E-care: a telecommunications technology intervention for family caregivers of dementia patients

OBJECTIVE

This study evaluated the effectiveness of a technology-based psychoeducational intervention for family caregivers of dementia patients. An additional objective was to determine if the intervention could be implemented by a community-based social service agency.

METHODS

Forty-six caregivers were randomly assigned to either a technology-based intervention or an information-only control condition.

RESULTS

Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidenced high depression at baseline experienced a significant decline in depression.

CONCLUSION

This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers.

A road map for the last journey: home telehealth for holistic end-of-life care

The Advanced Illness/Palliative Care (AIPC) program started as a 2-year pilot project to determine if a telehealth model of care would benefit veteran patients with life-limiting illness. The goals of the project were to manage the physical, emotional, functional, and spiritual care needs during the last 2 years of patients' lives and to foster an earlier enrollment of patients into hospice by educating providers about palliative care. The AIPC program partners the skills and expertise of both spiritual and medical care practitioners, along with cutting-edge home telehealth devices to improve symptom management and quality of life for veterans and families coping with end of life.

Pessimism and optimism in inter-professional working: the Sedgefield Integrated Team

The literature on inter-professional working tends to be dominated by explanations for lack of progress rather than accounts of achievements. This paper develops two models, termed the optimistic and pessimistic models respectively, to understand the factors that may underpin different rates of interprofessional achievement. A case study of the Sedgefield Integrated Team in County Durham, UK is used to test out aspects of the models. It is concluded that the grounds for pessimism have been overstated and that the scope for professional integration is greater than tends to be assumed.

Co-operation as a strategy for provision of welfare services a study of a rehabilitation project in Sweden

BACKGROUND

During the past 15 years, there have been many initiatives to improve the integration between different welfare agencies. This study is describing and analysing the co-operation between agencies involved in a rehabilitation project in Sweden, and discussing such inter-agency co-operation as a strategy for provision of complex welfare services.

METHODS

The study is based on a process evaluation, where the co-operation between the agencies was followed and documented during the time of the project. Different kinds of data were collected through interviews, focus groups and diaries. The contents of these data were analysed in order to evaluate the process of co-operation. In addition, there was also an evaluation of the effects of the co-operation, based on official documents, statistics, etc.

RESULTS

The evaluation shows that it was possible to co-operate across the organizational boundaries of the different agencies, but there were obstacles related to organizational and cultural differences of the agencies, divided loyalties of the officials and limited resources available to deal with the complex needs of the clients. At the same time, the commitment and the relations between the officials were facilitating the co-operation.

DISCUSSION

Based on the evaluation of this project, it seems that co-operation could be an effective strategy to deal with clients who need services from different welfare agencies. At the same time, however, it is clear that inter-agency co-operation requires a lot of time and energy and should therefore be used with caution.

The organisation, form and function of intermediate care services and systems in England: results from a national survey

This paper reports the results of a postal survey of intermediate care coordinators (ICCs) on the organisation and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, tick-box and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). The authors discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, they highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate their findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four-hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care, and the evidence for and aims of the policy as part of National Health Service modernisation, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.

[Family at-risk situation: model of care emphasizing health education]

This case study aimed at identifying family dynamics in face of risk situation, and to propose care strategies for health education based on the King's model. The case was a family considered to be at risk in the periphery of Fortaleza, Ceari, Brazil. Data were collected by domiciliary visits, participant observation, and interviews. The results showed that family care transcends the biomedical dimension, contemplates the family's perceptual field, and demands its participation in the elaboration of educational proposals aiming at the social construction of health under a participant and transforming perspective.

Reclaiming Futures: Communities Helping Teens Overcome Drugs, Alcohol and Crime—A New Practice Framework for Juvenile Justice

Increasing numbers of youth entering the juvenile justice system on drug-related charges require new practice frameworks for youth advocates. Screening, assessment and intervention capabilities have not kept pace with the youth who need them. This article presents an overview of a new approach, based on the system of care movement, to integrated care service provision for this population. Utilizing the Reclaiming Futures initiative--being piloted in 10 communities in the United States--as a model for change, the article suggests that juvenile justice, in partnership with treatment and other community stakeholders, can have a positive impact on this social problem.

Collaboration and partnership: a review and reflections on a national project to join up local services in England

The need to provide more joined services in health and social care is now recognized by governments as a major objective, and technology is increasingly seen as the key to achieving it. This paper is based upon the authors' experience as research partners in a national project in England known as FrAmework for Multi-agency Environments (FAME). In the first phase of FAME (April 2003 - October 2004) six local "strands" led by local authorities worked in partnership with service providers and IT suppliers. Each partnership aimed to support collaboration and interaction between professions in a particular set of services (for example, to vulnerable older people or disabled children) through effective and appropriate exchange of information. This paper examines the literature on partnership and collaboration in public services in order to contextualize and reflect upon IT-enabled multi-agency partnerships.

