ABSTRACT
Borders play a profound role in human life. In many settings, land borders are highly permeable and provide little barrier to movement, communication and interaction. In other circumstances, borders are highly rigid, difficult to cross and can demarcate vast economic and social disparities. The widely differing circumstances related to border creation and maintenance have deep effects that are worthy of social work attention and engagement. There has been serious attention to issues of globalisation, immigration and human rights in the social work literature. Our focus on borders is related to, but distinct from these issues, and therefore, has something unique to offer. Increased globalisation has led to a major reconceptualisation in our understanding of borders. The COVID-19 epidemic demonstrates the limited relevance of borders in some circumstances (spreading of the virus) but the heightened relevance of borders in other circumstances (travel restrictions). Social work practitioners have a role in framing the understanding of borders and resulting policies. Our focus is to address the question: How has social work engaged with border issues? We examine three international cases and conduct a comparative analysis to examine similarities and differences. From the analysis, we draw conclusions to further understanding for social work. Borders play a profound role in human life. This paper aims to examine how social work has engaged with borders. Conducting a comparative analysis of three international borders we describe impacts on practice and the profession. Noting similarities and differences we also assert generalisable conclusions and welcome engagement to further refine the analysis. Never before has it felt so timely to reflect on the issue of borders. The places that we come from have all been sharply affected by having land borders with neighbouring countries. At the time of writing, the contours of division that have marked our territorial separateness have come to the fore with COVID-19 restrictions impacting the movements of populations. Against this backdrop, social work has at its core an international definition and attendant global identity. Historically less clear is social work's position and stance adopted in dealing with borders. This paper is our attempt to bring attention to salient issues. First, by way of context, this topic will be examined within the context of key messages from literature.
ABSTRACT
Purpose/Objective(s): The COVID-19 pandemic posed challenges in resource allocation and breast cancer (BC) treatment decisions. Our study aims to understand changes in practice patterns of United States radiation oncologists (RO) treating BC during the COVID-19 pandemic. Materials/Methods: An IRB-approved 58-question survey with 6 clinical scenarios was distributed between July 17 and November 8, 2020 to ASTRO directory members. The cases included 1) Low-grade ductal carcinoma in situ (DCIS), 2) Low-risk BC treated with lumpectomy, 3) Low-risk BC treated with mastectomy with reconstruction 4) BC treated with neoadjuvant chemotherapy and mastectomy with reconstruction 5) BC treated with mastectomy and adjuvant chemotherapy but without reconstruction 6) Metastatic BC with enlarging breast mass. RO were surveyed about treatment recommendations if cases were seen pre-pandemic (PP) and hypothetically during the peak of pandemic (DTPP). Chi-square and McNemar-Bowker tests were used to examine the significance of changes. Results: A total of 285 respondents from 48 states completed the survey and reported treating at least one patient with BC in the past 12 months. 45% primarily practice in university affiliated hospitals and 43% in private practice. 22% reported treating ≥ 1 COVID-positive BC patients. Moderate hypofractionation (2.31 - 3 Gy per fraction) in the PMRT and immediate reconstruction setting was recommended by 0.7% PP compared to 10.5% DTPP. In the low-risk PMRT setting, recommendation of no further treatment increased from 13% PP to 20% DTPP. Further, 56% changed their DCIS recommendations if the patient was seen DTPP. For low-risk BC, whole breast RT was preferred by 83.5% PP compared to 46.7% DTPP, and 35.1% recommended delay of RT DTPP compared to 0.4% PP (P < 0.05). Increase in ultra-hypofractionation (> 5 Gy per fraction) was significant for low-risk BC after lumpectomy as 0.4% reported its use PP compared to 3.8% DTPP. In addition, utilization of brachytherapy as PBI modality decreased from 23.9% to 17% among respondents PP and DTPP respectively. The Florence fractionation schedule for PBI was recommended by 46.2% for early-stage BC and by 51.7% for DCIS DTPP compared to 20% and 34.4% PP. Finally, 68.1% reported the use of 10-25 fractions PP for the palliative scenario. However, of those who would change their recommendation (48.8%), 62.8% reported recommendation of ≤ 5 fractions DTPP. Additional subset analysis by geographic region and practice type were notable for variable changes in treatment recommendations, and will be presented. Conclusion: This large survey of Breast RO clinical decision making demonstrates significant differences in recommendations and rapid adoption of unique fractionation. While likely reflective of intent to optimize resource allocations during the pandemic, maintenance of new practice patterns remains subject to future investigation.
ABSTRACT
This policy analysis examines the impact of COVID-19 policy guidance on the role of workers who provide outreach to transition-age care leavers. The comparison focuses on four countries (US, England, Canada, Australia) and addresses the question: How do policy changes impact street-level bureaucracy (SLB) discretion, activities, resources, and constraints? A review of policy guidance identifies similar actions across the four countries focused on: public health measures, extension and flexibility of services, prioritization of cases, and enhanced use of technology. Extension and flexibility of services were particularly noted. Cautions about the temporary nature of these changes are identified.Note: In the interests of space, street-level theory and the pandemic context underpinning the articles for this Special Issue are discussed in detail in the Introduction to the Issue. © 2020 The Editor, Journal of Comparative Policy Analysis: Research and Practice.
ABSTRACT
Purpose: This paper aims to describe how a sense of normalcy for young people in foster care can be critical to their well-being. Design/methodology/approach: This paper reports on policy and practice efforts in the USA to promote normalcy for youth in care. The authors review policy that promotes normalcy and report on one organization's efforts to support these goals. Findings: COVID-19 has offered profound challenges to the goal of normalcy. Rise Above has adapted to meet the challenges. Originality/value: The authors argue that COVID may also offer opportunities to build toward a more robust paradigm of normalcy within child welfare policy and practice. © 2020, Emerald Publishing Limited.