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The contribution of professions to the governance of integrated care: towards a conceptual framework based on case studies from Denmark
- Authors:
- BURAU Viola, KUHLMANN Ellen, LEDDERER Loni
- Journal article citation:
- Journal of Health Services Research and Policy, 27(2), 2022, pp.106-113.
- Publisher:
- Sage
- Place of publication:
- London
Objective: Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark. Methods: We developed a framework, which identified the what, how and why of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements. Results: Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns. Conclusions: Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care. (Edited publisher abstract)
A personalized dementia care intervention for family carers from minority ethnic groups in Denmark: a pilot study
- Authors:
- NIELSEN T. Rune, NIELSEN Dorthe S., WALDEMAR Gunhild
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 21(2), 2022, pp.477-488.
- Publisher:
- Sage
Background: There is a growing number of people with dementia in minority ethnic groups in Denmark. Support for the increasing number of family carers from minority ethnic groups is crucial, as caring for a relative with dementia may negatively affect the carer’s health and quality of life. The aim of this study was to determine the feasibility of a personalized intervention for family carers from minority ethnic groups. The intervention was a modified version of a culturally sensitive case-management program developed in Australia which had been shown to improve carers’ sense of competence in managing dementia and their mental well-being. Methods: A small pilot trial was used to examine the feasibility and preliminary efficacy of the intervention. Feasibility indicators included data on recruitment, retention, adherence, and fidelity. Acceptability and suitability of the intervention was explored in post-intervention interviews with family carers, and baseline and follow-up scores for outcome measures were examined. Results: Ten (30%) of 33 eligible family carers consented to participate in the study, but three were lost to follow-up and seven (70%) family carers completed the trial. Intervention fidelity, acceptance, and satisfaction were high. Results for outcome measures indicated that the intervention may improve family carers’ sense of competence by helping them cope better with challenges relating to caring and managing dementia and improved their satisfaction with primary care services. Conclusions: The results suggest that the intervention is feasible and worth exploring for family carers of people with dementia from minority ethnic groups in Denmark. (Edited publisher abstract)
COVID-19 and policies for care homes in the first wave of the pandemic in European welfare states: Too little, too late?
- Authors:
- DALY Mary, et al
- Journal article citation:
- Journal of European Social Policy, 32(1), 2022, pp.48-59.
- Publisher:
- Sage
This article examines COVID-19 and residential care for older people during the first wave of the pandemic in 2020, comparing a range of countries – Denmark, England, Germany, Italy and Spain – to identify the policy approaches taken to the virus in care homes and set these in institutional and policy context. Pandemic policies towards care homes are compared in terms of lockdown, testing and the supply of personal protective equipment. The comparative analysis shows a clear cross-national clustering: Denmark and Germany group together by virtue of the proactive approach adopted, whereas England, Italy and Spain had major weaknesses resulting in delayed and generally inadequate responses. The article goes on to show that these outcomes and country clustering are embedded in particular long-term care (LTC) policy systems. The factors that we highlight as especially important in differentiating the countries are the resourcing of the sector, the regulation of LTC and care homes, and the degree of vertical (and to a lesser extent horizontal) coordination in the sector and between it and the health sector. (Edited publisher abstract)
Commodification and care: an exploration of workforces’ experiences of care in private and public childcare systems from a feminist political theory of care perspective
- Author:
- RICHARDSON Brooke
- Journal article citation:
- Critical Social Policy, 42(1), 2022, pp.107-128.
