Community agency support of family caregiving

Agencies that provided home care services for the elderly were surveyed to identify the services that they provided to support family caregivers. More than one-third of the responding agencies provided various family supports, including referral information, training and support groups, counseling, and hiring of family members as caregivers. Agencies favored expanding concrete and psychosocial services rather than financial supports.     

Teaching interactions of black and Cuban teenage mothers and their infants

Possible factors related to maternal teaching styles are socioeconomic status, ethnic group membership, maternal age, maternal locus of control, and the mother's “hidden agenda” or goals for her child. In this study, 32 lower income, Black and Cuban, teenage and adult mothers and their 12 month old infants participated in a simple task teaching their infant how to operate a “Jack-in-the-box”. The mothers were also interviewed on questionnaires designed to tap locus of control, “hidden agendas”, and demographic characteristics. The results showed that Cuban mothers demonstrated the task to their infant with verbalization significantly more often than the Black mothers. The groups did not differ on maternal “hidden agendas”. Adult mothers showed a more internal locus of control than teenage mothers. Infants of Black, teenage mothers vocalized significantly less often than infants of the other groups. Results of this study provide additional support for existing literature in which maternal age and cultural differences were reported for the amount of maternal verbalization during early teaching interactions.     

Economic analysis at the global level: a resource requirement model for HIV prevention in developing countries

Agencies operating at the international level have a need for economic analysis to help develop global health policies and determine resource requirements to support their advocacy efforts. This paper presents work commissioned by the Global Programme on AIDS to estimate the total resource requirements of implementing a package of HIV prevention strategies in developing countries. The modelling approach identified a hypothetical package which should be implemented and developed a set of assumptions relating the size, number and coverage of programmes required for each strategy to a set of demographic and other characteristics of individual countries. Costs were attached to estimate the total costs of the package for individual countries, regions and the developing world. Results are presented for regions and their implications discussed. Conclusions are drawn on the value of this type of modelling approach to estimating resource requirements.     

Resilience and Young People Leaving Care

How do we promote the resilience of young people leaving care? This article explores this question by bringing together research findings on the resilience of young people from disadvantaged family backgrounds with research studies on young people leaving care. These findings are applied to young people during their journey to adulthood: their lives in care, their transitions from care, and their lives after care. It is suggested that three main groups of young people can be identified from leaving care research studies: young people “moving on”, “survivors” and “victims”. It is argued that promoting the resilience of young people leaving care will require more comprehensive services across their life course. This will include, first, better quality care, providing more stability, holistic preparation, a positive sense of identity and assistance with education; second, opportunities for more gradual transitions from care, less accelerated and compressed, and more akin to normative transitions; and third, the provision of better quality and more extended support.     

Connecting with Practice in the Changing Landscape of Family Support Training

In order to effectively meet the needs of families, this paper argues that there is a need for people working in the arena of family support to incorporate theory and research into their practice and to engage in a process of reflective practice. An inter-disciplinary cyclical model of training for experienced family support practitioners is described, which involves identification and implementation of a practice task and subsequent reflection on the task one year later. The value of the model lies in the fact that it connects theory to practice in “real world” contexts, allows busy practitioners the time and space to reflect, facilitates the practitioners' agency to engage in service development, and, most importantly, supports services to examine how they can best meet the needs of children and families.     

District planning in the restructured N.H.S.—Facing up to uncertainty using computer models

The planning of health services must take place under conditions of uncertainty. Analysis of these uncertainties can be expected to help in the formulation of “robust” plans, but in the restructured N.H.S., community physicians and other District planners will for the most part have to do this with limited staff and other support.This paper identifies sources of uncertainty and argues that the use of computer modelsbased on increasingly cheap but powerful microcomputers, can be a key to the exploration of their effects on the plan's validity by local planners, rather than by technical specialists. It is claimed that models can be built which require only modest computer resources and little or no special technical expertise to operate, once developed. Examples are given of successful applications to support this claim.     

Education and young people in care

The Oxford Dictionary defines Education as the, “systematic instruction, development of character and mental powers”. To “Educate” is referred to as, “to train or to instruct intellectually”. Teachers and Tutors use education to pass on their own acquired knowledge, knowledge which will either be interesting or useful for those entering into the workplace. This article will look at the issues surrounding a young person in care and their education, it will also examine why other sections of society also tend to neglect their schooling. “Good practice” will also be highlighted and recommendations put forward for both discussion and implementation in the workplace.     

