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1.
Artigo em Inglês | MEDLINE | ID: mdl-36673712

RESUMO

Unaccounted-for migrant workers (UMWs), who have left their employment placement and whose whereabouts are unknown, make up a vulnerable population in Taiwan. The children of UMWs have a particularly precarious status because they are undocumented/stateless, immigrant, and young. Living with this precarious status limits their children's rights to survival and development. Moreover, services for female UMWs and their undocumented children are underdeveloped. This study explores the accessibility and availability of social services for UMWs and undocumented children, based on interviews with 12 stakeholders from multiple systems, including a local government, a child welfare placement center, a migrant worker detention center, a hospital, a regional religious center, and a foreign country office. Preliminary findings indicate the following: First, UMWs' rights to healthcare are not preserved, and they experience greater prenatal risks because their illegal status excludes them from universal health coverage. Second, undocumented children's rights to survival and development are concerning because these children can be placed in residential care without individualized care or environmental stimulation. Third, children's rights to cultural identity and permanency are uncertain in that repatriation or adoption does not guarantee their future best interests.


Assuntos
Migrantes , Imigrantes Indocumentados , Gravidez , Humanos , Criança , Feminino , Taiwan , Acesso aos Serviços de Saúde , Serviço Social
2.
Artigo em Inglês | MEDLINE | ID: mdl-36613211

RESUMO

Critical perspectives and practices are fundamental to social work, yet there are only scarce examples of direct critical practice in public social services, and even fewer empirical evaluations of their outcomes for service users and social workers. This article presents a rapid evidence review of 25 evaluation studies of five programs that operate in the social services departments in Israel according to the principles of the Poverty-Aware Paradigm (PAP). The PAP is a critical paradigm for direct social work practice with people living in poverty that was implemented in the welfare services by the Ministry of Welfare, targeting over 14,000 service users. The evaluation studies we reviewed encompass an overall quantitative sample of 4612 service users and 1363 professionals, and a qualitative sample of 420 service users and 424 professionals. The findings present: (1) the program's outcomes for service users in terms of relationship with social workers, financial circumstances, family relations, and children's safety; and (2) the program's impact on social workers' attitudes and practices. Finally, we discuss the lessons learned regarding social workers' role in combatting poverty, the construction of success in interventions with people in poverty, and the article's limitations.


Assuntos
Serviço Social , Assistentes Sociais , Criança , Humanos , Israel , Pobreza , Seguridade Social
3.
JAMA Netw Open ; 6(1): e2249731, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36598783

RESUMO

Importance: Palliative care improves quality of life for patients and families but may be underused. Objective: To assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization. Design, Setting, and Participants: This cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019. The study included 71 VA primary care sites serving rural veterans. Participants were adult veterans who received primary care services from a site enrolled in the program and who received inpatient hospital care. Data were analyzed from January 2020 to August 2022. Exposures: The PACT staffing program was a clinic-level intervention that provided 3-year seed funding to Veterans Health Administration medical centers to hire 1 or more additional social workers in primary care teams. Staggered timing of the intervention enabled comparison of mean outcomes across sites before and after the intervention. Main Outcomes and Measures: The primary outcome was the number of individuals per 1000 veterans who had any palliative care use in 30 days after an inpatient hospital stay. Results: The analytic sample included 43 200 veterans (mean [SD] age, 65.34 [13.95] years; 37 259 [86.25%] men) and a total of 91 675 episodes of inpatient hospital care. Among the total cohort, 8611 veterans (9.39%) were Black, 77 069 veterans (84.07%) were White, and 2679 veterans (2.92%) were another race (including American Indian or Alaskan Native, Asian, and Native Hawaiian or other Pacific Islander). A mean of 14.5 individuals per 1000 veterans (1329 individuals in all) used palliative care after a hospital stay. After the intervention, there was an increase of 15.6 (95% CI, 9.2-22.3) individuals per 1000 veterans using palliative or hospice care after a hospital stay, controlling for national time trends and veteran characteristics-a 2-fold difference relative to the mean. Conclusions and Relevance: This cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing. These findings suggest that social workers may increase access to and/or use of palliative care. Future work should assess the mechanism for this association and whether the increase in palliative care is associated with other health or health care outcomes.


