Health care and social work services: present concerns and future directions

This article reviews eight major social-health care issues of the eighties: controlling costs; access to care; changing organizational patterns; solo versus interprofessional care; regulations and accountability; social reform/special interest movements; ethics and values; and changing urban populations. The author formulates how changes in our medical care systems will affect the practice of social work in health care settings.     

Social work roles in collaborative research

Social workers in health care settings may be most effective in the development and implementation of collaborative research studies which jointly involve academic and health service institutions. This article describes: organizational issues significant to the integration of research into a health service system; interpersonal issues that effect the perspectives of research and service professionals in the daily operation of the research project; and social work skills for collaborative research studies. An on-going 5-year collaborative research study of approximately 7,000 participants will be used as a case example.     

Social Work Roles in Collaborative Research

Social workers in health care settings may be most effective in the development and implementation of collaborative research studies which jointly involve academic and health service institutions. This article describes: (1) organizational issues significant to the integration of research into a health service system; (2) interpersonal issues that effect the perspectives of research and service professionals in the daily operation of the research project; and (3) social work skills for collaborative research studies. An on-going 5-year collaborative research study of approximately 7,000 participants will be used as a case example.     

Ethical issues in environmental health research

Environmental health research encompasses a wide range of investigational topics, study designs, and empirical methodologies. As that arm of public health research concerned with understanding the health effects of the many environments in which humans live and work, the field is intimately connected with social concerns about environmental quality and disparities of power and privilege that place differential burdens upon members of underserved communities. Environmental health researchers thus engage many ethical and social issues in the work they do. These issues relate to the choice of research topics to study, the methods employed to examine these topics, the communication of research findings to the public, and the involvement of scientific experts in the shaping of environmental policy and governmental regulation. These and other topics are reviewed in this article. These ethical, legal, and social issues are becoming increasingly more complex as new genetic and molecular techniques are used to study environmental toxicants and their potential influence on human and ecologic health.     

Mental disorders in primary care services: an update.

Frank mental disorders, such as depression and panic disorder, are prevalent in primary care; they cause people substantial suffering and interfere with daily functioning. Even subthreshold or "subsyndromal" conditions, with fewer symptoms than necessary for making a diagnosis, cause substantial morbidity. Recent literature on mental disorders in primary care, where many, if not most, people with mental health problems are seen, is reviewed with focus on recognition and diagnosis issues, management of these problems in primary care, obstacles to accurate diagnosis and appropriate treatment, and prevention issues. In addition to a review of recent research, there is an effort to place these topics in the context of various directives, including research and Federal documents, that have direct implications for better treatment in primary care of people with mental disorders (for example, practice guidelines). Mental health problems and disorders seen in primary care are a public health problem meriting immediate attention and substantial work at many levels--clinical, educational, organizational, and budgetary.     

A critical review of recent US market level health care strategy literature

In this review, we argue that it would be profitable if the neoclassical economic theories that have dominated recent US market level health care strategy research could be complemented by greater use of sociological frameworks. Sociological theory can address three central questions that neoclassical economic theories have tended to slight: (1) how decision-makers' preferences are determined; (2) who the decision-makers are; and (3) how decision-makers' plans are translated into organizational action. We suggest five sociological frameworks that would enable researchers to address these issues better relative to market level strategy in health care. The frameworks are (1) institutional theory, (2) organizational ecology, (3) social movements, (4) social networks, and (5) internal organizational change. A recent global trend toward privatization of health care provision makes US market level strategy research increasingly applicable to non-US readers.     

