RESUMO
BACKGROUND: Research consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation. METHODS: We linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries. RESULTS: Children in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 - 2·48), in need (2·51, 2·00-3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 - 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01-1·68), children in need (1·62, 1·38 - 1·90), and children at risk (1·51, 1·11 - 2·04). CONCLUSIONS: All groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as 'in need' or 'at risk' by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.
Assuntos
Escolaridade , Serviço Social , Humanos , País de Gales , Feminino , Masculino , Criança , Adolescente , Serviço Social/estatística & dados numéricos , Estudos Retrospectivos , Estudos Longitudinais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Experiências Adversas da Infância/estatística & dados numéricos , Pré-Escolar , Hospitalização/estatística & dados numéricos , Cuidados no Lar de Adoção/estatística & dados numéricosRESUMO
BACKGROUND: Understanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life. METHODS: A retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life. RESULTS: Three distinct classes were identified: "Few care contacts," with limited interaction with any services; "Social service contacts," comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and "Numerous care contacts," with extensive contacts with both healthcare and social services. The "few care contacts" class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support. CONCLUSIONS: Using a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.
Assuntos
Análise de Classes Latentes , Overdose de Opiáceos , Humanos , Suécia/epidemiologia , Masculino , Feminino , Overdose de Opiáceos/mortalidade , Overdose de Opiáceos/epidemiologia , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Sistema de Registros , Transtornos Relacionados ao Uso de Opioides/mortalidade , Serviço Social/estatística & dados numéricos , Adulto Jovem , Overdose de Drogas/mortalidadeRESUMO
BACKGROUND: Social prescribing is often described as an intervention that can help reduce health inequalities yet there is little evidence exploring this. This study aimed to assess the feasibility of accessing and analysing social prescribing (SP) service user data to demonstrate the impact of SP on health inequalities. METHODS: The sample size consisted of records for 276 individuals in Site 1 and 1644 in Site 2. Descriptive analyses were performed to assess the characteristics of people accessing SP, the consistency of data collected and the missingness across both sites. RESULTS: Both sites collected basic demographic data (age gender, ethnicity and deprivation). However, data collection was inconsistent; issues included poor recording of ethnicity in Site 2, and for both sites, referral source data and health and well-being outcome measures were missing. There was limited data on the wider determinants of health. These data gaps mean that impacts on health inequalities could not be fully explored. CONCLUSIONS: It is essential that SP data collection includes information on user demographics and the wider determinants of health in line with PROGRESS Plus factors. Considering equity around who is accessing SP, how they access it and the outcomes is essential to evidencing how SP affects health inequalities and ensuring equitable service delivery.
Assuntos
Disparidades nos Níveis de Saúde , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Adolescente , Adulto Jovem , Criança , Pré-Escolar , Lactente , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricosRESUMO
Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs.
Assuntos
Assistentes Sociais , Humanos , Estados Unidos , Assistentes Sociais/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Feminino , Masculino , Adulto , Fonte de InformaçãoRESUMO
A Política de Assistência Social mantém a centralidade de suas intervenções na instituição familiar a fim de fortalecer a garantia de direitos à população em situação de desproteção social. Atento a esse cenário, o objetivo desta pesquisa consistiu em analisar a percepção das famílias sobre as intervenções realizadas pelos psicólogos em um Centro de Referência Especializado de Assistência Social (CREAS) situado em uma cidade do interior do estado do Paraná. Adotando uma perspectiva qualitativa, os seis participantes relataram a experiência desses atendimentos e seus impactos sobre a família. Como resultado, foi possível conhecer os receios e medos presentes nos primeiros contatos e como isso foi superado à medida que o vínculo afetivo era fortalecido, abrindo espaço para o relato das experiências difíceis de violência familiar. Ao final da pesquisa, foi possível compreender a relevância de construir uma sustentabilidade afetiva capaz de afirmar a vinculação e acolher as famílias. (AU)
Social Assistance Policy maintains the centrality of its interventions in the family institution in order to strengthen the guarantee of rights to the population in a situation of social unprotect. Aware of this scenario, the objective of this research was to analyze the perception of families on the interventions carried out by psychologists at a Specialized Social Assistance Reference Center (CREAS) located in a city in the interior of the state of Paraná. Adopting a qualitative perspective, the six participants reported the experience of these services and their impacts on the family. As a result, it was possible to know the fears and dreads present in the first contacts and how this was overcome as the affective bond was strengthened, opening space for reporting difficult family violence experiences. At the end of the research, it was possible to understand the relevance of building an affective sustainability capable of affirming the link and welcoming the families. (AU)
