Understanding corruption

Abstract

Like many governments across the globe, the Australian Government has embarked on major healthcare reforms. Part of this reform agenda included the establishment of sixty-two primary healthcare organisations (PHOs) originally called Medicare Locals (MLs), currently to be re-structured as primary healthcare networks. Primary health organisations were tasked with the coordination of primary health care delivery and with tackling local healthcare needs and service gaps. They were to drive improvements in primary healthcare and ensure that services are better tailored and integrated to meet the needs of local communities. This article puts forward the argument that new primary healthcare organisations have the potential and the ethical aspects of healthcare organisations are largely overlooked in the literature. To address this gap we outline two complementary frameworks: a theory of ethical communities and an emancipatory method. We conclude that these frameworks could be used as potential guides for new healthcare organisations to become transformative organisations.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.     

Proposing an Initiative Research Methodology for LGBTQ+ Youth: Photo-Elicitation and Thematic Analysis

ABSTRACT

A framework for approaching lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) youth is presented that honors their voice. This methodology utilizes participant-driven photo elicitation as a qualitative data collection method, and then integrates thematic analysis. A brief review of current literature is provided to outline gaps, which establish the need to expand effective research methods with LGBTQ+ youth. Photo elicitation is explained with discussion specific to use with LGBTQ+ youth. Thematic analysis is identified and explained as an analytic approach. Challenges of implementing this methodology are discussed with attention to ethical concerns.     

Tax-based research and data on non-profit organisations

Tax-exempt, non-profit organisations represent a significant and growing sector within the US economy. Between 1975 and 1990, assets of tax-exempt organisations increased in real terms by over 150 per cent while the revenue increased by over 227 per cent. This compares to a growth in real GDP of 52 per cent over the same period. A variety of tax policy issues on tax-exempt organisations and the non-profit sector can be addressed using several sources of data collected by the IRS from federal information and tax returns of exempt organisations. The Statistics of Income (SOI) Division, using sample data, conducts studies of many of the different components of the tax-exempt sector, including non-profit charitable organisations, organisations exempt under sections 501(c)(4)-(c)(9), private foundations and 4947(a) charitable trusts, and the unrelated business income of tax-exempt organisations. Income statement, balance sheet and other financial data, as well as a great amount of non-financial information, are collected in these SOI studies. The primary purposes of this article are: first, to document the role of the non-profit sector in the US economy and the evolving growth and change within the sector from the mid-1970s through to the present; and, second, to describe the ongoing SOI studies of tax-exempt organisations, the products and services available through SOI, and the future statistical plans at SOI for data collection and analysis of tax-exempt organisations and the non-profit sector.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

The Association Between the New Rural Cooperative Medical System and Health Care Seeking Behavior Among Middle-Aged and Older Chinese

The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.     

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.     

Voluntary organisations and the welfare state: the case of Norway

Taking as the point of departure the political-ideological and fiscal ‘crises of the welfare state’, this article emphasises recent changes in the relationship between voluntary organisations and the public sector in Norway, changes that open up new space for the voluntary sector both ideologically and as a service producer. We question whether voluntary organisations are able to cope with new and extensive welfare problems within the more decentralised welfare state. Do they express the values, and do they possess the resources that both governmental agencies and the organisations themselves take for granted? As part of that discussion, the article questions the dominant view within the literature, namely that Scandinavia has a very weak voluntary sector. We argue that ‘state-friendly’ Norway has a rather strong voluntary sector, that this sector is of a specific type, and that both of these factors have important theoretical implications not only for Scandinavia, but for an overall understanding of the voluntary sector.     

The Neighborhood History Calendar: A Data Collection Method Designed for Dynamic Multilevel Modeling

This paper presents a new data collection method, called the Neighborhood History Calendar, designed to collect event histories of community-level changes over time. We discuss the need for and the uses of this method. We describe issues related to the design of instruments, collection of data, and data entry. We provide detailed examples from an application of this method to the study of marriage, contraception, and fertility in rural Nepal. The paper addresses applications of this same technique to other settings and research problems. We also extend the technique to collection of other forms of contextual-history data, including school histories and health service histories. Finally, we discuss how Geographic Information System (GIS) technology can be used to link together multiple sources of contextual-history data.     

