Inspection of care: findings from an innovative demonstration.

In this article, information is presented concerning the efficacy of a sample-based approach to completing inspection of care reviews of Medicaid-supported nursing home residents. Massachusetts nursing homes were randomly assigned to full (the control group) or sample (the experimental group) review conditions. The primary research focus was to determine whether the proportion of facilities found to be deficient (based on quality of care and level of care criteria) in the experimental sample was comparable to the proportion in the control sample. The findings supported such a hypothesis: Deficient facilities appear to be equally identifiable using the random or full-sampling protocols, and the process can be completed with a considerable savings of surveyor time.     

用科学发展观探索流浪精神病的救助问题

  目的  分析流浪精神病患者肇事肇祸行为的临床特征及其相关因素,探索流浪精神病人救助管理新思路。  方法  将2008年1月 — 2014年12月南宁市社会福利医院收治的2 332例流浪精神病患者按其是否肇事肇祸分为研究组和对照组,并用SPSS 22.0软件对数据进行χ²检验和多因素logistic分析。  结果  2 332例流浪精神病人中肇事肇祸742例（31.8 %）,其中男性肇事肇祸发生率高于女性（P = 0.001）,外省患者肇事肇祸发生率高于南宁本市患者（P = 0.000）,离异患者肇事肇祸发生率高于已婚患者（P = 0.025）;肇事肇祸患者较非肇事肇祸患者更易出现骨折（P < 0.05）,流浪精神病人营养不良比例（70.9 %）较高,且传染病发病率（15.5 %）高于正常人群;肇事肇祸患者的主要精神病种为精神分裂症（75.9 %）,活性物质所致精神障碍患者肇事肇祸发生率54.4 %（37/68）、心境障碍患者肇事肇祸发生率52.4 %（22/42）,均高于精神分裂症患者肇事肇祸发生率43.9 %（563/1 283）（P < 0.05）;研究组出现妄想、幻觉、违拗、易激惹、被动性服从、情绪高涨等阳性症状多于对照组（P < 0.05）,情绪淡漠、思维贫乏、注意减弱、缄默等阴性症状低于对照组（P < 0.05）;多元回归显示,离异、无职业、精神分裂症、易激惹、幻觉、情绪高涨是肇事肇祸发生的危险因素。  结论  流浪精神病患者肇事肇祸有其明显的临床特征。肇事肇祸发生率较高;阳性精神症状促使其肇事肇祸;离异、无职业、精神分裂症患者更易肇事肇祸。建议加强流浪精神病患者家庭及社会支持,促进社会功能恢复,并将其救助工作纳入政府及相关部门的重要议程;救助医疗机构设立外科及传染病区等,提高综合救助力度。     

Engagement with health and social care services: perceptions of homeless young people with mental health problems

The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.     

Informed consent in psychiatric research: Preliminary findings from an ongoing investigation

Preliminary findings from an investigation of informed consent processes in four psychiatric research projects (two being carried out at a university medical center and two at a public psychiatric hospital) are reported. Study methods include the systematic observation of investigator/subject information disclosure sessions using audio and videotape, as well as the use of standardized interaction rating forms and subject understanding interviews. In an attempt to determine if subjects' understanding of research can be improved through increased subject education, several modes of information disclosure are compared. Partial results from the public psychiatric hospital portion of the investigation suggest low subject understanding in many areas with subjects often demonstrating difficulty differentiating between treatment and biomedical research. Subjects' problematic understanding of research purposes and methodology was compounded by investigator disclosures which often emphasized the therapeutic, personalistic and nonresearch-oriented aspects of the project. Nevertheless, even when information disclosures were significantly improved, subject understanding in many cases continued to be low--suggesting that additional factors aside from the quality of investigator disclosure are involved in psychiatric subjects' comprehension and understanding of research. The implication of these findings for informed consent, regulation of biomedical research and the protection of human subjects are discussed.     

