Informal care and economic appraisal: A discussion of possible methodological approaches

The role played by informal carers in the care of people with chronic disabilities is well known. Given its importance, it is essential to consider the evaluation methodology applied in economic appraisals of different care options. Few studies attempt any evaluation and those that do use varied, inconsistent and controversial methodologies. This paper aims to elicit the major issues and methodological problems related to economic appraisal of informal care. The main concern over the present methods utilized is the lack of explicit exploration of the benefits, as perceived by carers. Carers, through their decision to care it is argued, will consider both costs and benefits. Although concepts encompassed by benefits tend to be less tangible they may considerably outweigh any financial burdens. Various methods have been utilized in the past. Financial outlays are fairly straightforwardly costed, personal effort on the part of carers causes more problems. Methods applied include: the cost of substitute services; state benefits; and travel time values. The most useful is probably the latter, although it is not problem-free. Assessing benefits relating to concepts of direct and indirect utility and welfare is more complex and difficult to measure. Despite considerable literature on carers' attitudes, often these concepts are not applied (especially to residential care options) or if they are, negative aspects are emphasized (with domiciliary care). A useful application of economic appraisal would elicit optimal solutions to care dilemmas. Producing economic burden information about informal care may not be particularly constructive. Brief assessment of eight scenarios of care, considering cost differences for the public sector and the preferences of patient and carer gives insight to the problem. It emphasizes the complexity of the issue and the essential role likely to be placed on care managers in helping carers to maximize the net benefit of their efforts.     

Care for the other's selfhood: a view on child care and education through Heidegger's analytic of Dasein

Philosophical analysis concerning selfhood and care is of fundamental importance for child care and education. Martin Heidegger's analytic of Dasein introduces the concepts of self and care within the ontological domain while structuring the holistic understanding of human existence. Because of the ontological emphasis, Heidegger's concepts of self and care have mainly been overridden in relation to the more or less practical questions of child care and education. This article studies Heidegger's analytic of Dasein and its implications for the philosophy of child care and education. The interconnection between the phenomena of care and selfhood and the question of how to pay attention to a child's selfhood are studied in this article. As the outcome of the study, it is proposed that the analytic of Dasein, especially its ideas about selfhood and authentic care, could offer an advantageous ontological perspective for an elaboration of the theory of relational selfhood and reciprocal care.     

The effects of day care: A critical analysis

Maternal employment has increased over the last thirty years in the USA. The result of this increase means more families are in need of day-care for their children. Examined in this paper are research findings on the effects of day-care on pre-school children and their families. The implications of these findings for policy development are critically discussed.

Currently in the USA, over 50% of mothers work outside the home; this figure is expected to rise to 75% by 1990. The fastest growing segment of the working mother population is among those with children under two (Zigler and Gordon, 1982). This increasing rate of maternal employment over the last two decades has created the need for alternative arrangements for infants and young children. There is some concern among child developmental specialists that these alternative arrangements of caremay have detrimental effects on a child's social and psychological development.

Much of the concern about substitute care is based on the theory and research related to the negative effects of institutionalization on young children (Bowlby, 1951; Spitz, 1945). This body of literature, however, tells one little about the typical forms of substitute care experienced by most children. Obviously, children generally do not experience the extreme physical and social deprivation reported on in the institutional literature (Advisory Committee on Child Development, 1976: 117). Consequently, the quality of substitute care received by the majority of children is not comparable to the type of care studied in the institutional literature.

Still, the possibility remains that even with high quality care, differences may be found in the behavior and development of children as a function of the type of substitute care received. The literature reports numerous studies on the impact of various forms of substitute care; however, most of these studies are not well designed (Advisory Committee on Child Development, 1976: 118). The typical form of substitute care focused on in the literature has been high quality, university based day-care settings, a form of substitute care most children do not have access to (Santrock, 1983: 159). Even though the majority of these studies have weak methodological designs and are based on day-care settings not experienced by most children, some meaningful findings have emerged in the literature. This paper will focus on those relevant studies reporting on the impact of one very common form of substitute care, day-care for the pre-school child. The major emphasis of the review will be on how day-care impacts the pre-school child's intellectual development, emotional development, social development, and the child's family system. The authors will draw from these findings several major policy implications.     

