Mestrado em Serviço Social; O serviço social é uma área cujo principal objectivo de intervenção consiste em
promover a mudança social, colaborando com aqueles que se encontram em situação de
fragilidade ou desvantagem. Segundo este ponto de vista, este trabalho pretende reflectir
sobre a forma como o serviço social intervém junto de uma população muito específica, os
jovens com deficiência intelectual e desenvolvimental ligeira, procurando conhecer de que
forma o serviço social contribui para diminuir a desvantagem desta população face ao
mercado normal de trabalho. Para isso, são abordadas questões que se consideram pertinentes
nesta área, tais como as relacionadas com a inserção social e profissional das pessoas com
deficiência em geral, a definição e conceptualização da deficiência intelectual e
desenvolvimental, as dificuldades de inserção profissional dos jovens com este tipo de
deficiência, os pontos-chave relativos à intervenção do serviço social na área da deficiência e
a forma como as famílias participam nesta intervenção. Para concretizar este estudo, optou-se
pelo o método qualitativo, pois os objectivos a alcançar com o mesmo pressupõe um carácter
exploratório da investigação. Numa fase de recolha de dados...
OBJECTIVE—To investigate the relation between
social disadvantage and family composition on diabetes prevalence and
diabetes care outcome. DESIGN—Retrospective audit in the south west of
England of 801 children with diabetes mellitus. MAIN OUTCOME MEASURES—Prevalence of diabetes in
relation to the Townsend index. Admissions to hospital with diabetes
related problems, glycated haemoglobin, time spent in hospital,
outpatient attendance rates. RESULTS—There was no association between
social status and diabetes prevalence. Social deprivation increased the
likelihood of admission for hypoglycaemia. Children living with a
single parent were more likely to be admitted to hospital with a
diabetes related problem and stay in hospital longer. Having either a
parent with diabetes or a single parent increased the rates of clinic
non-attendance. No association was identified between medium term
diabetes control and either social disadvantage or single parent status. CONCLUSIONS—Social disadvantage has no effect on
diabetes prevalence and little on diabetes outcome in childhood. Family
structure and parental diabetes have adverse effects on some aspects of
OBJECTIVE: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. SETTING: Inner city group practice with a socioeconomically diverse population. SUBJECTS: 382 male and female subjects of all ages, with a total of 1296 person years of observation. MAIN OUTCOME MEASURES: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. RESULTS: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. CONCLUSIONS: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to...
Homicide is one of the leading causes of death among African-American and Hispanic men. We investigated how neighborhood characteristics associated with social disadvantage explain racial/ethnic homicide gaps in 10 U.S. cities. The test hypotheses were that (1) higher concentrations of African-Americans and Hispanics would be associated with higher homicide rates and (2) the relationship between racial/ethnic concentration and homicide would be attenuated after adjusting for neighborhood characteristics (e.g., unemployment, median household income, low educational attainment, and female headship). The test hypotheses were examined using separate Poisson regression models, which adjusted for spatial autocorrelation. Homicide rates were greater in neighborhoods with higher concentrations of African-Americans and Hispanics than in other groups, and the association of neighborhood racial/ethnic concentration with homicide was reduced after adjusting for neighborhood social disadvantage variables, especially percent female head of household and percent persons with less than a high school education. We also found that the relationship between neighborhood racial/ethnic concentration and homicide was explained more by social disadvantage variables in some cities than in others. Based on our findings...
Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.
Social stability is an understudied construct in public health that offers a useful framework for understanding social disadvantage across multiple domains. This study investigated prevalence and patterns of cooccurrence among a hypothesized set of social stability characteristics (housing, residential transition, employment, income, incarceration, and partner relationship), evaluated the possibility of underlying subgroups of social stability, and investigated the association between social stability and health outcomes. Data were from comprehensive interviews with primarily African-American low income urban women and their female social network members (n = 635) in Baltimore. Analysis included exploratory statistics, latent class analysis, and latent class regression accounting for clustered data using Stata and Mplus software. Social stability characteristics cooccurred in predictable directions, but with heterogeneity. Respondents had an average of three stability characteristics (S.D.: 1.4). Latent class analysis identified two classes of social stability: low (25%) and high (75%), with the higher class less likely to experience each of the included indicators. In controlled models, higher social stability was significantly correlated with social network characteristics and neighborhood integration. Higher social stability was independently associated with reduced risk of chronic illness (AOR: 0.54...
