Areas Of Service Provision Research Articles

The role of applied science in helping farmers to make decisions about environmental sustainability

Decision making about environmental sustainability is complex, involving both factual and value-based judgements by farmers. Some of the factors involved in making these decisions, such as the financial implications and riskiness, the urgency of the problem, ease of implementation and trialling and compatibility have been addressed elsewhere. The current paper discusses a number of less-explored issues involved in this type of decision making, including the need for multiple sources of knowledge such as farmers’ values and goals, an understanding of social and demographic issues, and consideration of the catchment or landscape context in which farmers live. It highlights scientific knowledge as only one of these knowledge sources, with other sources also needed in complex decision making. Evidence from a Western Australian case study suggests that there has been a shift in farmers’ values over the past few decades and that there is now a greater responsiveness to management solutions which include environmental considerations, even among the 40% of farmers driven primarily by monetary goals. Changing social conditions, particularly the roles of women on farms and of off-farm income, suggest greater potential for the incorporation of environmental considerations into farm management. However, demographic issues, particularly issues such as limited employment opportunities, the declining provision of services in areas dominated by an agricultural economy, and the trend of increasing privatisation of extension services, suggest that there remains potential for greater environmental exploitation in some areas. The role of scientists in helping farmers to address environmental sustainability is discussed, with an acknowledgment that there are insufficient scientists with the required skills available. Scientists need to work in teams with local people to develop a sufficient depth of understanding to translate abstract research findings into solutions that are relevant at the farm level. Highly participatory approaches (which empower farmers rather merely inform them) can help scientists to understand farmers’ needs and motivations, but involve losing control of highly focused research agendas. Environmental Management Systems are one way in which scientific research and group learning can help empower farmers to understand and make better decisions about the environment.

Health care in remote Australian Indigenous communities

Health care in remote Australian Indigenous communities

Professional discourse and service cultures: an organisational typology developed from health and welfare services for people with learning disabilities

This study focuses upon the effect of social policy upon a particular area of service provision. It is influenced by the Foucauldian concept of governmentality and the proposition by Lewis et al. (2000) that social policy needs to be understood in local contexts. Only through understanding the partial and fragmented impact of policy can we gain a clear insight into the outcomes for users. The study is undertaken through an exploration of the micro politics of organisations providing health and welfare services for people with learning disabilities. It involves an approach to discourse analysis that focuses upon text developed from interviews with service providers, which is brought into contact with published literature in an iterative process. The interpretation of the text produces four themes: power, trust, citizenship and managerialism. The development of these themes and a further holistic interpretation of the text suggest an emerging organisational typology. A typology based upon different articulations of the themes noted that work to produce particular outcomes for service users.

Service needs of hearing-impaired children and their families: report of a survey of parental attitudes

Universal Newborn Hearing Screening (UNHS) demands follow-up provision which is family-friendly. The attitudes to service provision in areas of North Wales, UK, were surveyed to highlight the speci...

Service needs of hearing-impaired children and their families: Report of a survey of parental attitudes

Universal Newborn Hearing Screening (UNHS) demands follow-up provision which is family-friendly. The attitudes to service provision in areas of North Wales, UK, were surveyed to highlight the specific needs of young children from a family perspective. Study aims were to identify with parents ways of reducing stress and anxiety by improving support and inter-agency collaboration, and to define a standard of care for audiology services wishing to implement universal newborn hearing screening. Fifty-four families with children 11 years old or younger and a hearing loss of 40 dB (HL) or greater in the better hearing ear were sent a copy of the Medical Research Council questionnaire, ‘Deaf or hearing-impaired children and their families: services provided and quality of life’. Families who completed the questionnaire were invited to participate in a second stage of information gathering, consisting of a semi-structured interview. A number of common themes emerged from the questionnaire and interviews, including support and explanation at the time of diagnosis, language needs and communication, and information. The need to focus on broader social and language support for deaf children and their families is being incorporated into current strategic planning.

Do information systems meet the needs of primary care trusts?

To function effectively, primary care trusts (PCTs) need information from a range of sources. The general practice clinical record is a key source of information for PCTs but has often proved to be of variable quality. PCTs have developed rapidly and now have responsibility for 75% of the healthcare budget. They have a range of information needs that must be met if they are to ensure that healthcare provision meets the needs of patients. Since the abolition of health authorities PCTs have full responsibility for developing practice systems as well as having a key role to play in developing information management and technology (IM&T) within local health economies. The paper describes the problems PCTs face in accessing information to support their core functions and the progress they have made in retrieving data to support service development. It also describes the progress and developments in information and information systems within general practice using data from the National Tracker Survey of Primary Care Groups and Trusts (PCG/Ts). The survey began in 1999 when PCGs were established and has tracked the progress of PCG/Ts over three years. This paper presents the findings from the third survey relating to the development of information to support the needs of PCG/Ts. The findings show that information available to PCG/Ts does not meet their needs in a range of key areas. Many PCG/Ts are collecting data to support the Coronary Heart Disease National Service Framework (CHD NSF) and monitoring some areas of service provision in general practice. The use of information management tools has risen significantly since the second survey and involvement in the Primary Care Information Services (PRIMIS) initiative has more than doubled. The paper concludes that although PCG/Ts and general practices have made substantial progress, there is a long way to go before information providers generate high-quality information to support the needs of PCTs.

