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.

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).

Defining Social Work within Holistic Public Defense: Challenges and Implications for Practice.

Social work has a history of forensic practice, but social work as an integral component of the holistic model of public defense is new and is creating a demand for better definition of roles and services. The intent of this article is to contribute to and encourage dialogue surrounding social work practice within the holistic public defense model. A brief overview of the indigent criminal defense system and its emerging models of defense practice is provided. Models of practice established by the Knox County Public Defender's Community Law Office are offered. Challenges, implications, and future directions are discussed.

Opiniones de los y las profesionales de Atención Primaria sobre el consumo de alcohol en mujeres. Barreras percibidas para la intervención / Opinions of primary care professionals about alcohol consumption in women. Perceived barriers for intervention

Objetivo: conocer la opinión de los y las profesionales de Atención Primaria (AP) acerca del consumo de alcohol, especialmente entre las mujeres, analizar las dificultades encontradas e identificar áreas de mejora. Materiales y método: Se ha realizado una investigación cualitativa, entre el personal de AP de Salamanca. Fueron seleccionados profesionales (enfermería, medicina, pediatría, trabajo social y matronas) con más de dos años de experiencia en AP. Se desarrollaron 14 entrevistas y 4 grupos de discusión, cuyas grabaciones fueron transcritas obteniendo el texto base del análisis discursivo. Resultados: Los y las profesionales de AP reconocen una especial dificultad para detectar e intervenir frente a consumos de riesgo de alcohol y especialmente en el caso de las mujeres. Entre los factores contribuyentes se identifican, prejuicios y estereotipos de género, el temor a invadir la intimidad del paciente, la sobrecarga y organización del trabajo, y otros relacionados con las habilidades para realizar la detección y la intervención breve. Discusión: Se precisan actuaciones sensibilizadoras y formativas con perspectiva de género que faciliten al personal sanitario el abordaje de situaciones de consumo de riesgo de alcohol, sistematizar el consejo preventivo y orientarlo a la salud de las propias mujeres. También se perciben carencias en la coordinación de los recursos disponibles tanto preventivos como asistenciales

Objective: to find out the opinion of Primary Care (PC) professionals on alcohol consumption, particularly among women; to analyze the difficulties that are found in the process; and to identify areas which can be improved. Materials and method: A qualitative study was conducted among Salamanca PC professionals. Different professionals (from the fields of nursery, medicine, pediatrics, social work and midwifery) with more than two years of experience in PC were selected. In total, 14 interviews and 4 group discussion sessions were carried out, and the recordings were transcribed to obtain the text for discourse analysis. Results: PC professionals recognize that it is particularly difficult to detect and intervene in cases of risky consumption of alcohol, and especially in the case of women. Among the contributing factors, the following were mentioned: prejudices and gender stereotypes, fear of invading patients’ privacy, work overload, structure of work load, and other aspects related to the abilities to carry out detection and brief intervention. Discussion: A set of training and awareness-raising activities with a gender perspective is required in order to facilitate the management of situations of risky alcohol consumption for healthcare professionals, as well as to systematize preventive advice and orient it towards women’s health. Deficiencies were also observed in the coordination of available resources, both preventive and healthcare-related

Trends in Social Work. Nephrology social work meets integrated care: A partnership for the road ahead.

Integrated care has brought changes to the field of nephrology social work. In turn, nephrology social work has brought innovative contributions to the field of integrated care. The new social work service delivery systems described in this article are sure to help the industry reach its goals to keep care patient-centered while maintaining quality and reducing the costs of treating end stage renal disease. Social workers are called to serve the needs of the client, the family, the community and the society at large. Nephrology social workers are right where they belong in the ESRD integrated care environment. They feel right at home.

Moving toward integrated health: an opportunity for social work.

With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.

Future trends in health and health care: implications for social work practice in an aging society.

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

Atypical alliances: the potential for social work and pharmacy collaborations in primary health care delivery.

The growing prevalence of chronic conditions is a cause for concern globally, both in terms of its impact on the health of populations and also the strain it is predicted to place on health resources. There is a push to adopt more holistic and collaborative approaches to health care, and for the education of health care professionals to be reformed if these efforts are to be successful. A research project was undertaken in New Zealand in 2010-2011 aimed at exploring the perceptions of health care professionals on competencies in the field of chronic care. This article aims to highlight learning from the project regarding the "atypical alliance" between social work and pharmacy. Based on this, the authors argue that, with the growing expectations for interprofessional collaboration, effective primary and community health care delivery is increasingly dependent on relationships between educators in different health disciplines, between health professionals-in-training, and between education providers and health organizations.

Cognitive remediation: a new generation of psychosocial interventions for people with schizophrenia.

