Preparing Social Workers for the Inevitable

Despite the centrality of grief as a universal response to loss, and its prevalence in the social work domain, little empirical attention has been given to the impact of grief instruction in social work courses. This article presents results of a study examining the impact of a multimethod grief course on graduate social work students' level of death acceptance and sense of preparedness to respond to personal and professional losses. A quasi-experimental, nonequivalent control group design was used. Findings suggest that the grief course assisted students to perceive greater competence in their knowledge, skills, and sense of preparation for working with grieving clients, and that the course increased cognitive and affective dimensions of death acceptance in students. Implications for future research and for social work education are discussed in light of the study limitations.     

Enhancing Palliative Care for Low-Income Elders with Chronic Disease: Feasibility of a Hospice Consultation Model

Challenges exist in assimilating palliative care within community-based services for nursing home eligible low-income elders with complex chronic illness as they approach the end of life (EOL). This study assessed the feasibility of a consultation model, with hospice clinicians working with three Care Wisconsin Partnership Program teams. Consults occurred primarily during team meetings and also informally and on joint patient visits and were primarily with the palliative care nurse addressing physical issues. Fifty-seven percent of consultant recommendations were implemented. Benefits of consultation were identified with focus groups of clinical staff as were opportunities and barriers to the implementation. Models of integration are proposed.     

Team effects on compensation: an application to salary determination in the National Hockey League

Studies of salary determination largely model pay as a function of the attributes of the individual and the workplace (i.e., employer size, job characteristics, and so forth). This article empirically investigates an additional factor that may influence individual pay, specifically coworker productivity. Data from professional sports are used to evaluate this question because both salary and teammate performance measures are readily available. We find that team attributes have both direct effects on an individual's pay, and indirect effects through altering the rates at which individual player productive characteristics are valued.     

The Quality Indicator Survey: Background,Implementation, and Widespread Change

The Quality Indicator Survey (QIS) is the most comprehensive regulatory change to the nursing home survey process since the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). In this article we describe the policy evolution that led to the QIS, summarize the QIS method and implementation, and profile the QIS survey results. Following over a decade of development, in 2007 the Centers for Medicare and Medicaid Services (CMS) began the national rollout of QIS. The intent was to improve consistency in the nursing home survey and to render the survey process more resident-centered and aligned with the intent of OBRA-87. We reviewed policy reports and firsthand accounts from the lead developer of the QIS methodology and leader of the national training contract for QIS. Changes in survey findings are profiled based on analysis of the publicly available Nursing Home Compare database from 2004 to 2010. Nineteen states implemented the QIS between 2007 and 2010, with nearly 20% of U.S. nursing homes receiving QIS surveys in 2010. Nursing homes surveyed with the QIS received more survey deficiencies on average than in the traditional survey; however, average numbers of deficiencies across states became more similar over the early implementation of QIS, with lower-than-average geographic areas experiencing increases and higher-than-average geographic areas experiencing decreases in survey deficiencies. The explicit and structured questioning of residents in the QIS is associated with increases in deficiencies related to choice, dignity, dental care, and nurse staffing. We describe ways in which the QIS affected the regulatory agencies, providers, and resident communities, although these effects are difficult to quantify. CMS's implementation of QIS is a significant step toward a more resident-centered, comprehensive, and consistent survey process. Substantial changes, however, are required not only among regulators but also among nursing homes. We argue that these new expectations and norms surrounding quality assessment and quality assurance are an important component of achieving culture change in U.S. nursing homes.     

A statewide introduction of trauma-informed care in a child welfare system

Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff.