湖南省解决农村贫困重度残疾人托养照护问题的实践与启示

解决农村贫困重度残疾人照护问题,既是党和政府的明确要求,也是残疾人和家属的热切期盼.湖南省农村贫困重度残疾人托养照护专项实践的主要启示:一是照护服务能有效改善农村重度残疾人生活质量和巩固脱贫攻坚成果;二是规划部署和经费配置是解决照顾问题的关键所在;三是"家庭自付+村社支持+政府补贴"的付费方式在实践中具有可行性和可持续性;四是农村地区需要优先发展保障急需的基本生活照护和寄宿照护服务,需要根据残疾人生活自理能力和家庭照护能力精准提供适合的照护服务.建议将"优先重点解决城乡低收入重度残疾人照护问题"纳入"十四五"规划及政府实事工程任务,加快建立以家庭照护为基础、社会化照护为支持、集中照护为补充的重度残疾人照护服务体系,完善以生活自理能力和家庭照护能力为核心指标的优先保障对象精准识别机制,通过"两补提标"、建立家庭照护和集中照护机构统一认定制度、评价制度和支持机制,完善残疾人帮扶机制.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

Understanding Care Leavers in Russia: Young People's Experiences of Institutionalisation

Abstract

Care leavers in Russia represent one of the most disadvantaged groups in society. However, they have rarely been the focus of welfare policy debate and they receive little or no support in their independent living. This paper presents the findings of a survey of Russian care leavers. The emphasis is on care leavers' experiences of the Russian institutional care system, and the issues that impacted on their postcare transition to adulthood. A number of factors were found to influence the wellbeing of care leavers, including placement instability, institutional isolation, poor education, stigmatisation of care leavers, relationships with “houseparents”, and supportive and often challenging friendships. Findings are discussed in relation to debates about the degree and nature of institutional care of children in Russia and elsewhere.     

The history, economics, and financing of mental health care. Part 3: The present

1. Health care system changes, particularly the managed care plans, are altering mental health practices in significant ways. The autonomy and independent judgment of clinicians are being limited. 2. Market expansion created child and adolescent hospitals in the private sector. This market was very favorable to growth because of the great ambiguity in diagnosis and treatment, and the nonexistence of commitment laws for this population. 3. While insurance coverage for psychiatric diagnoses has expanded, more affluent people, with good employment possibilities, still have better insurance than poor individuals.     

Ageing in the bush: The role of rural places in maintaining identity for long term rural residents and retirement migrants in north-east Victoria,Australia

As a consequence of local population ageing, which is more pronounced in rural areas, the issue of maintaining a positive quality of life for rural older people is attracting significant attention. While environmental psychology theory has advocated the role of place identity in defining the self, there has been little applied research exploring how this occurs in later life. This exploratory, qualitative study (n = 16) utilises 6 and 7 identity process theory to investigate how rural older Australians (retirement migrants and long-term residents) use place to sustain and build a sense of self at a time when many are susceptible to age-related loss. The paper draws on the concepts of distinctiveness, continuity, self-esteem and self-efficacy in order to explore how place identity is supported and maintained. Findings suggest that rural places are beneficial in terms of identity maintenance, with differences between long term and more recent rural residents. Furthermore, findings also highlight that place-related change or growth can potentially threaten older people’s identification as a ‘rural’ person.     

Managing everyday (in)securities: Normative values,emotional security and symbolic recognition in the lives of Russian rural elders

Qualitative studies of ageing have called for attention to be paid to the diverse experiences of older people and to their agency in negotiating opportunities and constraints. A lack of research into the experiences and subjectivities of rural elders has been noted. Yet, the majority of research concerning elderly people in contemporary Russia continues to treat old age as a category and focus on particular practical and material forms of assistance available to pensioners. This article, aims to contribute to the small but growing body of ethnographic studies which shed light on the lives of elderly people in Russia as subjects in their own right. Based on ethnographic fieldwork from rural Siberia, the article explores the ways in which elderly people experience and interpret day-to-day (in)securities, forms of care and social support. In doing so the article explores three key questions: Firstly, how do lived realities, both past and present, and normative values of rural life intersect in elderly people's experiences of (in)security in post-socialist contexts?; Secondly, what forms of assistance do older people view as legitimate in their everyday lives? In particular, how are emotional exchanges and interpersonal connections interpreted and what securities do they bring?; Thirdly, what is the significance of symbolic support and recognition for elderly people and how do these draw on practices and frameworks from the socialist past?     

