Hospital social workers and self-help groups

Self-help has developed into a significant trend in health care, and the relationship between professional services and self-help has begun to be explored. This article describes a survey that investigated hospital social workers' involvement with self-help groups and reports the need for a dual focus on research and clinical training to prepare social workers for the practice challenges presented by the self-help movement.     

Neue Entwicklungen in der Selbsthilfeförderung

Currently there are about 70.000 self-help groups in Germany. Two-thirds are patient self-help organisations offering support for people with different kinds of disabilities. Patient self-help groups thus play a vital role in public health care. Recently, financial support of self-help groups became legally regulated. According to § 20 Sozialgesetzbuch V (SGB V) and § 29 Sozialgesetzbuch IX, respectively, national health insurances as well as public rehabilitation organisations are now obliged to support self-help groups. Although realisation of these measures is progressing slowly, they have strengthen the role of self-help groups in public health care and will allow these groups to expand their activities.     

Self-help: What future role in health care for low and middle-income countries?

In the debate on 'Third options' for health care delivery in low- and middle-income countries it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform.Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a de-personalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure.In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as self-help groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems - they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.     

Professional and service-user perceptions of self-help in primary care mental health services

Self-help is becoming an increasingly accessible option for addressing mental health problems. Despite this, self-help is subject to a variety of interpretations, little is known about how professionals and service-users conceptualise self-help, or how service-users engage in self-help activities. This study aimed to explore the views of self-help by service-users and health professionals in one area of Scotland, including the perceptions of what constitutes self-help and how it might be used to address mental health problems in primary care. The research involved semistructured interviews with 31 primary care mental health professionals, and in-depth interviews with 34 service-users. We found that professionals and service-users describe self-help in different ways, which has great implications for referral to and implementation of self-help in primary care settings. It also emerged that self-help was not necessarily perceived to be able to address the causes of mental distress, which could leave some professionals defaulting to offering no interventions despite the fairly positive attitude service-users show to self-help strategies. Finally, professionals need to be convinced that interventions are useful, effective and accessible as there are significant barriers in professionals using self-help; if they are not convinced, such approaches will support their therapeutic approach. The research supports the need to develop methods of delivery that offer self-help as part of a broad package of care that also considers social causes of distress.     

Lay care in illness

This paper discusses lay care in illness with special reference to research and development in Northern Europe. The discussion concentrates on two components of lay care: individual self-care in illness and self-help groups. Individual self-care in illness is shaped in social environments, and in turn is a major determinant of the type and amount of health care services used. Self-help groups of all kinds have increased in recent years. Groups 'next' to the system and groups opposed to the system increased rapidly during the seventies. A form of self-help group that interfaces more directly with services is now being encouraged by physicians. Major issues concerned with these developments are considered.     

The role of self-help clubs in adaptation to chronic illness and disability

The paper discusses the establishment, growth, organization, services and programs of self-help health groups and their articulation with the institution of medicine. The recent proliferation of self-help groups constitutes a social movement of consumer-initiated services. Self-help groups provide assistance, encouragement and needed services for those with chronic, disabling conditions involving a number of emotional and social adaptive problems. These are problems that are not being adequately dealt with through the acute-illness physician-patient relational model. The groups are varied in organizational structure and services provided; in degree and style of affiliation with national organizations; and relationships with hospitals and medical practitioners. In view of the functions they perform, they seem to fill an important gap in the network of agencies and professional practitioners making up the health service delivery system.     

Primary health and social care services in the UK: progress towards partnership?

There has been a shift in the theoretical debates around the ways in which organisations deliver the state's objectives of providing health and social care services for its citizens, focusing on issues of welfare governance and the encouragement of partnership working between organisations. This article develops these theories by focusing on developments in primary health and social care policy in the UK, which have undergone a radical change recently. Responsibility for commissioning health care services now falls to primary care groups and trusts (PCG/Ts), run by general practitioners, other primary care practitioners, managers and lay members, and there is some pressure on primary care groups and primary care trusts to engage in partnership working with social services, for example, to cut hospital waiting lists or provide intermediate care services. One policy option is for these organisations to form Care Trusts, integrating the commissioning of health and social care for older people and ending the historical organisational divisions between health and social care in the UK. This paper examines evidence from the first stage of a 3-year longitudinal quantitative and qualitative study of the development of partnership working between PCG/Ts and social services departments in England. It examines whether the evidence suggests that the integration of health and social care is feasible or desirable in older people's services.     

