Addressing the workforce crisis in (rural) social care: A scoping review

BACKGROUND

This scoping review identifies strategies potentially addressing the 'workforce crisis' in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.

METHODS

The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.

RESULTS

The most common strategies for addressing social care workforce shortages were to improve recruitment and retention ('recruit and retain') processes without materially changing the workforce composition or service models. Further strategies involved 'revitalising' the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved 're-thinking' social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.

CONCLUSION

The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.

Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York

BACKGROUND

In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY.

METHODS

We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023.

RESULTS

There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12).

CONCLUSIONS

We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.

Social care data and its fitness for integrated health and social care service governance: an exploratory qualitative analysis in the Dutch context

INTRODUCTION

To date, little is known on how social care data could be used to inform performance-based governance to accelerate progress towards integrated health and social care.

OBJECTIVES AND DESIGN

This study aims to perform a descriptive evaluation of available social care data in the Netherlands and its fitness for integrated health and social care service governance. An exploratory mixed-method qualitative study was undertaken based on desktop research (41 included indicators), semi-structured expert interviews (13 interviews including 18 experts) and a reflection session (10 experts).

SETTING

The Netherlands; social care is care provided in accordance with the Social Support Act, the Participation Law and the Law for Municipal debt-counselling.

RESULTS

This study found six current uses for social care data: (a) communication and accountability, (b) monitoring social care policy, (c) early warning systems, (d) controls and fraud detection, (e) outreaching efforts and (f) prioritisation. Further optimisation should be sought through: standardisation, management of data exchange across domains, awareness of the link between registration and financing, strengthening the overall trust in data sharing. The study found five ways the enhanced social care data could be used to improve the governance of integrated health and social care services: (a) cross-domain learning and cooperation (eg, through benchmarks), (b) preventative measures and early warning systems, (c) give insight regarding the quality and effectivity of social care in a broader perspective, (d) clearer accountability of social care towards contracting parties and policy, (e) enable cross-sector data-driven governance model.

CONCLUSION

Although there are several innovative initiatives for the optimisation of the use of social care data in the Netherlands, the current social care data landscape and management is not yet fit to support the new policy initiatives to strengthen integrated health and social care service governance. Directions for addressing the shortcomings are provided.

Evaluating whole system reforms: A structured approach for selecting multiple outcomes

Whole-system reforms, including devolution and integration of health and social care services, have the potential to impact multiple dimensions of health system performance. Most evaluations focus on a single or narrow subsets of outcomes amenable to change. This approach may not: (i) capture the overall effect of the reform, (ii) identify the mechanisms through which system-wide changes may have occurred, (iii) prevent post-hoc selection of outcomes based on significant results; and (iv) facilitate comparisons across settings. We propose a structured approach for selecting multiple quantitative outcome measures, which we apply for evaluating health and social care devolution in Greater Manchester, England. The approach consists of five-steps: (i) defining outcome domains based on a framework, in our case the World Health Organisation's Health System Performance Assessment Framework; (ii) reviewing performance metrics from national monitoring frameworks; (iii) excluding similar and condition specific outcomes; (iv) excluding outcomes with insufficient data; and (v) mapping implemented policies to identify a subset of targeted outcomes. We identified 99 outcomes, of which 57 were targeted. The proposed approach is detail and time-intensive, but useful for both researchers and policymakers to promote transparency in evaluations and facilitate the interpretation of findings and cross-settings comparisons.

Impact of the COVID-19 Pandemic on Social Service Organizations in a Clinical-Community Collaboration

Increasingly, interventions are being developed to promote collaboration across health care and social service (such as food, housing, and transportation) sectors. During the COVID-19 pandemic, demand for social services grew while social service organizations' capacity declined due to constraints on staffing, funding, and operations. We used an organizational survey fielded from July through November 2020 and publicly available, county-level data to assess the pandemic's impact on 253 social service organizations in the Accountable Health Communities Model evaluation. Over half of surveyed organizations reported being severely impacted by the pandemic, and 92% reported being at least moderately impacted. Social service organizations without federal funding and those in counties with lower poverty (smaller proportion of residents in poverty) and higher COVID-19 case rates were most impacted by the pandemic. Understanding the pandemic's burden on social service organizations can inform planning for future collaborations across health care and social service sectors.

