Small Area Indices of Multiple Deprivation in South Africa

This paper presents the Provincial Indices of Multiple Deprivation that were constructed by the authors at ward level using 2001 Census data for each of South Africa’s nine provinces. The principles adopted in conceptualising the indices are described and multiple deprivation is defined as a weighted combination of discrete dimensions of deprivation. The methodological approach used is outlined and key findings are presented for one province—the Eastern Cape. The paper summarises the ways in which the research is being developed further and the potential uses of these tools for policy and research.     

Social Work and Complex Care Systems: The Case of People Hospitalised with a Disability

Health and hospital system reforms prioritise efficiency. However, initiatives can impact on people with new or existing disabilities who require time to maximise functional independence. With greater demands for shorter hospital stays social workers face increasing pressure to facilitate discharge. This paper reports findings from research identifying factors contributing to extended stays for adults with disabilities. We sought to better understand patient characteristics and discharge planning challenges by analysing a clinical dataset of 80 patients and qualitative interviews with five experienced hospital social workers. Three key factors are identified: issues around rehabilitation services; assessment and planning for community care; and availability of and access to discharge options. Strategies to reduce length of stay are reported. We argue that building collaborative partnerships and working across multiple, complex systems and disciplines are vital to ensure these patients access appropriate community-based resources within the current health reform environment.     

‘Back to our Roots?’ Re-visiting psychoanalytically-informed baby and young child observation in the education of student social workers

While there is a well-established literature on psychoanalytically-informed baby and young child observation in social work education, little has been published recently. This paper reviews the rationale for its use, evaluating its impact on students’ learning in the light of contemporary policy and practice contexts facing social work education. Analysis of feedback gained from a recent cohort, identifies three ways in which learning through baby and young child observation contributes: firstly, students encounter and learn about the complexity of child development from the direct experience of observing and secondly, observing facilitates the development of important skills for practice; students’ ‘use of self’. Thirdly, through observing, students describe how they develop the capacity to take-up and sustain a professional role. Well-structured teaching and learning through observation is therefore shown to provide a rigorous, theoretically-grounded contribution to the training of university-based social work students entering this complex and challenging professional field.     

Moral imagination in long-term care workers

Our study focused on the cultural construction of dying and death in long-term care facilities. This article centers on direct care workers' perspective of residents' deaths. The data on which this article is based were gathered in a multi-year, multi-site study through formal ethnographic interviews, informal conversations, and on-site observations of residents and staff members. During fieldwork, we noticed an aptitude of direct care workers to deal with residents' deaths, which we named "moral imagination." The term is borrowed from other disciplines to describe a "way of seeing" residents. The case studies presented--that of three direct care workers: a dietary aide, a nurse aide, and an assistant activities director--are suggestive of workers in each category. Our study offers implications for future research concerning direct care workers' value to residents' quality of life. We also propose questions for long-term care facilities about standards of formal caregiving at the end of life.     

An integrative framework for studying sustainable practices and its adoption in the AEC industry: A case study

The diversity of priorities and differing awareness of sustainable practices among stakeholders in the architecture, engineering and construction industry is critically shaping the adoption of green technology, and the rate at which the industry is shifting towards more sustainable practices. In this paper, we develop an integrated framework that allows reorganization and integration of existing sustainability research in the architecture, engineering, and construction (AEC) industry, emphasizing the perspective of decision-makers and stakeholders. Further, an agent-based model is introduced that allows study of the decision-maker with the decision context, thus making them an integral part of the decision-making process rather than independent of it. The coupled system is adaptive and dynamically organizes itself to reflect complex bottom-up interactions between individual stakeholders, their contexts and the constraints driving their decisions even as they implement or respond to top-down decisions pertaining to the adoption of sustainable practices. The contention of this research is that an integrative systems approach to top-down decision-making and an understanding of bottom-up influences in stakeholder decisions is critical to the understanding sustainable practices and decisions that lead to their adoption in the AEC industry.     

Statistical approaches for conducting network meta-analysis in drug development

We introduce health technology assessment and evidence synthesis briefly, and then concentrate on the statistical approaches used for conducting network meta-analysis (NMA) in the development and approval of new health technologies. NMA is an extension of standard meta-analysis where indirect as well as direct information is combined and can be seen as similar to the analysis of incomplete-block designs. We illustrate it with an example involving three treatments, using fixed-effects and random-effects models, and using frequentist and Bayesian approaches. As most statisticians in the pharmaceutical industry are familiar with SAS? software for analyzing clinical trials, we provide example code for each of the methods we illustrate. One issue that has been overlooked in the literature is the choice of constraints applied to random effects, and we show how this affects the estimates and standard errors and propose a symmetric set of constraints that is equivalent to most current practice. Finally, we discuss the role of statisticians in planning and carrying out NMAs and the strategy for dealing with important issues such as heterogeneity.