Facilitators of prenatal care access in rural Appalachia

BackgroundThere are many providers and models of prenatal care, some more effective than others. However, quantitative research alone cannot determine the reasons beneficial models of care improve health outcomes. Perspectives of women receiving care from effective clinics can provide valuable insight.MethodsWe surveyed 29 women receiving care at a rural, Appalachian birth center in the United States with low rates of preterm birth. Semi-structured interviews and demographic questionnaires were analyzed using conventional qualitative content analysis of manifest content.FindingsInsurance was the most common facilitator of prenatal access. Beneficial characteristics of the provider and clinic included: personalized care, unrushed visits, varied appointment times, short waits, and choice in the type and location of care.ConclusionThere is a connection between compassionate and personalized care and positive birth outcomes. Women were willing to overcome barriers to access care that met their needs. To facilitate access to prenatal care and decrease health disparities, healthcare planners, and policy makers need to ensure all women can afford to access prenatal care and allow women a choice in their care provider. Clinic administrators should create a welcoming clinic environment with minimal wait time. Unrushed, woman-centered prenatal visits can increase access to and motivation for care and are easily integrated into prenatal care with minimal cost.     

A Thematic Guide To Bulimia Nervosa

This article offers a thematic guide to bulimia nervosa for both therapists and clients. It explores the relationship of common themes — developmental, interactional, sociocultural and behavioural — to the central issue of control. It uses examples from therapy sessions to highlight the themes as they emerge in therapy and to illustrate the ways in which the problem may be addressed.     

Professional development laboratory: center for literacy and community services

We developed three Professional Development Laboratories: Centers for Literacy and Community Services that addressed four pressing needs in the current urban school crisis: the preparation of in-service teachers to be literacy specialists, the dire need for qualified teachers in urban settings, the professional development of uncertified urban teachers, and the literacy needs of the children and families these teachers serve. These centers were housed in three inner-city schools rather than at the university and thus were able to serve larger numbers of children. Since many of the teachers in these schools are novice or uncertified teachers, we offered on-site in-service courses in order to enhance their ability to help their students. By housing the Centers for Literacy and Community Services on site in the schools, we sought to reach students and families who might otherwise not be able to avail themselves of these services. Unique to this project was that our graduate literacy education students tutored students on site in schools, the university faculty worked alongside the graduate students, and both students and faculty provided services to enhance the professional development of teachers and administrators in the area of literacy. Additionally, this project was distinguished by the inclusion of a component designed to provide literacy education services to the families and caregivers of the children.     

A Need for Post-Impact and Policy Studies: The Case of the “Shetland Experience”*

This article argues that many studies of social impacts of energy development deal with prior predictions of impact rather than actual impacts of development. Further it suggests that more attention be paid to the intervening variables of policy and planning. To illustrate the need for post-impact studies, the “Shetland Experience” is described. Shetland, where the anticipation of onshore oil development has produced policy specifically designed to avoid negative social impacts, is often referred to as a success in dealing with rapid change. However, due to lack of empirical research, it is not yet known if the policy was effective.     

Making Privatization Work: Utilizing a Scorecard Model of Human Resource Strategy

Three-fourths of privatization efforts fail. Analyses of the other one-fourth have overlooked what is arguably the single most important element: successful management of human resources. In establishing the culture of change necessary to effect competitive initiatives and in motivating employees toward innovation and accountability, a scorecard-based human resource strategy is at the center of it all. A discussion of the strategic role of human resource management supporting privatization efforts in general, and of the remarkably successful Charlotte, North Carolina experience in particular, offers important lessons. Detailed here is a rubric of what works and why.     

Making Schools Meaningful

Schools can offer a secure and personally meaningful environment which facilitates self development, as well as academic and social competence. The purpose of this article is to present a point of view about the meaning of schooling experience, particularly that of students and teachers. There is a need to extend and deepen understandings of the human context of education which significantly influences the meaning of school experience. The authors of this paper, an educator and a clinician, have come together around their shared commitment to furthering the growth of children and adolescents, and their common conviction that the complexities of contemporary schooling require a sharing of professional knowledge and insights.     

Report Card on Katrina: Administrative Progress Four Years Hence

The history of Louisiana colorful politics and corruption in government is legendary and, in Louisiana, something celebrated, or at least warmly embraced, as part of the cultural richness of the State. An oft-repeated phrase here is that Louisiana is no more corrupt than any place else, it’s just that Louisianians are more proud of it. Such sentiments permeate the discussion of federal and private financial assistance to the State in the aftermath of Hurricane Katrina, and serves as an explanation regarding the lack of effective leadership and misuse of funds thus far distributed. Yet beyond concern for the loss of dollars in themselves are the very real and tragic consequences for the citizens who were most affected by hurricane Katrina, who have received but a trickle of the flood of money that poured into the State following the event. For these people, who remain without adequate shelter, resources, educational opportunities, healthcare, and separated from their support networks, the recovery progress remains little changed over the last 4 years. An overview of the political and ethical culture of Louisiana and reflections on how that contributed to and exacerbated administrative failure in the wake of Katrina is presented here.