- Publisher:
- Sage
Drawing on feminist care ethics and political theory (Engster and Hamington, 2015; Held, 2006; Noddings, 2015; Tronto, 2013), this paper examines how educators working in private (Ontario) and public (Denmark) childcare systems think about and practice care. Through interviews with pedagogues (Denmark) and early childhood educators (Ontario), linkages between the public/private positioning of care and the care experiences of educators are explored. The findings reveal differences in how educators think about and practice care in public and private systems. At the same time, notable similarities emerged in how educators resisted neoliberal system requirements. The findings illustrate the complexities of connecting good care practices to the systemic level without diminishing the importance of individual human agency in experiencing/practicing good care in Early Childhood Education and Care (ECEC). Findings suggest that good care and commodification are both theoretically and practically at odds with each other, though neither absolutely precludes the other. Implications for policy makers, particularly relevant in the contemporary COVID context, are discussed. (Edited publisher abstract)
A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: results from a mixed-methods study
- Authors:
- SKOV Sofie S, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 21(1), 2022, pp.316-334.
- Publisher:
- Sage
Background: There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. Design: A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark (N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants’ physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. Results: The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants’ physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. Conclusion: This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits. (Edited publisher abstract)
Action plans as active boundary objects
- Authors:
- BECK Anne-Marie Tyroll, RASMUSSEN Bo Morthorst, NIELSEN Tina K. Harlev
- Journal article citation:
- Research on Social Work Practice, 31(4), 2021, pp.382-389.
- Publisher:
- Sage
This article presents how action plans are used as active boundary objects in the meeting between the client, the social worker, and the interprofessional partners within the four core social service areas in Denmark: children and families, handicap, adults at risk, and employment. Empirically, the article is based upon the analysis of 16 action plans and 21 interviews. The theory of boundary objects is applied to illustrate and explore how action plans can create integration across different social and professional domains, or worlds. The degree of integration is illustrated through the theory of interprofessional collaboration, which forms the basis of four ideal types of action plans as boundary objects: the joint plan, the professional one, the administrative one, and the symbolic plan. We find that action plans have a large but often unexploited potential as an active and effective boundary object and only a few functions as joint plans. In order to be an active boundary object, both user and interprofessional involvement are required in making the plans. This requires a highly structured and preferably systematic involvement in face-to-face dialogue meetings led by the social worker as well as frequent follow-up at a distance. (Edited publisher abstract)
Rotational care practices in minority ethnic families managing dementia: a qualitative study
- Authors:
- NIELSEN T. Rune, WALDEMAR Gunhild, NIELSEN Dorthe S.
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(3), 2021, pp.884-898.
- Publisher:
- Sage
Background: Although minority ethnic families have a lower uptake of dementia care services, little research has explored how minority ethnic carers cope with and manage dementia care in their everyday lives. The aim of this study was to investigate organization of family dementia care in Turkish, Pakistani, and Arabic speaking minority ethnic families from the perspective of family carers, primary care dementia coordinators, and multicultural link workers in Denmark. Methods: Semi-structured qualitative individual and group interviews with minority ethnic family carers, primary care dementia coordinators, and multicultural link workers. Hermeneutic phenomenology was used as theoretical framework and results were analyzed using thematic analysis. Results: A total of 21 individual and four group interviews were conducted, including a total of 30 participants. A key finding was that the care responsibility was usually shared between several family members, who took turns to provide 24-hour care for the person with dementia. Rotational 24-hour care, either by having the person with dementia live with different family members or by having different family members take turns to move in with the person with dementia, emerged as a common alternative to formal care. Another important finding was that despite decreasing the burden of care of individual family carers, rotational care could be confusing and stressful to the person with dementia and could have a negative impact on the quality of life of all involved. Conclusion: The way minority ethnic families organize dementia care have implications for understanding and communicating about support needs. Higher reliance on shared family care should not be taken to indicate that minority ethnic communities are not in need of support from formal services. (Edited publisher abstract)
Lacking social skills: a social investment state’s concern for marginalized citizens’ ways of being
- Authors:
- PRIEUR Annick, JENSEN Sune Qvotrup, NIELSEN Vibeke Bak
- Journal article citation:
- Critical Social Policy, 40(4), 2020, p.608–626.
