Frontline Organizations Research Articles

Banging My Head Against a Brick Wall! Enablers and Barriers to Nurse Practitioners Delivering Opioid Agonist Treatments in Regional/Rural Victoria, Australia.

The Victorian government's Alcohol and other drugs (AOD) workforce policy calls for greater recruitment of alcohol and other drugs nurse practitioners (AODNPs). However, frontline organisations in Victoria report several systemic barriers to their recruitment and retention. Additionally, there is scant Australian literature that examines the experiences of AODNP in opioid agonist treatment (OAT) provision in regional/rural areas. This research aims to address this gap by examining the AODNP workforce issues in delivering pharmacotherapy treatments in regional/rural areas of Victoria. Using an interpretative phenomenological approach, we conducted qualitative, in-depth interviews with 11 OAT prescribing AODNP's working in regional or rural Victoria. We analysed transcripts using reflective thematic analysis and generated three themes: (1) Professional motivations and values, (2) Enablers to professional role and (3) Barriers to professional role. The findings suggest that AODNPs in regional/rural areas are a dedicated workforce who provide holistic and integrated care for OAT clients. AODNPs play an important role in reducing and providing timely and subsidised health care for OAT clients living in regional/rural locations. AODNPs face many systemic and organisational barriers. These include inadequate funding for AODNP positions to prescribe pharmacotherapy treatments, lack of understanding of the AODNP professional role at the executive/management level within organisations and irregular access to supervision, mentoring, training and education. Also, endemic stigma in the health system acts as a barrier in recruiting and supporting AODNP positions that focus on care for OAT clients.

Digitally enabled business models for a circular plastic economy in Africa

In recognition of the need for an economic logic that complements and reinforces the ecological imperative for the circular plastic economy, this paper explores the importance and impact of digitally enabled circular plastic business models across retailing and distribution systems. The paper draws from 16 focus group discussions, complemented by 17 semi-structured interviews of frontline organisations incorporating digital innovations in their businesses to enable the management of plastic waste in Africa. The study finds that, across African countries, the transition to a circular plastic economy has been hampered by the limited uptake of circular products by consumers. In order to accelerate the transition, innovative business models are required to invigorate the ecosystem and simplify the logistics of retailing and distribution systems. The paper proposes a new conceptual framework that explicates the impact of digital innovations in the processes of value creation and value capture across a whole spectrum of circular economy reverse logistics activities: recycling, redistribution, and remanufacture. The study also highlights two important social and policy implications of digitally-enabled circular business models: Firstly, the creation of new employment opportunities through the empowerment of a new labour force for the circular plastic economy; secondly, the heightened opportunity to enact an innovative sharing economy in typically resource-constrained contexts in which otherwise idle products and resources are more efficiently used in a process of collaborative consumption.

Harm reduction workforce, behavioral health, and service delivery in the USA: a cross-sectional study

BackgroundDespite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker?MethodsPurposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis.ResultsData from 41 states and Washington, D.C. were collected (N = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included.ConclusionsThe composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.

'Good morning Metro shoppers!' Food insecurity, COVID-19 and the emergence of roll-call neoliberalism.

From April 2020 to December 2021, the Canadian federal government earmarked $330,000,000 through the Emergency Food Security Fund to address food insecurity during the COVID-19 global pandemic. These funds were disbursed through a handful of national and regional emergency food and food justice agencies to smaller front-line organizations for the purchase of emergency food provisions and personal protective equipment, and to hire additional workers. We theorize these dynamics within the broader processes of neoliberalization and argue that the Canadian federal government was conscripting food justice and community development organizations into its efforts to address dramatically increasing rates of food insecurity across the country through charity emergency food provisioning. Within Peck and Tickell's stylized conceptions of the destructive (roll-back) and creative (roll-out) moments of the process of neoliberalization, we frame the crisis of COVID-19 as exposing a form of recalibration (roll-call) neoliberalism. We focus on this dynamic specifically within the context of household food insecurity in Canadian communities and argue that the federal government's funding regime during the global pandemic effectively directed food justice organizations (and by extension, the populace in general) away from a more ambitious social change agenda towards the more acceptable strategy (in neoliberal terms) of emergency food provisioning services.

