Suchergebnisse

AbstractFamily group conferencing (FGC) coordinators in public mental healthcare are confronted with clients who have little faith in professionals and organizations, who hold off decisions in their family life, who avoid care and who sometimes behave in a hostile manner. A lack of initiative to deal with their situation is not only reserved for clients – all bystanders, including professionals, can suffer from it. The multiplicity and severity of the client's problems lead to a situation wherein everyone involved waits for the initiative of the other. The independence of the FGC coordinator – a fellow citizen, who is free of organizational loyalties and comes to assist other citizens in establishing a plan – seems to work well with the client group of the public mental healthcare. However, the coordinator cannot always prevent deferral or failure of conferences. Drawing on empirical and theoretical findings, this paper considers the possibility of collecting feedback as a way to contribute positively to the alliance between FGC coordinators and those for whom a conference is deployed. We highlight findings from three case studies that centred on multiproblem families. The findings indicate the importance of feedback theory for FGC coordinators in enhancing trust and engagement.

Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in this article identified as care paralysis. The aim of this article is to understand the production and reduction of care avoidance and care paralysis. Care avoidance and care paralysis not only coincide, they reinforce and recall each other. Trust and initiative — the opposite of avoidance and paralysis — are affirmed under conditions as an experienced proximity between the local population and care facilities and the committed involvement of professionals to a bounded territory. Trust and initiative also coincide, reinforce and recall each other. The existence of a safety net like Public Mental Health Care is closely linked to the absence of this vitality.

AbstractBackgroundThe introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families.MethodA scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis.ResultsThe key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families.ConclusionAlthough qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised.

Summary Clients in public mental health care have limited social capital; they lack trusting and mutually supportive relations within bonded groups and do not have access to supportive external groups. Family Group Conferencing (FGC) is a promising decision-making model to restore social ties and mobilise informal support. From January 2011 to September 2013, 41 family group conferences were organised in a Dutch public mental health care setting and studied using a qualitative case study methodology. Twenty-three of the conferences were successful in meeting their goals. This article reports on findings from the other 18 family group conferences that apparently had failed as the preparations became stuck or because a plan was never reached or fully implemented. Semi-structured interviews with 118 out of a possible total of 215 FGC participants were conducted to examine the process and impact of the conferences. Findings The interviews indicate that conferences were often held as a last resort, in situations where professional care had already failed prior to the conference. The intended goals of the conferences were not achieved because support from the social network was insufficiently mobilised and clients themselves felt helpless that they could improve their conditions. Applications A single conference seems insufficient on its own to break through a sense of inadequacy and paralysis. Social capital theory points to the necessity of not only renewing informal networks ('strong ties') but of expanding networks through connecting public mental health care clients to paid and volunteer work ('weak ties'). FGC plans can include such action steps. Instituting a 'family manager' to monitor these steps may support the bonding of 'strong ties' and the bridging to 'weak ties'.

Summary The number of compulsory admissions in Dutch psychiatry has increased in the past 25 years. The reduction of coercion with Family Group Conferences in youth care has been successful. How, when and under what conditions can Family Group Conferences reduce coercion in adult psychiatry, is subject of an extensive inquiry. This paper, however, focusses on the reverse question, namely, in what circumstances can Family Group Conferences not be deployed? An answer to this question provides insights regarding situations in which Family Group Conferences may (not) be useful. Barriers in 17 cases were examined using multiple case studies. Findings The following barriers emerged: (1) the acute danger in coercion situations, the limited time available, the fear of liability and the culture of control and risk aversion in mental health care; (2) the severity of the mental state of clients leading to difficulties in decision-making and communication; (3) considering an Family Group Conference and involving familial networks as an added value in crisis situation is not part of the thinking and acting of professionals in mental health care; (4) clients and their network (who) are not open to an Family Group Conference. Applications Awareness of the barriers for Family Group Conferences can help to keep an open mind for its capacity to strengthen the partnership between clients, familial networks and professionals. The application of Family Group Conferences can help to effectuate professional and ethical values of social workers in their quest for the least coercive care.