Assuntos
Cuidados Paliativos , Admissão e Escalonamento de Pessoal , Veteranos , Adulto , Idoso , Feminino , Humanos , Masculino , Estudos de Coortes , Qualidade de Vida , Serviço Social
4.
Soc Work Health Care ; 62(1): 1-18, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36587833

RESUMO

There is increasing recognition of the salience of eHealth technologies in enhancing health service capacity. Yet social work remains "behind the curve" in progressing digital practices. As the demand for digital health care increases, particularly following COVID-19, it is becoming increasingly urgent to understand how social workers engage with eHealth technologies, and how technological engagement impacts on social work practice. In this scoping review, we sought to examine eHealth use in health social work practice. Our findings suggest that, while social workers recognize the strengths and opportunities to broaden the scope of their practice, they remain concerned that eHealth may not be congruent with the values and approaches of the profession. This review provides a broad overview of health social workers' engagement with eHealth technologies and considers implications for future research that examines the nuanced and complex nature of professional values, risk, and assessment in the digital space.


Assuntos
COVID-19 , Telemedicina , Humanos , COVID-19/epidemiologia , Atenção à Saúde , Pessoal de Saúde , Serviço Social
5.
PLoS One ; 18(1): e0278930, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662789

RESUMO

Social interventions are essential in supporting the health and well-being of people with disability, but there is a critical need to prioritise resources for those that provide the best value for money. Economic evaluation is a widely used tool to assist priority setting when resources are scarce. However, the scope and consistency of economic evaluation evidence for disability social services are unclear, making it hard to compare across interventions to guide funding decisions. This systematic review aims to summarise the current evidence in the economic evaluation of social services for people with disability and to critically compare the methodologies used in conducting the economic evaluations with a focus on the outcomes and costs. We searched seven databases for relevant studies published from January 2005 to October 2021. Data were extracted on study characteristics such as costs, outcomes, perspectives, time horizons and intervention types. Overall, economic evaluation evidence of social services for people with disability was scarce. Twenty-four economic evaluations were included, with the majority conducting a cost-effectiveness analysis (n = 16). Most interventions focused on employment (n = 10), followed by community support and independent living (n = 6). Around 40% of the studies addressed people with mental illnesses (n = 10). The evidence was mixed on whether the interventions were cost-effective but the methods used were highly variable, which made comparisons across studies very difficult. More economic evidence on the value of interventions is needed as well as a more standardised and transparent approach for future research.


Assuntos
Pessoas com Deficiência , Transtornos Mentais , Humanos , Análise Custo-Benefício , Transtornos Mentais/terapia , Serviço Social
6.
Health Soc Work ; 48(1): 43-53, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36511330

RESUMO

Oral health remains underutilized within both integrated service delivery and educational settings. Advancing social workers' roles in the education of oral health providers is one strategic way to expand oral health and social work integration. Although the involvement of social workers in dental education is not new, fewer than 18 percent of the country's 68 accredited dental schools have active social work departments or services. This exploratory study sought to determine how, as of 2021, social work has been integrated into U.S. dental education programs (N = 13). Findings offer an overview of current social work programs in existence, roles social workers have in addressing social and behavioral health needs in dental education settings, and barriers to and facilitators in developing and sustaining integrated partnerships. This article discusses ways social work and oral health educational settings can mutually benefit from developing and/or strengthening their integrated collaborations. It also addresses a comparison of educational missions, clinical learning opportunities across both professions, and how patient care can be improved by expanding oral health and social work integration.


