ABSTRACT Individuals in multiproblem situations frequently seek frontline legal support. The support by frontline legal professionals is limited by its focus on the legal issue instead of the underlying problems. A strong focus on client values – i.e. on the outcome that these services yield in the client’s perception – may lead to a more effective approach by targeting underlying problems. Through individual interviews with clients and professionals, the current study examines client values and services that may contribute to those client values. Besides functional client values that focus on resolving the problem situation, emotional client values, such as trust prove at least as important. Furthermore, client values are not only supported by the professional’s legal expertise, accessibility and ability to build a relationship, but also by the professional’s knowledge and skills relevant to multiproblem situations, such as his ability to empower the client, the willingness to work on concrete needs, and his ability to adopt an integrated approach. Research findings confirm the relevance of an integrated approach to multiproblem situations, with due attention to different client values. Similarly, it proves important to incorporate skills and knowledge that specifically address multiproblem situations in education and training programmes of frontline legal professionals.

Most European states have ratified the UN Convention on the Rights of Persons with Disabilities (CRPD), but implementation varies at national and local levels with municipalities often playing a key role. Decentralization policies have often led to municipalities providing social support as well, but little attention has been paid to the accessibility of municipal support for persons with disabilities in the light of the CRPD. Therefore, this article presents the Dutch 2015 Social Support Act (SSA) as a case study. The SSA introduces the right to an assessment. This legal evaluation moment has far-reaching consequences for persons with disabilities as it serves as the gateway for access to reasonable accommodations under the CRPD. Dutch municipal councils implement their assessment systems in different ways, but social district teams are usually set up to execute the assessment under the mandate of the municipality. It is often the case that social workers fulfil both counselling and gatekeeping roles, despite the fact that they are not necessarily trained to combine these dual responsibilities. This article identifies impeding factors that influence the gaining of access to municipal social support at the level of the social system, the involved organizations and the individual professionals. It takes a legal-anthropological approach based on in-depth multidisciplinary interviews with experts in the field of disability rights advocacy, social policy and human rights, or with experiential expertise. The results indicate a lack of alignment between the SSA and the CRPD. The discussion gives recommendations for a broader implementation of the CRPD.

Introduction: The Legal Services counters (LSC) is the first contact point for legal aid in the Netherlands. Professionals reported dealing with a client group combining problems on several dimensions, next to the legal issue. This combination (multiple problem situation, MP) seems to impair the effectiveness of the provided legal help. Methods: A face-to-face survey among 421 visitors of 4 LSC locations was administered (2019). Analyses: Statistical techniques were used to assess the occurrence of MP, the association with the numbers of contacts with the LSC, the background characteristics of clients with and without MP, and the multivariate association between stress, MP and use of the LSC. Results: 44,1% of the respondents reported MP. Those reported a higher number of contacts with the LSC in the past year. MP clients were older and had a lower education level. Financial (58%), conflictual (56%) and physical health (41%) problems were mostly reported. Stress and number of problems were related to a higher attendance to the LSC. Discussion: Legal aid services should set out systematic collaboration paths with other social services, starting off by an assessment of the problem domains, to contribute to an effective solution of those issues, including the legal one.

This research examines the legal capabilities of social care practitioners involved in a new decision-making process, ‘the kitchen table conversation’, used since the introduction of the 2015 Social Support Act in the Netherlands. This law delegates social care allocation to the local authorities, who employ social care practitioners to assess and decide upon the needs of applicants for personalised services. During the kitchen table conversation, social care practitioners, applicants and specialised services providers discuss the needs of applicants. The extent to which social care practitioners possess legal capabilities to deal with this new process is unknown. In a case study (Utrecht), data from kitchen table conversations with applicants suffering from cognitive impairment were gathered using participant observation techniques, semi-structured individual interviews and one group interview with social care practitioners, between October 2016 and May 2017. Content analysis showed the legal knowledge of social care practitioners and their awareness of the legal consequences of the kitchen table conversation. However, social care practitioners rely heavily on their interpersonal skills and on elective communication to avoid conflicts leading to legal procedures or involving their individual liability. More research is needed on the universal accessibility of social care services in the context of decentralisation.

The realization of human rights standards depends in part on the commitment of local actors. It can be argued that local public service professionals such as social workers can also be regarded as key players. The possible role of social workers becomes imperative if these professionals are working in a policy context that is not congruent with human rights. If existing laws or policies cause or maintain disrespect for human rights, social workers are in a position to observe that this is having an adverse impact on clients. When social workers are regarded as human rights actors, the question arises how they can or should respond to law and policy that impedes them in carrying out their work with respect for human rights. This article adds to existing theories on social workers as human rights actors by examining the practices of social professionals working in such a challenging policy context. The research took place among professionals in social district teams in the city of Utrecht, the Netherlands. Following a series of decentralizations and austerity measures the social care landscape in the Netherlands has changed drastically over the last few years. As a result, social workers may find themselves on the one hand trying to realize the best possible care for their clients while on the other hand dealing with new laws and policy expectations focused on self-reliance and diminished access to specialist care. The article explores how social professionals’ responses to barriers in access to care affect human rights requirements. In doing so, this socio-legal study provides insight into the ways in which everyday social work relates to the realization of human rights at the local level.

