COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSIP TASKS

The purpose of this article is to report on the attitudes of hospital administrators and social work administrators toward specific leadership tasks performed by social workers in hospitals. The study population was comprised of all hospitals offering social services in a sixteen-county Midwest area. Opinions on the importance of the tasks and frequency with which they were performed are assessed. The data indicate that there is no significant difference between attitudes of the hospital administrators and social work administrators in their evaluation of the importance of these tasks or the frequency of performance. These unexpected findings offer implications for hospital-based social workers seeking expanded influence in their institutions.     

Children's Participation in Child-protection Processes as Experienced by Foster Children and Social Workers

Children in foster care often have no means of influencing matters that concern them, and can easily become outsiders in their own lives. The United Nations Convention on the Rights of the Child enshrines the rights of capable children to express their views freely in matters affecting them and to be heard in any judicial or administrative proceedings concerning them. The aim of this study is to analyse foster children's participation in child welfare processes in different time periods and contexts from the perspective of children and social workers. The data comprise semi-structured interviews of eight children and young people aged seven to 17 in family foster care, as well as interviews of four child welfare social workers. Ethical questions were taken carefully into account. The results suggest that participation in matters concerning them is very significant to children, although they do not always want be active participants (e.g. in meetings). The children hoped that social workers would take a genuine interest in them, listen to them and take their opinions and wishes into consideration. Children sought true and essential information about the reasons for placements and the plans for their future. They felt they were better heard and more able to influence their own affairs after being placed in a foster home than during earlier phases of services. The study identifies many obstacles in children's participation at different systemic levels. Children's loyalty to their parents may prevent them from expressing their opinions. According to social workers, the most serious obstacles in participatory work with children are related to a lack of human and time resources. Social workers need time, work practices, skills and practical wisdom through which children's personal experiences, opinions and wishes can be better heard. They also seek support in handling the emotional aspects of child-protection work and suggest some other measures to develop their work.     

Modeling and reinforcement to combat HIV: the MARCH approach to behavior change

Theory and research suggest that behavioral interventions to prevent HIV/AIDS may be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present in the local environment. The Modeling and Reinforcement to Combat HIV (MARCH) projects combine key aspects of individual behavior change with efforts to change social norms. There are 2 main components to the program: entertainment as a vehicle for education (longrunning serialized dramas on radio or television portray role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level (support from friends, family members, and others can help people initiate behavior changes; support through changes in social norms is necessary for behavioral effects to be sustained over time). Both media and interpersonal intervention activities should be linked to existing resources in the community and, wherever possible, provide increased access to preventive services, supplies, and other supporting elements.     

The ecology of social work departments: empirical findings and strategy implications

Despite the fact that social work departments are dependent upon hospitals for resources and support, little research has been conducted to analyze organizational factors that promote or impede their development. The researchers hypothesized that departments are most likely to expand in hospital settings with missions that are supportive of clinical, preventive, and community-oriented services; that stress innovation; and that emphasize hospital-funded services and programs. Further, it was hypothesized that social work services would be most likely to expand in settings where hospital administrators perceive them to be relevant to practical needs of the institution. Findings from a survey of 50 non-profit hospitals in Los Angeles County in 1980 confirm these hypotheses and suggest that social workers need to use knowledge of the organizational context to develop high-level support for their departments.     

Prevention and control of AIDS: the role of NGOs

Because of their ability to more easily provide services to high-risk groups, non-governmental organizations (NGOs) will play a critical role in any successful AIDS prevention program. Since HIV is often transmitted through behavior deemed intimate or taboo, government health officials have a difficult time reaching the affected group. But NGOs, which have a long record of involvement in the field of health and social welfare, possess several advantages over government agencies: 1) they have rich experience working at the community level; 2) their autonomous nature allows them to respond more quickly; 3) they have access to marginalized groups; 4) they generally work with the target groups to raise their self-esteem; 5) they can act as a bridge between the community and the national level; 6) they often employ innovative methods; and 7) their method of operation allows for cost- effectiveness. Furthermore, NGOs can choose their own areas of involvement according to their feasibility, past experience, and priorities. NGOs can be instrumental in providing information on HIV infection and AIDS to the public particularly to special target group populations -- the young, women of reproductive age, prostitutes, and intravenous drug users. Additionally, NGOs can work in policy advocacy, in providing training for different groups, in providing counselling and other assistance to those affected by HIV, in screening donated blood, and in caring for AIDS patients. Though offering a great vehicle for combating the epidemic, NGOs will have to overcome several obstacles, including lack of government support, and lack of funds and resources.     

