Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

How Does Performance Management Affect Workers? Beyond Human Resource Management and Its Critique

While performance management (PM) is pervasive across contemporary workplaces, extant research into how performance management affects workers is often indirect or scattered across disciplinary silos. This paper reviews and synthesizes this research, identifies key gaps and explores ‘recognition theory’ as a nascent framework that can further develop this important body of knowledge. The paper develops in three main stages. The first stage reviews ‘mainstream’ human resource management (HRM) research. While this research analyses workers’ reactions to performance management in some depth, its focus on serving organizational goals marginalizes extra‐organizational impacts. The second stage reviews more critical HRM research, which interprets performance management as a disciplinary, coercive or inequitable management device. While this literature adds an important focus on organizational power, there is scope to analyse further how PM affects workers’ well‐being. To develop this strand of PM research, the third stage turns to the emerging field of recognition theory independently developed by Axel Honneth and Christophe Dejours. The authors focus especially on recognition theory's exploration of how (in)adequate acknowledgement of workers’ contributions can significantly affect their well‐being at the level of self‐conception. Although recognition theory is inherently critical, the paper argues that it can advance both mainstream and critical performance management research, and also inform broader inquiry into recognition and identity at work.     

The Institutionalization of Third Stream Activities in UK Higher Education: The Role of Discourse and Metrics

In this paper we examine the institutionalization of a new organizational practice around third stream activities in UK higher education from 1994 to 2008. Employing a longitudinal research design, involving archival, survey and contemporary interview data, we show how a new organizational practice diffused through the use of discourse and metrics around commercialization but over time was threatened on pure economic criteria. In response to the threat we explore how actors worked to institutionalize the new practice, reshaping both discourse and metrics to ensure that they were robust so that they could align with the interests and values of major stakeholders. In addition, actors worked to align discourse and metrics, as any misalignment between the two would have undermined the institutionalization of the new organizational practice.     

Influence of Parenting Behavior on Psychosocial Adjustment in Early Adolescence: Mediated by Anger Regulation and Moderated by Gender

Emotion regulation (ER)—one of the most important developmental tasks in early adolescence—has been proposed to mediate the relation between parenting and adolescents’ psychosocial adjustment. The aim of this study was to examine the influence of parental psychological control and autonomy support on adolescents’ problem and prosocial behavior (Strengths and Difficulties Questionnaire), as well as to examine the mediating role of adolescents’ anger regulation and the moderating effect of gender. We collected three‐year longitudinal questionnaire data from N = 923 parents and their (at first assessment) 9‐ to 13‐year‐old children. Path‐analysis results mainly support the mediating role of adolescents’ adaptive and maladaptive anger regulation and suggest parental autonomy support to be beneficial for regulatory abilities and psychosocial adjustment, whereas the opposite was found for psychological control. Gender differences were found for parent report data, but not for adolescent report data. Practical and theoretical implications are discussed.     

Efficacy of interventions targeting alcohol,drug and smoking behaviors in university and college students: A review of randomized controlled trials

Objective: To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students.Participants: College/University students.Methods: Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted.Results: 88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed.Conclusions: University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.     

Polymorphism-screening: genetic testing for predisposition—guidance for technology assessment

Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/SNP associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of “health” and “disease”, this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2–3 million SNPs are identified and the journals are full of reported “significant” associations between disease and mutation, only a few can be replicated unequivocally. The ACCE (Analytic and Clinical Validity, Clinical utility; Ethical, legal and social implications)-framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: (a) Prevalence, genotype-/phenotype-relation. (b) Clinical presentation: natural history; the different expressions of disease. (c) Performance of the genetic test. (d) Implications for therapy and prevention. (e) Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach.     

Interval estimates for variance components

The fiducial approach to the two components of variance random effects model developed by Venables and James (1978) is related to the Bayesian approach of Box and Tiao (1973). The operating characteristics, under repeated sampling, of the resulting interval estimators for the “within classes” variance component are investigated, and the behaviour of the two sets of intervals is found to be very similar, the coverage frequency of 95% probability intervals being approximately 91% when the “between classes” variance component is zero but rising rapidly to 95% as the between component increases. The probability intervals are shown to be shorter on average than a comparable confidence interval based upon the within classes sum of squares, and to be robust against nonnormality in the class means.     

Semiparametric methods for response-selective and missing data problems in regression

Suppose that data are generated according to the model f ( y | x ; θ ) g ( x ), where y is a response and x are covariates. We derive and compare semiparametric likelihood and pseudolikelihood methods for estimating θ for situations in which units generated are not fully observed and in which it is impossible or undesirable to model the covariate distribution. The probability that a unit is fully observed may depend on y , and there may be a subset of covariates which is observed only for a subsample of individuals. Our key assumptions are that the probability that a unit has missing data depends only on which of a finite number of strata that ( y , x ) belongs to and that the stratum membership is observed for every unit. Applications include case–control studies in epidemiology, field reliability studies and broad classes of missing data and measurement error problems. Our results make fully efficient estimation of θ feasible, and they generalize and provide insight into a variety of methods that have been proposed for specific problems.     

‘IF I FEEL LIKE THIS,HOW DOES THE CHILD FEEL?’ CHILD PROTECTION WORKERS,SUPERVISION, MANAGEMENT AND ORGANISATIONAL RESPONSES TO PARENTAL VIOLENCE

This study analysed workers’ experiences of supervision following interactions with hostile and intimidating parents. This analysis examined management and organisational responses to worker stress, and assessed the adequacy of support that workers received. An online survey was designed to collect data on workers’ experiences and free text responses were qualitatively analysed for references to the supervision they received in response to working with parents. 590 participants responded to the survey. 402 were qualified social workers, and 423 worked in child protection. Participants had experienced a range of violent behaviour from parents. The overwhelming theme in responses was the lack of support and supervision workers received, often in stressful and frightening circumstances. Approximately one quarter of participants only used organisational procedures, guidelines or protocols on dealing with hostile parents. Workers reported that mismanaged parental hostility affected their practice and the quality of protection that children received. The violence experienced had a significant negative impact on their personal and professional lives. Organisational responses in the form of supervision and education were often inadequate and resulted in children receiving reduced quality of protection. Recommendations for policy and practice change are discussed, with the aim of caring for workers and the children they protect.