Social Work Health and Mental Health

Practice, Research and Programs

Steven P. Segal

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317788089
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Rise to today's challenges with these innovative and helpful value-based solutions! Containing important, research-based insights into social work practice in these fields, Social Work Health and Mental Health Practice, Research and Programs provides unique perspectives on shared practice problems from around the world, offering new solutions to the dilemmas practitioners face every day, such as reduced reliance in inpatient/residential service provision, increased reliance on economics in the era of managed care, the move toward multidisciplinary service provision, the growing awareness of diversity of needs, and the cultural requirements of providing effective services. Social Work Health and Mental Health Practice, Research and Programs provides unique international perspectives on real-world social work practice issues, including:

• ways to use your social work skills to solicit organ/tissue donation for transplants
• how a social work directed community organization affected change in health behaviors in East Harlem, New York
• a look at how to promote psychosocial well-being following a diagnosis of cancer
• a survey of what mental health services Hong Kong elderly feel they need and what they now receive
• an examination of the role of demographics and social support in clinician- and patient-related compliance among HIV/AIDS patients
• a discussion of the appropriateness of hospice services for non-English speaking patients
• and much more!

PART I

SECTION 1:

THE CONTENT OF PRACTICE

Introduction:
Parts I and II

Alun C. Jackson, PhD

This volume provides an opportunity to present a collection based on papers presented at the Second International Conference on Social Work in Health and Mental Health held in Melbourne, Australia in January 1998. This very successful Conference, with over 700 participants from 30 countries, offering 450 presentations, built on the firm foundation set by the First International Conference held at the Hebrew University of Jerusalem, Israel, under the leadership of Professor Uri Aviram and Professor Gail Auslander.

We have diverged from the practice of our predecessors who edited the selection from the First Conference, who divided the papers into a health-oriented volume (Auslander, 1997) and a mental health-oriented volume (Aviram, 1997). We have chosen to present the papers from a different standpoint, namely in a form that integrates health and mental health concerns, and divides the collection into a concentration on social policy, research, and generic practice, and a concentration on practice fields. This way of organising the material reflects an increasing concern with the integration of health and mental health issues within holistic educational approaches to practice and the siting of such practice, in ‘generic’ settings such as community-based agencies that reflect this holistic orientation. Just as the boundary between health and mental health social work becomes blurred in the practice settings detailed in this collection, that practice has become more demanding of specialised skills within practice fields and requiring of more intense education within the fields of practice. For this reason, the parts making up this collection should be seen as companions rather than as distinct and unrelated collections of papers.

THE POLICY CONTEXT OF PRACTICE

The first section of this volume is concerned with the policy context of practice. Using his position as Director of Social Development at the United Nations, and drawing on his experience as a social worker, economist, and member of Parliament, Langmore identifies globalisation as a major social and economic force which needs to be considered as governments shape the policy and value context in which health and mental health social practice will occur. He challenges the notion that public sector spending cuts are a necessary corollary of globalisation. He recognises, however, that governments may well be tempted to demonstrate their ‘worthiness’ as investment destinations by showing good financial management in terms of reducing public health and welfare expenditure, having assumed that they can absorb the domestic political cost of marginalising public health and welfare users. Starting from a similar position to Langmore's, Feldman, in the following paper, highlights a changing macro political context created by globalisation and the increasing corporatising of health and welfare. Using managed care as an example, he challenges social work educators to develop effective responses to these changes in the context of practice. Not only is the challenge thrown down, Feldman makes a number of creative recommendations for the introduction of relevant health and mental health content to social work curricula.

Picking up the theme of government structuring of health and social services, Munford and Sanders, drawing on research conducted in New Zealand, identify a number of consequences which follow from changes in government funding practices. The paper suggests that the introduction of market mechanisms such as contracting by government for service provision by community sector health and welfare organisations, may lead to distortions in practice such as agencies responding to less well informed definitions, by service purchasers, of client need. While few would doubt the legitimacy of publicly funded agencies demonstrating high levels of accountability, the paper notes the complexities of tying funding to outcomes, rather than the older methods of relating funding to service inputs or outputs. It argues that there are many factors outside the control of the agency in determining outcomes, and that an unintended consequence of this shift of focus, is a limiting and fragmenting of services, working against an holistic orientation to practice. Orovwuje, also writing from the New Zealand experience, takes up the issue of what happens in a major mental health service when government restructuring of health and mental services is driven by an economic liberalism, a ‘New Right’ ideology, that is seen to be inimical to the effective delivery of social work services to marginalised segments of the population. These papers provide an interesting perspective on the role of government and the adoption of a corporate approach to service provision in a society which has a tradition of a highly interventionist central government and high levels of subsidisation of health and welfare services.

