Halfway There? Policy,Politics and Outcomes in Community Care

The community care reforms which followed the 1989 White Paper "Caring for People"were apparently focused on addressing the needs of people requiring long-term care, and on achieving improved outcomes and better quality of life.
The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence for users and carers have been achieved. The paper draws particularly on a programme of monitoring conducted jointly by the Nuffield Institute for Health and the King's Fund, based on national and local focus groups meeting over a two-year period. It proposes a framework for evaluation which consists of four components: the definition of desired outcomes; specification of service systems necessary to deliver such outcomes; promotion of access to services; and the development of supporting operational policies and resource allocation mechanisms.
This framework offers a substantial step beyond much of the monitoring of the community care reforms which has taken place to date. This has assessed progress largely in terms of the establishment of new systems and processes. We conclude that such changes were essential building blocks for delivering better-quality community care services, and in the short term it may have been legitimate to view their establishment as proxies for progress towards delivering user-centred services. However, monitoring and evaluation should now be increasingly oriented towards ensuring that these changes are in fact producing the desired service outputs and urn outcomes. We propose that our framework offers one such way forward.     

An assessment of the quality of developmental day center playgrounds for exceptional children

This study assessed the playgrounds of developmental day care centers and compared them with playgrounds of regular certified day care centers. Twenty playgrounds, randomly selected from the listing of developmental day centers, were compared with a matched sample of 20 playgrounds from certified day care centers in one state. A revision of Frost's Playground Rating System (1978b) was employed to rate the two groups of playgrounds on content, safety, and function. Data were analyzed using an analysis of variance technique. The quality of developmental day center playgrounds for exceptional children was inferior to that of regular day care center playgrounds in terms of playground content. No significant differences were noted on safety or function.     

Caregiving role affects family relationships of African American grandmothers as new mothers again: a phenomenological perspective

Currently, African American grandmothers are becoming caregivers to grandchildren whose parents, for various reasons, are not providing them with adequate care. Replacing their adult children, as parents, while continuing to mother them along with caring for grandchildren are essential components of this complex situation. A part of the findings from this qualitative study of the experience of grandmother caregivers indicated that family relations are affected with their grandchildren, the parents of their grandchildren, and their other adult children. Implications for culturally sensitive, family-centered clinical practice and future research are discussed.     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Approximate optimal allocation in repeated sampling from a finite population

Samples of size n are drawn from a finite population on each of two occasions. On the first occasion a variate x is measured, and on the second a variate y. In estimating the population mean of y, the variance of the best linear unbiased combination of means for matched and unmatched samples is itself minimized, with respect to the sampling design on the second occasion, by a certain degree of matching. This optimal allocation depends on the population correlation coefficient, which previous authors have assumed known. We estimate the correlation from an initial matched sample, then an approximately optimal allocation is completed and an estimator formed which, under a bivariate normal superpopulation model, has model expected mean square error equal, apart from an error of order n^-2, to the minimum enjoyed by any linear, unbiased estimator.     

On the relative accuracy of certain bootstrap procedures

We show the second-order relative accuracy, on bounded sets, of the Studentized bootstrap, exponentially tilted bootstrap and nonparametric likelihood tilted bootstrap, for means and smooth functions of means. We also consider the relative errors for larger deviations. Our method exploits certain connections between Edgeworth and saddlepoint approximations to simplify the computations.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Saddlepoint Approximation for Sample and Bootstrap Quantiles

The paper gives the saddlepoint approximation for the distribution function of the sample quantile. A comparison of the saddlepoint approximations for the distribution functions of the sample quantile and the bootstrap quantile shows that the error of the bootstrap approximation to the distribution of the sample quantile obtained by Singh (1981) as an absolute error is actually a relative error.     

A Multitude of Voices: Pushcart Prize Winning Publications 1976–2006

The Pushcart Prize, established in 1976, has a well-deserved reputation for highlighting the best in small press publication. The authors examined the first thirty volumes, 1976/1977 through 2006, to identify attributes of the items included in each volume and placed the volumes into five time periods of six volumes each to facilitate trend analysis. In order to identify the most productive publications, titles that had fewer than four selections in the thirty volumes and did not appear in at least two time periods were eliminated. The authors examined: press status as independent or affiliated, state and region where published, and type of work (poetry or other). Finally, highly productive titles were reviewed in WorldCat to determine how frequently these were held in the United States.California, Massachusetts, New York, and Ohio have a continuing, substantial presence in the Prize volumes. Most of the publications included were still active and were affiliated with a larger institution. The three small press titles appearing most frequently were Ploughshares, Paris Review, and American Poetry Review. The Pushcart Prize selections most frequently listed in WorldCat were the Hudson Review, the Paris Review, and the American Poetry Review. Each is held by more than eight hundred U.S. libraries.