PTSD after exposure to a traumatic event, with research demonstrating its effectiveness in acute care settings such as child advocacy centres and emergency departments. This case study illustrates the implementation of CFTSI in an emergency family shelter in a large urban area, highlighting the appropriateness of the intervention for the setting, its adaptability to client needs and its generalizability to other non-traditional intervention settings.     

Family Placements for People with a Learning Difficulty: A Study using Time Budgets

Correspondence to Dr R. F. Drewett, Department of Psychology, University of Durham, Science Building, South Road, Durham DH1 3LE. Summary The Durham County Council Family Placement Scheme offers long-termcare in families for adults with learning difficulties. Theactivities of the twenty-four clients in family placements werestudied using interviews and diaries kept by carers. Althoughmost of the clients were only mildly handicapped three wereseverely disabled. Most of the carers have either professionalor voluntary experience of work with people with learning difficulties.Although four of the placements have broken down, the levelsof activity of the clients still in their families were similarto those found in other types of community-based care, and werejust as extensive in the more disabled. The previous experienceof the carer had no clear relationship with the activity levelsof the client.     

Comparative Impacts of Alternatives to Adolescent Placement

The impacts of day treatment and family treatment as alternatives to adolescent placement are assessed in a longitudinal, quasi-experimental study. The development of the day treatment and family treatment programs greatly reduced the number of adolescent placements by a public county welfare agency. Substantial cost savings were associated with family treatment. Post-intervention delinquency rates, relative to pre-intervention rates, were lowest for adolescents initially served in out-of-home placement as opposed to alternatives. School performance among youth receiving all three types of service was poor and differences in school performance were small. Telephone follow-up interviewing suggested that parents of family treatment clients found services somewhat less helpful than did parents in the other programs.     

Troubled families: vulnerable families' experiences of multiple service use

This paper draws on a small‐scale study examining the experiences of highly vulnerable families with complex and enduring needs. The previous UK government and the current government have sought to develop policy and service initiatives that target families who present high levels of need and require high cost services. However, to date remarkably little is known about family perspectives and experiences. In this paper, family accounts of their experiences are presented and it is suggested that from these come some difficult practice questions. The family data reveal evident gaps in existing practice and challenges social work to ‘think family’ in new ways. The paper explores how families understand they are understood at the point of engagement, the assumptions that are made about family knowledge, and how families share and withhold information about their needs and experiences. In the discussion, the argument is made for the development of nuanced practice capable of recognizing and working with the ways highly vulnerable families ‘do family’, and the processes that support and inhibit professional interventions.     

和谐社会建设中的戒瘾康复研究

成瘾问题是国际社会共同关注的焦点,也是亟待解决的世界性难题。戒瘾者的康复过程分为生理康复、心理康复、社会康复等三个阶段,对成瘾者进行治疗而非强制性戒除是和谐社会介入成瘾行为的主要趋势。戒瘾社会工作对于戒瘾者的心理康复和社会康复发挥了巨大的作用。     

Foster Family Care for Frail Elderly

For the last 10 years, the development of cost-effective, community alternatives for chronically ill has been a serious concern of many service providers and policy-makers. The expanding of the elderly population has been well documented. In this state, projections show a need for an additional 1602 long-term care beds by the year 2000, almost double the current capacity. The state Medicaid Program is searching for ways to reduce the 50 million spent in 1982 for institutional long-term care. Already experiencing the shortage of long-term beds, hospitals have a chronic loss of revenue potential through the holding of non-acute patients in the hospital while waiting for a nursing home bed vacancy. At the 500 bed acute care hospital, 25-30 beds daily are occupied by nursing home wait-listed clients. The average wait-listed days per patient is 20.4. In September 1979, the hospital's department of social work began foster family care for elderly persons eligible for nursing home care. Foster families are extensively screened and trained for the severely dependent clients. The social worker and registered nurse team are closely involved in placements, developing and implementing an individualized written treatment plan to assure the clients quality of care. Data collected over the past three years clearly indicates that this setting provides cost-effective, quality care. Overall scoring on bathing, dressing, toileting, transfer, and continence, utilizing the KATZ Activity of Daily Living, shows that 71% of the clients improve after 3 months on placement. Although 45% of the clients are incontinent of bowel or urine at the time of placement, 33% make significant improvement to only occasional accidents. With 41% of the clients at placement requiring adaptive device and assistance for walking, 48% of the clients show functional improvements in walking. Most significant for continued survival of this type of care, the total program cost is half the cost of institutional care for these elderly clients. The paper will examine the multiple needs served through the program: the ill elderly person's need of a therapistic, caring environment; the hospital's need to curb loss of potential revenue; and the need of the Medicaid Program to contain costs. The paper also reviews client characteristics, foster family characteristics, quality assurance, and overall cost-effectiveness of the foster family model.     

