Community Care

An epidemiological study of Attention Deficit / Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3 ± 5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiationinduced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short -term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short -term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow -up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum, and the dysregulation of catecholamine systems in persons with ADHD. D (M.G. Paule).

Objective: In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD (MTA), the effects of medication management (MedMgt), behavior therapy (Beh), their combination (Comb), and usual community care (CC) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm (Comb+MedMgt) over those that did not (Beh+CC). This report examines 36-month outcomes, 2 years after treatment by the study ended. Method: For primary outcome measures (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms, social skills, reading scores, impairment, and diagnostic status), mixed-effects regression models and orthogonal contrasts examined 36-month outcomes. Results: At 3 years, 485 of the original 579 subjects (83.8%) participated in the follow-up, now at ages 10 to 13 years, (mean 11.9 years). In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment groups did not differ significantly on any measure at 36 months. The percentage of children taking medication 950% of the time changed between 14 and 36 months across the initial treatment groups: Beh significantly increased (14% to 45%), MedMed+Comb significantly decreased (91% to 71%), and CC remained constant (60%Y62%). Regardless of their treatment use changes, all of the groups showed symptom improvement over baseline. Notably, initial symptom severity, sex (male), comorbidity, public assistance, and parental psychopathology (ADHD) did not moderate children's 36-month treatment responses, but these factors predicted worse outcomes over 36 months, regardless of original treatment assignment. Conclusions: By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in ...

To develop and test a standardised clinical handover discharge strategy for improving information transfer between private mental health hospitals and community practitioners. A quality improvement intervention using collaborative, iterative methods to develop a standardised discharge and outcome assessment strategy. 150 patient participants were consecutively recruited from two private mental health care hospitals in New South Wales between April and September 2008. Opinions of community practitioners and patients on the discharge process and discharge documentation were solicited by written questionnaires and telephone interviews. Community practitioner satisfaction; patient satisfaction; documentation of discharge date at least 48 hours before discharge; faxing of discharge summaries to community practitioners within 48 hours of discharge; proportion of patients receiving a follow-up telephone call within 7 days or 14 days of discharge. Both community practitioners and patients b...

A~traet--Language that trauma center nurses directed to 29 distressed patients was systematically examined from videotaped data. A unique set of co-occurring linguistic features and intonation patterns which characterize the comfort talk register was identified. Descriptive data reveal that nurses reserve this register for patients only and that linguistic adjustments are made within the register for children. The nurses' comfort talk register is also characterized by a restricted set of pragmatic functions which include:

A B S T R A C T : Patients d i s c h a r g e d f r o m state psychiatric hospitals into c o m m u n i t y care h o m e s were followed for four m o n t h s . Both observers a n d the patients themselves r a t e d the h o m e s ' social e n v i r o n m e n t s as well as the patients' needs a n d capabilities. Patients' f u n c t i o n i n g in the c o m m u n i t y was s h o w n to be e n h a n c e d w h e n there was a c o n g r u e n c e between the patient a n d the e n v i r o n m e n t in p a r t i c u l a r areas. Results suggest t h a t patients' p e r c e p t i o n s of c o n g r u e n c e are better predictors of success t h a n are observers' j u d g m e n t s .

Full thesis is available through the Cork Open Access Archive, here: https://cora.ucc.ie/handle/10468/12426
*
Although the term ‘infantilisation’ is used across disciplines and in different contexts, its meaning is frequently unclear. Where adults are infantilized, are they treated -as- children or -like- children, or merely in some child-appropriate ways? Are they thought of as child-like, or as defective adults, or as children in the bodies of adults? Is infantilisation distinct from paternalism, or only a severe example of it? In this thesis I develop a concept and theory of infantilisation which addresses these questions. Both concept and theory are grounded in empirical studies on the infantilisation of adults in elderly care settings and of physically and cognitively disabled adults (both in care and in the community). I argue that infantilisation is conceptually distinct from paternalism, that it is an inapt conceptualization of any adult, and that the treatments which stem from it are harmful. I conclude that the infantilisation of adults – cognitively disabled or not – is both a social injustice and a conceptual failure.

Review of Mental Health in the Community: the case of Slovenia.

