Challenges in Evaluating Community-Based Health and Social Intervention

Prenatal care outreach is receiving growing attention as one component of multi-faceted strategies necessary to reduce infant mortality and low birth weight. This paper examines challenges in evaluating community-based prenatal care outreach programs, describes two studies that have successfully addressed such challenges, and offers recommendations to community agency administrators and program staff regarding reasonable approaches to integrating evaluation into program activities.     

Identifying health inequalities between Māori and non‐Māori using mortality tables

Abstract

While there is a need for more detailed information on health inequality to guide public health policy, the most complete and easily available data remain those in mortality tables. We investigate, via a comparative analysis of data from New Zealand on Māori and non‐Māori mortality, whether more detailed information than raw life expectancy may be extracted from the mortality tables. Given a parametric distribution for the mortality capable of fitting irregularities in mortality table data, the curvature of the survival and hazard rates can identify changes in mortality rates, such as infant and late‐life adult mortality, which allows for straightforward comparisons between the two sub‐populations. Our results identify an exogenous effect in earlier mortality among Maori, which correlates well with many published observations of health and health‐care inequalities between Māori and non‐Māori. This “proof of concept” for our method of analysis indicates that examination of bulk data such as those in mortality tables has a potential role in the design of more detailed studies involving causes of mortality.     

Experiences of Caregivers in a Dementia Simulation Program

Abstract

Objectives: Simulation-based training has been used in health care to increase clinical knowledge and skills and understanding the experience of others. There is a lack of research in exploring experiences of caregivers of people with dementia in a dementia simulation program and its potential benefits on caregivers. The purpose of this qualitative study was to explore experiences of caregivers of people with dementia who participated in a dementia simulation program, called Dementia Live?.

Methods: Fourteen caregivers were interviewed after participation in DL, and thematic analysis using NVivo 11 software was used.

Results: Three themes emerged, including: (i) the Dementia Live? as an eye-opening experience; (ii) the perceived benefits of the Dementia Live? on themselves; and (iii) recommendation of the Dementia Live? to other caregivers.

Conclusions: Dementia simulation programs such as the Dementia Live? may help caregivers to have more empathy, understand better about the behaviors and feelings of people with dementia, and to use strategies that can help when working with people with dementia. Further experimental research is needed to examine effectiveness of the dementia simulation program on caregivers and people with dementia.     

What Policies Advance Infants and Toddlers? Evidence to Inform State and Federal Options

A variety of civic actors—government, associations, and local agencies—work to help parents advance the vitality of our youngest children. Empirical findings accumulating over the past half-century identify benefits for infants and toddlers stemming from three policy models: paid leave for parents after a newborn arrives; regular pediatric assessments, including home visiting; and quality caregivers situated in homes or centers. We review what is known about the effects of these policies, along with constituent elements of quality (mediators) that operate proximal to children's health, cognitive, and emotional growth. Much has been learned about how such collective action, carried out by local organizations, advance infant–toddler development. Methodological advances foster new knowledge: moving closer to causal inferences and pinpointing social mechanisms that enrich infant–toddler settings. Less well understood is how policy levers can move the malleable elements of program quality to raise the magnitude or sustainability of program effects. We note the benefits of income-support efforts for fragile families, while urging new work on how economic dynamics touch the capacity of parents and caregivers to better nurture infants and toddlers.     

Social Empathy as a Framework for Adolescent Empowerment

ABSTRACT

Adolescent empowerment has been used to develop programs addressing a variety of issues that put young people at risk. Empowerment has been associated with positive outcomes in youth, including increases in resilience, self-efficacy, self-esteem, and civic engagement. This article reviews a selection of applications of empowerment with adolescents to identify how the concept is defined, applied, and measured. Key challenges to implementing adolescent empowerment programs are identified. Based on the review, social empathy is proposed as a framework for adolescent empowerment program developers. Using social empathy as a framework allows for consistency in definition and flexibility in application to apply to diverse groups of youth in various settings. A social empathy framework also establishes key outcomes that can be measured to ensure program effectiveness. By employing social empathy as a framework, service providers can draw on the value that empowerment, both as a process and an outcome, brings to their work with adolescents.     

