Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence

ABSTRACT

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

“It's hard work,believe me!”: Active efforts to optimise housing by people who live with mental illness and access housing assistance

Secure and appropriate housing is critical for the well‐being of people living with mental illness (consumers). Yet it is often difficult to achieve. Housing assistance is available, but is often difficult for consumers to access and negotiate. While the need for support is well‐recognised, little is known about the active part consumers play in finding and keeping appropriate accommodation. This paper addresses the research question: How do consumers who use housing assistance actively manage their housing situations? In‐depth interviews were conducted with 18 consumers who had used housing assistance within the past five years. These were analysed using constant comparative analysis, based on a grounded theory approach. Participants engaged in a range of activities to address six major concerns: working toward my home; following the rules to keep what I have; managing and improving my accommodation; working with housing services; living within my current situation; and finding and using supports. All participants described times when their mental health negatively affected their ability to do these activities. The findings highlight the need for housing services and mental health services to collaborate to develop policies and protocols that place reasonable demands on consumers and support their abilities to actively manage their housing situations.     

A Quantitative Evaluation of the Multi-Disciplinary Approach to Prevention Services (MAPS) Program to Protect Children and Strengthen Families

This article presents the results from an evaluation of a state-funded, prevention-based, pilot program called the Multi-Disciplinary Approach to Prevention Services that was designed to reduce the potential for child abuse and neglect. The program served 64 families of various races and ethnicities over two years. A quantitative pretest–posttest design was used to analyze existing program data related to client outcomes including parenting skills, parenting satisfaction, and the use of non-family resources to assist in improving skills and satisfaction. Means comparisons were used to assess the relationship between three standardized instruments (the Parenting Scale, the Eyberg Child Behavior Inventory and the Kansas Parental Satisfaction Scale). Findings indicated a statistically significant improvement regarding resource engagement by families, parenting behaviors and perceptions, and involvement with Child Protective Services. The results from this study offer insight into how to improve parenting behaviors and increase child protective factors for youth who are at risk of maltreatment. In addition, these findings contribute to strengthen the legitimacy of Weiner's Attribution Theory while providing the social work profession with additional data in areas of research targeting the intersection of financially viable prevention programs, family stability, parental education, resources engagement, and the reduction of child abuse and neglect. If additional research supports the efficacy of prevention programs such as MAPS, funding similar programs could lead to improved parenting and decreases in child maltreatment.     

Reducing waiting times in the Italian NHS: The case of Emilia-Romagna

In 2015, the Emilia-Romagna Regional Government implemented a plan to reduce waiting times for elective outpatient procedures. The objective set by the regional government establishes that at least 90 per cent of specialist services are to be provided within the following maximum waiting times: 30 days for the first specialist consultation, and 60 days for diagnostic tests. The plan adopted by the Emilia-Romagna Regional Government is of particular interest because it encompasses a combined strategy. Some of the interventions envisaged in the plan aim at increasing the supply of specialist services. Others address the demand side, seeking to reduce inadequate requests and discourage no-shows by patients. And others focus on combining supply and demand and neutralizing the effects of some perverse incentives. The Emilia-Romagna plan appears to have had a successful outcome. In the first 4 years of implementation, the 90 per cent target has not only been achieved but also widely exceeded.     

Free,free, set them free? Are programmes effective that allow job centres considerable freedom to choose the exact design?

Active labour market programmes are expected to be quite effective if job centres have a substantial degree of freedom to deliver tailor‐made individual services. For Germany, we studied the effectiveness of Schemes for Activation and Integration (SAI), which were introduced in 2009 to grant such freedoms to implement short training and private placement services. We estimated SAI participation effects on welfare recipients’ earnings and employment rate using propensity score matching and rich administrative data. We distinguished between participation in in‐firm training or training in other settings, and considered effect heterogeneity by gender, region and non‐employment duration. Participation substantially improved the participants’ earnings and employment rate, in‐firm training more so than training in other settings. Our employment effect estimates were not considerably larger than those previously found for comparable pre‐reform programmes. A lack of experience with SAI and a still inadequate client focus in the period studied might explain this.     

