Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec

BackgroundThe evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach.MethodInspired by empowerment evaluation, the transformative–participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation.ResultsThe knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.     

Provision of hepatitis C education in a nationwide sample of drug treatment programs

Hepatitis C virus (HCV) has reached epidemic proportions among drug users, and drug programs are in a unique position to provide each of their patients with HCV education. Using a nationwide sample (N = 434) of drug treatment programs, we report the results of a logistic regression analysis that differentiates programs providing HCV education to all of their patients versus programs that do not. Fifty-four percent of the programs provide HCV education to all of their patients. Programs are about four and a half times as likely to provide HCV education to all patients if they dispense methadone; almost four times as likely to provide this service if they educate most of their staff about HCV; twice as likely if they are residential; and almost twice as likely if they conduct HIV testing on-site. Our findings indicate that there is a need to increase HCV educational services in drug treatment programs.     

Step by step: tenant accounts of securing and maintaining quality housing with a housing choice voucher

Previous research on renters’ experiences in the Housing Choice Voucher (HCV) program is robust, but much of it has been conducted in the context of mobility interventions providing added resources. In contrast, this study focuses on HCV renters’ experiences searching for housing without the support of a mobility intervention. In semistructured interviews, 34 HCV renters describe their housing search processes and outcomes. We find that renters struggle to secure housing in their preferred neighborhoods due to limited information and financial costs such as application fees and security deposits. Discussion focuses on practice and policy reforms that might support greater housing choice.     

Hepatitis C knowledge among staff in U.S. drug treatment programs

Staff in drug treatment programs are in an optimal position to support the hepatitis C related needs of their patients. To do so effectively, however, staff need to have accurate information about the hepatitis C virus (HCV). This article examines the HCV knowledge of staff (N= 104) in two drug-free and two methadone maintenance treatment programs (MMTPs) in the New York metropolitan area. Five of 20 items on an HCV Knowledge Assessment were not answered correctly by the majority of the participating staff, and total scores on the Assessment averaged 70%, 71%, and 45% among the medically credentialed staff, non-medically credentialed staff in the MMTPs, and non-medically credentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in a training specifically devoted to HCV. Results suggest the need for effective HCV-related training for all staff in drug treatment programs.     

Enhancing Drug Treatment Program Staff's Self-Efficacy to Support Patients' HCV Needs

To increase HCV-related support for patients in substance abuse treatment programs, we implemented an on-site staff training in 16 programs throughout the United States. It aimed to increase participants' self-efficacy in assisting patients with their HCV-related needs. Findings indicate that participants' self-efficacy increased both 1- and 3-months post-training, resulting in providers' perceptions that they were better able to support patients regarding HCV. Implementing an engaging and interactive HCV training for social workers and other substance abuse treatment program staff has the potential to increase their HCV knowledge, self-efficacy, and the HCV-related assistance provided to patients both in the short- and longer-term.     

OTPs in NY to help study telemedicine to treat hepatitis C

Seven opioid treatment programs (OTPs) at 12 locations in New York state will participate in a study that uses telemedicine to integrate the treatment of opioid use disorder (OUD) and hepatitis C virus (HCV). The goal is to achieve better outcomes by delivering HCV treatment on‐site via telemedicine, instead of referring out. It makes sense that this would be more effective than sending patients elsewhere, but the study needs to be done.     

Puerto Rican injection drug users: Prevention implications in Massachusetts and Puerto Rico

This study examines whether place of residence is a factor associated with reporting a positive HIV/AIDS, Hepatitis C (HCV), or Sexually Transmitted Disease (STD) status in a sample of 400 injection drug users (IDUs) residing on the Island of Puerto Rico (N=139) and in western Massachusetts (N=261). Logistic regression models revealed that IDUs residing in western Massachusetts were 66% less likely to be HIV positive compared to IDUs residing in Puerto Rico (p<.000) while IDUs residing in western Massachusetts were about 67% less likely to have a positive STD status than those residing in Puerto Rico (p<.000). Place of residence was not significantly associated with HCV status. Results indicate the need to develop prevention programs tailored to the unique socio-cultural context of Puerto Rican IDUs residing on the Island of Puerto Rico whose circumstances differ from those in the mainland US. To reduce drug use, HIV/AIDS, HCV, and STDs among Puerto Ricans in both locales, the Capacity Enhancement Model is proposed in order to develop more effective prevention programs.     

Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV; previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons.     

Table of Contents

Federal Officials Concerned About ‘Bath Salts’ and Related Designer Drugs Company Steps in to Maintain Care for Gay Clients in California N.D. Counselors Would Have Access to PDMP in Landmark Bill NASADAD, NASMHPD Team up to Preserve Separate Block Grants NASADAD Outlines Core Policy Priorities for Health Reform Cuts Proposed Across the Board in N.Y., With 6.4 Percent for OASAS Harm‐Reduction Approaches Not as Effective for HCV as for HIV Briefly Noted In the States Coming up     

The Role of Perceived Racial Discrimination in the Marriage Gap Between Black and White People

Abstract

Many explanations offered for the gap in marriage rates between Black and White people are economic and cultural. Less often considered are how racial social psychological factors influence marriage rates. In this study, we use critical race theory and the life course perspective to investigate how perceived racial discrimination impacts the likelihood of marriage for Black and White people. Data for the study are taken from the Portraits of American Life Study (N?=?678). The results of logistic regression analyses show that among people who report perceived racial discrimination, White people generally have a higher probability of being married compared to Black people. Analyses by age demonstrate that among younger adults, Black people who perceive racial discrimination are equally likely to be married as White people and have a higher probability of being married than Black people who do not report perceptions of racial discrimination. A negative influence on the odds of marriage related to perceived racial discrimination for Black people becomes clearer as respondents age. The findings highlight the importance of considering perceptions of racial discrimination to better understand the marriage gap between Black and White people across the life course.     

“I AM STILL SUFFERING:” THE DILEMMA OF MULTIPLE RECOVERIES IN THE LIVES OF METHADONE MAINTENANCE PATIENTS

This study examines narratives on the meaning of addiction recovery through interviews with 45 methadone maintenance treatment (MMT) patients. Results show that heroin addicts are dealing with multiple recoveries and many are simultaneous to each other: recoveries concerning (1) addiction, (2) associational disruptions, (3) self-identity and actualization, (4) drug induced diseases (HIV/AIDS, HCV, etc.), and (5) catalyzing event(s). The research findings, anathema of clinical MMT views on recovery, suggest that drug addicted individuals might benefit from interventions that address their multiple recovery issues as opposed to ones that emphasize recovery strictly in sobriety terms.     

The mental health of young people aging out of care and entering adulthood: Exploring the evidence from England and France

This paper explores the research evidence from England and France on the mental health of young people aging out of care and into adulthood. It represents the first comparative review based on the evidence from these two countries. Set in the legal, policy and service framework for both countries, it reviews evidence on the mental health of young people in the general population, young people living in care, young people aging out of care, and young adults. It shows: the high levels of psychological adversity of young people entering care; the high rates of mental health problems of young people in care compared with the general population of young people; the increased risk of mental and physical problems at the time of aging out of care, and the general improvement in longer-term outcomes for young adults, although some continue to have serious mental health problems. In conclusion, it suggests that interventions across the life course of young people are needed.     

Challenging the Image: the involvement of young people with disabilities in volunteering and campaigning

Much of the debate about young people with disabilities focuses on the difficulties these young people experience and their needs in terms of service provision. Rarely is there a focus on the positive contribution that disabled young people themselves make to society. The paper describes research which aimed to highlight the contribution that young people with disabilities make to their communities, by focusing on their participation in volunteering and campaigning. A national survey of disabled young people's participation was undertaken, as well as two case studies of particular projects. The paper describes the range of voluntary and campaigning activities being undertaken by young people with disabilities, highlights the effects of participation on the young people and those around them, and identifies issues for organisations wishing to enable more young people with disabilities to participate in this way.     

