Working with families in Tower Hamlets: an evaluation of the Family Welfare Association's Family Support Services

This paper describes an evaluation carried out by South Bank University of the work of the Family Welfare Association's (FWA's) Family Support Services (FSSs) in Tower Hamlets, London. Tower Hamlets is a multi-racial area in east London that, according to the 1991 census, has high levels of poverty, overcrowding and unemployment. Increasing poverty and social exclusion, which further entrench inequalities in health, are reported by sources such as government, health and social services and research as requiring innovative local responses to meet pressing welfare needs. The evaluation reported here examined three projects: Family Support, Building Bridges and Quality Protects - these are referred to collectively as FSSs. The evaluation shows that FSSs are innovative services that demonstrate effective ways of working with vulnerable families affected by experiences of racism, bullying, mental health difficulties, domestic violence or child abuse. In common with other successful initiatives in the UK and abroad, FSSs are aimed to be non-stigmatising, non-intrusive and responsive to the ethnicity, views and specific needs of families. This paper focuses on the participatory work of FSSs with families to illustrate effective methods of quality support, detail outcomes, and draw lessons for policy and practice.     

Unemployment and health in the context of economic change

Evidence relating unemployment to health is found at every level of social science analysis from national population rates to individual psychophysiological stress response. At the population level of analysis, increase in the unemployment rate indicates recession and/or structural economic decline. At the individual level, unemployment is interpreted as a stressful life event. In both cases, inverse associations are found between measures of unemployment and indicators of health. We identify social science literatures associating health indicators with each of the following: economic growth, socioeconomic status, sociocultural change, economic instability, the status of being unemployed, social stress and work stress. Outstanding research issues include the requirements to identify and measure the effects of conditional factors and control variables in multivariate analysis and to examine a broader range of both severity of unemployment and severity of health outcomes. A research agenda proposes studies at the macro, meso and micro levels of analysis. We urge such research for its potential contribution both to analytic social science and to economic and social policy.     

The unemployment iceberg: what is beneath, behind, and ahead?

Unemployment is a complex issue, affected by many different factors, institutions, and policies. It can be viewed as the ultimate of four levels of institutional settings, each with its own options and processes: the potential working population; family/household patterns affecting labor force participation; the employment system, its working time regimens, and the allocation of paid and unpaid work; and finally, economic exclusion, by unemployment, poverty, or both. The author examines this complexity and describes the experiences of some OECD countries over the last few decades, then outlines some policy options for addressing the problem of unemployment. The article concludes with a discussion of some crucial tests confronting social democracy and the trade union movement.     

Using the photovoice method to understand experiences of people with physical disabilities working in social enterprises

BackgroundSocial enterprises can be an alternative option for people with disabilities to build confidence in the job market, where unemployment and difficulty securing a decent job is a social issue for this population. However, limited studies have examined these experiences from the participants’ perspectives.ObjectiveThis study explored the life experiences of people with disabilities working in social enterprises, using the photovoice method.MethodsFive employees with physical disabilities working in a social enterprise participated in five sessions of photovoice in South Korea. They took photos for each session on four themes and participated in group discussions.ResultsThis paper draws from narrations and photos shared during group discussions regarding four themes selected by participants: my current state, life changes after being employed in a social enterprise, feeling frustrated, and my future. The participants reported better quality of life both financially and socially, but also felt frustration facing interpersonal, health, or workload problems while working at a social enterprise. They expressed hope to continue working in their social enterprise, and thus ultimately experience better quality of life and a sense of contributing to society.ConclusionsEmployers can create more supportive and sustainable workplaces to secure decent job opportunities for persons with disabilities at a social enterprise and contribute social value. Social work professionals should provide professional support to employees with disabilities who are struggling with health and psychosocial problems that often occur in social enterprises.     

