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Padykula, Nora, Julie Berrett-Abebe, and Terri Haven. "Helping Community Partners Build Capacity within Integrated Behavioral Health." Advances in Social Work 20, no. 2 (September 10, 2020): 266–82. http://dx.doi.org/10.18060/23667.
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Social workers are recent additions to integrated health care teams; therefore, there is emerging literature about the work experiences and training needs of social workers in integrated settings. After receiving a Health Resources Services Administration-Behavioral Health Workforce Education and Training (HRSA-BHWET) integrated behavioral health (IBH) grant, our social work program conducted a survey among our social work field education sites to determine training needs. Results of the needs assessment revealed that a lack of clarity exists about what is meant by integrated behavioral health as well as ways to measure and interpret levels of integration within social work field education sites. Barriers to collaboration and areas of needed training revealed gaps in knowledge and workforce readiness for providing integrated care. Recommendations include using a bidirectional level of integration conceptual framework to support greater participation of social workers and social service agencies in integrated care, in addition to specific curricular and continuing education training opportunities. Social work educators are afforded a unique opportunity to support our field education partners in reviewing and enhancing their systems of care as they continue to train future social workers.
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Bloomquist, Candace D., Julie Kryzanowski, and Tanya Dunn-Pierce. "Applying quality improvement strategies within Canadian population health promotion." Health Promotion International 35, no. 2 (March 18, 2019): 422–31. http://dx.doi.org/10.1093/heapro/daz017.
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Abstract This article describes how quality improvement (QI) methodology was applied to partnership work in a population health promotion unit within a health care system. Using Kolb’s experiential model of learning, we describe and reflect on our experience as a population health promotion unit working on a QI initiative focused on community partnerships for intersectoral collaboration. We identify contextual factors that can guide QI for population health promotion work. The three main lessons we identified were to (i) frame the need for improvement effectively, (ii) start by setting the conditions for others to lead and (iii) be people-focused as well as process-focused. Health care systems can apply QI methods to improve and strengthen their role in working with partners to improve population health. By sharing our experience with other practitioners, we hope to find support and allies as we learn together to improve quality in population health promotion settings.
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Nazar, Nataliia. "The ecosystem approach in health social work." Mental Health: Global Challenges Journal 4, no. 2 (October 13, 2020): 16–18. http://dx.doi.org/10.32437/mhgcj.v4i2.90.
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Introduction
Health is the greatest value in our lives. Analyzing the current approaches of the WHO (2014), we consider this concept not only from the standpoint of physical health and the absence of disease, but understand this phenomenon as a holistic state of complete well-being, which includes, in addition to physical, emotional, mental, social, spiritual, sexual, environmental and many other aspects. This is the so-called holistic model of health (Orzhekhovska, 2013).
Our reasoning suggests (given various aspects of health) that this value does not depend only on an individual's choice to be or not to be healthy, and cannot be governed solely by personal actions. Here are some examples. The lack of geographically close medical services and / or free medical services causes the inability to receive emergency medical care and / or to systematically monitor health. Negative relationships in the family, the absence of a father or mother in the family can lead to emotional rejection of the child (psycho-emotional disorders), the acquisition of undesirable behavior (child addictive behavior or delinquent behavior), lack of self-care skills (this can cause various infectious diseases), getting into institutional care, which usually do not contribute to the full development of personality, etc. Inadequate social policies and an imperfect health care system in the country can cause outbreaks of socially dangerous diseases and provoke the spread of pandemics. Aggressive urbanization creates uncomfortable living conditions in cities due to traffic jams, pollution, noise, which causes other health risks from stress to cancer. As we can see, good health depends not only on the individual being healthy in the broad context of this word, but on the complex impact on us of a number of systems in which we are included. It is important to emphasize the role of social work in this context, the theory and practice of which aim, inter alia, to promote social development and well-being, as well as to improve the health care system and reduce social inequalities. Therefore, the task of social work in general and social workers together with other professionals in particular is to support the individual, family, community, society in the context of strengthening and maintaining the health of both individual and public. An ecosystem approach in social work helps us to understand the process of maintaining and strengthening health, which explains well the mutual influence of each element of the system.
Purpose
The aim of the article was to consider health social work according to ecosystem approach.
Methodology
The study used theoretical methods of research, in particular, analysis, comparison, synthesis and implementation of the results of the study of health social work based on the principles of integral ecology and ecosystem approach.
Results and Discussion
The ecosystem approach is used in various spheres of practical and scientific activity: public health, ecology, economy, legal and social spheres, church-religious sphere and even education (Forget, Lebel, 2001; Deinega, 2018; Veklych, 2017; Voronkin, 2017).
Kabanenko and T. Semigina (2004) write about the separation of the ecological approach in social work on the basis of systems theory (sociological group of social work theories). Within this approach, the authors consider the main models of work and tools that can be used by social workers in their practice: eco-maps, genograms, etc. Systems theory and environmental theory are mentioned in the manual "Introduction to Practical Social Work". In systems theory, "a whole is greater than the sum of its parts", so it is important to consider "the interaction of the client and the environment." Ecological theory considers a person in the context of his or her entourage, but not only the family, society, but also the environment (Klos, Mykytenko, 2005, 52-54). In contrast to the mentioned researchers, T. Syla (2012) explores the problem of violence in the context of the ecosystem approach, she notes that this approach originates from the socio-ecological theory of Bronfenbrenner in psychology. So, no matter what theories the ecosystem approach is based on, the idea behind this concept is a wide range of interconnections. Every smaller object, such as a person, is part of a large range of interactions of larger systems: family, community, society, environment, and so on. Each element of the system affects the other, so solving a problem situation in one area can be an impetus for positive change in another.
Chaikovska and O. Hlavatska talk about the need to train social workers with a "high level of environmental culture" (2019). In scientific works on social work we find the concepts "ecosystem approach" and "ecological approach", which are virtually identical in content. This perspective has formed over time one of the modern concepts of social work: "environmental social work", or "eco-social work", or "green social work". The latter in her current research is much covered by T. Semigina (2018). The researcher notes that "a healthy environment is seen as an inalienable human right, a component of human dignity and non-discrimination." However, today there is no research on health social work from the standpoint of an ecosystem approach.
The ecosystem approach resonates with another very important concept. It is an integrated ecology. This concept appeared in the church-religious sphere, and was covered in the Encyclical (papal document) "Laudato si" by the head of the Catholic Church Pope Francis (2015/2019). According to the vision of Francis, there can be no question of ensuring the common good, guaranteeing fundamental rights, social justice, if humanity understands nature as something separate and does not link environmental pollution with economic activity, behavior, etc.
Conclusion
Therefore, it is obvious that today, in the conditions of social transformations and globalization processes, the solution of any social problem should be considered from the standpoint of the ecosystem approach. Health issues in social work cannot be considered without taking into account changes in the environment. For such activities, it is necessary to train social workers in the context of the ecosystem approach, programs and projects should be developed to help overcome the problems of clients' health in a comprehensive way. Further research is needed to study existing and develop new forms and models of social work on the basis of strengthening and maintaining the health of clients, taking into account the ecosystem approach and the basics of integral ecology
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Monti, Kristina, and Arielle Rosner. "Social Work Leadership as Ambassadors of Health Care Reform: Developing and Implementing a Health Home Program Within a Large Urban Health System." Social Work in Health Care 54, no. 9 (October 21, 2015): 828–48. http://dx.doi.org/10.1080/00981389.2015.1084971.
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Silveira, Claudia Winter da, and Miriam Guterres Dias. "Social Work competencies in Matrix Support in Mental Health / As competências do Serviço Social no Apoio Matricial em Saúde Mental." Argumentum 10, no. 3 (December 23, 2018): 150–61. http://dx.doi.org/10.18315/argumentum.v10i3.23048.
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The Support Matrix is technical-pedagogical support technology and back-stop assistance to Primary Healthcare, provided for within the Unitary Health System (Sistema Único de Saúde (SUS)), which questions the hegemonic organisational and technical-assistance model, proposing links and support among teams with a view to delivering integration and Care resolution. It implies that professional Social Work actions in Mental Health Support Teams have been built and legitimised historically in the field of public policy. Social workers and managers agree that the social worker translates social reality, from the interdisciplinary and inter-sectorial perspective, providing concreteness, directional and visibility to the profession, and form part of the set of professional actions within the SUS.Keywords: Health Policy. Mental Health Policy. Unitary Health System. Matrix Support.Social Work.