Health and housing conditions in public sector housing estates

This article reports some of the findings of a study of health and housing conditions ina sample of households from eight different types of council housing areas in Gateshead.Controlling for age, there were found to be marked and consistent differences in self-reported health between individuals from different areas. For all age groups up to 65 years old, those living in “bad” housing areas reported poorer health, more long-standing illness, more recent illness and more symptoms of respiratory disease and depression. The clearest associations between poor health and bad housing emerged for the generally fittest age-groups (the under 25 years). For the people over 65 years the position was reversed, with those in “good” housing areas reporting poorer health, with the exception of recent illness. This is argued to be the result of local authority lettings policy, which gives priority to re-housing the less-fit elderly.Those in “bad” housing areas were also more likely to report housing defects which affected their health and to feel that their health could be improved by a change in their housing.The study found that “bad” council housing areas did not necessarily conform to thestereotype of non-traditional construction, or high-rise flats. Some consisted of traditionally built houses, while there was a sizeable representation among the “good” housing of system-built high-rise flats. The “bad” housing areas were marked off more by their location, their poor environment and the low quality of their construction.     

Developmental dyslexia and the nootropic concept

A review is presented of controlled studies using intensive teaching intervention to improve dyslexics' reading ability. The results of eight such studies reveal only one showing the superiority of teaching over other methods. With this background, the work on nootropics is reviewed. Both animal and clinical work with piracetam #opthe first of the nootropics#cp seems to indicate that this medication lacks significant or serious adverse effects and appears to improve memory and learning. Many double-blind studies of piracetam have now been conducted on dyslexic children, which suggest that piracetam improves their reading ability. In addition electrophysiological studies support the notion that piracetam may be “left hemisphere active.”     

Developmental awareness and moral stage development in child Abuse

In an attempt to better understand why children who have been sexually assaulted commonly fail to reveal their victimization to parents or other adults, a study was undertaken in which the “engagement strategies” of 41 perpetrators were examined, exploring common rationalizations, threats, etc. aimed at insuring continued silence on the part of the victim. The “appeal” for silence offered by the perpetrator to the child was analyzed according to Kohlberg's stages of moral development.

Results indicate that perpetrators appear to alter their engagement strategies to coincide with the developmental level of the child, thus further insuring silence by appealing to criteria for assessing “appropriate” or “inappropriate” behaviors (eg. sexual contact) which are developmentally consistent with the child's level of cognition and moral reasoning.     

The effect of sudden paternal death on young people and their family relationships: Some implications for practice

The importance for children and young people to be able to communicate openly about the death of a parent is evident from the literature. This small-scale investigation uses a case-study approach to illustrate the impact on siblings of the sudden death of a father. The abundance of comments from the young people in the study such as “talking is the only thing that helps” and “everybody has to get it out” emphasise the important role of communication within the family. Children tend to take their emotional cues from other family members and, paradoxically, restrict communication of their own grief in an attempt to protect others. Even if painful in the short term, certain lines of communication may need to be established if family members are to be able to support each other in dealing with the distressing experience of the death in a healthy manner. The study suggests that those who work with young people in such circumstances should take cognisance of these issues.     

The myth of alcoholism prevention

Although practically every article about alcoholism contains at least one or two paragraphs that stress the importance and need for prevention programs, the “hows” and the “specifics” are rarely spelled out in any detail.The analysis of why this situation exists points to the existence of three central premises around which the present alcohol prevention model is constructed. Each of these premises has at its core the existence of some invalid statements, the perpetuation of which effectively blocks the establishment of more appropriate prevention models.Awareness of “facts” about alcohol leads to a change in drinking. The paper cites evidence from experimental and empirical sources, illustrating that the presentation of facts, although in some cases altering attitudes, does not result in changes in certain behaviors. An explanation and model are provided stating the conditions under which “facts” do and do not result in behavioral change and where “alcohol facts” fit into this paradigm.Prevention programs centered around “consequences” are an effective way to produce change in drinking. The common theme most alcohol prevention programs share today is that their “message” deals with the consequences of drinking. This approach is highly unsuccessful in appealing to alcoholics whose characterological style ties them to the present and not the distant consequences of their behavior.Applicability of a medical primary and secondary prevention model to alcohol education. This section of the paper deals with the misapplication of the medical primary and secondary prevention models to alcoholism. It discusses why the etiology of alcoholism must be understood prior to the establishment of a primary prevention program. It also questions the methodological premises around which the early warning signs of alcoholism are built and their validity in successfully predicting the later development of alcoholism. The need for more longitudinal studies is suggested.     