Frontline organizations as experimental settings for policy change: why public management matters even more

ABSTRACT Termed here as Street-Level Policy Innovation, this study shifts attention to public managers’ role in policy change processes during which local street-level implementation adaptations are later formally adopted as a new policy instrument. The study develops an analytical framework drawing on the case of the Free Sidewalk program in Mexico. In summary three processes emerge such as the re-design of implementation arrangements, the accumulation of evidence, and the adoption of the experimented instrument as a formal policy change. The article contributes to understanding the role of frontline organizations as settings where managers explore, experience, and experiment with new policy instruments.

On the Front Lines: Nonprofits in the Homeless-serving Sector During the COVID-19 Pandemic

This article examines the experiences of the nonprofit, homeless-serving sector during the first wave of the COVID-19 pandemic. Qualitative interviews were conducted with staff and volunteers from frontline organizations in the two largest communities in Nova Scotia, Canada. Participants reported much strain on their organizations' human resources, but also the ability to adjust service delivery mechanisms quickly in order to continue offering supports. Most reported greater in-kind contributions from businesses and community members as well as more funding from the federal government in particular, albeit with administrative burdens and defined timelines. Nonprofits played a leadership role in developing responses to serve the needs of those experiencing homelessness, including developing comfort centres, installing portable toilets in downtown locations, and moving those without housing into hotels. They also advocated to government for state-level responses to those without housing, including calls to invest in new units and enhance funding for frontline service providers. At the same time, nonprofits reported working across sectors, noting better communication and relationships with state actors as well as other nonprofit organizations as a result of their COVID-19 response.

Evidence-based activation work and service individualisation: client and frontline worker experiences with a standardised intervention

ABSTRACT Evidence-based interventions standardise frontline social services, but may also promote policy ideals like service individualisation and client involvement. This article examines how clients and frontline workers experience activities within an evidence-based intervention known as Individual Placement and Support (IPS) in the Norwegian Labour and Welfare Administration. The article draws on interviews and fieldwork conducted in one frontline office from 2017 to 2019. The findings show how clients developed relationships with frontline workers, were given time to follow individual trajectories and received tailored support when facing challenges. Intervention activities were characterised by flexibility, a relational approach to clients and detachment from normal organisational procedures. The findings illustrate how evidence-based interventions can enable service individualisation in frontline organisations, but also indicate a need for additional professional resources due to the complexity of the work.

Alternate delivery platforms and implementation models for bringing evidence-based behavioral interventions to scale for youth facing adversity: a case study in West Africa

BackgroundYouth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone.MethodsA case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth entrepreneurship programs (ENTR) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, 8 weeks of supervision notes, 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery platform. Quantitative dissemination and implementation interviews administered to youth, facilitators, and agency leaders were analyzed using descriptive statistics and mixed linear models. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform.ResultsExtant data indicate the strong feasibility and acceptability of integrating the YRI into the ENTR program. Facilitators of integration of the YRI into the ENTR include mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions, and challenges in flexibility between donors and implementation partners operating in a fragile/post-conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI.ConclusionsYouth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions to youth in fragile and post-conflict settings. Quality improvement and sustainment of evidence-based interventions are novel concepts in such settings. The CTA strategy institutionalizes the integration of an evidence-based intervention into youth entrepreneurship programs.Trial registrationNCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).

Handling Tensions in Frontline Policy Implementation: Legitimating, Interpreting, and Shielding a Disruptive Intervention

ABSTRACT Policy implementation in public frontline service organizations is characterized by tensions between old and new institutional configurations. This study explores how frontline supervisors handled tensions when implementing a disruptive activation service intervention in local Norwegian Labor and Welfare Administration agencies. The empirical analysis is based on in-depth interviews and ethnographic fieldwork in two frontline organizations from 2017 to 2018. The study identifies three main strategies that supervisors enacted to handle tensions surrounding the intervention: legitimating, interpreting, and shielding. The findings highlight the specific activities through which frontline supervisors contribute to policymaking in the frontline.