Understanding pre-service teachers' construct of disability: a metacognitive process

This study identified pre-service teachers' understanding of disability as it relates to students they might teach and people they might meet in public, and determined the development of their understanding. Participants' voices were elicited through semi-structured interviews. Themes uncovered included: (a) many people with disabilities were 'hidden away'; (b) participants were afraid of people with disabilities; (c) participants lacked self-efficacy in teaching people with disabilities; (d) participants believed that people with disabilities lacked the ability to learn the same syllabus as typical students; and (e) participants also felt people with disabilities belonged and had rights in society. Conclusions drawn include the fact that in this Asian context, having a close relative with a disability did not presume that the participants would have a positive outlook on people with disabilities. Furthermore, there is a need for acceptance of people with disabilities in daily life activities, including in schools and other recreational activities.     

Exclusion of HIV-positive people with disabilities in the media

This current issue piece aims to address the harmful exclusion of people with disabilities in the Iranian media. In a case study, this author collected news related to statistics of HIV-positive people covered by popular news websites written in the Persian language between June 2011 and June 2012. Within the analysed electronic texts, no reference was made to the number of HIV-positive people with disabilities. Under the rubric of critical discourse analysis, one can argue that this lack of representation may also be linked to a more general level of discourse that constitutes the marginalization of people with disabilities. This damaging exclusion both legitimizes and reproduces the ideology that people with disabilities are social minorities who can be excluded to the benefit of powerful people. This current issue piece also discusses the potential negative consequences of excluding HIV-positive people with disabilities from the discourse of HIV/AIDS in the media. Ultimately, the conceivable reasons for the Iranian government failure or refusal to publish the statistics of HIV-positive people with disabilities will be provided. Studies from various countries could shed more light on the exclusion of HIV-positive people with disabilities in the media and the interplay between HIV/AIDS and disability issues.     

Not all experiences of precarious work lead to precarity: the case study of young people at university and their welfare mixes

The concept of precarity has gained momentum and challenges social scientists to consider the effects of labour-market insecurity across classes and welfare arrangements. This article discusses the varieties of experiences of precarious work by young people in university and identifies in which cases they are also experiences precarity. It is one of the first studies of its kind to investigate the material triggers of inequality by comparing young people’s experiences across countries (England, Italy and Sweden) and by looking at the welfare mixes available to young people who are working at university. Through a comparative qualitative research involving young people from different socio-economic backgrounds and ‘welfare mixes’, the article shows that experiences of precarity concern a minority of young people who have an absolute necessity to rely on labour-market sources, due to the lack or insufficiency of state support and family sources. It also identifies: a group of young people who feel pressure to get precarious jobs to fill a decline in family resources; and a convenient use of precarious jobs suiting the circumstances of young people with abundant family resources. Overall, the research found that precarity is deeply connected to young people’s welfare mixes.     

缤纷的彝族帽饰

彝族同胞特别注重头饰的装扮。多彩的彝族头饰流传数千年至今,形成了独树一帜的头饰文化。＂鸟美在羽毛,人美在头饰＂、“汉人顾脚,彝人顾尖”成为他们对传统头饰文化最好的诠释。彝族形态各异的头饰很多都缘于他们古朴的图腾或动植物崇拜。     

Self‐employment among people with disabilities: evidence for Europe

This paper examines the use of self‐employment among people with disabilities in Europe. Using data from the European Community Household Panel for the period 1995–2001 for 13 European countries we found that people with disabilities were more likely to be self‐employed than people without disabilities. Self‐employment provides flexibility and a better adjustment between disability status and working life. Moreover, the levels of satisfaction with job, type of job and working conditions of self‐employed disabled people are higher than those reported by disabled people who are wage and salary earners. Policy‐makers must encourage self‐employment to increase the levels of well‐being and employment of people with disabilities in Europe.     

Paradoxes of social mobility in London

We analyse social mobility in London and seek to address two paradoxes. Among people living in London, relative mobility, or social fluidity, appears to be remarkably low when compared with other regions of Great Britain. But social fluidity among people who were brought up in London is similar to that of people brought up elsewhere in Britain. This is our first paradox. Furthermore, it is widely held that social fluidity is higher among people with higher levels of education, yet, the proportion of people with a University degree is much higher among people living in London than in any other region: how is this compatible with its relatively low social fluidity? This is our second paradox. We address these puzzles and find that they are largely explained by patterns of migration into and out of London by two groups that have received little attention hitherto in studies of mobility in the capital: International migrants and people who were brought up in London but who no longer live there.