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Rogala, Maciej Bartłomiej, and Ewa Donesch-Jeżo. "Various dimensions of trust in the health care system." Emergency Medical Service 7, no. 4 (2020): 296–305. http://dx.doi.org/10.36740/emems202004109.
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Trust is one of the most important factors in building effective and long-lasting relationships in the entire healthcare sector. Trust becomes a valuable ally in situations of high risk and uncertainty as well as the increasing complexity of tasks that accompany the daily work of all medical professionals, especially paramedics, due to the nature of their work in the medical rescue system. Mutual trust is the basis of social capital thanks to which it is possible to achieve mutual benefits, easier to coordinate activities, create new quality and solutions through cooperation or strong ties. It is a kind of glue that binds various organizational and system links, thanks to which it is easier to plan and introduce necessary improvements and changes within individual medical units or the entire health care system. The high degree of trust increases the quality of clinical communication with the patient and the effectiveness of medical care and strengthens the employees’ motivation and willingness to cooperate. Creating social capital based on trust is in the interest of all internal and external stakeholders of the entire health care system, thanks to which joint, cross-sectoral projects for health in the public dimension are possible. The aim of the article was, on the one hand, to systematize the theoretical and practical knowledge related to the multidimensionality of trust in the health care system, but on the other, to identify and analyse the factors building trust that should be discussed and, above all, applied in everyday professional practice and social space of all employees of the health care system. with particular emphasis on paramedics.
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Dobl, Stefanie, Liz Beddoe, and Peter Huggard. "Primary health care social work in Aotearoa New Zealand: An exploratory investigation." Aotearoa New Zealand Social Work 29, no. 2 (July 26, 2017): 119–30. http://dx.doi.org/10.11157/anzswj-vol29iss2id285.
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INTRODUCTION: The social work profession has a long-standing history of contributing to health care in Aotearoa New Zealand. Traditionally, hospitals have been the stronghold for the profession. However, both international and national evidence demonstrates that social workers have also been integrated in primary health care practices (PHCPs). Primary health care (PHC) provides care in the community and is recognised for its potential to achieve health equity across all population groups. This article reports on a small, qualitative research project which explored the perceptions of key stakeholders about social work integration into PHC and the experiences gained by social workers working within PHCPs regarding their contributions to the achievement of national aspirations for PHC.METHODS: Semi-structured, one-to-one interviews with 18 participants representing three groups (social workers, other PHC professionals and key informants) were undertaken in 2012. The interviews took place in various locations in Aotearoa New Zealand. A general inductive approach was used to identify key themes. FINDINGS: Three key themes were identified from the data: these are issues of context, namely social work professional factors, organisational factors in PHC and lastly, wider factors in the health care system. The integrated social workers enhanced the access of populations to coordinated care, increased engagement with communities, and strengthened the workforce, among other things. These unique contributions towards the PHC vision were well recognised by all groups, with participants calling for the establishment of integrated social work positions on a larger scale. CONCLUSION: The study evidences the successful integration of social workers into PHC practices in Aotearoa New Zealand. This viable model should be of special interest for key stakeholders regarding the design of local, holistic, PHC services which serve populations most affected by health and social inequalities. Importantly, “health for all”, as anticipated by the PHC vision needs long-term and real commitment especially by financial decision-makers.
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Cash, Belinda, Suzanne Hodgkin, and Jeni Warburton. "A transformative approach to systems theory in caregiving research." Qualitative Social Work 18, no. 4 (December 25, 2017): 710–26. http://dx.doi.org/10.1177/1473325017749988.
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This paper illustrates how systems theory can be used in social work research design to understand the systemic issues associated with spousal care in rural Australia. Spousal caregiving is embedded within multiple formal and informal systems, including family, community, health and aged care practice, social policy, and social and cultural norms. It is therefore a complex phenomenon to explore in social research, with each of these systems interacting with and influencing other aspects of the care system. The purpose of this paper is to provide an illustration of a research design that explores this systemic complexity. The design is conceptually underpinned by the transformative paradigm; a critical approach that reflects social work principles of social justice. The methodology is based on an ecosystems approach to assessment, using multiple methods to explore interactions between systems of care at policy, practice and individual levels. This application of systems theory to research presents an innovative opportunity for social work research to reflect long-established practices of understanding complex phenomenon within its sociocultural context.
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Mano, Laureta, and Mirela Selita. "The Albanian Social Security System and the Institutions of Social Protection in Albania." European Journal of Social Sciences Education and Research 3, no. 2 (April 30, 2015): 18. http://dx.doi.org/10.26417/ejser.v3i2.p18-25.
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The social security system in Albania consists of social assistance and social services, health services and health care insurance and social insurance schemes. In the social objectives of the constitution are declared that the State within the constitutional competencies and the probable means as well as in the fulfillment of private initiatives and responsibilities, aims to higher possible standards of health, physical and mental; social care and services of elderly, orphan and invalids; medical rehabilitation, special education and integration in the community, of disabled persons. The Constitution foreseen that everyone has the right of social insurance when retired or in case of incapacity of work under a certain system established by a law. Everyone, when is unemployed for any reasons independent on individual will and when there is no living means, has the right of need under the conditions foreseen by law. Social insurance is a scheme protecting by benefits persons in respect of temporary incapacity due to sickness, maternity, old-age, disability and loss of breadwinner, employment accidents/occupational diseases, unemployment. Social Services are benefits in kind for disabled persons or vulnerable persons. Social Assistances are cash benefits given to families in need, that means families with lower incomes comparable with minimum standard of living or families without incomes. Health services consist of public health, primary health care, hospitalization services nurse's service, dental and pharmaceutical net. The Institutions of Social Protection in Albania are Social Insurance Institute, National Social Services and Health Care Insurance Fund.
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Batheja, Cyrus. "Transformational Executive Health-Care Leadership: What Makes a Good and Great Health-Care Leader?" Creative Nursing 27, no. 2 (May 1, 2021): 78–82. http://dx.doi.org/10.1891/crnr-d-21-00007.
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Health-care leaders work at the highest levels of organizations and face unique challenges in today's health-care systems. This article reports the lived experiences of an executive nurse to better understand their leadership journey and leadership shadow, exploring their professional development of health-care leadership while navigating change and conflict by interpreting critical turning points in their career and triangulating data to identify and analyze central themes. Offering a real-world perspective, the article uses personal reflection aligned to professional inquiry, workplace observations, document reviews, and personal accounts to focus on executive nursing and the construction of a social movement from within a large managed care organization. The purpose of this evaluation is to create deeper understandings of ways in which to improve patient and provider experiences, reduce system waste, and improve population health. The theme of transformational leadership emerged, and new insights were created to inform future thinking.
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Ringham, Catherine, Janet Rankin, and Lenora Marcellus. "The Social Organization of Neonatal Nurses' Feeding Work." Neonatal Network 39, no. 5 (August 1, 2020): 283–92. http://dx.doi.org/10.1891/0730-0832.39.5.283.
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PurposeWe report findings from an institutional ethnography (IE) of nurses' work of feeding infants within an increasingly technical organization of NICUs.SampleFive primary informants; 18 secondary informants.DesignThe institutional ethnographic approach included field observations, interviews, and phone and e-mail conversations. Our analysis followed accounts of what actually happened within the textual organization of nurses' work.Main OutcomeNurses' feeding practices are directed by protocols that arise within multiple documentation systems and clinical technologies. These systems produce barriers to nurses' efforts to skillfully feed infants.ResultsPrioritization of quality and safety perspectives can obscure and constrain the ordinary yet critical clinical reasoning neonatal nurses employ during feeding work. Clinical technologies that have been developed to improve safety can paradoxically disrupt the ability of nurses to respond in the moment to neonatal feeding cues. This finding provides nurses, leaders, and policymakers with insight into why policies and procedures may not be followed as expected.
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Tweed, Alison, Andrew Singfield, Julia R. A. Taylor, Lucy Gilbert, and Paul Mount. "Creating allegiance: leading transformational change within the NHS." BMJ Leader 2, no. 3 (September 2018): 110–14. http://dx.doi.org/10.1136/leader-2018-000088.