Effects of a prenatal “Information and Insights about Infants” program on the knowledge base of first-time low-education fathers one month postnatally

Pregnant women, in two clinics, one serving “low-risk” and the other serving “high risk” pregnancies, helped to recruit their male partners into a prenatal program. The 67 men, first-time fathers, all of low socio-economic status, were randomly assigned either to a control group or to an experimental group. The intervention group received two intensive 1 1#sh2 hour sessions of information and insights about infants in a small group within a clinical setting.

Father interviews and measures provided data on family parenting background; father attitudes towards infants; father perception of infants; father knowledge of when certain infant behaviors could be expected, couple dyadic adjustment, father social support, and father self-image. Postnatally fathers were videotaped with their infants during a feeding interaction. During the training sessions, detailed information about the behavioral capacities of the unborn#shnewborn and of infants during the first months of life were provided. Post test knowledge of infant scores of the experimental group were significantly higher #opp = 0.0001#cp than those of the comparison group.     

-appraising nursery water play

Recent research on water play in nurseries provides a focus for re-examining this traditional nursery provision. Using “dynamic structures” of space, time and task activities as a framework, I examine research evidence in the context of the nursery traditions and my own practice and thereby identify factors which can support quality play and learning.     

Parental views about services for children attending schools for the emotionally and behaviourally disturbed (EBD): a qualitative analysis

AIM: This study examines the views of parents of children attending schools for the emotionally and behaviourally disturbed (EBD). The study aims to gain an understanding of the journey through the educational system taken by these children and to explore their families' experience of services along the way. METHODS: Thirty parents of 25 children attending primary and secondary EBD schools in three South London boroughs took part in focus group discussions. Parents were asked about their experiences of services, including educational, health and social services, as well as how they thought services should be improved. RESULTS: Qualitative analysis identified a complex web of individual, professional and organizational factors which contributed to social exclusion of children with EBD problems and their families. These factors included children receiving inadequate education because of long periods of exclusion or inappropriate placements whilst waiting for a statement of special educational needs. Parents also felt personally socially excluded because of lack of childcare provision out of school hours. Many parents felt that their children did not fit into services and were constantly being passed on to other professionals. The analysis identified aspects of services that promote social inclusion and provide support to families, including acceptance of children into EBD schools, help from voluntary organizations and support from other parents with children with EBD problems. Parents particularly stressed the value of working in collaboration with professionals to achieve shared goals. CONCLUSION: EBD schools provide a valuable resource for parents. However parents often lack emotional and practical support in coping with their children's complex needs. Agencies need to improve communication and joint working to provide effective services for these families.     

Enhancing measurement in health outcomes research supported by Agencies within the US Department of Health and Human Services

Many of the Institutes, Agencies and Centers that make up the US Department of Health and Human Services (DHHS) have recognized the need for better instrumentation in health outcomes research, and provide support, both internally and externally, for research utilizing advances in measurement theory and computer technology (informatics). In this paper, representatives from several DHHS agencies and institutes will discuss their need for better instruments within their discipline and describe current or future initiatives for exploring the benefits of these technologies. Together, the perspectives underscore the importance of developing valid, precise, and efficient measures to capture the full burden of disease and treatment on patients. Initiatives, like the Patient-Reported Outcomes Measurement Information System (PROMIS) to create health-related quality of life item banks, represent a trans-DHHS effort to develop a standard set of measures for informing decision making in clinical research, practice, and health policy.     

An Academic Clinician’s Perspective on the Care of the Geriatric Patient

This paper discusses the role that the personal history plays in a patient’s perception of his or her own illness in the light of the patient’s own personal history. It demonstrates the regrettable modern tendency to regards the patient as the “bearer of a disease” rather than as a human being with personal values and experiences into which their current illness needs to be integrated. I illustrate my point by an exchange between a student and an “attending” and the “attending” and the patient. It represents only one out of unfortunately many such instances in which the pressures of “managed care” and “efficiency” have made truly knowing the patient as an individual with life experiences and personal values much more difficult.     

Children's Ways of Experiencing Peer Interaction

Educational practice in age integrated child groups rests on the assumption that children learn from their peers. The benefits of age integrated teaching is to enhance the value of heterogeneity in child groups. The fact that children are different from each other with different experiences is seen as an asset, which both children and teachers can benefit from. 22 children in a school class with children of mixed age; ranging from 7-9 years, were interviewed about their conceptions of peer interaction. How do children conceive peer collaboration, and what does it mean to children to teach someone something? A phenomenographic research approach is being used to discern the variation in ways of thinking about how children do when they teach someone something, and how they conceive peer collaboration at school. Children are conscious about the fact that they are able to teach their peers, and they can express this in different ways. Children also shift in their roles as “teacher” and “learner”. In some examples it is the “teacher” who plays the active role, in others it is the “learner” who has to be active by imitating the model/teacher.