Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

Lesbian Health Care: Women's Experiences and the Role for Social Work

ABSTRACT

Lesbian patients and their families may be exposed to discriminatory practices in the health care system. This qualitative study of 57 Midwestern lesbian parents used open- and closed-ended questions to examine the experiences the respondents had with their primary and secondary health care providers. Four themes emerged from the data: systemic barriers to health care, coming out to providers, seeking lesbian, gay, bisexual, and transgender-friendly health care providers, and concern about mistreatment and prejudice within the health care system. Implications for service delivery, health care education, and directions in policy and research are explored.     

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Abstract

Social work practice in a psychiatric emergency department presents a unique set of professional and personal challenges for the clinician. This article presents an individual account of practice within this setting and within a larger system of mental health care which is overwhelmed by individual and societal needs and limited provider options. The personal and professional challenges which arise in response to crisis work with chronic populations is discussed.     

Reducing Alcohol Abuse in Gay Men: Clinical Recommendations From Conflicting Research

ABSTRACT

Gay men entering the health care system present with unique needs essential for health care providers to comprehend and address. While data indicate mental health and substance abuse disorders are more prevalent among gay men compared with their heterosexual counterparts, the literature assessing abuse of alcohol by gay men is conflicting. This article explores the conflicting research examining the use and abuse of alcohol by gay men, common findings and themes among studies addressing the issue, the theoretical concepts of internalized homophobia and heterosexism as they relate to alcohol abuse, and clinical strategies providers can implement when encountering this issue among their gay male patients. This comprehensive assessment of the literature will also provide direction for future critical inquiries and outline ways to improve the current methods of inquiry.     

Models of 'ordinary' and 'special' daily living: matching residential care to the mental-health needs of looked after children

This paper proposes a set of distinctions between ‘ordinary’ and ‘special’ modes of everyday living in residential settings for young people in the ‘looked after’ system. The paper begins by reviewing both quantitative and qualitative evidence on the mental‐health needs of the young people, arguing that there is evidence of very high levels of mental distress and disturbance within this group, and that this distress is often undiagnosed and untreated both by psychiatric professionals and within the residential care system itself. There follows a commentary on the tacit assumptions underpinning much residential practice, especially the emphasis in some policy and legal documentation on the young people’s need for ‘ordinary’ everyday experience. The concept of the ‘ordinary’ is problematized, and it is argued that while young people do need to be supported towards mainstream ‘ordinary’ everyday living, they also need specialized everyday care in which their emotional and psychological needs can be recognized and responded to. Four models of ‘special everyday living’ are proposed, based upon existing literature on residential practice, and it is argued that residential care programmes should be based upon a mix of these special and ordinary provisions if the young people’s emotional needs are to be met.     

Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness

ABSTRACT

Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.     

Mental health practice in primary care: Some perspectives concerning the future of social work in organized delivery systems

Abstract

The rise of managed care as the dominant form of healthcare delivery in the U.S. clearly has dramatic implications for the profession of social work. Thus far and for good reasons, the professional dialog about managed care has largely focused on . the threats posed to the professional agenda of social work by managed care in its various forms. This article considers some of the more positive aspects of the transformation from fee‐based to population‐based healthcare systems, in particular the vigorous trend toward multidisciplinary primary care and collaborative mental health practice in primary care settings. It is argued that the market forces behind this trend also promote the emergence of models of social work practice that better integrate historically dichotomized aspects of health and mental health practice. Also considered are implications for social work education and the division of labor among the healthcare professions.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Supporting foster and kinship carers to promote the mental health of children

The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.     

Relative foster care: An emerging trend in foster care placement policy and practice

Abstract

Increases in the foster child population, at a time when terminations in foster care placement have decreased along with a decline in the number of non‐related foster parents, has resulted in an increasing use of relative foster care placement. Relative care as an emerging trend in foster care placement, is not without controversy. Its merits, however, should be assessed in terms of its benefits to the children in care, the fiscal and organizational costs, and the problems it creates for the child welfare system. This paper reviews what is known about the characteristics of relative caregivers and the children in their care. Federal and state policies that affect the use of relatives as an alternative placement resource for children are described. The available data regarding the length of time in placement, number of placements, physical, mental health and educational and permanency outcomes for children placed with relatives are discussed. Implications for practice are drawn and areas for further research are suggested.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

Commitment of Private and Public Agency Workers to Child Welfare: How Long Do They Plan to Stay?

ABSTRACT

Method: Child welfare professionals completing training to work in foster care were asked about reasons for taking their child welfare position, commitment to their agencies, and commitment to child welfare. Analyses compared responses from new public agency foster care workers (N = 100), public agency workers making lateral transfers to foster care (N = 64), and new private foster care workers (N = 105).

Results: Private agency foster care workers were less committed to their agencies and to child welfare and more likely to have taken the position because it was the only one available.

Conclusions: The practice by public child welfare of outsourcing foster care services to private agencies needs to be evaluated. This practice may not benefit children in care and may create organizational problems for agencies.     

An agenda for future research regarding the mental health of young people with care experience

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.     

Hospice and Latinos

Abstract

Research on hospice use by Latinos, although increasing since the late 1990s, remains sparse. This article presents a review of the recent available literature on this topic within the past 15 years. The main aspects discussed are access to hospice care and various factors that researchers suggest affect Latino utilization of hospice care. These factors include beliefs about health care, death and end-of-life care, lack of insurance, lower referral rates by health care professionals and the hospice caregiver requirement. Overall, Latinos underutilize hospice but the reasons remain unclear. No evidence exists to indicate that Latinos are dissatisfied with services once they receive them. Also, no evidence exists to indicate they want services but cannot obtain them. Implications for social work practice and research are discussed.     

Decision Making in Long-Term Care

Abstract

This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.     

Pre–Post Release Health in US Adult Male Convicts

Abstract

This study sought to determine whether need for healthcare and reported health status among adult men (N?=?1,113) in US Federal prisons (in 12 states) changed from pre-release to 15?months after release by analyzing data collected by the Serious and Violent Offender Reentry Initiative (SVORI). Specifically, the study was guided by three questions: (1) were there changes in treatment for specific diseases; (2) were there changes in health status, need for care, and access to and satisfaction with healthcare; and (3) did various social determinants of health predict any of the health outcomes at 15-month follow-up. The analysis of SVORI data found that men reported lower physical and mental health status and declines in receiving treatment following release, but greater satisfaction with healthcare. Further, analysis found the best predictors of health status as being satisfied with access to health care as well as employment. The greatest declines were in mental health treatment, however those ceasing treatment did not report worse physical health status, mental health scores, housing, employment, or recidivism. Future research is needed to determine the significance of the link between employment, satisfaction with access to health care, and health status among ex-prisoners.     

The Perception of Organizational Issues of Social Work Practitioners in Saudi Hospitals

ABSTRACT

Health care has evolved rapidly in Saudi Arabia, based upon a Western model of service that incorporates multidisciplinary professional teams. Social work practice forms part of patient care. This study explores how Saudi social workers perceive their role and how they describe their practice within the hospital context. A quantitative methodology was employed using a self-administered questionnaire. Analysis revealed that 219 social workers perceived formidable limitations to their daily work practice. The study identified factors relating to the hospital's organizational circumstances where a) organizational structural aspects, b) organizational resources, and c) hospital management and interprofessional teamwork impacted best practice. Future research and recommendations for further study are outlined.