Implementing a case management initiative in high-need schools

States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from the longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive.     

Does shift work lead to poorer health habits? A comparison between women who had always done shift work with those who had never done shift work

Shift work has been reported to predict health problems, and a possible explanation is that shift work may lead to poorer health habits, thereby increasing a person's vulnerability to illness. This study examined the association between shift work and health habits, as indicated by smoking, alcohol intake, physical activity and by being overweight. A questionnaire was sent to all 2795 female nurses working in the 10 hospitals of two Finnish health care districts. From the 2299 respondents, we selected those 506 shift workers who reported having always done shift work and those 183 day workers who had never done shift work. Shift workers were found to smoke more and to be overweight more often than day workers. These differences gradually increased in each successive age group, being 1.94 pack-years in smoking and 0.9 kg m^-2 in body mass index among nurses over 45 years of age. Shift work was not associated with alcohol intake or sedentary lifestyle. This evidence is compatible with the possibility that shift work in nurses increases smoking and being overweight to a degree that contributes to health problems, including coronary heart disease.     

我国农村社区卫生服务的现状与对策

农村社区卫生服务是我国卫生事业改革的重要课题,也是建设社会主义新农村的重要内容。经过近些年的努力,我国农村社区卫生服务取得了较大成绩,但仍然存在硬软件、资金、管理及服务内容不到位等方面的问题,基于当前现状,应着力从服务理念、政府主导功能、多元化资金渠道、信息化建设以及服务评估制度等方面加以完善。     

Who Is Adopted?

ABSTRACT

There are several advantages of using large representative samples to study adoption-related issues, and existing databases are increasingly used for this purpose. Large scale surveys are often limited, however, in the number and type of questions that are asked regarding adoption. Conceptual and methodological issues in measuring adoption status are discussed, and a rich new database-the National Longitudinal Survey of Adolescent Health (Add Health)-is used to illustrate these complexities. In Add Health school survey data, adolescents were asked a direct question about whether or not they were adopted and whether they lived with biological parents. During home interviews, adolescents were not asked about adoption status per se, but they could be classified as adopted if they lived with adoptive rather than biological parents. Parents' and adolescents' reports of adoption status and living arrangements are compared in Add Health data to illustrate the complexities of measuring adoption status when using archival data. For research to be scientifically credible and to enhance the accumulation of knowledge, investigators need to be precise about the concepts and measures they use in studying adoption-related issues, particularly when using previously collected survey data.     

Independent Mental Health Advocacy: A Model of Social Work Advocacy?

ABSTRACT

Advocacy has received less attention in social work research than other aspects of social work practice. This paper draws attention to two tensions in social work advocacy; between worker-led advocacy and person-led advocacy, and between individual advocacy and system level advocacy. We argue that human-rights-based social workers must choose a person-led approach over a worker-led approach while advocating with both systems and individuals. This argument is made by drawing on findings of an evaluation of Independent Mental Health Advocacy (IMHA) in Victoria, Australia. It is shown that social work training had not prepared social workers for rights-based, person-led advocacy and that social workers in public mental health services were struggling to maintain the rights of people in their services even with assistance from IMHA.

IMPLICATIONS

• Independent Mental Health Advocacy (IMHA) is a model of advocacy influenced by social work theory and delivered in part by social-work-trained advocates.

• Social work training is not preparing social workers for person-led, human-rights-based advocacy.

• Public mental health social workers are struggling to maintain the rights of people in mental health services even with the support of external advocacy services.

     

New Models of Contracting in the Public Sector: A Review of Alliance Contracting,Prime Contracting and Outcome‐based Contracting Literature

The coordination of public services is an enduring challenge and an important policy priority. One way to achieve collaboration across organizational boundaries, which is being considered in public services such as the English National Health Service (NHS), is through the adoption of alliance contracting, prime provider contracting and outcome‐based contracting. This article reviews the cross‐sectoral literature concerning the characteristics of these new contractual models, how they function, their impact, and their relation to public sector governance objectives. These new contractual forms are characterized as models which, in line with the New Public Management (NPM)/post‐NPM agenda, seek to incentivize providers through the transfer of risk from the commissioners to the providers of services. Key findings are that the models are likely to incur high transaction costs relating to the negotiation and specification of outcomes and rely heavily on the relational aspects of contracting. There is also found to be a lack of convincing cross‐sectoral evidence of the impact of the models, particularly in relation to improving coordination across organizations. The article questions the reconciliation of the use of these new contractual models in settings such as the English NHS with the requirements of public sector governance for transparency and accountability. The models serve to highlight the problems inherent in the NPM/post‐NPM agenda of the transfer of risk away from commissioners of services in terms of transparency and accountability.     

