Injury Patterns and Help-seeking Behavior in Hong Kong Male Intimate Partner Violence Victims.

BACKGROUND: Few studies have focused on the characteristics of male victims of intimate partner violence (IPV). Providers of care lack knowledge on the pathognomonic features to identify male IPV victims, who tend to be hidden. OBJECTIVES: This study investigated the injury patterns of male IPV victims and their help-seeking characteristics. METHODS: A retrospective cohort study was carried out in two regional hospitals in Hong Kong. Data were collected from the hospital computer databases (i.e., the Accident & Emergency Information System and the Clinical Data Analysis and Reporting System) and the medical charts completed by physicians. RESULTS: Medical records were retrieved from August 1, 2009 to December 31, 2011 for all IPV victims presenting at the accident and emergency departments. There were 372 cases in total, including 54 male and 318 female cases. Male victims were more likely to have abrasions/scrapes (66.7%), human bites (20.4%), and laceration/cutting (18.5%) than female victims (31.4%, 1.3%, 6.9%; p < 0.001, p < 0.01, p < 0.001, respectively). More male victims received dressing (38.9%) and injection (13.0%) than female victims (14.5%, 3.5%; p < 0.001, p < 0.01, respectively). Fewer male victims attended consultation by the medical social worker (MSW; 5.6%) than female victims (21.7%). CONCLUSION: Abrasion wounds are the most common in male victims of IPV. Male victims have lower rates of seeking help from MSWs, and most are aged 40 years or above. This study has identified important characteristics of male victims to aid the development of a comprehensive program for early IPV detection and management.

Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument.

OBJECTIVE: The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. METHODS: The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital system's IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. RESULTS: The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. CONCLUSIONS: The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.

Outcomes after delirium in a Japanese intensive care unit.

OBJECTIVE: Delirium in the intensive care unit (ICU) is recognized as a major public health problem. Few Japanese outcome studies have been reported. The purpose of the study was to investigate the hospital outcomes of ICU delirium in a Japanese general hospital. METHODS: Patients were drawn from consecutive admissions to an ICU at a tertiary care university hospital. Delirium assessments were conducted using the Intensive Care Delirium Screening Checklist (ICDSC). The following information was recorded: age, sex, the reason for ICU admission, the ICDSC scores, the COmplexity PRediction Instrument (COMPRI) scores, the length of stay (LOS) in the ICU, the total hospital LOS, hospital outcomes and social worker's consultation. RESULTS: Of the 126 patients who were evaluated, 35 (27.8%) developed delirium during the ICU stay. Older age and biopsychosocial vulnerability assessed by the COMPRI were risk factors of ICU delirium. ICU delirium was a predictor of increased mortality and associated with prolonged ICU and hospital LOS. ICU delirium was an independent risk factor for having social worker's consultation after ICU discharge. CONCLUSIONS: ICU delirium is associated with worse outcomes including mortality and LOS in Japan. ICU delirium is independently associated with further social worker's consultations, suggesting that early proactive social worker's intervention may be beneficial for the patients with ICU delirium.

Evaluating Adjustment to Health Condition and Adjustment to Hospitalization as indicators for intervention in Australia.

This article describes an exploratory study aimed at elucidating social workers' understandings of the concepts of Adjustment to Health Condition and Adjustment to Hospitalisation as Indicators for Intervention. Thematic analysis was utilised on data from in-depth semi-structured interviews and focus groups with 18 experienced health care social workers. The findings demonstrated that adjustment was conceptualised as a complex, multi-dimensional process including the key interrelated themes of coping, emotion, subjective meaning, adaptation, support, family-focus, and process orientation. The findings can assist social workers in conceptualising their practice and articulating their role with clients and with other health professionals in relation to crucial adjustment issues identified in health care settings.

The development of the Profile of Adaptation to Life within a medically ill population: PAL-M.

The social work department at a biomedical research hospital was challenged to improve efficiency and accountability regarding psychosocial care of its patients. This article presents the process of selecting and revising the Profile of Adaptation to Life (PAL) into a screening instrument that identifies the hospital's most vulnerable patients who need to have a full psychosocial assessment completed by the social worker. The PAL was selected because it includes identifiable risk factors across the psychosocial spectrum, is cost-effective, and easy to administer and score. Factor analysis and reliability analysis resulted in a promising instrument, the Profile for Adaptation to Life-Medical (PAL-M), for use in rapid, psychosocial risk screening with medically ill patients. Based on the analysis, the authors updated the PAL's original language, clarified introductory wording of some questions, and expanded demographic information.

Applying a theory of expertise in health social work administration and practice in Australia.

Social workers in health care have been urged to identify the nature of their expertise and to articulate profession specific roles (Peckuconis et al., 2003). This paper reports on the use of a theory of professional expertise (Fook, Ryan, & Hawkins, 2000) in management and clinical practice within two Australian hospital social work settings. This theory, directly applicable to social work, was applied within these hospitals to differentiate levels in social work industrial awards, in staff selection, in supervision and continuing professional development. Specific and broader implications for application of this theory are discussed.

Evidence that supports the value of social work in hospitals.

The value of hospital social work is supported by one hospital's tracking system that monitored social work discharge services and compared outcome with non-social work discharges. The sample consisted of a total of 64,722 patients admitted to the "med-surg" hospital unit over a two and one-half year time period from 2002 to 2004. Of the total patients in the sample, 15.7% (n = 10,156) had social work involvement. Sixty percent of the social worker patients were age 70 or over compared with the mean age of the sample of 56.2 years. The mean length of stay for social work served patients was 11.4 days (sd = 13.9) compared to 4.3 days (sd = 6.3) non-social work patients, a difference that was significant (t =-68.3; p = .000). The authors attribute the longer lengths of stay to social workers' receiving older and more difficult-to-place patients. An evidence-based case is made for the cost-containment value of social workers in hospitals and for the creation of a tracking infrastructure to aid in monitoring the daily achievements of medical/surgical social workers.