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BackgroundWithin the UK National Health Service (NHS) the move to Sustainable Transformation Plans/Partnerships and Integrated Care Systems reflect the increasing need and expectation for transformational change at a system level across both health and social care boundaries. Transformational change is complex, emergent and dynamic requiring new, non-traditional forms of leadership which are highly relational and persuasive.Aim of the studyThe current study aimed to explore a small number of NHS senior leaders’ experiences of undertaking transformational change within their localities over a period of a year following participation in a national transformational change programme designed to enhance personal capabilities.MethodFour pairs of leaders working on different change programmes took part in the study and were interviewed at three time points about their approach to their change work. The data were analysed qualitatively using template analysis.ResultsA core theme of Creating Allegiance to an Emergent Future World was developed. The senior leaders created allegiance to the transformational change through a process of Connecting on three levels: relational, with purpose and vision and through practice. Allegiance creation was attempted even if the transformational change work at the year-end was deemed successful or not.ConclusionsThe study highlights the types of leadership behaviours employed by the participants reflecting the complexity and social construction of their transformational work. The findings provide further evidence to the existing system leadership literature as well as emphasising the importance of creating stakeholder, multilevel buy-in to healthcare transformation.
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Teloni, Dimitra-Dora, and Sofia Adam. "Solidarity Clinics and social work in the era of crisis in Greece." International Social Work 61, no. 6 (October 14, 2016): 794–808. http://dx.doi.org/10.1177/0020872816660604.
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After the eruption of the crisis and the imposition of strict austerity measures, a number of grassroots solidarity initiatives emerged in Greece. The growth of Solidarity Clinics (SCs) emerged as an answer to the lack of primary health care for around 2.5 million people who were excluded from the national health system. This article presents and discusses the findings of a research project conducted from May 2014 to September 2014 in Greece. The aim and profile of SCs as well as the involvement of social workers in the initiatives are presented and discussed within the framework of the role of social work.
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Ule, Mirjana, and Slavko Kurdija. "Self-rated health among women and their assessment of the health care system / Samoocena zdravja med ženskami in njihov odnos do zdravstvenega sistema v sloveniji." Slovenian Journal of Public Health 52, no. 2 (June 1, 2013): 87–98. http://dx.doi.org/10.2478/sjph-2013-0011.
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Abstract Background: This article researches gender inequality in health based on subjective assessments of health, the accessibility of health care services and trust in the health care system between different social categories of women in Slovenia. Methods: The study is based on the Slovenian Public Opinion survey (ISSP Health Module) carried out in 2011 on representative samples of the adult Slovenian population. In the data, we investigated the gender differences and difference between different socio-economic categories within the female sub-sample in self-assessed health, and some other related topics such as: trust in doctors, trust in health care system, access to health care services and attitude to the health care policy in Slovenia. Results: The data shows significant inequalities in self-assessed health between different social strata. Self-assessed health is significantly lower among women at the bottom of the educational and income scale. The data also reveals strong support for the preservation of the available public health. Conclusion: Neoliberal economic reforms (of health care) affect vulnerable social categories the most, and women are particularly exposed. The use of women’s unpaid work in the family belongs among the basic (neo)liberal saving strategies. These want to take more care and health work within families from the shoulders of the state and place it onto the shoulders of family members, which mainly means women. In these circumstances, it is understandable that women subjectively assess their health as being worse than men’s. Moreover, conditions are being established that de facto could lead to worse health in the female population in Slovenia.
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Zegura, I., and G. Arbanas. "Mental Health Care of Transsexual, Transgender and Gender Nonconforming People in Croatian Health System." Klinička psihologija 9, no. 1 (June 13, 2016): 26. http://dx.doi.org/10.21465/2016-kp-op-0012.
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Objective: Health and legal care of transgender people in Croatia is still at its beginnings. Further effort from the professional side is being engaged in order to establish complete health care of transgender people in Croatia. Design and Method: The aim was to examine if there are any differences in the levels of transgender persons quality of life, experienced violence and their present stage of gender transition and perceived level of social support and perceived quality of health care. Transgender clients who are in the process of gender transition within Croatian mental health system were asked to fill in the online questionnaire. Results: 80% of our transgender participants consider psychologists as the most competent and affirmative professionals concerning transgender health care. 15.6% say the same for psychiatrists and 4.4% consider endocrinologists as the most competent professionals to deal with transgender health issues. 28.8% of our participants are mostly or completely satisfied with mental health care, in contrast to only 6.6 % of those who are satisfied with medical health care. Conclusions: According to the facts that we have presented above, the agenda of health, mental health and legal care of transgender people in Croatia must be to build on permanent education, scientific work, ethical principles, standards of care and accessible health care. Minding the human rights of each patient, high quality of practice must be governed by the principles of competence in the work with transgender clients through affirmation of gender as personal construct of each client.
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Appleby, Joanna. "Social work and service improvement: An example from the first youth forensic forum." Aotearoa New Zealand Social Work 32, no. 1 (April 19, 2020): 86–91. http://dx.doi.org/10.11157/anzswj-vol32iss1id709.
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INTRODUCTION: This article focuses on the social work contribution to service improvement by reflecting on the establishment of the first youth forensic forum in Aotearoa New Zealand, held in October 2018.APPROACH: An exploration of the Aotearoa New Zealand context that led to the establishment of the first youth forensic workforce forum is presented. Issues included disjointed mental health care for young offenders who move between secure residences, concerns about over- assessment of vulnerable young people, silo-ed specialist youth forensic knowledge, and a disconnected workforce. Led by a social worker, youth forensic workforce issues were addressed through the inaugural national youth forensic forum in 2018. The aim of the forum was to bring a disparate workforce together in order to improve mental health assessment experiences for young people within youth justice residences. This initiative was grounded in social work approaches of Māori responsivity, networking, ecological systems and relational practice.CONCLUSION: Social workers have an important role in advocating for, and effecting, system change. The process for doing so within the youth forensic forum is presented. Social workers in all fields of practice are encouraged to consider how they work to make systems more responsive to the people they serve.
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Carruth, Lauren, Carlos Martinez, Lahra Smith, Katharine Donato, Carlos Piñones-Rivera, and James Quesada. "Structural vulnerability: migration and health in social context." BMJ Global Health 6, Suppl 1 (April 2021): e005109. http://dx.doi.org/10.1136/bmjgh-2021-005109.
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Based on the authors’ work in Latin America and Africa, this article describes and applies the concept ‘structural vulnerability’ to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA–Mexico border and another in Djibouti. Migrants’ and providers’ various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.
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Winby, Stu, and Susan Albers Mohrman. "Digital Sociotechnical System Design." Journal of Applied Behavioral Science 54, no. 4 (June 22, 2018): 399–423. http://dx.doi.org/10.1177/0021886318781581.
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Digital platforms increasingly are dictating how work is carried out, breaking down boundaries between companies, geographies, customers, and other stakeholders and participants, and determining who will benefit from advancing technology. Existing organization design frameworks do not adequately address the new reality where both the technical and social elements of the full ecosystem need to be designed. Work is no longer carried out within a bounded organization, and individual organizations can no longer be the focus of design. Building on both the traditional sociotechnical systems framework and strategic organization design frameworks, we propose a digital sociotechnical systems design approach. It involves multiple stakeholders and participants in codesigning the digital system and the social system at the ecosystem level. A case example from health care is described and discussed.
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Klimek, Ludger, Claus Bachert, Oliver Pfaar, Sven Becker, Thomas Bieber, Randolf Brehler, Roland Buhl, et al. "ARIA guideline 2019: treatment of allergic rhinitis in the German health system." Allergo Journal International 28, no. 7 (October 22, 2019): 255–76. http://dx.doi.org/10.1007/s40629-019-00110-9.
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Abstract Background The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results The present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
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Wilberforce, Mark, Michele Abendstern, Saqba Batool, Jennifer Boland, David Challis, John Christian, Jane Hughes, et al. "What Do Service Users Want from Mental Health Social Work? A Best–Worst Scaling Analysis." British Journal of Social Work 50, no. 5 (December 3, 2019): 1324–44. http://dx.doi.org/10.1093/bjsw/bcz133.