Social workers and unemployment: Factors associated with using employment‐promoting practices in Israeli Municipal Departments of Social Services

Unemployment is a harsh social phenomenon with far reaching negative implications. Unemployed individuals often seek assistance from social workers working in Municipal Departments of Social Services around the world. However, little to no research exists on the factors involved in social workers’ choice to engage in employment‐promoting practices (EPP). The current study aimed to tackle this gap of knowledge, providing initial conclusions about the relationship between social workers’ attitudes towards unemployment, their knowledge regarding EPP, the extent to which they perceive their organisations as endorsing EPP and their actual implementation. The main research question dealt with the extent to which each of the examined factors, in itself or in combination with others, would be the best predictor of social workers’ utilisation of EPP. The study sample consisted of 163 social workers in Israel with varied experience in working with the unemployed, all working in public sector social services. Structural equation modelling performed on the attained data revealed that knowledge, skills and perceived organisational endorsement of EPP were positively associated with implementation of EPP. Contrary to the hypothesised, attitudes towards unemployment were not associated with the implementation of such practices. At the same time, professional training and seniority were associated with EPP only through the mediation of perceived organisational endorsement. Ultimately, perceived organisational endorsement of EPP emerged as the most influential factor involved in social workers’ decision to carry out EPP with their service‐users. Consequences of these findings for social work education, supervision, research and policy making are discussed, referring to the local Israeli context as well as its possible international inferences.     

Bridges, pathways and valleys: labour market position and risk of hospitalization in a Swedish sample aged 55-63

BACKGROUND: The combination of population ageing and increasingly early labour market exit (LME) throughout Europe has made older age a key issue in social policy and research. There is increasing awareness that older people are a heterogeneous group in which health inequalities persist. However, the effects of different types of LME on health have received relatively little attention. Existing studies reach different conclusions. This might be due to several reasons: different types of LME are rarely explored in conjuncture; studies often lack objective assessments of health and frequently rely on small populations. This paper aims to test the relative effects of different LME on the risk of hospitalization compared with those who remained in paid employment. METHODS: Using Government register data on pooled cross-section samples of Swedish workers aged 55-63 years (n=7,024) the authors have compared the likelihood of hospitalization for three types of LME - disability pension (fortidpension), unemployment, and early retirement - with those who continue working. RESULTS: Controlling for previous hospitalization, sex, age, social class, and health at work a significant increased risk of hospitalization was found following LME for the unemployed (OR=1.98). CONCLUSION: Early LME is a varied process with mixed effects on health, and hence is of possible importance for policy, which, therefore, requires more attention. Programmes to help older unemployed workers back into work will have positive health effects for individuals and reduce welfare costs of hospitalization.     

Unemployment, health and health services in German-speaking countries

The links between unemployment and health are manifold: Employment may lead to illness: health problems (that may lead to unemployment) often result from unfavourable working conditions of the (previous) employment. Another factor is job insecurity: fear of job loss increases the incidence of disease, and this applies not only to people who are emotionally unstable. Illness may lead to unemployment: in many cases, unemployment is caused by previous health impairments, which, to a considerable extent, also explain the duration of unemployment. Unemployment may lead to illness: there is evidence that unemployment not only reinforces existing physical disease but also acts as a risk factor for new ones. This seems particularly true for problem groups such as the unemployed elderly as well as for infants and children of unemployed people. The relations between unemployment and mental health are strong, mainly in terms of depression and alcoholism. Unemployment may lead to health: short-time work and short-term unemployment may improve health by reducing previous stress, caused by employment or by an overload with social roles. Even in the case of long-term unemployment there are some positive health effects as long as a minimum of social security and alternative social roles are available and useful activities--minor agricultural jobs, illicit work--can be carried out. The links between unemployment, work and society can considerably be loosened by a number of social factors and personal characteristics of the people affected. Existing health services are not in a position to deal with disease stemming from employment or unemployment except through symptomatical and curative therapies. In addition to general medical care, which is guaranteed by the German health insurance system for the unemployed, too, therapeutical measures are especially important in cases of depression and alcoholism. As a rule, the medical profession has no knowledge of the links between health, work and unemployment; such knowledge, however, would facilitate prevention. Individual prevention and rehabilitation measures are of great importance to problem groups suffering from cumulative or indirect unemployment, i.e. to unemployed elderly as well as to children of unemployed parents. Since the unemployed tend to isolate themselves, extramural services are useful. Specific services for the unemployed only are certainly not as helpful as multi-functional social services, such as those being already rendered by some self-help organizations, churches and trade-unions.(ABSTRACT TRUNCATED AT 400 WORDS)     

What do we know about partnership with service users and carers in social work education and how robust is the evidence base?