Letter

We are a group of intermediate care clinical leaders who are keen to establish a way of monitoring the capacity of the five intermediate care teams that have been set up in Leeds. We are aware of some tools that have been developed for district nursing but have found that the complexities of the workload and the interdisciplinary nature of intermediate care make the tools very difficult to adapt for our use. We would be keen to make contact with any colleagues who are grappling with the same issues, or indeed have developed a tool that works for them. It would also be good to share the experience that we have with others involved in this exciting, developing area of service provision.

Unity of diversity? Task profiles of general practitioners in Central and Eastern Europe

Background: The countries of Central and Eastern Europe, where - until the end of the 1980s - the Semashko health care system prevailed, are often perceived as a homogeneous group. If this highly centralized system, with its tight state control, together with the ‘equalizing’ influence of communism, has led to a uniformity in the provision of health services, this could be reflected in the service profiles of general practitioners (GPs). The aim of this paper was to find out whether this picture is justified and investigate differences between the former communist countries. Methods: In 1993 and 1994, standardized questionnaires were sent to (mostly random) samples of GPs (7,233 in total) in 30 European countries. Four areas of service provision were measured: the GPs' position in first contact with health problems and their involvement in the application of medical techniques, disease management and preventive medicine. Variation patterns and mean scores were analyzed by way of multilevel analysis. Results: There is no more uniformity in Central and Eastern Europe than in Western Europe. In Eastern Europe there are in fact considerable differences: GPs in former Yugoslavia have the most comprehensive service profile, whereas the lowest scores were found among doctors in the former Soviet Union. The countries which had a social insurance system before the Second World War, such as the Czech republic and Hungary, are situated in between. Conclusions: There are distinctive national differences in GPs' task profiles in Central and Eastern Europe, which provide clues for the country-specific design and implementation of primary care-oriented reforms.

Using Staff Consultation to Facilitate the Emotional Development of Adults with Learning Disabilities

The emotional development and emotional difficulties of people with learning disabilities is a much‐neglected area of service provision. Attempts to understand and treat the emotional‐developmental needs and problems of this population are reviewed. Whilst there is some evidence that psychotherapeutic methods have been successfully applied, it is unlikely there will ever be enough psychotherapists to provide adequate individual treatment. This article proposes one response to the problem by demonstrating how the process of consultation can enable care‐staff to develop an understanding response to this area of their clients' lives. A model of consultation (process consultation) that is relevant to the development of care‐staff's therapeutic skills is described.

Benchmarking quality implementation in a service context: A comparative analysis of financial services and institutions of higher education. Part I: Financial services sector

This paper examines the implementation of total quality management in a service sector context. It covers aspects of growth in the service industry, elements of service provision and the relevance of quality specifically to 'intangible' areas of service provision. The paper examines two contrasting service-based sectors, namely financial services and higher education. A benchmarking exercise using secondary data via three case studies from each sector was undertaken. This part covers the financial services sector.

Support for carers of people with Alzheimer's type dementia.