Health literacy: critical opportunities for social work leadership in health care and research

One-third of U.S. adults do not have adequate health literacy to manage their health care needs; and low health literacy is a major concern due to its association with poor health outcomes, high health care costs, and health communication problems. Low health literacy is a potential driver of health disparities, and its alleviation is central to the values and concerns of the social work profession. Despite the extensive knowledge and skills that social workers can bring to bear to assist patients with low health literacy, the concept of health literacy is underused in social work scholarship.This gap reflects missed opportunities for social workers to contribute their expertise to the evolving field of health literacy and to strategically align their work with organizational and national priorities.To address this gap, this article provides an overview of health literacy, its relevance to social work, and its representation in disciplinary literature; and it outlines opportunities for health social workers to systematically incorporate health literacy concepts and tools into their practices with patients and families. Implications for a social work research and practice agenda in health literacy are discussed.     

Goodness of fit: social work education and practice in health care

This study addresses the fit between social work education and practice in health care. A random sample of NASW members identifying with health care (N = 179) responded to a mail survey about the utility of core knowledge and roles that we had identified by reviewing seven commonly used health care social work texts. Quantitative data revealed knowledge and roles most frequently used in health care settings as well as differences in roles used dependent upon department name; and different professionals supervising social workers. Qualitative data from four open-ended questions provided suggestions for what knowledge and skills should be taught in social work programs, the best forums/methods for teaching this content, and topics for continuing education. Findings are discussed in relation to six key areas of the peer-reviewed literature: vulnerable populations/diversity, ethical dilemmas, interdisciplinary collaboration, mental health, managed care/accountability, and advocacy. Implications for social work practice, education, and research are discussed.     

Trends in maternal and child health care: implications for research and issues for social work practice

Trends are reviewed in four areas of maternal and child health care: (1) prenatal care; (2) infant mortality; (3) teenage pregnancy; and (4) HIV infected mothers and infants. The purpose of this review is to identify major trends in these programmatic areas, key indicators of physical-social health risk and survival, and central issues relevant to research and social work practice. Attention is directed to the status of research, and the usefulness of existing data sets available to researchers in the four programmatic areas of maternal and child health care under review. Emphasis is given to the importance of the integration of theory, research findings, and practice.     

Primary health care team effectiveness: developing a constituency approach

The difficulties of developing theoretically sound and practically useful models of primary health care team effectiveness are described. Three models of team effectiveness: the goal model; the internal process model; and the systems resource model are discussed in relation to the work of primary health care team (PHCTs). The value of the constituency approach is also examined and it is suggested that this is the most appropriate model for the situations of PHCTs. This paper describes an application of the constituency approach in developing measures of effectiveness for PHCTs. Results yielded effectiveness criteria in four major areas: consumer outcomes; quality of care; team viability; and organizational issues. The disadvantages of the constituency model are explored and the next steps in research towards developing a model of PHCT effectiveness is indicated.     

Bridging the gap: the development of knowledge briefings at the health and social care interface

The move to more evidence-based practice has been a recent and much-advocated feature of public policy, especially in health and social care. An essential element of this approach is to make available summaries of evidence in an understandable form, which can then be used to support decision-making in planning and practice. The present paper describes the development of just such a set of information digests for the health and social care interface. A distinct divide exists between the knowledge bases usually accessed by practitioners and professionals in these two fields, even though they often share populations and concerns. The authors describe the challenges and processes of developing a set of briefing documents summarising policy and research literature on health and social care topics. The paper introduces the project and its intentions, and describes the development and application of the conceptual basis and production methodology behind the briefings. The issues raised by summarising research evidence on potentially controversial topics within the limits of a briefing are also discussed.     

Organizational and personal resources of health promotion. Staying healthy despite or because of stress?

In the ongoing sociopolitical discussion of health promotion there is a shift from curative concepts to preventive concepts. In the context of the comprehensive and positive orientation to psychosocial health demanded by the World Health Organization the question of resources for the maintenance and promotion of health is gaining significance. In addition, issues pertaining to pathogenesis are making way for issues pertaining to salutogenesis: What personal (individual), social and organizational resources to enhance health and to cope with stress are available to individuals in demanding and stressful situations? Cognitive-emotional and instrumental coping patterns, greater control over one's work (decision latitude), and social support in the work and life domains are resources whose interactive effects call for further research. Precise answers to this question are of practical significance because they affect decisions about steps to be taken to promote intra- and extra-organizational health as well as job and organizational design approaches to maintain health.     