La Política de Asistencia Social mantiene la centralidad de sus intervenciones en la institución familiar para fortalecer la garantía de derechos a la población en situación de desprotección social. Conscientes de este escenario, el objetivo de esta investigación fue analizar la percepción de las familias sobre las intervenciones realizadas por psicólogos en un Centro de Referencia Especializado en Asistencia Social (CREAS) ubicado en una ciudad del interior del estado de Paraná. Adoptando una perspectiva cualitativa, los seis participantes relataron la experiencia de estos servicios y sus impactos en la familia. Como resultado, fue posible conocer los miedos y ansiedades presentes en los primeros contactos y cómo éstos fueron superados a medida que el vínculo afectivo se reforzó, abriendo un espacio para la denuncia de experiencias difíciles de violencia familiar. Al final de la investigación, se pudo comprender la relevancia de construir una sostenibilidad afectiva capaz de afirmar el vínculo y acoger a las familias. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Percepção Social , Serviço Social/estatística & dados numéricos , Família/psicologia , Intervenção Psicossocial , Apego ao Objeto , Política Pública , Brasil , Baixo Nível SocioeconômicoRESUMO
O artigo apresenta a discussão sobre os quilombos no estado do Rio Grande do Sul (RS) e as aproximações com as ofertas inscritas no Sistema Único de Assistência Social (SUAS), com objetivo de analisar as particularidades da questão étnico-racial acerca dos povos quilombolas no estado do Rio Grande do Sul, para a afirmação desta pauta na agenda do SUAS. Socializa os resultados de uma pesquisa documental de abordagem mista com ênfase qualitativa. Revela a potência e a complementaridade das informações encontradas nos instrumentos do SUAS, como nos dados do Censo SUAS (2019) do Centro de Referência de Assistência Social (CRAS) e do Centro de Referência Especializado de Assistência Social (CREAS) e os dados do Cadastro Único (2021), frente ao reconhecimento dos territórios quilombolas, embora ainda seja necessário ampliar as ações de educação permanente acerca do debate sobre a questão étnico-racial e os quilombos na agenda da política de assistência social
The article presents the discussion about the quilombos in the state of Rio Grande do Sul (RS) and the approximations with the offers registered in the Unified Social Assistance System (SUAS), with the objective of analyzing the particularities of the ethnic-racial issue concerning the quilombola peoples in the state of Rio Grande do Sul, for the affirmation of this agenda in the SUAS agenda. It socializes the results of a mixed approach documentary research with a qualitative emphasis. It reveals the power and complementarity of the information found in the SUAS instruments, as in the data from the SUAS Census (2019) from the Social Assistance Reference Center (CRAS) and the Specialized Reference Center for Social Assistance (CREAS) and data from the Single Registry (2021), in view of the recognition of quilombola territories, although it is still necessary to expand permanent education actions regarding the debate on the ethnic-racial issue and the quilombos in the social assistance policy agenda
Assuntos
Humanos , Masculino , Feminino , Serviço Social/estatística & dados numéricos , Quilombolas , Acessibilidade aos Serviços de Saúde , Brasil , Características de Residência , População Negra , Fatores RaciaisRESUMO
OBJECTIVE: To examine the associations between family-reported social needs in primary care settings and pediatric health care use. STUDY DESIGN: Data were obtained for a sample of 56 253 children and youths (age 0-21 years) who received primary care at a large hospital-based pediatric institution between June 2018 and October 2019 to estimate a propensity score for the probability of being seen in a primary care clinic. Inverse probability weighted regression specifications were used to examine the associations between reported social needs and health care use. Families were asked about 4 social needs: housing, utilities, transportation, and food. Outcomes included the number of Emergency Department (ED), inpatient, social work, and well-child visits (only for those aged 0-2 years) in the 6 months before and after needs screening. RESULTS: Overall, 12.0% of the families reported a general social need, with 28% of those needs identified as urgent. Food and transportation needs were most common. Patients with needs were more likely to have an ED or inpatient visit at 6 months prescreening and 6 months postscreening compared with those without needs. Among children aged <2 years, those with a social need were less likely to have completed a well-child visit at 6 months postscreening compared with those without a need. CONCLUSIONS: Social needs are linked to less preventive care use and greater reliance on emergency care services. Understanding how to better assist families in need requires greater attention.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Atenção Primária à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação das Necessidades , Serviços Preventivos de Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data. METHODS: Multilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers. RESULTS: In the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002). CONCLUSION: The analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.