Parents' use of nonmedical support services in the neonatal intensive care unit.

Parents frequently identify the need for support while their infant is in the Neonatal Intensive Care Unit (NICU), however, they may simultaneously distance themselves from traditional family and friend support. Recognizing this, many NICUs provide additional nonmedical support services such as social workers, chaplains/religious counselors, and support groups. This article, part of a larger research study, suggests an inverse relationship between social support and the use of supportive services. In addition, parents in this study appear to use support services less often than would be anticipated based on their reports of utility. Suggestions are provided to potentially improve desirability/accessibility of these services.

Measuring productivity in medical social work.

Our purpose was to discuss the need for measuring and documenting social work services, as well as to discuss the data and statistical collection method used in Mayo Clinic's Section of Medical Social Services, which may be useful to other social service departments. The lack of empirical data showing the value of social work services may lead to decreases in staffing in medical social work departments. Mayo Clinic uses a computer application called MedSoc to gather case information and measure productivity, which is based on demand and capacity. Through use of MedSoc, our section improved communication among social work staff members and justified an increase in staffing of 38% from late 1997 to 2002.

Differences and similarities between social work and nurse discharge planners.

Historically the tasks involved in discharge planning have been a part of the practice of social work as well as the field of nursing. Based on this history and need for collaboration, a study conducted in 1998 measured the responses of 178 nurses and social workers who practiced discharge planning in 58 different hospitals in Alabama. According to the information gathered in this sample, it was clear that social workers as well as nurses continued to be important service providers in the area of discharge planning. Demographic data, work setting, caseload, and task difference were compared and significant differences were reported. This article makes recommendations for social work's participation in advocacy, policy, and outcome research in discharge planning.

A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services.

The number of discharges (63,303) from a university-affiliated medical center in Israel were reviewed. Eight percent of cases in three departments rcceivcd social work services. Patients experiencing inappropriate hospital stay (discharge delay) and who received social work services were characterized and compared with social work clients not experiencing delay. Discharge delay patients differed from other social work clients on key sociodemographic variables. Patients admitted because of "injury" were significantly more likely to experience delay than patients admitted because of "illness." "Waiting for community/institutional resources" was the most common reason for delay and discharge to an institutional setting increased the likelihood of delayed discharge. High risk factors were department-specific and should be studied in context. Results suggested the limited but positive impact of hospital-community collaborative strategies in reducing the incidence of delay over time.

Discharge planning and social work practice.

Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% rcsponse rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.

Introduction: promoting and maintaining a reflective professional staff in a hospital-based social work department.

Promoting and sustaining a staff of reflective social work practitioners requires a supportive departmental structure and culture. Providing such support is a particular yet necessary challenge to social work administrators in the current health care environment. This article discusses an array of administrative strategies employed in one hospital social work department to promote reflective social work practice. More specifically, it describes the role of practice-based research in enhancing worker reflectiveness.

Comparing social work's role in renal dialysis in Israel and the United States: the practice-based research potential of available clinical information.

This paper demonstrates the use of clinical data-mining in a study of social work interventions with dialysis patients in two countries, the US and Israel. We aimed to examine the role of social workers in improving kidney patient outcomes and to determine the potential of readily available patient information for studying this process. The findings showed considerable differences between the patient samples in both countries, as far as the socio-demographic background was considered. In spite of this, there were numerous similarities in the type of psycho-social problems and reactions, as well as the social workers' interventions. Differences which arose in various patient states and outcomes were examined in light of variations in the health care systems and socio-cultural contexts of renal dialysis in both sites.

Dialysis patient characteristics and outcomes: the complexity of social work practice with the end stage renal disease population.

This article describes a demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients. The study is unique in including an interdisciplinary research team to guide the process, using available data contained within the medical record and focusing on interventions and outcomes over time rather than at one or two points in patients' treatment histories. It demonstrates the complexity of practice with dialysis patients and the crucial role for social workers in enhancing patient outcomes. Secondary benefits of this methodology and implications for social work practice and research are discussed.

Using available clinical information in practice-based research: mining for silver while dreaming of gold.

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated "gold standard" experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.

Mining clinical information in the utilization of social services: practitioners inform themselves.

When fully invested in applied studies regarding their own clinical and programmatic concerns, social work practitioners find that "mining" clinical information enriches their performance and services.

Screening for psychosocial risk in an urban prenatal clinic population: a retrospective practice-based research study.

Recognition of the need for early identification of risk factors led a "practice-based research" (Epstein, 1995) team of social workers in the prenatal clinic at Mount Sinai to develop a standardized, comprehensive screening, monitoring and evaluation instrument for all patients in their service. To explore the effects of psychosocial risk factors empirically, available information collected from 435 women screened with the original instrument between 1992-93 was converted into a quantitative data-base. The intention was to conduct a retrospective study of the prenatal patient population, including demographic characteristics, problems presented, social work interventions, and treatment outcomes. Among the findings anxiety and ambivalence related to pregnancy were significant risk factors. This model of social work service delivery is consistent with the focus of prenatal care as clinical preventative medicine.

Creating experimental analogs with available clinical information: credible alternatives to "gold-standard" experiments?

Comparison of the implementation and findings of a "gold standard" evaluation of social work intervention and its experimental analog based on available clinical information illustrates the strengths and weaknesses of each. From a practice-research integration perspective, however, "clinical data-mining" may be a credible alternative to randomized controlled experiments.