Social enterprise. Risky business

The skills needed to run a social enterprise are similar to those needed for conventional business. Accounts for social enterprises will have a 'double bottom line', showing social benefit as well as profit. Finding a good mentor is vital, as is setting out a clear vision and values in your business plan.

Knights, knaves, pawns and queens: attitudes to behaviour in postwar Britain

The choice agenda is currently one of the most prominent in public policy. One of its main architects, Julian Le Grand, has used the metaphors of knights, knaves, pawns and queens to characterise changing attitudes to questions of motivation and behaviour among public servants and service users. He has said, for example, that, in the immediate postwar period, public servants were perceived as public-spirited altruists (or knights), whereas service users were seen as passive (or pawns). It was only in the mid-1980s that public servants came to be seen as essentially self-interested (knaves) and service users came to be regarded as consumers (queens). However, this highly influential model has undergone remarkably little critical scrutiny to date. This article explores the debate over transmitted deprivation in the 1970s to provide a historically grounded piece of analysis to explore the accuracy and utility of these metaphors. It challenges Le Grand's arguments in three respects. Firstly, a concern with behaviour and agency went much broader than social security fraud. Secondly, the metaphor of pawns is inadequate for characterising attitudes towards the poor and service users. Finally, Le Grand's periodisation of the postwar era also has serious flaws.

APS participatory network case study review

The goal of this project was to establish the feasibility of linking a practice-based research network of Adult Protective Service (APS) workers to an academic institution. To determine whether this newly formed APS research network was feasible, a qualitative research project was attempted with network members who had e-mail. An e-mailed single case study with three questions sent to the 356 network members yielded a 31% return rate. APS workers suggested 73 different ideal and actual services for the case study abuse victim. Half of the respondents were unable to implement the ideal service. Barriers were predominantly financial, victim and daughter cooperation, and availability of resources. It is realistic and feasible to establish an adult protective service research network with an interdisciplinary academic research team.

Supporting the placements of children adopted out of care

This article reports the findings related to adoption support of a Department of Health-funded study: Costs and Outcomes of Non-infant Adoptions. This is the first UK study to comprehensively examine the support provided by Social Services Departments (SSDs), Health, Education, and Child and Adolescent Mental Health Services (CAMHS) beyond the first year of the adoptive placement. The services provided to 80 children, before Adoption Orders were granted, were examined from SSD records. Interviews with 54 adoptive parents then investigated the services provided to 64 of the 80 children post order. Families were initially supported primarily by Social Services but, post order, Health, Education and CAMHS shouldered most of the support responsibilities. A high proportion of the children were seen by these professionals over the course of the adoptive placements but many adopters felt that the services provided had been 'too little, too late'. While there were assessments of children's difficulties, mainstream services typically failed to provide what adopters considered sufficient or effective support. This was also largely true of the services provided by SSDs and is an important message for practitioners if they are to succeed in improving adoption support services.

Hospice use by older adults knocking on the door of the nursing facility: implications for social work practice

Since 1983, federal funding has been available for hospice services. However, research studies have found that hospice is underutilized by people with terminal illnesses and their families. Low-income older adults are particularly at risk for underutilization. This study examined utilization of hospice services by nursing home applicants in one Midwestern state. Characteristics of users and non-users, and potential barriers to hospice use were examined. Findings further document that hospice is underutilized, especially by the Medicaid population, and point to barriers to hospice utilization. Specific recommendations are made to help practitioners increase hospice access.

The production of therapy:the social process of construction of the mother of a sexually abused child

This study qualitatively examined the perspectives of clinical social workers on non-offending mothers of sexually abused children. The study examined whether clinicians still used collusion to explain mothers' behavior, despite research refuting collusion. Findings revealed that, although workers did not use collusion, they still constructed mothers negatively. Multiple contexts of agency practice influenced constructions. Administrative use of authority to implement external constraints led to workers' resistance, which involved humor with gender and ethnic components. The agency's role as a graduate social work teaching site contributed the following: Field instructors transmitted the belief that incest typified severe family difficulties and posed complex assessment and intervention problems. Implications for effective practice are discussed.

Home and hospital; hospice and palliative care: how the environment impacts the social work role

Social workers play key roles on interdisciplinary hospice teams and in hospitals on oncology or palliative care teams. Though palliative care settings include both home hospice and hospital-based consultation services, the different environments and scope of practice impact the role of the social worker. The purpose of this article is to examine the similarities and differences in coordination of care, teamwork, and collaboration in these two fields in order to highlight opportunities for enhancing clinical skills and developing our confidence and presence in asserting social work expertise with our transdisciplinary colleagues.