Women and Incarceration: Introducing a Gendered Lens into Smart Decarceration

Given the scope of mass incarceration, it is quite appropriate that promote smart decarceration (PSD) has been identified as one of the 13 Grand Challenges for Social Work. The aims of PSD are both ambitious and critical but do not address women explicitly. The authors argue that PSD should incorporate a gendered lens because a gender-responsive framework is critical for these three reasons: (1) women's pathways to incarceration are different than men's and are shaped by their social status and multiple forms of marginalization based on race, socioeconomic status, gender, and other factors; (2) women face gender-specific needs behind bars (especially those related to reproductive health) and have higher rates of behavioral health needs (e.g., mental health disorders, substance use issues) than men; and (3) although men and women face similar reentry challenges (e.g., housing, parenting, economic hardship, behavioral health), women experience many of these risk factors at higher rates, and their social status shapes how these needs impact their reentry. Until social workers and other advocates consider all the various and intersecting identities of all those impacted by the criminal legal system, they will be never be successful in ending mass incarceration.

Is It "Aging" or Immunosenescence? The COVID-19 Biopsychosocial Risk Factors Aggravating Immunosenescence as Another Risk Factor of the Morbus. A Developmental-clinical Social Work Perspective

COVID-19 has proliferated ageism. The impetus of this article is to show that immunosenescence is a risk factor to COVID-19 and not aging per se. Based on the idea that some older people are also healthier than younger ones, the emphasis of this article is on immunosenescence and not aging as a risk factor of COVID-19 complications. The paper utilizes a biopsychosocial approach to expound on the link between immunosenescence and COVID-19 risk factors. The article explores biological factors such as malnutrition, comorbidities, substance abuse, and sex. It also expands on psychosocial factors such as mental health disorders, homelessness, unemployment, lack of physical exercises, stigma, and discrimination. The article calls for gerontological social work to assume a developmental-clinical social work perspective to prevent the early onset and progression of immunosenescence. It calls for gerontological social work to prevent factors that promote unhealthy aging. The article promotes a preventative stance to practice and not just curative approaches. Treatment involves primary prevention which emphasizes on avoiding the onset of unhealthy aging. It is this approach that gerontological social work should aim also to address in building resilience in the face of pandemics.

Employing telehealth strategies for opioid addiction during COVID-19: implications for social work health care

As the COVID-19 global pandemic continues, more than 40 states have reported increases in opioid-related mortality. The issue of service access and delivery poses a major concern for those struggling with mental illness and substance use disorders in the United States. To ensure the continuity of health care during the pandemic and the co-occurring opioid crisis, the United States continues to adapt its healthcare delivery strategies, which include the introduction of telehealth. Telehealth is a relatively new concept and requires rapid systems changes as well as adjustments from both service providers and recipients. The proper adaptation to the new service delivery method could result in process optimization and improved outcomes for those struggling with opioid dependency. This study aims to bring attention to the opioid crisis that may be overlooked in light of the global pandemic and encourage social workers and other mental health professionals to utilize modern technological advancements to improve service delivery to their clients. This paper offers a literature review with four themes: (1) a retrospect on pain and opioids, (2) current telehealth models and practical strategies, (3) social work roles and functions in telehealth care, and (4) next steps and implications of telehealth for social work as a much-needed health-care delivery tool at the clinical and community social work practice level.

Aligning Health Care and Social Services to Reduce Hospitalizations and Emergency Department Visits: An Evaluation of the Community Care Connections Program

BACKGROUND

Integration of social services in health care delivery is increasingly recognized as a potential strategy for improving health and reducing the use of acute care services. Collaborative models that provide older adults with case management, linkages to social services, and assistance with health care navigation have emerged as promising strategies.

OBJECTIVE

The objective of this study was to evaluate the Community Care Connections (CCC) program, a cross-sector collaboration designed to align social and health care services for older adults.

RESEARCH DESIGN

We compared hospitalizations and emergency department (ED) visits 90 days after enrollment with a propensity score-matched group of non-CCC patients. Subgroup analyses were also conducted for adults with hypertension, diabetes, and high cholesterol.

SUBJECTS

A total of 1004 patients enrolled in CCC between June 1, 2016, and November 15, 2018, and 1004 matched patients from the same metropolitan area.

MEASURES

Mean hospitalizations and ED visits per patient 90 days after CCC enrollment.

