6.1. Develop a single service model and the provider/commissioning arrangements required to deliver the model. A single service model should reduce service variations that are evident in the current services and support the patient being in the right service at the right time. However, over the past ten years, the inpatient providers have tried to work to one service model, but service variation remained. For this reason, the GM-wide workshop convened to support the development of the case for change, concluded that the inpatient service should be provided by a single provider and a lead commissioner. This proposal was subsequently supported by the ODN Board and hence the proposal is:
Everyone has their own interests, needs and concerns. Conflict arises when someone feels that theirs are being ignored or not taken into account. Try to understand how the partnership’s way of doing things is impacting on an individual. For example, is it affecting their work performance, disrupting teamwork, hampering decision-making? Or is it affecting the way an individual feels cared for or supported? Be objective – focus on work issues and leave personalities out of the discussion.
SocialWork graduates from the University of Plymouth have enviable rates of employment on graduation. The vast majority of students have already secured employment within a professional role before they complete the course; such is the demand for our graduates. At present long term forecasts are that employment opportunities will continue to grow. Whilst the majority of our students will initially secure roles within local statutory organisations, graduates have secured posts within private organisations or charities. Graduates have followed careers in a variety of professional socialworksettings; working with children and families in child protection, fostering and adoption, youth justice; working with adults in the areas of mental health,
3.18. The Head of Mental Health and Addictions Services’ post (existing NHS post) has been extended to include the Learning Disabilities service. During the shadow period, it was agreed that this service, which was previously jointly managed by the Head of Adult SocialWork Service and the Head of Primary Care and Community Services, would be better aligned with Mental Health and Addictions Services.
At a senior management level, there seemed to be an ap- preciation of the value of the research for both the LAs and the young women they supported. Although senior managers acknowledged that it might be difficult to en- gage young women in the study and expressed some concerns about their vulnerability, they also saw the po- tential benefits of the study, in terms of providing young people with better opportunities, sexual health know- ledge and choices in their lives. However, social workers on the ground, appeared to view the research as an add- itional burdensome imposition on their already pres- surised time. Socialwork professionals often found it difficult to understand the need for RCTs in developing an evidence base for practice, the concept of equipoise was generally not understood, and there were variable interpretations of the rationale for randomisation. For example one social worker (LA1) thought that the rea- son for randomisation was a ‘resource issue’ (i.e. a lack of mentors available for all participants), while another thought we were measuring ‘how effective the computer matches [are] in comparison to the matches that you make yourself ’ (LA1 social worker). For one social worker, feelings about randomisation extended to a more generalised mistrust of research and academics:
Becker and Roe (2005) define five groups of vulnerable young people: ‘those who have ever been in care, those who have ever been homeless, truants, those excluded from school and serious or frequent offenders’. In 2003, 24% of vulnerable young people reported using illicit drugs frequently during the preceding 12 months, compared with 5% of their less vulnerable peers (Becker and Roe 2005). There were significantly higher levels of drug use among those who belonged to more than one vulnerable group. Substance misuse is associated with significant health risks including anxiety, memory or cognitive loss, accidental injury, hepatitis, HIV infection, coma and death. It may also lead to an increased risk of sexually transmitted infections. In England and Wales in 2003/04, class A drug use was estimated to cost around £15.4 billion in economic and social terms (Gordon et al. 2006).
and sustained in their social contexts. The NoMAD is the NPT’s accompanying tool. The NoMAD tool consists of 23 items that measure the process of implementation from the perspectives of professionals directly involved in implementing complex interventions. The NoMAD tool was selected as it is the first validated measure to assess implementation processes and can be used across multiple stakeholders and settings, providing insight into the adoption of new services at the service provider level. In addition, routinely collected service satisfaction data from CYP and family surveys will be audited to assess satis- faction with the CYPHP services. Surveys will be distrib- uted across service provider and commissioner channels across Lambeth and Southwark (eg, GP events, mailing lists and locality meetings), after implementation of the full CYPHP Evelina London Model of Care. The quan- titative data collected from the NoMAD tool and service satisfaction questionnaires will be analysed using descrip- tive statistics.
