Surviving Critical Illness: New Insights From Mixed-Methods Research

Current advanced medical technology allows survival of critical illness. However, the patient's psychological response to survival is relatively unexplored. Interviews with 32 older adult survivors, using the Hospital Anxiety and Depression Scale (HADS) and the Experience after Treatment in Intensive Care (ETIC-7) scale, Miller's Q-sort, and social work clinical wisdom, yielded unique and unexpected research results. Four response types were identified: avoiding, depressed, denial, and coping. Psychological agency during illness was found to be important. Participants did not reveal posttraumatic stress disorder–related phenomena predicted in previous literature but instead experienced posttraumatic growth. Hallucinatory experiences during illness were not traumatic, whereas social support emerged as a complicated concept. Participants unexpectedly revealed that childhood trauma was an important factor. Implications for clinical social work practice and research are outlined following the discussion of findings.     

Every child matters: a legal perspective

Recent legal and policy changes, including the introduction of the Human Rights Act, provide the context for the new child welfare and protection policies proposed for England. These proposals are discussed from a legal perspective in relation to early and coordinated intervention, sharing information between agencies and with children and families, partnership with children, information management, and structural and legal change. Consideration is also given to issues overlooked by the Green Paper, such as immigration and asylum, youth justice and the whole family justice system. The discussion concludes by arguing for the need for integrating cultural and structural change and for leadership (and investment of resources) across government to achieve such goals. Copyright © 2004 John Wiley & Sons, Ltd.     

Therapy with Lesbian Couples

Speaking as a therapist and a heterosexual, the author discusses her work with lesbian couples. She suggests that necessary components of good therapy are the therapist's awareness of his or her own views, fears and assumptions about homosexuality, and an understanding of the ways that society, including the world of therapy, still subjugates same sex relationships. Working with lesbian couples raises challenges that are pertinent to the wider issue of the redefinition of couple therapy in a society where the couple relationship itself is being redefined.     

‘Test Driving’ a Financing Instrument for Climate Adaptation: Analyzing Institutional Dilemmas using Simulation Gaming

Urban physical public infrastructure is a frontline defense mechanism to manage and mitigate climate-related impacts. Market instruments are often cited as possible means to spread risk and reduce financial burdens on the public sector. The authors argue that existing research tends to focus on the technical issues of instruments and neglects considering institutional dynamics that may enable or constrain local market-based financing mechanisms. In this article, three core dilemmas (values uncertainty, planning horizon, and indirect benefits) are used to analyze the responses of practitioners to a possible financing instrument. The findings indicate that the practitioner’s responses to tax increment financing were largely shaped by the adaptation dilemmas and not the characteristics of the instrument per se. By mapping the dilemmas onto whether they would recommend it, participants imposed a financial barrier on climate adaptation investments. The authors conclude that a key imperative in the design of policy instruments is to pay attention to the congruency of informal institutions at the ‘street level’ in order to be in-step with the current sociopolitical conditions. The findings also point to four key attributes that a local market-based instrument would need to be aligned and responsive to the Dutch planning and development context.     

Assessing small community groups

Many community groups in the UK do micro-project work to help families and young people in low-income neighbourhoods. This paper establishes a common set of criteria for assessing the effectiveness of small community groups and uses these as basis for developing an evaluation tool for community groups and those working with them. It draws on the literature to identify those factors that are seen to be important to the functioning of community groups, where necessary adapting these to smaller groups. These criteria are then ‘tested’ on a small number of community groups across the UK, using a participative approach and questionnaire to explore these issues with each group. Our framework appears to capture all the key aspects of the groups we visited, although some of the assessment criteria need to be interpreted carefully, helping to refine our own understanding of what makes a good community group. This approach is a useful way for community groups to identify their own strengths and weaknesses and, if developed further, has potential applications in the evaluation of capacity-building schemes.     

‘His mam,my dad,my girlfriend,loads of people used to bring him up’: the value of social support for (ex) offender fathers

This research analyses key findings from qualitative research conducted with (ex) offender fathers and their probation officers. This paper focuses on the critical role of family and social support for (ex) offender fathers who seek to build and maintain relationships with their children. The research reported in this paper shows that the men receive social support, both formal and informal from a wide ranging and complex network of family, friends and practitioners, which facilitates and enables their commitment to fathering. Drawing on social support theory, I argue that identification of support networks recognizes the productive possibilities of vulnerable families which constitute a source of strength and connection to be nurtured in contexts of adversity. This strengths‐based paradigm advocates the need to identify and facilitate family, friendship and professional networks in the context of social work with offenders and their families.     

In Whose Service? Technology,Care and Disabled People: The case for a disability politics perspective

This paper discusses the introduction of telematics technologies, which are advancing rapidly in Britain and throughout the world, and which impact increasingly on the lives of disabled people. The authors argue that, to date, technology-based services have been largely, if not exclusively, determined by the interests of care service professionals, technologists and the commercial sector. Missing from the debate has been the perspective of the disability movement, which challenges professional hegemony, and introduces important issues such as choice, control and access to the wider environment. Such a perspective is needed if technological advances are to empower disabled people and not simply provide administrative solutions to the problems of increasingly hard-pressed service providers.