Observational Research in Intergenerational Programming

Summary

Research in the field of intergenerational programming is rapidly growing in both quantity and quality. Both those who plan and work directly with intergenerational program participants in the human services and those who hold positions as researchers and evaluators need to be encouraged to research and evaluate their programs. We argue that observational research, though not without its shortcomings, should be more widely used to study and evaluate intergenerational program effectiveness and the relationships among people within them. We also provide some examples of observational strategies useful in practice-based research. We conclude that by recording details of the actual program interactions and relationships and examining them carefully or preserving them for later scrutiny, intergenerational program planners can learn to make relationship-based interventions successful and rewarding for their clients and themselves.     

An Exploratory Study of Soldiers' Attitudes Toward a Matched Savings Program in Korea

ABSTRACT

This study explores the possibility of implementing a saving program for military soldiers in Korea. Over the past decade, asset-based programs have been expanded in Korea. Using a vignette method describing a military matched savings program and logistic regression, this study examines soldiers' attitudes toward a matched savings program. This study with a final sample of 224 soldiers in a Brigade in Korea found that 67% of survey participants are willing to join a savings program. In addition, most soldiers expect the program to have a positive impact on their military life, saving habits, and life after army service. A logistic regression analysis found that family relationship, duty type, rank, and age are significantly related to a soldier's willingness to join the program. The study provides policy and practice implications in that a military savings program may help soldiers to adapt to army service and prepare for life after army service. This study concludes with possibilities for future research when examining soldiers' attitudes toward a military savings program.     

The relation between population and health in a crisis

This work argues that the economic crisis in Latin America resulting from structural adjustment programs and recession has had deleterious effects on the relationship between demographic factors and health. 2 works presented at the 1989 International Union for the Scientific Study of Population meeting in New Delhi considered the difficulty of demonstrating unambiguously the demographic effects of the economic crisis. This work, instead of looking at overall rates which may not have been greatly affected, focuses on 3 specific areas that reflect the relationship between population and health in the context of the crisis. Although the infant mortality rate has continued to decline in almost all countries and regions of Latin America during the crisis, the decline has been unequal in different sectors. A comparison of data from the 1987 National Survey of Fertility and Health in Mexico with that of the 1982 National Demographic Survey shows that rural infant mortality declined by only 1% between the 2 surveys, while urban infant mortality declined by 21%. An indicator of available services in the household showed the same increase inequality. Disaggregation of infant mortality data for Mexico suggests that even a presumably biological determinant, maternal age, loses much of its weight when socioeconomic factors are considered. Other studies, on the impact of maternal education, similarly indicate that the relationship is different for different social sectors. The infant mortality data taken together suggest that infant mortality continues to ba a valid indicator of social inequality, and that the crisis has had the effect of increasing inequality and worsening the relative conditions of the least advantaged. In the area of fertility, data from the 1989 National Survey of Fertility and Health in Mexico are used to argue that family planning programs are integral components of an authoritarian governmental political style. The survey indicated that sterilization is now the most commonly used contraceptive method in Mexico and that fully 12.4% of sterilized women did not make the decision to be sterilized themselves. 34% of illiterate women who were sterilized did not make the decision themselves. 14% of all the women but 33% of illiterate women reported they would not be sterilized if they could make the decision again. These data and others on the high proportion of women who undergo sterilization at young ages and low parities and without being informed of other methods suggest that the attitude of the official family planning program is becoming more authoritarian and less respectful of human rights as it seeks to curb population growth. The area of health effects has usually been ignored in migration studies. The phenomenon of Mexican migrant workers in the US who return to Mexico after contracting AIDS is an obvious example of the link between population variables and health.     