Assuntos
Neoplasias da Mama/terapia , Aconselhamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/economia , Feminino , Alemanha , Humanos , Pessoa de Meia-IdadeRESUMO
The extent to which oncology social workers (OSWs) are available and adapting to disruptions in service delivery throughout the COVID-19 pandemic is unknown.Objectives: The purpose of this report is to outline the initial impact of COVID-19 on oncology social work practice during the first six months of the pandemic.Methods: As part of a nationwide investigation of workforce conditions for OSWs, three professional organizations surveyed their members to assess the effects of COVID-19 on changes to work hours, employment status, work setting, pay, and mode for patient contact (e.g., telephone or videoconference).Findings: Among 939 OSWs, 20% reported a reduction in work hours, and two-thirds indicated a temporary shift in work to home, with most patient contact occurring primarily via telephone or videoconference.Implications: Results speak to the essential nature of oncology social work and the need for evidence to inform OSW training and advocacy efforts for however long the pandemic continues.
Assuntos
COVID-19 , Pessoal de Saúde/estatística & dados numéricos , Neoplasias/reabilitação , Prática Profissional/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Assistentes Sociais/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Humanos , Psico-Oncologia , Telecomunicações , TelefoneRESUMO
Health system data incompletely capture the social risk factors for drug overdose. This study aimed to improve the accuracy of a machine-learning algorithm to predict opioid overdose risk by integrating human services and criminal justice data with health claims data to capture the social determinants of overdose risk. This prognostic study included Medicaid beneficiaries (n = 237,259) in Allegheny County, Pennsylvania enrolled between 2015 and 2018, randomly divided into training, testing, and validation samples. We measured 290 potential predictors (239 derived from Medicaid claims data) in 30-day periods, beginning with the first observed Medicaid enrollment date during the study period. Using a gradient boosting machine, we predicted a composite outcome (i.e., fatal or nonfatal opioid overdose constructed using medical examiner and claims data) in the subsequent month. We compared prediction performance between a Medicaid claims only model to one integrating human services and criminal justice data with Medicaid claims (i.e., integrated model) using several metrics (e.g., C-statistic, number needed to evaluate [NNE] to identify one overdose). Beneficiaries were stratified into risk-score decile subgroups. The samples (training = 79,087, testing = 79,086, validation = 79,086) had similar characteristics (age = 38±18 years, female = 56%, white = 48%, having at least one overdose = 1.7% during study period). Using the validation sample, the integrated model slightly improved on the Medicaid claims only model (C-statistic = 0.885; 95%CI = 0.877-0.892 vs. C-statistic = 0.871; 95%CI = 0.863-0.878), with small corresponding improvements in the NNE and positive predictive value. Nine of the top 30 most important predictors in the integrated model were human services and criminal justice variables. Using the integrated model, approximately 70% of individuals with overdoses were members of the top risk decile (overdose rates in the subsequent month = 47/10,000 beneficiaries). Few individuals in the bottom 9 deciles had overdose episodes (0-12/10,000). Machine-learning algorithms integrating claims and social service and criminal justice data modestly improved opioid overdose prediction among Medicaid beneficiaries for a large U.S. county heavily affected by the opioid crisis.