Editor:
Vesna Švab

This book gives an up-to-date and hard-hitting assessment of the state of
mental health care in Slovenia and paints a clear picture of the direction
needed to improve mental health services. Appropriately the first word
goes to a service user/survivor Tone Vrhovnik Straka, who makes a series
of strong contributions to the book, stresses the need to focus upon the
independence of people with mental health problems, especially through
organising through NGOs.  In her opening chapter Vesna Švab  sets the
scene by saying that The history of psychiatry is rife with accounts of
neglect, abuse, injustice and discrimination.’  Subsequent chapter both
offer congratulations to the Slovenian government for its modern mental
health policy, and criticism for the lack of progress in its
implementation. Each chapter closes with a short summary of the key
practical recommendations of the authors to put real change into practice.
Živa Cotič, Simona Mlinar provide a very readable introduction to the
Convention on the Rights of Persons with Disabilities, and its
significance for Slovenia.

There is a consistent theme throughout the book upon recovery,
psycho-social rehabilitation and adopting a positive approach to social
inclusion during or after an experience of mental illness. Janko Kersnik
contributes an important chapter on the critical role played by primary
healthcare staff, especially during periods of mental health crisis. The
book goes beyond a narrow call for more or better state services, and
rather endorses a pluralism in mental helath care provisions, especially
emphasising the need for self-help groups, initiatives promoting work
opportunities, and psycho-education.  The authors repeatedly stress the
need for collaboration across traditional boundaries, for example between
health and social care, between primary and specialist care, and between
professionals and service users. They describe, in effect, a flexible
network of care providers as the model to develop for the future. In
keeping with the user-focussed tone of the whole book, the final chapter
by Renata Ažman describes her personal recovery.

Overall this is a deeply humane account of what is right and what is wrong
today in Slovenia in relation to the support that people with mental
health problems receive. Having made a ‘diagnosis’ with this situational
analysis, the author give a specific set of guidelines on how treatment
and care of people with mental illness can and should be improved in the
coming years.

Graham Thornicroft
Professor of Community  Psychiatry
Centre for Global Mental Health
King’s College London





For information about the NIHR Collaboration for Leadership in Applied
Health Research and Care (CLAHRC) South London see
www.clahrc-southlondon.nihr.ac.uk

Resumo - Com o objetivo de auxiliar as equipes de profissionais de saúde da família na organização e realização de práticas de prevenção de doenças e promoção da saúde, que sejam eficazes, cientificamente comprovadas e adequadas aos recursos disponíveis, uma equipe de pesquisadores da área de Medicina da Família e da Comunidade do Hospital das Clínicas da Faculdade de Medicina

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7-9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatm...

Zuurendonk. Zij waren verantwoordelijk voor de mondelinge afname van 358 vragenlijsten, 24 open interviews en 10 groepsinterviews. Een ander deel van de gegevens die betrekking hebben op de bewoners in de acht dorpen is verkregen in het voorjaar van 2006 via een schriftelijke vragenlijst die door plaatselijke bewonersorganisaties zijn bezorgd en opgehaald. Voor de lokale coördinatie waren verantwoordelijk Mw. P. de Moor (s'-Heerenhoek), Mw. M.C.J. van de Plasse-Nagelkerke (Kwadendamme), Mw. J. de Jager-Menheere (Lewedorp), Dhr H. van Dam (Nieuwdorp), Mw. W.E. Walhout-Markusse (Nisse), Dhr. G.J. de Wilde (Oudelande) en Mw. U. Leeflang-Behrens (Ovezande). De uitwerking van de op tape opgenomen open interviews met bewoners is uitgevoerd door student-assistent Waronne Sint.

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

Partiendo del principio protestante del "sacerdocio de todos los creyentes", que propuso Lutero , se plantean las implicaciones teológicas y eclesiales de este "sacerdocio universal", como la confesión de la "sanctorum communio". Se hace una intersección con la salud mental, en cuanto la comunidad cristiana responde, desde una ética del dolor, a las experiencias de sufrimiento psíquico. Se plantean las miradas de comprensión de dicho sufrimiento desde la psicopatología y los abordajes psicoterapéuticos, así como se plantean las formas de intervención desde las comunidades de fe para el crecimiento y la curación.

As a money-saving strategy, the majority of western countries have been moving away from institutionalized care and gravitating towards a home-based care system. Home care services continue to be promoted and a growing variety of services have become widely ...

