Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.     

Bereavement as a Psychosocial Transition: Processes of Adaptation to Change

There are many ways of construing the psychology of loss. This paper describes one such model, which enlightens some, but not all, aspects of bereavement and needs to be used alongside other models. Loss is one aspect of psychosocial transition, the psychological change that takes place whenever people are faced with the need to undertake a major revision of their assumptions about the world. The paper focuses on the ways in which people change or fail to change their internal model of the world in the face of emergent events. Examples are taken from bereavement, loss of a limb, and the succession of losses that mark the course of terminal illness. Implications for identifying people at risk and mitigating that risk are outlined.     

Life after Growing Up in Care: Informing Policy and Practice through Research

Abstract

Existing research on the impact of growing up in care focuses upon either the care experience itself or the period of transition from care to independence. Our knowledge of outcomes largely ceases when former residents of the care system reach their early twenties. There are strong social justice reasons for extending research into the older adult lives of such young people. We know a great deal about the multiple disadvantages that such individuals face as children. But research is largely silent about their subsequent adult lives. While we must be cautious in drawing causal links to the childhood care experience as the time period since life in care extends, we know that early experiences can affect care-leavers across their life course—just as childhood experience affects all adults in a variety of ways. In this review, we highlight evidence drawn from research in Australia, the United Kingdom, Canada, Ireland, and the United States, with particular attention paid to the first two of those countries. We use a wide range of sources and identify areas for further consideration, including access to personal records, mental health, education, and parenting. By doing so, we seek to open up this area for further research with the hope that such research will lead to an increasing recognition of care-leavers' needs and thus to improvements in social policy and service provision.     

Residential Air Exchange Rates in the United States: Empirical and Estimated Parametric Distributions by Season and Climatic Region

The purpose of this paper is to undertake a statistical analysis to specify empirical distributions and to estimate univariate parametric probability distributions for air exchange rates for residential structures in the United States. To achieve this goal, we used data compiled by the Brookhaven National Laboratory using a method known as the perfluorocarbon tracer (PFT) technique. While these data are not fully representative of all areas of the country or all housing types, they are judged to be by far the best available. The analysis is characterized by four key points: the use of data for 2,844 households; a four-region breakdown based on heating degree days, a best available measure of climatic factors affecting air exchange rates; estimation of lognormal distributions as well as provision of empirical (frequency) distributions; and provision of these distributions for all of the data, for the data segmented by the four regions, for the data segmented by the four seasons, and for the data segmented by a 16 region by season breakdown. Except in a few cases, primarily for small sample sizes, air exchange rates were found to be well fit by lognormal distributions (adjusted R² 0.95). The empirical or lognormal distributions may be used in indoor air models or as input variables for probabilistic human health risk assessments.     

A dynamic EM algorithm for estimating mixture proportions

We investigate the use of a dynamic form of the EM algorithm to estimate proportions in finite mixtures of known distributions. We prove a consistency result for this algorithm, which employs only a single EM update for each new observation. Our aim is to demonstrate that the slow convergence rate of the EM algorithm in many applications is of little practical consequence in a situation when data is frequently being updated.     

Indicators of gender equality for American states and regions

The indicators described in this paper are measures of status equality (as compared to measures of status attainment). Status equality was operationalized by expressing the status attainment scores for women as a percentage of the scores for men. Indicators of equality in the economic, political, and legal spheres of life were computed for each of the 50 U.S. states. The indicators were combined to create an overall Gender Equality Index and a subscale for each of the three spheres. Analyses of internal consistency reliability and construct validity are presented. Large state-to-state and regional differences were found for all three spheres. In respect to the overall Gender Equality Index the scores ranged from a low of 19 (i.e. 19% of what is needed for equality with men) to a high of only 60%.Paper presented at the 1986 meeting of the American Sociological Association. The research reported in this paper is part of the State and Regional Indicators Archive (SRIA). A bibliography listing papers and books of the SRIA is available from the Family Research Laboratory, University of New Hampshire, 128 Horton Social Science Center, Durham, NH 03824.     

Overcoming barriers to permanency planning

The authors describe their success with a permanency planning project that emphasized interagency cooperation and worked from the thesis that every child is adoptable if return to the biological family is not possible.