Re‐Organizing Work Roles in Health Care: Evidence from the Implementation of Functional Flexibility

Functional flexibility has been advocated as a mechanism for improving efficiency and service quality and is, it is argued, especially appropriate to service environments. In recent years the UK public health service has been subject to an ongoing programme of reform, designed to modernize the way in which health services are provided. A central feature of the reform involves breaking down traditional boundaries and the re‐organization of work roles. This article is concerned with examining the implementation of functional flexibility in three health‐care settings. Case‐study data are presented, focusing on the responses of employees and managers to initiatives to work more flexibly. For managers the implementation achieved efficiency gains and improvements to service quality, in spite of some resistance from employees. For employees the outcomes were more mixed. There was evidence of ‘humanization’ through greater job variety, challenge and access to training, but there were also costs in terms of intensification, role confusion and stress. The implications of these findings both for understanding the issues raised by the use of functional flexibility and for the implementation of policies in the NHS involving job redesign are discussed.     

Measuring racial disparity in child welfare

Overrepresentation of certain racial/ethnic groups in the foster care system is one of the most troubling and challenging issues in child welfare today. In response, many states have started reporting outcomes by race and ethnicity to identify disproportionately high rates of system contact. The identification of disproportional representation is the first step in developing targeted strategies to address disproportionality--highlighting where resources should be directed and guiding future research. However, present and future efforts to address disproportionality must be accompanied by statistically sound and meaningful methods of measurement. In this article, we argue for the adoption of a relative rate measure of representation--a "Disparity Index"--as the primary instrument for assessing racial disparity in child welfare.     

MSW Students' Perspectives on Social Work Goals and Social Activism Before and After Completing Graduate Education

This article analyzes perspectives on the goals of the social work profession and social activism of a cohort of MSW students before and after attending their graduate program. This study provides insights into the question about whether and how preexisting values, experiences, and background characteristics affect beginning and ending students' views of the goals of social work and also whether they anticipate being socially active in the future, utilizing a range of strategies to effect change. It found that students from all methods began with a dual (micro and macro) view of social work goals and much activism and then left the MSW program with the same confirmed person-in-environment perspective and a commitment to all types of social activism in even greater numbers.     

Theoretical Perspectives of Male Sexual Abuse: Conceptualization of a Case Study

The purpose of this article is to demonstrate the traumatic impact that sexual abuse can have on a young male's development by addressing mediating dispositions that can render a child vulnerable to the effects of sexual abuse. Consideration is given to three different theoretical perspectives that are not exclusive to male victims but shed light on the impact that sexual abuse can have on the development of a young boy. These perspectives include early family relationships and attachment theory, developmental psychopathology, and trauma theory. These theoretical lenses provide a conceptual understanding into why some victims are vulnerable to the effects of sexual abuse. Each theoretical view is applied to a case study of an adolescent male with a history of early trauma and sexual abuse. Clinical implications are discussed.     

Obesity and Food Choices Among Faculty and Staff at a Large Urban University

Abstract

Objective: In order to address increasing health care costs associated with obesity, this study sought to determine prevalence of overweight and obesity and examine eating behaviors, food choices, health beliefs, and attitudes of university employees. Participants and Methods: An online survey was distributed to > 3,800 faculty and staff at a large public metropolitan university in Winter 2008. Results: Almost half (48%) of 806 respondents were classified as overweight or obese. Compared to those with normal weights, overweight and obese respondents consumed fewer fruits and vegetables (p < .05), were less confident in making healthful food choices (p < .001), and were more influenced by food choices available in on-campus dining facilities (p < .05). Conclusions: Obesity among university employees warrants attention. Because these employees have less self-efficacy and consume less healthful diets than their normal weight colleagues, universities need to improve on-campus access to healthful foods.     

Jewish Hatzolah and the barriers to equivalent Aboriginal Australian cultural adaptation

Insofar as they perceive secularisation as loss of attachment to tradition and community, Orthodox Jews face difficulties somewhat similar to those facing Aboriginal Australians. Both fear that engagement with the wider society equates to loss of cultural particularity. Orthodox Australian Jews have responded to this fear by countering the trend to secularisation and adapting traditional cultural beliefs and practices so that they may be retained while also allowing engagement in modern secular life. Hatzolah is one adaptation that reconciles dissonances between cultural heritage, secular life and good health. My interest in Hatzolah is as a metaphor that may help in exploring the possibility of equivalent Aboriginal responses, whereby Aborigines may negotiate the discourse that, for them, pits culture against health, education and socio-economic status. In this case, powerful discourse makes structured adaptation like Hatzolah less likely than it might otherwise be. Yet in their everyday, Aborigines do negotiate the tensions of being modern, much as Orthodox Jews. I argue that the discursive oppositions are the product of public policy and identity politics that are both invested in a solidary culture, unitary identity and binary difference. I also argue that the emergence of Hatzolah-like adaptations depends on the recognition and full consideration in policy of Aborigines' contemporary lived realities of interculturality, subjective multiplicity and ambiguity.     

The particular challenges of being adopted

The authors propose that constructivism provides a theoretical framework suitable for the complexities of contemporary social work practice. The specific focus is on the areas of confluence of cognitive‐behavioral and psychodynamic theory and technique. Building on their earlier work on psychotherapy integration, the authors extend their notion of “starting where the client is,” is in fact a constructivist concept, critical to the meaning‐making process. Through the use of case vignettes and a select review of the literature from both the psychodynamic and cognitive‐behavioral traditions, the importance of the active participation of both the client and the therapist are demonstrated. The use of the therapeutic relationship is highlighted in both the psychodynamic and cognitive‐behavioral perspectives, as is the social context of the client.