Food Insecurity in Regional Rural Australia

ABSTRACT

This study explores food relief recipients' and providers’ experiences and perceptions of food insecurity in a large regional town in Australia. The cross-sectional qualitative methods research design incorporated survey-based interviews of four food relief services, a focus group of food relief recipients and two biographical interviews of food insecurity experience. Qualitative thematic data analysis provided insight into the respondents’ experience and perceptions of the causes of food insecurity, the provision of food relief and the limitations of a charity model. An ecological-model-based analysis shows that food insecurity is the product of multiple complex causes including chronic and situational poverty. Political dimensions emerged in terms of the policies that are developed or omitted.

IMPLICATIONS

• Social workers need to advocate for the human right to food and strengthen capacity at multiple levels to improve food security.

• Improving access to quality and culturally appropriate food requires the implementation of multiple strategies.

     

Does the Andersen Behavioral Model of Health Services Use predict college students’ use of on-campus mental health services?

Abstract

Objective: 10–50% of college students meet the diagnostic criteria for one or more mental illnesses; unfortunately, less than half seek treatment. This study assessed the predictive power of specific variables on students’ use of on-campus mental health resources using the American College Health Association’s National College Health Assessment (ACHA-NCHA) II. Participants: Respondents included undergraduate and graduate students ages 18–35?years (n?=?96,121). Methods: We analyzed data from the ACHA-NCHA II Fall 2014 and Spring 2015. Andersen’s Behavioral Model of Health Services Use enabled selection of predisposing, enabling, and need predictor variables; these were analyzed individually and collectively. Results: Predisposing, enabling, and need variables accounted for 9%, 2.3%, and 17% of the overall variance. Significant variables associated with a student’s decision to access on-campus mental health services accounted for 23% of variance total. Conclusions: This insight could allow universities to better recognize students at-risk for needing but not accessing mental health services.     

用以健康监控的微型光学传感系统

家庭健康监控是现代医疗的一个新兴领域,其目的主要在于监控老年人的机体功能,改善老年人的日常生活质量。一套完整的健康监控系统可以粗略地包括传感器、信号处理单元和通讯单元等功能模块。由于兼具灵敏和便于微型化的特点,光学传感系统逐渐成为研发的焦点,本文中我们将重点讨论两类光学传感系统:(a)以脉搏血氧计为代表的非侵入式光学传感系统;(b)以微型谐振器为例的用于体液检测的光学传感系统。这两个研究领域的目标都是希望能利用现有的半导体和集成化领域的工程技术来实现微型化、便携式、低成本的传感系统。     

Interactive effect of individual factors on nurses' health and sleep

Abstract

There is a tendency in studies concerning individual diferences in shiftwork tolerance to analyse the moderating effect of individual factors separately as if they acted independently. The aim of this study was to examine the interactive effect of individual factors (i.e. morningness, flexibility, languidity, neuroticism, extroversion) on nurses' health and sleep. A hundred female nurses (mean age 25.9 years, SD = 3.7 years) working a 2 × 12-h shift system were chosen from a larger study conducted among Intensive Care Unit staff. All subjects completed the Standard Shiftwork Index. Multiple regression analyses show that interactions of neuroticism and other factors (languidity, morningness) predict the majority of health and sleep complaints rather than neuroticism itself. Correlation analyses revealed that the interaction of neuroticism and languidity correlates higher with some indices of impaired health and sleep disturbances than when these factors are taken separately. The contribution of flexibility together with extroversion in interactions with neuroticism, and with neuroticism and languidity weaken the relations of languidity and neuroticism with health and sleep indices. The results show that some individual features tend to strengthen or counteract one another in relation to symptoms of shiftwork intolerance.