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Abstract Despite being a profession dedicated to the empowerment of service users, empirical study of mental health social work appears dominated by the perspectives of social workers themselves. What service users value is less often reported. This study, authored by a mix of academics and service users/carers, reports a Best–Worst Scaling analysis of ten social worker ‘qualities’, representing both those highly specialist to social work and those generic to other mental health professionals. Fieldwork was undertaken during 2018 with 144 working-age service users, living at home, in five regions of England. Of specialist social work qualities, service users rated ‘[the social worker] thinks about my whole life, not just my illness’ particularly highly, indicating that person-centred approaches drawing on the social model of mental health are crucial to defining social work. However, service users did not value help accessing other community resources, particularly those who had spent the longest time within mental health services. Continuity of care was the most highly valued of all, although this is arguably a system-level feature of support. The research can assist the profession to promote the added value of their work, focusing on their expertise in person-centred care and the social model of mental health.
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Aiello, Matt, and Julian D. Mellor. "Integrating health and care in the 21st century workforce." Journal of Integrated Care 27, no. 2 (April 15, 2019): 100–110. http://dx.doi.org/10.1108/jica-09-2018-0061.
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Purpose The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. “By learning together, we learn how to work together”. The paper aims to discuss these issues. Design/methodology/approach The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care. Findings With partnership working between arm’s length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care. Research limitations/implications The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity. Practical implications The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity. Social implications The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health. Originality/value This paper contains Health Education England project work and outcomes which are original and as yet unpublished.
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McCray, Janet, Adam Palmer, and Nik Chmiel. "Building resilience in health and social care teams." Personnel Review 45, no. 6 (September 5, 2016): 1132–55. http://dx.doi.org/10.1108/pr-04-2014-0095.
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Purpose Maintaining user-focused integrated team working in complex care is one of the demands made of UK health and social care (H&SC) organisations who need employees that are resilient, resilience being the ability to persevere and thrive in the face of exposure to adverse situations (Rogerson and Ermes, 2008, p. 1). Grant and Kinman (2012) write that resilience is a complex and multi-dimensional construct that is underexplored in social care team work. The purpose of this paper is to capture the views of managers in H&SC to explore the making of resilient teams, identify factors that influence team performance and inform organisational workforce development strategy. Design/methodology/approach A general inductive approach (Silverman, 2011) was applied. Five focus groups were facilitated (n=40) each with eight participants all of whom were leaders and managers of teams in H&SC, working in the integrated care context in the UK. Findings Findings indicate that further investment in strategies and resources to sustain and educate employees who work in teams and further research into how organisational systems can facilitate this learning positively may contribute to resilient teams and performance improvement. The authors note specifically that H&SC organisations make a distinction between the two most prevalent team types and structures of multi-disciplinary and inter-professional and plan more targeted workforce development for individual and team learning for resiliency within these team structures. In doing so organisations may gain further advantages such as improved team performance in problematic care situations. Research limitations/implications Data captured are self-reported perceptions of H&SC managers. Participant responses in the focus group situation may have been those expected rather than those actually modelled in the realities of team work practice (Tanggaard, 2008). Further, in the sample all participants were engaged in a higher education programme and it is possible participants may have been more engaged with their practice and thinking more critically about the research questions than those not currently undertaking postgraduate study (Ng et al., 2014). Nor were the researchers able to observe the participants in team work practice over time or during critical care delivery incidents. Practical implications The preliminary link made here between multi-disciplinary and inter-professional team type, and their different stress points and subsequent workforce intervention, contributes to the theory of resilient teams. This provides organisations with a foundation for the focus of workplace learning and training around resilience. H&SC practitioner views presented offer a greater understanding of team work processes, together with a target for planning workforce development strategy to sustain resilience in team working. Originality/value This preliminary research found that participants in H&SC valued the team as a very important vehicle for building and sustaining resilience when dealing with complex H&SC situations. The capitalisation on the distinction in team type and individual working practices between those of interprofessional and multidisciplinary teams and the model of team learning, may have important consequences for building resilience in H&SC teams. These findings may be significant for workforce educators seeking to develop and build effective practice tools to sustain team working.
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Cruz, Taylor M. "Perils of data-driven equity: Safety-net care and big data’s elusive grasp on health inequality." Big Data & Society 7, no. 1 (January 2020): 205395172092809. http://dx.doi.org/10.1177/2053951720928097.
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Large-scale data systems are increasingly envisioned as tools for justice, with big data analytics offering a key opportunity to advance health equity. Health systems face growing public pressure to collect data on patient “social factors,” and advocates and public officials seek to leverage such data sources as a means of system transformation. Despite the promise of this “data-driven” strategy, there is little empirical work that examines big data in action directly within the sites of care expected to transform. In this article, I present a case study on one such initiative, focusing on a large public safety-net health system’s initiation of sexual orientation and gender identity (SOGI) data collection within the clinical setting. Drawing from ethnographic fieldwork and in-depth interviews with providers, staff, and administrators, I highlight three main challenges that elude big data’s grasp on inequality: (1) provider and staff’s limited understanding of the social significance of data collection; (2) patient perception of the cultural insensitivity of data items; and (3) clinic need to balance data requests with competing priorities within a constrained time window. These issues reflect structural challenges within safety-net care that big data alone are unable to address in advancing social justice. I discuss these findings by considering the present data-driven strategy alongside two complementary courses of action: diversifying the health professions workforce and clinical education reform. To truly advance justice, we need more than “just data”: we need to confront the fundamental conditions of social inequality.
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Twigg, Julia. "Integrating Carers into the Service System: Six Strategic Responses." Ageing and Society 13, no. 2 (June 1993): 141–70. http://dx.doi.org/10.1017/s0144686x00000830.
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ABSTRACTThis paper discusses the mechanisms whereby the needs and interests of carers might be integrated into the service delivery system. Over the last decade, informal care has emerged as a major subject for research and discussion, and much work has been undertaken exploring the experiences, burdens and needs of carers. Carers are increasingly recognised as central to community care, but little work has so far addressed the means whereby their needs and interests might be integrated within mainstream service provision. The mechanisms for achieving this are underdeveloped. This paper puts forward six possible strategic responses, and discusses the merits and demerits of each. The responses are: taking evaluation a step further; consumerism; case management; performance or service indicators; rights; and targets. The issues raised in the discussion have relevance beyond the subject of informal care, and address questions that are central to the provision of welfare services generally.
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Bail, Kari M., Jennifer Foster, Safiya George Dalmida, Ursula Kelly, Maeve Howett, Erin P. Ferranti, and Judith Wold. "The Impact of Invisibility on the Health of Migrant Farmworkers in the Southeastern United States: A Case Study from Georgia." Nursing Research and Practice 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/760418.
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Migrant farmworkers represent one of the most marginalized and underserved populations in the United States. Acculturation theory cannot be easily mapped onto the transnational experience of migrant farmworkers, who navigate multiple physical and cultural spaces yearly, and who are not recognized by the state they constitute, “the Citizen’s Other” (Kerber, 2009). This paper utilizes narrative analysis of a case study to illustrate, through the relationship of the narrator to migrant farmworkers and years of participant observation by the coauthors, how isolation from family and community, as well as invisibility within institutions, affect the health and well-being of migrant farmworkers in southeastern Georgia. Invisibility of farmworkers within institutions, such as health care, the educational system, social services, domestic violence shelters, and churches contribute to illness among farmworkers. The dominant American discourse surrounding immigration policy addresses the strain immigrants put on the social systems, educational system, and the health care system. Nurses who work with farmworkers are well positioned to bring the subjective experience of farmworkers to light, especially for those engaged with socially just policies. Those who contribute to the abundant agricultural produce that feeds Americans deserve the recognition upon which social integration depends.
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Genova, Angela. "Health care outputs, outcomes and performance: a review of the debate." SALUTE E SOCIETÀ, no. 2 (July 2010): 145–66. http://dx.doi.org/10.3280/ses2010-su1011.
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Comparative studies on health systems in Europe show growing convergence in terms of general characteristics, while insufficient attention is paid to the overall range of varying welfare policies within which the health systems operate. By developing the theoretical model of health systems, this work puts forward the construction of an analytical approach able to contextualise health policies within the relative welfare systems. It proposes health regimes as an analytical category, defined on the basis of the different roles played by the actors called on to respond to health needs: the state, the market, the services sector and the family. Through a comparative study of a number of indicators, it outlines the four main ideal types of health regime in Europe. The attention on the contexts in which health systems operate makes it possible to recognise and valorise the contribution that the various actors make in responding to health needs, thus promoting a more complete vision for the analysis of health policies in Europe.
