城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

中国商业银行个人理财业务的发展策略

在介绍国外商业银行个人理财业务的基础上,分析国内商业银行个人理财业务的发展现状和前景,探讨国内商业银行个人理财业务的发展策略。     

Abused Women in Taiwan Who Seek Religious Support

ABSTRACT

This research explores the types of religious healing that abused women use and surveys their experiences with these practices in Taiwan. Fifteen semi-structured interviews were conducted with a sample of abused women, who had been recruited from 12 agencies. The findings show that participants sought religious healing for a variety of reasons, and that they had both positive experiences (e.g., useful religious support) and negative experiences (e.g., encountering deceptive jitongs and spending a large amount of money on services) regardingr the support provided by different religions. This study also found that women who believed in traditional Eastern religions had more negative experiences than women who believed in Western religions.     

Community-Based Services and Depression from Person-Environment Fit Perspective: Focusing on Functional Impairments and Living Alone

ABSTRACT

Guided by the Person-Environment Fit perspective, we investigated the extent to which personal and environmental factors influence depression among community-dwelling adults. The data came from the special section about community-based service utilization in the 2012 Health and Retirement Study (N=1,710). Although community-based service was not significantly associated with depression after controlling for covariates, respondents with functional limitations and living alone were less likely to be depressed when using community-based services. This study demonstrates the different associations between community-based services and depression depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations.     

A Multi-Dimensional Conceptual Framework for Trauma-Informed Practice in Addictions Programming

Previous research has conceptualized trauma-informed practice in relation to five key values: safety, trust, choice, collaboration, and empowerment. This research identifies key organizational, programmatic, and interpersonal characteristics in community-based residential addictions treatment programming that exemplify each of these principles. Utilizing qualitative research methods, involving open-ended, one to one interviews with clients in residential substance misuse treatment (n = 41), respondents identified the importance of experiencing “safety” in relation to physical safety, confidentiality, reassurance, rule enforcement, and peer relationships. “Trust” was manifested in sharing, staff availability, nonjudgmental interactions, positive relationship dynamics, and caring. “Choice” was articulated in relation to individual needs, participation, opportunities, and focus of efforts. “Collaboration” was characterized in relation to opportunities for feedback, planning, goal setting, specificity, and support. Finally, “empowerment” was characterized by comfort in sharing, trigger management, trauma awareness, and understanding. The findings provide a conceptual framework for a trauma-informed social services organizational practice environment. Findings can inform adaptations to social service delivery processes and programs to become aligned with the values of trauma-informed practice. Future research can build on this framework by testing the study findings with quantitative methods along with replicating current methods in other social service delivery sectors.     

Improving the Efficacy of Administrative Data for Evaluation of Holistic Defense

A college of social work developed a partnership with a state commission on indigent defense to examine existing data-collection procedures, potential case outcomes, and practical implications of implementing holistic defense programs. The holistic defense model responds to the complex challenges of justice-system-involved defendants by providing social services in public defense offices. Using chi-square and logistic regression analyses of administrative data for a sample of 15,994 public defendants from a single judicial circuit, this research study examined case outcomes before and after implementation of a holistic defense program. Results were mixed regarding effectiveness of holistic defense in mitigating the effect of justice involvement for indigent defendants. Implementation of holistic defense was associated with a decrease in case dismissals. However, defendants receiving holistic representation were less likely to be indicted than defendants prior to program implementation. Once indicted, there were no changes in levels of diversions, and more defendants were held on bond, convicted as guilty, and incarcerated. After program implementation, fewer defendants were sentenced to alternatives to incarceration; more defendants were sentenced to time served, avoiding further incarcerative penalty. These findings suggested the need for further research to determine whether holistic defense practices are producing desired legal and social service outcomes.     

Constructing prevention programmes with a Māori health service provider view

Mainstream approaches to chronic condition management and prevention inadequately address the needs of Māori, the Indigenous people of New Zealand. Māori health service providers (MHSPs) are uniquely placed to address the critical gap in the prevention of chronic conditions. In this paper, we report qualitative research findings investigating how prevention was being modelled, practiced and measured in selected MHSP settings. Results indicate barriers to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions-focused discourse, along with responding to acute need, is a driver of service delivery norms.There are examples of shifts in organisational structure and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by MHSPs. Consolidation of these approaches requires significant work and increased resources as well as a broader systems-level response that prioritises prevention.     

Agreement and discrepancy between children,parents, and social workers on school‐based effort avoidance in child welfare services

A multiperspective approach is beneficial for obtaining reliable and multifaceted pictures of child behaviour problems. The goal of the present study is to examine interrater agreement on school‐based effort avoidance between children receiving child welfare services, parents, and social workers. Given previous findings, interrater agreement is expected to be low. Self‐reported data on school‐based effort avoidance were gathered for children and adolescents in child welfare services. Additionally, social workers (using the Teacher‐Report Checklist for social and learning behaviour) and parents (using the parallel version of the self‐rating questionnaire on school‐based effort avoidance) were asked to complete an external assessment tool to compare children's perspectives with the ratings of significant adults. The results confirmed significant discrepancies between parents' and children's ratings on effort avoidance tendencies. Furthermore, there were only small to moderate correlations between children's self‐ratings and the adults' assessments; however, the consensus between adults was higher than the interrater agreement between children and social workers. Discrepancies in ratings from multiple informants underline the importance of integrating multiple perspectives, especially children's perspectives, in the diagnostic process in order to plan and adapt appropriate care and treatment.     

Developing an undue influence screening tool for Adult Protective Services

The study purpose was to develop and pilot an undue influence screening tool for California’s Adult Protective Services (APS) personnel based on the definition of undue influence enacted into California law January 1, 2014. Methods included four focus groups with APS providers (n = 33), piloting the preliminary tool by APS personnel (n = 15), and interviews with four elder abuse experts and two APS administrators. Social service literature—including existing undue influence models—was reviewed, as were existing screening and assessment tools. Using the information from these various sources, the California Undue Influence Screening Tool (CUIST) was developed. It can be applied to APS cases and potentially adapted for use by other professionals and for use in other states. Implementation of the tool into APS practice, policy, procedures, and training of personnel will depend on the initiative of APS management. Future work will need to address the reliability and validity of CUIST.