Schizophrenia is a mental health condition characterized by broad impairments in cognition that place profound limitations on functional recovery. Social work has an enduring legacy in pioneering the development of novel psychosocial interventions for people with schizophrenia, and in this article the author introduces cognitive remediation, the latest advance in psychosocial treatments for the disorder designed to improve cognition. First, the author presents an overview of the nature of cognitive impairments and their functional consequences in schizophrenia, followed by a description of the theoretical basis and key practice principles of cognitive remediation. Next, the author reviews the latest biopsychosocial evidence for the efficacy of cognitive remediation in schizophrenia. Finally, the author presents a model cognitive remediation program, cognitive enhancement therapy, which was developed and evaluated by a social work-led multidisciplinary team. Cognitive enhancement therapy is a significant advance in cognitive remediation for schizophrenia and uses a unique holistic approach that extends beyond traditional neurocognitive training to facilitate the achievement of adult social-cognitive milestones and broader functional recovery. Cognitive remediation is an effective next-generation psychosocial intervention that social workers can use to help improve the lives of many people who live with schizophrenia.

Moving toward reconciliation in indigenous child welfare.

The Touchstones of Hope reconciliation movement consists of principles (culture and language, self-determination, structural interventions, non discrimination, and holistic approach) that guide a reconciliation process of truth-telling, acknowledging, restoring and relating to reshape indigenous child welfare led by indigenous peoples and supported by their non-indigenous counterparts. This article describes a reconciliation movement in Canada grounded in Touchstones of Hope principles, involving a reconciliation process between indigenous and non-indigenous individuals, which has enabled culturally relevant concepts of child welfare and plans for child safety to emerge.

Human genome and the african personality: implications for social work.

The integration of the human genome with the African personality should be viewed as an interdependent whole. The African personality, for purposes of this article, comprises Black experiences, Negritude, and an Africa-centered axiology and epistemology. The outcome results in a spiritual focused collective consciousness. Anthropologically, historically (and with the Human Genome Project), genetically Africa has proven to be the source of all human life. Human kind wherever they exist on the planet using the African personality must be viewed as interconnected. Although racism and its progeny discrimination preexist the human genome project (HGP), the human genome provides an evidence-based rationale for the end to all policy and subsequent practice based on race and racism. Policy must be based on evidence to be competent practice. It would be remiss if not irresponsible of social work and the other behavioral scientist concerned with intervention and prevention behaviors to not infuse the findings of the HCPs. The African personality is a concept that provides a wholistic way to evaluate human behavior from an African worldview.

Propuesta de implementación del proceso de fibromialgia. Distrito Sevilla. La fibromialgia desde Atención Primaria / Proposal for implementing the fibromyalgia process. Seville district. Fibromyalgia from primary care

El objetivo de este artículo es concienciar a la Atención Primaria, Administraciones sanitarias, ayuntamientos y Asociaciones de Fibromialgia que, es posible desarrollar el Proceso Asistencial Integrado de Fibromialgia 2005 de la Consejería de Salud de Andalucía en el Distrito Sanitario Sevilla. Los recursos humanos y materiales, casi todos existen ya, solo habría que organizarlos. La Atención Primaria juega un importante papel como puerta de entrada (AU)

This article aims to raise awareness among Primary Care, Health Authorities, Municipalities and Fibromyalgia Associations that it is possible to implement the Fibromyalgia 2005 Integrated Health Process of the Andalusion Health Department in the Seville Health District. The human and material resources, already exist, and only have to be organised. Primary Care plays an important role as gateway to this process (AU)

Medical clowning: even adults deserve a dream.

The article examines the significance of the integration of medical clowns as an intervention strategy with adult outpatients suffering from chronic illnesses. The study is based on content analysis of the documentation of the work of two medical clowns over two years. The dominant theme involves the definition of the clown's role and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The finding is discussed in light of the dual role of the medical social worker as coordinator and as a case manager, and the challenge of integrating medical clowns in treatment of adult patients. There is room for further exploration of the contribution of medical clowns to assisting and improving the quality of life for patients and hospital staff.

The mind-body connection: not just a theory anymore.

The field of psychoneuroimmunology has witnessed an explosion of empirical findings during the last two decades. Research has documented the mechanisms through which stressful emotions alter white blood cell function. Stress diminishes white blood cell response to viral infected cells and to cancer cells. Moreover, vaccination is less effective in those who are stressed and wounds heal less readily in those who are stressed. While stress decreases the activity of some white blood cells, stress does not compromise the function of all types of white blood cells. Indeed, some types of autoimmune disease, which involve particular subsets of white blood cells, are exacerbated by stress. The literature documents the efficacy of talk-therapy interventions in altering immune system parameters and enhancing the body's ability to combat disease. The literature also documents the impact of the chronic stress of poverty on immune system function.

Complementary alternative medicine in health and mental health: implications for social work practice.

This article describes the increasing use of complementary alternative medicine (CAM) in this country and its implications for social work practice, education, research and policy in the health care field. Descriptive examples of CAM treatment modalities are provided along with their underlying rationale, common uses and available empirical support. It is concluded that patients will be better served by social workers who have knowledge of CAM treatment modalities. Furthermore, the need for further research on the efficacy of many CAM treatments and the certification of CAM treatment providers is discussed.