Halfway There? Policy,Politics and Outcomes in Community Care

The community care reforms which followed the 1989 White Paper "Caring for People"were apparently focused on addressing the needs of people requiring long-term care, and on achieving improved outcomes and better quality of life.
The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence for users and carers have been achieved. The paper draws particularly on a programme of monitoring conducted jointly by the Nuffield Institute for Health and the King's Fund, based on national and local focus groups meeting over a two-year period. It proposes a framework for evaluation which consists of four components: the definition of desired outcomes; specification of service systems necessary to deliver such outcomes; promotion of access to services; and the development of supporting operational policies and resource allocation mechanisms.
This framework offers a substantial step beyond much of the monitoring of the community care reforms which has taken place to date. This has assessed progress largely in terms of the establishment of new systems and processes. We conclude that such changes were essential building blocks for delivering better-quality community care services, and in the short term it may have been legitimate to view their establishment as proxies for progress towards delivering user-centred services. However, monitoring and evaluation should now be increasingly oriented towards ensuring that these changes are in fact producing the desired service outputs and urn outcomes. We propose that our framework offers one such way forward.     

Understanding How Case Managers Use ‘Sabotage’ as a Frame for Clinically Difficult Situations

Case managers are among the direct service providers responsible for engaging people with severe mental illnesses. Understanding how they interpret and respond to clinically difficult situations can inform ways to intervene and reduce service disengagement. This qualitative study explored clinically difficult situations when case managers invoked the term ??sabotage??. Interviews were conducted with 21 case managers and analyzed by co-coders focusing on how case managers used the term sabotage to describe service user behavior. Themes that emerged were attributing sabotage to; fear of success, fear of attaining what you desire, avoidance of responsibility and change, and a lack of structured support. Drawing on the concepts of clinical case management and mental health recovery, we consider implications for the training and supervision of case managers and how services are structured.     

Austerity and the lives of people with learning disabilities. A thematic synthesis of current literature

Abstract

The Financial Crisis of 2008 resulted in many western economies implementing cuts in health and social care. This systematic review provides a holistic picture of the impact of austerity policy on the lives of people with learning disabilities (LD) and the collateral effects on the people who support them. Our review suggests that in the current climate of economic austerity, available funding to support people with LD is no longer aligned to their care needs. Cuts in disability services have adversely affected the well-being both of people with LD and their informal carers. Individuals with LD have lost social support and are experiencing increased social isolation. Heightened demands on family carers’ time have negatively influenced their wider roles, including parental functioning, and labour market participation. Our review provides the foundations for further discourse and research on the effects of austerity on people with LD and their family carers.     

Semi‐Parametric Models for the Multivariate Tail Dependence Function – the Asymptotically Dependent Case

Abstract. In general, the risk of joint extreme outcomes in financial markets can be expressed as a function of the tail dependence function of a high‐dimensional vector after standardizing marginals. Hence, it is of importance to model and estimate tail dependence functions. Even for moderate dimension, non‐parametrically estimating a tail dependence function is very inefficient and fitting a parametric model to tail dependence functions is not robust. In this paper, we propose a semi‐parametric model for (asymptotically dependent) tail dependence functions via an elliptical copula. Under this model assumption, we propose a novel estimator for the tail dependence function, which proves favourable compared to the empirical tail dependence function estimator, both theoretically and empirically.     

Australian Social Work Reviewers 2010

Abstract

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care.     

Qualitative Research for and in Practice: Findings from Studies with Homeless Adults Who Have Serious Mental Illness and Co-Occurring Substance Abuse

This article draws upon findings from the New York Services Study, a Federally-funded qualitative study conducted in practice settings representing two fundamentally different approaches to serving homeless adults with serious mental illness and co-occurring substance abuse. The findings yielded four themes??cumulative adversity, individual acts of kindness in a system designed to control, discordant case managers?? perspectives, and the benefits of permanent housing. Recommendations for practice include respecting individuality, being sensitive to previous traumas, and working to achieve housing security sooner rather than later. Future research is needed to study the micro-level contexts of service delivery and how they inhibit or encourage engagement in care.     

Living with Nuclear Power: A Q-Method Study of Local Community Perceptions

The issue of new nuclear power is once again high up on the public policy agenda in many countries, and candidate sites for new civilian stations are likely to include those that have existing nuclear facilities. A common assumption is that existing nuclear communities will be more accepting of new build because of the direct economic and other benefits nuclear power already makes to a local area. Surprisingly, there is a dearth of contemporary data on perceptions of the risks, benefits, and values associated with nuclear power within such communities. This study uses Q-methodology to investigate the perspectives on living with nuclear risk among people ( n  = 84) drawn from communities near to two nuclear power stations in the United Kingdom. Both stations, at Bradwell-on-Sea and Oldbury-on-Severn, had been in operation for over 40 years. The Q-analysis identified four main perspectives, or points of view, accounting for 53% of total variance. These were interpreted as: Beneficial and Safe; Threat and Distrust; Reluctant Acceptance; and There's No Point Worrying. We conclude that the "landscape of beliefs" about nuclear power in such communities is both subtle and complex, avoiding simplistic bipolar dichotomies such as "for" or "against," and that there is a need for extensive and meaningful dialogue with such communities over any new build plans. The usefulness of Q-methodology for investigating the ways in which people live with risk is highlighted, as are the implications of the results for theories of risk and trust.