Communication between health care professionals and deaf patients

A review of the literature about communication between health care professionals and deaf people demonstrates that a continuum of accuracy in perceptions of deaf people and their communication problems exists in health care settings. The author provides information on deaf culture, history, population size, sign language, and communication needs that is used to evaluate professional journal articles. Examples of research on this topic are presented and the need for further studies and the role of social workers are discussed.     

The experience of deafened adults: implications for rehabilitative services.

This study explored the psychological and social effects of becoming deaf as an adolescent or adult and the adequacy of rehabilitation services offered to such individuals. Qualitative interviews were conducted with a sample of eight deafened adults in the Province of Ontario, Canada. The results indicated that medical interventions (for example, audiometric testing, hearingaidprovision, and cochlear implantation) were relied on exclusively as rehabilitation servicesfor the deafened adults. None of the study participants were referred to individual, family, or group counseling by their physicians or hearing health services providers, despite the many negative effects of becoming deaf that participants described. This gap in service makes it apparent that the rehabilitation system for adventitious deafness needs the involvement of counselors and social workers to better ensure that the psychosocial needs of clients are addressed.     

Conceptualising successful partnerships

Partnership working has become a central feature of British social welfare policy since 1997. Although this development is applicable to all areas of public welfare, nowhere is it more evident than in the planning and provision of care that overlaps health and social services. The literature survey described in the present paper focused on research examining the impact of partnership working in these areas to assess the evidence concerning its effects and to investigate how partnership 'success' is conceptualised. The literature conceptualised the success of partnerships in two main ways: (1) process issues, such as how well the partners work together in addressing joint aims and the long-term sustainability of the partnership; and (2) outcome issues, including changes in service delivery, and subsequent effects on the health or well-being of service users. The authors found that research into partnerships has centred heavily on process issues, while much less emphasis has been given to outcome success. If social welfare policy is to be more concerned with improving service delivery and user outcomes than with the internal mechanics of administrative structures and decision-making, this is a knowledge gap that urgently needs to be filled.     

Patterns of support among gay lesbian deaf persons

In order to study the patterns of support among gay deaf men and lesbian deaf women a research project was conducted from January, 1977 to May, 1978. Initially, an informal study was conducted at various social gatherings of gay deaf men, such as interpreting at the first and only gay deaf wedding ever to be held in Pennsylvania, possibly the United States. Later research methods included formal interviews with gay deaf men and lesbian deaf women, as well as their families. In addition, survey questionnaires were sent to professionals and agencies serving both the gay/lesbian and the deaf communities. The research project identified a significant client population in need of social services. The project also indicated that trying to determine patterns of support among the gay/lesbian deaf subculture is a complex problem which needs to be studied on several different levels.The author is a clinical social worker and the Deaf-Blind Coordinator at the at the UPSAL Day School for Blind Multi-Handicapped Children in Philadelphia, Pa.     

Adverse perinatal conditions in hearing-impaired children in a developing country

Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries.     

Are social workers turning a deaf ear? A study of social services to the deaf.

This study assessed the quality and quantity of social services received by deaf persons residing in Salt Lake County, Utah. It was found that although a majority of human service agencies in the county have had some contact with deaf clients, only those agencies that have made an effort to develop programs especially for the deaf and employ someone who is skilled in sign language could deliver services effectively to this population.     

Cultural competency: professional action and South Asian carers

Inequality and exclusion are characteristic of the experience of UK South Asian communities. In health care, community needs are often not addressed by health and social welfare services. An increase in cultural competency is now part of identified policy. The aim of this paper is to examine the extent to which there is evidence of cultural competency amongst professionals concerning South Asian parents caring for a person with cerebral palsy. Semi-structured interviews were conducted with respondents from 19 service organisations. Results are presented on perceptions of service delivery and on the dynamics of service development: evidence is found that inadequate service delivery continues despite professional knowledge that it exists. Conditions necessary for the achievement of cultural competence are discussed. We suggest that service development to meet the needs of South Asian carers must form part of an overall strategy geared to change at different levels within and outside service organisations.     

Deafness, social network and social protection

Deafness brings consequences to deaf people's life as well as to their families, who usually has its dynamic changed in the struggle to adapt to the new needs and demands. In this sense, the families not only use their internal resources, but also, they look for help and support out of their group, in their social network. The goal of this paper is to describe the social network used by families with a deaf member in their everyday life. Also, it discusses the meaning of these networks in the framework of social protection. A qualitative research was developed, using a semi-structured interview to collect data. Eighteen parents of deaf children or teenager assisted at a center of rehabilitation were interviewed. Mapping the networks of relationships and social resources that the families of a deaf person use to deal with deafness showed the interconnection between family members, other relatives, friends, neighbors, professionals, private and public services. The networks play an important role of support and social protection to the deaf person's family in the everyday life.     