Assuntos
Direito Penal/estatística & dados numéricos , Aprendizado de Máquina , Medicaid/estatística & dados numéricos , Overdose de Opiáceos/epidemiologia , Serviço Social/estatística & dados numéricos , Adolescente , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Overdose de Opiáceos/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Estados Unidos , Adulto JovemRESUMO
Background: Throughout history, the field of medical social work has been shaped by epidemics and pandemics. As COVID-19 rapidly overwhelmed the healthcare system in 2020, oncology departments found that space, staff, and funds were reallocated to address patient needs during the pandemic. Traditional outpatient services were required to operate with reduced resources, with special attention to additional measures to protect workers and patients from exposure to the virus. Little is known about how these changes affected the nature of the practice of oncology social work.Methods: We compared data on OSW interventions for three months (March-May) 2019 to the same period in 2020. Mount Sinai Downtown Cancer Center's Department of Social Work routinely collects data on services provided by social workers using a validated instrument. As NYC became the epicenter of the COVID-19 in March 2020, the comparison of these time periods creates a natural experiment to examine whether and how the presence of the virus impacted the services provided by OSWs.Findings: There was little difference in the number of encounters that took place between the two time periods (2186 encounters in 2019 and 2084 encounters in 2020); however, there were notable differences in the types of interventions. While interventions involving supportive counseling decreased in 2020, we identified a significant increase specific to bereavement counseling.Conclusion: The study shows a remarkable consistency in the volume and types of services provided by OSWs, in spite of the radical increase in stressors they experienced during the height of the COVID-19 pandemic. These findings suggest that the OSWs did not allow these stressors to interfere with their work with patients. This study demonstrates how routine use of an instrument to measure OSW interventions can be used to examine services provided over time and to evaluate potential influences of external factors.
Assuntos
COVID-19 , Neoplasias/reabilitação , Estresse Ocupacional/psicologia , Intervenção Psicossocial , Serviço Social , Assistentes Sociais/psicologia , Adulto , Humanos , Psicometria/instrumentação , Intervenção Psicossocial/normas , Intervenção Psicossocial/estatística & dados numéricos , Serviço Social/normas , Serviço Social/estatística & dados numéricosRESUMO
OBJECTIVES: To model and analyse conceptions of determinants of health and cancer that are expressed and perceived by school children aged 6-11 based on a multiphase qualitative protocol. METHODOLOGY: This is a multicentric, qualitative study of human and social sciences conducted among school children aged 6-11 years old. Two different tools were used, e.Photoexpression and Photonarration, in four French schools. This innovative and exploratory method addresses global health during the first phase (e.Photoexpression) and the theme of cancer during the second phase (Photonarration). The children express themselves through photography and narration. RESULTS: 1498 qualitative productions were made by 381 children aged 6-11 years old. The analysis of these productions of expression and narration through images allowed modelling of determinants of health and cancer as perceived by children through 7 fields and 28 categories. The conceptions of determinants of health and child cancer refer to rationalities that are centred on individual determinants (76%), minimise environmental determinants (20%) and conceal the parameters of access to healthcare and social services (3%). DISCUSSION: These findings provide new data to the international literature on children's perceptions of determinants of health and cancer. These research findings, which can be applied to interventions and current practices, will enable prevention workers to act more effectively, closer to children's perceptions and needs.
Assuntos
Imagens, Psicoterapia/métodos , Neoplasias/psicologia , Percepção/fisiologia , Instituições Acadêmicas/estatística & dados numéricos , Criança , Feminino , França/epidemiologia , Comportamentos Relacionados com a Saúde/fisiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Imagens, Psicoterapia/estatística & dados numéricos , Masculino , Narração , Avaliação das Necessidades , Neoplasias/prevenção & controle , Pesquisa Qualitativa , Serviço Social/estatística & dados numéricosRESUMO
Better understanding of the proportion of children who ever receive special educational needs (SEN) provision or social care services during school years is highly relevant for healthcare as reductions in one or more of these services could impact on healthcare. Using the National Pupil Database linked to the all-of-England children looked after return and children in need census, we estimated the cumulative incidence of SEN status among (1) children ever in care during school, (2) children in need but not care, and (3) neither. We observed a very high proportion of children who were in care or need during school years had SEN provision at some point (83% and 65%, respectively), and that a high proportion of children in neither of these groups did so, too (37%). Healthcare, SEN provision and social care services focus on a similar population of children. Better integration of these services could lead to synergies and cost-efficiencies and better support for these children and their families.
Assuntos
Educação Inclusiva/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Criança , Serviços de Saúde da Criança , Bases de Dados Factuais , Inglaterra , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Incidência , MasculinoRESUMO
OBJECTIVES: Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time. METHODS: This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique. RESULTS: Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. DISCUSSION: These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.
Assuntos
COVID-19/psicologia , Casas de Saúde/organização & administração , Papel Profissional/psicologia , Percepção Social , Serviço Social/estatística & dados numéricos , Assistentes Sociais/psicologia , Adaptação Psicológica , Idoso , COVID-19/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Assistentes Sociais/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
Moving beyond typical dichotomous rural-urban categorizations, this study examines older adults' likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014-2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults' ability to live.