Research has highlighted the problems for carers of people with dementia. These include the effective loss of companionship and support of a life partner, social isolation and complex financial, legal and social decision making. The burden of caring is financially, emotionally and physically significant. Studies of the effects of ways of supporting carers and reducing the burden of caring often examine a range of outcomes. Probably because of these characteristics, no formal overview of this area of service provision has been undertaken. Moreover, the term 'intervention' in relation to caregivers of people with Alzheimer's disease is open to wide variations in interpretation at the level of service provision. Interventions range from the application of 'hi-tech' computer technology for socialy isolated carers, to the formation of specialist support groups and respite services. The objective of this review is to provide an assessment of the effectiveness of health and/or social interventions designed to help support the carers of people with Alzheimer's-type dementias. The Cochrane Controlled Trials Register was searched using the terms 'carer*' and 'caregiv*'. See the Cochrane Dementia & Cognitive Impairment group's details for the full search strategy. All randomised trials in which primary carers of people with Alzheimer's disease are allocated to either intervention or non-intervention/control groups and where the intervention was provided by healthcare and/or social services. Data was extracted by both reviewers and was found to be unsuitable for quantitative synthesis. A qualitative overview is presented and structured according to the comparisons used in the review. Weighted Mean Differences (weighted by sample size) for each outcome and its subcategories are also presented. The results of the review are inconclusive. No evidence was found for the following comparison interventions: 1) individualised service assessment and planning versus conventional support 2) technology-based carer networking (via computers or telephones) versus conventional support 3) carer-education/training versus conventional support 4) multi-faceted/dimensional strategies (such as specialised carer assessment and training) versus conventional support Whilst the overview suggests little or no evidence that interventions to support caregivers of people with Alzheimer's disease are of quantifiable benefit, the poor quality and small sample sizes of the studies, as well as the diversity of interventions examined and outcomes reported, mean that this conclusion cannot be put forward without the need for caution, particularly as some of the studies put forward qualitative evidence which contradicts this conclusion. With the limited nature of the research evidence in mind, it is not possible to recommend either wholesale investment in caregiver support programmes or withdrawal of the same. With the addition of further studies in future updates of this review, expected in early 1999, this presently inconclusive picture may become clearer. A number of conclusions relating to future areas of research can be put forward with more conviction. Specifically, 1) Future trials need to examine interventions included in the existing knowledge base on Alzheimer's carer-supportive interventions. 2) Outcome measures used should mirror those in similar studies. 3) Outcome measures need to be clinically and 'lay' relevant. 4) Trials need to be of longer duration given the 7-10 years median life expectancy of people with Alzheimer's Disease. 5) Sample sizes need to be increased and calculated properly given the likelihood of a moderate intervention effect (if any). 7) Blinding at the outcome assessment stage needs to be a part of future basic trial designs if bias is to be avoided. 8) If reviews are to have their power increased then quality o

Huntington's Disease: An update

Abstract Huntington's disease is a complex and debilitating genetic disease which has significant implications for all members of the families it touches or threatens. Over the last fifteen years significant advances in the areas of service provision and genetic science have improved the potential to assist these families. However, because of misdiagnosis, family secretiveness, misinformation and limited professional awareness many Huntington's families and individuals may not be accessing the help available. In order to maximise the likelihood of this assistance being received if it is wanted, this article encourages social workers to familiarise themselves with some of the basic issues and services associated with the condition and be prepared to respond accordingly.

Bargaining or Bludgeoning? Compulsory Tendering and Enterprise Bargaining in Victoria

ABSTRACT Compulsory competitive tendering is primarily concerned with creating a more competitive, open, market in areas of service provision which may previously have been closed. This may be perceived exclusively in terms of efficiency and efforts to standardise service provision within specific sectors across government (or other) boundaries. Alternatively, it may be viewed as a reconfiguration in government-citizen power relations. Similarly, enterprise bargaining may be considered something of a free market approach to collective labour forces. Equally, it may be seen to present alternative relations between citizens, state and federal governments, agencies and apparatuses. In each instance, changes in conceptions and activities of citizens and state instruments are becoming apparent Most notably the fundamental issues of public and social policy—rights, responsibilities and rewards—are being redefined and allocated according to new criteria and conditions.

Change in general practice and its effects on service provision in areas with different socioeconomic characteristics.

To investigate the changes in the structure and service provision of general practice in areas with different socioeconomic characteristics. Interview survey; postal questionnaire. 260 group and 80 singlehanded general practices in six family health services authorities in England. Changes in computerisation, premises, staffing, incomes, and service provision since the introduction of the 1990 contract, including comparison with data from a study in 1987. In 1993, 94% (245) of group practices were computerised compared with 38% in 1987, and 35% (90) of practices had used the cost rent scheme since 1987. Practice managers were employed in 88% (228) of group practices, and practice nurses in 96% (249) (61% and 60% respectively in 1987). Diabetes and asthma programmes were generally more common in the more affluent areas than elsewhere. A minority of practices (27% (9/33)) in the London inner city area achieved the higher target level for cervical smear testing, compared with 88% (230) overall. A similar trend was apparent for childhood immunisation. Perceived workload increased sharply between 1987 and 1993. Differences in the mean net incomes of general practitioners between areas were much lower than in 1987. Singlehanded practices generally had more problems than group practices in improving service provision. Practices in all areas have shown a strong response to the new incentives. The evidence suggests, however, that generally the urban and inner city practices still lag behind practices in rural and suburban areas in terms of practice structure and service provision.

Managing to care: the importance of using existing information to guide service provision for informal carers.

