Parental views of in-home services: what predicts satisfaction with child welfare workers?

Evidence on client satisfaction deserves consideration in the design of child welfare policies, programs, and practices. Data in this study come from the National Survey of Child and Adolescent Well-Being. Clients receiving in-home services reported moderate levels of satisfaction with their child welfare workers. Caregiver reports of having less than two child welfare workers, having more recent contact, and receiving timely, responsive services were associated with higher perceived quality of relationships with child welfare workers. The child welfare workers' reports of cooperativeness by the caregiver were also associated with higher caregiver-reported relationship quality.

Child welfare knowledge transmission, practitioner retention, and university-community impact: a study of Title IV-E child welfare training

This paper describes the implementation of a Title IV-E child welfare training program in Louisiana. A collaborative arrangement between the state child welfare agency and seven state university social work programs provides for student monetary stipends in return for child welfare training and work as public child welfare employees upon graduation. On a test of child welfare knowledge, students in MSW and BSW programs scored higher following child welfare training; BSW student stipend recipients made greater gains than non-recipients when controlling for initial scores. MSW students' results appear to approach significance; they may not be significant due to low power of the statistical analysis. Child welfare agency retention of the stipend student graduates is considered good by the agency.

Achieving change in health care practice

This study evaluated a practice development programme consisting of nine projects together known as STEP (South Thames Evidence-Based Practice Project). The aim of STEP was to establish and assess evidence-based practice in nursing and other health care practice areas. Objectives of the independent evaluation were to identify and assess outcomes from the process of change and investigate the association between these intermediate outcomes and patient outcomes. Outcomes were measured before and after the changes were introduced. Data collection methods included interviews with the change agents and other stakeholders, and a questionnaire to staff in each centre. Patient outcome data were collected from each centre. The findings revealed 'dissemination' of information to staff and 'adherence' by staff to new practice guidelines to be important intermediate outcomes in the process of change. The need emerged for a supportive organizational culture and commitment, recognition of the importance of change and a credible change agent. There was some evidence of linearity in the process of change in that a logical route appeared from dissemination of information to staff through adherence to the change guidelines to improvement in patient outcome in six of the nine centres. Linearity was less apparent in the other three centres, where the process of change seemed more dynamic and chaotic. These three centres were affected more than the others by organizational barriers to change. Our conclusions support the view that the linear model of change can work in settings with high levels of certainty but complexity theory is more likely to underpin the process of change in organizations characterized by uncertainty.

Growing up and living with cystic fibrosis: everyday life and encounters with the health care and social services--a qualitative study

The purpose of this qualitative study was to illuminate experiences of growing up and living with cystic fibrosis (CF). The patients' and their families' encounters with health care and social services were of particular interest. Four focus groups (adults with CF and parents of children with CF) were conducted. Three main themes emerged from the analysis: "From uncertainty to certainty," "A demanding but normal life," and "A wish for continuity, stability, and respect." As also documented by other studies on the chronically ill, normalization seems to be an important strategy, a strategy that seems not to be fully understood by the helpers.

Beyond cultural competence: language access and Latino civil rights

Social services remain largely unresponsive to the values and needs of Latino families, who often need Spanish-language services. This article discusses access to linguistically appropriate services, not just as a culturally competent practice, but also as a civil rights issue. Spanish speakers have protection from discrimination in federally funded human services under Title VI of the Civil Rights Law of 1964. The article discusses implications for all aspects of private and public child welfare, including investigations, foster care, family preservation, adoption, and quality assurance.

A culturally responsive practice model for urban Indian child welfare services

This article describes collaboration among a university, a state child welfare agency, and a Native American community organization to develop a culturally driven practice model for urban, Native American child welfare. The approach includes a strategy to build resources to serve Native American clients, a training program for child welfare and court personnel using a culturally responsive curriculum, and an advocacy program that monitors for Indian Child Welfare Act compliance and provides assistance to child welfare workers and the court. The discussion identifies challenges and opportunities in addressing the needs of urban Native American communities. The article concludes with principles for culturally responsive practice for urban Native American child welfare practice.

Beyond the rhetoric: strategies for implementing culturally effective practice with children, families, and communities

Culturally effective practice remains elusive within child welfare agencies. Recognizing the hierarchical nature of becoming culturally competent, this article presents specific strategies that enhance cultural effectiveness at the individual, interprofessional, middle management, and upper management levels. The approaches evolve from a five-stage model of change: precontemplation, contemplation, preparation, action, and maintenance. Becoming culturally competent requires a clear assessment of where the individual practitioner and agency are on the change continuum. The article also explores barriers to culturally competent practice, with a focus on multilevel strategies that work within child welfare agencies.