Retaining Experienced Hospital Administrators: A Neglected Topic in Healthcare

The sharp increase in the present need for healthcare services has been attributed to the expanding population of older adults (those above the age of 65 years) and the increasing number of aging healthcare professionals seeking retirement without enough qualified replacements. In this regard, retaining experienced healthcare professionals, especially hospital administrators, may be the key to managing this growing demand for healthcare services at present and for the future. Veteran hospital administrators have many years of experience and can offer a wide array of skills and competencies to their organization. As such, organizations should make every effort to retain these individuals and implement efforts for their continued contribution to the healthcare industry. Given the nature of their work and the various changes accompanying aging, experienced hospital administrators may have specific personal and professional challenges that may be compelling them to consider retirement options. The authors’ primary focus was to identify the unique issues associated with retaining experienced hospital administrators and to propose certain accommodations and recommendations to promote their continued and valued contributions to the healthcare industry.     

Research in social work practice: benefits of and obstacles to implementation in the Department of Veterans Affairs.

Although research is an important part of social work practice in health care, there is little systematic information that sheds light on research productivity, the benefits of conducting research, or the obstacles that must be overcome. This article represents the viewpoints of nearly all the directors of social services departments in the largest multihospital system in the United States, the Department of Veterans Affairs. The organizational characteristics of hospitals and the attitudes of the directors about research were important correlates of research productivity. Although lack of time, resources, and interest were cited as common obstacles, more than one-third of the departments were conducting or involved in at least one study. Information about the research efforts of other social services departments was considered an important resource, particularly for departments with no ongoing studies. The implications of these findings for social work research in health care are discussed.     

Services to families with children. A study of community work in Uppsala

This article describes some of the results of a study of services to families and children in a suburban district, Sweden. Services included in the study were: maternal and child health care, child psychiatry, services for handicapped children, school health care, day care services, community social services and family counselling services. The baseline studies comprised analyses of official goals expressed in legislation and recommendations, interviews with local politicians and administrators, record studies, studies of working time distribution and questionnaires to field professionals and families. The results indicate that services with traditional goals and well-defined tasks (e.g. health supervision) were more satisfied with their goal attainment, less inclined to collaborate with other services, and more occupied with direct client work than services with non-traditional goals and vaguely defined tasks (e.g. strengthening democracy).     

The productive sector

In the last 25 years, the production sector in Spain has undergone important changes. Among these changes, the important growth of the services sector at the expense of the primary sector, the increasing flexibility of the labour market, and the rise in the female workforce could be considered as the most relevant ones. Spanish women have higher rates of unemployment, temporary jobs and part time contracts than Spanish men. Moreover, job access and work conditions are highly related to gender and social class. Because women are forced to compensate for the scarcity of social services for caring for young children and for dependent elderly, they become informal and socially unrecognised caregivers, preventing them from getting or holding a job, and significantly limiting their opportunities for professional development. These social conditions are closely related with the fact that work conditions for women involve higher temporality rates and shorter contracts than those of men, given the sectors and jobs in which they tend to work (due to segregation). Similarly, workers of the less privileged social classes have poorer work conditions. Thus, women of the lower income class are mainly suffering the worst job contracts and the poorest work conditions. More social services are needed to make it possible to attend to family needs and still be able to access and maintain a job contract. Policies tending to conciliate labour and family life are indispensable and should incorporate measures to equally distribute the house keeping activities between women and men.     

Psychosocial Services for Children and Adolescents With Hemophilia and Their Families: Result of a National Survey

Seventy-one providers at 53 hemophilia treatment centers were surveyed concerning their patient populations, types of problems encountered, type of psychosocial services provided, and obstacles to service delivery. Respondents, who were social workers, nurses, and psychologists, reported that they spent more time providing direct services for illness-related problems compared with general psychological problems. The most time-consuming problems included problematic child-adolescent adjustment to hemophilia (21.6%), parental adjustment to hemophilia (20.5%), child-adolescent adjustment to HIV (17.4%), and parental adjustment to HIV (14.0%). Practitioners utilized a wide range of services to address clinical problems, such as providing information and support to parents; assessment of child, parent, and family adjustment; psychotherapy for children and parents; and identification of community services and referral contracts for families. The families' distance from the center was rated as the most significant obstacle to delivery of psychosocial services. Findings have potential implications for planning for psychosocial services for children with hemophilia and their families as well as for support and education of service providers.     

Mapping as a method for analysing policy response in the management of health services.