Partnership work with service users and carers in social work education is a policy requirement, and it is also central to the anti-oppressive and rights-based values of social work. This paper reports research findings which are drawn from an educational context, but are also relevant to the wider field of health and social care. The research team undertook a systematic knowledge review using the Evidence for Policy and Practice Information and Coordinating Centre system, which had been used in health and education, but which had not previously been used in social care and social work. This involved an extensive search of electronic databases and rigorous screening to identify studies which had sufficient relevance to be subjected to detailed analysis. The research team also undertook a practice survey of the teaching, learning and assessment of partnership in prequalifying programmes in England, Wales and Northern Ireland. This involved three stages: a document search; telephone interviews; and focus groups held with students, academic staff, and service users and carers. Throughout the research process, the interdisciplinary team was advised and supported by a stakeholder group which consisted of service users and carers, students, and employer representatives. In the second part of the paper, subsequent discussion explores key findings from the research, including the disputed nature of the concept of partnership, models of partnership work within social work education and the dearth of research on partnership outcomes. Five related questions are identified as a means of interrogating the robustness of the research process and findings. The paper concludes by arguing for work to be done to theorise partnership, and to develop effective strategies for improving the quality of partnership working in education, and health and social care practice.     

The burden of proof: The process of involving young people in research

Patient and public involvement in research includes non‐academics working with researchers, on activities from consultative tasks, to joint working, and on user‐led initiatives. Health and social care funding bodies require involvement in research projects. A current debate focuses on a perceived lack of empirical “proof” to demonstrate the impact of involvement upon the quality of research. It is also argued that the working relationships between researchers and those becoming involved need to be understood more fully. These areas are beginning to be reported upon but there are few studies of young people involved in health research. This study describes the experiences of adult academics and young people, working together on a large‐scale, UK health research programme. Using qualitative interview and focus group methods, the aim was to explore participants’ perceptions about the process and outcomes of their work together. The importance of cyclical, dynamic and flexible approaches is suggested. Enablers include having clear mechanisms for negotiation and facilitation, stakeholders having a vision of “the art of the possible,” and centrally, opportunities for face‐to‐face working. What is needed is a continuing discourse about the challenges and benefits of working with young people, as distinct from younger children and adults, understanding the value of this work, without young people having to somehow “prove” themselves. Involvement relies on complex social processes. This work supports the view that an improved understanding of how key processes are enabled, as well as what involvement achieves, is now needed.     

Adult disclosures of childhood sexual abuse and section 3 of the child care act 1991: past offences,current risk

In the Republic of Ireland Section 3(1) of the Child Care Act 1991 places an obligation and legal duty upon the State child protection services “to promote the welfare of children in its area who are not receiving adequate care and protection.” This article focuses on a specific element of this duty; the social worker’s responsibility to accept and assess retrospective reports of childhood sexual abuse. Retrospective disclosures of abuse are referrals made by adults of experiences they encountered as children. This article argues that current social work practice in this area lacks clarity and cohesion and while new policy and practice approaches are emerging ultimately there is a sense of confusion for both social workers and those adults affected by childhood abuse who come forward to disclose. This article presents an examination of the key judgement of Justice Barr in M.Q. v. Robert Gleeson and Ors [1998] 4 IR 85 and subsequent, related, precedents and how they relate to current Irish social work policy in this area. Adult disclosures of childhood abuse have the potential to bring alleged abusers to justice and thereby protect current and future children from harm. This article seeks to provide clarity, to social workers and those working with adults affected by abuse, regarding the Irish legal framework relating to adult disclosures of abuse as it stands. The article ultimately argues that further research and policy guidance is required.     

Mental health and individual experience of unemployed young adults in Japan

This study focused on the subjective experiences and mental health of young, unemployed adults in Japan. We explored how individuals describe their experiences of becoming unemployed and how these experiences influence their mental health within the current Japanese sociocultural context, using a social constructionist approach. We collected data from October 2012 to January 2013. Participants were 25 young unemployed Japanese job seekers (15 females), who were recruited using a purposive sampling strategy including snowball sampling. We conducted semi-structured interviews focusing on participants’ previous work and job search experience, their lifestyle and health, the social support they considered necessary, their future job-seeking plans, and their demographic characteristics. Using thematic analysis, we identified four key themes from the interview data: stress relief, re-energization for future work, new job skills acquisition, and lifestyle change. The findings indicate that unemployment is sometimes experienced as more beneficial than employment. This might be because of the poor working environment in Japan, the financial support participants received, and the experience of short-term unemployment. The findings suggest that intervention is necessary to help young adults in Japan find high-quality jobs and that we must promote fair employment and decent working conditions for them.     