Drug addiction as a lifestyle

Drug addict rehabilitation programs receive a small proportion of the funds made available through the social welfare system. Emphasis has traditionally been placed on the pathological rather than the salutogenic elements of an addicted lifestyle. A new test of a person's sense of coherence in life (Antonovsky's 9-item Sense of Coherence scale) may be of interest in rehabilitation work with drug addicts, and in focusing more attention on this aspect of addiction treatment. Thirty drug addicts in treatment and rehabilitation and 10 former drug addicts were interviewed using the 9-item Sense of Coherence scale. The results obtained were compared to a well known test of distress, the 24-item Symptom Checklist. Drug addicts in treatment facilities had significantly lower mean scores on the 9-item Sense of Coherence scale (2.3) and higher scores on the 24-item Symptom Checklist (2.3) than both drug addicts in rehabilitatively oriented institutions (3.3 and 1.6) and the long-term rehabilitated non-using former drug addicts (4.2 and 1.5 respectively). The differences between the group in rehabilitation and the former drug addicts were also statistically significant. The levels of the two psychometric tests suggested a gradual movement towards normal values and an increased sense of meaning in life among the former drug addicts, contrary to findings by other researchers. The length of time before these tests return to normal values may exceed the observation period often used in follow-up at treatment facilities. Increased social welfare may follow if a disclosure of salutogenic possibilities in drug addicts is obtained. Further prospective research is, however, necessary to confirm our findings.     

Social Workers' Implementation of Client Participation: What Factors Make the Difference?

ABSTRACT

Client participation is both a value and a strategy in social work, involving clients in decisions influencing their lives. Nevertheless, the factors encouraging its use by social workers in social services have received little research attention. This article reports on a study drawing on Goal Commitment Theory to examine, for the first time, four categories of variables that might predict its implementation: background variables (intervention method, age, experience, education, supervision); personal resources (self-esteem, mastery); organizational variables (superiors' support, organizational commitment); and situational factors (previous client participation, perception of client participation).

A sample of 661 Israeli social workers completed questionnaires. Hierarchical regression analysis and t-tests revealed that intervention method, mastery, superiors' support, and both situational variables contributed significantly to explaining the variance in client participation. Moreover, social workers valued client participation significantly more than they used it. The implications for researchers and professionals in social services are discussed. Proper training could increase social workers' awareness of client participation and provide tools for implementation. Policy makers should set standards for its use and evaluation, and require its inclusion in all interventions. Further research investigating clients and managers of social services could provide a broader picture of the factors impacting client participation.     

The long arm of the welfare state shortened: Home help in Sweden

Old age care in Sweden expanded greatly in all areas in the 1960s and 1970s. In the 1980s, both institutional and in-home services have retreated. Little substitution between the two kinds of care can be observed. Cutbacks relative to demographic needs, and probably also to actual needs, have occurred, nationally and locally. Home help is analyzed as a metaphor for social services and welfare at large. The strategy has been to give priority to the frailest and oldest clients. Others often have to make do without any services. Also, current recipients of home help services now get different inputs: in the 1980s and earlier, 8 of 10 home help hours were used for homemaking (such as shopping, cooking, cleaning and laundry); in the 1990s about half is used for personal care of the clients.     