Partizipative Rehabilitationsforschung

Background

The rehabilitation and participation of chronically ill persons are core tasks of the German welfare state. They were formulated in the Code of Social Law IX in 2001. Rehabilitation sciences began to develop at the beginning of the 1990s. They study all aspects of rehabilitation, using a pluralist approach to theory and methods. The support of self-help by the state health insurance was codified in the Code of Social Law V in 2000. In the last 10 years representatives of self-help organisations have been increasingly involved in health-care advisory committees—partly as stipulated by law, partly “voluntary”.

Goal

The goal of participatory rehabilitation research is a more patient-friendly health-care system. The article describes the promotion of participatory research by “Deutsche Rentenversicherung“ (the German Pension Insurance) showing how patients, members of self-help groups and self-help organisations are involved in rehabilitation research. Furthermore the article presents self-help groups and organisations which support and initiate research in addition to their work on advisory committees and in public relations.

Result

Cooperation between researchers and self-help organisations offers great potential. The article discusses how participationary research could be implemented in rehabilitation research and self-help.     

A selective look at self-help groups in the United States

Government health policies in the United States have emphasized private business and professional solutions, benignly neglecting self-help mutual aid. This paper presents a selective overview of the development and current situation of self-help groups (SHGs) and resource centres in the United States based on a literature review, recent interviews and the author's observations. The development of contemporary self-help groups is linked with the 1935 founding of Alcoholics Anonymous (AA). AA is a model for 100 or more other SHGs which are non-hierarchical direct democracies that avoid advocacy. The major growth of groups occurred in tandem with the civil rights and women's movements especially during and after the 1970s; both challenged bureaucracies and traditional authority. Self-help groups are often criticized for focusing on emotional support. However, major changes occurred stemming from separate self-help advocacy movements for persons with cancer, AIDS, mental illness, disabilities, alcohol problems and women's conditions. Currently, self-help resource centres which provide information and referral, among other services, are viewed as important linking organizations. The social demographic composition of self-help group members has been estimated to be disproportionately white middle class females. An active interdisciplinary network of over 200 researchers, most from academia, studies self-help mutual aid. The future of resource centres is less certain than for groups since centres have little legitimacy while requiring substantial resources. The impact of current changes in health care (e.g. managed care) on self-help mutual aid is unknown.     

Learning to cross boundaries: The integration of a health network to deliver seamless care

We analysed the development of an integrated network from a learning perspective to see how care givers from different organisations were able to cross the professional and organisational boundaries that existed between them to make sure patients receive the right care, at the right moment, in the right place. We show how through a process of collective learning social contacts between health professionals increased and improved. These professionals learned to speak each other's language, learned how other professionals and organisations work and learned to look at the care process from a network perspective instead of only from a professional or organisational perspective. Through this learning process, they also experienced the limitations of standardizing knowledge in criteria, protocols and rules, and the value of direct contact for sharing information and knowledge, to ensure continuity in care.     

Learning to cross boundaries: the integration of a health network to deliver seamless care

We analysed the development of an integrated network from a learning perspective to see how care givers from different organisations were able to cross the professional and organisational boundaries that existed between them to make sure patients receive the right care, at the right moment, in the right place. We show how through a process of collective learning social contacts between health professionals increased and improved. These professionals learned to speak each other's language, learned how other professionals and organisations work and learned to look at the care process from a network perspective instead of only from a professional or organisational perspective. Through this learning process, they also experienced the limitations of standardizing knowledge in criteria, protocols and rules, and the value of direct contact for sharing information and knowledge, to ensure continuity in care.     

Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social needs

This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.     

Fair Access to Care Services (FACS): implementation in the mental health context of the UK

Since April 2003, all adults requiring social care services must have an assessment to determine their eligibility, which is set within the four-level framework of Fair Access to Care Services [FACS; LAC (2002)13]. This paper examines the implementation of FACS by community mental health teams in eight sites in mental health partnership trusts, and one in a mental health and social care trust in the UK. Twenty-eight respondents (managers within trusts and social services departments) participated in in-depth qualitative interviews, which were undertaken between August 2004 and February 2005. The interviews covered: consultation with users and partner organisations; training and briefings for staff; FACS thresholds; integration of FACS and the Care Programme Approach; and the impact of implementing FACS on budgetary arrangements between health and social care. Using the framework analysis approach to analyse data, it was found that FACS implementation in mental health services has been somewhat haphazard, and has identified real differences between health and social care approaches to eligibility determination, assessment and priorities. In particular, the type and amount of consultation, training and induction into FACS was variable, and in some cases, unacceptably poor. While FACS may have reduced variability between authorities, the exercise of professional judgement in the operation of FACS and the lack of high-quality preventative services remain as potential sources of inequity within the system. The authors conclude that FACS has revealed and reinforced a growing separation rather than an integration of mental health and social care ideas and practices, at least in the participating sites.     