The European Cancer and Work Network: CANWON

Purpose The number of cancer survivors is rapidly growing due to improved treatment and ageing population. Almost half of cancer patients will experience a cancer diagnosis during working age when career and work-related issues play an important role. Many cancer survivors are at risk for unemployment which greatly affects their quality of life and financial situation. Research on cancer and work is therefore of great importance but scattered over Europe and lacking appropriate dissemination. Moreover, interventions supporting employment of cancer survivors are urgently required but scarcely developed. Methods The European Cancer and Work Network (CANWON) aims to combine knowledge on: (1) prognostic factors of unemployment in cancer survivors including gender- and country-specific differences; (2) work-related costs of survivorship for both patients and society; (3) the role of employers; and (4) development and evaluation of innovative, interdisciplinary interventions which effectively support employment. Furthermore, it aims at disseminating research knowledge and best practice worldwide. Results CANWON currently unites 23 teams from 15 countries across different stakeholders and research areas. The expected benefits are rapid exchange of research knowledge, standardised methods and techniques, innovative interventions, future guidelines on cancer and work and the improvement of quality of life of cancer patients. Conclusions Understanding prognostic factors, work-related costs, role of the employer and innovative interventions in relation to work in cancer survivors might progress the understanding of other patients with long-term conditions therefore the knowledge resulting from CANWON will benefit a wide range of patient groups.     

Informal work, unemployment and health in Brazilian metropolitan areas, 1998 and 2003

This study investigates whether employment with no social security, as well as short and long term unemployment are associated with worse health among Brazilians. The representative study sample was taken from two National Health Surveys and included men aged between 15 and 64 who lived in one of the eight metropolitan regions of Brazil in 1998 (n = 31,870) and 2003 (n = 32,887). Both surveys showed that full and part time workers with no social security, as well as those in short and long term (> 12 months) unemployment had worse health indicators, regardless of age or schooling, when compared with full-time workers (> 40 hours/week) who had some form of social security through their employment. Hepatic cirrhosis was the disease most strongly associated with labor market status. Its prevalence was higher among individuals in long term unemployment and those with no social security. Labor market status was also negatively associated with the use of health care services, especially medical visits. The present study shows that the absence of social security at work, unemployment and length of unemployment, characterize heterogeneous groups of individuals in relation to health. Results reinforce the need to incorporate labor market status in research into health inequalities.     

Does health status improve after re-assumption of ABM employment?

Due to structural problems of the East German economy the level of unemployment will probably remain high for the next ten years. Thus, thousands of health-employment-schemes are established to reduce negative social and financial consequences of unemployment for those groups that are most affected. In this study the effects of temporary re-employment on health within the bounds of a job-creating measure are examined. By questionnaire employees of two firms in Magdeburg that exclusively occupies former unemployed men and women were asked about their subjective health status and changes in health status since re-employment. 217 employees filled the questionnaire (response rate: 50%; mean age: 45 years, mean duration of former unemployment: 18 months). About one half of the employees (48%) report positive effects on health after re-employment. This percentage is highest in the age group 50 years and older. The frequency of health impairments remained unchanged for half of the workers, the rest mainly stated fewer impairments. Poor working conditions or physical overtaxing decreases the positive effects of re-employment. Employees who had a positive attitude towards their work report on positive effects on health and other aspects of life more than average. CONCLUSIONS: Negative consequences of unemployment on physical and psychological health are well understood. On the other hand, our study demonstrates positive effects on health and a reduction of health impairments by temporary job-creating measures. This is influenced by the working conditions and the social environment of the employees. Further investigation are needed for detailed medical evaluation of job-creating schemes.     

The research, policy and practice interface: reflections on using applied social research to promote equity in health in Malawi

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.     

Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

This article reports the results of a review of the research evidence related to joint working in the field of adult health and social care services in the UK. It explores whether recent reforms to joint working have met the objectives set by policy‐makers. The review followed an established methodology: electronic databases were searched using predetermined terms, abstracts were screened against inclusion criteria, studies that met the criteria were read in full and assessed for inclusion and data were extracted systematically. The findings of the review suggest that there is some indication that recent developments, in particular the drive to greater integration of services, may have positive benefits for organisations as well as for users and carers of services. However, the evidence consistently reports a lack of understanding about the aims and objectives of integration, suggesting that more work needs to be done if the full potential of the renewed policy agenda on integration is to be realised. Additionally, while the review acknowledges that greater emphasis has been placed on evaluating the outcome of joint working, studies largely report small‐scale evaluations of local initiatives and few are comparative in design and therefore differences between ‘usual care’ and integrated care are not assessed. This makes it difficult to draw firm conclusions about the effectiveness of UK‐based integrated health and social care services.     

Accumulated labour market disadvantage and limiting long-term illness: data from the 1971-1991 Office for National Statistics' Longitudinal Study

BACKGROUND: Both social class and unemployment have been shown in many studies to be related to ill health. Recent work in social epidemiology has demonstrated the importance of examining the accumulation of disadvantage over the life course. This paper therefore uses a large longitudinal data set to examine the accumulation of both disadvantaged class and unemployment over a 20-year period in a representative sample of the male working population of England and Wales. METHODS: Logistic regression. RESULTS: Both membership of semi- or unskilled social class and unemployment in 1971 were related to limiting long-term illness (LLTI) in 1991 independently of each other, and of subsequent social class and unemployment. Any occurrence of disadvantaged social class or of unemployment added significantly to the risk of LLTI. A labour market disadvantage score comprising the number of occasions on which a study member had been either in a disadvantaged social class or unemployed showed a clear and graded relationship to illness, with odds of 4 to 1 in the worst-scoring group. CONCLUSION: The experiences of disadvantaged social class or unemployment at any time during this period contributed independently to an increased risk of chronic limiting illness up to 20 years later in the life course. Whereas improvements in social conditions at any one time will lessen the long-term combined impact of accumulated labour market disadvantage on health, it may not prove easy to obtain short term improvements in health inequality.     

Workshop on funding opportunities within the Food Standards Agency

During this workshop, held as part of a joint Nutrition Society and Food Standards Agency (Agency) meeting on Micronutrient interactions and public health, several precepts for a successful funding application to the Agency were discussed. These precepts, many of which can be used as guiding principles for project proposals to other funding bodies, are summarised as follows: remember that the Agency only supports research that will help them formulate or change human food policy; read the research requirements document thoroughly and plan your project to answer the call; remember that the Agency issues contracts, not grants; your project will be just one project within a focused and coordinated programme; collaborative work is encouraged, but this type of approach is not a licence to double or treble your costs; write a one-page executive summary and attach it to the front of the form;the statistical basis for your experimental design and proposed statistical analysis of your results are important criteria in the evaluation of your proposal; your plans for dissemination and exploitation are very important;match your project duration against your research plan; abide by the Agency plan for quality assurance for the management of research; make full use of the programme adviser and the Agency policy contact and the 'feedback' stage to refine your scientific ideas in line with Agency policy.     

Evaluation and design of a political-pedagogical project for nursing undergraduate programs

This work presents the results of an experience which aimed primarily at the evaluation of the Political-Pedagogical Project--PPP of the nursing undergraduate program from UNIOESTE (Cascavel town Campus) and at pondering on a new curricular proposal for that program. Thus, a research project was designed to be used by all professors teaching that program, with the participation of students, former students, and professionals working on the health care delivery network, where field work can be carried out through practical activities and training periods for the students. The data gathered by them have been used as subsidies for a proposal to build a new political-pedagogical project, that was took effect in the year 2003. Besides designing a new pedagogical proposal, strategies for a continued evaluation of the PPP implantation process have been defined. This evaluation is to be performed at the end of each term.     

Medical employment growth,unemployment, and the opportunity cost of health care

This policy note examines the relationship between the growth in the share of the workforce in medical care and the shares of workers who are unemployed, working in services or government employment, or working elsewhere in the economy. These changes provide measures of the opportunity cost of higher medical care spending, the majority of which is on labor. Using state data over the period 1990–2010, we find that, in years of high economy-wide unemployment, growth in medical employment in a state reduces the unemployment rate significantly; it does not appear to displace employment in other services or government employment. In periods of low economy wide-unemployment, the growth in the medical employment share does not reduce unemployment. We argue that the opportunity cost of higher medical care employment may sometimes not be so high in terms of real labor resources, nor in terms of employment for needed government services.