Coming Home? Patterns and Characteristics of Return Migration in Kyrgyzstan

Bishkek, the capital of Kyrgyzstan, Russia and Kazakhstan are all major destinations for labour migrants from rural areas of southern Kyrgyzstan. Along with searching for better income, younger men and women also migrate for educational purposes; children and elderly people stay behind. While older migrants often regard this separation from their families as temporary, younger people start to put down roots in places other than their homes and this has long‐term consequences for development in rural areas. The paper therefore looks into families’ multi‐local settings and why young migrants fail to return home. It also considers the potential impact on rural development including remittance dependency, an increasing shortage of qualified labour and new conditions of social care. The paper concludes with an assessment of the policy implications.     

The changing nature of rurality and rural studies in Russia

This paper seeks to outline different strands of the reconfiguration of the social and spatial perspectives on the countryside in Russia in the last 20 years. The country's transition implied changes in the production of knowledge, including the re-examination of research topics and bringing new theories into rural studies. The article strives to develop a theoretically informed critique of the recent studies, specifically addressing the changing vision of rurality. Taking as a starting point traditional concerns in rural discourses, i.e. the ways rurality have been traditionally studied in Russia, this paper seeks to identify what rural studies might gain and lose from the shift in academic research. Critics have focused on the problems of bringing together past and recent trajectories in rural research, concentrating on the power of construction of particular rural discourses in different environments. The reconstruction of changing rural discourses aims to provide an interpretative framework for understanding the ways various rural images and policy concepts are implicated in the construction of the Russian countryside.     

From Women's Struggles to Distorted Emancipation

This article develops a critical analysis of transformations of the idea and practice of women's emancipation in late-modern western society under the influence of globalizing advanced capitalism. It builds on analyses of feminist critical theory and critical globalization studies and argues that global capitalism initiates processes in which the practice of emancipation is distorted. Distorted emancipation refers to the social consequences of the marketization and commodification of areas of social life that were previously excluded from market relationships. Care practices, which have been a fundamental issue in women's emancipatory struggles, are used as a reference point. The article argues that even if commodification creates certain possibilities for financial rewards of care, it institutionalizes a double misrecognition of care as both nonproductive work and paid work that cannot be a source of social recognition. Furthermore, distorted emancipation makes positive moments of changing gender patterns available only for some groups of women in socioeconomically, geopolitically or culturally privileged positions. These positive moments are dependent on transnational care practices, which are understood as a manifestation of distorted emancipation.     

On the Need for an Ethical Understanding of Health-Care Accountability

Abstract

In Sweden, as in many other Western countries, public health care is challenged by increasing demands for care and continuing budget deficits. Person-centred care (PCC) has been introduced as a new strategy to ameliorate the perceived fragmentation in care and is expected to decrease treatment time, reduce the need for return visits, as well as increase patient satisfaction. However, the changing clinical practices necessary for the PCC approach are assumed to require new accountability practices. This article is primarily an attempt to provide a conceptual analysis of ethical accountability, i.e. a type of accountability that takes into account the human relational responsibility, partial incoherence, and power of reflection. On the grounds of this characterisation, the article aims to provide a basis, among other things, for a discussion of the possibilities of identifying and empirically studying the multimodal expressions in communication that are relevant for this type of accountability. After an initial discussion of the debate on the limits of viewing accountability as transparency, we then turn to our methodological approach and introduce a conceptual analysis of accountability. Next, we discuss some additional features of accountability. Finally, we discuss the possibilities of empirically studying the institutionalisation of ethically informed accountability within person-centred health care.     

