Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.     

Child Sexual Abuse in Zimbabwe

Although child sexual abuse is a significant public health problem globally, its incidence, prevention, and management is less well described in resource-poor settings. In poorer settings prevention initiatives assume even more importance since resources for managing abused children are severely limited. This article examines the current status of policy and practice related to the prevention of child sexual abuse in Zimbabwe. It identifies implementation challenges and highlights opportunities that could be embraced to reduce CSA in Zimbabwe, based on evidence synthesized from recent work. Although Zimbabwe has a well-established legal and regulatory framework to protect children from child sexual abuse, implementation of existing policies is weak. Financial, human, and material resource constraints are frequently cited to explain limited prevention activity. Effective strategies for the prevention of child sexual abuse should focus on implementing existing legislation, targeting schoolchildren, and getting community involvement. A dedicated budget would help entrench these strategies, but gains can be achieved even in the absence of this.     

The Value of Cultural Adaptation Processes: Older Youth Participants as Substance Abuse Preventionists

This National Institutes of Health (National Institute on Drug Abuse) funded study employed focus groups to explore the value of: (a) engaging youth as experts in their own drug culture to engage them in open, honest discussion around substance use in their communities; and (b) allowing youth within a range of settings to systematically recreate unique workbook and video scenarios while maintaining the core components of an evidence-based substance abuse prevention program. Researchers collaborated with community based agencies that serve high risk youth, including youth who were incarcerated, homeless, in alternative high schools, in low-income housing programs, and on the US-Mexico border. The research indicates that high-risk youth in community settings can be actively engaged in adapting evidence-based prevention curricula. Youth emphasized their reasons for using drugs, as well as the salient consequences, and the value of tailored scenarios that incorporate their life experiences, language, drugs of choice, and relevant motivators. Serendipitous findings noted attitude changes related to dissonance between the adaptation component participants’ behaviors and their input as “Preventionists.” Findings have implications for developing prevention strategies that may be helpful for older, high-risk youth.     

Developing an educational workshop on teen depression and suicide: a proactive community intervention

Eight years into the YES emergency services collaboration, a comprehensive Youth Emergency Services model has emerged, one that incorporates a proactive approach to clinical and prevention strategies. In addition to direct service provision, these strategies include: (1) workshop training of school and community professionals so that they can identify young persons at highest risk for suicidal thoughts, threats, and attempts; (2) prevention education for both adolescents and parents about suicide, risk factors, and interventions; (3) a partnership with the local hotline to facilitate community screening and referral to appropriate crisis services for families and youths; (4) collaboration with a large primary care provider network to streamline the after-hours crisis referral process, using the hotline; and (5) the use of a website to inform individuals about services and resources. It is proposed that this is a contemporary model that can meet the present primary and secondary intervention needs for children, adolescents, and their families.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Health care for older persons in Singapore: integrating state and community provisions with individual support

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.     

Health Care for Older Persons in Singapore

Abstract

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

Helping parents with mental illnesses and their children: a call for family-focused mental health care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.     

Community mobilization and health care in rural China

This study is based on interviews conducted in Xiao San Jiang Township, China. This article describes the health care system before and after the reforms of the late 1970s and the impact on community mobilization and health care provision. The success of the Chinese health care system is attributed to mass participation in disease prevention. There were the public health campaigns of the 1950s at the brigade level that mobilized people to adopt personal and environmental sanitation, pest control, and primary health education. There were organizations, such as the Youth Leagues and the Women's Federations. The large groups encouraged use of services, such as family planning services, gynecological screening, and immunization. The Barefoot Doctor and Cooperative Medical Care Insurance Schemes were introduced. Brigades became directly involved in health care delivery, and health workers increased access to primary health services. There was multisectoral collaboration between mass and government organizations. Each commune official had multiple roles and information flowed between sectors. The end result was community mobilization of resources in an organization-intensive social structure and increased hopes for improvements in health. The propaganda was effective in health promotion. In the late 1970s, township management districts and village committees replaced the brigades and communes. The responsibility system gave households responsibility for the productivity of specific plots of land in order to fulfill government quotas. Members of a health project funded by a Hong Kong-based primary health care organization discovered a number of problems. Community mobilization was waning, and mass organizations were not effective. The insurance system collapsed. People tired of political slogans. Although other countries are now adopting community health approaches, China is moving away from this approach.     

A study of disabled children and child protection in Scotland — A hidden group?