The effects of day care: A critical analysis

Maternal employment has increased over the last thirty years in the USA. The result of this increase means more families are in need of day‐care for their children. Examined in this paper are research findings on the effects of day‐care on pre‐school children and their families. The implications of these findings for policy development are critically discussed.

Currently in the USA, over 50% of mothers work outside the home; this figure is expected to rise to 75% by 1990. The fastest growing segment of the working mother population is among those with children under two (Zigler and Gordon, 1982). This increasing rate of maternal employment over the last two decades has created the need for alternative arrangements for infants and young children. There is some concern among child developmental specialists that these alternative arrangements of caremay have detrimental effects on a child's social and psychological development.

Much of the concern about substitute care is based on the theory and research related to the negative effects of institutionalization on young children (Bowlby, 1951; Spitz, 1945). This body of literature, however, tells one little about the typical forms of substitute care experienced by most children. Obviously, children generally do not experience the extreme physical and social deprivation reported on in the institutional literature (Advisory Committee on Child Development, 1976: 117). Consequently, the quality of substitute care received by the majority of children is not comparable to the type of care studied in the institutional literature.

Still, the possibility remains that even with high quality care, differences may be found in the behavior and development of children as a function of the type of substitute care received. The literature reports numerous studies on the impact of various forms of substitute care; however, most of these studies are not well designed (Advisory Committee on Child Development, 1976: 118). The typical form of substitute care focused on in the literature has been high quality, university based day‐care settings, a form of substitute care most children do not have access to (Santrock, 1983: 159). Even though the majority of these studies have weak methodological designs and are based on day‐care settings not experienced by most children, some meaningful findings have emerged in the literature. This paper will focus on those relevant studies reporting on the impact of one very common form of substitute care, day‐care for the pre‐school child. The major emphasis of the review will be on how day‐care impacts the pre‐school child's intellectual development, emotional development, social development, and the child's family system. The authors will draw from these findings several major policy implications.     

Children’s participation in Dutch youth care practice: an exploratory study into the opportunities for child participation in youth care from professionals’ perspective

ABSTRACT

Since 2015, local municipalities in the Netherlands have been responsible for the organisation of the youth care and child protection system. One of the basic assumptions underlying the new Youth Act (2015) is the mobilisation and empowerment of the family to help solve their problems. Consequently, the participation of children and parents is essential in the implementation of youth care services. However, it seems that substantial differences exist between municipalities in realising children's participation in decisions that are taken concerning their care and protection. This article provides an interdisciplinary perspective on child participation; it explores both the legal opportunities for participation and the extent to which children can make use of these opportunities in practice. It is concluded that municipalities have large discretion in giving shape to child participation in the access to voluntary and coercive youth care. However, child participation is better regulated and implemented in practice with respect to compulsory youth care via court orders. Throughout almost the entire process, the minimum age limit from when children are involved in the decision-making process is 12 years, which means that children below that age have scarce opportunities to participate.     

妇幼保健机构内部控制建设与实施探索

随着我国市场经济的不断发展,妇幼保健机构的经济体系也在不断地完善,国家每年都要持续投入大量财政资金用于开展妇幼保健领域相关业务.完善的内部控制体系建设可以为妇幼保健机构各项业务和经济活动的开展奠定基础,为单位运行减少风险并保障公益性职能作用的充分发挥.由于妇幼保健机构内部控制起步较晚,其建设工作还有待于探索.采取科学的...     

妇幼保健机构人力资源的微观管理探讨

当前，对各种组织机构中人力资源的研究已经成为业界普遍关注的课题，文章对妇幼保健机构人力资源微观管理的背景、存在问题等进行分析并提出相应对策。     

Implementing health and social care integration in Scotland: Renegotiating new partnerships in changing cultures of care

Health and social care integration has been a long‐term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or “boundary spanners” in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll‐out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or “boundary spanners” and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled.     

Privatisation in health care: concepts, motives and policies

Over the last decade privatisation has been used frequently as a policy instrument to reduce the financial burden of the public sector. In most countries there is a mix of public and private interests in health care. Because of this, privatisation is an important issue in health care policy analysis. In this article we deal with different concepts and motives for privatisation in general. We will distinguish various types of privatisation and show how these can be applied to changes in health care policy. As far as the latter is concerned we will use Dutch experiences. In the analysis we emphasise especially the effects of privatisation in health care on the private non-profit organizations.     