- Publisher:
- Sage
The Danish state is preoccupied with its citizens’ social skills, which are seen as important for the nations’ competitiveness. Such skills regard self-presentation, communication, emotional control etc. This article relies primarily on interviews with Danish social workers who are involved either in assessing young marginalized welfare clients’ personal readiness for schooling or employment or in preparing them for this through social skills training. Secondarily, it relies on fieldwork data from young Danes at the margins of the educational system and/or the labour market, who are frequently confronted with a devaluation of their personal ways of being. As personal resources related to ways of being, communicating, handling emotions etc. are ascribed social value, especially at the labour market they may work as a form of capital, while the lack of them may be a source of marginalization. These findings are discussed as signs of more general social normative demands, theoretically grasped in the meeting point of Bourdieu’s understanding of embodied cultural capital, of Skeggs’ analysis of how subjects are attributed value or not, and of Illouz’s investigation of the emotional demands contemporary capitalism puts on employees. Understanding the experiences of those who fail to comply with implicit social requirements for personal resources thus shed light on contemporary requirements regarding how to behave and communicate with other people as well as on the state’s investments in the most personal spheres of its citizens. (Edited publisher abstract)
The effect of long-term, group-based physical, cognitive and social activities on physical performance in elderly, community-dwelling people with mild to moderate dementia
- Authors:
- JUNGE Tina, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 19(6), 2020, pp.1829-1843.
- Publisher:
- Sage
Background: Elderly people with dementia are known to be less physically active compared with elderly, healthy people, emphasizing the need for interventions in order to maintain a high level of independence in activities of daily living. The aim was to evaluate the effect of long-term, group-based rehabilitation including physical activity on physical performance in elderly, community-dwelling people with mild to moderate dementia. Methods: A quasi-experimental study of 18 elderly, community-dwelling people, diagnosed with mild to moderate dementia, participated in an ongoing rehabilitation programme based on integrated physical, cognitive and social activities. The outcome measure was physical performance: the 30-second sit-to-stand test, Guralnik balance test, 10-metre walking speed test, timed 6-metre walk test and a timed dual task walk test. The repeated measure ANOVA was used to analyse any overall differences between related means. Results: No significant effect of time was found for the five outcome measures during the entire period. The variation in the estimate of most outcome scores was higher within subjects than between subjects during the period. Profile plots illustrated that three of the participants, who experienced severe cognitive deterioration, markedly declined in all physical performance tests. Conclusion: The expected, progressive deterioration in physical performance was delayed in a small group of home-dwelling people with mild to moderate dementia participating in long-term, group-based rehabilitation. Long-term, group-based rehabilitation may have the overall potential to delay deterioration in activities of daily living performance in home-dwelling people with mild to moderate dementia; however, more studies with larger samples are needed to confirm the findings of this study. (Edited publisher abstract)
User involvement in social work innovation: a systematic and narrative review
- Authors:
- MULLER Maja, PIHL-THINGVAD Signe
- Journal article citation:
- Journal of Social Work, 20(6), 2020, pp.730-750.
- Publisher:
- Sage
This article focuses on user involvement in social work innovations in the public sector and provides an overview of how public innovation via user involvement in social work has been studied to date. Through analyses based on a systematic review combined with a narrative review of the identified literature, the study offers a typology of social work innovations. The article concludes by discussing possibilities and barriers inherent in user involvement in social work and suggesting topics for future research. Findings: Through a systematic review the authors identify the relevant literature describing different kinds of user involvement in social work innovation. In the narrative review, they analyze the literature and identify three types of innovation: user-centered innovation, co-produced innovation, and citizen-driven innovation. With empirical examples the study illustrates the different types of innovation and the citizen’s role in the different innovation processes. Application: The typology provides an analytic tool to differentiate types of innovation and user involvement, but it may also function as inspiration to practitioners to reflect more about the roles of users and frontline workers and to be more aware of existing barriers when designing new social initiatives in the public sector. (Edited publisher abstract)