Here, we provide an overview of the cultural aspects of epidemiological findings and provision of mental health care to people with intellectual disability (ID). The prevalence of intellectual disability may vary between cultural and ethnic groups, but this depends to a large extent on the definition and assessment methods used. Although human-rights-based policies have led to de-institutionalization and community care, stigmatization and discrimination of individuals with ID and health inequalities are common across cultures, which may be associated with the high rates of mental illness in this population. Negative attitudes of mentalhealth professionals towards those with ID or minority groups may lead to double discrimination and diagnostic overshadowing, and communication issues and complex caregiver networks further complicates the recognition and management of mental illness in individuals with ID. There are several ways in which clinicians could improve practice, including awareness of culturally associated explanatory models, providing person-centred care while also building a working relationship with caregivers, and addressing communication barriers, which may improve the care of individuals with ID and reduce discrimination and health inequalities in all cultural groups.

Der von Bund, Kommunen und Selbsthilfeorganisationen ausgerufene ‚demenzfreundliche‘ Umbau der Gesellschaft wird einer kritischen Analyse unterzogen. Hierfür werden die polit-ökonomischen und wohlfahrtstaatlichen Rahmenbedingungen des sozialpolitischen Konzepts der ‚sorgenden Gemeinschaft‘ rekonstruiert, welches die Zivilgesellschaft zu einer wesentlichen Akteurin ‚demenzsensibler‘ Kommunen erklärt. Unter den gegebenen Bedingungen läuft diese Entwicklung Gefahr, den mangelnden Ausbau sozialstaatlicher Transfer- und Dienstleistungen in der Altensorge abzufedern. Am Beispiel des Konzepts der ‚demenzfreundlichen Kommune‘ wird gezeigt, dass bürgerschaftliche Sorgepraktiken Menschen mit Demenz zugleich Emanzipationsgewinne in Form von steigender sozialer Partizipation und Selbstbestimmung ermöglichen. Ausgehend von diesem Spannungsverhältnis wird ein Vorschlag unterbreitet, wie gemeinwesenorientierte Care-Arrangements jenseits der Dichotomie von sozialstaatlichem Sparmodell und idealistisch verklärter Sorgegemeinschaft zu fassen wären.

Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking. Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP). Prospective psychometric instrument validation study. A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between Februar...

Thailand has been engaging ageing population, life expectancy of the populations including older people has been increasing. The numbers and proportion of the elderly have rapidly increased. In addition, reduction in family size and increasing of single family has been observed. There has been migration of labor forces from rural to urban areas and women have been increasing their role in economic activities outside their homes. Such changes inevitably deter individual household in providing care to their older members and reflect the need for studying and development of community care for older people.

The study aimed to assess community care models for older people in four studied provinces in order to generate knowledge and propose appropriate community care model for Thailand. The study employed cases study conducted in 4 sites, Payoa in the North, Yasothon in the Northeast, Supanburi in the Central and Nakhonsrithammarat in the South. In-depth interviews and focus group discussions were conducted among key actors in the communities including formal and informal community leaders, health workers, social workers, volunteers, older persons and care givers.

Results indicated that caring for older people remained individuals’ responsibility. Community services, both health and social, were available in all the studied sites, but with different coverage and intensity. Contexts of the community, i.e. culture, social networks, community economy, and community capacities including fund raising capacity are crucial in development of community services. The government policies on decentralization and universal coverage enabled community financial capacity in providing care for older people. Coverage of health services for independent elderly was quite adequate, but quality of care remained need special attention. Social care was not systematically developed and lack of integration and continuity of services. Moreover, health and social services for dependent elderly were very limited and urgent needed for improvement.

This paper describes the forms and contents of television representations of mental illness in the UK in 1992. The theoretical framework is provided by Moscovici's theory of social representations and some modi®cations are proposed for the case of madness. Quantitative and qualitative methods are used in the empirical analyses. It is shown that madness has multiple meanings on television, while at the same time violence is commonly included. It is also suggested that a partial recon®guration of the representational ®eld has taken place in recent years. Media stories about the responsibility of the policy of community care for scandals and tragedies are now commonplace. # 1998 John Wiley & Sons, Ltd.

An epidemiological study of Attention Deficit / Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3 ± 5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiationinduced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short -term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short -term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow -up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum, and the dysregulation of catecholamine systems in persons with ADHD. D (M.G. Paule).

