Use of an Online Community to Provide Support to Caregivers of People With Dementia

One challenge faced by many family members caring for persons with dementia is lack of information about how to take care of others and themselves. This is especially important for persons from ethnic minority groups, because linguistically and culturally appropriate information is often not available. In response to these needs, we developed a web site for Spanish-speaking caregivers. Cuidatecuidador.com provides bilingual information on dementia and caregiver issues. Content was developed and then evaluated by caregivers residing in 3 countries. Findings suggest trends that exposure to information may be related to a higher sense of mastery and a reduction of depressive symptomatology.     

Measuring Support Provisions for People Living With Disabilities in South Asia: An Accessibility Index

ABSTRACT

The terms “empowerment,” “rights,” and “inclusiveness” are now commonly used in public policy, but little emphasis is placed on “accessibility” issues in the integration of disabled people. This article proposes a composite index to measure economic support provisions, such as employment, vocational training, microfinance, and safety nets. The index was tested in a case study (N= 245) of two districts in Pakistan. Results support a “cost/benefit”-based philosophy, rather than the “means–ends” goal, where the disabled poor are viewed as unproductive and risky payers, instead of giving them an opportunity to exercise their potential. Change for the disadvantaged poor can be brought about with the mandatory use of this index in local annual audits. Future research might examine the impact of the index and standardize it for global use.     

Transitions in Caregiving: Evaluating a Person-Centered Approach to Supporting Family Caregivers in the Community

Caregivers of older adults provide a wide range of informal supports and services that enable older adults to continue living in the community. This study describes the use of a multicomponent intervention combined with a person-centered approach to assist caregivers of older adults in the community. Four hundred and eighteen caregiver and care recipient dyads participated in this study and their outcomes related to burden, depression, well-being, and care recipient functional status were evaluated. The findings suggest that adult child and spousal caregivers experience burden differently. Programs designed to support caregivers must tailor services to the unique needs of adult child and spousal caregivers.     

Developing a Faith-Based Caregiver Support Partnership

Caring Together, Living Better (CTLB), a partnership of nonprofit and faith-based organizations, developed a culturally appropriate regional network of supportive caregiver services in the south suburbs of Chicago, IL. This article describes the findings of a mixed-methods evaluation that included network analysis to track network growth and development, tracking of service delivery, assessment of caregiver-related outcomes using standardized pre-post measures, and analysis of change stories elicited from project partners. Results include documentation of network expansion and statistically significant improvements in caregiving self-efficacy and adequacy of help. Story themes highlight participants’ positive experiences with CTLB and improved caregiver quality of life.     

Chorus for Community Integration and Recovery for Men with Psychiatric Disabilities in a Supportive Housing Community

This study reports the findings from a mixed-methods evaluation of the effectiveness of a choral program for 34 homeless men with substance abuse and mental illnesses. The evaluation focused on the chorus experience as one way to promote community integration and recovery. Fifteen residents (44.1%) were chorus members (CMs), and their responses were compared with those of 19 nonmembers (NCMs). When examining the quantitative data only, significant differences were not found between CMs and NCMs. However, narrative data and participant observation revealed that the choral program may have helped CMs improve their subjective experience of community integration by enhancing psychosocial components.     

An Interpersonal Dialogue Group for Students With and Without Disabilities

This narrative documents my experience cofacilitating a group of 17 undergraduate students. One half of the students and the cofacilitator of the group had disabilities. The purpose was to foster understanding between students with disabilities and students who were able bodied. The group members learned about people with diverse disabilities and the discrimination and difficulties they experienced. Students with disabilities learned about perceptions of the students who were able bodied and their differences and commonalities. Group members experienced mutual aid. The author learned important lessons about herself as a group worker and social work educator.     

Social Support for Mothers of Children With Disabilities in China

ABSTRACT.