Framework for culturally competent decisionmaking in child welfare

This article provides a framework to understand the cultural, social, political, and economic factors that affect decisionmaking when working with ethnically and racially diverse families in the child welfare system. The article describes external factors affecting the decisionmaking process, including community environment, agency structure, and family characteristics. It then reviews the core stages of the casework process, describing key decisions during intake, assessment, service planning, implementation, evaluation, and closure. Although the framework is based on casework process in the child welfare system, it can be adapted to other child-serving systems, including education, mental health, and juvenile justice.

Unmet drug and alcohol service needs of homeless people in London: a complex issue

Little research has been conducted on the drug use of those who sleep rough (on the streets) in the United Kingdom (UK). During 2000, to fill in the gaps in the knowledge base, researchers at the National Addiction Centre, London, carried out a community survey using a structured questionnaire amongst 389 homeless people recently or currently sleeping rough, in order to investigate their met and unmet drug and alcohol service needs. In total, 265 (68%) had a need for drug services and 97 (25%) for alcohol services. Over half of the current drug users (170/324, 52%) and 88 (33%) of the 264 current alcohol users wanted help with their substance use, but few were currently accessing the appropriate services, other than needle exchanges. The challenge for services is to build these potential clients' motivation to accept health-conferring intervention.

Understanding adjudication: origins, targets, and outcomes of ethics complaints

Various bodies and standards regulate social work practice. Social workers can be held accountable by licensure or credentialing boards, by civil and criminal laws, and by various professional organizations to which they belong. NASW considers complaints against its members for violations of the organization's Code of Ethics, yet the average member may know little about the nature and process of such actions. This article describes the professional review process and analyzes the results of a study of ethics cases filed with NASW from 1986 to 1997. This article also describes the parties involved in complaints and violations, the disposition of cases, and the corrective actions required of those who were found in violation of the Code. These research findings are compared with NASW membership data and the results of other studies on malpractice and ethics violations.

Providing accessible services to minority ethnic deaf people: insights from a study in Alberta, Canada

Evidence suggests that minority ethnic people in general and minority ethnic deaf people (MEDP) in particular face numerous formidable obstacles in their attempts to gain access to services in the community. Deaf people from minority ethnic groups who have no English and/or American Sign Language (ASL) skills have particular difficulty gaining access to services. The study therefore was concerned with identifying some of the special needs and difficulties of MEDP who are trying to gain access to services in multiethnic communities. Qualitative approaches were used in data gathering and analysis. The results indicated six areas of difficulty for MEDP in gaining access to services: (a) communication barriers, (b) a lack of recognition of the needs of MEDP, (c) inappropriate service delivery and a lack of information on available services, (d) insufficient cultural sensitivity on the part of service providers, (e) issues of user involvement, and (f) a lack of specific programs for MEDP.

Sexual orientation and gender identity: an administrative approach to diversity

Research indicates that gay, lesbian, bisexual, transgender, and questioning (GLBTQ) teens in the care of a northeastern child welfare department do not receive adequate services due to the workers' homophobic attitudes. These teens are at high risk for alcohol and drug abuse, homelessness, prostitution, and suicide. A training module was developed for administrators. Pretest and posttest instruments measured their education and support of GLBTQ issues before and after the training.

Attitudes and knowledge concerning alcohol abuse: curriculum implications

This study presents data regarding social work practitioner experiences, attitudes and knowledge about alcoholism. A standardized instrument was used to survey BSWs and MSWs (N = 105) at three sites in Canada. Significant findings were: (a) these practitioners had low levels of knowledge about alcoholism as measured on the Alcohol Knowledge Scale (AKS), and (b) professional experiences, not personal ones, shaped their knowledge. The latter included whether they had participated in any post graduate coursework/continuing education or conducted research with this population. Implications are directed toward curriculum development for educators and practitioners working in this field.

The Esperance primary prevention of suicide project

BACKGROUND

Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia.

AIMS

To evaluate the effect of three evidence-based initiatives for the primary prevention of suicide: (i) providing suicide awareness sessions for staff members in health, education and social services; (ii) limiting the sale of over the counter analgesics (aspirin and paracetamol) to packets containing less than the minimum lethal dose; and (iii) implementing Commonwealth media guidelines in the reporting of suicides by media.

METHODS

Changes in knowledge, awareness, attitudes, comfort and use, before and after each intervention were assessed using standardized instruments and pro forma derived from previous work, such as the Youth Suicide Prevention Training Manual and Suicide Intervention Beliefs Scale. Percentage changes in the number of retail outlets selling over the counter analgesics to less than potentially lethal quantities (less than 8 g of paracetamol or aspirin) were also measured. Media representatives were interviewed to gain their perceptions of Commonwealth Guidelines for the reporting of suicide, and encouraged to consult the project team before reporting suicide related issues.

