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PubMed2001

Egalitarian aspects of medical and social services.

Unmet needs for medical and social services are present in all socioeconomic strata, but workers and poor people suffer most. Satisfaction of the needs of these groups could help to narrow the differences in health and survival between social classes. As needs for services change with the historical period, age, and changing attitudes to help-seeking in younger generations, we require cohort studies of needs measured directly in random samples of the population. Cohort analyses could form the basis for future plans to provide services equitably.

Health Care Rationing↗
PubMed1980

Distribution of social service expenditures: a study.

Because this country is providing more social service through public programs, it is important that professionals as well as policymakers understand how the billions of dollars devoted to these services are being spent. This study investigated patterns of distribution of social service expenditures and found a trend toward equalization of expenditures among the states.

Analysis of Variance↗
PubMed1997

Population predictors of community health and social service use in Northern Ireland.

STUDY OBJECTIVE: To investigate the characteristics of elderly populations associated with variations in their use of community health and personal social services and to test the hypotheses that the variations are related to: (a) the age structure of an elderly population; (b) the population's socioeconomic composition, including the level of deprivation; and (c) household or living arrangements. DESIGN: A common file of 1991 population census and 1994 NHS community trust operational variables was constructed for 67 postcode sectors, with the independent variables describing the age-sex groups to be studied. Clear criteria for the exclusion of "empty" sectors were developed. Relationships using bivariate and multivariate correlation and stepwise multiple regression were explored. SETTING: Eastern Health and Social Services Board area, Northern Ireland (Belfast and hinterland). PARTICIPANTS: Population of statutory pensionable age; in aggregate, younger and older age bands. MAIN RESULTS: The age structure or mean age of the elderly population had only a weak association with the community health and social service client rate, but there were strong associations with socio-economic variables, particularly the percentage of those living alone who were without a car and the percentage of pensioner households that included an adult of below pensionable age. Parsimonious multiple regression models accounted for between 46% and 80% of the variation in the NHS community trust client rate. Greater explanations were achieved for the young elderly population than for those aged 75+ years and, when the population was divided between young and old age bands, for men than for women. CONCLUSIONS: Community health and social services for elderly people in eastern Northern Ireland were focused on those with a low income and those who were not co-resident with adults of working age. When local elderly populations are compared, per capita morbidity and dependency are often higher where the mean age is low, and vice versa, because of the inverse relationship between socioeconomic status and survival in old age. Capitation scales for resource allocation with positive age weighting will be of little use if no account is taken of the relative prevalence of need in the youngest or base age group.

Age Distribution↗
PubMed1999

Costs of health care and social services during the first year after ischemic stroke.

OBJECTIVES: Knowledge of resource use and costs can be useful when evaluating existing services or planning new services. This study investigates the use of health care and social services during the first year after a stroke. Total costs are calculated, costs are compared across subgroups of patients, and resource items of major importance for the total costs are identified. METHODS: The study is based on a database comprising data on all stroke patients admitted to a university hospital in Copenhagen, Denmark, over a 1-year period, 1994-95. Patients were followed for 1 year after the stroke, and data on resource use during and after hospitalization were collected prospectively at interviews. This paper focuses on a subset of 385 patients who were admitted because of cerebral infarct or unspecified stroke. RESULTS: The mean cost, based on all patients, of health care and social services during the first year was 142,900 DKK (US $25,500). The hospital care until the first discharge, including acute care and rehabilitation, cost 101,600 Danish krones (DKK) (US $18,100), i.e., 71% of the total cost. Major resource items after discharge were nursing homes, readmissions, outpatient rehabilitation, and home help. The cost during the first year varied with a number of factors, with the most important being survival and degree of disability. Patients who survived the acute phase and who had severe disability (Barthel Activities of Daily Living [ADL] Index: 0-9) 7-10 days after admission had a total cost during the first year that was five times as high as patients with no disability (Barthel ADL Index: 20). CONCLUSION: Costs of health care and social services during the first year after a stroke vary considerably. Disability as measured with the Barthel ADL Index is a stronger predictor of costs than Scandinavian Stroke Scale scores and other clinical and demographic variables.

Aged↗
PubMed1996

Community care and social services.

