Delivering Home-Based Services

Delivering Home-Based Services: A Social Work Perspective

Susan F. Allen
Elizabeth M. Tracy
Copyright Date: 2009
Pages: 344
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  • Book Info
    Delivering Home-Based Services
    Book Description:

    Service providers are increasingly called upon to serve clients at home, a setting even a seasoned professional can find difficult to negotiate. From monitoring the health of older populations to managing paroled offenders, preventing child abuse, and reunifying families, home-based services require models that ensure positive outcomes and address the ethical dilemmas that might arise in such sensitive contexts.

    The contributors to this volume are national experts in diverse fields of social work practice, policy, and research. Treating the home as an ecological setting that guides human development and family interaction, they present rationales for and overviews of evidence-based models across an array of populations and fields of practice. Part 1 provides historical background and contemporary applications for home-based services, highlighting ethical, administrative, and supervision issues and summarizing the social policies that shape service delivery. Part 2 addresses home-based practice in such fields as child and adult mental health, school social work, and hospice care, detailing the particular population being treated, the policy and agency context, theories and empirical data, and practice guidelines. Part 3, the editors present a unifying framework and suggest future directions for home-based social work.

    eISBN: 978-0-231-52030-0
    Subjects: Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-xii)
  4. Part I: Introduction
    • One Historical and Current Context
      (pp. 3-13)

      Despite the different terms used and the different reasons for delivering services in homes, the unifying thread across social work fields of practice for the service models described in this book is the dynamic of providing help in the ecological context of the home. This chapter introduces the historical and current context for home-based social work practice and discusses the rationales for delivering services in the home. This chapter also discusses the skills needed for delivering home-based services, as the home environment can affect each step of the social work intervention process. The chapter concludes with comments on the dimensions...

    • Two Ethical Issues and Guidelines
      (pp. 14-33)

      As these accounts illustrate, social workers in home-based services must apply recognized ethical principles to novel and occasionally unpredictable circumstances. Given the isolation and autonomy that characterize in-home services, it is especially important that workers possess broad knowledge of ethics and sound decision-making skills. This chapter examines some elements of home-based services that give rise to ethical dilemmas and describes the application of principles such as self-determination, competence, and confidentiality to in-home practice. An ethical decision-making model is introduced and applied to a case to illustrate the critical thinking required for effective, ethical in-home practice.

      The term “ethics” refers to...

    • Three Administrative Supports and Practices
      (pp. 34-54)

      No matter whether located in a child welfare agency, a school, or a health clinic, home visiting requires different administrative supports than services provided in an office or clinic, and the role of the supervisor often must expand or deviate from the role of the supervisor in a traditional agency. In leaving the agency, the social worker gives up the familiarity, convenience, and safety of an office to practice in a constantly changing environment. This chapter will cover some of the additional support needed by these workers and the role of the supervisor in providing that support.

      The first section...

    • Four Social Policy Context
      (pp. 55-78)

      Individuals must have basic needs met for both survival and functioning in society. Families have historically played the predominant role in providing for their care and overall well-being. In fact, families provide up to 90 percent of all the education, counseling, caregiving, and norm enforcement for their members (Briar-Lawson et al. 2001). Nonetheless, they rely on societal institutions to help with resources, services, and supports.

      The twentieth century ushered in a number of social-service programs and policies in support of individuals and families. Whether provided by public, voluntary, or for-profit organizations and facilities, many key services have undergone pendulum-like swings...

  5. Part II: Home-Based Services in Social Work Fields of Practice
    • Five Early Childhood Programs
      (pp. 81-110)

      Home-based programs for families with young children serve families during pregnancy and until their children are five years old and eligible for public-school kindergarten. Programs are usually divided into those that serve families from pregnancy until the child turns three and those that serve preschoolers. These programs target two populations: families whose child has been diagnosed with a disability and those whose child is assessed as having factors that put them at risk for poor developmental outcomes. Despite programmatic differences, early childhood home-visiting programs share the “same underlying assumption” that the years before children begin formal education “is a unique...

    • Six School-Based Services
      (pp. 111-133)

      Home visiting is prevalent in the history of school social work practice, and this type of intervention has seen a resurgence of applications over the past decade, being utilized in numerous programs aimed at helping high-risk children and families. A primary function of school social workers is to build partnerships with families and link community resources with the school, in order to remove barriers to academic achievement. Home visiting is a school intervention well suited for this purpose.

