中国特色社区老年照顾的定位及其发展策略

20世纪80年代以来,中国老龄化问题日益严峻,社区老年照顾发展起来。中国社区与西方社区不同,有自身的特点,因此在发展中存在着两个问题：一是定位问题,二是推进策略问题。在定位问题上,宜将社区老年照顾定位为家庭养老的辅助;在发展策略上。宜先行发展收费型老年服务业,然后有选择地实现低偿或无偿照顾。这两个问题的解决对于社区老年照顾事业的均衡发展具有重要意义。     

Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

Links between informal caregiving and volunteering in Sweden: a 17-year perspective

This article analyses informal caregiving and volunteering in organizations over 17 years in Sweden, with a focus on links between these two forms of unpaid activities. The discussion is based on results from a national survey that was repeated four times in the period 1992–2009. Links were found between the different types of activities. In all four studies a substantial group of the population was involved both in informal caregiving and volunteering. This group of ‘active citizens’ are commonly also engaged in informal social networks. This ‘double active’ group had increased over time and they provide a substantial amount of hours of involvement. Patterns outlined in this article demonstrate that unpaid activities represent a multifaceted phenomenon, and that the boundaries between informal caregiving and volunteering as forms of engagement may be more fluid than has previously been acknowledged. The results challenge the literature in which informal caregiving is viewed as a major obstacle to volunteering. At the same time, however, informal caregiving in general was found to be increasing. There might be reasons to be cautious about the possible risk that too much pressure on citizens for informal caregiving might jeopardize the type of double involvement that is outlined in this article.     

Issues Affecting Utilization of Hospice Services by Rural Hispanics

Abstract

As the population of Hispanics in the U.S. is growing, their utilization of hospice care remains low. In a study of 110 rural His-panics, most (88%) were not familiar with hospice, but did report willingness to accept such service in their homes. The most important possible barrier to receiving hospice care was language, along with poverty, lack of health insurance, and low levels of education. Hospice social workers can contribute greatly to an effort to increase access to hospice by offering education to the Hispanic community and promoting cultural awareness among hospice staff.     

College students with congenital heart disease: A critical time for transition

As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. Participants: A case of a male with CHD presenting to the college health clinic with a new onset headache. Methods: The authors discuss some of the unique challenges that college health practitioners may face when caring for students with CHD. In addition, they make recommendations on how best to care for these patients and how best to coordinate care with CHD students other care providers. Results: This student with a history of coarctation of the aorta presented with new onset headaches and was found to have high blood pressure. He was diagnosed with recurrent coarctation, underwent percutaneous treatment with stenting and quickly resumed classes. Conclusions: As more students with CHD enter college, college health providers will need to understand some of the health risks that CHD students face. In addition, understanding some of the optimal ways to coordinate care with CHD providers can ease the transition that CHD students face as they enter college.     

Extending systems thinking in planning and evaluation using group concept mapping and system dynamics to tackle complex problems

Group concept mapping (GCM) has been successfully employed in program planning and evaluation for over 25 years. The broader set of systems thinking methodologies (of which GCM is one), have only recently found their way into the field. We present an overview of systems thinking emerging from a system dynamics (SD) perspective, and illustrate the potential synergy between GCM and SD. As with GCM, participatory processes are frequently employed when building SD models; however, it can be challenging to engage a large and diverse group of stakeholders in the iterative cycles of divergent thinking and consensus building required, while maintaining a broad perspective on the issue being studied. GCM provides a compelling resource for overcoming this challenge, by richly engaging a diverse set of stakeholders in broad exploration, structuring, and prioritization. SD provides an opportunity to extend GCM findings by embedding constructs in a testable hypothesis (SD model) describing how system structure and changes in constructs affect outcomes over time. SD can be used to simulate the hypothesized dynamics inherent in GCM concept maps. We illustrate the potential of the marriage of these methodologies in a case study of BECOMING, a federally-funded program aimed at strengthening the cross-sector system of care for youth with severe emotional disturbances.     

Teaching research in practice courses

Students of social work and related professions are often resistant to study research. Efforts to resolve this problem have focused on making research courses more experiential and developing a 'user friendly' curricula. This article presents an experimental strategy used in one American school of social work to teach research-related content within the context of a practice course. Students' and teachers' evaluations indicate that this may be useful to enable students to acquire tools with which to use and conduct research.     

Dementia Special Care Units

Abstract

Despite continued interest and growth in special care units in the United States, there is no uniform agreement on characteristics for these units, specific outcomes, or satisfaction with them. This study examined family satisfaction with Dementia Special Care Units (SCUs) using a modified standardized instrument and follow-up interviews. The study included five SCUs in one state, three participating in a dementia SCU demonstration project. Family outcomes were evaluated using surveys and interviews. The only significant difference between facilities in the demonstration project and the comparison facilities was one variable noting family with residents in the demonstration project had more positive perceptions regarding resident safety. The study illustrates a need for policy makers to more clearly identify and regulate special aspects of SCUs, taking family perceptions into consideration.     

Promoting Children's Welfare by Inter‐professional Practice and Learning in Social Work and Primary Care

Social work in the United Kingdom is an activity that benefits from, and often requires, co‐operation between different staff and across different professions. How this is to be achieved has been a central dilemma for practice and policy for many years. Primary care health services often play a key role. New policy and practice developments are designed to promote inter‐professional working with children, where research has shown significant problems in the community‐based health care of looked after children, children leaving care, and children at serious risk. There is, however, little evidence from research that supports current developments in inter‐professional practice; analysis of the particular nature of the inter‐professional problems is lacking, as are therefore the relevant inter‐professional solutions. A framework for better analysis, linked to developments in practice‐based research, one that would yield significant improvements for children's welfare, is presented here.