Suitability of Social Services for the Older Persons: Analysis of Degree of Fit between Needs and Services.

Increased life expectancy coupled with decreased birth rates has led to a notable aging of the population. In the social care sector, resources for the older persons should be allocated by means of objective instruments that ensure an appropriate fit between older people's needs and the characteristics of the services. This paper analyzes the appropriacy of actual assignments of resources in a sample of 632 older users of social services, evaluating the degree of fit between these assignments and those made by a Decision Making Model (DMM) which is strictly based on an objective assessment of user's needs and characteristics. The results indicate that biopsychosocial variables included as predictors in the DMM are appropriate for ensuring that the needs of the older persons are met and resources are optimized. However, the current assignments of users to services cannot be explained by relying solely on these variables, suggesting that the allocation of users to services may be conditioned by factors that are different from those covered by the DMM.

Accountable Communities of Health, Health and Social Service Systems Alignment, and Population Health: Eastern Washington State, 2017-2019.

Objectives. To assess health system transformation and alignment in the Better Health Together (BHT) accountable community of health (ACH) region of Eastern Washington.Methods. This trend study leveraged cross-sectional data collected in 2017 and 2019 in Eastern Washington. A total of 165 responses from individuals representing 112 organizations were collected in 2017, and 211 responses from individuals representing 92 organizations were collected in 2019. More than one third (38%; n = 35 organizations) of cases overlapped between the 2 samples. Implementation of the ACH model is the exposure. Outcomes of interest included indicators of system transformation and alignment.Results. Organizations throughout BHT's region became more engaged, less siloed, and better connected from 2017 to 2019. At least some of the increased connectivity observed was directly attributable to the role BHT played in facilitating the creation or maintenance of interorganizational relationships across Eastern Washington.Conclusions. The ACH model is a promising approach to aligning health and social service systems for population health improvement. Evidence shows that ACH organizations can serve as trusted conveners able to facilitate interorganizational relationships across sectors.

A novel social work approach to emergency department buprenorphine induction and warm hand-off to community providers.

STUDY OBJECTIVE: Medications for opioid use disorder (MOUD) is considered gold standard treatment for persons with an opioid use disorder and can be successfully initiated in emergency departments (EDBUP). Perceived provider barriers to EDBUP adoption include increased provider work, lack of provider knowledge about outpatient MOUD resources, and a lack of viable MOUD treatment options within health systems. We evaluated the feasibility of a novel EDBUP institutional design that utilizes the social work team to drive ED care for patients with OUD and coordinate MOUD referral to existing community resources. METHODS: This is a retrospective, cohort, single-center study describing patient outcomes in a social work driven EDBUP program with referral to community MOUD providers. ED patients with OUD were identified via patient request, standardized nurse screening, or ED provider concern. All identified patients received an urgent social work consult to explore willingness to seek treatment for OUD. Social workers developed individualized follow up plans with participating patients. Clinical data was abstracted from the Electronic Health Record. Social workers tracked continuity with outpatient MOUD services in a clinical care database. RESULTS: From June 1, 2018 through August 31, 2019, 120 patients opted for ED buprenorphine induction. 61% presented to initial outpatient intake appointment and 39% remained engaged in treatment after 30 days. CONCLUSIONS: EDs can effectively utilize the expertise of social workers to drive EDBUP and coordinate outpatient MOUD referrals. Our interdisciplinary EDBUP program structure is feasible and has the potential to yield meaningful reductions in physician workload and ED cost.

More that unites us than divides us? A qualitative study of integration of community health and social care services.

BACKGROUND: The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation. METHODS: Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis. RESULTS: We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building. CONCLUSIONS: Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

Implementing an Evidence-based Tobacco Control Program at Five 2-1-1 Call Centers: An Evaluation Using the Consolidated Framework for Implementation Research.