The deleterious impact of adverse childhood experiences (ACEs) may be confounded with frequently co-occurring social disadvantage. In this analysis we test the effects of ACEs on adult mental health within a social disadvantage framework, using a population-based survey (n=7,444; mean age=55.2 years) from Washington State. We also examined the protective effects of socioemotional support, and the distinct and combined contribution of the measured ACE factors. Results demonstrated sustained impact of ACEs on mental health many decades later, even net of social disadvantage and demographic contributors. Protective factors provided both direct and moderating influences, potentially masking the elevated effects of ACEs for those with few resources. Toxicity examination of ACE items evinced differential effects of ACE experiences on mental health. These results demonstrate that interventions ameliorating the effects of ACEs and bolstering protective resources such as socioemotional support may be effective toward augmenting mental health even late in life.
Background: An association between social disadvantage and established psychosis is well documented in the literature, but there remains a lack of data on the social circumstances of patients before they became ill. We investigated whether social disadvantage at, and prior to, first contact with psychiatric services, is associated with psychosis. Method: We collected information on social disadvantage in childhood and adulthood from 278 cases presenting with their first episode of psychosis to the South London and Maudsley National Health Service Foundation Trust and from 226 controls recruited from the local population. Three markers of childhood social disadvantage and 3 markers of disadvantage in adulthood were analyzed. Results: Long term separation from, and death of, a parent before the age of 17 years were both strongly associated with a 2- to 3-fold-increased odds of psychosis. Cases were also significantly more likely to report 2 or more markers of adult social disadvantage than healthy controls (OR = 9.03) at the time of the first presentation with psychosis, independent of a number of confounders. When we repeated these analyses for long-standing adult social disadvantage, we found that the strength of the association decreased but still remained significant for 1 year (OR = 5.67) and 5 years (OR = 2.57) prior to the first contact. Conclusions: Social disadvantage indexes exposure to factors operating prior to onset that increase the risk of psychosis...
non-peer-reviewed; Background: Research has examined the efficacy of whole-class language intervention implemented by mainstream teachers to school-aged children from socially disadvantaged backgrounds (Goodwin & Ahn 2013; Hadley et al. 2000; Joffe 2011) however, little research has explored the experiences of these teachers.
Objectives: This study examines the experiences of teachers delivering a whole-class Vocabulary Enrichment Programme (VEP) to first years in schools of social disadvantage.
Methods: A qualitative methodology was used for this study. 8 teachers who had delivered the VEP participated in semi-structured interviews about their experiences delivering the programme. Interviews were video and audio-recorded and analyzed using thematic analysis.
Results: Analysis of the interviews identified 5 factors which were key to teacher experience of the VEP: (1) Initial teacher reactions to programme; (2) Support given; (3) Practicalities of programme delivery; (4) Student reactions and results; (5) Team-teaching experience.
Conclusions: Results indicate that teachers had a positive experience delivering the VEP and found it to be beneficial for students. This study begins to fill a gap in the research regarding how teachers experience delivering a whole-class programme in schools of social disadvantage...
non-peer-reviewed; Background: Decreased vocabulary skills have been identified in adolescents from socially
disadvantaged backgrounds. Reduced language competence during adolescence is linked to
poor academic achievement and social, emotional and behavioural difficulties. Research for
adolescent language intervention is limited and there is a lack of evidence for effective
intervention with adolescents from socially disadvantaged backgrounds.
Aims: To investigate whether a whole class vocabulary programme implemented by
teachers in socially disadvantaged secondary schools will improve students’ performance on
selected vocabulary measures. The study also aimed to investigate if there is a relationship
between students’ pre intervention scores and amount of improvement following
Methods & Procedures: 245 first year students (M= 12; 8) from four socially disadvantaged
secondary schools participated in the study. Whole schools were randomly assigned to two
groups: treatment versus waiting controls. All participants were assessed pre and post
intervention on the BPVS III and CELF 4 subtests. The treated group received 12 weeks of
whole class vocabulary intervention delivered by secondary school teachers in a classroom
setting. The vocabulary programme targeted key concepts and vocabulary through word
non-peer-reviewed; Background: Adolescents from socially disadvantaged areas typically have lower vocabulary skills when compared with their age-matched peers from areas of social advantage (Spencer et al 2012). These difficulties put them at greater risk of academic failure, low self-esteem (Bercow 2008) and SEBD (Joffe and Black 2012). Currently, there is limited research on whole-class vocabulary interventions targeting adolescents (Cirrin and Gillam 2008).
