The Business of Caring: Women's Self‐Employment and the Marketization of Care

Our goal in this article is to contribute to a differentiated analysis of paid caring work by considering whether and how women's experiences of such work is shaped by their employment status (for example, self‐employed versus employee) and the nature of care provided (direct or indirect). Self‐employed care workers have not been widely studied compared with other types of care workers, such as employees providing domestic or childcare in private firms or private homes. Yet their experiences may be quite distinct. Existing research suggests that self‐employed workers earn less than employees and are often excluded from employment protection. Nonetheless, they often report greater autonomy and job satisfaction in their day‐to‐day work. Understanding more about the experiences of self‐employed caregivers is thus important for enriching existing theory, research and policy on the marketization of care. Addressing this gap, our article explores the working conditions, pay and levels of satisfaction of care workers who are self‐employed. We draw on interviews from a small‐scale study of Canadian women engaged in providing direct care (for example, childcare) and indirect care (for example, cleaning).     

Training Mental Health Professionals on Ethical Issues and HIV/AIDS

This report describes the importance of ethics training for mental health professionals working with persons infected or affected by HIV/AIDS. We first describe three major ethical dilemmas (confidentiality, duty to warn, and suicide) faced by mental health providers serving persons with HIV/AIDS, and the legal and clinical aspects of these dilemmas. We present data from the South Texas AIDS Training Project describing the types of mental health professionals who have attended workshops on ethical issues and HIV/AIDS. Finally, we report observations about the impact of the ethics training sessions on the participants' knowledge and attitudes.     

Organizational Restructuring in European Health Systems: The Role of Primary Care

The main goal of this paper is to review the strategies developed across European health care systems during the 1990s to improve coordination among health care providers. A second goal is to provide some analytical insights in two fields. On the one hand, we attempt to clarify the relationships between pro‐coordination strategies and organizational change in health care. Our main conclusion is that the specific features of health care impede the operation of either market or hierarchical coordination mechanisms. These can, however, be selectively successful if applied as levers to promote the role and impact of the pro‐cooperative coordination strategies which are ultimately required to foster adequate inter‐professional and inter‐organizational coordination. On the other hand, we try to cast some light on the ongoing debate on convergence versus path dependency within the broader field of welfare state reform. Evidence on pro‐coordination reforms in health care apparently supports some insights from previous work on the centrality of the socio‐political structure to account for varying patterns of selective path dependency across countries. In particular, the informal power resources of specialist physicians vis‐à‐vis primary care professionals and the state are critical to explain the different rhythm and fate of pro‐coordination reforms across Europe. Against received wisdom, the evidence examined suggests that selective path dependency might apparently be compatible with a general trend towards convergence understood as hybridization.     

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers’ Perspective

ABSTRACT

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers’ perspective of gaps in services for male CSA survivors. “Limited Male CSA Programs”, “Institutional Barriers”, “Attitudinal Barriers”, and “Systemic Gaps” emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.     

Pathways to Self-Sufficiency: Successful Entrepreneurship for Refugees

ABSTRACT

This study examined the successes and challenges of refugee entrepreneurs by interviewing 50 refugees, service providers, and technical assistance providers. Qualitative data analyses revealed that successes and challenges occurred both at the individual and family levels as well as at the community and agency levels. The findings underscore the need to acknowledge the importance of the personal characteristics of the individual entrepreneurs, to deal with the competing factors revolved around family commitments, to encourage agencies to provide sufficient literacy and financial training, and to have community collaborations for capacity-building.     

Intergenerational Programs

Abstract

The purpose of this research was to provide an overview of the current state of intergenerational programming in one Canadian city. One-hundred and seven individuals in charge of programming in youth and seniors' organizations completed a telephone survey about intergenerational programs. More than one-third of organizations surveyed reported offering intergenerational programs, and the majority of these perceived their program to be successful. Participants added that there were no current overlaps in services, though a variety of gaps in and barriers to intergenerational programming were identified. There was also significant interest in and ideas for offering a diverse range of programs in the future. It was concluded that while interest in offering intergenerational programs was high, multiple barriers currently exist to offering such programs.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

Rethinking Needs Assessment in Planning Services for Older Adults

ABSTRACT

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.     

Examining the Structure and Dynamics of Kinship Care Groups

ABSTRACT

In the fall of 2006, a self-administered Internet survey was made available to all kinship care group facilitators listed in the 2006 New York State Office for the Aging's directory for kinship care providers. The survey sought facilitators' views on the purpose and structural aspects of the groups and to understand whether and how mutual aid processes were occurring. A purposive sample of 16 participants (53% response rate) completed the online quantitative survey that included space for qualitative comments. Findings revealed that 75% of participants facilitated a kinship care group in the past 5 years, and they believed their group purposes primarily included support and growth. Additionally, participants reported that all mutual aid principles occurred in their groups, with the supportive mutual aid interventions occurring more frequently than the challenging ones. Finally, themes from open-ended responses included 1) an enhanced sense of solidarity developed among group members, 2) the importance of facilitators' show of compassion for group members, and 3) facilitators' need to have a working knowledge of and ability to maximize available resources. Implications for serving the needs of kinship care providers through groups and other practices are addressed.     

城镇居民医疗保险医疗供方道德风险博弈分析

在分析城镇居民医疗保险医疗供方道德风险影响因素的基础上,通过医疗供方与参保城镇居民患者及城镇居民医疗保险经办机构之间的博弈分析,提出从加强医疗供方职业素质教育、弱化医疗供方道德风险利益驱动、建立有效的道德风险监督与激励机制、建立信息公开透明机制等方面规避城镇居民医疗保险中医疗供方的道德风险。