Evaluation Research on Social Work Interventions: A Study on the Impact of Social Worker Staffing

ABSTRACT

This study examined the impact of social worker staffing on depression and health-related quality of life (QOL) of end-stage renal disease patients on hemodialysis. Social workers in most dialysis units work a 5-day week. Patients are usually dialyzed three times per week. Patients on a Monday-Wednesday-Friday schedule have access to their social worker 3 days a week, while the Tuesday-Thursday-Saturday schedule patients have only 2 days; that is, contact with the social worker is reduced by one third for those patients. Findings demonstrated that those patients who had access to the social workers one third less time had statistically significant poorer QOL on 4 of the 5 domains measured, and had clinically indicated levels of depression. Findings reinforce the importance of the social worker in the life of the dialysis patient.     

非医疗因素对长期腹膜透析患者生存质量的影响

目的 研究可能影响长期腹膜透析患者生存质量的非医疗因素,旨在为临床工作中如何提高患者的生存质量提供依据.方法 采用横断面研究方法调查79例慢性肾衰竭进行持续非卧床腹膜透析(CAPD)患者.记录患者的年龄、性别、工作状况、文化程度、医疗负担及家庭支持等情况.采用国际通用的KDQOL-SFTM1.2中的短表SF-36评估患者的生存质量.采用汉密尔顿焦虑抑郁量表评估患者的焦虑、抑郁指数.结果 SF-36评估患者的生存质量提示:CAPD患者生存质量的8个方面得分均显著低于中国一般人群(P＜0.05或＜0.01);在职患者和有医疗保障患者SF-36得分分别为(45.78±16.93)分和(49.62±13.20)分,明显高于非在职患者的(32.65±12.26)分和无医疗保障患者的(33.85±6.24)分(P＜0.05);人均年收入越高的家庭,患者生存质量就越高;有子女和老伴共同照顾的患者生存质量最高,而由保姆或个人照顾的患者生存质量最低;79例患者中焦虑的发生率为54.4%(43/79),抑郁的发生率为15.2%(12/79),二者均与生存质量呈显著负相关.结论 家庭支持、工作状况、医疗保障和心理障碍均对CAPD患者的生存质量产生重要影响.     

Use of focus groups to identify concerns about dialysis. Choice Study.

BACKGROUND: Patients with end-stage renal disease (ESRD) may have quality-of-life (QOL) concerns that are not fully appreciated by their providers. The authors conducted focus groups with dialysis patients and dialysis professionals to determine whether this qualitative method would reveal differences between patients' and providers' views about: 1) domains of QOL that are affected by ESRD and dialysis; and 2) aspects of dialysis that affect QOL. METHODS: Separate focus group discussions were held with: 8 adult hemodialysis patients (mean age 50 years; 3 women; mean duration of dialysis 8.5 years), 5 adult peritoneal dialysis patients (mean age 54 years; 3 women; mean duration of dialysis 4.6 years), 8 nephrologists (mean of 12 years of dialysis practice), and 9 other health professionals involved in dialysis care (3 nurses, 2 dietitians, 2 social workers, and 2 technicians; mean of 10 years experience in dialysis care). Discussions were audiotaped, transcribed verbatim, and reviewed independently by three investigators to identify and categorize distinct thoughts. RESULTS: 1,271 distinct thoughts were identified and grouped into 20 related categories, which included ten QOL domains and ten aspects of dialysis that affect QOL. Compared with the professionals, the patients identified one additional relevant QOL domain (10 vs 9), and one additional aspect of dialysis that affects QOL (10 vs 9), and expressed more thoughts per domain (p < 0.05), although the contents of their comments were frequently similar. Among QOL domains, the numbers of related thoughts identified by patients and professionals, respectively, were: freedom/control (60, 89); social relationships (36, 11); anxiety (37, 4); role function (24, 10); energy (12, 10); body image (16, 4); sex (11, 21); mental attitude (21, 0); sleep (15, 1), and cognitive function (13, 7). Among aspects of dialysis that affect QOL, the numbers of thoughts identified by patients and professionals were: general dialysis issues (159, 105); relationships with staff (62, 110); patient education (63, 68); diet (44, 40); scheduling (57, 3); vascular or peritoneal access issues (31, 17), adaptation to dialysis (16, 14); dialysis dose (18, 8); symptoms (25, 0), and self-care (5, 24). CONCLUSIONS: Although health professionals have a good understanding of patient concerns about the effects of ESRD and dialysis, the focus group discussions revealed a breadth and depth of QOL concerns that they may not fully appreciate.     