From “what works” to “making it work”: A practice perspective on evidence‐based standardization in frontline service organizations

AbstractEvidence‐based standards are becoming increasingly influential in frontline services connected to labor market inclusion of vulnerable citizens. To increase our understanding of standardization in such public service delivery, this study draws on interviews and ethnographic fieldwork from two frontline offices in the Norwegian Labour and Welfare Administration (2017–2018) that use the evidence‐based Individual Placement and Support (IPS) standard. Adopting a theoretical perspective of organizational practices, the study highlights two distinct approaches to practicing IPS in the frontline organizations: as a “practice shift” in one organization (i.e., creating and legitimizing radically new service practices involving closer collaboration with employers) and as a “practice revival” in the other (i.e., reinstating more traditional service practices involving a holistic client orientation). Each approach relates to a specific constellation of recruitment practices, dynamics between frontline supervisors and staff, and team integration. The study contributes to the literature in two ways. First, it shows the underlying flexibility embedded in standardization and how standards may be implemented and adapted in ways that may either promote more radical change or revive traditional practices. Second, it nuances positions in the literature on the impact of standards on professional service work. On this basis, the study suggests broadening the attention in research on evidence‐based standards in public service delivery from discussions of “what works” to understanding the broader organizational dynamics involved in “making it work.”

Deliberation and Deliberative Organizational Routines in Frontline Decision-Making

AbstractDeliberation is a widely recognized but understudied aspect of frontline decision-making. This study contributes to theory development by exploring deliberative practices in frontline organizations and their implications for decision-making. Drawing on a multi-sited ethnographic study in three Danish child welfare agencies, the analysis clarifies the multiple purposes of deliberation in everyday practice and shows how deliberation is enabled and structured by formalized and informal deliberative organizational routines. Findings show that deliberation may influence individual decision-making or amount to collective decision-making. Depending on how deliberative organizational routines are enacted, deliberation may serve to enhance professional judgment, ensure appropriate justification for decisions, and alleviate uncertainty and emotional strain. Yet, while deliberation represents a productive form of collective coping, deliberative routines may also obscure transparency and reify dysfunctional group dynamics. A conceptual framework is developed to support further research into the purposes, practices, and implications of deliberation across diverse street-level contexts.

Dealing with disgust: Street-level bureaucrats as agents of Kafkaesque bureaucracy

Bureaucracy is deeply implicated in the biopolitical regimes that create and render invisible social waste—individuals classified as abnormal, deviant, or useless—in contemporary societies. According to previous theorists, bureaucracy is able to carry out this critical task through moral distance and reliance on technical efficiency. By specifically focusing on street-level bureaucrats, a unique tier of bureaucracy which is often afforded neither moral distance nor clear directions, this article explains the microprocesses of classification, managing and recycling through which social waste management is carried out in contemporary society. In doing so, this article highlights that in addition to official policies, informal factors like social, organizational, and group norms are critical determinants of bureaucratic behavior in front-line organizations and problematize some of the key assumptions of Weberian bureaucracy. Unlike functional interpretations, we argue that, in some instances, the informal factors influencing street-level bureaucrats are more regressive than official public policies and help explain some of the dystopian features of contemporary bureaucracy and its impact on social inequity.

From Street-level to Cyborg Bureaucrats: Theory and Evidence on Socio-materiality in Public Administration

Despite the ever-increasing role of technology in governance, public administration research continues to treat technology as a passive object. The ability of technology to organize human agencies has so far not been explored in depth. To address this important gap, this article analyzes the role played by technologies of vision in mediating the citizen-state relationship through a socio-material analysis of an illustrative case. Specifically, this article illustrates how the production of legal IDs in frontline organizations involve multiple socio-material practices enacted by cyborg (human-machine hybrids) bureaucrats and their clients. The findings illustrate that instead of being treated as either street-level or screen-level bureaucrats, contemporary frontline workers should best be conceptualized as cyborgs whose decision making is entangled with material conditions of their intra-action with citizens. This research has important implications for study of bureaucratic behavior and provides a theoretical template for future studies on socio-materiality of contemporary public administration.

