The Power of Naming: Co-Constructing Knowledge About Violence in the Family

Orphans are vulnerable to abuse and violence due to the precarious situation they find themselves in. Some of these abuses could differ based on where the orphans live. This study was therefore designed to compare the violence experienced by orphans in institutionalized and family settings. It also determined the influence of residential placement on violence experienced by orphans in orphanages and family settings in Nigeria. The study employed a concurrent mixed-methods research design. The sample comprised 3893 orphans (2418 living in family settings and 1475 living in orphanages) who were between the age ranges of 10–17 years. Multistage sampling procedure was used to select the sample for the study. A self-developed instrument titled “Orphans Needs and Vulnerability Questionnaire” was administered on the respondents. Data collected were analyzed using frequency count, percentages and chi-square. The results indicated that orphans experienced varying forms of violence in both family and institutional settings. The result further showed a prevalence of 1.6% for physical violence in the family setting and 0.2% in the orphanages. The results also revealed that flogging (1st), fetching water from a far distance (2nd) and verbal abuses (3rd) were the most ranked violence experienced by orphans in the family settings while, flogging (1st), severe/corporal punishment (2nd) and verbal abuses (3rd) were the most ranked violence experienced by orphans in the orphanages. Furthermore, the results showed that there was a significant influence of residential placement on violence experienced by orphans in Nigeria (χ2 = 57.104, p < 0.05) with the family settings more engaged in violence against the orphans. The study concluded that orphans in family settings experienced more violence than orphans in orphanages. It is recommended that special intervention programmes to protect orphaned children from physical, psychological and sexual abuse in family settings should be put in place.

The presence of IPV in foster care cases: Examining referrals for services, reunification goals, and system responsibility

Toward a post‐neoliberal social citizenship?

Public mental health authorities are faced with the responsibility of containing costs, improving quality, and providing greater accountability. In response, a number of states began developing mechanisms to assess consumer outcomes and provider performance. In the late 1990s Virginia took a proactive stance by pilot testing the Performance and Outcome Measurement System (POMS), which was based on the ConsumerOriented Report Card of the Mental Health Statistics Improvement Program (MHSIP). The Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services implemented the pilot project at eight sites. Implementing POMS statewide was intended to serve two major purposes: it would continuously improve the quality of services, and it would increase accountability for taxpayer dollars. POMS was designed by a committee that included major stakeholder groups: consumers, family members, and providers. This committee also oversaw the implementation of the pilot project and obtained input from a wider array of stakeholders throughout the implementation process. In early 1997 six community mental health centers and two state hospitals were selected to participate in the pilot project. Two sites each were selected to represent adult mental health, child and adolescent mental health, adult substance abuse, and inpatient services. A total of 46 different indicators were tested across the four populations. The goals of the pilot project were to determine which of these indicators provided the most useful information at the lowest cost and to develop recommendations for improving POMS and for implementing the program statewide. The pilot project took place from 1997 to 1999.

