Facing Up to Underfunding: Equity and Retrenchment in Community Care

Local social services departments in the UK are expected to distribute their cash-limited budgets for community care in ways that achieve an equitable allocation of resources in situations where, with present levels of funding, they cannot meet all the needs with which they are presented. This paper discusses a case study of the introduction of a "needs-based" formula to allocate a local authority's budget for home care services and a follow-up survey to investigate whether services reached the people intended to benefit. The article argues that the "gatekeeping" role of community care assessments is important to safeguard equity without the inflexibility of highly standardized tests of eligibility. However, with the new Labour government seeking to reduce dependency on public expenditure, and a growing lobby for national standards of social care, it will be increasingly important that local authorities justifiy their different practices with evidence about how they relate to local needs.     

Social Workers' Use of Spiritual Practices in Palliative Care

Abstract

Numerous studies have examined client use of spiritual and/or religious practices to cope with illness and adversity. This study explores social workers' use of spiritual practices as reflected in their work with palliative care clients. Survey results (n = 327) indicated significant relationships of spiritual practices such as yoga, prayer and meditation to working with palliative care clients. The total number of these approaches is predicted by factors such as theoretical orientation and the social workers' own struggles with palliative care and other issues. Our study supports the need for additional investigation of spiritual issues in practice.     

Facilitating Forgiveness and Peaceful Closure

Abstract

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end-of-life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.     

Is Evidence‐Based Organizational Innovation in the NHS a Chimaera – Or Just Elusive?

Evidence-based adoption of organizational innovations requires explicit definition of the outcomes the innovations are intended to produce. Implementation theory, however, suggests that organizational innovations are often politicized in the sense that the prospect of implementing them provokes conflicts of interests among the parties affected. Then the intended outcomes of the innovation are liable to be formulated ambiguously, misleadingly or not at all, which makes evidence-based organizational innovation unattainable. Analysis of 61 organizational innovations in nine English NHS primary care trusts suggests that while the majority of innovations were not politicized in this way, a substantial minority were. Innovations whose adoption is motivated by evidence can therefore be differentiated from politicized innovations whose adoption is not so motivated, even when they nevertheless do have evidential support .     

Social workers' attitudes towards family group conferences in Sweden and the UK

The New Zealand family group conference (FGC) approach to decision making in child welfare and protection has attracted strong interest among policy makers and professionals all over the world. While New Zealand’s legislation makes use of FGCs more or less mandatory in child protection, other countries permit social workers to refer families to an FGC at their own discretion. Knowledge about social workers’ attitudes towards the model is thus paramount if we want to understand implementation and evaluations of FGCs outside New Zealand. This study looks at attitudes towards and actual referrals to FGCs amongst 219 social workers from 18 local authorities in Sweden and the UK. Results reveal an overwhelmingly positive attitude towards FGCs in both countries. Given these attitudes it was striking that only 42% of the social workers had initiated at least one FGC over an 18‐month period. The number of implemented FGCs was almost exactly the same in Sweden and the UK, after adjusting for time and number of social workers. Possible explanations for this paradox are discussed, using data from the survey and child welfare literature.     

Job demands and job control as correlates of early retirement thoughts in Finnish social and health care employees

Given the ageing workforce, there is an increasing interest in understanding the retirement process. This study examined whether early retirement thoughts can be explained by job demands, job control and their interaction, a hypothesis derived from the job demand-control model of Karasek (). The moderated hierarchical regression analyses of early retirement thoughts were based on a sample of 274 male and 2798 female employees aged 20 to 65 years in Finnish social and health care. Our results suggest that job demands and job control are independent predictors of early retirement thoughts even when adjusted for age, gender, educational level and self-rated health. Furthermore, our results offered support for the interaction effect of job demands and job control on early retirement thoughts. Among people over 45 years old, these associations were even stronger, compared to the whole sample. This indicates that one way to reduce the number of people taking early retirement would be to put the emphasis on psychosocial factors, such as job control, affecting the older workers.     

History of perinatal loss and maternal–fetal attachment behaviors

BackgroundMaternal–fetal attachment (MFA) is an important requirement for optimal maternal–infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/neonatal death) affects maternal attachment in pregnancy.Research question“Does a history of perinatal loss affect maternal–fetal attachment behaviors?”MethodsOne hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly's Maternal–Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann–Whitney tests.FindingsFinding showed that total score of MFA for women with a history of PL (68.95 ± 9.20%) is not significantly different from this score for women without such a history (71.22 ± 11.75%; p < 0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors “differentiation of self from fetus” compared to women without of a history of PL (78.25 vs. 83.21%; p < 0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups.ConclusionIn this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal–fetal attachment behaviors related to “differentiation of self from fetus” in a subsequent pregnancy.     

An Evaluation of a Multifaceted Prenatal Program Serving a Diverse Inner-City Population

ABSTRACT

A multifaceted prenatal program incorporating social service and educational components as well as medical care has been operating in Cleveland, Ohio since 1966. We evaluate this program's effect on reducing infant mortality with data from linked birth, infant death and program files for 1985–87 resident birth cohorts. Adjusted for level of risk, participation in the prenatal program was associated with improved survival of newborns among African-Americans and possibly also Hispanics. However, Non-Hispanic White clients, some of whom may have been of Appalachian background, had an excessively high rate of postneonatal mortality. We discuss several hypotheses which might account for these findings.     

Social Work as Management

Abstract

The purpose of this study was to explore the utilization of corporate management functions, such as planning, organizing, coordinating, motivating, advocating, and monitoring and evaluating, by social work care managers. Method: The sample included 122 care managers in 13 urban hospital settings. Each care manager chose two completed cases, one judged by them to be a good and one a poor case. They then completed an open-ended questionnaire about each case. Results: Content analyses indicated that themost frequently utilized goals and interventions were traditional corporate management functions. Logistic regression analyses indicated that the presence versus absence of 5 management outcome variables (planning, organizing, coordinating the interdisciplinary team, coordinating hospital and community resources, and advocacy), taken together as a scale, correctly predicted 89.1% pre-designated good cases, and 83.8% poor cases. Conclusion: Successful social work cases required the use of corporate management functions.