The case for enhanced educational supports for children in public care: An integrative literature review of the educational pathway of children in care

For many years, the adult outcomes of young people who have grown up in foster care have been an object of broad concern. Numerous studies show that young adults who were former foster children lagged behind their community peers on a number of socio-economic indicators. Educational attainment is seen as a key developmental outcome and one that is highly associated with positive adult adjustment. Most young people today undertake a gradual process of becoming independent, but this emancipation process is very different and often traumatic for young people who age out of child protection care. This review considers the published literature that explores the educational and associated outcomes of children who leave the care of child protective services.     

Professionalised intimacy: how dementia care workers navigate between domestic intimacy and institutional detachment

This article reports an ethnographic study of the handover routines in Germany's first dementia village, with a central focus on how care is balanced between domestic intimacy and institutional detachment. The term ‘professionalised intimacy’ is used for the vivid interplay between comfort and intimacy that renders the interaction between care workers and residents far more complex than previous theories have articulated. Because of the intimacy involved in community building, however, the promise of personalised care must clash with the bureaucratic structures of an official institution, potentially depriving the care workers of their public, respected identity in the process. The study further suggests that most care workers, in fact, support this division between domestic intimacy and institutional detachment. Even if they subscribe to a dementia village's philosophy of personalised care, their medical training and enculturation has endowed them with a habitus compatible with the modern health profession, with incentives on achieving quantifiable health goals. The dementia village is thus illustrated as a pioneering health care experiment that negotiates rivalling discourses of intimacy, professionalisation, and medicalisation.     

Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development

ObjectiveIn this article, we describe one approach for evaluating the value of developing quality indicators (QIs).Study Design and SettingWe focus on describing how to develop a conceptual measurement framework and how to evaluate the need to develop QIs. A recent process to develop QIs for injury care is used for illustration.ResultsKey steps to perform before developing QIs include creating a conceptual measurement framework, determining stakeholder perspectives, and performing a QI needs assessment. QI development is likely to be most beneficial for medical problems for which quality measures have not been previously developed or are inadequate and that have a large burden of illness to justify quality measurement and improvement efforts, are characterized by variable or substandard care such that opportunities for improvement exist, and have evidence that improving quality of care will improve patient health.ConclusionBy developing a conceptual measurement framework and performing a QI needs assessment, developers and users of QIs can target their efforts.     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

The Child's Start in Day Care Centre

10 children have been followed from their start in day care and during the first months by means of qualitative observations. Their parents and kindergarten teachers have been interviewed. A basic issue in the study is that starting in day care means on the one hand separation from the family and on the other hand possibilities of new activities and new social relations. How does this issue figure in the day care life of the child? The day care centre appeared to be a place for exploration and activities with much attraction for the child. The separation was only difficult for one of the children. For this child a caring kindergarten teacher, opportunities for exploration and support in these activities from the kindergarten teacher was of importance in overcoming the difficulties with the separation. It furthermore appeared that right from the start the content in the child's day care life is related to activities with things and facilities and soon also with peers. The relation with the kindergarten teacher is important for the child in that through the caring attitude of the kindergarten teacher it becomes appreciated and a participant in the joint life.     

An investigation of factors related to the use of respite care services for children with severe motor and intellectual disabilities (SMID) living at home in Japan

Limited time away from the child is cited as the main factor that increases the burden for the primary caregiver of severely disabled children. The aim of this study was to quantitatively elucidate the factors related to the desire to use social services and the actual use of respite care services by the primary caregivers of severely disabled children in Japan. In this study, we investigated the use of respite care services in accordance with the primary caregivers’ wishes by examining inhibiting or promoting factors associated with respite care service use only among those who wished to use social services. A total of 169 Japanese mothers participated and answered the questionnaires. We conducted a logistic regression analysis and a multiple regression analysis to investigate the factors related to respite care service use. The most important factors affecting a primary caregiver's desire to use social services were the belief that the child would enjoy using social services and the family's approval of the social service use. The most important factors affecting respite care service use were the family's approval of the use and a large care burden on the primary caregiver. Respite care services should be sought out before the care burden becomes too great to enable the primary caregiver to more easily contribute to the continuation of home care. A background of mother–child separation anxiety disrupted the use of respite care. However, believing that the child enjoys using social services may reduce primary caregivers’ psychological resistance to being separated from their child, which is supported by tradition. Thus, it is also important for respite care service providers to provide information about the children to their primary caregivers and families while they are using respite care services.     

