Contrasting perspectives of parents and service providers on respite care in Queensland,Australia

Abstract

Parent-carers need support to continue to care for their child with significant disability in their home. There has, however, been little evidence that respite interventions have consistent or enduring beneficial effects on carer well-being. This article reports the findings of a qualitative study which adopted an Appreciative Inquiry philosophy to interview parent-carers of children with significant intellectual and/or developmental disabilities on how formal support services have helped them maintain their health and well-being, and disability support staff on how they help such parent-carers foster their health and well-being. We conclude that better communication and collaboration between service providers and users, more targeted training of workers, and embracing a person-centred and family-centred approach to respite services are needed. In addition, clearer definition and communication of the scope of respite services are required to best support families of children with significant disability in their home.     

Dementia: challenges for social work education in Europe

ABSTRACT

Dementia has been identified as a global challenge across the spectrum of health and social care (World Health Organisation. (2012) Dementia: A public health priority. Geneva: WHO). This paper will explore the implications of this for social work education and the challenges it poses. There is a lack of this focus on social work with older people and people with dementia (pwd) in social work education. Based on calls for an infusion of content on ageing and dementia in social work curricula, paper proposes that we should adopt a person-centred philosophy alongside gerontological social work competencies to achieve this. The specific aim of this paper, therefore, is to explore how we can use these ideas as teaching tools to engage social work students in the discourse on dementia and to develop appropriate skills to work with pwd, their families and carers.     

Leaving a licensed boarding house: transcending trans-institutionalisation with person-centred transitions

While de-institutionalisation set out with the laudable aim to improve the quality of life of people with disability, the untethering of accommodation from support services has in some cases led to less than desirable outcomes. Poor regulation of for-profit boarding houses licensed to care for people with disability has led to the exploitation and abuse of some of Australia’s most vulnerable and marginalised people. Recognition of this, and a number of other factors, has led to the closure of many of New South Wales’ licensed boarding houses. This research presents the experiences of 15 former residents of licensed boarding houses and their supporters spanning from their time as a resident, the transition to other accommodation and their quality of life post transition. While finding the transition challenging, almost all of the former residents identified improvements in their lives since leaving the boarding house.     

On the Need for an Ethical Understanding of Health-Care Accountability

Abstract

In Sweden, as in many other Western countries, public health care is challenged by increasing demands for care and continuing budget deficits. Person-centred care (PCC) has been introduced as a new strategy to ameliorate the perceived fragmentation in care and is expected to decrease treatment time, reduce the need for return visits, as well as increase patient satisfaction. However, the changing clinical practices necessary for the PCC approach are assumed to require new accountability practices. This article is primarily an attempt to provide a conceptual analysis of ethical accountability, i.e. a type of accountability that takes into account the human relational responsibility, partial incoherence, and power of reflection. On the grounds of this characterisation, the article aims to provide a basis, among other things, for a discussion of the possibilities of identifying and empirically studying the multimodal expressions in communication that are relevant for this type of accountability. After an initial discussion of the debate on the limits of viewing accountability as transparency, we then turn to our methodological approach and introduce a conceptual analysis of accountability. Next, we discuss some additional features of accountability. Finally, we discuss the possibilities of empirically studying the institutionalisation of ethically informed accountability within person-centred health care.     

Effective assessment: a key knowledge and skill for a sustainable profession

Assessment is an essential element of social work practice. However, by trying to realize the so-called triple-mandate of social work, professionals and students on qualifying training sometimes struggle to consider simultaneously client and organizational aspects, and to embrace both outcome-orientation and process-orientation. Societal requirements focus on outcomes and standardized procedures whereas client’s needs require individualized and situationally appropriate consideration. The tensions are more acute with demands for rigorous professional decision making based on evidence, with increased attention to risks. Multiprofessional working has many benefits for clients, but places new demands on social work assessment. Current models are limited in embracing these tensions, and more integrated models are required. Established frameworks together with practice and teaching experience are applied in this paper to extend the traditional Taylor and Devine model to address these contemporary challenges. Elements of a new model (ALOHA) have been trialled on professionals as well as students on qualifying social work training. Such robust assessment models synthesized from theory, research, and best practice are essential to meet contemporary practice challenges, maintain public credibility, and sustain social work internationally.     