Introduction: The Smoke-Free Homes (SFH) Program is an evidence-based intervention offered within 2-1-1 information and referral call centers to promote smoke-free homes in low-income populations. We used the Consolidated Framework for Implementation Research to conduct a mixed-methods analysis of facilitators and barriers to scaling up SFH to five 2-1-1 sites in the United States. Methods: Data were collected from staff in 2015-2016 via online surveys administered before (N = 120) and after SFH training (N = 101) and after SFH implementation (N = 79). Semi-structured telephone interviews were conducted in 2016 with 25 staff to examine attitudes towards SFH, ways local context affected implementation, and unintended benefits and consequences of implementing SFH. Results: Post-implementation, 79% of respondents reported that SFH was consistent with their 2-1-1's mission, 70% thought it led to more smoke-free homes in their population, 62% thought it was easy to adapt, and 56% thought participants were satisfied. Composite measures of perceived appropriateness of SFH for 2-1-1 callers and staff positivity toward SFH were significantly lower post-implementation than pre-implementation. In interviews, staff said SFH fit with their 2-1-1's mission but expressed concerns about intervention sustainability, time and resources needed for delivery, and how SFH fit into their workflow. Conclusions: Sites' SFH implementation experiences were affected both by demands of intervention delivery and by SFH's perceived effectiveness and fit with organizational mission. Future implementation of SFH and other tobacco control programs should address identified barriers by securing ongoing funding, providing dedicated staff time, and ensuring programs fit with staff workflow. Implications: Smoke-free home policies reduce exposure to secondhand smoke. Partnering with social service agencies offers a promising way to scale up evidence-based smoke-free home interventions among low-income populations. We found that the SFH intervention was acceptable and feasible among multiple 2-1-1 delivery sites. There were also significant challenges to implementation, including site workflow, desire to adapt the intervention, time needed for intervention delivery, and financial sustainability. Addressing such challenges will aid future efforts to scale up evidence-based tobacco control interventions to social service agencies such as 2-1-1.

The Importance of Governmental and Nongovernmental Investments in Public Health and Social Services for Improving Community Health Outcomes.

OBJECTIVE: To explore whether health outcomes are influenced by both governmental social services spending and hospital provision of community health services. DESIGN: We combined hospital provision of community health services data from the American Hospital Association with local governmental spending data from the US Census Bureau. Longitudinal models regressed community health outcomes for 2012-2016 on local government spending on health, social services, and education from 5 years previously, controlling for sociodemographic and hospital marketplace characteristics, spatial autocorrelation, and state-level random effects. For counties with hospitals, models also included county-level data on hospitals' provision of community health services. SETTING: All analyses were performed at the county level for US counties between 2012 and 2016. PARTICIPANTS: Complete spending, hospital, and health outcomes data were available for a total of 2379 counties. MAIN OUTCOME MEASURES: We examined relationships between governmental spending, hospital service provision, and 5 population health outcome measures: years of potential life lost prior to age 75 years per 100 000 population, percentage of population in fair or poor health, percentage of adults who are physically inactive, deaths due to injury per 100 000 population, and percentage of births that are of low birth weight. RESULTS: Governmental investments in health, social services, and education positively impacted key health outcomes but mainly in counties with 1 or more hospitals present. Hospitals' provision of community health services also had a significant positive impact on health outcomes. CONCLUSIONS: Hospital provision of community health services and increases in local governmental health and social services spending were both associated with improved health. Collaboration between local governments and hospitals may help ensure that public and private community health resources synergistically contribute to the public's health. Local policy makers should consider service provision by the private sector to leverage the public investments in health and social services.

Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035.

BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 µg/m3; and (4) NO2 annual European Union limit values reached (40 µg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.

Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry.

BACKGROUND: A parental mental illness affects all family members and should warrant a need for support. AIM: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration. METHODS: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients' main diagnoses, comorbidity, children below the age of 18, and child-focused interventions. RESULTS: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care. CONCLUSIONS: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

The role and the interventions of the Hospital Social Service (HSS) for the integration of the health and social activities: a comparative survey between 2008 and 2014 in the Social Service of the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome, Italy.