      From the very inception of school social work practice, home visitation has had an important role for school social workers. Even though...

    • Seven Child Welfare
      (pp. 134-159)

      Historically, the field of child welfare has centered primarily on the best or most appropriate home for children that would support their development. This has meant removing children from their home and family in problematic cases in which safety and related risk factors were evident. Century-old images of orphan trains stopping in communities across the country remind us that the overriding focus of practice has centered on mobilizing homes for children who either lacked them or for whom the homes were deemed problematic (Berebitsky 2000). Thus, for decades services were dominated by home-finding activities rather than providing support for at-risk...

    • Eight Child Mental Health
      (pp. 160-188)

      Child mental health agencies employ social workers in various roles in the provision of home-based services to reach at-risk children and prevent hospitalization. This chapter considers the special issues of working in home- and community-based settings with children with mental health challenges and their family members, includes a brief review of the evidence base for children’s mental health home-based services, and highlights social workers’ roles and tasks and the effect these services have on the well-being of children with serious emotional problems and their families.

      Meeting the mental health treatment needs of children and youth is a serious and growing...

    • Nine Criminal Justice
      (pp. 189-214)

      Ordinary offenders face significant challenges returning to communities: stigma, poverty, estrangement from families and neighborhoods, limited availability of housing and jobs, and reentry to society from highly regulated institutions. Juvenile and adult offenders with special needs have even more barriers to successful reentry. Special needs is defined here as “any changeable factors associated with disorders of cognition, thought, mood, personality, development, or behavior that are linked to desired outcomes for offenders at any phase of the justice process” (Ashford, Sales, and Reid 2001a, 5). Special needs offenders include those with serious mental illness or at risk for suicide; alcohol and...

    • Ten Adult Mental Health
      (pp. 215-239)

      The tenor of the times, fiscal policies, and key legal decisions all conspired to form the perfect storm: beginning in earnest in the second half of the 1960s, there was a dramatic depopulation of the nation’s state psychiatric hospitals. This period in history, retroactively labeled the deinstitutionalization movement, has been analyzed from a myriad of angles and perspectives and simultaneously cheered and jeered. Aside from scholarly interests and an honest desire to learn from the past, the question of the primary locus of mental health care has long been decided. Indeed, as Mechanic and Rochefort (1992, 146) noted over fifteen...

    • Eleven Older Adult Services
      (pp. 240-262)

      The United States is aging, in part thanks to improvements in health care preventing deaths from cancers, heart attacks, strokes, and other common serious conditions of late life. As the oldest of the Baby Boomer generation hits the age of sixty, another influx of older adults is just around the corner. The group over age sixty-five is projected to increase from its current 12.4 percent of the population to 20.7 percent by 2050. And the “oldest old,” those aged eighty-five and over, are projected to increase the most rapidly, more than tripling their proportion of the population over the next...

    • Twelve Hospice and End-of-Life Care
      (pp. 263-284)

      Care of the dying at home is certainly not a new phenomenon. However, with the rise of hospital systems and advances in medical treatments that can prolong life almost indefinitely, the site of death has undergone a dramatic shift. Even though most people prefer to die at home, in the general population of the United States, about one-half of all individuals that die do so in an acute care setting (Teno et al. 2004).

      The provision of hospice care services in the home relative to other aspects of the health care system is a recent development. The option of Medicare...

  6. Part III: Conclusion
    • Thirteen Conclusions and Considerations for the Future
      (pp. 287-296)

      Service delivery in the home is a vital aspect of care across many service-delivery systems and client populations. Home-based services are evident across the lifespan—from early childhood programs to hospice and end-of-life care. As stated in chapter 1, authors contributing to this book have presented the “who, what, when, and where” of home visiting within contemporary social work practice. Chapters identify different target audiences for home-based services (the who) and describe the type and scope of such services (the what) within the dimensions of the lifespan period to which the services are directed (the when) and the larger service-delivery...

  7. Appendix: Organizations Associated with Home-Based Programs, Research, or Policies
    (pp. 297-306)
  8. List of Contributors
    (pp. 307-312)
  9. Index
    (pp. 313-332)