(1994) and in a Department of Health series of research studies, summarised in Department of Health (1995). Social workers in child care were directed to change the balance of their approach by conducting holistic needs assessments of children and their families. On the face of it, such assessments should have provided a more individualised service with the potential for social workers to build good caring relationships with children and young people. Studies have documented some benefits such as improved recording and inter-agency working (Cleaver and Walker, 2004). However, assessments are linked to specific timescales and targets which afford workers little time to build relationships and, because of scarce resources, are often limited to risk assessment and the procedural realm of child protection. Although the ‘Framework’ drew attention to the need to see, observe and interact with children, it made no reference to children's rights, and the only mention of these in the associated ‘Reader’ (Horwath, 2000) was a slight reference to the use of advocates at the end of a chapter on empowering children to
Therefore, all children in foster care should have a medical home in which they receive ongoing pri- mary care and periodic reassessments of their health, development, and emotional status to determine any changes in their status or the need for additional services and interventions. Ideally, at a minimum such reassessments should occur monthly for the first 6 months of age, every 2 months for ages 6 to 12 months, every 3 months for ages 1 to 2 years, every 6 months for ages 2 through adolescence, and at times of significant changes in placement (foster home transfers, approaching reunification). These periodicity recommendations, although not backed by evidence-based data, are considered by this com- mittee to be the minimal number of preventive healthcare encounters required to closely monitor these children. Depending on the stability of the placement and changes in the child’s status, addi- tional visits may be indicated. Any child prescribed psychotropic medication must be closely monitored by the prescribing physician for potential adverse effects. The social worker should maintain contact with the provider and receive periodic updates on the child’s progress. When changes in foster place- ment are planned or when decisions regarding per- manency planning are anticipated, pediatricians can help child welfare professionals evaluate these deci- sions in light of the child’s age and developmental level. Pediatricians can also work with the child wel- fare agency and the court to determine what is truly in the child’s best interest.
The number of children looked after away from home has fallen by about half in the last 25 years. The proportion of children in foster care and residential care has also changed significantly. Twice as many children and young people are in foster care today, the reverse of the situation in 1976. This has occurred for a variety of reasons. There has been a general, policy preference for children and young people to be cared for in family settings and for services to be directed towards supporting and helping the family as a unit to prevent the need for children to be received into state care (Directors of SocialWork in Scotland, 1992). A recent review of child protection, however, found that some children remained in their family home, suffering harm, because professionals did not want to remove them into state care. Although they recognised the weaknesses of this approach, they had clear reasons for not removing children. These included the strong attachments children had to their family; the poor outcomes for looked after children; the lack of good quality residential and foster care placements; and residential provision not being able to meet the needs of the child (Scottish Executive, 2002b).
Devising and implementing different health promotion efforts often originate in a professional settings and i.e. decision makers such as health professionals, teachers and civil servants approach the tasks according to their professional background and specific agendas. However, in an active social field such as a school, the narrow administrative outlook collides with a completely different and disorganized everyday outlook. It may be assumed that children view issues such as ecology and health entirely dependent on their individual values and attitudes. This collides with traditional
Since its beginning, the managed care organizations and HMOs went through tremendous changes in providing services and enrollments due to various fiscal and clinical environmental reasons (Kongstvedt, 2004). Through the implementation of the Balanced Budget Act of 1997, Medicare and Medicaid managed care and other private managed care organizations have become the predominant healthcare delivery systems in the United States (Sultz & Young, 2006). For more than a century, the United States has been experiencing changes in its healthcare delivery systems due to the involvement of various political, legislative, and economic reasons. The changes have driven healthcare systems to be more complex and dominated by bigger private corporations (Sultz & Young, 2006). Managed care influences the practice of medical delivery in two ways. Firstly, with the evolution of the utilization review process, clinical guidelines by managed care organizations may choose alternate therapies for cutting costs. Secondly, by benchmarking healthcare provider standards, medical care is standardized, and the provider has to follow the stipulated guidelines (Simonet, 2007).
Social workers must engage in ongoing professional development to maintain competence within their fields of practice. Professional development activities relevant to socialwork practice in healthcaresettings may include developments in clinical care, research or technology, healthcare policy and legislation, community resources and services, ethics, and leadership and administration, among other topics. Numerous opportunities for professional development exist within NASW, allied professional organizations, schools of socialwork, healthcare institutions, and organizations providing services to or on behalf of various constituencies (such as children, older adults, or people with disabilities) at the local, state, national, and international levels.
not all children and young people would be aware of the issues and disadvantages faced by children in care and the importance of stability in educational placements. It may also be that there was a lack of understanding around school selection favouring children in care as almost a quarter of respondents (24%) said they were unsure. This was corroborated by the focus group participants where one commented that prioritising children in care was unfair because “they’re the same as any other child, they’ve only got different parents” (boy, Key Stage 4, PRU) and “everyone should be equal” (girl, Year 6) without any acknowledgement of the disadvantages faced by children in care because of their background circumstances. Where young people recognised this, they felt priority for these children was fair: “because they have a harder time than us” (boy, Year 6) and “it’s way worse for them” (boy, Year 9).
the involvement of children and young people. Interviewee D expresses her views as follows: “We worked with the Hospital’s Youth Forum Group. This is a group of patients interested and involved in the hospital, advising the Trust on a range of issues. Consequently they were already motivated but additionally we tried to make the sessions fun and engaging”. Confidentially is another main possible issue or obstacle in the project. As interviewee B explained, the adopted solution for the issue was a full explanation about the new hospital – use of picture and consent to be involved via parents or school. Consent should be obtained in order to use the participant’s photograph or name but if it was an anonymous consultation, verbal agreement would be adequate to proceed (Interviewee D). In order to sustain children and youngpeoples participation during the life cycle of the project, the youth forum is kept alive and maintained, even when the members had to leave the forum when they get older (interviewee D). Furthermore, as interviewee D explains: “As part of the PPI team, the role … was influencing the new development hospital board for the patient involvement and looking for a way to make sure that we were involving young people, children and carers”. In order to solve the mass confusion issue, a limited number of children for each project were involved.
