An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

基于社会服务项目的儿童福利资源整合

当前,我国儿童福利资源存在资源匮乏、供给分散、可获得性弱等问题,而社会服务项目则是解决这些问题的一种路径。以福利治理为理论视角,尝试以一个留守儿童社会服务项目为例的研究发现,该项目通过不同形式的合作整合了来自政府、军队、群团组织、社会组织、企业、社区等资源,提高了福利资源的供给效率,满足了留守儿童多元化的福利需求,但是,由于项目本身的周期性、制度保障的缺乏等限制,导致了项目难以持续发挥作用。因此,基于社会服务项目的福利资源整合只是一种基于实践基础上的暂时的整合,而最根本的还需要在福利制度上进行整合。     

Shit is good: Mental health social work with lives of squalor

This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with particular regard to the transference and countertransference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.     

The Representation of the Family’s Voice in Serious Case Review Reports of Child Maltreatment

Australia and the United Kingdom have mandatory systems of case reviews, which are conducted whenever a child known to welfare or health services has died or been seriously harmed due to maltreatment. In the United Kingdom those conducting case reviews are required to involve family members in their deliberations. This study employed discourse analysis to examine the representation of family voices in 41 Overview Reports of Serious Case Reviews undertaken in England and published during 2014. The findings revealed that the contributions of family members were generally relegated or their legitimacy undercut by the positivist framing of most overview reports. However, the research also identified how the framing of family contributions within an interpretivist paradigm could engender highly complex understanding of deficiencies in child protection systems and lead to crucial new learning for professionals.     

Young People Leaving Care: Participatory Research to Improve Child Welfare Practices and the Rights of Children and Young People

Abstract

This paper discusses participatory research with young people who are leaving public care in Finland to begin independent lives. The aim of the research, organised by SOS Children's Villages International, was to bring about change in alternative care arrangements, particularly those involving young people's transition to independence. The project used a participatory research design based on employing care-leaving peers as co-researchers. This paper adheres to the methodological principles of empowerment in analysing the personal experiences of young people leaving alternative care with the goal of informing good practice. The findings suggest that the peer research method can be an effective means of empowering young people to develop research skills and to be involved in knowledge production, as well as serving as a means of promoting improved services for “care-leavers”, those young people who are leaving either foster care or institutional care. The participatory and peer research method challenges the traditional understandings of expertise and knowledge production. Although the hierarchy between adult researchers and young people as co-researchers is still evident, the method provides possibilities for better understanding the social- and health-service systems and their challenges and pitfalls from a user's perspective.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Long-term care in Spain: Difficulties in professionalizing services

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.