The aim of community care is to enable people with various types of disability to live in their own homes, rather than in institutions. This involves the provision of support and services at home by various agencies. After a critical report in 1986 identified problems with coordination and flexibility of community care services, the white paper Caring for People (1989) stated the government's aim to provide a "needs led," responsive range of services, promoting maximum independence of those wishing to live at home rather than enter institutional care. New arrangements were introduced in 1993, involving a formal assessment procedure and the production of a personalized care plan for each individual, incorporating services provided by private and voluntary agencies as well as by social services departments. This article describes the components of community care services supplied by local social services authorities, including housing adaptations, equipment, telephones and alarms, home care, meals, and respite care.

Aged↗
PubMed1976

Unmet social service needs in skilled nursing facilities: documentation for action.

The skilled nursing facilities in Hennepin County were surveyed to measure 21 specific social services in five general categories of service. Quantitative distribution summaries were made on understanding, performance, and satisfaction for each social service, and the five general categories of service were compared. Cross-tabulations indicate a significant difference in facilities with social work staff. Further study is recommended, and immediate actions to rectify current social service deficiencies are cited.

Aged↗
PubMed1976

The health of clients of a social service department.

A survey was undertaken of the health problems and current medical care of new clients making contact with the Social Service Department of an outer London borough. The findings indicated that social-service clients represent a high-morbidity group of the population: 47 per cent of the survey sample showed evidence of major physical illness or disability, and 16 per cent of major mental illness. A sub-group was identified, corresponding to about 300 new clients annually, who suffered from serious ill-health or disability, but were at the time not under medical care.These findings support the argument for closer liaison between medical and social services in the community and, in particular, for more social-worker attachments in general practice.

Adolescent↗
PubMed2001

Health and social service utilization among elderly immigrants from the former Soviet Union.

PURPOSE: To explore factors that affect health and social service use among elderly Russian immigrants from the perspectives of the elders, their adult caregiving children, and the health and social service professionals who serve them. METHODS: A qualitative, case-oriented study design was used and 17 elderly Russian immigrants, 8 adult caregiving children, and 15 health professionals were interviewed in the Boston area in 1998. Perceptions about the patterns of and reasons for Russian elders' health and social service use were summarized through content analysis of the interview data. FINDINGS: Participants across groups perceived extensive service use by elderly Russian immigrants. Life circumstances associated with immigration, cultural norms and beliefs, and structural characteristics of the local Russian immigrant community accounted for service use. CONCLUSIONS: Findings indicate that providing support for depression and loneliness associated with immigration, educating immigrants about the role of primary care providers in the US as well as realistic expectations for American medicine, and managing care to decrease the use of unnecessary services would facilitate appropriate service use among elderly Russian immigrants.

Aged↗
PubMed2005

Interprofessional working in the context of newborn hearing screening: Education and Social Services compare challenges.

This article presents data from a study undertaken as part of the national evaluation of the introduction of the newborn hearing screening programme (NHSP) in England. It considers the impact on Education and Social Services of NHSP from the perspective of how each agency perceives each other's role in circumstances where NHSP is requiring a greater focus on interagency and interprofessional working. The qualitative interview study involved 27 education and 15 social services respondents from phase 1 NHSP sites. It reveals considerable agreement on the poorly developed nature of joint working but considerable disagreement about the roots of such. Education is more likely to focus on issues of role, value and skills; social services on conflicts of ethos and culture. The problem of social services' capacity to respond to referrals concerning deaf children was common to both. The findings are placed in the context of government guidance, in particular Early Support and Children's Trusts, both of which support a strategic and statutory basis for interprofessional working in this context.

England↗
PubMed1992

[Problematic situations of intercultural misunderstanding in social services].

This article discusses research on the difficulties of practising social work in a multicultural and multiethnic context. The research is based on critical incidents that were experienced by 40 social workers in "the most ethnic" public social service centres of the Montréal region in 1990-1992. The most significant culture shocks that occurred between workers of a developed Western-type society and clients from developing, non-Western societies relate to a different notion of the role of social services, to different methods et educating children, to unequal relationship between men and women, to a different notion of family and to a different notion of physical and mental health. The authors emphasize that a better understanding of these shocks and an effort to identify and analyze these sensitive zones of intercultural encounter can have a definite impact on the practice and training of social workers.

Adolescent↗
PubMed1998

Changes in primary health care policy: the implications for joint commissioning with social services.