RESULTS

The baseline survey illustrated that mental health staff and general practitioners were more aware of suicide issues, risk factors for suicide and awareness of professional and ethical responses than staff from other services, and were more willing to raise the issue with a person at risk. Thirty-three subjects participated in suicide awareness training of whom 21 (66%) returned questionnaires. There were significant increases in awareness of suicide-related issues and risk factors, as well as reported levels of knowledge of professional and ethical responses and comfort, competence and confidence levels when assisting a person at risk. Only three media representatives were aware of the Commonwealth Health Department Guidelines for reporting suicide and only one believed that the guidelines influenced their reporting. The local newspapers subsequently contacted the researchers to check that their reporting met the guidelines. As regards access to analgesics, one out of seven retailers agreed to implement the strategy (pending agreement from other retailers), another claimed increased awareness of the danger of analgesics, and three maintained that they would attempt to monitor excessive amounts sold to one individual.

CONCLUSIONS

Local initiatives can improve the awareness and knowledge of staff in the assessment of suicide risk, as well as of local media. These need to be complemented by initiatives at State or Commonwealth level to produce change in statewide media, or sales of over the counter analgesics.

Use of UNAIDS tools to evaluate HIV voluntary counselling and testing services for mineworkers in South Africa

HIV voluntary counselling and testing (VCT) is now an integral part of many HIV care and control programmes. However, very little work has been done to assess the quality of VCT services. An evaluation of VCT services for mineworkers in Welkom, South Africa was conducted to assess client and counsellor satisfaction, the quality of the services and to identify barriers to uptake of VCT. A cross-sectional survey was carried out using tools developed by UNAIDS, consisting of semi-structured interviews and observation of counselling sessions. Twenty-two nurse counsellors and six community volunteers were interviewed. Twenty-four counselling sessions were observed and 24 client exit interviews were conducted. Although nine of the 22 nurse counsellors had only in-service rather than formal training for HIV counselling whereas all community volunteers had been formally trained, nurse counsellors demonstrated better interpersonal skills than did community volunteers. Both clients and counsellors identified fear of a positive result as a major barrier to HIV testing. Clients also raised concerns about confidentiality. UNAIDS evaluation tools were a feasible and an acceptable method of assessing VCT in this operational setting. The study identified areas where training needs to be strengthened and suggested ways of improving the services, and changes to the service have now been implemented in line with these recommendations.

Home care leadership of the future

Home care leaders have been given an important responsibility--to assure the delivery of quality care to patients in need. And yet we accomplish this important goal only through the work of others. As leaders in home care we must work to continually assess and refine our leadership skills. There are several key themes that can assist and benefit you as a home care leader.

Ethical dilemmas in charging for care: contrasting the views of social work and legal professionals

This article draws on the findings of a recent study funded by the Nuffield Foundation. The study explored attitudes, practices and policy in relation to charging and assessing older people who were considering entering residential and nursing home care. In five differing local authorities, a sample of social services practitioners (care managers) completed a postal questionnaire and interviews were held at a number of levels with staff. At the same time, independent legal practitioners in these areas, who are involved in advising older people, were surveyed and a small number of individual practitioners were interviewed. The focus of this article is on contrasting the attitudes and views of care managers and legal practitioners towards their work in relation to older people, finances and charging for long-term care. In particular, there will be an emphasis on the ethical dilemmas identified by the respondents from the different professions involved in the study.

Using performance standards to evaluate social programs with incomplete outcome data. General issues and application to a higher education block grant program

The idea of program evaluation is both simple and appealing. Program outcomes are measured and compared to some minimum performance standard or threshold. In practice, however, evaluation is difficult. Two fundamental problems of outcome measurement must be addressed. The first, which we call the problem of auxiliary outcomes, is that we do not observe outcome of interest. The second, which we call the problem of counterfactual outcomes, is that we do not observe the threshold standard. This article examines how performance standard should be set and applied in the face of these problems in measuring outcomes. The central message is that the proper way to implement standards varies with the prior information an evaluator can credibly bring to bear to compensate for incomplete outcome data. By combining available data with credible assumptions on treatments and outcomes, the performance of a program may be deemed acceptable, unacceptable, or indeterminate.

Portrait of social work

Social work is concerned with enhancing the well-being of people within their social contexts. It is a broad profession with diverse practices. These range from a focus on the personal distress of individuals to the collective arrangements and social processes that influence the well-being of groups and communities. The unique contribution of social work to the caring professions is its broad contextualised approach to addressing human needs. Yet this breadth of scope also provides fertile ground for competing discourses within the profession. This paper provides an overview of the 'highly contested' nature of social work's goals, theories and methods of practice.