Introduction: In October 2015, the Belgian Health Ministers launched a joint plan in favour of chronic patients entitled “Integrated Care for Better Health” [1]. Through this plan, they expressed their intention to move from a fragmented system to an integrated care system for patients with chronic diseases. They decided to implement this plan in a bottom-up way: they launched a call for multidisciplinary four-year pilot projects involving field actors in a co-creation process in order to initiate innovation at the local level. Methods: This qualitative and inductive research draws on several data collection methods: interviews N=21, focus groups N=7, direct observation 90.5 hours, documentary analysis operational documents and a literature review. The data, pertaining to two aspiring pilot projects, were collected during the “conceptualisation phase”, i.e. the application writing period. Results: According to the authorities ‘guidelines, pilot project consortia had to identify a pilot zone and include a variety of first-line and second-line care actors together with non-medical actors e.g. social and cultural actors working in this zone. They were asked to identify the needs of their population and the available/missing resources in their pilot zone. On the basis of this, they had to write a loco-regional action plan in which they outlined their common vision, their strategic and operational objectives and the actions they would implement to achieve these objectives. Discussions: During the conceptualisation phase, different actors, who would probably not have met otherwise, came to work together, overcoming the traditional fragmentation between first- and second-line of care. More than that, by including non-medical stakeholders, the pilot project consortia extended to the community. Multidisciplinarity, coconstruction, cooperation, coordination, targeting a community/defined population in a delimited territory, initiatives “driven by community health needs” [2], sharing goals and resources, all these elements characterising the pilot projects also characterise community health care [3]. Conclusions: Opting for implementation through the use of pilot projects has led local actors to engage in the development of what could become “community health microcosms” in the future. Pilot projects appear to be tools supporting the development of “community-based integrated care” [2]. Lessons learned: Building multidisciplinary projects entails that local actors reach an agreement on their common vision and goals, which is a challenging task. This implies dealing with controversies by meeting, understanding their respective roles, exchanging ideas, negotiating and overcoming their personal interests. Becoming a group, a community aware of its existence is a task in itself, which takes time. Besides, co-designing health care with local actors brings unpredictability to the process: the result of local actors’ reflections can be different from the authorities’ expectations. Limitations: Nineteen pilot projects submitted applications. For practical reasons of feasibility, this research focuses only on two pilot projects and, more specifically, on the application file co-construction process of these pilot projects. Suggestions for future research: The selected pilot projects will implement their loco-regional action plans during the execution phase starting in January 2018. Focusing on the concrete execution of their loco-regional action plans seems to be a logical continuation of this research.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Pakistan suffers from neglect in delivery or planning of experiment-based pilot projects before launch of social policy interventions. The aim of the chapter is twofold: (1) to summarize information from past interventions that have been delivered in the country for women’s protection and wellbeing, and (2) to identify limitations for better planning of future pilot projects and interventions. The types of interventions to support women’s wellbeing that are included in the chapter are restricted to what has been delivered in the country and is primarily funded by foreign donors, focusing on women of reproductive years as beneficiaries. Furthermore, the interventions are mostly found in areas of mental health and reproductive health, thus excluding areas such as preventive health, social literacy, and chronic disease management. Despite the few interventions (randomized controlled trials and experiment-based interventions) found, five major limitations have been identified, which need to be considered before planning pilot projects for social policy development in the country. The chapter concludes that no social welfare or policy initiative must be launched before pilot testing in Pakistan and that future pilot projects must consider the following areas: (1) better sampling of different women population groups and longer trial duration; (2) preventing contamination to secure valid results; (3) better baseline assessment and the use of combined assessment for more reliable results (perception-based surveys, clinical assessment, and community needs assessment, etc.); (4) improvement in service quality of social workers or other intervention facilitators to improve uptake by women; and (5) cost analysis of pilot projects for better financial forecasting to plan upscale.

South Africa’s social sector has evolved from simple and disjointed nonstate initiatives into a complex set of interventions, institutions, programs and services. The review presented in this paper shows that the development of social policy and institutions in South Africa has been shaped by the political and economic situation both locally and internationally. Like social policy in many other countries around the world, the state was initially reluctant to accept responsibility for the provision of social welfare services; most of the services were provided in a fragmented way by nonstate actors, including the Church. But from the 1920s, the state started to gradually accept the responsibility to provide social services including education, health care, housing and social welfare. Although different South African governments have, from colonial times to the 21st century, consistently rejected the idea of making South Africa a welfare state, the state has, with time, increasingly taken on greater responsibility, not only in terms of regulating all social services but also the provision of all public services in the country. Of all the social services, it is the cash transfer program (social grants) that currently attracts political and public attention in the country. However, it is the provision of education services that has consistently accounted for the largest share of public expenditure since the beginning of the democratic dispensation in 1994. For instance, in the 2022 to 2023 national budget, education services accounted for 20.4 percent of total public expenditures, followed by social development (social welfare) at 16.9 percent, and health care services at 12 percent. Social policy expenditure together accounts for almost half of government expenditure, which is roughly about 14 percent of gross domestic product (GDP). The social policy scholarship in the country has historically focused on social welfare, a situation that gives the impression that social policy is synonymous with social welfare policy. Although this article focuses on the history of social welfare policy in South Africa, it is important to note that social policy is a broader field of public policy that includes education, health care, and social welfare (which in South Africa is also referred to as social development). One of the fundamental features that defines the history of social policy in South Africa is racial discrimination; institutionalized during colonial and apartheid periods, it has continued to shape and reproduce racial disparities in access to social services even thirty years after the fall of apartheid. While the democratic South African government has increasingly accepted and taken greater responsibility to provide social services, social policy in the country is characterized by a persistent tension arising from the commitment to neoliberal principles of fiscal discipline and austerity on one hand and espousing social democratic principles which emphasize the provision of meaningful support to citizens both as a form of social investment, as well as an instrument for addressing the legacies of colonialism and apartheid on the other. Since the dawn of democracy, this tension has been exacerbated by the growing calls to address racial injustices of the past, as evident in the number of protests, against the background of persistently weak economic growth since 2010.