2001-2010年儿童肥胖相关的卫生保健服务文献热点分析

目的分析儿童肥胖相关的卫生保健服务的研究热点和规律。方法以“（child）AND（obesity）AND（de—liveryofheahhcare）”为检索策略，收集PubMed数据库中收录的2001～2010年发表的儿童肥胖相关的卫生保健服务文献，下载文献所标引的主题词并统计其出现的频次。根据设定阈值截取高频主题词进行系统聚类分析。结果共检出儿童肥胖相关的卫生保健服务文献808篇，截取30个高频主题词。共词聚类分析结果为：社会支持和社会经济冈素相关的研究，该类别中共包含10个高频主题词，分别为知识、态度和实践、调查表、体重指数、横断面研究、体重、社会经济因素、儿童营养生理学现象、家长／心理学、亲子关系和治疗效果；生活方式相关的研究，该类别包含5个高频主题词，分别为健康态度、生活方式、健康行为、活动和饮食习惯；健康教育和健康促进相关的研究，该类别下共包含9个高频主题词，分别为肥胖预防及控制、健康促进的方法学研究、运动量、儿童营养科学研究、项目评估、前驱性研究、肥胖／流行病学、社会营销和健康促进；儿童肥胖相关基线信息的研究，该类别下共包括6个高频主题词，分别为危险因素、患病率、卫生保健需求、美国／流行病学、护士角色和儿童福利。结论社会支持、生活方式、健康教育和儿童肥胖的基线信息研究是目前儿童肥胖相关的卫生保健服务领域的研究热点。     

Conceptualising body work in health and social care

Body work is a central activity in the practice of many workers in the field of health and social care. This article provides an introduction to the concept of body work--paid work on the bodies of others--and demonstrates its importance for understanding the activities of health and social care workers. Providing an overview of existing research on body work, it shows the manifold ways in which this can inform the sociology of health and illness--whether through a micro-social focus on the inter-corporeal aspects of work in health and social care, or through elucidating our understanding of the times and spaces of work, or through highlighting the relationship between mundane body work and the increasingly global movements of bodies, workers and those worked-upon. The article shows how understanding work undertaken on the bodies of others as 'body work' provides a mechanism for relating work in the sphere of health and social care to that in other sectors, opening up new avenues for research.     

Research Priorities for Fertility and Conception Research as Identified by Multidisciplinary Health Care Practitioners and Researchers

The Robinson Research Institute of the University of Adelaide convened a multidisciplinary group of n = 33 clinicians, researchers and representatives of government organisations on the 2 October 2014 for a workshop entitled “Promoting fertility and healthy conception. How do we generate greater reproductive health awareness?” The key aim of the workshop was to assess the body of knowledge that informs clinical practice and government policy, and to identify questions and additional information needed by health practitioners and government representatives working in the field of reproductive health and to frame future research and policy. The workshop identified topics that fell mostly into three categories: lifestyle-related, societal and biological factors. The lifestyle topics included nutrition and diet, exercise, obesity, shift work and other factors deemed to be modifiable at the level of the individual. The societal topics included discussions of matters that are structural, and resistant to change by individuals, including specific ethical issues, social disadvantage, government and educational policies. The biological factors are intrinsic physical states of the individual, and included many factors where there is a dense body of scientific knowledge which may not be readily accessible in less academic language. This workshop thus provided an opportunity to identify further actions that could be undertaken to meet the needs of diverse organisations and groups of professionals with an interest in human fertility. Since so many factors in our social and biological environment can impact fertility and preconception health, it is imperative to involve many disciplines or levels of government or societal organisations that have not traditionally been involved in this area.     

