Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

Gender differences in the associations of self esteem, stress and social support with functional health status among older adults with heart disease

This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors were controlled. Men were significantly more likely than women to maintain or improve in functioning. Self esteem, stress, compliance with medication regimens, and marital status were significantly associated with maintenance or improvement of functioning among women. Only age and stress were significantly associated with maintenance or improvement in functioning among men. Findings indicated that: (1) stress and self esteem were stronger predictors of functioning, especially among women, than demographic and clinical factors; and (2) women in the highest quartile of the self esteem distribution were approximately five times as likely to maintain or improve their functioning as women in the lowest quartile.     

Change and Inertia in the New York State Medicaid Personal Care Services Program: An Institutional Case Study

This study analyzes how competing logics (belief systems) of stakeholders have influenced patterns of change and inertia in the development of the New York Medicaid Personal Care Services (PCS) program. A case-study methodology was used to collect documents, statistics, and interview data from four key stakeholder groups: state and city officials, PCS agencies, a labor union, and consumer advocates covering the period 1999 to 2005. The New York PCS program is one of the oldest, largest, and most stable programs in the United States. Its early unionization of workers resulted in relatively generous wages and benefits and made New York number one nationally in PCS spending per capita. In spite of wide support from stakeholder groups, the overall number of participants has gradually declined since 1999. A consumer-directed model of personal care developed in 1995 challenged the status quo and has grown steadily. Resistance by public officials, agency providers, and union representatives to the consumer-directed model has resulted in a small program that is often targeted toward individuals labeled “difficult to serve.” Dominant stakeholders in New York have ensured a stable personal care program that has resisted change and led to program inertia.     

‘The politics of free speech’

The present article addresses the support and supervisional relations of Palestinian Israeli single mothers vis-à-vis their families and communities. It links the theoretical discussion on intersectional analysis with power relations and gender. In this article I focus on the importance of employing analytical models that take into consideration the internal variance within this social category of ‘Palestinian Israeli single mothers' which emerge due to the contradictory social trends typifying Palestinian society in Israel today – models that examine the implications of the complexity of women's lives in discrete locations, the changes society is undergoing, together with processes of discrimination and the strengthening of conservative trends. The article is based on data gathered during in-depth, semi-structured interviews that were conducted and analyzed with a commitment to the principles of feminist research.     

Interpretive Engagement and the Study of Civil Society Networks: An Illustration of Interpretive Methods

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - This article explores the use of interpretive methodologies to study civil society networks within the field of third...     

“The First Mark of Pain”: Toward a child-centered methodological reorientation of social theory,race and corporal punishment in American life

The current white supremacist racial order in America fundamentally relies on fear and pain to shape the subjectivities of Black people in childhood. This violence is most visible when enacted by police officers against unarmed Black youth. A less visible yet more pernicious form of racist violence against Black children is exercised by community proxies such as Black teachers and parents. Annual government reports reveal that Black children are more likely to be injured or killed by their parents than by police. In this paper we inquire as to why, despite the many Black writers who have described parental violence as an intergenerational re-enactment of the violence of slavery, and despite decades of research on the harms of hitting children, social theorists have not analyzed how Black parents can serve as proxies for white supremacist violence. We argue that Black parenting culture has in many ways internalized the white supremacist view that corporal punishment is required to instill the discipline necessary to spare Black youth from police violence and incarceration. We conclude that until social scientists foreground the voices of Black youth in their studies, rather than adults, our ability to understand and confront the reproduction of white supremacist violence will be impeded. We argue that the physical punishment of children in Black families is an aspect of the legacy or “afterlife” of slavery. We contend that this omission persists because Black youth voices are absent from social analysis on the issue of physical punishment, existing only in clinical studies divorced from macro-sociological analysis, and we discuss how this omission occurred as a matter of scholarly history.     

Understanding and reducing stress and psychological distress in older women with heart disease

Stress and psychological distress were assessed in 457 older women who were subsequently randomized to a six-week heart disease management program ("Women take PRIDE") or to a "usual care" control group. Baseline distress was significantly associated with age, symptoms, physical functioning, social support, optimism, and self-esteem (p < .05). Only 20% of women reported their physician had recommended reducing stress. At four months follow-up, intervention women compared to controls were significantly more likely to report reductions in stress levels (p = 0.02) and also showed improvement in emotional behavior (p = 0.09).