Assuntos
Saúde Bucal , Assistentes Sociais , Humanos , Educação em Odontologia , Serviço Social
8.
Health Soc Work ; 48(1): 7-10, 2023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36525392
9.
Int Nurs Rev ; 69(1): 96-105, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34547107

RESUMO

AIM: This study describes student perceptions on health inequalities and causes of poverty. BACKGROUND: As frontline providers, social workers and nurses are expected to engage with patients from socioeconomically diverse backgrounds. METHODS: In this cross-sectional study, a socio-demographic questionnaire, a questionnaire on health inequalities and the Perceived Causes of Poverty Scale were administered using a convenience sample of 155 students in social work and 266 students in nursing undergraduate programmes at a state university in Turkey. Mann-Whitney U test and Spearman correlation coefficient were used in the analysis of the data. FINDINGS: Social work students were more likely to attribute the cause of poverty to social injustice and a lack of opportunities, whereas nursing students had more fatalistic explanations or beliefs, maintaining that outcomes are pre-determined and therefore cannot be changed. In both groups, those who agreed that there were problems and deficiencies in health service provision and that there was ill-health among poor groups were more likely to associate poverty with social injustice and lack of opportunities. Those without a systemic understanding of poverty and health inequalities showed a tendency to hold more individualistic/fate-related perspectives. CONCLUSION AND IMPLICATIONS FOR NURSING AND EDUCATION POLICY: The nursing students, as compared to the social work students, tended to explain poverty more on the basis of individual responsibility and fatalism and were less likely to link poverty with health inequalities and to advocate for policies to end health inequalities. The students' perceptions on the causes of poverty affected their views on health inequalities. These findings suggest the need to develop curricula that equip nursing students with an understanding of poverty as a systemic cause of health inequality. Health inequality and poverty need to be positioned at the centre of training curricula by professional accreditation bodies. Interdisciplinary collaboration is recommended to foster advocacy skills in students. Furthermore, transformative changes are needed in nursing and social work education to prepare students to adequately address the Social Determinants of Health. Curricula should incorporate leadership and political activism within courses to facilitate structural change.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Estudos Transversais , Disparidades nos Níveis de Saúde , Humanos , Pobreza , Serviço Social
10.
Artigo em Espanhol | PAHO-IRIS | ID: phr-56885

RESUMO

[RESUMEN]. Objetivo. Analizar los procesos facilitadores y obstaculizadores y los efectos de la implementación de las medidas de salud pública no farmacológicas para la prevención de la COVID-19 en los centros de protección de la infancia y la adolescencia de dos departamentos (Antioquia y la Guajira) de Colombia durante el período 2020-2021. Métodos. Estudio de métodos mixtos con un diseño paralelo convergente en 13 internados de protección de la infancia y adolescencia de Colombia (11 en Antioquia y 2 en La Guajira). Se aplicó un cuestionario a 145 niñas, niños y adolescentes y 23 entrevistas a mediadores de la implementación de las medidas del sistema nacional de bienestar familiar. Resultados. Las medidas de salud pública no farmacológicas implementadas no difieren por departamento; las más complejas para aplicar fueron el distanciamiento físico y la restricción de las visitas familiares. Conclusiones. En los centros de protección de la infancia y la adolescencia de Antioquia y la Guajira, las medidas de salud pública no farmacológicas contribuyeron a mitigar la propagación del virus en entornos considerados de riesgo.


[ABSTRACT]. Objective. Analyze facilitating processes, obstacles, and effects of the implementation of non-pharmacologi- cal public health measures for the prevention of COVID-19 in child and adolescent protection centers in two departments (Antioquia and La Guajira) in Colombia during the period 2020–2021. Methods. Mixed methods study with a convergent parallel design in 13 residential child/adolescent protection facilities in Colombia (11 in Antioquia and two in La Guajira). A questionnaire was given to 145 children and adolescents, and 23 interviews were held with persons responsible for the implementation of measures in the national family welfare system. Results. The implemented non-pharmacological public health measures did not differ by department; the most complex to implement were physical distancing and restriction of family visits. Conclusions. In centers for the protection of children and adolescents in Antioquia and La Guajira, non-phar- macological public health measures helped mitigate the spread of the virus in environments considered at-risk.