Met de transities in het sociaal domein en de daarmee veranderende rol van de sociaal werker wordt een mensenrechtenbenadering relevanter, omdat deze de neveneffecten van het nieuwe beleid voor clienten zou kunnen ondervangen. Het sociaal werk wordt steeds vaker geprofileerd als ‘mensenrechtenberoep’ omdat deze professionals een brugfunctie vervullen tussen de leefwereld van burgers en het lokale beleid. Doordat sociaal werkers in wijkteams bepalend zijn geworden voor detoegang tot sociale zorg en ondersteuning, zouden zij een rol kunnen spelen in de manier waarop bepaalde sociaal-economische mensenrechten worden gerealiseerd. Toegang tot sociale zorg en ondersteuning kan worden gezien als onderdeel van het recht op gezondheid, het recht op een behoorlijke levensstandaard, en het recht op sociale zekerheid. Wanneer als gevolg van regelgeving en beleid belemmeringen ontstaan in toegang tot zorg, brengt dit risico’s met zich mee voor de realisatie van deze mensenrechten op lokaal niveau. Dit praktijkonderzoek schept een beeld van de invloed van sociale professionals op dit proces. Aan de hand van interviews met sociaal werkers en teamleiders in wijkteams is in kaart gebracht welke belemmeringen in toegang tot zorg en ondersteuning worden geconstateerd in de praktijk. Vervolgens is gekeken naar hoe sociaal werkers en teamleiders met deze belemmeringen omgaan.

Background: Dutch residents of Turkish origin frequently utilize healthcare in Turkey. Methods: To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. Results: Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. Conclusions: These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.

Met recht een zorg: lokale sociale professionals als poortwachters van de Wet maatschappelijke ondersteuning 2015 Op basis van één casestudy van een wijkteam in Amersfoort gaat dit artikel in op de mate van juridische kennis van lokale sociale professionals over de Wet maatschappelijke ondersteuning 2015 (Wmo 2015). Ook komen knelpunten aanbod, die zij ervaren in de uitvoering van de juridische procedure. Als hulpverlener dienen ze de belangen van hun cliënt te behartigen. Tegelijkertijd bepalen ze als poortwachter, onder mandaat van de gemeente, wie in aanmerking komt voor een maatwerkvoorziening op basis van de Wmo 2015. Deze dubbele pet heeft onbedoelde consequenties voor geschillenbeslechting. Professionalisering is nodig om de kwaliteit van besluitvorming door sociale professionals te verbeteren en de rechtspositie van mensen met een beperking sterker te waarborgen.

Background Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands. Methods Data of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival. Results Adequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt. Conclusion These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.

BACKGROUND:Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.METHODS:Data of 101,882 patients diagnosed with CC in 1996-2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.RESULTS:Adequate LN evaluation was significantly more likely for patients from 'other Western' countries than for the Dutch (OR 1.09; 95% CI 1.01-1.16). 'Other Western' patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05-1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13-0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03-2.61) was statistically explained by differences in adjuvant chemotherapy receipt.CONCLUSION:These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients' health literacy when looking at ethnic differences in treatment for CC.

Background: Despite high prevalence of mental problems among elderly migrants in The Netherlands, the use of psychosocial care services by this group is low. Scientific evidence points at the crucial role of social support for mental health and the use of psychosocial services. We therefore explored the role of social networks in the access to psychosocial care among elderly migrants in The Netherlands. Methods: A qualitative study was conducted using semi-structured group interviews and individual interviews. The eight group and eleven individual interviews (respectively n = 58 and n = 11) were conducted in The Netherlands with Turkish, Moroccan, Surinamese, and Dutch elderly. The data were analysed through coding and comparing fragments and recognizing patterns. Results: Support of the social network is important to navigate to psychosocial care and is most frequently provided by children. However, the social network of elderly migrants is generally not able to meet the needs of the elderly. This is mostly due to poor mental health literacy of the social network, taboo, and stigma around mental illness and the busy lives of the social network members. Conclusions: Strategies to address help-seeking barriers should consider mental health literacy in elderly migrants as well as their social networks, and counteract taboos and stigma of mental health problems.

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region. A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n=3220) were recruited through organisations involved in YHC (participation: 88%). The YHC workforce is multi-disciplinary, 62% had > 10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range: 688-1007). All essential public health operations were provided. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need. The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries

Background: Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly.Objectives: Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly.Design: Qualitative semi-structured group interviews and individual interviews.Setting: The Netherlands.Participants: Seven group interviews (n = 50) followed by individual interviews (n = 5) were conducted, in the preferred language of the participants.Methods: Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage. Results: This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care.Conclusion: In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses. (C) 2015 Elsevier Ltd. All rights reserved.