Social work management in emerging health care systems

An overview of the health care industry's trend toward multihealth systems is presented and specific adaptive strategies for social work managers in health care are suggested. The challenges to social work leaders during this transition from largely free-standing, privately owned health care institutions to corporately owned, horizontally and vertically integrated delivery systems are discussed in terms of identity, style, and substance. Directors of social work departments in multihealth corporations will need to resolve issues of institutional versus corporate identity as well as those of corporate versus professional identity. A multioptional management style that incorporates networking and political expertise should be cultivated. Substantive demands in the areas of management information systems, productivity, quality assurance, and budgeting also must be addressed. The emergence of multihealth systems poses major challenges and unique opportunities to the social work profession. Awareness of managerial strategies and critical content areas can help social work leaders enhance the role and contribution of social work in these exciting and complex health care delivery systems.     

Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States

Nurses and social workers are fundamental to the delivery of quality health care across the continuum of care. As health care becomes increasingly complex, these providers encounter difficult ethical issues in patient care, perceive limited respect in their work, and are increasingly dissatisfied. However, the link between ethics-related work factors and job satisfaction and intent-to-leave one's job has rarely been considered. In this paper, we describe how nurses and social workers in the US view the ethical climate in which they work, including the degree of ethics stress they feel, and the adequacy of organizational resources to address their ethical concerns. Controlling for socio-demographics, we examined the extent to which these factors affect nurses and social workers' job satisfaction and their interest in leaving their current position. Data were from self-administered mail questionnaires of 1215 randomly selected nurses and social workers in four census regions of the US. Respondents reported feeling powerless (32.5%) and overwhelmed (34.7%) with ethical issues in the workplace and frustration (52.8%) and fatigue (40%) when they cannot resolve ethical issues. In multivariate models, a positive ethical climate and job satisfaction protected against respondents' intentions to leave as did perceptions of adequate or extensive institutional support for dealing with ethical issues. Black nurses were 3.21 times more likely than white nurses to want to leave their position. We suggest several strategies to reduce ethics stress and improve the ethical climate of the workplace for nurses and social workers.     

Concepts of social epidemiology in health services research

Background

Social epidemiologists aim to identify social characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms. Some important concepts of social epidemiology are: social inequalities, social relationships, social capital, and work stress.

Discussion

Concepts used in social epidemiology can make a useful contribution to health services research because the underlying social factors do not only influence health but are also related to health care. Social inequality indicators like education or income have an impact on access to health care as well as on utilization and quality of health care. Social relationships influence adherence to medical treatment, help-seeking behavior, utilization of health services, and outcomes. Social capital in health care organizations is an important factor for the delivery of high-quality coordinated care. Job stress is highly prevalent among health care providers and can not only affect their health but also their performance.

Summary

The theoretical considerations behind factors like social inequalities, social relationships, social capital and work stress can enrich health services research because theory helps to specify the research question, to clarify methodological issues, to understand how social factors are related to health care, and to develop and implement interventions.

     

St Joseph's Community Health Centre model of community-based interdisciplinary health care team education

As our reliance on interdisciplinary health care teams for meeting the multidimensional needs of the community becomes greater, new interdisciplinary education programmes and learning experiences are needed to educate students and health care professionals to become better team players. The St Joseph's Community Health Centre (SJCHC) model of community-based interdisciplinary health care team education was developed with support from McMaster University and the Educational Centre for Aging and Health's Clinical Teaching Unit Without Walls. The SJCHC model is structured as one 3-h session each week for eight consecutive weeks and is an elective learning experience for students. Six to eight senior health, social science and other health-related students work with two group facilitators as a team on discussion theme topics: team dynamics; role issues and professional values; collaboration and conflict; communication, leadership and power; client-centred goal-oriented care; and consumerism issues. The success and impact of the SJCHC model has been measured by several primary and secondary outcomes outlined in the Charting the Outcomes of Educational and Clinical Approaches (COECA) model.     

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.