A systematic approach for providing concrete services and discharge planning based on using information handouts

While information handouts are commonly used in healthcare education, this paper is about social workers systematically developing and using them to provide timely, efficient, and ultimately better patient care for concrete services and discharge planning. How to identify topics and suggestions for composing user-friendly handouts are discussed. Many clinical uses for handouts are considered including: engaging, assessing, and empowering patients, groups, and families. Related uses are considered such as educating the treatment team and students. How handouts can be a crucial bridge to developing a comprehensive, focused social resource database is considered. Follow-up survey results with an inner city VA social work staff (N= 41) confirm that social work discharge planners and non-discharge planners find systematically developed handouts valuable for providing efficient, better patient care.

Integrating health and social services for older adults: a case study of interagency collaboration

As public housing residents age in place, they require health and social services outside of those traditionally offered by housing authorities. A promising response to these emerging needs is for housing authorities to collaborate with local public health departments to deliver coordinated services to older adult residents. Aging residents' health needs include health promotion activities, preventive health services, health education, and mental health services, among others. From 2001-2004 the New York City Department of Health and Mental Hygiene (DOHMH) and the New York City Housing Authority (NYCHA) collaborated to implement the Senior Wellness Project. This outreach program integrated health and social services provided by DOHMH and NYCHA, and delivered these services to older adult residents on site in 21 New York City public housing developments. Services were rendered at senior centers located in the housing developments and in residents' apartments. The program also referred residents to community healthcare providers to address special needs such as addiction. This article retroactively applies a formal model for interagency collaboration, the Stages of Collaboration, to describe and analyze the process of collaboration between DOHMH and NYCHA. It identifies the successes and shortcomings of the collaborative process, and explores the theory that successful collaboration leads to inherent challenges for implementation. Recommendations are then made for other public housing and public health agencies that have considered collaborating to address the needs of public housing residents who are aging in place.

The Olmstead decision and the journey toward integration:the evolution of social work responses

The Olmstead decision declared unnecessary institutionalization as discrimination and triggered an expansion of community-based care for all people with disabilities including the elderly, thus accelerating integration. Setting a context for Olmstead and related social work interventions, this paper describes the evolution of definitions of disability and examines how social work has responded to the development of critical social policies aimed at increasing community integration.

Survey on death and dying in Hong Kong: attitudes, beliefs, and preferred end-of-life care

Social Workers in end-of-life and palliative care have a particular opportunity to ease the dying process by providing culturally appropriate services to the dying and their families. In today's multicultural social environment, with an ever-increasing immigrant population, social workers are challenged to be knowledgeable about diverse cultures. Recently, a forum of health care professionals and social workers in Hong Kong conducted a survey of the general population to assess death and dying attitudes, beliefs, and preferences for end-of-life care. Four-hundred-thirty Hong Kong Chinese participated in a telephone interview. Responses were compared by gender. The survey results not only contribute to an understanding of Hong Kong Chinese, but can inform social workers who practice with Chinese immigrants to the United States.

Collaborative models of patient care:new opportunities for hospital social workers

Hospitals are increasingly recognizing the importance of moving away from the traditional medical model of care to more collaborative models that integrate patients and families into the planning and delivery of healthcare. A few existing studies suggest that collaborative models of care result in higher levels of consumer satisfaction, treatment compliance, effective team performance, and increased care coordination (Gance-Cleveland, 2005; DiMatteo et al., 2002; Reid Ponte et al., 2004; Institute for Family-Centered Care, 2004). Key values underpinning social work practice make medical social workers well-positioned to play leadership roles as hospitals make the shift to more patient-centered care. Specific strategies are presented for medical social workers to use in advocating for change in the way health services are planned and delivered within hospital settings.

Screening for intimate partner violence within a health care setting:a systematic review of the literature

The purpose of this review is to present literature regarding intervention research on Intimate Partner Violence (IPV) screening. Articles were obtained by searching six databases and review of reference pages. Of the articles selected for this review, all measured disclosure rates of IPV screening and five addressed safety practices, one study included both screening and safety practices. Two studies evaluated advocacy's impact on safety and the level of violence. Five studies reported referral initiation to advocacy services. The results suggest that screening is effective in identifying IPV; however, a causal link between screening practices, increased safety practices, and decreased violence cannot be established. Practice and research implications for social work are discussed.

Promoting leadership skills in field education:a university-community partnership to bring macro and micro together in gerontological field placements

Social workers are being called upon to utilize a wide range of skills in practice including not only skills of working directly with clients, but also skills related to practice in organizations such as program management, inter-organizational cooperation, research and evaluation. This article describes an innovative geriatric field education program that prepares social workers with leadership skills in both direct service and management, and engages community agencies as both sites for student learning and as beneficiaries of their professional development projects. Case examples are provided and benefits and challenges to the model are discussed.