Drawing on Language Awareness (LA) approaches developed for francophone classrooms and a sociocultural theoretical perspective on language and learning that posits the genesis of new knowledge construction is situated in social interactions and shaped by socio-historical context, we conducted a small-scale case study of the implementation of LA activities in elementary school. Fieldwork practices included observing and videotaping classroom interactions among French Immersion students in Vancouver and students from the mainstream francophone programme and classes d'accueil in Montreal, individual and focus group interviews with students, and collecting relevant documents for context description. In this paper, our analysis of data demonstrates how LA activities enabled teachers to engage students in focused discussions about language diversity and fostered the emergence of a community of learners who had access to a repertoire of languages that expanded beyond official languages. We examine how collaborative LA activities encouraged students to draw on collective language resources to approach languages unknown by the majority. We argue that valuing and sharing knowledge of diverse languages in classroom discussions fostered the discursive co-construction of new knowledge about the evolution of languages, relationships between languages, as well as a critical stance on the relative status of languages.

Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

This study aimed to examine the mediating role of meaning in life (presence of meaning and search for meaning) in the relationship between intolerance of uncertainty and subjective well-being across different life stages. The research focused on three distinct age groups: emerging adults (18–24 years), young adults (25–44 years), and middle-aged adults (45–65 years). A total of 1155 participants (672 female, 483 male) from Türkiye participated in the study. Structural equation modeling was used to test the mediating role of meaning in life in the relationship between intolerance of uncertainty and subjective well-being. The findings revealed that the presence of meaning positively predicted subjective well-being, while the search for meaning negatively predicted it. Intolerance of uncertainty decreased the presence of meaning while increasing the search for meaning. These effects varied significantly across life stages. The presence of meaning played a stronger role in mediating model in older individuals, whereas the search for meaning was a more influential factor among young adults. The results provide valuable insights into how the impact of meaning in life on subjective well-being evolves across developmental stages. By addressing the relationship between uncertainty and well-being within the context of life stages, these findings contribute to understanding the individual and social functions of meaning in life within Turkish culture.

Chapter 1 introduces the chief claim and main argument of the book, which we call the life stage relativity of values. This is the claim that different values matter more at different stages of our lives. During early life, caring, trust, and nurturing ought to figure prominently, due to the vulnerabilities and needs that characterize infancy and childhood. By young adulthood, the capacity to develop greater physical and emotional independence makes autonomy a focal value. During later life, we face heightened risk for chronic disease and disability, which makes maintaining capabilities central, and, in the face of loss, keeping dignity intact. Chapter 1 raises the concern that moral theories reflect life stage bias, in particular, midlife bias. Midlife bias consists of applying the values central during midlife to all life stages. Countering it requires addressing empirical, conceptual, and psychological naïveté and situating values within the context of life stages.