Enhancing Longitudinal Studies by Linkage to National Databases: Growing Up in Australia,the Longitudinal Study of Australian Children†

Growing Up in Australia is a national longitudinal study of the development and wellbeing of 10,000 Australian children. The study has been committed since inception to support data linkage to other datasets, to value‐add to the primary modes of data collection from parents and others. It can increase the efficiency of data collection by reducing respondent and interviewer burden as well as adding new dimensions to addressing key research questions. The viability of data linkage needs to take into account the relevance of the data for research and policy, as well as data quality and cost, privacy and consent issues and the ease of access. This article documents the various sources for data linkage considered for Growing Up in Australia, including government health and education records, child care accreditation data, and community‐level data, and examines the strengths and challenges associated with each.     

Substance use disorders and COVID-19: the role of telehealth in treatment and research

ABSTRACT

Telehealth, or the use of telecommunications and virtual technology to deliver health care and engage with patients outside of traditional health-care facilities, can play an important role in addressing the treatment and study of substance use disorders (SUDs) during the ongoing COVID-19 crisis. COVID-19 and related safety restrictions have thrust healthcare workers and researchers into a new reality of healthcare that relies heavily, or even exclusively, on telehealth methods. These changes have forced treatment providers and researchers to be agile in adopting these methods in order to maintain continuity of patient care and data collection. There are unique considerations that should be taken into account as telehealth practices continue to augment SUD care and research, even when restrictions have been lifted. Overall, we propose that telehealth can support innovation in treatment and research focused on SUDs and should be an integral part of our work, beyond COVID-19.     

Care managers’ perceptions of eHomecare: a qualitative interview study

To implement information and communication technology (ICT) in elderly care can be a challenge for healthcare organisations. In Sweden, care managers (CMs) are responsible for offering ICT as a new part of homecare, i.e. eHomecare. The aim of this study was to focus on CMs’ perspectives and describe their perceptions of eHomecare. The study has a qualitative approach. Semi-structured interviews based on vignettes were conducted with 12 CMs in a medium-sized municipality in central Sweden. Data were analysed using qualitative analysis. The findings showed that CMs are influenced by surrounding organisations and relatives in their decision to grant eHomecare. There were also difficulties in CMs’ management of eHomecare. Furthermore, eHomecare was perceived to improve the quality of everyday life for older. It is understood that the management of eHomecare is a challenging task for CMs and a complex mission. Interactions among CMs, relatives, care providers, and other factors as for example CMs’ own attitudes have an impact on CMs’ decisions.     

Does Self-Neglect Occur Among Older Adults With Dementia When Unsupervised in Assisted Living? An Exploratory,Observational Study

The phenomenon of older adults with dementia who develop behavioral expressions when they are unsupervised in assisted living residences is understudied. This qualitative study aimed to bridge this gap in the literature by focusing on 12 residents in various stages of dementia. Grounded Theory was followed to guide data collection and analysis. Data were collected in two special care units of an assisted living residence for 10 months. Participant observation was the primary data collection strategy. Semistructured interviews with staff and managers and review of clinical records augmented the observation data. While unsupervised, residents exhibited a wide spectrum of negative emotional states, behavioral expressions, functional difficulties, wayfinding difficulties, serious hygiene problems, and safety risks. More than half of the identified incidents represented self-neglectful behaviors. The study highlights the need for enhanced supervision and targeted interventions for residents with dementia who are susceptible to self-neglect.     

Rights discourses in relation to education of people with intellectual disability: towards an ethics of care that enables participation

In this paper we argue that human rights approaches for intellectually disabled people have failed to recognise the complexity of rights claims made by and on behalf of this group. Drawing on a research project into discourses of education for intellectually disabled people in the Eastern Cape, South Africa we discern three rights discourses; namely, rights to full participation, rights to special services and rights to protection. These draw off a social model, a medical model and a protective model, respectively. We note that these discourses may be set up in contestation with each other. However, we argue that they can be seen as complementary if viewed within an ethics of care that enables participation. Within this conceptualisation, participation is viewed within relations of care but is subject to a critique that examines the role of context and disciplinary power in constructing dependency.     