Child sexual abuse is a pervasive social disorder, posing distressing psychological, social and economic implications to the victims as well as to the society. Children are more likely to be the victims of abuse, and especially sexual abuse, which has long-lasting impacts on the overall well-being of the child not only during childhood but also into adulthood. Alternative care settings are a part of society and are a reflection of a society's child protection measures. In order to understand the prevalence of the issue at hand, within the context of alternative care, an attempt is made to compile and analyze the reported sexual abuse incidences that have been published in various research articles, reports and newspapers, and recommendations are put forward for combating sexual abuse in the community and in alternative care.

ISSN 0151-0193 | pages 49 à 83 Pour citer cet article : -Béland F., Bergman H., Lebel P., Dallaire L., Fletcher J., Contandriopoulos A.-P. et Tousignant P., Des services intégrés pour les personnes âgées fragiles (SIPA). Expérimentation d'un modèle pour le Canada, Gérontologie et société 2008/, n° 124, p. 49-83.

This prestigious three year PhD studentship is available beginning 1st October 2015. The new Rehabilitation and Recovery Service for People with Severe and Enduring Mental Health Needs was introduced in January 2015. The service aims to better support service user recovery through more enhanced community support, and less reliance on inpatient care. It is a radically different prototype emphasising collaborative team working across statutory and third sector providers, and a philosophy focused on the community recovery element of the service in-reaching into the inpatient ward to provide more holistic and intensive support. It is anticipated that this model will help avoid institutionalisation and will promote better outcomes for service users (core of around n=50 p/yr) who may be characterised as ‘high need’ and ‘slow moving’. It is anticipated, that this model of community service will be more widely implemented across other Trust community services. A partnership evaluation is on-going and consists of a questionnaire at 1mnth, 6mnths, and 12mnths.
The project will provide a complementary, qualitative evaluation of the service using ‘photo elicitation’. Photo elicitation is a developing method of inquiry in which participants are invited to take photographs which help them to express something of their experience around the topic of investigation. The researcher provides a structure by having an introductory meeting to clarify the topic of investigation, to answer questions, and provide a digital camera, if one is needed - participants can use their own phone/tablet if they like. A time-frame is agreed for the photos to be taken and sent to the researcher (e.g., by e-mail attachment) and for the participant and researcher to meet to discuss the meaning of the photos in an audio-recorded research interview. The research entails undertaking photo elicitation with service users (n~16) about their experience of the new service and to include purposefully sampled staff as well (n~8 including inpatient service and community partners). The aims are to provide:
• an in-depth understanding of the experience of service users and staff to complement the quantitative service evaluation currently ongoing in the Trust;
• an understanding of the strengths of the service and areas requiring further development, from the perspective of both service users and staff;
• an evidence-base from which to develop the service, for example, through exploring the possibility of integrating the method in an on-going cycle of service evaluation and service use technology skill development;
• to provide a platform to apply for additional funding for a public engagement and knowledge transfer/dissemination to other services.

Im Beitrag wird ein Evaluationsprojekt zum Thema ‚Inklusives Wohnen‘ behandelt, das am Department für Soziale Arbeit am Management Center Innsbruck im Studienjahr 2017/18 durchgeführt wurde. Die Lebenshilfe Tirol orientiert sich an der Verpflichtung zur Inklusion im Sinne der UN-Behindertenrechtskonvention und hat in der Folge im Jahr 2016 ein Wohnhaus für Menschen mit Lernschwierigkeiten und Mehrfachbehinderungen aufgelöst. Seitdem leben insgesamt acht Menschen je zu zweit in Wohnungen in einem Wohnquartier. Die Betreuung erfolgt rund um die Uhr durch Assistenzkräfte, die eine eigene Wohnung als Stützpunkt ha-ben. Die neue Wohnform soll Menschen mit Unterstützungsbedarf mehr Selbstständigkeit und Selbstbestimmung ermöglichen und die Einbindung in das soziale Umfeld fördern. In der Evaluation wurden drei Perspektiven (Bewohner_innen, Mitarbeiter_innen und Nachbar-schaft) mit qualitativen und quantitativen Methoden in einem Mixed-Methods-Ansatz er-forscht. In einem innovativen, inklusiven Forschungsdesign wurde die Forschungsgruppe von einem Peer-Berater der Lebenshilfe Tirol konsultiert und unterstützt. Die Ergebnisse wurden den Bewohner_innen, ihren Angehörigen, dem Team, weiteren Stakeholdern und der Nach-barschaft mittels eines Animationsfilms in Leichter Sprache und in World-Café-Diskussionsgruppen vorgestellt. Nach einer kurzen Darstellung der Problemlage und des Ent-stehungszusammenhangs des Projektes werden Forschungsmethodik und ausgewählte Er-gebnisse präsentiert und im Lichte der Entwicklungen seit Abschluss des Projektes kritisch reflektiert.