RESULTS

Mean hospitalizations were lower among CCC patients 90 days after enrollment than among non-CCC adults [difference=-0.039, 95% confidence interval (CI): -0.077 to -0.001, P=0.044]. They were also lower among CCC patients with hypertension (difference=-0.057, 95% CI: -0.103 to -0.010, P=0.017). However, 90 days after enrollment mean ED visits were higher among CCC patients relative to non-CCC adults (difference=0.238, 95% CI: 0.195-0.281, P<0.001).

CONCLUSIONS

Connecting older adults to social services while being served by the health care system may lead to decreases in hospitalizations. Cross-sector partnerships that address social and economic needs may reduce the use of costly health care services.

Vers une décolonisation des ressources de soins et services sociaux : les travailleurs communautaires locaux au Nunavik

OBJECTIVES

According to the World Health Organization, discrepancies in health statistics reflect unequal access to resources. The Truth and Reconciliation Commission of Canada calls for an increase in the number of Indigenous workers within health and social services. The involvement of local community workers is essential to ensure the cultural security of care and the decolonization of services. This article presents the role played by these workers in the expansion of mental health services and social interventions in Nunavik, the contextual considerations that influence their practice and their place within professional teams.

METHODS

A thematic analysis was conducted on semi-structured interviews done in 2016 with 60 Inuit and non-Inuit individuals working in the broad field of health and social services in Nunavik.

RESULTS

The integration of local community workers is perceived to bring several benefits, including the improvement of interventions and unique learning opportunities. However, several factors hinder this collaboration, such as clarity of mandates, access to pre-requisite training and diplomas, recognition of local knowledge, and staff turnover. More flexibility and support after hiring would allow for the service structure to be adapted to the complex reality of Nunavik.

CONCLUSION

This article adds to the body of literature highlighting the importance of collaboration with local community workers. The decolonization of services necessarily involves redesigning structures in order to recognize their contribution and to give a place to local knowledge.

Impact of the COVID-19 pandemic on persons with multiple sclerosis: Early findings from a survey on disruptions in care and self-reported outcomes

OBJECTIVE

To describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing.

METHODS

A cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic.

RESULTS

Persons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer's stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person.

CONCLUSIONS

The quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.

Social work and telehealth: How Patient Aligned Care Team (PACT) social workers in the Veterans Health Administration responded to COVID-19

In March 2020, the Veterans Health Administration (VA) responded to pandemic shutdowns with a rapid pivot toward providing services via telehealth. Using data on Veterans who received interventions from social workers between 2019 and 2020 at sites that participated in a national program to increase social work staffing in primary care, we examined changes in frequency and modality of social work encounters that occurred with the onset of the COVID-19 pandemic. We found that primary care social workers maintained a consistent level of engagement, with increases in telephone and video telehealth encounters as in-person visits decreased. Through front-line perspectives, we discuss the practical innovations and policies that enabled those changes in care from VA primary care social workers.

Addressing the social needs of individuals with food allergy and celiac disease during COVID-19: A new practice model for sustained social care

COVID-19 has led to high rates of food insecurity. Food insecure patients with food allergy and celiac disease are especially vulnerable during the pandemic when foods become limited. This paper describes a practice innovation implemented by a community-based organization, Food Equality Initiative (FEI), whose mission is improving health and ending hunger among individuals with food allergy and celiac disease. FEI responded to the pandemic by converting their in-person pantries to a contactless delivery of safe foods. The practice innovation is discussed in relation to three system-level elements necessary to sustain the integration of social care into the delivery of healthcare.

Covid-19: A critical time for cross-sector social work care management

Covid-19 has profoundly impacted social work and has exposed the existing inequities in the health care system in the United States. Social workers play a critical role in the pandemic response for historically marginalized communities and for those who find themselves needing support for the first time. Innovative approaches to care management, including the Center for Health and Social Care Integration (CHaSCI) Bridge Model of transitional care provides a foundation from which social workers can rise to meet these new challenges.

cAIR: Implementation of peer response support for frontline health care workers facing the COVID-19 pandemic

Purpose: While global pandemics such as the COVID-19 public health crisis are known to increase the likelihood of frontline health care workers experiencing the negative effects of stress and trauma, many health care workers on the frontlines of the COVID-19 pandemic lack adequate support. This paper presents the findings of a social work led peer support model, COVID-19 Am I Resilient (cAIR), developed and deployed during the first wave of the COVID-19 pandemic.Methods: This quality improvement initiative was developed and piloted within the Clinical Education and Practice department at a large urban health care system. The pilot included provision of peer support through synchronous video presentations, one-on-one peer support, and resourcing and referral. Pilot outcomes of feasibility and staff engagement were evaluated using participant responses to an online survey as well as attendance records at project activities.Implications: Developed to help frontline health care workers thrive in the midst, and wake, of the COVID-19 pandemic, the pilot study of the cAIR peer support model has implications for further development and implementation of peer support for typically underrepresented health care disciplines working during the COVID-19 pandemic as well as future public health emergencies.