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Gask, L., and P. Coventry. "Person-centred mental health care: the challenge of implementation." Epidemiology and Psychiatric Sciences 21, no. 2 (February 29, 2012): 139–44. http://dx.doi.org/10.1017/s2045796012000078.
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Within mental health care, ‘person-centredness’ has been generally interpreted to convey a holistic approach with an attitude of respect for the individual and his/her unique experience and needs. Although it has been possible to demonstrate that professionals can acquire such skills through training, the impact on clinical outcomes has been more difficult to demonstrate in randomized controlled trials. Indeed what is becoming increasingly apparent in the literature is the need to acknowledge and address the degree of complexity that exists within the health care system that militates against achieving satisfactory implementation and outcomes from person-centred mental health care. In addressing this, we must develop and work with more sophisticated and three-dimensional models of ‘patient-centredness’ that engage with not only what happens in the consulting room (the relationship between individual service users and healthcare professionals), but also addresses the problems involved in achieving person-centredness through modifying the way that services and organizations work, and finally by engaging families and communities in the delivery of health care. A truly meaningful concept of ‘people-centredness’ encompasses how the views of the population are taken into consideration not only in healthcare but also in health and social care policy, and wider society too.
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van Heugten, Kate. "Registration and social work education: A golden opportunity or a Trojan horse?" Journal of Social Work 11, no. 2 (April 2011): 174–90. http://dx.doi.org/10.1177/1468017310386695.
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• Summary: The Social Workers Registration Act (2003) introduced a system of voluntary statutory registration of the social work occupation in Aotearoa New Zealand. This was hailed as a measure that would protect the public from unsafe practices, and enhance the status of the profession. More recently, however, commentators have noted that these positive effects may not necessarily be forthcoming. This article explores the impact of registration on educational programmes, by placing regulation of the occupation in the context of hegemonic neoliberalism. • Findings: Neoliberal approaches to social care not only constrain the delivery of services, but attempt to shape the perspectives of the social care workforce. Education is a potentially powerful tool for achieving that shaping. Where statutory regulation of social work is in force, competency based training threatens to supplant critical analysis, which is a hallmark of higher education. To retain viability as an academic discipline, social work educators must champion social work’s continuing role in analysing and theorizing the distribution of power in social welfare and social care. • Application: Social work educators have a role in supporting practitioners, who struggle to maintain disciplinary integrity whilst employed within 21st-century human services, by continuing to engage in critical debates, and advancing knowledge about the theory—practice nexus. In advancing such knowledge, they also have much to offer other disciplines in institutions of higher education that are looking to explicate their utility in the ‘real world’.
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Levin, Kate A., Martine A. Miller, Marion Henderson, and Emilia Crighton. "Implementing a step down intermediate care service." Journal of Integrated Care 27, no. 4 (October 10, 2019): 276–84. http://dx.doi.org/10.1108/jica-08-2018-0056.
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Purpose The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere.
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Imes, Christopher C., and Eileen R. Chasens. "Rotating Shifts Negatively Impacts Health and Wellness Among Intensive Care Nurses." Workplace Health & Safety 67, no. 5 (March 2, 2019): 241–49. http://dx.doi.org/10.1177/2165079918820866.
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The impact of shift work on sleep and health has been examined in the past, but most studies utilized cross-sectional designs relying on between-subject differences. The purpose this study was to examine the within-subject differences in self-report measures of health and wellness among a group of nurses engaged in rotating shifts. Patient-Reported Outcomes Measurement Information System (PROMIS) measures, collected post-day and post-night shift, were used to assess health, sleep disturbances and sleep-related impairment, fatigue, emotional distress (anger), satisfaction with social roles outside of work, and applied cognitive abilities. Among the sample of 23 White, mostly female (91.3%) nurses, all PROMIS measures were worse indicting lower health and wellness after working night shifts compare to after working day shifts ( p values from .167 to < .001). During both time points of assessment, sleep-related impairment was highly correlated with greater emotional distress, greater fatigue, and worse memory and concentration. Study findings support prior studies that shift work can negatively impact health and wellness.
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Ørtenblad, Lisbeth, Lucette Meillier, and Alexandra R. Jønsson. "Multi-morbidity: A patient perspective on navigating the health care system and everyday life." Chronic Illness 14, no. 4 (September 15, 2017): 271–82. http://dx.doi.org/10.1177/1742395317731607.
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Objective The importance of everyday life when managing the burden of treatment is rarely studied. This article explores the burden of treatment among people with multi-morbidity by investigating the tension between everyday life and the health care system. Method This was an ethnographic study using individual interviews and participant-observations. An inductive analytical approach was applied, moving from observations and results to broader generalisations. Results People with multi-morbidity experience dilemmas related to their individual priorities in everyday life and the management of their treatment burdens. Dilemmas were identified within three domains: family and social life; work life; agendas and set goals in appointments with health professionals. Individual resources and priorities in everyday life play a dominant role in resolving dilemmas and navigating the tension between everyday life and the health care system. Discussion People with multi-morbidity are seldom supported by health professionals in resolving the dilemmas they must face. This study suggests an increased focus on patient-centredness and argues in favour of planning health care through cooperation between health professionals and people with multi-morbidity in a way that integrates both health and everyday life priorities.
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Ricciardelli, Rosemary, R. Nicholas Carleton, Taylor Mooney, and Heidi Cramm. "“Playing the system”: Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel." Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 24, no. 3 (September 16, 2018): 259–78. http://dx.doi.org/10.1177/1363459318800167.
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There are growing concerns about the impact of public safety work on the mental health of public safety personnel; as such, we explored systemic and individual factors that might dissuade public safety personnel from seeking care. Public safety personnel barriers to care-seeking include the stigma associated with mental disorders and frequent reports of insufficient access to care. To better understand barriers to care-seeking, we thematically analyzed the optional open-ended final comments provided by over 828 Canadian public safety personnel as part of a larger online survey designed to assess the prevalence of mental disorders among public safety personnel. Our results indicated that systematic processes may have (1) shaped public safety personnel decisions for care-seeking, (2) influenced how care-seekers were viewed by their colleagues, and (3) encouraged under-awareness of personal mental health needs. We described how public safety personnel who do seek care may be viewed by others; in particular, we identified widespread participant suspicion that coworkers who took the time to address their mental health needs were “abusing the system.” We explored what constitutes “abusing the system” and how organizational structures—systematic processes within different public safety organizations—might facilitate such notions of abuse. We found that understaffing may increase scrutiny of injured public safety personnel by those left to manage the additional burden; in addition, cynicism and unacknowledged structural stigma may emerge, preventing the other public safety personnel from identifying their mental health needs and seeking help. Finally, we discuss how system-level stigma can be potentiated by fiscal constraints when public safety personnel take any leave of absence, inadvertently contributing to an organizational culture wherein help-seeking for employment-related mental health concerns becomes unacceptable. Implications for public safety personnel training and future research needs are discussed.
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Rayner, Jennifer, Laura Muldoon, Imaan Bayoumi, Dale McMurchy, Kate Mulligan, and Wangari Tharao. "Delivering primary health care as envisioned." Journal of Integrated Care 26, no. 3 (July 2, 2018): 231–41. http://dx.doi.org/10.1108/jica-02-2018-0014.
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PurposeFor over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.Design/methodology/approachThe MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.FindingsThe MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.Originality/valueAs comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.
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Aldridge, Zena, Victoria Davies, and Karen Harrison Dening. "Admiral Nursing: supporting families affected by dementia within a holistic intermediate care team." British Journal of Neuroscience Nursing 15, no. 5 (October 2, 2019): 231–37. http://dx.doi.org/10.12968/bjnn.2019.15.5.231.