This article analyzes the gendered parenting experiences of mothers of children with disabilities in China. These mothers struggle to meet their children's needs, including daily care, financial security, and child development. In the context of China's social welfare development, are social services responding to their needs, so that mothers can share responsibility for the needs of their children with disabilities? The research analyzed qualitative data about 6 case-study children in rural and urban China. The data were derived from observation and interviews with their parents and other family and community members. The analysis revealed that the capacity of the mother, community, and local social services had an impact on the rights of the children and mothers. They experienced social discrimination, insufficient social support, and local failure to implement central policy social services and income support. These findings are consistent with international research about disability rights. They reinforce the importance of economic redistribution to enable local implementation of the national disability rights policies, rather than merely relying on ephemeral concepts of cultural change. Further research about the comparative impact of economic and social change in China on mothers and children with disabilities would extend these findings.     

The Case for a New 'Case' Management in Services for People with Learning Disabilities

Micro-organization is currently fragmented in services for peoplewith learning disabilities. Care management, person-centredplanning (PCP) and direct payments have developed through separatepolicy strands, with tasks and agency responsibilities blurred.A wide diversity of care management arrangements currently operate,with the relationship between care management, PCP and directpayments imprecisely defined. PCP and direct payments have alsobeen variably implemented. This paper argues for a new ‘person-centredcase management’, with these different devices betterintegrated and decision-making and action more person-centred.Drawing on practice experience from the original British casemanagement experiments, the new ‘case’ managementwould be centred on the needs and wants of individuals, be conductedindependently from assessment, operate outside the public sectorand be able to access personal budgets. It would consequentlyhave the capacity to further de-institutionalize services andsupport and transfer more control to people with learning disabilities.     

Formal Alternative Transportation Options for Older Adults: An Assessment of Need

ABSTRACT

This study measured the need for formal alternative modes of transportation among older adults by applying traditional factors of the Behavioral Model. Survey participants who regularly drove were compared to those who could no longer drive. Race/ethnicity and self-reported health were significant predictors of perceived need for transportation services for both groups. However, income and service awareness were significant predictors only for drivers, while family proximity was a significant predictor only for non-drivers. Results suggest the importance of gaining a better understanding of the factors associated with need for senior-focused transportation services to more effectively plan such programs.     

公交卡高额押金与公共产品的有效提供

近几年来,我国很多城市公交卡收取的高额押金问题引起了人们的强烈关注。从公共产品基础理论出发,公交系统垄断经营是合理的,但同时应该注意,公共交通等公共产品的有效提供,离不开政府部门的严格监管和公共财政的必要支持。     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

Individually-Tailored Support for Ethnically-Diverse Caregivers: Enhancing Our Understanding of What Is Needed and What Works

Family caregivers play a crucial role in maintaining older adults in the community, often at great cost to themselves. We discuss a program serving ethnically-diverse caregivers in New York, offering, on average, 11 case-management hr per client. Participants reported statistically significantly reduced stress and burden. Respite was the most requested service, belying an assumption underlying policies and services that families, particularly among minority populations, can and will care for their older members. Thus, services must be carefully tailored to meet actual caregiver needs, including provision of alternatives that reduce caregiver involvement. We discuss practice and policy implications.     

灾荒与关中交通关系研究——以民国十八年（1929）为中心

民国十八年,关中遭遇重大灾荒,对社会经济发展造成严重威胁。当时中央及地方政府采取各种措施应对灾荒,其中以工代赈加大交通修建的政策,为民国时期关中交通的发展带来契机。当时全国各地的赈济款项与物资,源源不断地流入关中。大批因灾而流亡的灾民也为交通修建提供廉价劳动力,交通的发展必然为关中经济的后续发展创造条件。     

'Policies Don't Protect People, It's How They Are Implemented': Policy and Practice in Protecting People with Learning Disabilities from Abuse

Recent years have seen the development of policy guidance documents in both Wales and England relating to the protection of vulnerable adults from abuse. This policy guidance does, however, require translation into policies at the local level and that these policies are then implemented in day‐to‐day practice. This article reports some of the findings of a two‐year study that examined the development and implementation of such policies in services for people with learning disabilities within Wales. Data were gathered by means of a survey of service providers from across Wales and also via focus groups held with direct care staff and those with a responsibility for investigating alleged abuse. Positive developments include a commitment to multi‐disciplinary working, increased clarity and consistency, and greater awareness. Less positive aspects include the potential for policy ‘overload’ and a feeling that, while there is awareness of the existence of vulnerable adults policies, knowledge of their content may be more limited. Recommendations are made for the development of policy, practice and research.     

