An ethic of care? Academic administration and pandemic policy.

This reflexive essay examines the adoption of an intentional 'ethic of care' by social work administrators in a large social work school located in the Pacific Northwest. An ethic of care foregrounds networks of human interdependence that collapse the public/private divide. Moreover, rooted in the political theory of recognition, a care ethic responds to crisis by attending to individuals' uniqueness and 'whole particularity.' Foremost, it rejects indifference. Through the personal recollections of one academic administrator, the impact of rejecting indifference in spring term 2020 is described. The essay concludes by linking the rejection of indifference to the national political landscape.

Health social work in Canada: Five trends worth noting.

Highlighting a strong human rights and social justice orientation underlying health social work in Canada, this paper describes recent contributions of Canadian health social work practitioners and scholars to five areas identified by Auslander (2001) in a delphi study of health social work in its first century. Five current 'trends' are discussed which correspond with Auslander's themes of professional legitimacy and scope, social causation, dissemination of knowledge, interventions, and cultural appropriateness. These trends are: 1) defining the scope of health social work practice; 2) addressing the social determinants of health; 3) promoting evidence-based practice in health social work; 4) delivering client and family-centered care; and 5) implementing cultural safety and trauma-informed practice. Suggestions are made to further strengthen the position of health social work in Canada.

What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review.

BACKGROUND: Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. METHODS: Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21-34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms "trauma-informed" and "child*" or "youth," plus "inpatient" or "residential" plus "psych*" or "mental." After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies; Collaborative Problem Solving; Sanctuary Model; Risking Connection; and the Fairy Tale Model. RESULTS: Five factors were instrumental in implementing trauma informed care across a spectrum of initiatives: senior leadership commitment, sufficient staff support, amplifying the voices of patients and families, aligning policy and programming with trauma informed principles, and using data to help motivate change. CONCLUSIONS: Reduction or elimination of coercive measures may be achieved by explicitly targeting specific coercive measures or by implementing broader therapeutic models. Additional research is needed to evaluate the efficacy of both approaches.

Why informally employed Chinese women do not go to the doctor.

Informal employment, in which workers have no security of employment and receive few or no health insurance benefits, has risen sharply in urban China in the last decade. The percentage of women in informal employment in China is higher than in the formal employment sector; 'feminization' has thus become a key feature of informal employment in China. A feminized informal labor sector has far-reaching effects on the status of women's health and on women's health-seeking behavior. To better understand this behavior, especially barriers to health seeking, we conducted 34 interviews informally employed women in Guangzhou, China. For comparative purposes, we also interviewed 22 men in the informal labor sector. Findings reveal that compared with men, women have more serious health problems but report seeking medical attention less frequently. Financial constraints, distrust of doctors and medical expenses, unfriendly treatment environments and traditional attitudes about health and illness among women were the main barriers to health seeking. Implications for health promotion are discussed.

Predictors of admission to acute inpatient psychiatric care among children enrolled in Medicaid.

This study examined acute inpatient psychiatric admissions among child Medicaid recipients with a mental health diagnosis in one Midwestern state. The authors used multivariable logistic regression to determine the demographic, clinical, and service factors associated with admissions among 51,233 Medicaid enrolled children 3-17 years old who were identified as having a mental health diagnosis. Compared to available data from other states, the overall acute admission rate was low (2.5 %). Clinical factors were the strongest predictors of hospitalization. Youths with mood, disruptive and psychotic disorder diagnoses were 14.1, 6.2, and 5.8 times more likely than other mental health beneficiaries to experience one or more acute inpatient psychiatric admissions. Other predictors of acute admission included prior hospitalization, receipt of two or more concurrent psychotropic medications, older age, and urban residence. A low rate of acute inpatient admissions may indicate successful delivery of community-based mental health services; conversely, it may suggest underservice to youths with mental health need, particularly those in rural areas. Implications for publicly funded children's mental health care are discussed.

Selecting an EBP to reduce long-term foster care: lessons from a university-child welfare agency partnership.

A growing implementation literature outlines broad evidence-based practice implementation principles and pitfalls. Less robust is knowledge about the real-world process by which a state or agency chooses an evidence-based practice to implement and evaluate. Using a major U.S. initiative to reduce long-term foster care as the case, this article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor, and tailoring the model to the practice context. Use of implementation science guidelines and lessons learned from a unique private-public-university partnership are discussed.

Increasing the effectiveness of community mental health center social skills groups for children with autism spectrum disorder: a training and consultation example.

The goal of this collaboration between a university and two community mental health (CMH) centers was to increase capacity among staff serving children with autism spectrum disorder (ASD) in usual care social skills groups. University researchers observed two usual care social skills groups in two sites; identified needs and strengths; delivered tailored trainings on behavioral management principles; and provided follow-up coaching. After training and coaching, CMH staff demonstrated significant gains in self-reported and observed behavioral management skills. Foundational education in behavior management may benefit successful implementation of ASD-specific evidence based practices in community settings.

Usability testing, initial implementation, and formative evaluation of an evidence-based intervention: lessons from a demonstration project to reduce long-term foster care.

The field of child welfare faces an undersupply of evidence-based interventions to address long-term foster care. The Permanency Innovations Initiative is a five-year federal demonstration project intended to generate evidence to reduce long stays in foster care for those youth who encounter the most substantial barriers to permanency. This article describes a systematic and staged approach to implementation and evaluation of a PII project that included usability testing as one of its key activities. Usability testing is an industry-derived practice which analyzes early implementation processes and evaluation procedures before they are finalized. This article describes the iterative selection, testing, and analysis of nine usability metrics that were designed to assess three important constructs of the project's initial implementation and evaluation: intervening early, obtaining consent, and engaging parents. Results showed that seven of nine metrics met a predetermined target. This study demonstrates how findings from usability testing influenced the initial implementation and formative evaluation of an evidence-supported intervention. Implications are discussed for usability testing as a quality improvement cycle that may contribute to better operationalized interventions and more reliable, valid, and replicable evidence.

Defining a target population at high risk of long-term foster care: barriers to permanency for families of children with serious emotional disturbances.

Long-term foster care (LTFC) is an enduring problem that lacks evidence of effective strategies for practice or policy. This article describes initial activities of a statewide project of the national Permanency Innovations Initiative. The authors sought to: (1) verify the relevance of children's mental health as a predictor of LTFC, (2) describe critical barriers encountered by parents of children with serious emotional disturbances, and (3) identify systems barriers that hinder permanency for this target population.

Characteristics of children with autism spectrum disorders who received services through community mental health centers.

Despite the presence of significant psychiatric comorbidity among children with autism spectrum disorders (ASDs), little research exists on those who receive community-based mental health services. This project examined one year (2004) of data from the database maintained by 26 community mental health centers (CMHCs) in the Midwestern US state of Kansas. Children with autism were compared to children with other ASDs - Asperger's disorder, Rett's disorder, and PDD-NOS. Children with autism predictably received more special education services than children with other ASDs, while the latter were more likely to have experienced prior psychiatric hospitalization. Children with ASDs other than autism were also significantly more likely to be diagnosed with attention deficit hyperactivity disorder, oppositional defiant disorder, depressive disorders, and bipolar disorder. In 2004, Kansas CMHCs served less than 15 percent of the children estimated to have an ASD. Implications of these findings are discussed.