‘Downpressor man’: securitisation, safeguarding and social work

The Counter Terrorism and Security Act came into force in July 2015 in the UK. This places a statutory duty on many front-line organisations, for example, schools, social services and prisons, to work within the PREVENT agenda, a policy arising from Britain’s overall counterterrorism policy, CONTEST. We argue that PREVENT is representative of increasingly securitised social policies that serve to: first, view people within particular individualised neoliberal discourses and thin narratives; and, second, coerce the profession of social work into hitherto unknown areas, namely, national security and counterterrorism. We note the unapologetic linkage of traditional forms of what we term here ‘welfare safeguarding’, customarily the domain of social work, with what we term ‘security safeguarding’. If the profession of social work in the UK, and we suspect other Western regimes, wishes to avoid becoming a profession of ‘downpressor men’, the uncritical incursion into issues of national security and counterterrorism must be highlighted.

Vaccination guideline for Immigrant in Korea by Korean Society of Infectious Diseases.

Korea's immigrant population has been rapidly increasing because of economic growth, government policies designed to attract foreigners, and a decline in industrial populations resulting from changing national attitudes. In 2013, the number of foreigners in Korea, including ex-patriots, was approximately 1,576,000, exceeding 3% of the total population for the first time [1]. The majority of foreign-born individuals living in Korea were from Asia, primarily China (49.4%), followed by the United States (8.5%), Vietnam (7.6%), Japan (3.6%), and the Philippines (3.0%). However, the domiciles of foreign-born individuals are expanding to include Africa and other parts of the world [1]. At the same time, the number of overseas students attending Korean universities increased from 49,000 in 2007 to 86,000 in 2013, with students entering the country from various regions, including China (58.6%), Japan (5.1%), Mongolia (4.5%), Vietnam (3.5%), the United States (3.1%), and Taiwan (2.0%) [2]. These changes are closely related to the spread of infectious diseases. In 2014, a measles outbreak in Asian countries such as the Philippines and Vietnam spread primarily to schools in Korea, a country that had previously eradicated measles [3]. Vaccination of the immigrant population is therefore an important issue for the health of both foreigners living in this country and Korean people. Infectious diseases, vaccination rates, and mandatory childhood vaccination schedules vary by country. Difference in the seroprevalence of vaccine preventable diseases and the nationality of foreigners residing domestically must be considered when developing vaccination recommendation. Some Western countries have developed vaccination programs and recommendations for their immigrant population. However, Korea had not yet developed such vaccination recommendations, which has caused difficulties for front-line organizations responsible for vaccinations. The Committee of Adult Immunization of the Korean Society of Infectious Diseases (KSID) recognized the necessity of vaccination recommendations for adult immigrants to respond to the changing domestic environment. After forming a team of experts and gathering data through a literature review, we developed vaccination recommendations based on the current situation in Korea. Unlike developed countries with sufficient statistical data to inform public health policies and mandatory childhood vaccination programs, less developed and developing countries have little or no data regarding disease statistics, childhood vaccination policies, or population immunity. We emphasize the difficulties in developing accurate and objective recommendations because of these data limitations. Our recommendations were developed by selecting infectious diseases with high morbidity in immigrant populations living in Korea for at least 3 months (depending on the vaccine, these recommendations may be applied for stays of less than 2 months).

Organizational reform in a hierarchical frontline organization

Purpose– The purpose of this paper is to track changes in organizational and occupational stress in the Finnish police force during the police reform years. It also estimates the effects of organizational stressors on labor turnover intention (LTI).Design/methodology/approach– The study is based on six distinct cross-sectional Police Personnel Surveys from 1999 to 2012. The surveys are not sample based, but have targeted the entire police force with good response rates. The study employs hierarchical logit models to predict LTI.Findings– Police agencies can be depicted as hierarchical frontline organizations. Major reforms in such agencies can be expected to give rise to increased organizational conflicts and stress. The empirical findings of the paper fall in line with the theory. Organizational stress and LTI have been increasing in the Finnish police force during the police reform years. However, at the same time, personal and occupational stressors have actually been reducing in the police force. Turnover intention was observed to be a positive function of those particular organizational stressors that have increased the most over the reform years.Research limitations/implications– The data are cross-sectional. No direct causal conclusions can be drawn from the results of this study. A non-material violation of the linearity assumption was detected in two logit models.Originality/value– Relying on Tops and Spelier's 2013 theory of police organizations as frontline organizations, the paper introduces a new theoretical construct – hierarchical frontline organization – and combines its theoretical ideas with comprehensive long-term data from the Finnish police force.