Health services are susceptible to changes in health need, resource allocation, public-health debates and health policies. Service mapping is considered a useful tool for analysing complex issues, monitoring changes over time and facilitating change. It also enables one to describe pathways of care and the relationships between services. This article centres on two projects--a London-wide project 'Service networks for HIV Care' and a local survey 'Mapping of HIV-related services for illicit drug users'--and demonstrates the usefulness of mapping for both studies. Mapping of service networks allowed exploration of a variety of connections between treatment centres, and led to recommendations for a model of HIV service networks across London. The mapping of HIV-related services for illicit drug users confirmed that the service provision was balanced in time, space and target groups, but also identified gaps showing that services were not very successful in attracting women and members of ethnic minority groups. It is clear from both studies that mapping provides an overview of existing services, describing details of services, their target groups or links. It can assist to monitor changes over time, to reconfigure services according to need, and to target resources where need becomes apparent. Mapping exercises also can be useful in identifying new areas for collaboration and interagency work.     

Changes in primary health care policy: the implications for joint commissioning with social services

Both the primary health care team (PHCT) and social services departments in the UK have undergone substantial changes to their organization and function since 1990. This paper looks at developments in primary health care policy that have affected the relationships between them regarding the commissioning of health and social care services. It focuses on evidence from seven initiatives designed to involve members of the PHCT in commissioning social care services. It examines some of the benefits and challenges of working together to commission services for health authority managers, GPs, district nurses, care managers and social work team managers in the light of impending changes to the PHCT, particularly the abolition of fundholding and the introduction of Primary Care Groups.     

Snapshot of flexible funding outcomes in four countries

This article reviews social participation outcomes identified in discrete studies of flexible funding programmes across four countries. The outcomes of an Australian flexible funding support programme were studied in 2007; a study tour of independent living programmes was conducted in England and Scotland during 2005; Swedish co‐operatives and government administrators providing personal assistance to live independently were visited in 2006 and Australian independent living support groups operating for over 20 years were visited in 2008. Fifty‐six interviews were conducted with people with a disability, families, support services, government administrators and researchers. A structured interview schedule was used in the 2007 Australian study and a semi‐structured format was used in all other studies. Notes from the interviews were reviewed for themes related to social participation and their contributing factors. Ecological systems theory was used to identify what factors from the micro to the macro system level facilitated or hindered social participation. The key finding is that flexible funding did result in a range of social participation activities in each setting studied. The studies also indicate that social participation increases when people have access to information and support services; can choose their individual workers and move to a new agency if need be; and have adequate resources to meet their needs. The cultural and political context plays a large part in determining these factors. The implications of this study are that adequate resources are needed and the complex systems impacting on flexible funding need to be understood to achieve the intended outcomes.     

Trends and issues in child and adolescent mental health

An estimated 11 percent of American children have a mental health impairment, yet they rely upon a piece of the health care system that does not work well. Government policies for children's mental health operate in two ways: by affecting health insurance for children, and by funding services directly. Major changes within both categories have shaped the types, sources, and financing of services for children with mental health problems. These policies, along with scientific advances in child mental health, social changes, and health policy more generally, have contributed to an improvement in child mental health services over the past fifteen years.     

Predicting Patterns of Social Work Staffing in Hospital Settings

One long-standing problem of social work departments in acute care hospitals has been their diverse patterns of staffing. The lack of a standard or guide has tended to diminish the utilization of social work services in hospital settings. Over a period of six years, the Society Hospital Social Work Directors of the American Hospital Association developed and revised a guide for inpatient staffing. The guide is designed to assist hospital and social work administrators establish an inpatient line staffing plan which is based on the number of hospital beds, the number of patients to be served and the number of functions carried. The logic of the inquiry and the findings can serve as a base for future research in inpatient, ambulatory care and other settings which serve special populations.     

The formation of the emergency medical services system

The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types.     

Management trends that may lead nursing to new paths

The changes in the economic and social context have led to the need of new management strategies for organizations. In the area of services, healthcare and nursing organizations have suffered the impact of these changes within their work processes. Our goal was to reflect on the new management trends and how they could influence the nursing work organization in healthcare services and the actions by managing nurses in strategies that meet the challenges of the profession in a changing social context. These new trends have pointed to the emphasis on the development or learning organizations, investment on human capital, inclusion of new knowledge and skills, searching for an open, flexible and participatory administrative practice, based on reason, creativity, sensitivity and intuition.     

Evaluation research on the effectiveness of social work intervention on dialysis patients: the first three months

The research reported in this article examined the effectiveness of a dedicated, timed, recurring Master's level social work intervention with patients new to dialysis. Study participants were evaluated for depression and levels of adjustment when first beginning dialysis and three months later. A control group received standard, mandated social work services while the experimental group received an additional counseling component. The experimental group showed statistically significant changes over time in lowered levels of depression and maladjustment.