Social and psychological care before and during hospitalisation

Hospitalisation is a stressful experience, especially for children. While maternal separation has been as a major cause of distress among younger children, a broader perspective is required to understand the links between the individual, familial, professional, institutional and structural levels of hospital care affecting children. This can be seen in the changing attitudes in hospitals to parents as visitors, and the gradual introduction of open visiting. A model of discontinuity is proposed to analyse the experiences of children, parents, and professional staff in the ward. A variety of ameliorative techniques are discussed, in terms of their implications for change to hospitalised children or to hospital organisation. Studies in the development of children's concepts of illness show the need for providing information relevant to their developmental level.It is suggested that more should be done to involve parents in the care of their children in hospital, and to offer them support during this time. The effects on nursing and other staff are considered. The introduction of play schemes has benefits for children, but may lead to organisational complications if the priorities between therapy and welfare are not reassessed. More attention should be given to the psychological risks of treatment in assessing effects of medical intervention. A move towards more child centred care should in particular involve a change in the role assigned to the family within the medical sphere, and a reduction in the insularity of hospitals and fragmentation of treatment derived from existing medical and nursing practices.     

Child care in Slovenia: an example of a successful transition

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full-time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971-1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in-kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three-quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three-quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.     

Home care in Austria: the interplay of family orientation, cash-for-care and migrant care

This article discusses the development of the home care sector in Austria. It analyses what impacts the interplay of the traditional family orientation to care, a universal cash-for-care scheme (reaching about 5% of the population) and a growing migrant care sector have on formal home care in Austria. The article is based on an analysis of research papers, policy documents and statistical data covering the period from the introduction of the cash-for-care scheme in 1993 up to 2011. Some authors have argued that generous cash benefits with no direct link to service use - as in the case of Austria - limit the development of home care, particularly in countries with a traditionally strong family orientation towards long-term care. Additionally, a tradition of family care and an emphasis on cash benefits may be conducive to the employment of migrant carers in private households, as a potential substitute for both family care and formal care. Despite this context, Austria has seen a substantial increase in formal home care over the past two decades. This has been driven by clients using their increased purchasing power and by policy priorities emphasising the extension of home care. Migrant care work was regularised in 2007, and the analysis suggests that while migrant care has usually worked as a substitute for other care arrangements, migrant care can also become a more integral element of care schemes. The article concludes that family orientation, unconditional cash benefits and the use of migrant carers do not necessarily preclude the development of a strong social service sector. However, there is a risk that budgetary limitations will primarily affect social service development.     

基于TOPSIS法的我国妇幼保健工作质量评价

目的 对我国各省市妇幼保健服务质量进行评价，了解现状，为进一步提升妇幼健康服务提供参考。 方法 结合权威资料选取可以体现妇幼保健水平的相关合理指标，利用熵权TOPSIS法综合评价2018年全国各省市、自治区妇幼保健工作质量。 结果 依据计算所得的Ci值大小对各省市妇幼保健服务质量进行排序，前三位是上海、北京、吉林，末三位是云南、广西、西藏。 结论 我国不同省市、区域间妇幼保健服务质量仍存在较大差异，国家应加强财政投入、精准施策，重点强化中西部基层妇幼保健机构专业人才培养，提升其服务能力，以期不同区域间的妇幼群体均能享受公平、可及且优质的妇幼卫生服务。     

Development and consequences of group living in Sweden : A new mode of care for the demented elderly

The process of developing a new mode of care for the demented elderly, group living (GL), is evaluated and the consequences discussed.The increasing proportion of very old persons in Sweden means a higher prevalence of dementia. The majority of patients in traditional institutional long term care show cognitive deterioration. An insufficient caring situation, both in quantity and quality has long been observed. This, and a better knowledge and understanding of dementing diseases, their symptoms and consequences, has been the impetus to develop an alternative care model, group living (GL), for well defined groups of demented elderly. The concept of GL discussed here means a setting strictly adapted to the abilities and psychosocial needs of moderately diseased Alzheimer and vascular demented patients. Security, integrity promoting therapy and activation are specially stressed. The importance of informing and educating different kinds of actors simultaneously to structural changes in social and physical patterns within the implementation of the new concept is illustrated.