From Hospital to Home with NDIS Funded Support: Examining Participant Pathway Timeframes Against Discharge Expectations

ABSTRACT

For patients with disability who require funded supports to leave hospital, the introduction of the National Disability Insurance Scheme (NDIS) represents opportunity and challenges. At a time of major reform, timely and supported discharge is reliant on overcoming interface complexities. The purpose of this study was to examine the NDIS participant pathway timeframes against discharge expectations for hospitalised adults with spinal cord injury (SCI) or acquired brain injury (ABI) and interrogate delays for the two groups. Administrative data on 54 participants (ABI?=?18 and SCI?=?36) were analysed. Both groups experienced delays to discharge and significant variability in timeframes between NDIS pathway processes and extent of delays. Group differences were identified regarding inefficiencies across the continuum, with type of support a factor to investigate further. This study has uncovered critical points in the NDIS pathway that could impact discharge of participants and where collaboration and adaptive strategies could be targeted to improve processes.

IMPLICATIONS

• Ensuring the National Disability Insurance Scheme (NDIS) pathway operates effectively in the hospital setting is critical to the timely discharge of people with complex needs who require funded supports.

• Monitoring implementation of the NDIS in the health setting is important to avert interface problems that impede timely discharge and access.

     

Fostering benign Tibetan nationalism: Tibetan schooling passions in the Diaspora

ABSTRACT

Scholarship on the ‘manufacturing of citizenship’ has focused primarily on European and American nationalism. Scholars have noted the scarcity of research on identity construction among children in the Diaspora. This study explores the role of the altruistic principle and the Middle Way approach (a political strategy for the resolution of Sino-Tibetan issues) on the construction of nationalism amongst Tibetan children in Diaspora. The 2004 Basic Education Policy for Tibetans stresses the principle of ‘altruism’ in the identity construction of Tibetan children. Inclusive nationalism is germane in the schooling process. The study presents an interview analysis of four Tibetan Education Ministers about the intersection of altruistic principle, the Middle Way approach, and Tibetan nationalism. Additionally, 34 school children (14 boys and 20 girls) from the 6th, 7th, and 8th grades participated in a drawing activity. The analysis of children’s ‘cultural artifacts of nationalism’ is also included. The study found that neither the Tibetan children nor the Ministers expressed any feeling of hatred or animosity towards Chinese nationals. The willingness and desire to co-exist in harmony with their counterparts were evident. The principle of altruism is deeply entrenched in the Middle Way approach and Tibetan nationalism.     

扩张的中国高等教育：教育质量与社会分层

本文利用2011年首都高校生发展状况调查的数据，分析北京高校学生的分层现状，并讨论了1999年高等教育扩张对大学生入学和就业分层的影响，发现这一轮扩张强化了社会阶层的复制而非再生产。一方面，在其他条件不变的情况下，来自社会优势阶层家庭的学生有更大概率进入具有更好教育质量的精英院校，这说明中国高等教育在这一时期具有排他性的特征；家庭的社会阶层背景对子女教育分层的影响在中学阶段更加明显；家庭背景对专业选择没有显著影响。另一方面，在控制家庭社会经济背景的影响后，教育质量与学生选择市场化部门就业的概率和工作起薪显著正相关。如果高等教育扩张降低了教育质量，就可能削弱高等教育对社会阶层流动的促进作用。     

Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

Replication: Framing effects in intertemporal choice with children

This paper investigates the effects of framing in intertemporal choice by elementary school children. Sutter, Yilmaz, and Oberauer (2015) recently demonstrated that intertemporal choice in children is malleable with respect to simple defaults. Using a similar approach, we replicated their study. We also found that children are more willing to select the immediate option in (standard) control frames than in alternative ones that appear to promote delay of gratification. This finding is consistent with previous experiments on children as well as adults and may have implications for cultivating the ability to delay gratification in individuals.     

Attitudes to debt among indebted undergraduates: A cross-national exploratory factor analysis

This paper reports the results of a cross-national study spanning England, New Zealand and the United States. A total of 496 first year undergraduates studying business or social science completed a 20-item questionnaire. This focused on their attitudes to their debt incurred while studying, as measured on a five-point Likert scale. A factor analysis model was developed, from which four consistent factors emerged, explaining 45 percent of the variation and consistent between countries. These factors were named: Anxiety, Utility-For-Lifestyle, Utility-For-Investment and Awareness. The first three factors were found to be uncorrelated with each other, but higher Awareness was associated with lower levels of Anxiety and Utility-For-Lifestyle and higher levels of Utility-For-Investment. The relationship with previous studies and implications for theory and practice are discussed.     

论路翎创作中的存在关怀——以《财主底儿女们》为例

路翎是一个存在感极强的作家,对人之存在的追问贯穿于他的创作中。从《财主底儿女们》的文本分析可以看出,在存在哲学的视野中,路翎对存在的关怀主要体现在三个方面:领悟孤独、审视"沉沦"与追求自由。无论对个体命运的关注还是对民族命运的思考,作家最终都指向了对人之存在状态、价值与意义的关怀。路翎创作中的存在关怀,表现着文学的灵魂深度与哲学深度。     

Juggling and Dealing: The Creative Work of Care Package Purchasing

In conventional diagrams of the new service delivery process, assessment of need is linked to purchase by a single line or arrow; the implication is that purchase follows more or less logically and directly from assessment. This paper focuses on the complex creative work that goes on in the "space" between assessment of need and purchase of service, and the changing influences on that work. "Purchase" is deconstructed to reveal the complex processes and calculations involved, and the ways in which budgets "free" resources and markets influence the final outcome. The paper describes the effects on care package construction and purchase of changing policies, budget arrangements and financial limits; it goes on to outline the difficulties and complications in using information on unit costs in purchasing. Unit costs are only part of a complex equation in which prices are negotiated and total cost juggled in the context of budgets, financial limits, real accessibility and balanced by quality considerations. It is suggested that talk of "playing shops" and use of "off-the-shelf" services underestimates the complexity of care package construction and purchase. Micro-purchase of care services has more in common with dealing and juggling than with lifting standardized, packaged, pre-priced goods off shelves in Sainsbury's.     

Putting the Children Act Independent Person Procedure under the Spotlight

The Children Act 1989 required local authorities to appoint independent people to participate in their complaints procedures. The Department of Health has concentrated largely on monitoring these newly established procedures. In contrast, very little guidance has been given about the role of independent people. Nor has there been much published research in this area. This paper is based on a study of the response of two neighbouring local authorities. The aims were to discover how these authorities had interpreted the imprecise guidance from the Department of Health, and thereby to analyse the application of principles of independence within complaints procedures. The findings showed how a "pool" of independent people had been selected, trained and employed to participate in Children Act complaints procedures. Analysis of this system raises fundamental questions about the potential of this system to provide the kind of objective representation intended to be helpful to complainants. It also contributes to the debate about the most effective ways of safeguarding the welfare of children and young people by providing them with an accessible complaints procedure. The study identifies areas for future research, including the nature of complaints and the "practice wisdom" being acquired by independent people.