Virtual family town hall: An innovative multi-family telehealth intervention during COVID-19

The COVID-19 pandemic has posed unprecedented challenges to the U.S. mental healthcare system. Immediate action has been required to transform existing social work practice models to ensure uninterrupted delivery of essential mental health services. This paper describes how clinicians in a residential program, who offered an in-person multi-family education workshop, rapidly pivoted in the context of the pandemic to develop and implement an alternative and unique multi-family intervention model - a virtual family town hall. This innovative telehealth practice model serves as an exemplar of best practices amidst the COVID-19 pandemic as it prioritized health and safety, increased accessibility, and allowed clinicians to effectively respond to family members' heightened informational needs.

Supporting families struggling with food insecurity during the COVID-19 pandemic: An innovative cross-sector collaboration

Food insecurity is an ongoing and persistent problem for many individuals and families in the United States and in New York City. The COVID-19 pandemic has exacerbated the scope of the problem and data show that food insecurity rates have increased almost three times over pre-COVID rates. In addition, with unemployment increasing daily and the closure of safety net programs and services, there became a need for creatively attending to the basic needs of individuals and families. SCO Family of Services (SCO), a large human service provider in New York City and Long Island, launched an innovative project with DoorDash during the early days of the COVID-19 pandemic and successfully got food into the homes of more than 1,900 families. This article discusses the practice innovation, project impact, lessons learned, and social work implications.

In the Global Epicenter: Social Work Leadership in a New York City Hospital

The Mount Sinai Hospital in New York City was in the epicenter of the COVID-19 pandemic and had to transform from a tertiary to crisis care hospital and increase its bed capacity by 50 percent to care for COVID-19 patients. The size, scope, complexity and uncertainty of this crisis was unparalleled. This article describes the comprehensive response of the Department of Social Work Services, one of the largest hospital social work departments in the country. The response was informed by four Departmental principles, as well as crisis intervention strategies. This article describes organizational structures, practice models, policies, and protocols developed to respond quickly and effectively, given infection prevention mandates, to patient, population and workforce needs. Finally, it includes how social workers addressed COVID-19 related physical and psychosocial needs and applied and modified interprofessional communication and collaboration. Lessons learned and clinical and administrative changes that will assist in navigating "new normal" operations are discussed.

Social work leadership in a medical school: A coordinated, compassionate COVID-19 response

The COVID-19 pandemic has exposed the systemic inequities in our health care system and society has called for actions to meet the clinical, psychosocial and educational needs in health care settings and communities. In this paper we describe how an organized Department of Health Social Work in a medical school played a unique role in responding to the challenges of a pandemic with community, clinical, and educational initiatives that were integral to our community's health.

Supporting survivors of campus dating and sexual violence during COVID-19: A social work perspective

The issue of dating and sexual violence (DSV) on college campuses has received increased attention nationwide as a criminal justice and public health issue. College and university employed social workers play a critical role in preventing and responding to campus DSV through direct clinical services to students as well as prevention through educational programming and training. COVID-19 has negative implications for DSV student victims, as well as service delivery and accessibility. This paper examines the innovative methods used by university employed social work clinicians and educators to meet evolving mental health care needs and continue violence prevention services during COVID-19.

Hearts above water: Palliative care during a pandemic

Social workers and nurses, as members of interprofessional palliative medicine teams, faced unfamiliar challenges and opportunities as they endeavored to provide humanistic care to patients and families during the coronavirus (COVID-19) pandemic. Typical methods for engaging patients and families in medical decision-making became thwarted by visitation restrictions and patients' dramatic health declines. This paper presents an innovative social work and nursing intervention aimed at enhancing humanistic patient/family care and advanced directive dialogs. Through incorporating a narrative synthesis of the teams' reflective journals from COVID-19, the paper chronicles the intervention implementation, patient/family responses, and team members' personal and professional meaning-making processes.

