A complex solution to a complicated problem? Early messages from the national evaluation of the Children's Fund Prevention Programme

This paper is concerned with exploring the research and policy base that underpinned the development of the Children's Fund Prevention Programme. It discusses how the initiative developed, how it is being evaluated and how it is now contributing to the new policy agenda around prevention services. Early findings are discussed highlighting some of the challenges local projects have to manage around partnership working, participation of children and young people in the programme, and the embedding of prevention strategies in local practice. Finally the conclusion sets the Children's Fund in forthcoming central government policy activity and examines how the evaluation can best inform the development of collaborative preventative services to children and their families.     

Systemic Consultation in Intellectual Disability Case Management

Systemic consultation is a form of tertiary case supervision derived from the principles of systemic family therapy. The present study defines the process and outcomes of systemic consultation through the experiences of case managers (CMs) working with people who have an intellectual disability. CMs were invited to present and discuss one of their complex cases with a team of consultants and attend a follow up session 4 to 6 weeks later. Measures of levels of stress, perception of workplace functioning, and workflow information were completed pre and post‐intervention and compared to measures completed by a second group of CMs receiving regular supervision only. After participation in systemic consultation, the networks of people CMs consulted about the case were significantly smaller and they scored significantly higher on a network measure of efficiency of information flow. The CMs experienced lower levels of stress and higher perception of workplace functioning, these differences approached significance. After attending the consultation outcome, themes included a reduced sense of being stuck and stressed, becoming an agent of change and taking perspective. The approach allows CMs space for reflection on practice and new perspectives to be heard. Case management has been under‐represented in documented research and evidence‐based training and supervision models, and is an area in which professional theory appears to be lacking.     

Medical Treatment of Women with Lupus. The case for sharing knowledge and decision-making

Few women patients in this study were found to be active partners in the medical management of systemic lupus erythematosus (SLE). Despite the growing emphasis on doctors and patients sharing knowledge and decision-making power, most of the women were struggling to have their symptoms and needs taken seriously, and appeared relatively powerless in relation to the medical profession. Acknowledging patient expertise requires that doctors share some of their power, and we suggest this may be especially problematic when medical resources and power are primarily located in the hands of white men, and when the patients are typically women and often from the black community. Implications for action that are considered include maximising the influence of women with SLE on research, training and practice.     

The power of silence: Ethical dilemmas of informed consent in practice evaluation

This paper critically examines the concepts of minimal risk and informed consent when practitioners use their own case material for practice evaluation and single subject research. Two student research projects conducted as requirements of a second year masters seminar in practice evaluation are used to identify specific ethical dilemmas and practice research implications are discussed.This paper is the product of class discussions in two year long research seminars conducted in 1990–1991 and 1991–1992 as part of the second year masters program at Simmons College School of Social Work. It is important to recognize that the voices of every seminar participant and the discussions generated are represented in this paper. An earlier version of this paper was presented at the 39th Annual Program Meeting of the Council on Social Work Education, New York, March 1, 1993.     

Expectancies and Mental Models as Determinants of Adolescents' Smoking Decisions

Cigarette smoking has been identified as the single most preventable source of mortality and morbidity in the United States. Experimentation with tobacco typically begins in adolescence, and smoking during this period is one of the strongest and most consistent predictors of adult smoking status. In the present paper, we review several prominent decision models that have been applied to adolescent smoking, and point out important limitations of these models. We then propose a new process-oriented framework of decision-making based on the concept of mental models, and discuss the implications of this framework for developing effective smoking prevention and cessation interventions for adolescents.     

Gaining Satisfaction? An Exploration of Foster-Carers' Attitudes to Payment

The payment of foster-carers has long been controversial, reflectingboth philosophical debates as to whether fostering should bea voluntaristic or professional activity and concerns aboutplacement provision and service delivery for children. Althoughmany research studies have touched upon the question of foster-carers’satisfaction with payments, this has not been explored in anydepth. Drawing on findings from a study involving 1,181 foster-carersin twenty-one agencies, this article attempts to provide suchan analysis with four main objectives. These comprised: examiningassociations between attitudes towards payment and demographic,socio-economic and fostering career variables; comparing responsesbetween carers based in local authorities (grouped accordingto levels of payment and performance criteria) and independentagencies (IFAs); gauging the influence of carers’ ‘orientations’towards foster-care as a ‘professional’ task; andanalysing payments in terms of their different components, suchas fees, maintenance and certain designated expenses. Amongmany detailed findings to emerge were the generally low levelof satisfaction among local authority carers, especially incomparison with their IFA counterparts and the growing supportamong carers for salaried status. There was mixed evidence onlinks between attitudes towards remuneration and the performanceof agencies.     

Health care segregation and race disparities in infectious disease: the case of nursing homes and seasonal influenza vaccinations

Examining nursing home segregation and race disparities in influenza vaccinations, this study demonstrates that segregation may increase both susceptibility and exposure to seasonal flu for black Americans. Evidence based on the 2004 U.S. National Nursing Home Survey shows that individuals in nursing homes with high percentages of black residents have less personal immunity to flu because they are less likely to have been vaccinated against the disease; they may also be more likely to be exposed to flu because more of their coresidents are also unvaccinated. This implies that segregation may generate dual disease hazards for contagious conditions. Segregation appears to limit black Americans' access to personal preventive measures against infection, while spatially concentrating those people who are most likely to become contagious.