All managerial decisions are taken on the basis of the information that is available. It is important that managers use appropriate information to base their decisions upon about service provision to ensure efficient use of resources. This basic premise serves as a framework for examining how quantitative and qualitative information can be of help to nurse managers in taking these decisions in the context of developing services for informal carers. The current emphasis on surveys as a means of assessing client need is questioned and it is suggested that a wealth of evidence, relating to the experience of carers, already exists. Examples of accounts which express the needs of informal carers are presented and their utility, in terms of highlighting the carers' perspective, is discussed to reinforce the importance of utilizing this information. The paper concludes that nurse managers can use these sources as a basis for decision-making in the area of service provision and this may result in a more effective use of resources through a needs-based approach.

GOVERNMENT'S CHANGING POLICY IN THE PROVISION OF HOME CARE SERVICES FOR ISRAEL'S FRAIL ELDERLY

The relationship between the governmerit and non‐government organisations (NGO's) providing welfare and human services has been dealt with extensively by researchers and scholars, from theoretical as well as empirical perspectives. Such research has addressed the changing role of the government and changing division of labour between the government and provider organisations, In this context, studies have discussed the strengths, weaknesses and level of effectiveness of the existing relationship, in which the government sets policies, provides funding and controls the quality of services while provider organisations actually deliver the services. Studies have also pointed to the organisational, managerial and economic differences between government agencies, non‐profit organisations (NPOs) and for‐profit organisations (FPOs). The findings indicate that neither sector has a clear‐cut advantage over the other. Rather, each sector has relative advantages in different areas of service provision.

Family Service Agencies: Responding to Need in the 1980s

The family has been the focus of social work practice for at least 100 years, and family service agencies have evolved as one of the major providers of social services to the family. One legacy of the conservative mood of the Reagan administration has been a general impetus to look to the private sector for provision of necessary services. A nationwide survey of Family Service America member agencies was undertaken in an effort to assess the impact of this impetus on one segment of the private sector. Results of this survey indicate that family service agencies experienced tremendous growth in the 1980s in both client caseloads and areas of service provision. Today's family service agency client is increasingly likely to be a minority person seeking counseling within the framework of services provided through the workplace. The demand for services appears to be the greatest in the areas of domestic violence, alcoholism, drug abuse, and eldercare. Family service agencies in the 1980s have offered an increasing number of programs in direct response to the greater demands of families in their communities.

Other cities, same problems.

London's health care problems, particularly underfunding, are mirrored in other major cities in the United Kingdom and abroad. None has found the perfect solution, but the debates on the Tomlinson report provide an opportunity to review how to manage the three major areas of service provision, medical education, and research in London. Mr Robert Maxwell suggests that some aspects of the successful ambulatory care initiative in New York could be adapted by the capital's primary care providers while the secondary services might learn from the rationalisation of specialist services in Paris.

Intervention with Cocaine-Abusing Mothers

Increasingly, human services professionals are faced with the challenge of providing services to families of mothers who are addicted to cocaine and other drugs. The existing literature provides little guidance for meeting the needs of families in this emerging area of service provision. The authors describe a multidisciplinary approach to serving mothers who abuse cocaine, with the goal of providing a model for development of services for this population of high-risk parents and their vulnerable children. An overview of the problem of cocaine use by pregnant women is provided, followed by a detailed description of the specific services included in a hospital-based intervention program.

Quality of care of the terminally ill: the carer's perspective

The experience and opinions of carers of 106 patients dying of cancer in Pontefract Health District were obtained by semistructured interview approximately six months after bereavement. A balanced population of patients who had died either at home or in hospital was selected by quota sampling. The interview investigated the perceived quality of key areas of care and also collected carers' spontaneous comments about the service. These comments were grouped into the following categories related to dimensions of satisfaction with health care: organization of care; interpersonal relationships with health care professionals; communication of information; and the hotel services and environment in hospital. A total of 106 carers, 63% of those contacted, were interviewed and there was no significant difference in response rate between patient categories. Despite general satisfaction with medical treatment, 65% of carers cited inadequate control of symptoms; 58% of patients had not applied for any financial benefits, despite almost universal eligibility. Nearly 60% of patients had died in hospital, but a carer was present at the time of death in only 40% of these cases. Over half the carers had received no support since bereavement. Spontaneous comments about palliative care and relationships with staff were generally favourable, but were highly critical of communication with professionals and of the organization of care, although no carer had lodged any formal complaint. A smaller, local hospital was preferred to the district general hospital. It is concluded that informal carers provide a perspective on the quality of palliative care which complements that of health professionals. Methods of gathering carers' views which do not restrict comment to those areas perceived as important by health professionals should be an integral component of the monitoring and evaluation of all services involved in the provision of palliative care. The results of this study have already proved highly influential in directing the attention of the health authority to areas of service provision where deficiencies had not previously been recognized.