The cost of caring for patients with an illness: contagion to the social worker.

This article will examine the effects of hospital work on social workers. It will highlight the events of a focus group that was used to gather data in an attempt to begin to understand the stressors faced by the worker. The Self-Constructivist Model (McCann & Pearlman, 1990b) is utilized in relation to trauma experienced by the social worker, while working with patients diagnosed with an acute, chronic or life-threatening illness. Findings are summarized and recommendations are made to assist hospital social workers in coping with the aftermath of secondary trauma.     

Enhancing social networks: a qualitative study of health and social care practice in UK mental health services

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over‐arching themes – worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub‐themes which were identified included worker attitudes; person‐centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals’ access to social capital within networks.     

Predicting young children's quality of life

This paper represents an investigation into the determinants of young children's quality of life (QOL) in Thailand. The empirical work is based upon a sample of 498 children (aged 5-8); 220 were urban children and 278 children of construction workers in Bangkok. Their QOL was assessed using a new self-report QOL measure for children. Multiple regression analyses indicated that the father's income and education, type of school, mode of transportation to school, and the amount of time that the child spent on extra study courses were significant explanatory variables. It was found that these factors had different influences on the QOL of urban children and those of construction workers. Extra sport-related activities and extra work (other than housework) improved the QOL of urban children, while the QOL of construction workers' children was directly linked to father's education and income. This result is consistent with income having a diminishing marginal effect on the QOL of children. There is also evidence that amongst construction workers' children, boys have a lower QOL than girls. The different causal explanations for the QOL of urban and construction workers' children suggests that it is context specific, and what impacts one group of children's QOL within a particular context may not impact another group in a different situation. This has important policy implications. Throughout the study we could find no significant impact of health on QOL-neither chronic, acute nor severe illness has any significant impact on QOL. This is consistent with the hypothesis that QOL is influenced by expectations (Social Science and Medicine 41 (10) (1995) 1403). Findings of the effects of social and environmental factors on children's QOL are new in this field and should be further investigated.     

Evidence that supports the value of social work in hospitals

The value of hospital social work is supported by one hospital's tracking system that monitored social work discharge services and compared outcome with non-social work discharges. The sample consisted of a total of 64,722 patients admitted to the "med-surg" hospital unit over a two and one-half year time period from 2002 to 2004. Of the total patients in the sample, 15.7% (n = 10,156) had social work involvement. Sixty percent of the social worker patients were age 70 or over compared with the mean age of the sample of 56.2 years. The mean length of stay for social work served patients was 11.4 days (sd = 13.9) compared to 4.3 days (sd = 6.3) non-social work patients, a difference that was significant (t =-68.3; p = .000). The authors attribute the longer lengths of stay to social workers' receiving older and more difficult-to-place patients. An evidence-based case is made for the cost-containment value of social workers in hospitals and for the creation of a tracking infrastructure to aid in monitoring the daily achievements of medical/surgical social workers.     

Gerontological social work and cardiac rehabilitation

Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.     

乳腺癌患者综合社会支持干预效果评价

目的探讨综合社会支持干预对提高乳腺癌患者术后应对能力和生命质量的效果。方法按病区将98例乳腺癌术后患者分为实验组和对照组各49例,实验组接受综合社会支持干预,对照组接受常规护理。分别在术后1~5天内及术后1个月、3个月进行社会支持、应对和生命质量各指标的测量。结果干预后,实验组和对照组的社会支持得分、应对量表8个方面得分和生命质量的生理维度、心理维度、和医务人员关系维度的得分及生命质量总分均的差异均存在统计学意义（P〈0.05）,社会支持得分、应对量表得分和生命质量得分均随干预时间推移而变化,干预方法与干预时间存在交互作用。结论综合社会支持干预可以提升患者对社会支持的感知度,增强正性应对,提高患者的生命质量。     