[RESUMO]. Objetivo. Analisar os processos que facilitam e dificultam a implementação de medidas não farmacológi- cas de saúde pública para a prevenção da COVID-19 em centros de proteção de crianças e adolescentes em dois departamentos (Antioquia e La Guajira) da Colômbia, e os efeitos de tal implementação, durante o período 2020-2021. Métodos. Estudo de métodos mistos com delineamento paralelo convergente em 13 internatos para a proteção de crianças e adolescentes na Colômbia (11 em Antioquia e 2 em La Guajira). Foi aplicado um questionário a 145 crianças e adolescentes, e foram realizadas 23 entrevistas com os responsáveis pela implementação das medidas do sistema nacional de bem-estar familiar. Resultados. As medidas não farmacológicas de saúde pública implementadas não diferiram por departa- mento. As mais complexas de serem aplicadas foram o distanciamento físico e a restrição de visitas familiares. Conclusões. Nos centros de proteção de crianças e adolescentes de Antioquia e La Guajira, medidas não farmacológicas de saúde pública contribuíram para mitigar a propagação do vírus em ambientes considera- dos de risco.


Assuntos
Serviços de Saúde da Criança , Adolescente , Serviço Social , COVID-19 , Colômbia , Saúde da Criança , Adolescente , Serviço Social , Saúde da Criança , Serviço Social , Colômbia
11.
J Korean Med Sci ; 37(48): e342, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36513053

RESUMO

BACKGROUND: The impact of persistent coronavirus disease 2019 (COVID-19) symptoms on quality of life remains unclear. This study aimed to describe such persistent symptoms and their relationships with quality of life, including clinical frailty and subjective health status. METHODS: A prospective longitudinal 3-month follow-up survey monitored symptoms, health quality, support needs, frailty, and employment. RESULTS: A total of 82 patients with a mean age of 52 years (ranging from 23-84 years) were enrolled, including 48 (58.6%) men, and 34 (41.5%) women. The fully active status decreased from 87.8% before admission to 78.1% post discharge. Two patients (2.4%) were ambulatory and capable of all self-care but unable to carry out any work-related activities 12 weeks after discharge. Clinical frailty scale (CFS) levels 1, 2, 3 and 4 changed drastically between admission and 12 weeks later after discharge. Just after admission, the median EuroQol visual analogue scales (EQ-VAS) was 82.23 (± 14.38), and it decreased to 78.10 (± 16.02) 12 weeks after discharge; 62 (75.6%) of patients reported at least one symptom 12 weeks after discharge. The most frequent symptom was fatigue followed by smell disorder, anxiety, sleep disorder, headache, depressive mood, dyspnea, and taste disorder. CFS was definitively associated with fatigue. Decreased EQ-VAS was associated with fatigue and palpitation, cough, taste disorder, and chest pain. EQ-VAS was worse in women (28%) than in men. Compared with regular outpatient clinic visits before admission, 21 patients (25.6%) reported increased outpatient clinic visits, one (1.4%) reported readmission, and one (1.4%) reported emergency room visits. Six of the 54 (77.1%) patients who were employed before admission lost their jobs. And most vulnerable type was self-employed, because three self-employed job workers were not working at 12 weeks after discharge. CONCLUSION: COVID-19 sequelae should not be underestimated. We find a decrease in health quality and increase in psychological problems in discharged COVID-19 patients, and some patients experience unemployment. The number of patients suffering from COVID-19 sequelae would not be negligible considering there are more than one million COVID-19 infection cases in Korea. Hence, the government should start a systematic monitoring system for discharged patients and prepare timely medical and social interventions accordingly.


Assuntos
COVID-19 , Síndrome de Fadiga Crônica , Fragilidade , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Qualidade de Vida , Assistência ao Convalescente , Estudos Prospectivos , COVID-19/epidemiologia , Alta do Paciente , Serviço Social , Progressão da Doença , Distúrbios do Paladar , Fadiga/epidemiologia , Fadiga/etiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-36497541

RESUMO

We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals' perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users' assessment of the care received within the program framework; (6) users' perception of the impact on health and wellbeing; (7) users' demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users' satisfaction with the care received.