论唐代广州内外港与海上交通的关系

唐代广州港分为扶胥港等外港和广州城等内港。扶胥港是中外商舶进出广州的必经之地,人们在此停泊一般与参拜南海神庙有关,扶胥港在中外商贸活动中作用有限。但其在护卫中外商贸交通,保证海上丝路畅通方面起到了重大作用。而广州对外贸易的繁荣与海上交通密不可分,广州城港不仅可利用珠江与广大腹地相连,而且直接与海外交通。广州城内外的相关官署和海阳等馆驿大都位于沿城南、城西的水滨,与海外贸易交通有关。唐代中后期历任广州地方官员的贪廉都对外贸的发展产生了一定的影响。     

发展社区组织,完善社区养老功能

针对成都市老年人的人口特点及养老服务中存在的资金缺口大、服务人员缺乏、服务项目少、社会化程度低及年青人敬老爱老观念淡薄的现状,提出坚持政府为主导,政府除做好财政支持和监管工作和基础建设外,更重要的是整合社区资源,调动社区民间组织积极性,开展丰富的养老服务形式,倡导敬老爱老的社区文化的解决措施,完善社区居住、文体教育、互助的功能,使社区养老模式不仅解决养老的困难还起到丰富老年人的精神生活,提高老年人生活质量的作用。     

Community Treatment Orders for People with Serious Mental Illness: A New Zealand Study

New Zealand legislation allows for the involuntary outpatienttreatment of people with serious mental illness. This studyexamines the views of service users, family members and mentalhealth professionals (MHPs) about the impact of this regime.Semi-structured interviews were completed with forty-two serviceusers, twenty-seven family members and ninety MHPs, with recentexperience of the regime. Participants were asked to commenton the functions of community treatment (or non-resident) orders,their benefits and restrictions, decisions about their terminationand any impact on relationships. Most service users believedthe main purpose of the order was to ensure they took medication.They also believed the order provided better access to othertreatments, supported accommodation and care from MHPs. Familiesconsidered the orders provided relief for them and a supportivestructure for their relative’s care. MHPs found the ordersuseful for engaging service users in a continuing therapeuticrelationship, and for promoting treatment adherence. In eachgroup, a majority of those interviewed viewed involuntary communitytreatment in a generally positive light, while acknowledgingthe restrictions imposed on service users’ freedom.     

Current Developments in Social Care Services for Older Adults in the Czech Republic: Trends Towards Deinstitutionalization and Marketization

ABSTRACT

Deinstitutionalization and marketization of eldercare has been delayed by 20 years in the Czech Republic compared to Western Europe, and it takes place in a completely different context, characterized by the legacy of communism, a growing older population, and less generous public subsidies. This study is the first in the Czech Republic to examine how deinstitutionalization and marketization effect implementation of these principles on the availability and quality of eldercare services at regional and municipal levels. A mixed-method approach was used, combining several data sources (policy documents, administrative data, statistics, expert panel, and secondary use of qualitative data). The findings suggest that the support for and availability of home-based care has declined, despite the ever-increasing number of older adults and policy preference for deinstitutionalization. Furthermore, home-based services have failed to adjust to growing care needs of older adults (e.g., inflexible schedules, limited provision of time-demanding care, inadequate staff composition). This situation occasioned an unintended outcome: the emergence of nonregistered, semilegal, for-profit nursing homes offering low-quality care and poor working conditions, and subject to no quality control. The health and even lives of older adults are at risk if they choose such services. Research is needed to study older adult decision making and offer them tools to identify and avoid questionable services.     

Critical Components in Implementing Evidence‐based Practice: A Multiple Case Study of Individual Placement and Support for People with Psychiatric Disabilities

When developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence ‐based practice (EBP ). Individual Placement and Support (IPS ) is an evidence ‐based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, we have followed three IPS demonstration sites for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research (Damschroder et al. 2009 ). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for.