Cultural diversity competencies in child and youth care services in Portugal: Development of two measures and a brief training program

Few researchers have examined the training of child care workers in cultural diversity competencies, despite the growing number of ethnic minority children and youth in residential care. The present paper reports two studies. In study 1, we aimed to adapt and develop two measures of cultural diversity competencies—a self-report questionnaire and an objective measure based on a case vignette (n = 51). In study 2, we proposed a brief training program. A quasi-experimental design (n = 30) was used, with cultural competencies being evaluated before and after the training. Results revealed that (1) child care workers tended to over-estimate their self-perceived competence and that (2) the experimental group was more capable of including cultural elements in their definition of strategies and relational aspects of intervention after a brief training than the group that received no training (control). Implications of this study are discussed for further development of cultural diversity competencies in professionals working in residential child care.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

It takes a team: Improving placement stability among children and youth with Fetal Alcohol Spectrum Disorder in care in Canada

Concerted efforts have been devoted to improving placement stability for children in care. These efforts have been driven by evidence of negative outcomes for foster children who experience frequent placement changes. Of particular concern are significantly higher rates of placement disruptions among children in care who experience Fetal Alcohol Spectrum Disorder (FASD). This mixed methods study examines the impact of enhanced child welfare practice interventions on placement stability for 182 children in care who experience FASD. A quasi-experimental matched comparison group design was employed, where rates of placement change were compared between children in the Project Regions who received enhanced practice standards to those in the Comparison Regions who did not. The sample included 182 participants including 98 children and youth in care from the Project Region and 84 cases from the Comparison Region. The Project Regions reported considerably lower placement changes (M = .33) than the Comparison Region (M = .98). Logistic regression analysis revealed that worker contact was found to be predictive of placement stability. Specifically, as worker contact increased, the likelihood of placement change decreased [B = − .28, W (5.35, p = .02)]. In keeping with the adage that it takes a village to raise a child, one could add for children affected by FASD, that it takes a dedicated team to promote placement stability and better life trajectories.     

Area-based partnerships in rural Poland: The post-accession experience

The paper examines the characteristics of area-based partnerships in rural Poland. It is based on the study of partnerships created after the accession to the European Union in 2004. Partnership structures have been rapidly adopted in rural Poland due to opportunities provided by the LEADER+ Pilot Programme. However, the research showed that partnerships are frequently subject to elite domination by local authorities and hence fail to fully engage a range of community and private sector actors. Funding rules for LEADER, most notably the condition that money will only be paid on the completion of projects, has been particularly significant in perpetuating the domination of partnerships by organisations with existing access to financial and human capital. Hence funding arrangements can undermine the ability of Polish partnerships to operate in ways which harness the endogenous capacities of local communities. To date power differentials between notional ‘partners’ have been experienced to a greater extent than in advanced liberal democracies. The research found that overt domination of partnership structures by state agencies limited the possibilities for community led development initiative in rural Poland.     

Health,personal mobility and the use of health services in rural Norfolk

Trends towards the centralisation of both primary care and hospital services are increasing the distances that rural residents must travel to receive health care. Contradicting the widely held image of the healthiness of rural people, data from social surveys in Norfolk show that some of the remoter rural areas have populations with a relatively high need for health care. Furthermore, the groups with most need for health care (the old, the disabled, the poor, etc.) are also those with low levels of personal mobility, for whom travelling long distances to centralised health services is particularly difficult. After adjustments have been made for variations in need, it is shown that people in the remoter areas receive much less health care than comparable people in more accessible areas. However, branch surgeries do seem to make the general practitioner service more accessible, particularly to less mobile rural residents.     

Is that all there is? The concept of care and the dialectic of critique

Recognition of the usefulness of critical social analysis for gerontology has been increasing just as a range of new problems, ranging from globalization to the anti-aging movement, are posing fresh questions about ideology, legitimation and inequality for the study of aging. Such problems and questions represent the negative moment of critique in the theory–practice dialectic. As is generally true of critical theory, in critical gerontology it is rare to find research that reflects a positive movement toward emancipatory change. Yet gerontology is one of the fields that offers special opportunities for critiquing the status quo of aging and elders in society, envisioning new possibilities for aging and developing practices that produce positive change. This paper describes the movement of our own thinking and work, away from a primary focus on analysis and critique and toward an embrace of the possibilities of generating and sustaining change in organizational care settings. We argue that principles of critical developmental and social theory can be used to reframe the concept of care, and we describe briefly how the methodology of action research can be applied in efforts to create new opportunities and possibilities in the everyday experience of elders in long-term care. In our work, we are learning how a constructive theory–practice dialectic can be initiated when critical principles are applied to a practical and urgent domain — the domain of interpersonal care within long-term care institutions for elders.     

The Brief Assessment Checklists (BAC-C,BAC-A): Mental health screening measures for school-aged children and adolescents in foster,kinship, residential and adoptive care

More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).     