Issues Related to the Use of Short-Term Groups for Adjustment to Divorce

Programs for divorce adjustment which utilize short-term groups provide a viable treatment intervention for meeting the needs of divorced clients. Through a comparison of such programs, this article identifies and discusses some of the issues and gaps in our present knowledge about the use of short-term groups for adjustment to divorce. Guidelines are provided for practitioners and agencies interested in developing divorce adjustment group programs or modifying existing ones.     

Social Work and Child-centred Family Court Mediation

Correspondence to Dr Greg Mantle, APU, Ashby House, Floor 2, Brook Street, Chelmsford CM1 1UH, UK. E-mail G.J.Mantle{at}apu.ac.uk Summary In April 2001, the Children and Family Court Advisory SupportService (CAFCASS) became responsible for family court work,including the provision of mediation services. Family courtmediation offers a gateway for social work with children andfamilies whose needs are largely left untouched by current services,and could thereby play an important part within the broaderextension of prevention, early intervention, parenting and supportservices recommended by government. Over the past two decades,mediation has become a popular approach to reducing conflictand resolving disputes in a wide range of inter-personal, communityand organizational settings. Given the professional interestthat social workers have in helping their clients achieve moreharmonious lives, the space for mediation would appear considerableand yet the connections between mediation and social work are,as yet, insufficiently mapped and analysed, in terms of boththeory and practice. This paper draws on literature and recentresearch to review the relationship between family court mediationand social work.     

Exploring intergenerational communication and stress in refugee families

More than half of the refugees who have resettled to the United States in recent years have been youth. Refugee youth have often witnessed or experienced violence and family separation prior to resettlement and face barriers to successful resettlement such as language and educational challenges. These factors elevate risk for mental and emotional distress, and protective factors like strong familial relationships are important to promoting mental well‐being. This study utilized focus groups with 36 refugees ages 18 to 25 from four ethnic groups to explore conceptualizations of and communication about mental and emotional distress within and outside of family systems. Youth reported a nuanced conceptualization of their premigration and postmigration stressors and their patterns of communication about distress in three domains: (a) exposure to traumatic stress prior to resettlement, (b) stressful experiences in resettlement, and (c) communication about mental health inside and outside of family groups.     

Long-term planning and decision-making among midlife and older gay men and lesbians

This article examines the issues of long-term planning and decision-making among midlife and older gay men and lesbian caregivers. Using a qualitative methodology, in-depth interviews were conducted with 19 gay men and lesbians over 50. Participants reported on their long-term planning and decision-making processes. All but four persons reported that their partners had advance directives, but the majority of caregivers did not have advance directives for themselves. Concerns about informal family dynamics and interactions with formal systems were expressed, along with financial and ownership issues. It is important for social workers to intervene across individual, organizational, and community levels in advocacy for the needs of older gay men and lesbian clients.     

Key decisions in child protection services in cases of domestic violence: maintaining services and out‐of‐home placement

This paper looks at the response of the child protection services (CPS) system in cases where exposure to domestic violence occurs alone or together with abuse or neglect, focusing on the factors involved in decisions to maintain the case open for ongoing services or remove children from the home. The study is based on an analysis of clinical and administrative data from the files on children reported to a CPS agency in Montreal, Canada. A total of 1 071 substantiated reports were documented, including 337 cases of co‐occurrence (32%). Analysis of the data shows that domestic violence does not by itself constitute a factor liable to lead to more intrusive intervention. The CPS response appears to be influenced more by the existence of other forms of maltreatment and risk factors. Additionally, while domestic violence may be associated with more severe individual and family problems, it does not influence the decision to keep the case open because the child still need services. The lack of any connection between domestic violence and this decision is a cause for concern, as results indicate that such families need help. Knowing how to respond to their needs therefore remains a major challenge.