Assuntos
Cuidadores , Prestação Integrada de Cuidados de Saúde , Humanos , Pesquisa Qualitativa , Grupos Focais , Serviço Social
13.
PLoS One ; 17(12): e0278240, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36525421

RESUMO

BACKGROUND: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. OBJECTIVES: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. METHODS: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. RESULTS: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. CONCLUSIONS: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Saúde Pública , Acontecimentos que Mudam a Vida , Política Pública , Serviço Social , Ontário/epidemiologia
14.
Health Res Policy Syst ; 20(1): 135, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36527014

RESUMO

BACKGROUND: Public involvement in health and social care research is increasingly prioritized by policy-makers and research funders. Often, the impact of the involvement is described in terms of how it has contributed to the research outcomes and how it has affected the involved members of the public. There is a dearth of studies reporting from the perspective of researchers themselves of having involved members of the public in their research. Nevertheless, there is a general expectation for researchers to accept and embrace public involvement in research. This study aims to explore researchers' views of involving informal carers in health and social care research. METHODS: Eleven individual in-depth interviews with researchers in the fields of social work, caring science, health science and medical science constituted the dataset of this qualitative study, inspired by discourse psychology. RESULTS: The qualitative data analysis resulted in two interpretative repertoires describing researchers' views of involving informal carers in research, "Philosophy of Science" and "Personal relationships and growth". Both repertoires need to be recognized; however, as of today, the Philosophy of Science repertoire is more acknowledged, while the second repertoire describing empathy, relationships and emotions may be viewed as the researcher being "unprofessional". Further, the findings highlighted the dual perspective of being a researcher and a carer as creating opportunities for growth on the part of the researcher, on both a professional and a personal level. CONCLUSIONS: Researchers and their research work would benefit from acknowledging, discussing and reporting both interpretative repertoires in their publications, as well as recognizing the benefit of dialectal positions, for example, having a dual perspective as both a researcher and an informal carer.


Assuntos
Cuidadores , Apoio Social , Humanos , Cuidadores/psicologia , Pesquisa Qualitativa , Pesquisadores , Serviço Social
15.
BMC Geriatr ; 22(1): 978, 2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36536315

RESUMO

BACKGROUND: One in six older adults living in communities experience abuse and neglect. Elder abuse has serious consequences for individuals, families, and society, including mortality, physical and psychological morbidities, and increased care requirements. Timely and effective interventions for elder abuse should therefore be a priority. This study used a qualitative focus group approach to address the following questions: What are the essential elements of elder abuse interventions? What can be done to improve current interventions? METHOD: The 32 participants in this focus group study included social workers, medical social workers, and nurses from seven organizations who shared their knowledge and insights. All sessions were conducted online, audio-recorded, and transcribed verbatim. Three researchers with backgrounds in social work and psychology independently coded the transcripts and agreed on the themes emerging from the focus groups. RESULTS: Based on the experiences of frontline helping professionals in Hong Kong, we highlighted the key factors for effective elder abuse intervention: 1) identification and assessment; 2) essential skills and attitudes; 3) elements of effective interventions; 4) collaborative efforts across disciplines and agencies; and 5) raising awareness among professionals and the public. CONCLUSIONS: Training can equip frontline professionals with the necessary skills to identify elder abuse cases and to assess the risk of abuse. Effective interventions should not only address clients' safety and need for tangible support but also respect their autonomy and privacy. A client-centered, strength-based approach that involves supportive peers and addresses the complex family relationships involved can be useful. Interventions should also involve cross-discipline and cross-agency collaboration.