A Comparison of Subsidized Guardianship and Child Welfare Adoptive Families Served by the Illinois Adoption and Guardianship Preservation Program

Abstract

This study compares the outcomes of 113 subsidized guardianship families and 733 child welfare adoptive families served by a therapeutic counseling program for adoptive/guardianship families at risk of child placement or dissolution. No significant differences are found in the percentage of children in placement at the end of services or the level or parental commitment to their children. Children in subsidized guardianship families are more likely to be minority children who are older at removal from their birth families and at placement with their current families. Also they are less likely to have a history of abuse than children in adoptive families.     

Athena's Legacy: Preparing Women for a Mentoring Program

ABSTRACT

A community-based research study conducted in 2004 identified a number of women from disadvantaged communities who sought mentoring in personal, educational, and vocational aspects of their lives. Informed by this earlier research, a program titled Map Your Future was developed, and a pilot mentoring program commenced in 2005. This article describes the group program that was developed to prepare the women for a mentoring relationship, and the research methodology underpinning its development. It concludes with an exploration of the women's experiences of the program.     

Attitudes towards reproductive technologies for humans

Abstract

The aim of this exploratory study was to measure attitudes towards various applications of real and hypothetical reproductive technologies for humans, including prenatal gender selection. A total of 121 undergraduate university students completed a questionnaire measuring knowledge, interest, trust, risks and benefits, and attitudes towards reproductive technologies for humans. An exploratory factor analysis showed that participants rated the use of these technologies as unacceptable if it was for personal enhancement but acceptable for “medically useful” applications. Participants also reported not having a gender preference for their (hypothetical) unborn child, were they to use prenatal gender selection, an application very few approved of. Results failed to support a general desire to use prenatal gender selection or to hypothetically favour one gender over the other. Attitudes towards reproductive technologies cannot be simply summarised in a “pro or against” manner as they heavily depend on the context.     

Breaking the germline barrier in a moral vacuum

ABSTRACT

In November 2018 a Chinese scientist claimed to have used CRISPR/Cas 9 technology to genetically modify two human embryos that were then gestated in one adult woman through an IVF pregnancy and brought to term. The twin girls are allegedly the first babies born with their prenatal genomes edited. Using both English language and Chinese supporting documents, this paper discusses the background of this human experiment, the social context of Chinese science, and the alleged ethical transgressions of its principal scientist.     

Lessons Learned From the First-Year Evaluation of a Small-Scale Home Visitation Program

ABSTRACT

Home visitation programs to prevent child maltreatment are offered in many communities. Agencies in these communities want to help families in need while under increased pressure to provide effective services. Funding is limited and competitive; some agencies might choose to limit funds spent on supervision, training, and evaluation as a way to provide more direct service. In this article, we use an implementation science framework and the results of an evaluation of a small home visitation program to underscore the importance of ongoing training and supervision, attention to fidelity, and program evaluation. The evaluation included 17 families entering the program during 21 months. Evaluators visited families in their homes at the beginning of the program and again 10 months later. Like many other well-intended, small-scale programs, this one “borrowed” from evidence-based models and expanded enrollment criteria in an attempt to better serve families. Findings from the evaluation suggest that the program, as it was carried out, was not effective at reducing parenting behaviors known to be associated with child maltreatment. We offer advice to funding and community agencies based on these findings and implementation science. Future evaluation research must pay greater attention to fidelity and implementation.     

The Mother Who Didn't See Her Baby and the Hospital That Didn't See the Psychiatrist

Abstract

This paper discusses the initiation of an infant preschool child psychiatric consultation service in a tertiary level paediatric hospital, where there had been no service such as this in the past ten years. The case presented illustrates the complex nature of both feeding disorders in infants and the cases seen in this tertiary level institution. It also describes a parallel process: The mother who was uninvolved with her infant and the hospital that was indifferent to the child psychiatric-consultation service development process. An understanding of the psychodynamic aspects of the child, the mother, and the interactions between the medical team and the child psychiatrist were crucial to the success of the treatment. This psychodynamic understanding is also essential to the development of a continuing working relationship between the child psychiatric-consultation liaison service and the hospital.     