Investigating the nature of formal social support provision for young mothers in a city in the North West of England

Young mothers often require support to remain socially 'included' after becoming pregnant and this, in its turn, could protect their health. In this context, new policy initiatives aimed at tackling social exclusion, such as those implemented under the National Teenage Pregnancy Strategy, could be working to build social support mechanisms. The present paper addresses the issue of whether statutory services do in fact deliver 'social inclusion', through the provision of appropriate social support for young mothers. Data are drawn from semistructured interviews with service providers from a variety of different settings. The questionnaire was structured around an established model of social support, developed by M. Barrera, called the Inventory of Socially Supportive Behaviours. The study took place in a deprived inner city in North West England. Eleven participants were interviewed from seven separate organisations. The findings indicate that there were well-developed referral systems between services, with services adopting a social model of health. Much informational and emotional support was provided. What was less clear is how services are enabling social support to be developed amongst peer groups accessing the services particularly at community level. It is questionable to what extent services are able to foster the development of social support through social activities and support groups, and even whether it is appropriate to expect them to do so. In some sense, services go some way to delivering social inclusion, in that they are providing advice about income, housing and other opportunities. However, services appear to be missing an opportunity to foster social inclusion through the lack of development of supportive networks amongst groups of peers, which may have implications for the health of young mothers.     

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing,China: A case study

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.     

Decentred comparative research: Context sensitive analysis of maternal health care

Cross-national comparison is an important tool for health care research, but too often those who use this method fail to consider important inter-national differences in the social organisation of health care and in the relationship between health care practices and social experience. In this article we make the case for a context-sensitive and reflexive analysis of health care that allows researchers to understand the important ways that health care systems and practices are situated in time and place. Our approach--decentred comparative research--addresses the often unacknowledged ethnocentrism of traditional comparative research. Decentred cross-national research is a method that draws on the socially situated and distributed expertise of an international research team to develop key concepts and research questions. We used the decentred method to fashion a multilevel framework that used the meso level of organisation (i.e., health care organisations, professional groups and other concrete organisations) as an analytical starting point in our international study of maternity care in eight countries. Our method departs from traditional comparative health systems research that is most often conducted at the macro level. Our approach will help researchers develop new and socially robust knowledge about health care.     

Community care in practice: social work in primary health care

This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.     

Health education: a new approach

This article describes a series of experiences in the area of Health Education. The experiences, carried out with groups of health professionals working in institutions, begin with the social relationships in which these professionals are involved in their day-to-day work, in contact with other social agents and groups. One of the basic assumptions is that social relationships are an important aspect of the public health services provided to the population. As a result, health workers need specific training in this area to develop and improve their professional performance. The experiences show the importance of making theoretical and methodological approaches (like Educational Psychodrama and the Arvoredo Method) available to these workers. Those who have participated in such training programs have considerably improved their professional/social skills. One of the basic tenets of these approaches is the constant search for autonomy, as an essential element for people to increase awareness of themselves as individuals and as citizens, be they health care professionals or users. The experiences and methods described in this article may serve as one way of reducing the serious gaps in today's public health services.     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.     

An activating state and active citizen groups in the German health care system

Summary Enabling state and active civil society in the German health care cystemThis paper discusses the question, to what extent concepts of an enabling state are realised in the German health policy and wether they meet active citizens with corresponding competencies. The analysis is based on a review of the literature refering to the promotion and development of the self-help movement and citizen partizipation in the German health care system. The results show, that since 1999 the following enabling health policy measures were adopted: the promotion of independent patient advisory services and shared decision-making, the enactment of participation rules in the rehabilitation system and the compulsory subsidy for self-help groups, self-help organisations and clearing houses for self-help. The active engagement of the citizens both as co-producers of health on the individual level and as participants in processes of communication and decision-making on the system level is still restricted to a small part of the population. An enabling health policy and a broad citizen participation are still in the beginning, but they have the potential to strengthen each other and to realise synergetic effects. Even though some corresponding institutions were already established and attitudes of the health care professionals start to alter, the question wether the health policy will change from a welfare producing state to an enabling state cannot be answered completely yet.