城市农民工生命质量及影响因素分析

目的了解城市农民工生命质量(QOL)现状及其影响因素,为制定相应的政策和措施提供理论依据。方法采用健康调查量表(SF-36)对贵州省贵阳市522名农民工进行QOL测定。结果共发放调查表570份,收回558份,其中合格调查表522份,合格率为93.55%;522名农民工中男、女性分别为248和274人,平均年龄(28.43±8.06)岁;未婚、已婚和其他(离异或/和丧偶)分别为223,282,17人;小学及以下、初中、高中及以上文化程度者分别为73,255和194人;SF-36量表的分半信度和Cronbach’sα系数分别为0.806 7(P0.01)和0.777;躯体疼痛、总体健康、活力和精神维度上男性高于女性,仅总体健康维度上不同年龄、教育程度和婚姻状况间差异有统计学意义(P0.01);多元逐步回归分析结果提示,两周患病、住处更换次数、自评健康和主观、客观支持是影响城市农民工QOL的重要因素。结论农民工整体健康水平较差,生理、心理和社会适应等方面均不同程度地影响其QOL。     

Families of chronically mentally ill people: siblings speak to social workers

Twenty siblings of chronically mentally ill people discussed their emotional responses to the mental illness of their brother or sister. The findings were drawn from a study that was part of the author's practice experience as a social worker in a community mental health setting. The findings also paralleled the author's life experiences as a sibling of a chronically mentally ill person. Sibling emotional responses were categorized into grief and loss phases of denial, anger, bargaining, depression, relief/respite, and acceptance. Siblings believed that their expressions of grief and loss were impaired by characteristics of mental illness and by mixed messages from the mental health system. The siblings recommended inclusion of siblings in client treatment; support and education for siblings; clear communication between social worker and family; a social worker focus on family strengths; and, most of all, effective client intervention. The sibling perspective points out the salient need for social workers to use their ecological, person-in-environment training to facilitate healthier family support networks for chronically mentally ill people.     

Demographic and clinical characteristics associated with quality of life in patients with chronic obstructive pulmonary disease

Purpose

Despite an increasing interest in the relationships among multiple symptoms and quality of life (QOL), little known about the association between anxiety, depression, and pain and both disease-specific and generic QOL in patients with chronic obstructive pulmonary disease (COPD).

Methods

In a cross-sectional study of 100 COPD patients, disease-specific QOL was measured by St. George’s Respiratory Questionnaire and generic QOL by the QOL scale. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and pain was assessed with a numeric rating scale.

Results

Of the 100 patients, 31 % reported clinically meaningful anxiety, 13 % depression, and 45 % reported the presence of pain. Younger patients (p = 0.02) and those with higher anxiety scores (p = 0.02) reported worse disease-specific QOL. Patients with lower physical function (p = 0.04) and those with higher depression scores (p < 0.001) reported worse generic QOL. Age, comorbidity, physical function, anxiety, depression, and pain explained 19.2 and 49.6 % of the variance in disease-specific and generic QOL scores, respectively.

Conclusions

Findings from this study suggest that the relationships between patient characteristics and common symptoms and QOL differ when disease-specific and generic measures of QOL are evaluated. Additional research is warranted to confirm these findings in COPD patients. Clinicians need to evaluate these common symptoms when planning and implementing symptoms management interventions to improve COPD patients’ QOL.     

Quality of life of patients in renal replacement therapy in Brazil: comparison of treatment modalities

Purpose

This study aimed to analyze and compare the quality of life of renal replacement therapy patients undergoing hemodialysis, peritoneal dialysis and those with renal transplantation in Brazil. In addition, we aimed to verify factors associated with patients?? quality of life and the relationship between quality of life and treatment modality, socioeconomic and demographic conditions as well as aspects related to the disease and health services.

Methods

A representative sample of the dialysis units and transplant centers was obtained. Structured questionnaires were used to interview 3,036 patients in one of three treatment modalities: hemodialysis, peritoneal dialysis and renal transplant. Information was collected about socioeconomic and demographic characteristics and quality of life measures.

Results

There were significant differences between renal transplants and both forms of dialysis for all dimensions of the SF-36. Hemodialysis patients showed better results in the dimensions of functional capacity, physical aspects and social aspects, compared to peritoneal dialysis patients. Renal transplant patients had the best mean score in the physical component of quality of life. There were no significant differences among treatment groups regarding the mental component of quality of life. The physical and mental components were associated with comorbidities and age; however, older patients had better mental quality of life but worse physical quality of life. Patients in a higher socioeconomic class and patients that were not hospitalized also reported better quality of life. Unmarried and male patients presented better physical quality of life. The dialysis units and transplant centers influenced the patients?? quality of life.

Conclusions

Renal transplant patients have the best quality of life of the three treatment modalities. It is necessary to increase access to renal transplants.     