This paper is based on analysis of data collected for a study, commissioned by the Scottish Government, which examined child protection work with disabled children. At a conceptual level, the paper draws on Goffman's frame analysis and on different models of disability. Focus groups were conducted with five Child Protection Committees (40 individuals) and semi-structured interviews with a further 21 practitioners from social work, education, health services, third sector organisations and the police. The findings show that, for various reasons, abuse of disabled children may go undetected. Where it is suspected, effective action does not always follow, for example, where practitioners over-empathise with parents. When child protection work is undertaken, disabled children may remain relatively invisible in terms of participation and professional focus. It is suggested that the ways in which practitioners and managers “frame” disabled children has implications for how abuse is responded to and how well these children are protected. Participants also “framed” disability in different ways, and it is suggested that a social relational model seems particularly applicable. In conclusion, in many respects disabled children experiencing abuse may remain absent from or to some extent hidden within child protection services in Scotland. While some creative work is taking place, considerable changes are required to make child protection services accessible to all disabled children, sensitive to their needs and respectful of their rights.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Preventing child sexual abuse: parents' perceptions and practices in urban Nigeria

This study examined parents' perceptions of child sexual abuse as well as prevention practices in an urban community in southwest Nigeria. Questionnaires were collected from 387 parents and caregivers of children younger than 15 years of age. Results showed that many parents felt CSA was a common problem in the community, and most parents disagreed with common child sexual abuse myths. In addition, almost all parents ( >90%) reported communicating with their child(ren) about stranger danger. However, about 47% felt their children could not be abused, and over a quarter (27.1%) often left their children alone and unsupervised. There were no significant variations in the perceptions of child sexual abuse and communication practices. The implications of findings for child sexual abuse prevention are discussed.     

The neglected priority: sexual abuse in the context of residential child care

In 1995, a questionnaire was sent to Scotland's residential child care services. Of 89 questions, five concerned sexual abuse. Responses were analysed along several variables—service type, gender and age of residents. A detailed report was compiled (Lindsay, 1997). The response rate was 94% of all Scottish services. The largest group of services were children's homes (112–49%), then residential schools (43–19%), residential respite care (28–12%), care leavers services (16–7%), services for young homeless people (15–7%) and secure units (5–3%), with other service types seven (3%). Two‐thirds of services believed they were caring for children who had been abused and one third for children who had abused others. Where children who had abused others were present, in 91% there were also abused children in the same service. The results were consistent across the variables. In a few cases, allegations of abuse had been made against staff. This was commoner in services for males than females. Staff requested more training and support in their stressful role. These findings have implications for the practice and training of residential staff, management policies and procedure and the design of new services. Copyright © 1999 John Wiley & Sons, Ltd.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

An exploratory study examining the spatial dynamics of illicit drug availability and rates of drug use

This study examines the spatial relationship between drug availability and rates of drug use in neighborhood areas. Responses from 16,083 individuals were analyzed at the zip code level (n = 158) and analyses were conducted separately for youth and adults using spatial regression techniques. The dependent variable is the percentage of respondents using drugs in the past year. Neighborhood drug availability (the major independent variable) was measured by the percentage of non-drug users who had been approached to purchase drugs. Data were obtained as part of the Fighting Back community evaluation. For youth (aged 12 to 18), drug sales in adjacent and surrounding areas were positively associated with self-reported drug use in areas where youth were residents. For adults, drug sales within the neighborhood were negatively associated with drug use, while drug sales in immediately adjacent neighborhoods were positively related to self-reports of drug use. Findings suggest that the areas where rates of drug users are greatest are not necessarily the same area where drugs are sold. Designing strategies to reduce the supply of drugs should receive input from city and regional planners and developers, as well as law enforcement and public health professionals.     

Pediatricians and foster children

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.     

Promoting Children's Welfare by Inter‐professional Practice and Learning in Social Work and Primary Care

Social work in the United Kingdom is an activity that benefits from, and often requires, co‐operation between different staff and across different professions. How this is to be achieved has been a central dilemma for practice and policy for many years. Primary care health services often play a key role. New policy and practice developments are designed to promote inter‐professional working with children, where research has shown significant problems in the community‐based health care of looked after children, children leaving care, and children at serious risk. There is, however, little evidence from research that supports current developments in inter‐professional practice; analysis of the particular nature of the inter‐professional problems is lacking, as are therefore the relevant inter‐professional solutions. A framework for better analysis, linked to developments in practice‐based research, one that would yield significant improvements for children's welfare, is presented here.