Healthcare and education networks interaction as an indicator of social services stability following natural disasters

Healthcare and education systems have been identified by various national and international organizations as the main pillars of communities' stability. Understanding the correlation between these main social services institutions is critical to determining the tipping point of communities following natural disasters. Despite being defined as social services stability indicators, to date, no studies have been conducted to determine the level of interdependence between schools and hospitals and their collective influence on their recoveries following extreme events. In this study, we devise an agent-based model to investigate the complex interaction between healthcare and education networks and their overall recovery, while considering other physical, social, and economic factors. We employ comprehensive models to simulate the functional processes within each facility and to optimize their recovery trajectories after earthquake occurrence. The results highlight significant interdependencies between hospitals and schools, including direct and indirect relationships, suggesting the need for collective coupling of their recovery to achieve full functionality of either of the two systems following natural disasters. Recognizing this high level of interdependence, we then establish a social services stability index, which can be used by policymakers and community leaders to quantify the impact of healthcare and education services on community resilience and social services stability.

"You never stop being a social worker:" Experiences of pediatric hospital social workers during the acute phase of the COVID-19 pandemic

The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers' roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic's impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.

Development of a Weighted Well-Being Assessment Mobile App for Trauma Affected Communities: A Usability Study

A well-being mobile app was built and tested by performing a usability study in a trauma affected community (TAC). Seven usability tasks were given to social workers during Phase 1. Phase 2 of the usability study was a re-test of the same tasks with the same social workers after refinements were applied. The results showed that most users preferred darker foreground colors, lighter background colors, larger fonts, and larger sized UI components. Statistically significant improvements were found after changes were implemented to the app and included time for page navigation (Z = -2.366, p = 0.018), logout (Z = -1.997, p = 0.046), and item selection in a page (Z = -2.371, p = 0.018). UI positioning and size changes proved to be a significant determinant of user satisfaction based on the positive feedback received from the computer systems usability questionnaire (CSUQ). (User1: p = .000, User 2 withdrew; User3: p = .010, User4: p = .000, User5: p = .001, User6: p = .006, User7: p = .025). HIM professionals assisted in the design, development, and administration of the usability study. This is another area in which HIM professionals are needed when assessing health and wellness in communities affected by trauma.

The relevance of transformational leadership for promoting professional social work competence with EBPA

Health care social workers' attitudes towards evidence-based practice (EBP) are an indispensable precursor of implementing EBP. Using a subset including 405 health care social workers from the first nationally representative survey of social workers in China, this study empirically assesses how transformational leadership (TFL) promotes health care social workers' attitudes towards EBP. The results show that organisational learning capacity (OLC) and professional competence (PC) fully mediate the positive relationship between TFL and EBP attitudes. Furthermore, TFL, OLC and PC explain 56% of the variance in health care social workers' attitudes towards EBP. This result supports the perspective that both organisational factors and individual factors may facilitate social workers' positive attitudes towards EBP, but organisational factors are more important. Therefore, to adopt, use and sustain EBP in health care social work, learning and innovation in the organisation should be increased. Furthermore, it is important to help social workers improve their PC.

Preparing Social Services and Public Services Professionals for Meaningful Roles in Disaster Services

This manuscript reviews the importance of disaster preparedness for the social services and public services professional. The value in separating fact from fiction in regard to probabilities for biological, chemical, and nuclear terrorism is highlighted. The various phases of disaster preparedness are elucidated along with the components of the effective all-hazards plan. Consideration of the psychological impact of disasters is presented in conjunction with the role of the mental health worker in the amelioration of outcomes. The role of electronic technology in disaster preparedness is elaborated, and useful websites are cited to facilitate disaster planning.

Accepting what we do not know: A need to improve professional understanding of brain Injury in the UK

Acquired brain injury (ABI) can lead to life-long changes and disability. The complex and extensive nature of behavioural, cognitive, executive, physical and psychological difficulties mean ABI survivors and their families may come into contact with a range of health and social care services as part of their long-term care. This study aimed to understand the ABI knowledge base of professionals across a range of organisations within the UK, and to identify areas for improvement. This was achieved through a mixed methods approach using a mixed methods questionnaire (117 participants) and qualitative semi-structured interviews about service experiences (31 participants) of professionals and service users (families and individuals with ABI). Participants included UK health and social care professionals, ABI specialists, ABI survivors and family members. Data were collected from February 2017 to April 2018. The results of the study identified a lack of knowledge and understanding of ABI among health and social care professionals in the UK, from those involved in acute care through to long-term community services. Poor knowledge was associated with a lack of understanding of "hidden" disabilities associated with ABI, a lack of empathy and a lack of knowledge regarding specific safeguarding. Health and social care professionals across a range of services could benefit in ABI-specific training to improve their knowledge and improve the service currently being provided to individuals with ABI and their families.