Introduction. The development of innovative high quality care forms is a challenging issue in rapidly aging society of Lithuania. The new shape integrated homecare services for people with chronic conditions have been constructed and have been functioning over the year as the pilot projects in the 21 municipality around Lithuania. In almost all integrated care pilot municipalities except two regions (in Alytus and Sakiai, with primary health care units as integrated care providers) the initiative to develop team based integrated homecare services to persons with chronic conditions has been taken by departments of social services. The purpose of this study is to identify the key contextual elements and related strategic, organizational processes from pilot municipalities as facilitators and obstacles in developing mobile team based integrated homecare services as contrast to traditional institutionalised care. Theory/Methods. Pettigrew and Whipp's context, content and process model of strategic change was used as theoretical framework for the case studies of team based integrated homecare pilots. According this framework the data collection focused on three entities: what external and internal contexts instigated municipalities and service providers to take the challenge to develop the new shape integrated team based homecare services and how service providers perceive, construct and implement integrated team based homecare; and finally, what outcomes have been shaped with new form integrated care. Data were analysed from transcripts of 20 focus groups with administrators, social and health care providers and 12 in depth interviews with care receivers (informal caregivers and patients) in ten purposively sampled municipalities: pilots executed by municipality social provision departments in partnership with private and state agencies, directly by social services departments and by primary health care unit. The findings were compared with factors and dimensions of Normalisation Process Theory (May et al. 2007). Results and discussion. The study revealed the obstacles and facilitators related to individual and different organizational levels in constructing team based integrated homecare. The study 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117127– http://www.ijic.org/ revealed individual level topics such as trust and collaboration building between integrated team care providers and informal caregivers, challenges in building new routines and habits for patient in homecare process, resistance and adaptation to presence of constant changing strangers’ at home. The study exposed the organizational issues related to interaction between team members and administration, tensions issues in status difference between social and health care providers, tasks distributions between team members, perception diversity of team and care, lack of teamwork experience and sense of shared responsibility, issues of staff commitment due to termed pilots. The inter-institutional and intra-institutional hindering tensions between social and health care providers unclosed the competition over the homecare field; new institution as threat to monocracy of health care; lack of skills and early transition from hierarchical to dialog based horizontal structures; inequality of resource distribution between integrated team members uncompensated travel costs for social care providers vs. car with fuel coverage for health care providers. The mentality of monolog culture with highly hierarchic structures in health care system hinders recognition of nursing as separate profession with certain competencies: avoidance by nurses to take decisions on nursing issues without consultation with physician even in areas of their professional competence supremacy as care of bedsores. The important facilitators were the support of municipality in service development and participatory involvement of the unit from the beginning of project planning. The professionally organized integrated homecare services facilitated transition to collaborative relationship between health care and social care providers. The requirement to follow literally description of project activities even the performance of planned activities contradicted the reality in practice hinders development of new service. As study limitation is the administrators gatekeepers’ role in accessing research participants: patients, informal caregivers, health and social care providers. In some municipalities the presence of head of the unit in the focus group suppressed openness of the staff. The study had insufficient data on patients’ experience of care as the integrated care pilots addressed severely ill patients with limited communication abilities. Conclusions. The study revealed micro, mezzo and macro levels obstacles and facilitators in constructing team based integrated homecare. The distinction of developed models of team based integrated homecare services participatory interaction between stakeholders of the care with the traits of patient centred approach and collaborative practices between existing social and health care structures. The move from the tradition of hierarchical model of service development ( i.e. from “above” perspective constructing orders of ministers with limited perception of reality and municipalities as executive committees with resistance performing commandments and shaping service delivery imitation) grounded the participatory practice in service development.

BackgroundLaw enforcement officers (LEOs) come into frequent contact with people who inject drugs (PWID). Through service referrals, LEOs may facilitate PWID engagement in harm reduction, substance use treatment, and other health and supportive services. Little is known about PWID and LEO attitudes and concerns about service referrals, however. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico.MethodsWe assessed service referral preferences and perceived likelihood of participation in health and social services, integrating data from structured questionnaires with 280 PWID and 306 LEOs, contextualized by semi-structured interviews and focus groups with 15 PWID and 17 LEOs enrolled in two parallel longitudinal cohorts in Tijuana, Mexico.ResultsAmong potential service referral options, both PWID (78%) and LEOs (88%) most frequently cited assistance with drug- and alcohol-use disorders. Over half of PWID and LEOs supported including harm reduction services such as syringe service programs, overdose prevention, and HIV testing. The majority of PWID supported LEO referrals to programs that addressed basic structural needs (e.g. personal care [62%], food assistance [61%], housing assistance [58%]). However, the proportion of LEOs (30–45%) who endorsed these service referrals was significantly lower (p < 0.01). Regarding referral acceptability, 71% of PWID reported they would be very likely or somewhat likely to make use of a referral compared to 94% of LEOs reporting that they thought PWID would always or sometimes utilize them. These results were echoed in the qualitative analysis, although practical barriers to referrals emerged, whereby PWID were less optimistic that they would utilize referrals compared to LEOs.ConclusionsWe identified strong support for LEO service referrals among both LEO and PWID respondents, with the highest preference for substance use treatment. LEO referral programs offer opportunities to deflect PWID contact with carceral systems while facilitating access to health and social services. However, appropriate investments and political will are needed to develop an evidence-based (integrated) service infrastructure.