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There are increasing pressures on the health and social care system, particularly within acute hospital care. This has led to significant changes being implemented throughout the NHS England Long Term Plan (2019) , such as moving services closer to home and improving ‘out of hospital’ care. Intermediate care services are being developed to improve timely discharge from hospital and prevent unnecessary hospital admissions and premature transfer to residential care. An innovative intermediate care model, inclusive of Admiral Nursing, has been developed within Olympus Care Services to support families living with dementia, implementing an intensive 8-week intervention model. It is essential that intermediate services are accessible for people with dementia, inclusive of the needs of the family, and that they work within the context of integrated and collaborative models of care across traditional organisational boundaries. The aim is not only to improve resilience and quality of life, but also to offer opportunities to promote the narrative of living well with dementia. This service model illustrates how this can be achieved with inclusion of Admiral Nursing working within reablement services.
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Malik, Baber, Jude Wells, Jane Hughes, Paul Clarkson, John Keady, Alys Young, and David Challis. "Complex care needs and devolution in Greater Manchester: a pilot study to explore social care innovation in newly integrated service arrangements for older people." Australian Health Review 44, no. 6 (2020): 838. http://dx.doi.org/10.1071/ah19168.
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ObjectiveThe aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. MethodsA case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. ResultsSix case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. ConclusionComponents of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. What is known about the topic?The devolution of health and social care arrangements in Greater Manchester has aroused considerable interest in much wider arenas. Necessarily much of the focus in available material has been upon strategic development, analysis of broader trends and mechanisms and a concern with changes in the healthcare system. What does this paper add?The findings from this study will enable emerging approaches to be described and codified, and permit the specific social care contribution to the new arrangements to be discerned. The findings are relevant beyond the immediate context of Greater Manchester to wider integrated care. The evidence can be used by commissioners and services, providing a sound basis for further work as service systems develop. What are the implications for practitioners?This research is important because it is one of the first pieces of work to examine the new integrated care arrangements in Greater Manchester. By providing guidance to promote evidence-based practice, this study contributes to service development in Greater Manchester and the achievement of the broad national service objectives of improving user and carer experiences and ensuring value for money.
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Muchacha, Munyaradzi, Charles Dziro, and Edmos Mtetwa. "The implications of neoliberalism for the care of orphans in Zimbabwe: Challenges and opportunities for social work practice." Aotearoa New Zealand Social Work 28, no. 2 (August 18, 2016): 84–93. http://dx.doi.org/10.11157/anzswj-vol28iss2id227.
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The paper explores the implications of neoliberal social policies for the care of orphans in Zimbabwe and looks at the challenges and opportunities for social work practice in such a context. It is estimated that Zimbabwe is home to over 1 million orphaned and vulnerable children most of whom are being looked after by their relatives. As from 1991, Zimbabwe switched over from a “socialist” socio-economic policy trajectory to a neoliberal dispensation. This neoliberal policy regime entails the implementation of austerity measures such as severe cuts on social expenditures, the introduction of stringent means tested social safety nets and reduction of the civil service wage bill. This paper argues that this neoliberal policy regime negatively affects the care of orphans and access to services such as health and education. The reduction of expenditure on social services has also resulted in severe cuts on social work posts within the civil service leading to high caseloads and poor social work practice. The paper concludes by identifying and arguing for developmental social work practice as a social work strategy to challenge and address the implications of neoliberalism through strengthening the capacities of the kinship system, advocacy and contribution to the social policy making process
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Reho, Tiia T. M., Salla A. Atkins, Nina Talola, Mervi Viljamaa, Markku P. T. Sumanen, and Jukka Uitti. "Frequent attenders in occupational health primary care: A cross-sectional study." Scandinavian Journal of Public Health 47, no. 1 (May 27, 2018): 28–36. http://dx.doi.org/10.1177/1403494818777436.
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Aims: This study characterizes frequent attenders in primary care provided by occupational health services (OHS) in Finland. Methods: This is a nationwide cross-sectional study using medical record data from an OHS provider in 2015. Frequent attenders were defined as persons who were within the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10) at any of the OHS’s 37 stations. FA10s within this study consulted the OHS primary care unit eight or more times during 2015. We used logistic regression to analyse factors associated with frequent attendance in OHS primary care. The independent variables were age, gender, employer size and industry, health professionals visited and diagnoses given during visits to the OHS. The dependent variable was belonging to the FA10 group. Results: Altogether 31,960 patients met the inclusion criteria and were included in the study. The FA10 group included 3617 patients, who conducted 36% of visits to healthcare professionals. The findings indicate that working within the manufacturing industry, health and social services, or public administration, and being employed in medium or large companies, are associated with frequent attendance. Frequent attendance was also associated with being female, diagnoses of the musculoskeletal system, or mental and behavioral disorders. In particular, depressive episodes and anxiety were associated with FA10s. Conclusions:This research characterized FA10 clients at a Finnish OHS. Illnesses of the musculoskeletal system and mental and behavioral disorders were accentuated among FA10s. The stability of the FA10 group, along with their sickness absences and work disabilities, should be investigated further.
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Muirhead, Andrew, Derek George Ward, and Brenda Howard. "The Digital House of Care: information solutions for integrated care." Journal of Integrated Care 24, no. 5/6 (October 17, 2016): 237–48. http://dx.doi.org/10.1108/jica-08-2016-0029.
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Purpose The purpose of this paper is to describe the development of a digital tool in an English county striving towards a vision of integrated information that is used to underpin an increasingly integrated future of health and social care delivery. Design/methodology/approach It discusses the policy context nationally, the origins and implementation of the initiative, the authors’ experiences and viewpoint highlighting key challenges and learning, as well as examples of new work undertaken. Findings In all, 12 health and care organisations have participated in this project. The ability for local commissioners and providers of services to now understand “flow” both between and within services at a granular level is unique. Costs are modest, and the opportunities for refining and better targeting as well as validating services are significant, thus demonstrating a return on investment. Key learning includes how organisational development was equally as important as the implementation of innovative new software, that change management from grass roots to strategic leaders is vital, and that the whole system is greater than the sum of its otherwise in-silo parts. Practical implications Data linkage initiatives, whether local, regional or national in scale, need to be programme managed. A robust governance and accountability framework must be in place to realise the benefits of such as a solution, and IT infrastructure is paramount. Social implications Organisational development, collaborative as well as distributed leadership, and managing a change in culture towards health and care information is critical in order to create a supportive environment that fosters learning across organisational boundaries. Originality/value This paper draws on the recent experience of achieving large-scale data integration across the boundaries of health and social care, to help plan and commission services more effectively. This rich, multi-agency intelligence has already begun to change the way in which the system considers service planning, and learning from this county’s approach may assist others considering similar initiatives.
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Honawar, Mangala. "Social Work Intervention with Women Offenders: A Pathway to Prevent Recidivism." Asian Social Work Journal 4, no. 4 (November 2, 2019): 35–46. http://dx.doi.org/10.47405/aswj.v4i4.112.
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Literature has consistently shown that women offenders often have unique needs compared to men primarily due to their role as primary care givers within the family structure. The challenges and needs of women offenders vis-à-vis their vulnerabilities, biases against them, discriminations at various levels and of various kinds in the society and several such factors demand both a professional and a holistic approach towards preventing recidivism among them. Over a period, there has been a growing need for specialized interventions for various populations of people in conflict with law. For example, there is a growing area of intervention for specific categories such as juvenile offenders, young offenders, etc. The statistics on crime show an increasing involvement of women in crime and an emerging need to deal with the issue differently than the existing approach of the Criminal Justice System. It is in this context that professional social workers have an important role to play in prison settings, particularly in the context of women, their vulnerabilities and their involvement in crime. They can intervene during crucial phases such as when the women enter the prison for the first time, during their under-trial detention, conviction period and also provide family related services, health and mental health support and counseling, educational support, facilitate skill development, and job placement in addition to monitoring prison conditions. Social work intervention holds the potential to prevent recidivism among women offenders.
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SMITH-CARRIER, TRACY, THUY-NGA PHAM, SABRINA AKHTAR, GAYLE SEDDON, MARK NOWACZYNSKI, and SAMIR K. SINHA. "‘It’s not just the word care, it’s the meaning of the word…(they) actually care': caregivers’ perceptions of home-based primary care in Toronto, Ontario." Ageing and Society 38, no. 10 (May 17, 2017): 2019–40. http://dx.doi.org/10.1017/s0144686x1700040x.