Towards an agenda for disability research in Europe: learning from disabled people’s organisations

This paper addresses the challenges of building capacity for collaborative participatory research with disabled people’s organisations in European countries. The paper presents initial findings from the project ‘European Research Agendas for Disability Equality’ (EuRADE), which seeks to build the capacity of civil society organisations to participate in future research collaborations in partnership with academic institutions. The findings draw on survey data identifying the research capacity, needs and priorities of 68 organisations in 25 countries and focuses, in particular, on responses from national or European level representative organisations of disabled people. The findings demonstrate a high degree of motivation and readiness for collaboration in academic research but raise concerns about the readiness of academic institutions to engage disabled people as equal partners within social model and rights‐based approaches. Respondent organisations identified a wide range of research needs that raise challenges for collaborative responses from the academic community. In this way, the findings provide a basis for developing user‐led agendas for European funded research within the emancipatory paradigm, and indentify important opportunities for new international research collaborations between activists and academics.     

Residential Child Care Agencies as Learning Organisations: Innovation and Learning from Mistakes

The residential child care sector has been scrutinised via numerous inquiries following revelations of abusive and poor practice. These inquiries have made numerous recommendations which involve changes in practice and organisational culture, much of which is congruent with the features of a learning organisation. This article details research which evaluates the extent to which residential child care agencies exhibit the characteristics of a learning organisation. The research involved qualitative and quantitative methods, drawing on the experiences of a range of staff from the residential child care sector within Scotland. The findings revealed that residential child care agencies exhibit many features of a learning organisation, yet the extent to which these characteristics are perceived to exist differs significantly in line with the position staff occupy. Most significant were the findings that many staff do not feel supported to take risks nor encouraged to develop innovative practice; mistakes are not used as learning opportunities and a culture of blame is felt to exist. The implications of this are significant and this article identifies changes necessary to allow residential child care agencies to operate as learning organisations.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

Materializing architecture for social care: Brick walls and compromises in design for later life

This article reports on an ethnography of architectural projects for later life social care in the UK. Informed by recent debates in material studies and “materialities of care” we offer an analysis of a care home project that is sensitive to architectural materials that are not normally associated with care and well-being. Although the care home design project we focus on in this article was never built, we found that design discussions relating to a curved brick wall and bricks more generally were significant to its architectural “making”. The curved wall and the bricks were used by the architects to encode quality and values of care into their design. This was explicit in the design narrative that was core to a successful tender submitted by a consortium comprising architects, developers, contractors, and a care provider to a local authority who commissioned the care home. However, as the project developed, initial consensus for the design features fractured. Using a materialized analysis, we document the tussles generated by the curved wall and the bricks and argue that mundane building materials can be important to, and yet marginalized within, the relations inherent to an “architectural care assemblage.” During the design process we saw how decisions about materials are contentious and they act as a catalyst of negotiations that compromise “materialities of care.”     

Brief Behavioral Interventions for Symptoms of Depression and Insomnia in University Primary Care

Abstract

Objective: To describe how behavioral activation (BA) for depression and stimulus control (SC) for insomnia can be modified to a brief format for use in a university primary care setting, and to evaluate preliminarily their effectiveness in reducing symptoms of depression and insomnia, respectively, using data collected in routine clinical care. Participants/Methods: Chart review data were obtained for 11 patients treated between August 2009 and December 2010 with 1 session of brief BA for depression and 17 patients treated with 1 session of brief SC for insomnia. Results: At 2-week follow-up, patients reported significant decreases in symptoms of depression on the Patient Health Questionnaire-9, t(10) = 3.95, p < .05, and insomnia on the Insomnia Severity Index, t(16) = 5.43, p < .05, respectively. Conclusions: This case report provides preliminary evidence of the external validity of brief BA and SC after they were adapted for use within university primary care.