Assuntos
Abuso de Idosos , Humanos , Idoso , Grupos Focais , Abuso de Idosos/psicologia , Hong Kong , Serviço Social , Assistentes Sociais/psicologia
16.
Syst Rev ; 11(1): 266, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36503510

RESUMO

BACKGROUND: Good interpersonal communication is the cornerstone of social work practice, enhancing the outcomes of people in receipt of its services. Social workers' communication skills are often identified as an area of concern. Communication skills can be developed and refined through training or education. The teaching and learning of communication skills is firmly embedded in many social work qualifying courses; however, considerable heterogeneity exists regarding such complex interventions and the theoretical underpinnings of which have not been made explicit. Realist synthesis can help explain how, why, for whom and in what circumstances an intervention might work, which is an important first step for helping educators to tailor courses to meet the needs of different learner groups and, where applicable, the employing agencies and government departments who fund them. METHODS: Realist synthesis is an interpretive, theory-driven and explanatory approach that aims to explain the interplay between the context, mechanisms and outcomes of interventions. This realist synthesis seeks to understand and explain to what extent, how, why, for whom and in what circumstances complex educational interventions aimed at teaching communication skills to social work students produces its effects. A five-step process will be followed iteratively. In step 1, the initial programme theory will be developed. Step 2 will involve searching for evidence. In step 3, selection and appraisal will take place. Step 4 requires data to be extracted and organised, and in step 5, data will be analysed and synthesised. DISCUSSION: The teaching and learning of communication skills in social work education is under theorised. The findings from this realist synthesis aim to help policymakers and educators make informed decisions about the design and delivery of complex educational interventions aimed at improving the communication skills of social work students. The realist synthesis will be conducted and reported in accordance with the RAMESES guidelines and standards. SYSTEMATIC REVIEW REGISTRATION: The review is registered with the Open Science Framework. https://doi.org/10.17605/OSF.IO/BYHC7.


Assuntos
Competência Clínica , Aprendizagem , Humanos , Comunicação , Serviço Social , Estudantes
17.
BMC Health Serv Res ; 22(1): 1585, 2022 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-36572882

RESUMO

BACKGROUND: Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS: Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS: Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS: These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.


Assuntos
Administração de Caso , Serviço Social , Humanos , Pesquisa Qualitativa , Atenção à Saúde , Hospitais
18.
Artigo em Inglês | MEDLINE | ID: mdl-36554265

RESUMO

Interdisciplinary social work practice produces and circulates narratives of young women in residential care. The dominant narratives often present negative descriptions of this group, and less attention has been paid to their resistance to these "big stories". This study's aim is to illuminate this resistance of young women in residential care and to explore how they narrate their experiences of being children at risk who have become women managing everyday life. This study utilises a narrative approach and includes three selected personal stories: two from the participants and one from the first author's reflections on resistance. Through contextual analysis at the macro, meso and micro levels, we focus on how personal stories can influence interdisciplinary social work services. We found resistance to dominant narratives on the different levels in the chosen stories. Resistance can create space to reconstruct and renarrate reality together and help understand the meaning and power of storytelling and silence. Participants' resistance can be a tool to rebalance the power between social work practitioners and service users. Based on this analysis, we suggest that interdisciplinary collaborative social work should emphasise service users' personal stories to a higher degree and, in this way, increase user participation in residential care.


Assuntos
Comunicação , Narração , Criança , Humanos , Feminino , Serviço Social
19.
Soc Sci Med ; 314: 115473, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332530

RESUMO

This article analyses the provision of community care for urban disabled elderly women. With the emergence of an aging society in China and the empty nest syndrome in Chinese families, the number of elderly people who cannot take care of themselves is increasing. With the reduction in family size and the weakening of the home care function, traditional family care in China is facing immense challenges. On the one hand, a growing number of disabled elderly women are in urgent need of care; they encounter many difficulties in daily life, including poor health status, the loss of their spouse and living alone, an inability to support themselves economically, the lack of a spiritual life, and a significant reliance on their children to take care of them. On the other hand, the family's function of providing for the elderly has been weakened, and the traditional way of care is affected by the changes in modern society. Based on a qualitative study in Beijing, this article examines the demand for care from disabled elderly women and the current supply of community care. It puts forward a community-centred and targeted assistance model and social work intervention. This study argues that the community care system for disabled elderly women in urban areas should focus on four aspects, namely living care, medical care, spiritual consolation, and emergency assistance; and the protection mechanism should be improved to support disabled elderly women from three aspects: a protection system, a fund guarantee and services from health and social cafe staff and social workers.