Do programs for Aboriginal and Torres Strait Islander people leaving prison meet their health and social support needs?

The objective of this review was to synthesise evidence on the health and social support needs of Aboriginal and Torres Strait Islander people leaving prison and on programs which aid successful community re‐entry. A systematic literature review was undertaken of peer‐reviewed and grey literature published between 2001 and 2013, focusing on the post‐release needs of Aboriginal and Torres Strait Islander adults and pre‐ and post‐release programs. Aboriginal and Torres Strait Islander people have high health and social support needs on leaving prison. There is little literature evidence that re‐entry programs commonly consider health needs, support linkages with primary care or Aboriginal Medical Services, or are designed in consideration of the particular needs of Aboriginal and Torres Strait Islander people. In the absence of evaluative evidence on re‐entry programs in this group, we have synthesised the best practice recommendations. Re‐entry programs must be culturally competent in design and delivery, holistic, take a long‐term view, involve families and communities, demonstrate interagency coordination and promote linkages between prison and community‐based services. There is an urgent need for accessible pre‐ and post‐release programs which meet the particular needs of Aboriginal and Torres Strait Islander people, including their health needs. Programs must be flexible, comprehensive and accessible to those on remand or with short sentences. Stronger linkage with primary care and Aboriginal and Torres Strait Islander community controlled health organisations is recommended.     

Social health insurance: to each according to his needs; from each according to his means--but what might that mean?

Despite the substantial literature on the financing and benefit incidence of social health insurance, the principles underlying such schemes are little debated. This article examines one of these key principles: to each according to his needs; from each according to his means. The authors discuss both sides of this principle at a conceptual level. On the needs side, they examine the issue of vertical equity. The approach of "communitarian claims" is proposed, both for eliciting the components of need and for determining the relative weights to be attached to the vertical dimensions of equity in health service delivery. On the means side, the authors also look to communitarian claims to assist in determining who should bear what burden in paying for social health insurance. They argue that with respect to the concept of "from each according to his means," it is useful to incorporate an element of willingness to pay, but meaning here the community's willingness to pay.     

Across the health-social care divide: elderly people as active users of health care and social care

Several ways in which elderly people may assume an active role when using welfare services are discussed here. Selected findings are presented from a study that explored the experience and behaviour of elderly people on discharge from inpatient care with regard to criteria indicating user influence or control (namely participation, representation, access, choice, information and redress). Data were collected via semistructured interviews with service users (n = 30) soon after their return home from hospital. A number of differences were revealed between health care and social care in relation to users being provided with opportunities to assume an active role and in being willing and able to assume an active role. These differences were manifest in elderly service users accessing services, seeking information, exercising choice and acting independently of service providers. It appeared paradoxical that contact points were more easily defined with regard to health care yet users were more likely to exercise choice and act independently in securing social care. It is suggested that social care needs and appropriate service delivery are more easily recognised than making the link between perceived health care needs and appropriate services. In addition, it appeared that informal and private providers are more widely available and accessible for social care. If comprehensive continuing care is to be provided, incorporating both health and social care elements, greater uniformity appears to be required across the welfare sector. Lessons for social care provision from the delivery of health care suggest the clear definition of contact points to facilitate service use. Making health care more accessible, however, does not appear to be easily attainable due to the monopoly provision of health care and the lack of direct purchasing power by potential users.     

Setting the stage for school health-promoting programmes for deaf children in Spain

Implementing health-promoting programmes for the most excluded and at-risk social groups forms a key part of any efforts to address underserved populations and reduce health inequalities in society. However, many at-risk children, particularly children in deaf communities, are not reached, or are poorly served, by health-promoting programmes within the school setting. This is so because schools are effective as health-promoting environments for d/Deaf children only to the extent that they properly address their unique communication needs and ensure they are both able and enabled to learn in a communication-rich and supportive psycho-social environment. This article examines how the usually separate strands of school health promotion and d/Deaf education might be woven together and illustrates research with deaf community members that involves them and gives their perspective. The primary objective of this study was to map deaf pilot bilingual education programmes in Spain-one of the first countries to ratify the Convention on the Rights of Persons with Disabilities (United Nations. (2006) Convention on the Rights of Persons with Disabilities, Resolution A/RES/61/106.)-with particular attention to their compliance to the Convention's article 24. Following pre-testing, 516 key informants were surveyed by mail (response rate: 42.08%) by using a snow-ball key-informant approach, within a Participatory Action Research framework, at a national, regional and local level. The results show that although some schools have achieved recommended standards, bilingual programmes are in various stages of formulation and implementation and are far from being equally distributed across the country, with only four regions concentrating more than 70% of these practices. This uneven geographical distribution of programmes probably reflects more basic differences in the priority given by regions, provinces, and municipalities to the deaf community's needs and rights as an important policy objective and may reinforce or widen inequalities by favouring or discriminating rather than achieving access and equity for this noticeably overlooked community.     

