Older People and Access to Care

Correspondence to Denise Tanner, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: d.tanner{at}coventry.ac.uk Summary At the heart of a number of New Labour health and social policyinitiatives are stated concerns with supporting independence,preventing deterioration and extending access to services. Thisarticle examines the potential impact of these initiatives,including Prevention Grants (Department of Health, 2000b), theNational Service Framework for Older People (Department of Health,2001a), the Fair Access to Care Services Guidance (Departmentof Health, 2002a), and the Single Assessment Process (Departmentof Health, 2002b), on older people with ‘low level’needs who have increasingly been excluded from services targetedat those in high risk categories. Key standpoints for this analysisare research findings indicating what older people themselveswant from preventive services. Central messages, consistentwith those from other service user ‘groups’, arethe need for support services that enable older people to continueto exercise choice and control over their lives. New preventivemeasures are evaluated in the light of these findings and foundwanting. It is argued that recent policy initiatives are likelyto do little to widen access to support services for those withlow intensity needs, and, moreover, that the processes involvedin identifying those at future high risk will detract from ratherthan enhance citizenship. A more diffuse approach to preventionis advocated, based on mutuality, community development, andcapacity-building.     

Predicting Assault by Juvenile Psychiatric Patients

This paper reports a post hoc study of the symptoms reported on admission of day and in-patient children, who subsequently proved to be violent to staff or other patients in a child and adolescent psychiatric hospital setting. Patients who were likely to be violent were easily identifiable from the data reported at the first interview. The early identification of such patients was thought to be of importance for their subsequent management, and for the maintenance of a safe environment within the hospital setting.     

A validity scale for the Sharp consumer satisfaction scales.

Because of the apparently inflated scores commonly reported for consumer satisfaction with mental health services, we developed a 5-item validity scale for the SHARP questionnaire. The scale discriminated significantly (P less than .001) between those former clients who offered suggestions for improvement of services and those who did not (N = 38). In another experiment, the scale significantly improved the ability to predict the 46 clients' true scores from their obtained scores via stepwise regression (p less than .01). Weights were obtained from that sample of former clients, which significantly reduced the deviation of the obtained satisfaction scores from the true scores, with all p less than .05. In two successive experiments (N = 49 and 26), weights were applied to new samples, significantly reducing deviation from the criterion scores for 5 of the 6 scales (p less than .05), and new weights were then derived. A final set of weights was derived from the combined samples of the three experiments, (N = 121) which significantly improved prediction of the criterion and lowered the mean on all scales, with all p less than .05.     

Our favourite melodies: musical consumption and teenage lifestyles

The present study explores the determinants and lifestyle correletes of musical preferences among a large sample of high school students in Toronto, Ontario. Our work is informed by theory and research on cultural stratification and adolescent subcultures. In terms of cultural stratification, we engage with Bourdieu's (1984) and Peterson's (1996) conceptualizations of elite taste, while subcultural theory encourages us to focus upon more dissenting tastes and to explore connections between musical tastes and peer group activity. Our findings suggest that racial and ethnic identity, school experiences and cultural capital are significant sources of variation in musical tastes that loosely correspond to existing typologies; they also confirm what has often been inferred - that musical tastes and peer group cultural practices are closely linked. Our findings are then discussed in the light of current debates about the nature and dimensions of listening audiences for music.     

Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town

The article reports on an exploratory study that examined access to alcohol and other drug treatment for historically disadvantaged communities in the Cape Town metropole. In-depth interviews were conducted with 20 key informants from various sectors of the alcohol and drug treatment system, including treatment service providers, members of local drug action committees and social workers from district social service offices. Findings highlighted three structural barriers to service delivery: (i) difficulties in developing and implementing a strategic plan relating to alcohol and drug problems due to poor capacity and other infrastructural issues, such as a lack of information, poor intersectoral collaboration and limited consultation with service providers; (ii) limited allocation of resources to alcohol and drug treatment which has restricted the availability of affordable services as well as the capacity of established services to meet increased demand for services in this area; and (iii) fragmented service delivery. The study highlighted the need for further transformation of the South African social welfare system responsible for alcohol and drug treatment service delivery through public–private partnership development and the introduction of a management information system.     

Shildrick’s monster: exploring a new approach to difference/disability through collective biography

Working with memories generated in a collective biography workshop on difference/disability and drawing in particular on Shildrick’s analysis of monstrosity, this article analyses the ambivalent processes through which difference is othered and abjected. The article argues that through the process of abjection we disown for ourselves whatever qualities are being categorised as monstrous, with negative effects not just on the other, but also on the self. We look at the ambivalence of ‘reclaiming the monster’. This article opens up an alternative of expanding the possibilities of being by focusing not on difference as categorical otherness, but rather difference as movement, as differenciation, or becoming.     

Coloniality and Intersectionality in Social Work Education and Practice

The history of social work education is deeply entangled with the structures of White supremacy and coloniality. Through an analysis of coloniality, the system from which social work operates, this article outlines an alternative framework of intersectionality, which decodes the dominant discourse in relation to power, privilege, White supremacy, and gender oppression. The framework of intersectionality moves professional social work pedagogy and practice from the trenches of coloniality toward decoloniality. The concepts of intersectionality and critical consciousness are operationalized to demonstrate how social work education can effect structural and transformational change through de-linking from its white supremacists roots.     

Patient-centered approach to building problem solving skills among older primary care patients: problems identified and resolved

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues.     

Gender,social change,and the professions: The case of pharmacy

This paper examines the nature of increasing female entry into the profession of pharmacy. Using data from a survey of Ontario pharmacists, it compares the work experiences and career paths of 668 men and women in the profession. In terms of hours worked, where they work, and the nature of the work that they do, we found considerable differences between males and females that are becoming increasingly pronounced as more women enter the profession. These findings are then discussed in terms of available theories of gender, professions and social change.