Assuntos
Pessoas com Deficiência , Feminino , Criança , Idoso , Humanos , Apoio Social , China , Serviço Social , Cônjuges
20.
BMC Health Serv Res ; 22(1): 1400, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36419047

RESUMO

BACKGROUND: Mental health challenges are highly significant among older individuals. However, the non-utilization of mental health services increases with age. Although universal health coverage (UHC) was reported to reduce unmet health care needs, it might not be sufficient to reduce unmet mental health care needs from a clinical perspective. Despite the existence of UHC in Japan, this study aimed to explore the factors related to the non-utilization of formal mental health care systems among middle-aged and older people with urgent, unaware, and unmet mental health care needs. METHODS: Purposeful sampling was used as the sampling method in this study by combining snowball sampling and a specific criterion. The interviewees were nine practitioners from four sectors outside the mental health care system, including long-term care, the public and private sector, as well as general hospitals in one area of Tokyo, where we had conducted community-based participatory research for five years. The interviews were conducted by an interdisciplinary team, which comprised a psychiatrist, a public health nurse from a non-profit organization, and a Buddhist priest as well as a social researcher to cover the broader unmet health care needs, such as physical, psychosocial, and spiritual needs. The basic characteristics of the interviewees were enquired, followed by whether the interviewees had case of middle-aged or older individuals with urgent, unaware, and unmet mental health care needs. If the answer was yes, we asked the interviewees to describe the details. The interviews pertinent to this study were conducted between October 2021 and November 2021. In this study, we adopted a qualitative descriptive approach. First, we created a summary of each case. Next, we explored the factors related to the non-utilization of formal mental health care systems by conducting a thematic analysis to identify the themes in the data collected. RESULTS: The over-arching category involving "the factors related to an individual person" included two categories, as follows: 1) "Individual intrinsic factors," which comprised two sub-categories, including "difficulty in seeking help" and "delusional disorders," and 2) "family factors," which comprised "discord between family members," "denial of service engagement," "multiple cases in one family," and "families' difficulty in seeking help." The over-arching category "the factors related to the systems" included four categories, as follows: 1) "Physical health system-related factors," which comprised "the indifference of physical healthcare providers regarding mental health" and "the discontinuation of physical health conditions," 2) "mental health system-related factors," which comprised "irresponsive mental health care systems" and "uncomfortable experiences in previous visits to clinics," and 3) "social service system-related factors," which comprised "the lack of time to provide care," "social service not allowed without diagnosis," and "no appropriate service in the community," as well as 4) " the lack of integration between the systems." Apart from the aforementioned factors, "the community people-related factor" and "factors related to inter-regional movements" also emerged in this study. CONCLUSIONS: The results of this study suggest a specific intervention target, and they provide further directions for research and policy implementation. The suggested solutions to the issues pertinent to this study are as follows: the recognition of the ways in which older people may inadequately understand their health or be unaware of available services, the building of a therapeutic alliance for "the individual intrinsic factors." Regarding the "family factors," the solutions include the provision of particularly intensive care for families with family discords, families with multiple cases, and families who find it difficult to seek help, as well as making intensive efforts for ensuring early involvement after contact with health care services. Regarding the "the factors related to the systems," the solutions include the implementation of mental health education campaigns aimed at enhancing mental health knowledge among non-mental health professionals, as well as formulating and implementing reforms ensuring that such professionals are increasingly responsible especially with regard to emergency inpatient care. It also include listening without ageism in clinical practice, the expansion of social services regarding human resources and the flexibility of use which increases the breadth of the types of care, as well as facilitating the integration between the associated health care systems. Further suggestions include encouraging community residents to join social security systems as well as the provision of particularly intensive care for people who have just moved in.


Assuntos
Serviços de Saúde Mental , Pessoa de Meia-Idade , Humanos , Idoso , Acesso aos Serviços de Saúde , Serviço Social , Assistência de Longa Duração , Pacientes Internados
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