Do NHS services have to be provided by the NHS?

After 18 months of political trench warfare over the health bill, the Westminster bandwagon is moving on. However, for the NHS, this is the beginning not the end. Leaders in the NHS need to make sense of the hand they have been dealt and start turning the Health and Social Care Act 2012 into a workable system that delivers better care for patients. At times like these, it is useful to look back on the past decade or so of policy-making in healthcare – in the NHS and further afield. A constant issue that governments have faced has been finding a balance between centralisation and localism. Advocates of centralism stress and place value on ‘the need to standardise’ and emphasise ‘equitable access’. Meanwhile, advocates of localism prize the importance of ‘clinical freedom’ and ‘encouraging innovation’. Behind such ideas lies a recurrent, fundamental and often unhelpfully polemical debate about the best way to ensure that equitable, high-quality healthcare is available to all of a country’s citizens rather than an elite few, with no wide gulf in citizens’ quality of care. It is therefore well worth reflecting on the way policy makers and senior leaders in the UK have responded to the question over the past 15 years to see what that tells us about the future. To begin, one should recognise the ideological factors in play; for example, people in the UK fundamentally believe that access to healthcare is a universal right and have strongly supported this principle since the inception of the NHS. However, in recent years, the policy development of using choice and competition to move from a universally available, average system to a higher quality, more-personalised and individually tailored system has begun to challenge these fundamental assumptions. In light of this, the issue of centralism versus localism has often and misleadingly equated the centralist view with a predominant desire for equity, while the non-centralist view has been equated to a less-managed, deregulated world in which a market philosophy sits more comfortably. This has led to decentralisation policy becoming a political question and, unhelpfully, has turned what should have been an evidence-based debate about policy into a hotly contested political debate. In 1997, the incoming Labour government did not hesitate to declare its preference on the spectrum, moving immediately to centralise and standardise the offer for patients. It abolished the previous Conservative government’s flagship GP fundholding programme, which was perceived to be highly partial and, after eight rounds of applications, had only just managed to cover more than 50% of the nation. The Labour government put in place primary care trusts to commission services with universal coverage, the National Institute for Health and Clinical Excellence (NICE) to standardise decision making on treatment, and performance-managed national targets. Interestingly, there was an opportunity to decentralise in 2000 when the Labour government set out the NHS plan – a ‘national framework within which they could have encouraged local freedom’ – and backed this with a huge increase in resources. However, the desire of ministers to account for the use of these resources to improve waiting times led to centralised performance management – not empowerment of frontline organisations. In their defence, policy makers of that time might point to the creation of foundation trusts, arguing that the decentralisation of power was focused on provider side policy rather than commissioning. However, many – including some former ministers – would say that the aspirations to liberate foundation trusts to act as real local agents were frustrated – first by political concessions and then by an overzealous regulatory regime. To this day, many foundation trusts question the notion of having thousands of members as part of their governance arrangements. A second big opportunity for decentralisation came three or four years later. The NHS was performing well against central targets, with dramatic reductions in waiting times across the country, new money was coming on stream and understanding

Prepared to react? Assessing the functional capacity of the primary health care system in rural Orissa, India to respond to the devastating flood of September 2008

BackgroundEarly detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary.ObjectiveThe objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008.MethodsAn onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units) of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA® 10.ResultsData from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods.ConclusionThe 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness planning. Additionally each facility should maintain contingency funds for emergency response along with local vendor agreements to ensure stock supplies during floods. The facilities should ensure that baseline public health standards for health care delivery identified by the Government are met in non-flood periods in order to improve the response during floods. Building strong public primary health care systems is a development challenge. The recovery phases of disasters should be seen as an opportunity to expand and improve services and facilities.