The Use of Program: Review and Update

SUMMARY

This paper focuses on what has been thought of in social group work as “program”—program skills, program content, program media, or use of program—and what is now known as nonverbals, exercises, simulations or games, or expressive therapy. Certain dilemmas of the past, e.g., process vs. product (content), talking vs. doing, social work vs. recreation, are reviewed as obstacles to the integration of doing-oriented activities within the major theoretical approaches to group work in social work. Such obstacles have been less encumbering to other professions which have presently assumed the dominant theoretical leadership in this area. Some recent developments in knowledge, technology, and social-cultural forces are described which have contributed to a present milieu that places increased value of diverse modes of expressiveness. The paper concludes with seven future-oriented proposals that theory, practice. and research in this area demand.     

An Exploratory Analysis of Seven Child Welfare Workers who Confused SIDS with Child Maltreatment Fatalities: A Brief Research Report

Abstract

Previous research shows that child welfare workers (CWWs) have low levels of knowledge of risk factors for child maltreatment fatalities. Further, these gaps in knowledge leave CWWs with misconceptions about causes of deaths and the characteristics of the perpetrators. This brief research report focuses on CWWs’ gaps in knowledge with regard to CMFs and sudden infant death syndrome (SIDS) and explores the socio-demographic characteristics of seven workers who confused fatal child maltreatment and SIDS. These workers were experienced professionals—who were in their middle-age, mid-career, and well-educated—and had been trained in how to recognize risk factors for CMFs. Implications for training and collaboration with other professionals are discussed, as well as the need for research to evaluate training efficacy.     

The Price Effects of Family Caps on Fertility Decisions of Poor Women

ABSTRACT

Family Caps have been a popular welfare reform policy designed to discourage women on welfare from bearing additional children. It has been thought that the principal mechanism through which a Cap achieves its objective of lower birth rates is the financial pressure placed on women by the denial of cash benefits. Our study uses instrumental variables Probit modeling to directly measure the contribution that price makes to Cap impact on births. We reexamine data from the New Jersey Family Development Program (n = 8,393) experiment and find that only a very small percentage (about 2.5%) of the overall Family Cap effect reported in earlier studies can be attributed to price. Moreover, the price effect holds only for short-term Black welfare recipients. We speculate that much of the unexplained Family Cap treatment effect stems from a message of social pressure and disapproval toward welfare receipt and childbearing on welfare. We offer a possible direction for future research which would directly measure the social disapproval component.     

A Qualitative Evaluation of a Conditional Cash Transfer Program in Turkey: The Beneficiaries’ and Key Informants’ Perspectives

ABSTRACT

Since the 2001 economic crisis, conditional cash transfers (CCTs) have been provided to poor families in Turkey to improve education and health outcomes of children. Under the framework of CCT programs, grants provide an incentive for poor households to use available basic social services. The aim of this study is to explore beneficiaries’ perspectives in relation to a CCT program in Turkey. The in-depth study design entailed semistructured qualitative interviews with beneficiary households and key informants. A total of 397 in-depth interviews were conducted. Analysis results suggest that the CCT program not only positively affected health and educational outcomes, but also contributed to the empowerment of women and improved the self-esteem and self-confidence of beneficiary children. Recommendations for future research are made including the need for an impact evaluation analysis that employs quantitative research methods designed to improve the provision and quality of the basic social services.     

Family policy,economic development and infant mortality: a longitudinal comparative analysis

Ferrarini T, Norström T. Family policy, economic development and infant mortality: a longitudinal comparative analysis Int J Soc Welfare 2010: ??: ??–??© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. In the present study, the impact of family policy legislation and economic development on infant mortality was estimated. Time series analyses indicate that economic growth decreased infant mortality in the earlier part of the 20th century, while the postwar period showed a zero or even a reversed correlation between economic development and child health. The results from fixed effects modelling of data for 18 welfare democracies for the period 1970–2000 are in line with the hypothesis that the more generous the earnings‐related parental leave benefits, the lower the infant mortality.