Towards the end of the 1970s the concept of ‘community care’ was emerging as the preferred alternative to institutionalized service provision. For feminist writers it presented a potential problem in that the family was identified as the location within which this community-based care would be provided and that the ‘burden’, therefore was likely to fall on women. Community care has been presented as the ideal form of provision on the grounds of cost-effectiveness, moral responsibility (family members have a duty to care for one another) and as a safeguard against the abuse of individual that may occur in institutional settings. The ‘community care’ bandwagon continued to gain momentum throughout the 1980s. The National Health Service became separated and there was subsequent criticism of the fragmentary nature of social provision. The Griffiths Report of 1988 identified the role of social service as an enabling body rather than a service provider. In keeping with government policies, Social Service Departments were to make use of both private and voluntary sectors in purchasing services, and this was adopted in the 1990 National Health Service and Community Care Act.

Zuurendonk. Zij waren verantwoordelijk voor de mondelinge afname van 358 vragenlijsten, 24 open interviews en 10 groepsinterviews. Een ander deel van de gegevens die betrekking hebben op de bewoners in de acht dorpen is verkregen in het voorjaar van 2006 via een schriftelijke vragenlijst die door plaatselijke bewonersorganisaties zijn bezorgd en opgehaald. Voor de lokale coördinatie waren verantwoordelijk Mw. P. de Moor (s'-Heerenhoek), Mw. M.C.J. van de Plasse-Nagelkerke (Kwadendamme), Mw. J. de Jager-Menheere (Lewedorp), Dhr H. van Dam (Nieuwdorp), Mw. W.E. Walhout-Markusse (Nisse), Dhr. G.J. de Wilde (Oudelande) en Mw. U. Leeflang-Behrens (Ovezande). De uitwerking van de op tape opgenomen open interviews met bewoners is uitgevoerd door student-assistent Waronne Sint.

The twelve years preceding the introduction of the community care reforms in 1993/4 saw an increased demand for health and social services generated by the increase in numbers of older people (particularly the over 85s) and reflected in the rapid growth of residential and nursing home places over a twelve year period (from 224,000 in 1983 to 427,000 in 1994). While the move into the residential and nursing home sector was partly driven by the perverse incentives offered by social security in the early 1980s, it may also have reflected a real increase in the levels of dependency experienced by older people coming into contact with the services during the period. This has fuelled concern about rising costs. However, there are competing forecasts of how big a burden the costs of care will be. One of the difficulties is in determining how far the burden will fall on statutory services or formal services (provided by either the statutory or independent sectors) and how far the pool of in...

This article discusses the organisation of community care for older people in two rural municipalities in Slovenia, which are contrasting in terms of “wellbeing” attained. The two case studies are part of a wider research project on community care in the country, aiming to establish the typology of institutional care for older people at the level of municipality. As a follow‑up to the initial research, both cases assessed the typology “on the ground”. The various actors were selected by snowball sampling and interviewed about past and present forms of caring for older people. Contrary to the typology, the results of both cases show that institutional forms of care exist in both municipalities but differ in the field of cooperation among various formal and informal local care‑practitioners. Care within families, still the prevalent informal care provider in both communities, hides the financial inability of locals to use some formal care services in their community. Uniform national standards for organisation of formal care notwithstanding, the results show the communities’ peculiar adjustments to population ageing and their partial integration into society.

Pierre Robin sequence (PRS) is associated with long-term respiratory, nutritional, and developmental difficulties. Hypoxic complications, including cerebral impairment, cor pulmonale, and failure to thrive may be prevented or minimized with early detection and comprehensive care. This article reviews the embryological development of PRS and outlines the medical and nursing implications for treatment. Partnership with parents and a coordinated community care team are essential for successful management of infants and children with PRS.

Background: Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.

Background: While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care.