BACKGROUND: Ethnic inequalities in colorectal cancer care were reported previously in the United States. Studies specifically reporting on ethnic inequalities in rectal cancer care are limited. OBJECTIVE: This study aimed to explore potential ethnic inequalities in rectal cancer care in the Netherlands. DESIGN: This was a nationwide, population-based observational study. SETTINGS: The study linked data of the Netherlands Cancer Registry with the Dutch population registry and the Social Statistics Database of Statistics Netherlands. Data were analyzed using stepwise multivariable logistic regression models. PATIENTS: All of the patients diagnosed with rectal carcinoma in 2003–2011 in the Netherlands (N = 27,159) were included. MAIN OUTCOME MEASURES: We analyzed 2 rectal cancer treatment indicators (preoperative radiotherapy and sphincter-sparing surgery) and 2 indicators of short-term outcome of rectal cancer surgery (anastomotic leakage and 30-day postoperative mortality). RESULTS: Patients of Western non-Dutch and non-Western origin with rectal cancer were significantly younger and had a higher tumor stage than ethnic Dutch patients. Considering preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality, no ethnic inequalities were detected. After adjustment for age, sex, disease characteristics, and socioeconomic status, Western non-Dutch and non-Western patients were significantly more likely to receive sphincter-sparing surgery than ethnic Dutch patients (OR = 1.27 (95% CI, 1.04–1.55) and OR = 1.57 (95% CI, 1.02–2.42)). LIMITATIONS: This study was limited by the relatively low numbers of non-Dutch patients with rectal cancer. CONCLUSIONS: Non-Dutch ethnic origin was associated with a higher rate of sphincter-sparing surgery. The absence of ethnic inequalities in preoperative radiotherapy, anastomotic leakage, and 30-day postoperative mortality suggests that ethnic minority patients have similar chances of optimal rectal cancer care outcomes as Dutch patients.

INTRODUCTION:Worldwide, refugees show a poorer mental and physical health than the populations among which they resettle. Little is known about the factors influencing health after resettlement. We examined the development of mental and physical health of refugees. As experienced living difficulties might decrease with obtaining a residence permit, we expected this to play a central role in health improvement after resettlement.METHODS:A two-wave study conducted in the Netherlands among a cohort of 172 recent (n = 68) and longstanding (n = 104) permit holders from Afghanistan, Iran and Somalia between 2003 and 2011. Multivariate mediation analyses were conducted for the effect of changes in living difficulties on the association between change in status and changes in health. Health outcomes were self-reported general health, number of chronic conditions, PTSD and anxiety/depression.RESULTS:Recent permit holders had larger decreases in PTSD score (-0.402, CI -0.612; -0.192) and anxiety/depression score (-0.298, CI -0.464; -0.132), and larger improvements in self-rated general health between T1 and T2 (0.566, CI 0.183; 0.949) than longstanding permit holders. This association was not significant for changes in number of chronic conditions. Mediation analyses showed that the effect of getting a residence permit on health improvements transited through an improvement in living conditions, in particular employment and the presence of family/social support.CONCLUSION:These results suggest that change in residence permit is beneficial for health mainly because of the change in living difficulties. These results add up to the evidence on the role of social circumstances for refugees upon resettlement, and point at labour participation and social support as key mechanisms for health improvements.

Objective: Insight into the role of acculturation in dietary patterns is important to inform the development of nutrition programmes that target ethnic minority groups. Therefore, the present study aimed to investigate how the adherence to dietary patterns within an ethnic minority population in the Netherlands varies by acculturation level compared with the host population.Design: Cross-sectional study using data of the HELIUS study. Dietary patterns were assessed with an ethnic-specific FFQ. Acculturation was operationalized using unidimensional proxies (residence duration, age at migration and generation status) as well as on the basis of the bidimensional perspective, defined by four distinct acculturation strategies: assimilation, integration, separation and marginalization.Setting: Amsterdam, the Netherlands.Subjects: Participants of Dutch (n 1370) and Surinamese (n 1727) origin.Results: Three dietary patterns were identified: (i) 'noodle/rice dishes and white meat' (traditional Surinamese pattern); (ii) 'red meat, snacks and sweets'; and (iii) 'vegetables, fruit and nuts'. Surinamese-origin respondents adhered more to the traditional Surinamese pattern than the other dietary patterns. Neither the unidimensional proxies nor the bidimensional acculturation strategies demonstrated consistent associations with dietary patterns.Conclusions: The lack of consistent association between acculturation and dietary patterns in the present study indicates that dietary patterns are quite robust. Understanding the continued adherence to traditional dietary patterns when developing dietary interventions in ethnic minority groups is warranted.

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region. A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n=3220) were recruited through organisations involved in YHC (participation: 88%). The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688-1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need. The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.

Majda Lamkaddem, post-doctoral researcher on the field of Migration and health and health care utilization at the department of Public Health, Academic Medical Centre of the University of Amsterdam, the Netherlands. Some of the studies presented in this article were conducted during her PhD thesis, which looked at the course of health and health care utilisation of ethnic minorities over time. m.lamkaddem@amc.uva.nl