Housing and Disabled Children: The Art of the Possible

Children, Youth and Environments Vol. 15 No. 1 (2005) ISSN: 1546-2250 Housing and Disabled Children: The Art of the Possible Bevan, Mark A. (2002). Policy Press, London; 26 pages. $17.95. ISBN 1861344643. The study of the housing needs of disabled children is a muchneglected topic by both housing practitioners and academics. This makes Mark Bevan’s interesting and informative report, funded by the Joseph Rowntree Foundation (JRF), a welcome addition to a small but growing area of research and scholarship. Bevan’s objective is to highlight the different ways in which the housing needs of disabled children and their families are addressed by particular individuals and agencies in positive and beneficial ways in the UK. The report begins by outlining the broader issues relating to meeting the needs of disabled children in the home environment. As Bevan suggests, a fundamental problem in trying to address the housing needs of disabled children “is the lack of sufficient focus on this group within current legislation” (p. 1). This, for Bevan, is compounded by the disabling nature of much domestic design that limits children’s ease of use of domestic spaces. Drawing on previous research, Bevan notes that the housing needs of disabled children are often not met by welfare and other agencies due to a lack of money, lack of awareness and service fragmentation. A key problem for families with a disabled child, as the report highlights, is lack of information for parents about where to get assistance to meet their housing needs. Chapter 2 describes some frontline organizations that are proactive in their transparency and clarity about what services are available, and it is suggested that they operate on the principle of empowerment which is defined in the report as “families being able to make informed choices about how to deal with their needs” (p. 9). This, though, seems to be a limited definition of what empowerment is or ought to be and seems to suggest that (a) families have choices, and (b) can exercise them. However, this is not always so, and recent changes to the 417 welfare state in the UK mean that choice is often more illusory than real. Chapter 3 looks at the ways in which housing services are delivered, and highlights practices in which disabled people are seen as “the experts on their own needs” (p. 10; also, see Allen et al. 2002). It describes various ways in which housing can be adapted and highlights the need for disabled children to have access to play facilities. However, the delivery of good environments for disabled children requires multiple agencies to work together but, in Chapter 4, Bevan notes that a key problem is severe fragmentation of service provision for families with a disabled child. For Bevan, an important task is to ensure that agencies have a common understanding of the extent and range of unmet housing need in relation to disabled children and their families. He also suggests that different agencies should develop specific joint arrangements, such as pooled budgets, that could be utilized to meet housing needs. While such observations are timely and appropriate, a broader discussion of ideas relating to children, disability, and housing would have been useful. I also felt that much of the material was a regurgitation of already well-known relationships between disabled children, their families, and service providers. I was surprised that there was no reference to, or discussion of, the JRF report by Allen et al. (2002) on disabled children and housing environments in which the authors show how children have potential to develop coping strategies or means to overcome disabling barriers in the home environment. This work is interesting because it challenges conventional views that disabled children are passive or, in Allen’s (2000) terms, “physiological dopes,” without capacities to transform aspects of their lives. This suggests that service users have much to learn from listening closely to disabled children about what they think of their environment and how they use it and adapt it to meet their own needs. Bevan refers to the term “empowerment” but not in relation to children themselves. I was struck that the examples of good practice that he provided did not...

¿Quién se opone a la prevención? Un mapa de los actores pro tabaco en España

ObjectivesFor a comprehensive approach to policies on smoking, the map of actors related to tobacco and their political ties needs to be identified. The present article constitutes the first attempt at this task in Spain. MethodologyAnalysis of the press, industry publications, and interviews with key people. Active actors favoring smoking in Spain were identified and classified according to their characteristics, the sphere in which they act, and their preferred territorial arena. ResultsWe identified tobacco companies (Altadis and Philip Morris dominate the market), tobacco trade organizations (tobacconists), front-line organizations created by the tobacco industry (The Smokers for Tolerance Club), organizations of tobacco growers, and processing companies. Distribution to retailers is dominated by Logista, owned by Altadis. Other sectors to take into account are vending companies and those manufacturing related products (cigarette paper, matches or lighters). The contacts of these actors with the public administration are reviewed, notable among which are the role of the Commissioner for the Tobacco Market, the Ministry of Agriculture, the Ministry of Finance and the Ministry of the Economy. Ties were also found with employers’ organizations, some political parties, and unions, as well as with other sectors with social influence such as the media and advertising sectors. ConclusionsThe map of actors favoring smoking in Spain is complex and goes beyond the confines of the tobacco industry. Understanding this web is crucial to promoting comprehensive prevention policies.