The non-profit sector and community-based care for the elderly in the U.S.: A disappearing resource?

Non-profit health and social service agencies have traditionally been an extremely important element of non-institutional community-based care for the elderly in the U.S. Policy shifts, commencing in 1981, increasingly concerned with medical cost containment are challenging private non-profit sector agencies delivering care to the elderly. At issue is the ability of communities to maintain a viable service sector predicated on service needs and service accessibility, as opposed to a highly discrete, medicalized, and fragmented service delivery system that is available primarily (or only) to those who can pay.     

Future Trends in Health and Health Care: Implications for Social Work Practice in an Aging Society

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the “graying of America” promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.     

Come on my child, let's have some massage?"Puxação", midwives and reproduction in Melgaço, Pará

This article presents ethnographic data, collected between 2004 and 2005, about the obstetric service offered by a group of 21 midwives in the city of Melga?o, state of Pará, Brazil. The literature has largely described the work of midwives in Brazil and in many other countries around the world. However, there is a kind of practice, which was analyzed very scarcely up to now. The objective of this article is to discuss precisely the practice called puxa??o, an abdominal massage performed mainly on pregnant women to alleviate indispositions, inform the position and sex of the fetus, help define the date and place of delivery, socialize women for maternity and put pregnancy into the context of the local patterns of reproduction, family, well being and health. It can be observed that these midwives offer a very suitable and appropriate pre-natal service, well adapted to the specific needs of the women of the town. Even though homebirth has been slowly giving way to hospital birth, this personalized service and practice keeps increasing.     

An Exploration of Women's Psychosocial Support Needs in the Context of Assisted Reproduction

This article explores the nature of psychosocial support needs and service provision in the context of assisted reproduction. Using qualitative data from a doctoral research project, the views of non-metropolitan women in Australia are presented along with a review of literature and an overview of participants' actual sources of, and needs in relation to, formal and informal support. It is argued that while social workers and other human service professionals have played a consistent role in providing psychosocial support to service users, the overarching approach to service provision remains biomedical in focus. This often adversely affects the overall quality of service provision. On this basis, social workers are urged to maintain their focus on human rights, respect, and multidimensional approaches to supporting women and their partners before, during, and after reproductive technology service use.     

Health and social services integration: a review of concepts and models

Health and social services integration is particularly relevant for populations whose needs span physical health, mental health, housing, and disability services, along with others. Veterans, homeless, chronically ill, and aging are among those populations. This review examines recent peer-reviewed literature about different approaches to services integration, rationales behind those approaches, and successes of those approaches, including factors that make them succeed or fail. The focus here is on services that cross disciplinary boundaries; that is, those that integrate health services with social services, health services with mental health services, or one social service with a categorically different social service.     

An Exploration of Women's Psychosocial Support Needs in the Context of Assisted Reproduction

This article explores the nature of psychosocial support needs and service provision in the context of assisted reproduction. Using qualitative data from a doctoral research project, the views of non-metropolitan women in Australia are presented along with a review of literature and an overview of participants' actual sources of, and needs in relation to, formal and informal support. It is argued that while social workers and other human service professionals have played a consistent role in providing psychosocial support to service users, the overarching approach to service provision remains biomedical in focus. This often adversely affects the overall quality of service provision. On this basis, social workers are urged to maintain their focus on human rights, respect, and multidimensional approaches to supporting women and their partners before, during, and after reproductive technology service use.     

Non-Technical Correctives for High-Tech Systems in Social Service Agencies

Currently, expert systems are being introduced into almost every facet of social service delivery. Because this technology is sustained by computerization, many practitioners believe that objective knowledge will be available to guide program planning. 0ften overlooked, however, is the micro-world that enables computers to operate. The presuppositions associated with this micro- world provide social life with an abstract identity. Therefore, expert systems tend to be insensitive to situational exigencies and generate precise but irrelevant information. To remedy this situation, these systems must be implemented within a reflexive environment, so that they are sensitive to the logic persons use to organize their lives. Several suggestions are made pertaining to creating a reflexive social service agency.