Multiple stories: Collaborative and generative possibilities for psychological evaluation

This paper explores a collaborative generative approach to psychological assessment employed in Puerto Rico, with children, adolescents, and adults. It begins with a critical reflection on how the dominant discourse of mental health, founded in the suppositions and practices of Euro-American-centred psychological knowledge, has been disseminated to the globalise south under the claim that its assertions are unaffected by social, ideological, or historical forces. It discusses how its claims of expert scientific knowledge have contributed, through classificatory instruments such as the DSM and the ICD, to the production and re-production of deficit narratives in our day-to-day life. It also examines how these practices have been applied in the use of assessment instruments in Puerto Rico. It then describes, how, through a collaborative approach and narrative theory, the established colonising practices and narratives of traditional forms of psychological assessment can be questioned, deconstructed, and transformed. This approach promotes the co-creation of dialogic and generative spaces that allow for the emergence of multiple stories and performances that give meaning to a person's identity and relational being. A brief clinical case exposition is used to illustrate how this collaborative, dialogic, and culturally sensitive approach to psychological assessment can help to undermine and disrupt deficit-based narratives and provide families with new generative possibilities for re-storying and re-performing their lives and particularly, the lives of their children.     

Beyond rural idylls: Imperfect lesbian utopias at Michigan Womyn’s music festival

Whilst rural idylls have dominated some discussions of rural social difference, little attention has been paid to rural utopias. Imagined, material and discursive experiences of utopian rural ideals are critically examined in this paper. It takes as its focus the Michigan Womyn’s Music Festival - an annual US womyn-only festival - in order to understand the mutual construction of empowering rural spaces and non(hetero)normative women’s bodies. The first part of the paper moves away from the current focus on ‘rural idylls’ to understand social difference and ruralities, and argues that the notion of ‘rural utopia’ is a useful framework to reconsider rural possibilities for those considered ‘other’ to dominant (heterosexual) hegemonies. The context of the festival and qualitative empirical research methodologies are explained. In the second part of the paper four themes that arose from this research are explored. Firstly, the ‘free expression’ of sexualities, including sex and relationships is seen as creating a ‘slice of lesbian rural utopia’ at Michfest. Secondly, rural utopian understandings of Michfest as womyn’s space where diverse bodily aesthetics are celebrated are compared and contrasted to urban spaces, and particularly the gendered embodiments of ‘everyday’ life. Third, while womyn’s bodies may contest heteronormative performances of femininity, they also reiterate normative and embodied versions of ‘women’, creating womyn’s space through the controversial ‘womyn-born-womyn’ entry policy. Fourth, rural tensions are examined around the negotiation of work (voluntary and paid). The paper concludes by arguing that a focus on imperfect (lesbian) utopias furthers our understanding of gender, sexuality and rurality.     

“Do you guys hate Aucklanders too?” Youth: voicing difference from the rural heartland

This paper extends recent work in the geography of childhood and youth studies by examining the ways in which rural youth voice their understandings of what it means to be a young person at this historic moment (the end of the twentieth century) in New Zealand. Youth First¹ has been a nationwide project which has sought to privilege what young people 10–17 years say as a basis for evaluating the last 15 years of economic and cultural change in New Zealand. Over the course of 3 years a methodology was used to constitute spaces where youth voices would be heard. Focus Groups and “Youth Tribunals” have been conducted across New Zealand involving young people from diverse social and ethnic backgrounds. This methodology was supported by a development programme for beginning researchers also from diverse backgrounds and disciplines, and by the significant participation by young people in the design and conduct of the “Youth Tribunals”. Their participation has been critical to the power of the methodology to constitute spaces where rural youth have provided rich testimonies about their complex lives. While the voices of rural youth in the study resonate with national youth themes, including the theme of “not being listened to” they also speak to the nuances and differences in the lives of rural New Zealand youth. We would argue that in sharp contrast to the organizing concept of one “rural childhood” our research clearly shows that there are different possibilities in growing up rural. Maori and Pakeha² youth for example draw on different cultural and linguistic resources to voice their relationships to place and identity. Although vehemently clear about the ways in which they were excluded from participation in community life and their strategies of resistance, rural youth in this study also provided analyses which showed their commitment to positive possibilities which they saw as part of rural lives and communities.