Ethnic aged discrimination and disparities in health and social care : a question of social justice

Older overseas-born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a 'special needs' group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian-born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult.

Morals, rights and practice in the human services : effective and fair decision-making in health, social care and criminal justice

Provides a synthesis of human rights theory and human services practice and offers a rights based model to aid professional decision making and practice.

Power and participation: enhancing service user agency in social care

The research explored how community services organisations could enhance service user agency through a participatory approach to service development. It demonstrates, theoretically and empirically, how participation can offer individual empowerment and wellbeing benefits to service users, and deliver insights for organisations and government into how they could improve their services.

The origins of contemporary primary health care

This chapter begins by exploring the concept of primary health care (PHC), linking this to relevant international and national policy documents, and introducing the concept of PHC developed by the World Health Organization. The chapter then focuses on the UK. It explains how PHC is not just found within the NHS, reviews the different sectors involved in PHC, and then discusses the current structure of PHC in the NHS. Key concepts, including the primary health care team, primary care trusts and integrated heath and social care trusts, and the relevant current UK policy documents are introduced.

The chapter then moves on to discuss four important issues in the provision of primary health care in the community: health promotion; tackling health inequalities; health and regeneration; and, tackling domestic violence. The subsection on each of these will explain why the issue is of particular significance and review briefly a number of studies/projects which illustrate what is happening/can be done; this will introduce a range of current research. The chapter concludes with a short review of challenges for the future, emphasising the important role that the nursing profession has to play in meeting these challenges.

Coproduction in practice : participatory action research to develop a model of community aged care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.

Using vignettes to evaluate the outcomes of student learning : data from the evaluation of the new social work degree in England

This paper reports the use of vignettes as a methodology to analyse the extent to which the new social work degree programmes enabled students to develop their analytical and reflective capabilities. Two vignettes, which focused on children and families and adult social care respectively, were developed for the study. Students were asked to respond in writing, from the perspective of a social worker, to a standard set of questions at the beginning (T1) and end of their degree programme (T2). Considering the responses to all questions across the two vignettes, a series of scales was developed to measure the key themes which had been identified by qualitative analysis. These included ‘Attention to process of relationships’ and ‘Social/structural/political awareness’. Responses were also rated as ‘descriptive’, ‘analytic’ or ‘reflective’.

Students from six universities in England participated. From an original sample of 222 students, it was possible to match 79 T1 and T2 responses. Analysis of variance demonstrated statistically significant increases in nine of the 11 themes and increases in ratings for analysis and reflection.

In conclusion, vignettes can be used to produce both qualitative and quantitative data in respect of changes in students’ acquisition of knowledge and skills over time.

Communication pathways in community aged care: an Australian study

Background:
Health and social care practitioners collaborate in discharge planning for older people. Difficulties securing timely and quality discharge information and unclear role boundaries can be challenging. There are limited reports in the literature describing community-based practitioners' roles communicating client information.

Aim:
To describe the roles of community-based practitioners in communication of older clients' information in an Australian context.

Design:
A descriptive and exploratory qualitative research design was applied.

Methods:
Four focus groups were conducted in 2009 with a small sample (n = 16) of district nurses, practice nurses and aged care case managers.

Results:
All participants described communication as a core characteristic of their role focused on minimising risks for older people. Participants valued dialogue with other health and social care providers in real time with an emphasis on telephone communication, face-to-face meetings, and case conferences. Telephone communication was considered important where there was an urgent need to problem solve. Written communication was noted as less effective.

Conclusions:
There is an increasing need for stronger models of communication in community-based settings to facilitate safe, efficient and sustainable health and social outcomes for older people.

Implications for practice:
There is limited available research with this focus to guide practice. Findings from this exploratory study indicate a number of important areas for further research: (i) to understand how communication feedback systems and pathways between community and inpatient providers could improve information exchange and (ii) to describe community nurses' roles in communication and medication risks for older people.

A systematic narrative review of consumer-directed care for older people: implications for model development

Consumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people.

Learning and teaching assessment: reviewing the evidence

The authors have recently completed a research review on learning and teaching of assessment in social work which was commissioned by the Social Care Institute for Excellence (SCIE) and the Social Policy and Social Work Learning and Teaching Support Network (SWAPltsn) to support the development of the new social work award in England. This involved reviewing relevant literature from social work and cognate disciplines back to 1990 with the aim of identifying best practice in learning and teaching of assessment skills.

Although assessment has been recognised as a core skill in social work and should underpin social work interventions, there is no singular theory or understanding as to what the purpose of assessment is and what the process should entail. Social work involvement in the assessment process may include establishing need or eligibility for services, to seek evidence of past events or to determine likelihood of future danger, may underpin recommendations to other agencies, or may determine the suitability of other service providers. In some settings assessment is considered to begin from the first point of contact and may be a relatively short process, whereas elsewhere it may be a process involving several client contacts over an extended period of time. The assessment process may range from the collection of data on standardised proforma to a flexible approach depending on circumstances. These variations permeate the literature on the learning and teaching of assessment in social work and cognate disciplines.

Several different approaches to classroom based learning were proposed in the literature including case-based teaching, interviews with actors who have been trained to play 'standardised clients', and observation of children and families, as well as didactic lecturing and various uses of video equipment and computers. Furthermore learning by doing has long been one of the hallmarks of social work education, and there are a number of models proposed in which students learn about the assessment process through conducting assessments. The evidence to support these different approaches to learning and teaching is variable. Based on the evidence reviewed, recommendations as to what is good practice in learning and teaching about assessment will be presented.

Population ageing and the politics of demographic alarmism : implications for the nursing profession

Objectives
This article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people is highlighted.

Setting
Australia

Subjects
Australia's ageing population and succeeding generations over the next 40 years

Primary argument
According to the Australian government, population ageing in Australia is poised to cause unmanageable chaos for the nation's public services. The cost of meeting the future health and social care needs of older Australians is predicted to be unsustainable. Officials argue that government has a stringent responsibility to ration current and future resources in the health and social care sector, cautioning that if this is not done, the nation's public services will ultimately collapse under the strain of the ever increasing demands placed on these services by older people. This characterisation of population ageing and its consequences to the nation's social wellbeing may however be false and misleading and needs to be questioned.

Conclusion
The nursing profession has a fundamental role to play in ensuring responsible debate about population ageing and contributing to public policy agenda setting for the effective health and social care of Australia's ageing population.

Towards a framework for implementing individual funding based on an Australian case study

Although individual funding is increasingly being used around the globe as a mechanism to fund social care, its implementation is proving to be problematic and implementation strategies are not well developed. This paper proposes a framework for the successful introduction and implementation of individual funding programs based on the analysis of data collected in a qualitative case study conducted in an Australian not-for-profit disability agency over a 4-year period from 2003 to 2007. Data were gathered through participant observation and interviews with program participants and managers, and the findings were validated with those involved. Bronfenbrenner’s ecological systems theory is used to analyze the findings from a micro, meso, exo, and macro perspective. The following factors were found to be important for successful implementation: the meaningful involvement of the person with disability in decision-making; adequate resources; access to information and appropriate supports; suitable activities being available; knowledge of policies and procedures; policies ensuring oversight and responsible accountability; employment conditions for workers being safeguarded; and support for staff and managers to adjust to their new roles. Knowledge of effective implementation strategies is important for disability agencies and for governments promoting individual funding because this radically different funding arrangement requires new implementation strategies.