Perceptions of Stigma and User Involvement in Child Welfare Services

Correspondence to Dr E. M. Scholte, Department of Social and Behavioural Sciences/Centre for Research on Youth Welfare, University of Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands. Summary This paper explores the perceptions of social disqualificationor ‘stigma’ that service users attributed to publicchild welfare services in random samples of service users takenfrom the Netherlands, a part of Spain (Catalonia) and a partof the United Kingdom (Wales). It was found that, in all threesamples, foster and residential care invoked the greatest senseof stigma, while the health related and the preventive familyservices were perceived as the least stigmatizing types of publicwelfare services. Comparative analysis further revealed thata positive attitude towards the use of public welfare services,a perception of supportive or non-stigmatizing social normsregarding the use of such services, and a perception of publicwelfare services as helpful correlated in all three sampleswith higher levels of user satisfaction and involvement in theservices. It was further found that, in the British and Spanishsamples, a positive attitude towards public welfare services,as well as a perception of public welfare services as helpfulfor their recipients, were the predominating factors promotinghigher levels of satisfactory user involvement in the services,while, in the Dutch sample, a perception of supportive socialnorms was the factor that most promoted satisfactory user involvement.     

Testing the Effects of Similarity on Risky Choice: Implications for Violations of Expected Utility

Our aim in this paper was to establish an empirical evaluation for similarity effects modeled by Rubinstein; Azipurua et al.; Leland; and Sileo. These tests are conducted through a sensitivity analysis of two well-known examples of expected utility (EU) independence violations. We found that subjective similarity reported by respondents was explained very well by objective measures suggested in the similarity literature. The empirical results of this analysis also show that: (1) the likelihood of selection for the riskier choice increases as the pair becomes more similar, (2) these choice patterns are consistent with well-known independence violations of expected utility, and (3) a significant proportion of individuals exhibit intransitive choice patterns predicted under similarity effects, but not allowed under generalized expected utility models for risky choice.     

How do Australian adult mental health clinicians manage the challenges of working with parental mental illness? A phenomenological study

Adult mental health clinicians face a range of challenges that hinder their use of family‐focused practices when working with consumers who are parents. The purpose of this study was (a) to examine clinicians' experiences when working with parents and (b) identify strategies they found to be effective when working with parents. Eleven Australian mental health clinicians were recruited who regularly worked with consumers who are parents. Semistructured interviews were conducted within a qualitative paradigm and analysed using interpretative phenomenological analysis. Themes were identified which related to (a) managing sensitive parenting conversations, (b) making decisions about child safety in unclear or unpredictable situations, and (c) working with child protection services. Participants had developed strategies for managing the challenges of the first two practice issues and suggested organizational changes that could facilitate collaboration with child protection services. The findings highlight that the challenges of working with parents with mental health issues cannot be addressed with a one‐size‐fits‐all approach. Initiatives to facilitate the effective support of parents and their children need to be informed by contextual factors, including clinical practice.     

‘We’re Civil Servants’: The Status of Trauma-Informed Care in the Community

ABSTRACT

Trauma-informed care (TIC) in social service organizations means that the organizations operate with the understanding that everyone involved has possibly experienced trauma in their lifetime. This qualitative study examined local service organizations’ usage of the 5 main principles of TIC: safety, trustworthiness, collaboration, empowerment, and choice (as developed by Fallot & Harris, 2006). Ten focus groups (n = 69) and 6 individual interviews (n = 6) with employees from administration through management were interviewed such that almost all facets of each agency were represented. The participants were asked about their agencies’ policies and practices for utilizing the 5 principles of TIC. The results suggest that the vast majority of organizations in this study implemented many of the principles of TIC with clients, though they had not labeled their practices as “trauma-informed.” However, although clients were receiving TIC, some of the principles were neglected as they pertain to staff, such as choice and empowerment. The findings of this study suggest that agencies are unaware of the relevance of TIC as it relates to staff. It is recommended that future research examine whether the use of TIC in agencies prevents “burnout,” high turnover rates, and vicarious traumatization of staff.     

Accountability in research using persons with mental illness

Although medical research involving the use of persons with mental illness is critically important, in order for the research to be ethical and legal there are certain considerations and restrictions which should be immediately readdressed in order to insure that the welfare of these vulnerable research subjects is protected, and their best interests are assured. A brief historical examination of medical research codes, guidelines, recommendations and Federal Regulations reveals the various considerations and restrictions on informed consent and accountability applicable to the use of persons with mental illness in medical research. Several concerns are raised about how these considerations and restrictions have been interpreted, and specific recommendations are offered to improve them immediately by means of representation from consumers and/or their families, and organizations, e.g., NAMI members.     

Physician duties in the conduct of human subject research

In this article, I examine a skeptical argument against the possibility of ethically justifying risky human subject research (rHSR). That argument asserts that such research is unethical because it holds the possibility of wronging subjects who are harmed and whose consent to participate was less than fully voluntary. I conclude that the skeptical argument is not in the end sufficient to undermine the ethical foundation of rHSR because it fails to take account of the special positive duty researchers owe their clients and future patients. Although the skeptical argument is defeated, it exacts certain novel concessions from the pro‐research position. Of particular importance are the admissions (a) that researchers presumptively owe a fiduciary duty to research subjects, (b) that because the most important risks of rHSR are unknown and unquantifiable that duty must be explicitly waived by all subjects before they participate in any protocol, and (c) that such waivers must be made by individuals who satisfy objective criteria of competence for giving fully voluntary consent. The implementation of procedures responsive to these concerns might have a dampening effect on the conduct of research. However, the article concludes with a consideration of the likely benefits to researchers and society of a more cautious ethical regime.