Due to the demanding structure of caring for a child with a life-threatening disease (LTD), parents experience psychosocial distress. Studies have shown that stress in parents of children with LTDs can be increased by unmet needs or fragmented care and may be mitigated by coordinated and comprehensive care. Limited literature exists about unmet needs of parents of children with LTDs and the barriers they encounter to accessing mental health resources within pediatric palliative care (PPC) programs. This research study applied quantifiable descriptive methods including a purposive sample of ninety-eight (98) PPC and other pediatric practitioners through the distribution of anonymous online surveys in order to examine unmet needs for mental health resources as they relate to parents of children with LTDs who experience psychological distress exacerbated from psychosocial stressors of care giving. Influenced by Andersen’s predisposing, enabling, and need factors, this study found that PPC practitioners perceived parents encountering waitlists and/or denials when referred to community mental health resources as demonstrating resistance against seeking help.

The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg’s and Parry’s conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.

Background: In Sweden, health outcomes for children placed in care have been disappointing. ‘Placed in care’ refers to social out of home care (OHC). Hälsofam is a medical home model for healthcare of children in OHC currently delivered in Uppsala. Aim: To explore how social workers perceive and experience the Hälsofam model. Methodology: A qualitative explorative study with ten semi-structured individual telephone interviews. The criteria for inclusion in the study sample were employees within the social service, working in a specialised case unit and having experience of referring children and/or adolescents to Hälsofam. Results: Working with Hälsofam has offered social workers a way into the health care sector, which is something that previously has been limited. The Hälsofam model has offered the social workers an active collaborative working situation, where focus has been given to organised work across the ‘silos’ of care services for these children. However, the findings raised the question of whether or not all children and adolescents have the same possibility to receive care from Hälsofam. Conclusion: The Hälsofam model appears to have had a positive impact on the interrelations between the social service and the health care sector. Social workers perceive it to facilitate necessary support for children and adolescents in OHC. Yet, findings show that personal views of the social worker and the societal situation in which they operate create limitations for providing care for every child and adolescent. / Bakgrund: I Sverige har hälsoutfallen för barn och ungdomar inom socialtjänstens placeringar utanför det egna hemmet varit bristande. Hälsofam är en organisatorisk modell inom hälso- och sjukvård för barn i placeringar utanför det egna hemmet i Uppsala. Syfte: Syftet med denna kvalitativa studie är att undersöka hur anställda inom Socialtjänsten har upplevt och erfarit Hälsofam-modellen. Metod: En kvalitativ explorativ studie med tio semi-strukturerade individuella telefonintervjuer användes. Kriterier för inkludering i studieurvalet var att personen skulle vara anställd inom Socialtjänsten, arbeta med denna typ av fall samt ha erfarenhet av att remittera barn och unga till Hälsofam. Resultat: Arbetet med Hälsofam har erbjudit anställa inom socialtjänsten en väg in till hälso- och sjukvården, vilket tidigare upplevts begränsat. Hälsofam har erbjudit anställda inom socialtjänsten ett aktivt samarbete, där fokus har lagts på organiserat interprofessionellt arbete. Frågan har också rests, huruvida alla barn och ungdomar har samma möjlighet till vård inom Hälsofam. Slutsats: Hälsofam-modellen har haft en positiv inverkan på det inbördes förhållandet mellan Socialtjänst och hälso- och sjukvårdssektorn. Anställda inom socialtjänsten upplever även att arbetet med att stödja de barn och unga som får vård utanför hemmet, har blivit lättare i och med Hälsofam. Resultatet visar dock att det personliga perspektivet hos den anställda samt den samhälleliga situationen där de arbetar, skapar begräsningar för att erbjuda vård till alla barn och unga.