‘Sitting on the Mourning Bench’: Mental Health Workers and an Elderly Client

Abstract

The present article documents the experience of a first year social work student on fieldwork placement in an Aged Persons Mental Health Service. The student was part of a team providing service to a long-term client of the service when he was diagnosed with a life-threatening illness. The student's compassionate response to the client raises questions about grief and professionalism, which she explored through a journal and in discussion with her supervisor and other team members working with the client. As part of their reflective practice, the student, her supervisor and the client's mental health workers formed a collective to document their experience and present a staff education session. This article is the outcome of these processes and explores important grief issues in Aged Psychiatry and demonstrates the valuable contribution made by a student to the work of the team in the rich learning environment of a fieldwork placement in aged psychiatry. It is published with the kind permission of the client's next of kin.     

Editorial Note: Referees

As the volume of UK social research addressing ethnicity grows, so too do concerns regarding the ethical and scientific rigour of this research domain and its potential to do more harm than good. The establishment of standards and principles and the introduction of guidance documents at critical points within the research cycle might be one way to enhance the quality of such research. This article reports the findings from the piloting of a guidance document within the research commissioning process of a major funder of UK social research. The guidance document was positively received by researchers, the majority of whom reported it to be comprehensible, relevant and potentially useful in improving the quality of research proposals. However, a review of the submitted proposals suggested the guidance had had little impact on practice. While guidance may have a role to play, it will need to be strongly promoted by commissioners and other gatekeepers. Findings also suggest the possibility that guidance may discourage some researchers from engaging with ethnicity if it raises problems without solutions; highlighting the need for complementary investments in research capacity development in this area.     

Gender‐ and Age‐Related Differences in the Association Between Social Relationship Quality and Trait Levels of Salivary Cortisol

The majority of studies linking individual differences in the quality of social relationships and activity of the hypothalamic‐pituitary‐adrenal (HPA) axis have focused on the early development of attachment between infants and their caregivers. Later in development, during middle childhood and adolescence, the parallel HPA links to age‐appropriate social relationships with peers, parents, and siblings remain largely unspecified. This study addressed this knowledge gap. Early morning saliva samples were obtained from 367 children in middle childhood (ages 6–10) and 357 adolescents (M age=11–16 years) on two successive days 1 year apart and assayed for cortisol. Latent state–trait modeling was employed to separate variance in cortisol levels attributable to “stable trait‐like” versus “state or situational specific” sources to minimize the high moment‐to‐moment variation in basal adrenocortical activity. During adolescence but not middle childhood, and for girls but not boys, lower levels of “trait cortisol” were associated with poor quality social relationships. The pattern was robust, extending to the quality of relationships with parents, siblings, and peers. Importantly, the relationship was independent of the rates of internalizing or externalizing problem behavior. We found that isolating the variance in cortisol levels attributable to stable intrinsic sources revealed an interpretable pattern that linked individual differences in basal HPA activity to social relationships during adolescence. Studies are needed to reveal the biosocial mechanisms involved in the establishment of this gender‐ and age‐specific phenomenon and to decipher whether or not individual differences in this hormone‐behavior link are adaptive.     

Outcomes assessment: evaluation in routine practice

Evaluating the quality and effectiveness of human services, whether social services or medical services, is critically important for the providers, for the organization, and for the payers of those services. We propose that outcomes assessment, a continuous model of evaluation designed for routine services settings, can be considered for use in evaluating the effectiveness of human services on a routine basis. In medical care, outcomes assessment measures initial and subsequent disorder-specific and generic outcomes domains as well as prognostic or case-mix characteristics that can be used to adjust outcomes among groups. We describe a current implementation of outcomes assessment in a state mental health system in the US and make recommendations for the future of the field.     

What (a) Difference a Degree Makes: The Evaluation of the New Social Work Degree in England

After many years of debate in the UK about the need for a degree-levelqualification in social work, the arguments for a minimum degree-levelqualification were accepted. The requirements for the degreein England were developed drawing on work from a number of sources,including a benchmark statement for undergraduate degrees insocial work and focus groups with stakeholders. The new degreein England, launched in 2003, involves one extra year’sstudy; improvements in the qualifying standard for social work;and specific curriculum and entrance requirements. At the timeof launching the degree, the government department responsiblefor funding (Department of Health) commissioned a three-yearevaluation of the implementation of the new degree to establishwhether the new qualifying level leads to improvements in thequalified workforce. The aim of the evaluation is to describethe experiences of those undertaking the degree, collect theviews of the various stakeholders about the effectiveness ofthe degree and measure the impact of a degree-level qualificationon those entering the workforce. This article, written by theteam undertaking the evaluation of the England degree, exploresthe reasons for the methodological approach adopted and theissues that have arisen in setting up the research.     

Applying Lee-Carter under conditions of variable mortality decline

The Lee-Carter method of mortality forecasting assumes an invariant age component and most applications have adopted a linear time component. The use of the method with Australian data is compromised by significant departures from linearity in the time component and changes over time in the age component. We modify the method to adjust the time component to reproduce the age distribution of deaths, rather than total deaths, and to determine the optimal fitting period in order to address non-linearity in the time component. In the Australian case the modification has the added advantage that the assumption of invariance is better met. For Australian data, the modifications result in higher forecast life expectancy than the original Lee-Carter method and official projections, and a 50 per cent reduction in forecast error. The model is also expanded to take account of age-time interactions by incorporating additional terms, but these are not readily incorporated into forecasts.