The social worker in the emerging field of home care: Professional activities and ethical concerns

Although home care is one of the fastest growing segments of the health care delivery system, there is little empirical data on the professional functions or ethical concerns of social workers employed in home care. To provide this information 118 social workers in proprietary and nonprofit agencies in one midwestern and one southern state were surveyed. The results indicated that social workers performed a wider array of professional functions with a more diverse population of patients than had been documented previously. Workers experienced ethical concerns related to self-determination, barriers to access of services, implementing advance directives, and assessment of mental competence most often. Workers in proprietary agencies rated the ethical concern of barriers to access of services as occurring significantly more often than workers in nonprofit agencies.     

Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.     

麻风病患者抑郁状态与生存质量关系的多重线性回归分析

目的 分析麻风病患者抑郁状态与生存质量各维度间的相关关系。方法 采用流行病调查用抑郁自评量表（center for epidemiologic studies depression scale,CES-D）和世界卫生组织生存质量简表（world health organization's quality of life questionnaire-brief version,WHOQOL-bref）对广东省麻风病患者进行抑郁程度和生存质量调查,用多重线性回归方法分析抑郁程度得分与生存质量各维度间的关系和强度。结果 共263名麻风病患者完成了调查,其中男性177名（67.3%）,女性86名（32.7%）。131名（49.8%）调查对象有抑郁症状,有抑郁症状调查对象生存质量各维度评分均低于无抑郁症状对象,差异均具有统计学意义（均有P<0.05）。在各维度中,生存质量总评、生理健康、心理健康、社会关系和环境因素得分与抑郁症状的回归系数分别为-0.340、-0.322、-0.644、-0.424和0.244,除生存质量总评外,其他回归系数差异均具有统计学意义（均有P<0.05）。结论 广东省麻风病患者的抑郁症状发生率高,生存质量得分与CES-D得分有关联,应采用多层次的干预措施防止麻风病患者抑郁症的发生。     

Organizing social work services with adult cancer patients: integrating empirical research.

Today only half of those diagnosed with cancer will die of the disease, leaving enormous room for psychosocial interventions to improve the psychological or functional status of those coping with the disease. Therefore, social workers in oncology must be current with empirical research. In an effort to integrate current research into social work practice, we reviewed empirical studies with sound research designs to answer the following questions: (1) What portion of cancer patients are likely to need social work services? (2) What types of services do social workers provide to meet these needs? and (3) Who is likely to be (or not to be) the recipient of these services. Does intervention research include diverse (non-traditional, non-white and non-middle class) clients? The results show about one third of patients will be judged at high-risk for psychosocial problems but that only 15-25% of those who are diagnosed with cancer will eventually use psychosocial oncology services. Some have mainly instrumental, concrete needs, and others will use psychosocial counseling. A review of the inclusion of minorities and non-traditional, non-middle-class groups, shows that they are not adequately represented in current intervention research in psychosocial oncology. Methods for enlarging their access and participation are suggested.     

Utilization of health social work services by older immigrants and veterans in Israel

The authors examined factors related to utilization of health social work services among older immigrants from the former Soviet Union and veteran residents of Israel, using Andersen's behavioral model. A sample of 476 patients age 55 and older was interviewed. The immigrants and veterans had similar backgrounds, but immigrants had fewer resources and higher need. Veteran Israelis were twice as likely to have been in contact with a hospital social worker. Factors related to seeing a social worker were male gender, social network size (no network or large network), activity limitations, and sick days. The main barriers to contacting a social worker stemmed from information problems. The findings have implications for providing services in areas with large numbers of immigrants.     

Gender and social support in the context of cardiovascular disease

OBJECTIVE: Gender and social support (SS) can affect the level of adjustment to cardiovascular disease (CVD). In this study we attempted to determine the effects of both factors on negative mood state, quality of life (QOL) and perceived health control (PHC) in patients at high CVD risk or with CVD. We also tested for an interactive effect of gender and SS. METHOD: One hundred and fifty-three chronic outpatients (89 females and 60 males; 4 provided no information on gender) were assessed. Levels of social support were measured. Other psychosocial variables included were negative mood state, domains of QOL (satisfaction and free time) and PHC. RESULTS: The results, as expected, indicated main effects of gender and social support. Females experienced higher negative mood state and lower PHC in comparison with males. Patients with low SS reported less satisfaction, free time and PHC and had more negative mood state. No interaction of gender by social support was found. CONCLUSIONS: Levels of social support and gender are important aspects that influence emotional and psychological functioning in patients with CVD. Specific interventions designed for females and individuals with poor emotional and instrumental support may contribute to positive changes in their adjustment.