Both the primary health care team (PHCT) and social services departments in the UK have undergone substantial changes to their organization and function since 1990. This paper looks at developments in primary health care policy that have affected the relationships between them regarding the commissioning of health and social care services. It focuses on evidence from seven initiatives designed to involve members of the PHCT in commissioning social care services. It examines some of the benefits and challenges of working together to commission services for health authority managers, GPs, district nurses, care managers and social work team managers in the light of impending changes to the PHCT, particularly the abolition of fundholding and the introduction of Primary Care Groups.

Journal Article↗
PubMed2006

[The future economic burden of dementia on health and social services].

INTRODUCTION: Demographic changes in Denmark over the next 15 years will result in an increased number of elderly people and of individuals with dementia. As a result this will increase the demand for health care and social services. The aim of this study was to shed light on the likely economic consequences of this development. MATERIALS AND METHODS: A simple static, comparative model based on Danish incidence and cost data for different age groups and different levels of dementia severity was developed. The model projected the costs of the health and social services for treatment and care of people with dementia up to the year 2020. RESULTS: The future demographic changes and an increasing number of people with dementia will result in a 30% increase in health and social service costs due to dementia. This increase will be lower if individuals with dementia have a higher mortality rate than other individuals. If annual productivity gains of 1-3% can be achieved, the future cost (in real prices) could be reduced. CONCLUSION: The Danish health and social services will in the future be faced with increased costs for the treatment and care of people with dementia. This could be achieved through productivity gains, an increased level of financing or prioritisation of services that provide good value for money.

Aged↗
PubMed1997

Homeless veterans: perspectives on social services use.

This study analyzes the nature and scope of homelessness and issues related to social services use. Using focus group interviews, this exploratory study examined the expressed needs of homeless veterans and the obstacles encountered in obtaining health and human services. Types of problems and social services barriers were developed with exemplars from the interviews. These veterans self-reported a high incidence of health and mental health problems, limited resources, negative public perceptions and treatment, insensitive service providers, dehumanizing policies and procedures, and high levels of stress and frustration with the service delivery system. They encountered personal, situational, and bureaucratic barriers to obtaining services and were highly critical of service providers. These findings suggest a need for greater emphasis on advocacy-based case management services, affordable housing, employment opportunities, increased sensitivity in service delivery systems, and empowerment-centered practice.

Adult↗
PubMed1977

Can private hospitals afford to provide social services?

This article describes a fee-for-service charging system for social work services in a "private" hospital. This system was developed because the financial pressures of the day appear to be causing a trend to decrease the level of social services provided in hospitals. The system has provided the Department of Clinical Social Work the opportunity to demonstrate the marketability of social work and to assure the department's financial viability.

Attitude of Health Personnel↗
PubMed2001

Social services referral of adolescent trauma patients admitted following alcohol-related injury.

Alcohol screening of severely injured patients should be universal. Hospitalization following alcohol-related injury provides an opportunity for intervention to reduce recidivism. This study examines the frequency of social services referral of an alcohol positive cohort of adolescent trauma patients. This was a retrospective analysis of data collected from 1994 through 1998 by the National Pediatric Trauma Registry. All patients between the ages of 12 and 17 who had a blood alcohol level (BAL) measured were analyzed. Patients receiving referral to the department of social services, family counseling, or addiction services, and those receiving any substance abuse education intervention were considered a positive referral. There were 6006 children age 12 to 17 included in the database during this five-year period, 751 of whom had a BAL measured. Of those screened, 15.5% were positive. Sixty-eight (59%) of the BAL positive patients were referred for intervention through social services. The only statistically significant predictor of referral was whether or not the patient was the operator of a vehicle involved in the motor vehicle collision. Nearly half of the adolescents in this study, who screened positive for alcohol, received no social services support.

Accidents, Traffic↗
PubMed2004

Privatized management in urban public housing: a comparative analysis of social service availability, utilization, and satisfaction.

This article presents the results of a study that assessed the effect of privatized management on social service availability, utilization, and resident satisfaction in public housing communities. The respondents were heads of household who lived in public housing "projects" in Miami, Florida-more than 90 percent of whom were African American women. A quasi-experimental design with nonequivalent control groups compared respondent data from privately and publicly managed sites. Publicly managed sites reported more availability of social services, but privately managed sites reported higher levels of use. Implications for welfare reform, public housing demolition or renewal policies, the importance of social services with self-sufficiency efforts, and the need for culturally sensitive social work practices in ethnic minority public housing communities are discussed.

Consumer Behavior↗