Aims: This research aims to determine whether a whole-class vocabulary intervention programme improves the vocabulary skills of secondary school students, measured on standardised measures, in areas of social disadvantage. A secondary aim is to investigate the relationship between pre-treatment scores and the amount of improvement made.
Methods and Procedures: 231 students from four socially disadvantaged schools took part, (M= 12;08). Schools were randomly assigned to Treated (n= 135) or Control groups (n=96.) All students were assessed on standardised measures, BPVS III (Dunn et al 2009) and vocabulary subtests from the CELF-4 (Semel et al 2003). The Treated group received twelve weeks of whole-class vocabulary intervention delivered by their teachers. The teachers were trained and supported by a SLTs. The Control group’s intervention was delayed.
Outcomes and Results: There were greater improvements for the Treated group for three raw score measures: BPVS...
non-peer-reviewed; Purpose: Vocabulary difficulties are common in adolescents, particularly in adolescents in
areas of social disadvantage (Spencer et al 2012). However, research on interventions for
improving vocabulary skills in secondary school students is limited (Cirrin & Gillam 2008).
This study evaluated the efficacy of a collaborative, whole school vocabulary intervention
programme for improving vocabulary skills on selected measures of vocabulary, in secondary
school students, not identified with language impairment, from schools in socially
Method: Four Irish secondary schools in areas of social disadvantage were chosen to
participate in the current study. Two schools were randomly assigned to a treatment group,
and two schools to a control group. First year students’ vocabulary skills were evaluated on
selected measures of vocabulary at pre-treatment (n=245) and post-treatment (n=231),
using three subtests from the CELF-4, and the BPVS-3.
Results: The treatment group improved significantly more than the control group on raw
score versions of three out of five measures, suggesting that treatment had a significant
effect in improving the treatment group’s participants’ raw scores on those three measures.
There were no significant differences in raw scores between the treatment and control
groups on the other two measures...
OBJECTIVE: To examine longitudinal associations between mental health and welfare receipt among working-age
Australians. METHOD: We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and
income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours
and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity
to receive welfare payments. Random effect models tested the effects of income support transitions. RESULTS: Socio-demographic and financial variables explained the association between mental health and income support
for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving
income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents.
CONCLUSIONS: The poor mental health of welfare recipients may limit their opportunities to gain work and participate
in community life. In part...
BACKGROUND: Most public dental care services provide preventive, general dental care on a chronological, first come-first served basis. There is concern about lack of transparency, equity and timeliness in access to public dental services across Australia. Using social determinants as screening criteria is a novel approach to triage in dental care and is relatively untested in the literature. The research evaluated the discriminant and predictive validity of relative social disadvantage in prioritising access to public general dental care. METHODS: A consecutive sample of 615 adults seeking general dental care was selected. The validation measure used was clinical assessment of priority. Nine indicators of relative social disadvantage (RSD) were collected: Indigenous status; intellectual disability; physical disability; wheelchair usage; dwelling conditions; serious medical condition; serious medical condition and taking regular medication; hospitalised within 12 months; and, regular medical visits. At the first dental visit, dentists rated care as a priority if treatment was required ≤6 months (PriorityTx) and otherwise non-priority (non-PriorityTx). A standardised dental examination was conducted. Sensitivity, specificity, positive and negative predictive value and area under the ROC curve analyses of 1+ of RSD in predicting clinical priority were calculated. RESULTS: In bivariate analyses...
BACKGROUND: Depression is more common amongst those who are economically disadvantaged. However there is inconsistent evidence concerning the relationship between socioeconomic position and antidepressant use. Moreover, evidence of greater antidepressant use amongst those of lower socioeconomic position may reflect their greater psychiatric morbidity, a prescribing bias towards pharmacological treatments, or provide evidence of an effective social safety net. This study investigates these issues whilst addressing methodological limitations of earlier studies.