Most pre-training survey respondents (N ¼25) had received no formal training on working with people with alcohol issues. Table 2 shows the challenges that participants identified in the pre-survey responses. On the practical side, when discussing the challenges they experienced in respond- ing to a service user’s alcohol issues, social workers in the focus groups expressed concerns about having to manage demands on their time which meant that responding to alcohol issues could not be prioritised. Limited time to undertake assessments meant fewer opportunities to offer adequate support with alcohol issues. Underlying their practical concerns were more fundamental questions con- cerning role perception, role boundaries and who they considered to be responsible for working with alcohol-related issues. By working mostly with people with dependency, participants believed that building a long-term relationship with a service user with alcohol problems was a vital key to supporting them. This support was usually offered through referral to services and participants in the focus groups often expressed a lack of necessary knowledge and understanding of alcohol problems to provide appropriate support them- selves. Moreover, working across a broad remit of social and healthcare, social workers in the focus groups resisted being ‘jack of all trades’. They also drew a distinction between the assessment function and the ‘enabling’ (support) function of their work. The complexity of issues associated with alcohol use, particularly where these involved a mental capacity assessment or were related to safeguarding concerns including self-neglect, were seen as the most challenging. Apart from feeling inadequately prepared to deal with alcohol problems themselves, concerns over relationships with clients were often voiced in the focus groups. It was felt that raising issues
Understanding the effect of community life on the health status and patient condition was the skill that separated hospital social workers from the work of nurses and volunteers. Ida Cannon was among the first medical social workers who sought to standardize the skills and competencies required for hospital social services; such skills and competencies distinguished the professional worker from the volunteer and supported the recognition of medical socialwork as a distinct identity within professional circles. The effort to develop standards of practice led medical socialwork to become part of the curriculum at Boston University School of SocialWork, which advanced the use of scientific principles in professional socialwork. By 1916, medical social workers established the first professional socialwork organization. The early 20 th century is noted for American society’s awakening to the problems of rapid urbanization that coincided with an influx of immigrants who were ill equipped to deal with the exigencies of their new environment. This is also a time when diseases spread out of control, threatening large population groups. Social workers had a clear mission to seek out and identify the health and social problems of mothers, infants and children in which they lived. Some social workers gravitated to the community activist role in health services during the early part of the settlement house movement. As early as 1912, social worker Julia Lathrop directed the Federal Children’s Bureau, which monitored the well-being of children nationally. Social workers, with the backing of the Federal Children’s Bureau, were active in the formulation of the Sheppard Towner Legislation of 1921, and in the Maternal and Child Health (MCH) Title V Federal Legislation of 1935, which provided prenatal care and child healthcare as a public service of state and local government health departments. According to
Over the past several decades, the United States has witnessed a significant increase in the prevalence of overweight and obese children. Given that the immediate and long-term implications of obesity on a child’s physical and emotional well-being can be severe, biomedical researchers, social scientists, and the general public have made an aggressive push towards finding an explanation for what some have now deemed a national health epidemic. Despite a large body of empirical research on the impact of environmental, behavioral, and societal factors on the obesity increase in the past thirty years, surprisingly little attention has been devoted to examining the impact of one notable change occurring during the same time period: an increase in women’s labor force participation, and consequently an increase in child care usage. This three chapter dissertation examines the effects of maternal employment and usage of non- parental after- and/or before-school supervision on elementary school-age children’s body mass statuses.
While their importance to the sustainability of elder care is increasingly acknowledged , these workers are his- torically understudied in Canada — in part because they are unregulated and, in most provinces and territories, unrepresented in the health workforce. An expanding scope of work and increasing demands for more com- plex care are suggested as factors in the incidence of burnout, absenteeism and turnover among these workers in Canada and other countries [8 – 10]. Exploring these relationships is the purview of work psychology, and health workforce psychology, researchers. Our study of- fers several novel and timely insights into the nature of HSWs ’ work psychology. Arguably, all aspects of the work environment that we examined (perceptions of organizational support-supervisor, perceptions of work- place safety, and QWL) are within the power of manage- ment to modify; however, our analysis suggests that those that we highlight above — QWL, perceptions of supervisor support, and perceptions of workplace safe- ty—offer particularly promising means by which to influ- ence HSWs’ work attitudes and work outcomes. Even modest modifications to some aspects of the work envir- onment could precipitate a cascade of positive effects. Both LTC and HCC are sectors in which “visibility” is low for HSWs, their residents/clients, and episodes of care. Our findings raise this visibility. We have insights now into how HSWs’ perceptions of their work environ- ments influence how they feel about their work, and how these work attitudes in turn influence their work behaviors and performance. HSWs play a critical role in elder care; these early insights into their work psych- ology lay a foundation for further studies, ultimately leading us to respond in an informed and effective way to their work-related needs. This may go some way to- ward addressing system sustainability concerns about the care of older adults [59, 60].