Uncounted care

Family care (care for dependent persons at home by family members and friends) is widely endorsed, politically and personally, as the chronic care option that is superior to institutionally-based, formal care services. Politicians, health planners, and analysts may be especially supportive of a preferred form of care which is also believed to be economical. But the full costs of family care, including the value of the unpaid work of caregivers, are rarely acknowledged. This article reviews studies of caregiving and its costs and acknowledges the gender bias inherent in caregiving which has been regarded as free before its costs were calculated. Policy and health care practice will benefit from examination of both the costs and benefits of family care.Debbie Ward is Assistant Professor in the Community Health Care Systems Department of the School of Nursing (mail stop SM-24) at the University of Washington, Seattle, WA 98195. She trained as a family nurse practitioner at Yale University in New Haven, Connecticut, and earned her Ph.D. in health policy from Boston University. Her research interests include women's paid and unpaid labor, and public health policy.     

The Impacts of Acculturative Stress and Social Competence on the Mental Health of Mainland Chinese Immigrant Youth in Hong Kong

Correspondence to Dr Daniel Fu Keung Wong, Associate Professor in the Department of Social Work and Social Adminstration, 1317 K K Leung Building, The University of Hong Kong, Pokfulam Road, Hong Kong.E-mail: dfkwong{at}hkucc.hku.hk Summary Attempts were made to examine migration stressors, social competence,and mental health status of immigrant youth in Hong Kong andto examine the effects of social competence on stress and themental health of immigrant youth. Data on 106 immigrant youth,which were collected through a structured questionnaire, wereanalysed. It was discovered that immigrant youth found survivalissues and losses, rather than cultural differences and unfulfilledexpectations, to be stressful. Male immigrant youth exhibitedmore psychological distress symptoms than female immigrant youth.Hierarchical regression analyses revealed that social competenceexerted moderating effects on stress and the mental health ofimmigrant youth. Immigrant youth who had a higher level of socialcompetence, in terms of self-control, empathy, assertivenessand the ability to read social cues, had less stress and enjoyedbetter mental health. In conclusion, personal and socio-culturalreasons are put forward to explain the findings. Practice andpolicy implications are also discussed.     

The empirical basis of risk assessment in child welfare: the accuracy of risk assessment and clinical judgment

The importance of risk assessment is juxtaposed with the lack of empirical support regarding the validity of risk inventories. This study compared risk ratings of one risk assessment tool to decisions made by case managers. The researchers sampled 450 children and compared predictive utility of risk assessment to child protection decisions. Risk assessment was consistent with clinical judgment in 74% to 81% of cases, more than previously reported in studies of risk assessment validity. Further analyses identified discriminate functions at the instrument's category and individual-item levels. The results have implications for the validity of the instrument and its utility in child welfare.     

Substance use during sexual and physical assault in HIV-infected persons

Data from the HIV-Alcohol Longitudinal Cohort was used to determine the prevalence of substance use by victims and assailants during physical and sexual assault against HIV-infected persons and whether these findings differed by gender. Of the sexually assaulted participants, 31% of victims and 70% of assailant(s) had used drugs/alcohol during sexual assault. Compared with men, women had higher odds of substance use during sexual assault (adjusted odds ratio [OR] 3.8, 95% confidence interval [CI] 1.6 to 8.7) and of substance use by their assailant(s) during sexual assault (adjusted OR 5.9, 95% CI 1.7 to 20.6) in adjusted analysis. Of the physically assaulted participants, 66% of victims and 85% of assailants used drugs/alcohol during physical assault; these results did not differ by gender.     

Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys

South Africa is unique in being a developing country which has asked questions on pregnancy-related deaths in both its 2001 census and 2007 household survey, and monitors maternal and pregnancy-related mortality through vital registration and a confidential enquiry into maternal deaths. These sources of data provide a wide range of estimates of maternal mortality for the country. This paper examines these estimates to assess to what extent the differences between them are due to data deficiencies, methodological deficiencies or definitional differences. The results show that since maternal deaths are relatively rare it is fairly difficult to establish the maternal mortality rate with a great degree of accuracy in a setting where data are less than perfect. They also show that to some extent the differences are due to differences and errors in processing of data but that pregnancy-related mortality should not be treated as synonymous with maternal mortality. However, after adjustment, pregnancy-related mortality from vital registration was comparable with the level that may be expected using several alternative approaches, while the rate reported by households in census and surveys was about double that from vital registration. Nonetheless, all the data indicate an upward trend in maternal mortality that is in keeping with the impact of the HIV/AIDS epidemic, which is likely to have contributed to the discrepancies.     

Constructing undesirables: A critical discourse analysis of ‘othering’ within the Protecting Canada's Immigration System Act

Immigration policy in Canada has recently shifted, reflecting changes in other Western countries. We studied the discursive constructions of forced migrants within Bill C‐31 “Protecting Canada's Immigration System Act” and its associated Backgrounder documents published by the Canadian Government. The documents were analysed using an approach to critical discourse analysis adapted from Bacchi's (2009) methodology and informed by a theoretical framework of “othering”. Particular groups of migrants were represented as posing threats to the economy, the integrity of the refugee system, and national security. The documents offered three solutions: the creation of specific categories of migrants, an emphasis upon efficiency of the system, and expanded powers to the government. The problematization of asylum seekers as posing multiple threats to Canadian society obfuscates governmental responsibilities to this population and reflects common strategies of neoliberal governance.     

The Nature and Extent of Substance Use Education in Qualifying Social Work Programmes in England

Alcohol and other drug (AOD) use is a common feature of modern social work practice. Concerns about the problematic use of such substances cross all areas of social work practice, including adults' and children's social care. In England, surveys have highlighted social workers' experiences of AOD education during their qualifying social work training. However, this study sought the perspectives of the social work educators. Its primary aim was to explore the nature and extent of education on AODs on the qualifying social work programmes in England. Using an online survey tool, all qualifying social work programme leads were invited to take part (n = 157). Fewer than half responded (40%, n = 63). Initial findings appeared positive suggesting that 94% of responding qualifying programmes provided some teaching and learning on AODs. Further analysis revealed significant variation in what is taught and the depth of coverage. It highlighted a lack of consistency across programmes and possible over-reporting. However, the majority of respondents felt that teaching and learning on AOD use should be a higher priority for their qualifying social work programmes.     

The Development of Employment-Based Education on Substance use for Social Workers in England: Embedding Substance use Training in Frameworks of Continuing Professional Development

Service users in the social care sector affected by substance use need a workforce which is skilled at protecting and supporting them, and who are able to carry out their roles and responsibilities with confidence. Workforce/Learning Development departments in children's and adults' services in England play an important role in preparing social workers to engage effectively with service users and to develop as practitioners. Drawing on data from a survey of 94 Workforce/Learning Development departments, this article examines the development of employment-based education on substance use. Only 33% of these departments had a dedicated training strategy or series of programmes on substance use, although more than half (59%) provided tools for identifying and assessing substance use. A wide range of professionals were involved in the development of this training, particularly those in specialist safeguarding and substance use roles. Social work and substance use textbooks are the main source of materials accessed to support training development. A lack of strategic engagement with substance use in social care was one of the barriers cited to adequate training provision. Implications for social work education include the importance of embedding AOD education in post-qualifying training frameworks at both university and employer levels.