Measuring coping strategies in an educational intervention for individuals with psychiatric disabilities

Coping is a critical theoretical concept believed to be a mediator for successful outcomes produced through a variety of different social work interventions. This article describes an approach used to measure coping with stressors and was designed specifically for an intervention, the Michigan Supported Education Research Project, aimed at providing support for people with psychiatric disabilities to pursue college or vocational education. Hypothetical scenarios were developed that matched the content of material covered in the program. Open-ended responses were elicited from program participants as part of an in-person interview. Key findings included a participation effect on the number of positive coping strategies of participants and a significant relationship among some coping strategies and later outcomes. Implications for social work practice and research are identified.     

Tackling the needs of the homeless: a controlled trial of health advocacy

The objective of the present study was to assess the effectiveness of a health advocate's casework with homeless people in a primary care setting in terms of improvements in health‐related quality of life (QoL). The impact of the health advocacy intervention was assessed in a quasi‐experimental, three‐armed controlled trial. Homeless people moving into hostels or other temporary accommodation in the Liverpool 8 area of the UK and patients registering at an inner‐city health centre as temporary residents were allocated in alternating periods to health advocacy (with or without outreach registration) or ‘usual care’ over a total intake period of 3 years. Health‐related QoL outcomes were assessed using three independent self‐report measures: the Life Fulfilment Scale; the Delighted–Terrible Faces Scale; and the Nottingham Health Profile. Out of the 326 homeless people who were given baseline questionnaires at registration, 222 (68%) returned usable questionnaires. Out of these individuals, 171 (77.0%) were traceable at follow‐up, and 117 (68.4%) follow‐up questionnaires were returned. The majority of respondents (n = 117) were women (72%) who were under 30 years of age (74%), white British (91%), and single (63%) or separated (23%), many of whom were living with their children (41%) in either women's refuges (30%) or family hostels (25%). Improvements in health‐related QoL were greatest in people recruited and supported by a health advocate early in their stay in temporary housing, in comparison with those in the control group given ‘usual care’ at the health centre. The model of streamlined care for patients with complex psycho‐social needs is shown to be a worthwhile and effective option for primary healthcare providers.     

Living with epilepsy: ordinary people coping with extraordinary situations

This replicated study explores the ordinary people theory generated in the original research among American youth with cystic fibrosis through the experience of Israeli youth with epilepsy. The authors used the qualitative life history method in a sample of 14 adolescents and young adults with epilepsy. They employed the constant comparative method of analysis to analyze the data collected from the in-depth interviews. The results show that epilepsy was not central to the participants' everyday lives. Their perceptions of the disease followed developmental stages. The authors found that coping methods were adaptive and took into account social stigma and practical outcomes. This study provides a positive and normalcy perspective of exploring the lifestyle of people with chronic diseases and disabilities as opposed to deficit models. It adds to the trustworthiness of the model's cross-cultural applicability through its use in a different context among a population with a different diagnosis.     

Teaching public health: an innovative method using computer-based project work

Restructuring of training in public health in the Hungarian medical schools is being undertaken in the context of a major European Union tempus Joint European Project. Under the aegis of this project a common core curriculum of public health has been developed. As part of the implementation of the curriculum, new approaches to learning are being explored that should enable students to appreciate the nature and magnitude of the major challenges to public health in Hungary and promote the development of their analytic, interpretative and presentational skills. One of the approaches is based on the individual preparation of reports on important public health issues, making use of secondary data from electronic databases (WHO HFA/PC and OECD Health Data) and traditional printed sources (annuals). This method called 'computer-based project work' was introduced in Debrecen in 1992–1993 with a secondary objective to develop basic computing skills. The initial experiences of introducing computer-based project work to the curriculum have been positive. This paper describes a practical example of the implementation of innovative approaches to teaching in a highly traditional setting in Central Europe, and one that provides ideas and encouragement to those facing similar problems in the countries of Central and Eastern Europe and the former Soviet Union.     