Unmet needs of informal carers of the oldest old in Portugal

Oldest-old individuals are a growing segment of the population that faces several challenges in terms of care demands. Informal caregivers experience more or less challenges, namely depending on the support they can access. The present study explores the unmet needs of a sample of informal caregivers of community-dwelling older adults aged 80+ and analyses the association of such needs with sociodemographic information, care-giving context (e.g., length of care),and health characteristics of the caregivers and care receivers (e.g., cognitive status and functionality). We recruited 175 care-giving dyads from the North of Portugal. Descriptive statistics summarised the sample's characteristics. Informal caregivers were mainly women with a mean age of 60.6 years (SD = 9.8). Care receivers' mean age was 88.7 years (SD = 5.6) and were functionally dependent (9.3 points [SD = 7.0] and 27.0 points [SD = 3.5] for Basic and Instrumental Activities of Daily Living, respectively). A thematic analysis of an open-ended question on unmet needs was performed, revealing the presence of unmet needs. The most relevant ones (financial support, caregiver support, primary care/medical specialities, and labour regulation) were further analysed, concerning the care-giving dyad's using Independent Student's t test or Mann-Whitney U Tests, and Chi-squared test or Fisher's Exact test depending on the variable. The most frequent unmet needs were associated with the caregiver's age, care receivers' kinship, number of care-giving hours, the caregiver's gender, professional status, the caregiver strain and medicines intake. Findings suggest the need for establishing policies that ensure adequate sustainability of the provision of informal care that takes into account the needs of care-giving dyads in the planning process.

Social Workers Being Effective in Disaster Settings

Research about social workers' impact during disasters is not widely recognized. Among the various roles social workers play during disasters are to handle asurge of clients and to support peers and leaders in their respective departments by filling in gaps in services. Dissemination of social workers' best practice approaches during actual disasters is important because their collective contributions facilitate their own resilience and improve their ability to care for their clients, which could inform other fields in the helping professions as well. Qualitative findings from (N = 8) US Department of Veterans Affairs social workers and social work leaders across the nation in regions that experienced hurricanes during 2017 and 2018 suggested the following best practices during disasters:1) adapting new roles;2) collaboration and organizational support; and3) practicing self-care. Findings suggest the need to enhance content in social work education and training with the knowledge and skills pertaining to providing services in disaster settings. During disasters, it is important for social workers to both collaborate with their team and to practice self-care in order to be most effective for their clients.

A pilot study of an integrated mental health, social and medical model for diabetes care in an inner-city setting: Three Dimensions for Diabetes (3DFD)

AIMS

We examined the effectiveness of a service innovation, Three Dimensions for Diabetes (3DFD), that consisted of a referral to an integrated mental health, social care and diabetes treatment model, compared with usual care in improving biomedical and health economic outcomes.

METHODS

Using a non-randomized control design, the 3DFD model was offered in two inner-city boroughs in London, UK, where diabetes health professionals could refer adult residents with diabetes, suboptimal glycaemic control [HbA_1c ≥ 75 mmol/mol (≥ 9.0%)] and mental health and/or social problems. In the usual care group, there was no referral pathway and anonymized data on individuals with HbA_1c ≥ 75 mmol/mol (≥ 9.0%) were collected from primary care records. Change in HbA_1c from baseline to 12 months was the primary outcome, and change in healthcare costs and biomedical variables were secondary outcomes.

RESULTS

3DFD participants had worse glycaemic control and higher healthcare costs than control participants at baseline. 3DFD participants had greater improvement in glycaemic control compared with control participants [-14 mmol/mol (-1.3%) vs. -6 mmol/mol (-0.6%) respectively, P < 0.001], adjusted for confounding. Total follow-up healthcare costs remained higher in the 3DFD group compared with the control group (mean difference £1715, 95% confidence intervals 591 to 2811), adjusted for confounding. The incremental cost-effectiveness ratio was £398 per mmol/mol unit decrease in HbA_1c , indicating the 3DFD intervention was more effective and costed more than usual care.

CONCLUSIONS

A biomedical, psychological and social criteria-based referral system for identifying and managing high-cost and high-risk individuals with poor glycaemic control can lead to improved health in all three dimensions.