A qualitative exploration of reentry service needs: The case of fathers returning from prison

The challenge of community and family reentry after a parent's release from prison remains an under‐addressed area of collateral damage stemming from high rates of U.S. incarceration. Many fathers released from prison return to living with family, and later attribute family connections and parent–child contact as key factors in their postrelease success. However, reentry planning is hampered by a dearth of research on family‐focused reentry services, and consequently, often omits attention to resuming family and parenting roles. To address this gap, we conducted 38 semi‐structured interviews with 19 previously incarcerated fathers, 9 co‐parenting mothers, and 10 relatives to explore service needs of fathers during reentry. Findings suggest programs not only should be multimodal, emphasizing family connections complemented by socioeconomic, self‐care, and social support services, but also should be accessible and relatable, offered within the community, and engaging for fathers and family members. Findings reinforce the importance of self‐determination and human agency while underscoring the multiple challenges fathers face upon reentry. By including the voices of those most affected by incarceration, this study advances knowledge to shape reentry programs and policies, contributes to efforts addressing criminal justice inequities, and promotes well‐being among formerly incarcerated parents and their families.     

养老服务的逻辑、实现方式与治理路径

养老服务是不同供给主体将不同内容、质量和价格的养老产品或项目,以不同的方式配送到不同需求老年群体的过程。不同供给主体基于责任驱动和利益驱动,为需求主体提供适应性养老服务,是养老服务的基本逻辑。养老服务的实现,是在特定地域、特定的社会关系网络中,通过优化配置养老服务资源,聚集整合养老服务资本,来保障有质量、有尊严的老年生活。鉴于养老服务供给的多元性和需求的复杂性,养老服务的治理则需要运用先进的合作治理与参与治理理念、选择科学的治理工具和现代化的治理技术,保障养老服务供给与需求的适应性匹配,进而保障养老服务实现方式的有序运行。     

Is There a Woodwork Effect? Addressing a 200-Year Debate on the Impacts of Expanding Community-Based Services

In U.S. social welfare history, many have suggested that if benefits were too attractive, consumers would come out of the woodwork to take advantage of the opportunity. Clinical trials have provided evidence of the woodwork effect’s existence, suggesting caution when expanding home- and community-based services (HCBS). However, it is unclear whether these studies are best suited to assess whether a system-level effect occurs. Using state and federal data tracking Ohio’s long-term services and support (LTSS) system from 1995 to 2015, this paper examines changes in the utilization rates and expenditures of Medicaid LTSS to explore whether a woodwork effect occurred as Ohio moved to improve its LTSS system balance (80% Nursing Home [NH], 20% HCBS) to (49% Nursing Home [NH], 51% HCBS). After accounting for population growth of individuals older than 60 and those with two or more impairments in activities of daily living, there was no change in utilization rates of older people with severe disability (1995: 491 per 1000 population, 2015: 495 per 1000 population) or overall LTSS expenditures (1997: $2.7 million [in 2013 dollars], 2013: $2.9 million). Our results suggest that states can make significant strides in HCBS expansion without increasing the overall long-term services utilization rate.     

Send for the cavalry: Political incentives in the provision of agricultural advisory services

This article examines how political incentives shape the implementation of agricultural advisory service reforms. Using the Uganda experience as a typical case we find that elections incentivized the Government to add a subsidized input component to the existing service. Growing pressures from local politicians, the Ministry of Agriculture and increasingly disgruntled army factions then constituted a strong and interlocking set of further incentives to revert to a recentralized, top‐down model dominated by the new, subsidized input component. Our findings point to how well designed implementation processes can be disrupted by the changing incentive structure, an insight which calls for more patient and much more pragmatic approaches to adopting “trial and error” models rather than more ambitious, but perhaps unrealistic, options.