This is a report for which I am frequently asked for copies.  Completed in 1995, it presents the results from a local area study which examines the impact that community care has  on those most directly affected: those who require help, the clients or users (and potential users) of services; their informal caregivers; and the providers of formal community support services. To inform the further development of social policy the study examines the need for help at home among a group of predominantly older people who had been referred to an Aged Care Assessment Team in an Australian urban community. It then considers the outcomes of the support provided to these people over a three year period. It also looks at the nature and amount of assistance provided, from both formal services and unpaid family and friends. A further interest is the relationship between community support and alternative provisions, most importantly those made available in nursing homes and hostels.
The report presents findings from the Community Support Services and Their Users project, commenced in 1989 by the Social Policy Research Centre to provide a detailed case study of the operation of community support in practice, five years after the introduction of the Home and Community Care Program. The study was conducted from 1989-1993 in a suburban region in New South Wales that we have called Broadleigh. The research followed a group of 60 predominantly elderly people referred to the Aged Care Assessment Team, who, though in need of ongoing care, were assessed as being able to remain in their own homes. The study was also concerned with the community support services in Broadleigh, and with the factors which affected their access and use.

This paper intends to evaluate the mental health system in Italy thirty years after the psychiatric reform, using epidemiological evidence on the prevalence of mental disorders and the features of primary care and community mental health services (data from five Regions). The network of community mental health facilities appears to be complete as concerns Residential Facilities and Community Mental Health Centres, and less complete as concerns General Hospital Psychiatric Units. Substantial variation exists between Regions and between disorders, the treatment gap being smaller for schizophrenic than for mood disorders. High quality information is essential to improve mental health care; therefore, it should be systematically collected and extensively used to prime over the next decade a virtuous circle of positive changes.

International Journal of Health & Ageing Management, September 2006, v1, n1. ... International Journal of Health & Ageing Management Volume 1 Number 1 (September) 2006 <http://www.academicglobalpublications.com/ijham/> ... How can we develop a ...

... Reproduced with the cooperation of the Beinecke Rare Book and Manuscript Library, Yale University. ... Rushen and Pajor, 1987), a subtle type of withinlitter competition that persists throughout lactation (Fraser, 1990), and a rich repertoire of vocal communication (Grauvogl, 1958 ...

Despite increased international concern about fall prevention throughout the past twenty years, only limited attention has been paid to the experiences and perspectives of health care providers who deliver fall prevention programs. The purpose of this interpretive phenomenological study was to explore the meaning of the experience of enacting fall prevention, through individual semi-structured interviews, among six members of an inter-professional geriatric outreach team in Ontario, Canada. Findings suggest that "enacting careful practice" was essential to the experience of enacting fall prevention, represented by four inter-related phenomenological themes: caring fully for older clients, carefully seeing older clients in their life contexts, enacting therapeutic relationships, and experiential learning in inter-professional teams. We discuss findings in relation to literature on emotional labor, leading to suggestions for the policy and practice of fall prevention.

This article presents the results of a survey on personal assistance (PA) for disabled people, conducted among PA users and members of the independent living movement in Europe. The survey was developed and implemented in the spirit of emancipatory disability research, and was informed by the social model of disability and the independent living philosophy. Participants were asked to assess a series of characteristics of PA in terms of their impact on users’ choice and control. Their responses help identify which characteristics of PA are considered to be enablers of choice and control, which characteristics are perceived as barriers and which characteristics elicit disagreement or lack of consensus among PA users and members of the independent living movement in Europe. Plans for using the results of the survey to develop a tool for evaluating PA schemes are also discussed.

Background: Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives. Family members of persons with dementia provide much of the care for older adults with dementia in the community. Caring for a demented relative is not easy and fraught with emotional strain, distress, and physical exhaustion. Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder. Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers.

Since the closure of many psychiatric hospitals, case management has come to be accepted worldwide as a method of community care for the seriously mentally ill. Although case management has many commendable values, it falls short of providing a comprehensive treatment. It focuses almost exclusively on environmental interventions and largely ignores psychological elements of an individual's functioning. In particular, case management rarely provides clients with evidence-based therapy techniques, such as those developed from a cognitive-behavioral perspective. Consequently, clients with mental illness are not being provided with skills which could help them systematically reduce their emotional disturbance. It is hypothesized that the effectiveness of mental health case management may be enhanced by incorporating evidence-based psychological therapies within a community care model.