INTRODUCTION: In the Azienda Ospedaliera Universitaria Policlinico Umberto I in Rome, the Hospital Social Services (HSS) is located within the Directorate of Health, reporting directly to the Chief Medical Officer, providing counselling and supporting clinical services. The HSS is part of a network with its own technical, professional and assessment independence. It often serves as liaison between the hospital and the territory, facilitating the development of services and contributing to public health recovery and maintenance, therefore improving the citizens' standard of living thanks to aid projects and specific interventions. METHODS: The present Report is based on two different studies carried out in 2008 and 2014, both examining the work of the Hospital Social Service in the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome. The purpose is to compare these surveys and work out the results. The data collection is based on a number of social records from the HSS archives (814 records in 2008 and 790 in 2014). The research project followed subsequent stages: planning a draft of the research, where ethnomethodology was used as empirical evaluation technique; collecting data from the HSS's paper and file archives (biographical, clinical and social data); revising, analysing and elaborating the data which showed relevant changes leading to interesting conclusions. RESULTS AND CONCLUSIONS: The comparative analysis of data showed a higher demand of HSS healthcare services, despite a smaller number of beds and hospitalisations available in standard regime. Also, it indicated an increase of patients below 18 years and a decrease of the over-65s age group. As for the geographical origin of patients reported to the HSS, there was a decrease in the percentage of Italian citizens, while the percentage of irregular non-EU and EU patients increased by over 5%. Significant results were found comparing the days between the report to the HSS and patient discharge. Data concerning the 'more than 7 days' group was steady over the years, being more consistent for both the variables considered and increasing in 2014. In the comparative analysis, the interventions with more significant differences were those aimed at promoting homecare and entering sheltered housing. In the former cases, a considerable decrease was observed, if compared to the activation of the integrated health and social homecare services, while there were more requests for homecare assistance; in the latter ones the analysis highlighted a sharp decrease in the percentage of the variable called "assessment to enter Extended Care Units". The causes of these changes are remarkable and have to be found in the political, historical and cultural scenario: - a first factor is the increase in the more recent migratory flow from non-EU countries to Italy, which could explain the rising percentage of foreigners taken over by the HSS; - regional policies, economic cuts imposed on healthcare and higher income limits in order to calculate the patient's economic participation in the costs of institutionalisation have affected the above-mentioned changes; - the innovations in the regulatory field of Latium Region have brought structural changes in long-term care facilities and in the level of care in Extended Care Units (ECU).

Down Syndrome and Alzheimer's Disease: Issues and Implications for Social Work Practice.

Owing to recent medical advancements, people with Down Syndrome (DS) are now able to live considerably longer lives and thus experience a variety of complex issues as they age. Alzheimer's Disease (AD) frequently occurs in older adults who have DS, but few practice guidelines exist to inform social work practice with older adults who have this dual diagnosis. This commentary will highlight the connection between these two conditions within a neurobiological framework and discuss implications for practice based on the available literature on this intersection of ability status, cognitive status, and age.

Ward social workers' views of what facilitates or hinders collaboration with specialist palliative care team social workers: A grounded theory.

BACKGROUND: Inpatient, generalist social workers in discharge planning roles work alongside specialist palliative care social workers to care for patients, often resulting in two social workers being concurrently involved in the same patient's care. Previous studies identifying components of effective collaboration, which impacts patient outcomes, care efficiency, professional job satisfaction, and healthcare costs, were conducted with nurses and physicians but not social workers. This study explores ward social workers' perceptions of what facilitates or hinders collaboration with palliative care social workers. METHODS: Grounded theory was used to explore the research aim. In-depth qualitative interviews with masters trained ward social workers (n = 14) working in six hospitals located in the Midwest, United States were conducted between February 2014 and January 2015. A theoretical model of ward social workers' collaboration with palliative care social workers was developed. RESULTS: The emerging model of collaboration consists of: 1) trust, which is comprised of a) ability, b) benevolence, and c) integrity, 2) information sharing, and 3) role negotiation. Effective collaboration occurs when all elements of the model are present. CONCLUSION: Collaboration is facilitated when ward social workers' perceptions of trust are high, pertinent information is communicated in a time-sensitive manner, and a flexible approach to roles is taken. The theoretical model of collaboration can inform organisational policy and social work clinical practice guidelines, and may be of use to other healthcare professionals, as improvements in collaboration among healthcare providers may have a positive impact on patient outcomes.

Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

PART 2. NEPHROLOGY SOCIAL WORK: LOOKING BACK, LOOKING FORWARD.