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ABSTRACTThe frail and homebound older adult populations currently experience difficulties accessing primary care in the medical office. Given this fundamental access to care problem, and the questionable care quality that arises when navigating a labyrinthine health-care system, these populations have typically been subject to inadequate primary care. To meet their needs better, growing research stresses the importance of providing comprehensive home-based primary care (HBPC), delivered by an inter-professional team of health-care providers. Family care-givers typically provide the majority of care within the home, yet their perceptions of HBPC remain under-researched. The purpose of this study was to explore unpaid care-givers' perceptions of and experiences with HBPC programmes in Toronto, Canada. We conducted qualitative inductive content analysis, using analytic procedures informed by grounded theory, to discover a number of themes regarding unpaid care-givers' understandings of HBPC. Findings suggest that, compared to the standard office-based care model, HBPC may better support unpaid care-givers, providing them assistance with system navigation and offering them the peace of mind that they are not alone, but have someone to call should the need arise. The implications of this research suggest that HBPC could be a model to help mitigate the discontinuities in care that patients with comorbid chronic conditions and their attendant unpaid care-givers experience when accessing fragmented health, home and social care systems.
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Østergaard, Simon. "Evaluation of dispatch outcomes and staffing of the Copenhagen mobile health and social care unit – Sociolancen." Dansk Tidsskrift for Akutmedicin 2, no. 3 (April 30, 2019): 46. http://dx.doi.org/10.7146/akut.v2i3.112988.
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Background: The mobile health and social care unit – Sociolancen (MHSCU) is a specialized unit within the Emergency Medical Services (EMS) of the Capital Region of Denmark. The unit provides acute social care for homeless and social deprived groups and is staffed with a social worker and a paramedic and available through the EMS dispatch during daytime. The MHSCU is dispatched to citizens where the need for acute social care is suspected, falling outside the normal scope of practice for emergency ambulances. The aim of this study was to evaluate the dispatch outcomes of the MHSCU and the constellation of paramedical and social effort.
Methods: Data on the total number of MHSCU dispatches and outcomes in 2016 and 2017 was retrieved from the dispatch system operated by EMS Copenhagen. Outcome data was grouped for descriptive statistics.
Results: During the data collection period the MHSCU was dispatched 2976 times. The outcome resulted in 384 (12.9%) citizens being brought to a somatic emergency department (ED) and 255 (8.6%) citizens being brought to a psychiatric ED. A total of 355 (11.9%) citizens were left to selfcare and 196 (6.6%) citizens were brought to a shelter. Number of citizens handed over from emergency ambulances was 41 (1.4%), number of citizens handed over to emergency ambulances was 4 (0.1%), number of citizens handed over to police was 13 (0.4%). In 1386 (46.6%) cases MHSCU were doing outreach work, citizen had left scene or MHSCU was cancelled. Number of dispatches labeled ‘unknown’ was 342 (11.5%).
Conclusions: The outcome of MHSCU dispatches indicate the need for both paramedical and social staffing when attending the homeless and social deprived citizens, as there is an approximately even distribution between health related and social related referral. Half of dispatches covers outreach work not within the normal scope of practice for emergency ambulances, enabling MHSCU to provide community service and security. Further, based on the low referral to emergency ambulances and police, the dispatch of MHSCU seems well-prioritized.
Acknowledgments: The authors wish to thank Paramedic Martin Betzer for assistance.
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McDonald, Kathryn M. "The diagnostic field’s players and interactions: from the inside out." Diagnosis 1, no. 1 (January 1, 2014): 55–58. http://dx.doi.org/10.1515/dx-2013-0023.
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AbstractFor diagnoses that require inputs from multiple players – patients, informal caregivers, health care professionals – a team approach to coordinating diagnostic care has the potential to improve outcomes. Taking a patient-system perspective helps elucidate important factors relevant to team-based diagnostic performance. These factors are conceptualized as a metaphoric playing field that has goals, players interacting, unavoidable uncertainties and influential social conditions specifically tied to the diagnosis phase of care. In terms of rules of the game, the patient-system interaction might be guided by application of Gittell and colleague’s relational coordination concepts, and understood within a broader social network framework of diagnosis, adapted from work by Berkman and colleagues. Patient-centered metrics are also needed to monitor the success of diagnosis.
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Bantug, Elissa Thorner, Kimberly S. Peairs, Lillie D. Shockney, Nelli Zafman, Carol D. Riley, Jennifer Barsky Reese, Claire Frances Snyder, Vered Stearns, and Antonio C. Wolff. "Making it work: Breast cancer survivorship care at Johns Hopkins." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 61. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.61.
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61 Background: Breast cancer survivor numbers are increasing due to population aging and improved treatment outcomes but many of their long-term health care needs are unmet. Integrated follow-up care strategies that enhance care coordination, education, and access to survivorship resources are needed to provide patients with evidence-based care that addresses medical and psychosocial needs after cancer treatment. Methods: In 2008, we established the Johns Hopkins Breast Cancer Survivorship Program with representation from the Schools of Nursing, Public Health, and Medicine to address the needs of patients completing initial cancer treatment and transitioning to long-term follow-up. Patient educational resources were created within an interactive website ( http://bit.ly/hZfzFi ) including > 35 patient/provider educational video clips, blogs and social media. Activities including provider educational events, educational folders, and trainee curriculum additions have been ongoing. Starting May 2011, Hopkins patients were offered a one-time transition visit with a nurse practitioner focusing on individualized treatment summary/survivorship care plan activities (e.g., cancer screening/surveillance, medical intervention, psychosocial support, and care coordination with non-cancer providers). Results: Our website is averaging 3,000 hits monthly. We have participated in 22 provider/trainee formal educational presentations. In the pilot phase of these transition visits (n=40), age/race breakdown of participants were representative of our breast cancer population (median age 51, range 34-69; 17% African Americans). Our post-visit survey (n=37), 97% found the survivorship visit beneficial and all reported that this one-time consultation helped with transitioning away from treatment. Conclusions: A multidisciplinary patient-centered approach to breast cancer survivorship allowed us to develop comprehensive clinical and educational service models to benefit patients and their cancer/non-cancer providers. This program aims to enhance education, overcome the fragmentation of the health care system, and improve overall health and wellness of breast cancer survivors as they transition to long-term survivorship.
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Adlam, John. "“Scallywag battalions”: reflective practice groups with multidisciplinary teams in mental health and social care systems." Organisational and Social Dynamics 19, no. 2 (November 1, 2019): 168–85. http://dx.doi.org/10.33212/osd.v19n2.2019.168.
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“Reflective practice” is a term imprecisely understood and used to describe a wide range of different activities or interventions. In this article I examine the Reflective Practice Group (RPG) as an intervention offered to multidisciplinary teams (MDTs) in mental health and social care settings. Drawing extensively upon the work of Wilfred Bion and on the “Northfield I” experiment which he led in 1942, I formulate the existential, conceptual, and functional challenges of the MDT in terms of the problematic interplay between the drive towards autonomy and the exigencies of interdependence. I take this interplay as the figure, with the ground being the baseline disarray of traumatised systems that both defines and contextualises the individual worker’s predicament within the team. Analysing the nature of the MDT sheds new light on longstanding controversies about what ailment the RPG is there to address; what skill set is needed to facilitate it; and what methodology may be most appropriately used for its delivery.
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Wong, Emily Claire, Celia Kaplan, Dianne Shumay, Yan Leykin, Laura Van't Veer, Allison Stover-Fiscalini, Laura Esserman, and Michelle Melisko. "Patient utilization of supportive care services identified through the Athena Breast Health Questionnaire System." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 226. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.226.