METHOD: Data were from a large, random community survey of Australian adults (N=4493) with linked administrative data for primary-care service use. Depression was measured using the Patient Health Questionnaire, with other measures of current mental health and history of depression included in analysis. Multiple personal indicators and a combined measure of social disadvantage were considered. A series of analyses systematically examined competing explanations for socioeconomic differences in depression and antidepressant treatment. RESULTS: Markers of socioeconomic disadvantage were associated with a greater likelihood of antidepressant use. This finding was not attributable to the higher rates of depression amongst the disadvantaged. A similar pattern of results was evident for non-pharmaceutical treatments (primary care consultations). Socioeconomic position was not associated with use of complementary medications for depression...
Accidents in the home to children under 5 in a multiracial population with a high level of social disadvantage were studied by interviewing at home the parents of 402 children attending the accident department of a west London hospital during one year. The parents' country of birth, whether they were employed, and their housing conditions were recorded using the definitions of the 1981 census. Four ethnic groups (British (183 children), Asian (127), Caribbean (61), and other (31)) were identified. Though attendance rates based on the populations of electoral wards at the census and standardised for distance from the hospital showed no significant differences among the ethnic groups, there was a strong gradient by social class and strong associations with unemployment of the mother (although not of the father), overcrowding, and tenure of housing.
Evidence suggests variability in adult obesity risk at a small-scale geographic area is associated with differences in neighborhood socioeconomic status (SES). However, the extent to which geographic variability in child obesity is associated with neighborhood SES is unknown. The objective of this paper was to estimate risk of child obesity associated with multiple census tract SES measures and race within a large urban U.S. county. Height, weight, age, sex, medical insurance type and census tract residence were obtained for 6–18 year old children (n = 8,616) who received medical care at a health plan in King County, Washington, in 2006. Spatial analyses examined the individual risk of obesity (BMI ≥95th percentile) with 2000 US census tract measures of median household income, home ownership, adult female education level, single parent households, and race as predictors. Conditional autoregressive regression models that incorporated adjacent census tracts (spatial autocorrelation) were applied to each census tract variable, adjusting for individual variables. We found that in adjusted spatial models, child obesity risk was significantly associated with each census tract variable in the expected direction: lower household income...
This paper analyses the economic disadvantage experienced by disabled persons of working-age using data from the British Household Panel Survey. We argue that there are three sources of disadvantage among disabled persons: pre-existing disadvantage among those who become disabled (a ¿selection¿ effect), the effect of disability onset itself, and the effects associated with remaining disabled post-onset. We show that employment rates fall with disability onset, and continue to fall the longer a disability spell lasts, whereas average income falls sharply with onset but then recovers subsequently (though not to pre-onset levels).
From a detailed analysis of the roles of childhood experience, schooling and educational qualifications in the emergence of adult social exclusion, two key patterns emerge: Educational qualifications show a strong relationship to all 36 measures of adult disadvantage (at ages 23 and 33 for both men and women; and the association is generally stronger at age 33 than at age 23. This relationship emerges net of controls for a wide range of childhood factors. Childhood poverty is the most frequent clear predictor of negative adult outcomes. Additionally: Mother's interest in schooling is more salient for women, whilst father's interest matters more for men; Low parental interest in schooling, frequent absence from school, and low educational test scores are all quite influential on subsequent disadvantage, even net of qualification levels; Early contact with the police is more closely related to adult outcomes for men, but school absences are more influential for women. Specific continuities in exclusion also emerge: The father being in Social Classes IV or V remains a clear predictor of male survey members also being in these Classes at ages 23 and 33; Growing up in social housing shows a similar specific legacy of being in social housing for both men and women at ages 23 and 33; Childhood behaviour indicators most specifically relate to adult malaise.
A review of research evidence suggests that low levels of educational attainment are crucial in generating and sustaining social exclusion. Test scores at school are the most effective predictor of many adult outcomes. School attendance and soft skills are also important. Reviewing the factors accounting for the variance in educational attainment, it is evident that combinations of social disadvantage powerfully affect school performance with up to 75% of school variation in 16 year old attainment at GCSE associated with pupil intake factors. But school factors can raise attainment by up to 14 GCSE points for average pupils. Hence schools are a good place to improve children's skills. Research suggests that higher per pupil spending, smaller class sizes and teacher quality in schools all seem to make a difference and some have most impact on disadvantaged pupils. However an approach which focuses solely on the improvement of average school performance is likely to be a less effective means of reducing social exclusion than an approach which creates incentives that rewards improvement among the least able. Other factors such as the behaviour and hiring decisions of employers also require attention if improved educational performance is to provide high pay offs.