The field of nephrology social work has undergone considerable change since the release of the 1976 federal regulations requiring a master's level social worker to be part of the renal team. Moderated by veteran nephrology social worker Stephanie Johnstone, LCSW, those who have served patients in the front lines of kidney care speak here about the past-"What has nephrology social work contributed in the last three decades, and what it has struggled to accomplish?" - and about the future: "How can nephrology social workers best serve patients in the years ahead? Where is their greatest potential to advance the industry?" Ms. Johnstone, an NN&I Editorial Advisory Board member, has worked for Fresenius Kidney Care for over 33 years. She is currently the Field Support Liaison, Clinical Innovations Team and Lead Social Worker, So Cal Region for FKC, and is based in San Diego.

Examining the Presence of Congregational Programs Focused on Violence Against Women.

Religious congregations are uniquely poised to provide programs to support survivors of violence against women; yet little is known regarding the prevalence of such programs. In this study, we used data from three waves of the National Congregation Study (N = 3334) to examine change across time in the presence of a congregational program to support survivors of sexual assault or domestic violence. We also explored results among different Christian religious traditions across time. Given the gendered nature of this violence, we also tested whether the (a) gender of the head clergy (i.e., religious leader), and (b) ability of women to serve in congregational leadership roles predicted the presence of programs. As points of comparison, we also examined the total number of congregational social service programs and food programs in particular. Overall, we found different patterns of change across religious traditions for the different programs. Moreover, clergy gender and the ability of women to serve in leadership roles predicted the presence of different types of programs. Limitations, implications, and directions for future research also are discussed.

American Indian/Alaska Native Elders: A Growing Demographic that Is Changing How We View Aging.

Today, AIAN Elders are more actively engaged in their families and communities, encouraging the development of intergenerational programs, language and cultural revitalization, being stewards in research conducted in their communities, as well passing on their knowledge and experiences on how to live as healthy Native people. Elders have traditionally been quiet and observant of their environment, but the current and future cohorts of Elders are advocates, leaders, and culture bearers for their families and communities and they are now in positions of leadership. Western society acknowledges the value of traditional knowledge and AIAN Elders are viewed as exemplars of healthy aging and their lessons and experiences can be attributed to our own lives. This commentary highlights the paradigm shift in how society views older adults, specifically AIAN Elders and their role in health and wellbeing.

[80 years of soial service in medicine]. / Los 80 años del servicio social (SS) en medicina.

Hace 80 años, la Escuela de Medicina de la Universidad Nacional, en voz de su director, Gustavo Baz Prada, hizo una propuesta que pronto se convirtió en realidad y finalmente en norma, la que desde entonces se conoce como SS. Esta iniciativa se vio como una manera para que los estudiantes de medicina del último año retribuyeran a la sociedad una parte de lo que esta invirtió en su educación, consolidaran su formación mediante la exposición a las realidades de todos los días en los medios más necesitados, se pusieran a prueba sobre sus verdaderas capacidades para atender pacientes y participaran en la solución de un problema de atención sanitaria que en ese entonces era mucho más apremiante que ahora. Unos años después, los recién egresados de otras licenciaturas (pasantes) también fueron incorporados a esta estrategia y, al fin, se reconoció formalmente como una responsabilidad de las instituciones educativas. Las aportaciones del SS a la salud de las personas y a la formación de los médicos han sido incuestionables, y la experiencia humana que ha representado para quienes lo han vivido ha dejado marcas indelebles.

Trends in worker hearing loss by industry sector, 1981-2010.

BACKGROUND: The purpose of this study was to estimate the incidence and prevalence of hearing loss for noise-exposed U.S. workers by industry sector and 5-year time period, covering 30 years. METHODS: Audiograms for 1.8 million workers from 1981-2010 were examined. Incidence and prevalence were estimated by industry sector and time period. The adjusted risk of incident hearing loss within each time period and industry sector as compared with a reference time period was also estimated. RESULTS: The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined. However, the risk remained high for workers in Healthcare and Social Assistance, and the prevalence was consistently high for Mining and Construction workers. CONCLUSIONS: While progress has been made in reducing the risk of incident hearing loss within most industry sectors, additional efforts are needed within Mining, Construction and Healthcare and Social Assistance.