Programmatic determinants of successful referral to health and social services for orphans and vulnerable children: A longitudinal study in Tanzania

Background

Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system.

Methods

Data for this secondary analysis come from the first two years (2017–2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations.

Results

During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26–49 versus 18–25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively.

Conclusion

CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.

Challenges and Opportunities of Evidence Use in Practice in Australian Children's Development Programs

This paper explores the role of evidence and its use in a cluster of Australian community-based child development programs. The paper draws on findings from a 2016-2017 study commissioned by a not-for-profit organization to review their programs' alignment with government evidence-based program expectations. Cunningham and Duffee's (2009) evidence-based practice style typology is utilized to examine how different purposes of use drive styles of and approaches to evidence sourcing, application, and reporting. Perspectives on what constitutes evidence and how such evidence is valued, used, and reported can vary considerably between individual programs, irrespective of enforced standards and expectations. It is argued that a single-dimensional approach to program evidence-based evaluation and reporting is not appropriate and potentially damaging in contexts where community-based programs have different purposes, structures, cultures, and intentions. Given a program's particular evidence-use style, evidence-based criteria, processes, and reporting requirements should be matched accordingly.

Evolving an evidence-based model for homelessness prevention

While some progress has been made in addressing chronic homelessness through supportive models, a comprehensive solution for housing loss must include prevention. The purpose of this article is twofold: to conduct a review of the literature on the domains of the Framework for Homelessness Prevention; and to use literature on the concept of quaternary prevention, preventing the harms of service provision, to theorise an additional domain. The Framework for Homelessness Prevention draws upon theory from public health exploring primary, secondary and tertiary prevention, and also integrates primordial prevention. This leads to a typology of homelessness prevention that incorporates the following five domains: (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability. By systematically reviewing the literature we build out the evidence-base supporting these domains. The team used research databases, internet searches and retrospective reference list reviews to identify high-quality journal articles on prevention, which were then sorted by level of prevention. Through this process, we evolved our thinking on the Framework in considering that quaternary prevention was not initially included. Therefore, we explored the literature related to quaternary prevention in the context of homelessness and offer a sixth domain for the Framework: Empowerment. Ultimately, a comprehensive Framework for Homelessness Prevention will support communities and governments to more effectively prevent homelessness through upstream approaches.

Social Workers Must Address Intersecting Vulnerabilities among Noninstitutionalized, Black, Latinx, and Older Adults of Color during the COVID-19 Pandemic

Scant attention has been paid to intersecting vulnerabilities experienced by Black, Latinx, and older adults of color (BLOAC) that increase COVID-19 related risks. Structural inequities have resulted in disproportionate rates of chronic conditions and limited access to care. Media coverage, focused on COVID-19 mortality among institutionalized older adults (OA), has overlooked community-dwelling OA, leaving their unique risks unaddressed in research and intervention efforts. Key vulnerabilities impacting noninstitutionalized BLOAC exacerbating adverse health outcomes during COVID-19 are discussed, and recommendations are given for gerontological social work (GSW) education, training, and practice to meet the needs of BLOAC during the COVID-19 pandemic.

An Innovative Telephone Outreach Program to Seniors in Detroit, a City Facing Dire Consequences of COVID-19

We write this letter to share our telephone outreach project that aims to address the health implications of loneliness, social isolation, and limited access to resources among older African American adults living in Detroit during Covid-19. The extreme health disparities evidenced by case numbers and death rates of Covid-19 demands our use of basic technology, the telephone, to provide social support and document their experiences to later share in their voice. It is our hope that other groups working with older adults can replicate these strategies.

The Consequences of Ageist Language are upon us

The COVID‒19 pandemic has highlighted the ease in which ageist language is employed and ageist stereotypes are used to characterize older adults. These are harmful and display an impressive lack of future thinking - as younger and middle-aged adults who use this language and forward these concepts also hope to live long lives. The disproportionately negative outcomes for older adults in this pandemic in part, reflect social and economic inequalities that are manifest throughout the life course of marginalized groups including persons of color. They also reflect major problems with institutional living be it in prisons or nursing homes. Social workers and allied professionals can work to address these manifestations of ageism in part by employing inclusive language - as advised by the Reframing Aging Project, working to build and support strong intergenerational relationships, working to eradicate social and economic disparities at all life stages, and advocating for a more critical look at institutionalization of older adults.