The paper by Heinonen, MacKay, Metteri and Pajula comparing the effects of restructuring of the health systems in Finland and Canada, and the paper by Levin and Herbert on community-based health care service delivery in Canada, further develop the theme of how health policy changes can seriously affect the context of practice. Heinonen et al. suggest that in Finland in particular, social workers are increasingly having to demonstrate their effectiveness in, for example, rapid assessment and effective discharge planning in hospitals. In both Canada and Finland, they point to the need for social workers to be pro-active in shaping the policy and organisational contexts of their practice. Levin and Herbert identify the shift from acute care-based social work service delivery to community-based delivery as a major consequence of health reform in Canada, and ask whether social workers are equipped for this change. From their analysis of attitudes towards community practice and their perception of their preparedness for such practice, they are led to question social workers' competence in this arena of practice and, as Feldman did, they throw out a timely challenge to educators to examine whether they are adequately preparing social work practitioners to work from a truly ecological perspective.

This section concludes with Pohjola's discussion of the health effects of long-term unemployment, following her analysis of a three-year program targeting the long-term unemployed in the north of Finland. She identifies a range of intervention options, including the need to provide access for this population to rehabilitation services. This option clearly requires a major re-think on the part of government about what the relationship is between acute and chronic health problems and employment potential, and what an interventionist government must do in order to minimise the social exclusion of this group.

RESEARCH

This section offers a number of papers focusing on practice research issues. The first paper, by Berkman and Maramaldi, was given by Professor Berkman in a section of the Second International Conference dedicated to Helen Rehr, Professor of Community Medicine Emerita, Mount Sinai School of Medicine, in recognition of her contribution to the development of practice-based research in health social work. We are very pleased to reaffirm this dedication in selecting this paper for publication. Berkman and Maramaldi suggest that research on practice has gone through a number of stages in terms of the focus of assessment, from a concern with the structure of practice, followed by a focus on assessment of process, to a focus on outcome assessment. Noting the need to clearly define health outcomes, Berkman suggests that social work practitioners, researching the effects of their interventions, have been reluctant to embrace some particularly useful ways of assessing health-related quality of life. To address this deficit, she suggests the SF-36+ as an example of a reliable and valid standardised measure that could be of considerable value in outcome measurement. Starke and Svensson, from the International Paediatric Growth Research Centre in Sweden, take up this issue of the use of standardised instruments in health and mental health social work research and practice with a detailed discussion of the construction of a global assessment scale of family functioning. They explore the properties of the Family Adaptability and Cohesion Evaluation Scale (FACES III), which posits a relationship between cohesion, adaptability and family functioning, factors crucial to the quality of adjustment by families to circumstances such as the chronic illness of a family member. The paper concludes with a useful argument about the methodological issues involved in constructing a global score form multi-item scales.

Gathercole and DeMello shift attention from the practitioner researcher to the manager researcher, with their description of the creation of the Workload Analysis Scale (WAS). The Scale was designed to help assess the likely workload that a given client would generate for a social worker working in an assessment and rehabilitation service. As a research and management tool, the WAS could be used to allocate cases fairly among work teams, with respect to work intensity; flag cases requiring extensive input; track changes in workload and as an educational tool for making better known the nature of case complexity and requisite practice resources needed for effective intervention.

In the paper by, Jackson, Johnson, O'Toole and Auslander take up the theme of case complexity introduced by Gathercole and DeMello. They tackle a fundamental question of interest to service funders, managers and practitioners alike, that of ‘What do social workers actually do?’ It is not always easy to obtain answers to this question, as much health and mental health social work, particularly in acute care settings, is conducted in private, necessitating the use of worker self-reports, client satisfaction measures or a range of surrogate measures of what the interventions consisted of. This paper explores in some detail the nature of discharge planning practice in a paediatric setting. In so doing, it seeks t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• About the Editors
• Table of Contents
• Part I
• Part II
• Part III
• Index