Funneling Child Welfare Consumers into and through the Mental Health System: Assessment, Referral, and Quality Issues

This qualitative study explores how consumers of child welfare services reach nonpsychiatric mental health providers and the perceived quality of these services. It relies on iterative interviews with individuals and groups, as well as on court observations from one metropolitan area. Results suggest that, consistent with theories of street-level bureaucracy, efficiency issues drive mental health service use, as clients are routinely subjected to psychological evaluations and funneled into mental health services as a matter of course. Referral practices are shaped by child welfare professionals' routines, discretion, and desire to meet such system objectives as providing short turnaround times for reports. The results suggest that, despite stakeholders' best intentions, maltreated children are not benefiting from thoughtful processes geared to screen for, assess, and provide targeted treatment for unmet mental health needs.     

Exploring the squeezed middle: Aucklanders talk about being ‘squeezed’

ABSTRACT

This research explores how middle-class Aucklanders, participants in ‘the middle’, see themselves in terms of being squeezed. It is intended to augment existing statistical based work on class stratification and life chances and facilitate aspects of qualitative research around giving voice. The research confirms the notion of a squeezed middle for the participants based in Auckland, and a striking feature of that confirmation is the centrality of age in demarcating both resourcing (in particular, homeownership versus renting) and narratives. Insofar as the research captures the zeitgeist of the middle, this confirms a neoliberal governmentality wherein a class analysis is interpolated with personal responsibility – and the latter remains paramount. Further, the research demonstrates that empathy is associated with social proximity. The semi-structured interviews also illuminated a widespread sense of resentment. This had two dimensions: directed against neoliberalism as an historic transformation that is seen as the cause of an increasingly squeezed middle, and; against baby boomers. Participants in their 40s demonstrated the highest levels of resentment, and this confirms other research which identifies them as a problematic age cohort because of changing socio-economic conditions.     

Learning in organizations: HR implications and considerations

This paper looks at learning in organizations as one response to competitive pressure and accelerating environmental change. Two approaches, the learning organization and HRD, are examined in the light of new models of management and learning and a move towards the integration of work, learning, and strategy. The significance of employee participation is considered in relation to learning and some benefits and drawbacks discussed. The development of a learning orientation is seen as an organization-wide responsibility but HR practitioners can play a key role in the promotion of learning by gearing the more traditional HR activities towards the achievement of organizational goals.     

St Christopher's and the future

The founding vision of St Christopher's Hospice was based on a recognition that permeating mainstream health care services would be essential and an emphasis on an adaptable philosophy rather than a building. Today, demographic and disease related changes mean that need and demand for end-of-life care will inevitably outstrip professional and financial resource. Hospices must engage with the development of cost-effective models of service delivery and rational planning. Only partnership working with the National Health Service, care homes, and others will ensure that appropriate care is available to everyone wherever the bed in which they die, regardless of diagnosis. Only collaboration and active engagement will ensure that future strategy in end-of-life care retains the original insight that its focus rightly includes not only patients but also the social context that will be affected by their death. Cost and patient choice dictate an emphasis on care at home. Health-promoting, public education and family-focused strategies will be essential. At a pivotal moment for the delivery of health care generally, hospices can play a vital part by marrying the role of "insistent conscience" of the health care service with continued cost-effective clinical innovation.     

Pathways to Ready Schools

To encourage communities to play a more significant role in getting kids ready for school and schools ready for kids, the W. K. Kellogg Foundation launched Supporting Partnerships to Assure Ready Kids (SPARK) in 2001. This nationwide initiative emphasized community-based collaboration and the development of strategic infrastructures to support early care and education and school readiness among at-risk children. As part of this initiative, the authors were charged with developing a definition of a ready school. Following consultation with experts, a literature review, and four site visits, the authors identified the following nine pathways to ready schools: children succeed in school; a welcoming atmosphere; leadership; connections to early care and education; connecting culturally and linguistically with children and families; parental involvement; partnering with the community; using assessment results for individual student progress and improving school performance; and quality improvement including professional development and training.     

Racism and anti-racism in placement reports

The focus of this article is upon the way in which practice teachers and students considered individual and institutional racism and anti-racism in a sample of 40 placement reports. First of all we will examine the background to the development of CCETSW policies and requirements for social work courses and the way in which they consider racism and anti-racism. Then we will consider the limitations and aims of our research. We will present a brief summary of our findings which contrasts the content of the placement reports from two cohorts of students in 1995 and 1997, whose reports were prepared using two different placement report frameworks: one framework developed from CCETSW's 1989 guidelines, the other framework from the revised guidelines dating from 1995. We go on to consider in some depth the overall comments of practice teachers and students in the placement reports about work with black clients/users, the use of 'what if' scenarios and case studies. We continue by examining the way in which students considered the numbers of black people in the local population, and the use made by black people of the placement agencies. Also examination is made of multiple oppression, any challenges to racism made by students, differences in terminology used to consider issues associated with 'race' and the attention given to racism and anti-racism as future learning needs. Finally, we consider implications for future research and a summary of the findings.     

Anaemia following initiation of androgen deprivation therapy for metastatic prostate cancer: A retrospective chart review

Objective. Haemoglobin levels often decline into the anaemic range with androgen deprivation therapy (ADT). We conducted a chart review of patients receiving ADT for metastatic prostate cancer to assess anaemia-related symptoms.

Methods. 135 stage IV prostate cancer cases were reviewed for treatment type; haemoglobin values before and after treatment; and symptoms of anaemia. Mean haemoglobin levels before and after for all treatment forms, for leuprolide alone, and for combination leuprolide/bicalutamide were calculated and evaluated for significant differences. The numbers of patients developing symptoms were recorded and the effects of specific therapies evaluated.

Results. For all ADT treated patients, mean haemoglobin declined by ?1.11 g/dL (p < .0001). Leuprolide-alone treated patients had a mean decline of ?1.66 g/dL (p < 0.0001). Leuprolide and bicalutamide combination treatment caused a mean decline of ?0.78 g/dL (p = 0.0426). 16 of 43 patients had anemia symptoms. Contingency analysis with Fisher's exact test shows patients receiving leuprolide therapy alone versus other forms of ADT were significantly less likely to have symptoms (χ² = 0.0190).

Conclusions. The present study confirms that ADT results in a significant drop in haemoglobin levels into the anaemic range. A number of patients become symptomatic from this change. Practitioners should monitor haemoglobin levels, and treat symptomatic patients.