User involvement in the development of a health promotion technology for older people: findings from the SWISH project

Successive English government policies about older people’s health and well‐being aim to improve health and quality of life by promoting independence. Improving access to information and services that can improve health and well‐being and reduce health risks is central to the modernisation of health and social care. Most recently, tailored and person‐centred approaches with a strong emphasis on promoting health and well‐being are central to policy, including the proposals for ‘Life Checks’ and the recent emphasis on commissioning ‘community well‐being’. We carried out a qualitative study to identify the key aspects of social situations that affect health and well‐being, from the perspectives of older people and professionals, to enrich and expand an existing health risk appraisal tool so that it could be used for self‐assessment of health and social well‐being. This tool, Health Risk Appraisal in Older people (HRAO), has been evaluated in different European settings, including English general practice. Focus groups were recruited from general practice, older people’s forums, social care and voluntary organisations in two London boroughs where the HRAO tool had previously been tested. The social factors determining health that were prioritised by older people and service providers and recommended for inclusion in the health risk appraisal tool were recent life events, housing and garden maintenance, transport, both public and private, financial management, carer status & needs, the local environment and social networks and social isolation. This study has identified key social determinants of health that could usefully be added to ‘Life Checks’ for older people and that could also inform the commissioning of community well‐being. Modified with the addition of social domains, the HRAO technology could be a suitable tool to achieve current policy objectives.     

Posthospital needs of elderly people at home: findings from an eight-month follow-up study.

In a study of 737 elderly hospital patients discharged to their homes in suburban areas northwest of Chicago, Illinois, 60 percent were assessed as needing help with personal care or housekeeping. Only 19 percent were referred by the hospital to community service agencies and, in the immediate postdischarge period, a large proportion of help in both personal care and housekeeping was given by relatives. Eight months after discharge, however, the proportion of care provided by relatives had decreased and the proportion of paid help had increased. The use of help at both points in time was strongly related to limitations in the basic activities of daily living (ADL) at time of hospital discharge. Many patients were unaware of available community services, and 64 percent said that no one in the hospital had talked with them about managing at home. These findings indicate the need for rethinking criteria for hospital discharge planning, more effective communication between service providers and patients, and community focus of attention on elders coming home from the hospital.     

The montefiore community children's project: A controlled study of cognitive and emotional problems of homeless mothers and children

Objectives This study compares the prevalence of emotional, academic, and cognitive impairment in children and mothers living in the community with those living in shelters for the homeless. Method In New York City, 82 homeless mothers and their 102 children, aged 6 to 11, recruited from family shelters were compared to 115 nonhomeless mothers with 176 children recruited from classmates of the homeless children. Assessments included standardized tests and interviews. Results Mothers in shelters for the homeless showed higher rates of depression and anxiety than did nonhomeless mothers. Boys in homeless shelters showed higher rates of serious emotional and behavioral problems. Both boys and girls in homeless shelters showed more academic problems than did nonhomeless children. Conclusion Study findings suggest a need among homeless children for special attention to academic problems that are not attributable to intellectual deficits in either children or their mothers. Although high rates of emotional and behavioral problems characterized poor children living in both settings, boys in shelters for the homeless may be particularly in need of professional attention.     

The health of homeless people in Britain: A review

Housing has long been identified as a prerequisite for goodhealth. In Britain not all members of the population have accessto housing. The homeless population may be divided into thosewho are officially accepted as homeless and the unofficial homelesspopulation. The official homeless population is dominated byfamilies with children whilst the unofficial homeless populationincludes a range of circumstances from those living in squatsto those literally living on the streets. In Britain the numberof official homeless tripled between 1978 and 1992 and is currently143,500 households (approximately 330,500 people). It is estimatedthat there are a further 6, 000 people living on the streetsand 50,000 in hostels giving a total estimated homeless populationof 386, 050. Demographic data indicate that there are importantdifferences in the composition of the official and unofficialhomeless populations. The official homeless group consists almostexclusively of young families, usually headed by a lone female.The unofficial homeless group is predominantly male and older.The official homeless population report higher prevalences ofchronic health problems and general psychiatric problems thanthe general population whilst the unofficial group are characterizedby elevated rates of psychiatric disturbance and alcohol consumption.These data indicate that homeless people are not a homogeneoussocial group but present a variety of different health needswhich require the provision of appropriate services.