Assuntos
Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Serviço Social/estatística & dados numéricos , Idoso , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Serviços de Saúde para Idosos/provisão & distribuição , Humanos , Masculino , População Rural/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , VirginiaRESUMO
OBJECTIVES: Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership. METHODS: The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression. RESULTS: Four distinct hospitalization trajectory groups emerged: "never" (43.1%)-individuals who were rarely hospitalized during the study period, "increasing" (19.9%)-individuals who experienced an increased risk of hospitalization, "decreasing" (21.6%)-individuals with a decreased risk, and "frequent" (15.8%)-individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the "frequent" trajectory relative to the "decreasing" trajectory. The density of primary care physicians was not associated with the trajectory group membership. DISCUSSION: Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.
Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Medicaid , Michigan , Desenvolvimento de Programas/estatística & dados numéricos , Estados UnidosRESUMO
Repeat referral to adult protective services APS (recurrence) is a much-discussed topic among APS agencies as it may indicate ongoing harm, yet there is limited research examining prevalence or causes. This paper provides a foundational investigation of recurrence within a California APS county program. Drawing from thirty-three months of de-identified reports, we used logistic regression to examine the impact of intake report characteristics on repeat referral within one year after baseline case closure. One-fifth of the sample was recurrent (19.9%, n=987/4,958), with self-neglect being the most common type of report to recur (14.3%, n=307/2,141). Overall recurrence was predicted by female gender, older age, living alone, and multiple elder abuse, neglect, and exploitation (ANE) types reported at baseline, and report placed by social service provider, friends, family, landlords, and victim self-reports. Reporters personally related to the victim and social service providers are potential partners in identifying ANE, and alternate intervention approaches may be necessary.
Assuntos
Abuso de Idosos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Autonegligência/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Estudos RetrospectivosRESUMO
During the state of alarm declared in Spain by COVID-19 due to the pandemic, the country's authorities declared Social Services and their workers to be essential, considering that the activity of these professionals with the vulnerable population was crucial and that services should continue to be provided to guarantee the well-being of users in this exceptionally serious situation. This article analyzes the impact that the COVID-19 and the state of alarm has had on Spanish social service professionals. An ad hoc questionnaire was used, administered on-line, individually, voluntarily and anonymously to 560 professionals working in social services, both in the public and private sectors, based throughout Spain. This questionnaire has five different parts: socio-demographic profiling, impact that the health crisis has had on the practice of professional functions, degree of knowledge of the measures imposed to guarantee the protection and safety of professionals and users, impact that it has had on the professional and personal development of social services professionals and, the fifth and last part, degree of adaptation of the measures aimed at the care of the vulnerable population. These results are discussed based on the situation in which professionals working in this sector find themselves in the face of the changes they are experiencing in the development of their work, and we are able to determine the profile of the workers who have felt most affected by the situation, with the consequent and foreseeable mental and emotional affectation that this implies. These professionals tend to value more negatively the set of measures developed to mitigate the impact of COVID-19 on Spanish social services.
Assuntos
COVID-19/epidemiologia , Serviço Social/estatística & dados numéricos , Adulto , Emoções , Emprego/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Percepção , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
Language development has been consistently linked with socioeconomic status (SES), with children from lower SES backgrounds at higher risk for language delays. The objective of this study is to investigate the relationship between familial social service use and language development during the first year of life. Thirty-one low-income mothers and their infants were recruited from the New York metropolitan area. Mothers provided information about demographics and utilization of social services (Women, Infants, and Children (WIC), food stamps, Medicaid, and public housing). Infant language skills were assessed using the Preschool Language Scale. Multiple linear regressions were used to investigate the relationship between social service use and language skills. We found that the number of social services utilized was not an overall significant linear predictor of language skills. However, social service use interacted with poverty level to predict language skills. Specifically, for families living in deep poverty, higher service use significantly predicted higher infant language scores (ß = 3.4, p = 0.005). These results suggest that social services may be an appropriate target to help narrow socioeconomic disparities in language development.
Assuntos
Idioma , Pobreza , Serviço Social , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , New York , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Classe Social , Serviço Social/estatística & dados numéricos , População UrbanaRESUMO
INTRODUCTION: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. CONCLUSIONS: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.