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226 Background: Psychological wellbeing and lifestyle changes are important factors in long-term health of cancer survivors. As part of the Athena Breast Health Network, the UCSF Breast Care Center (BCC) incorporated an electronic health questionnaire system (HQS) that collects patient-reported data on physical and psychological symptoms, medical conditions, family history, and lifestyle to identify patients’ supportive care needs. Methods: Through a semi-automated process, patients whose HQS responses meet pre-established thresholds are referred to Psycho-Oncology, social work, genetic counseling, and Onco-Fertility. Referrals generated within the HQS are signed and routed by clinicians at the time of a BCC visit. When patients decline appointments with these services, staff members document reasons within the electronic medical record (EMR). A retrospective chart review identified patients who did not receive supportive care services to which they were referred and a qualitative analysis was performed. Results: From 7/1/14-12/31/14, 525 patients completed an HQS and agreed to have their data used for research. The table summarizes referral information. 45 patients referred to Psycho-Oncology did not complete an appointment. Of these, ten did not respond to phone contact to schedule visits. 35 were reached, but declined an appointment. 25 (71.4%) were not ready to make an appointment; 5 (14.3%) cited distance as a primary barrier; 3 (8.6%) were satisfied with the psychological services they were receiving elsewhere; and 2 (5.7%) did not have insurance coverage. Reasons women disregarded referrals for genetic counseling and fertility are being evaluated. Conclusions: HQS can assist in identifying patient supportive care needs, but despite automation of referrals, many patients do not follow through to use supportive care and clinical resources. Timing and resource accessibility may be key. Through analysis of reasons for non-utilization, we hope to better tailor the delivery of supportive care services, when indicated, to better serve patient needs. [Table: see text]
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Dunkle, Ruth, Katherine Cavagnini, Joonyoung Cho, Laura Sutherland, Helen Kales, Cathleen Connell, and Amanda Leggett. "Barriers and Challenges Faced by Social Workers Caring for Dementia Patients in Acute Care Settings." Innovation in Aging 4, Supplement_1 (December 1, 2020): 76–77. http://dx.doi.org/10.1093/geroni/igaa057.251.
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Abstract The nature of dementia care provided by social workers across various hospital settings is unexplored. This study utilized the “rigorous and accelerated data reduction” (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings. Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016. Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition). Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP. While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g. there is more focus on discharge planning and less management of competing demands in the IP than in the ED. Also, social workers were more involved in the diagnosis of dementia in the ED than other settings. We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.
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Flutra Musta and Monika Bogdanova. "Analysis of interventions and social work services in the Psychiatric Hospital “Sadik Dinci” Elbasan, Albania." World Journal of Advanced Research and Reviews 10, no. 1 (April 30, 2021): 270–78. http://dx.doi.org/10.30574/wjarr.2021.10.1.0175.
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Recent changes, especially after the 90s in Albania, have marked an important turn in the whole health system and even more so in the field of mental health. With health services, policies and social services were implemented to people with mental health problems, and it in this form that there was a need to bridge these policies and services to beneficiaries, such as social workers in mental health. Now the social worker is one of the key persons in the multidisciplinary team whose purpose is to identify, diagnose, treat, plan and integrate these people into society. The study aims is to identify the support and role of social work in persons with mental health disorders at Psychiatric Hospital “Sadik Dinçi” Elbasan, Albania and in the supported housing in this city. Qualitative method was used for conducting the study, and semi-structured interview with a focus group of 4 social workers of this hospital, 2 social workers of Elbasan Community Mental Health Center and 4 day-care ergo therapists located within the premises of the hospital was used as measuring instruments to this hospital. Also, a survey was conducted with 15 patients of the hospital. According to the study, the role of the social worker is well positioned in the field of mental health, but at the same time the study highlights the need for modern European interventions and models for integrating these individuals away from the walls of psychiatric hospitals, models where these individuals are supported and integrated in society.
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Kumar, Santosh, Rajesh Garg, Haroon Ali Siddiqui, and Rupali Roy. "Health services rendered through Accredited Social Health Activists to rural Uttar Pradesh, India: community’s perception." International Journal Of Community Medicine And Public Health 4, no. 3 (February 22, 2017): 662. http://dx.doi.org/10.18203/2394-6040.ijcmph20170736.
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Background: To reduce infant and maternal mortality in India, the Government of India (GOI), under its flagship program, National Rural Health Mission (NRHM), in 2005, introduced a new village based health functionary named Accredited Social Health Activist (ASHA) to act as a bridge between rural population and health care delivery system. To a large extent the actualization of the goals of NRHM depends on the functional efficacy of ASHA as a grass root health activist.Methods: The Study was conducted in a Chiraigaon Block of District Varanasi, Uttar Pradesh., India from October 2008 to September 2009. A total of 270 beneficiaries comprising of mothers, who have delivered during the study period or within last six months since initiation of the study were enrolled and interviewed. Apart from that, 20 Multi Purpose Health Workers- Female (MPHW-F), 30 elected village Heads and five Medical officers were interviewed independently to know their opinions about work performance of ASHA.Results: This study revealed that 80 % of beneficiaries availed Ante Natal Care (ANC) check up. A total of 97% of the beneficiaries had received 100 tablets of Iron Folic Acid (IFA), 72% of the beneficiaries were counseled for nutrition during pregnancy and the child immunization coverage was more than 80%. About 75% of multi purpose Health Worker-Female (MPHW-F), 83 % of the village heads and 80% of the Medical Officers were of the opinion that the maternal and child health (MCH) services have improved after ASHAs introduction. Conclusions: Overall, ASHA’s impact in the form of counseling on health services utilization by beneficiaries was observed to be statistically significant.
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Peer, Kimberly S., and Chelsea L. Jacoby. "Powerful Lessons from Cuban Medical Education Programs: Fostering the Social Contract in Athletic Training Programs." Athletic Training Education Journal 14, no. 4 (October 1, 2019): 275–82. http://dx.doi.org/10.4085/1404275.
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Context The Cuban medical education and health care systems provide powerful lessons to athletic training educators, clinicians, and researchers to guide educational reform initiatives and professional growth. Objective The purpose of this paper is to provide a brief overview of the Cuban medical education system to create parallels for comparison and growth strategies to implement within athletic training in the United States. Background Cubans have experienced tremendous limitations in resources for decades yet have substantive success in medical education and health care programs. As a guiding practice, Cubans focus on whole-patient care and have established far-reaching research networks to help substantiate their work. Synthesis Cuban medical education programs emphasize prevention, whole-patient care, and public health in a unique approach that reflects disablement models recently promoted in athletic training in the United States. Comprehensive access and data collection provide meaningful information for quality improvement of education and health care processes. Active community engagement, education, and interventions are tailored to meet the biopsychosocial needs of individuals and communities. Results Cuban medical education and health care systems provide valuable lessons for athletic training programs to consider in light of current educational reform initiatives. Strong collaborations and rich integration of disablement models in educational programs and clinical practice may provide meaningful outcomes for athletic training programs. Educational reform should be considered an opportunity to expand the athletic training profession by embracing the evolving role of the athletic trainer in the competitive health care arena. Recommendation(s) Through careful consideration of Cuban medical education and health care initiatives, athletic training programs can better meet the contract with society as health care professionals by integrating the Accreditation Council for Graduate Medical Education's core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice now promoted in the Commission on Accreditation of Athletic Training Education's 2020 Standards for Accreditation of Professional Athletic Training Programs. Conclusion(s) Educational and health care outcomes drive change. Quality improvement efforts transcend both education and health care. Athletic training can learn valuable lessons from the Cubans about innovation, preventative medicine, patient-centered community outreach, underserved populations, research initiatives, and globalization. Not unlike Cuba, athletic training has a unique opportunity to embrace the challenges associated with change to create a better future for athletic training students and professionals.
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Živanović, Dejan, Jovan Javorac, Zvonko Dimoski, and Sanja Šumonja. "Nursing profession in the contemporary healthcare system and public health: New roles and challenges." Zdravstvena zastita 50, no. 2 (2021): 73–86. http://dx.doi.org/10.5937/zdravzast50-30873.
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Given the general importance of caring for the health of the population, it is understood that the healthcare system is organizationally one of the most complex systems in a country, with elements that should provide physically, geographically, and economically accessible, integrated and quality healthcare. Historically, nursing as a profession has gone through several developmental stages, always trying to respond to professional challenges and follow modern trends and needs of society. By defining nursing as an integral and independent profession within the healthcare system, the modern nurse is faced with a number of professional, educational, and social challenges, especially in those countries where the nursing profession still has an inadequate social image, both in public and professional environment. The change of nurses professional role in reformed European and North American healthcare systems ̓ is particularly visible in primary health care and public health, where nurses have taken on one of the leading roles in the organization of the work process. With a unique professional focus that can be directed on the individual and family, or system and community, modern nursing as a healthcare profession is extremely well-positioned to respond to the need of modern society for the integration of health services and to make an active contribution to positive changes in the modern healthcare system, at the same time.