The need to bring an end to the era of eligibility policies for a person-centred,financially sustainable future

Attention within the social care sector in England is moving away from consumerist notions of choice towards good professional practice as the route to personalisation. This demands a new focus on how to make practice that is person-centred the norm. The following sets out that this is unlikely to happen until the use of eligibility policies is ended. The lessons are relevant not only to England, but to other countries who may be looking to the United Kingdom as pioneering in the personalisation agenda.     

Person-centred communication in dementia care: a qualitative study of the use of the SPECAL® method by care workers in the UK

Abstract

Communication has featured prominently in person-centred dementia care research, but no consensus has been reached on which communication techniques are most helpful in supporting person-centred care. This qualitative study explored communication techniques used by domiciliary and community care workers of people with dementia in the UK. Care workers trained in the SPECAL® method (Specialised Early Care for Alzheimer’s) were invited to semi-structured interviews. The data were analysed using a constructivist grounded theory approach. Themes from the data were discussed as a potential basis for developing a substantive theory. The care workers contributed to client well-being through modifying their communication techniques, expressing a protective, empathetic and reassuring approach, underpinned by reflection. Clients exhibited greater well-being and less anxious behaviour. The care workers’ use of SPECAL® communication methods, supported by supervision, may provide a unique combination of techniques, contributing to the development of caring relationships, to care worker and client well-being, and to the maintenance of client personhood.     

Types of separation-individuation in relation to mothers and fathers among young people entering adulthood

This paper presents a study on emerging adults’ separation-individuation in relation to parents from a person-centred perspective. The participants, aged 18 through 28 years (N?=?2040, 73% female), offered self-reports on separation-individuation in relation to their mother and father separately. We used the Individuation Test for Emerging Adults (Komidar, L., M. Zupan?i?, G. So?an, and M. Puklek Levpu??ek. 2014. “Development and construct validation of the Individuation Test for Emerging Adults (ITEA).” Journal of Personality Assessment 96 (5): 503–514), specifically designed to tap individuation issues in emerging adulthood. Clustering procedures revealed four internally replicable and structurally consistent types across parents, representing the current relationship dynamics of parent – child relationships. The consistency analysis of cross-parent type membership suggested that about a half of the participants were assigned to the same type of separation-individuation in relation to their mother and father. We considered the individuated-related and the individuated-independent type as healthy separated-individuated yet distinct types, whereas the anxious and the dependent type reflected likely difficulties in separation-individuation. The type membership was significantly associated with the participants’ age, gender, and adult role transitions.     

Conversation takes two: understanding interactions with people with dementia

The term ‘person-centred’ underpins dementia policy and approaches to support people with dementia. However, ‘person-centredness’ remains hazy, and words and definitions matter greatly when they are at the heart of defining what happens in people’s lives. Drawing on data from an ongoing project, this article suggests that conversations which include a person with dementia can elucidate how ‘relational’ support is enacted in practice and the implications this can have on our understanding of ‘person-centredness’. Identities are shaped in part through how we speak to people, and how they speak to us. This is particularly pertinent to the aims of ‘person-centredness’. A conversation analytic approach to dementia support may therefore move us towards seeing ‘personhood’ as jointly constructed and reconstructed through interactions with others.     

Strengths-based practice: social care’s latest Elixir or the next false dawn?

There has never been such a consensus that social care is in crisis in England. However, it cannot be assumed this will result in fundamental rethinking of the future. Social care continues to search for a miracle cure that will painlessly transform it into a system both personalised and will cost less. The current ‘elixir’ is ‘strengths based practice’. This article suggests, however, that the current depersonalising and wasteful practices which strengths based practice is meant to replace are a product of the system within which practitioners work. There is unlikely to be significant change until that system has changed. If the current sense of crisis translates only into short-term action to keep the system afloat, the elixir will most likely be the prelude to the next false dawn.