Voluntary Care Research Articles

Healthcare Barriers, Health Outcomes, and Annual Health Checks for Autistic Adults: A Cross-Sectional Study of General Practitioners’ Knowledge, Attitudes and Practices

Various physical conditions appear with greater frequency in autistic individuals in comparison to non-autistic people and can lead to higher morbidity, lower quality of life, and lower life expectancy. A voluntary primary care annual health check (AHC) scheme is in place in the UK for patients with intellectual disabilities (ID), some of whom will also be autistic. We report the results of a study involving an online questionnaire disseminated via Twitter to investigate knowledge, attitudes, and practices of UK General Practitioners (GPs) concerning barriers and enablers to autistic adults accessing primary healthcare services. Amongst other matters, we found that (1) autistic people who are independent for the most part face the greatest struggles accessing primary healthcare, and (2) advocates of AHCs for autistic adults face the twin challenges of convincing extremely busy GPs to prioritise AHCs, and of advocacy on behalf of people with other conditions.

Value-Based Care and Kidney Disease: Emergence and Future Opportunities.

The United States health care system has increasingly embraced value-based programs that reward improved outcomes and lower costs. Health care value, defined as quality per unit cost, was a major goal of the 2010 Patient Protection and Affordable Care Act amid high and rising US health care expenditures. Many early value-based programs were specifically designed for patients with end-stage renal disease (ESRD) and targeted toward dialysis facilities, including the ESRD Prospective Payment System, ESRD Quality Incentive Program, and ESRD Seamless Care Organizations. While a great deal of attention has been paid to these ESRD-focused programs, other value-based programs targeted toward hospitals and health systems may also affect the quality and costs of care for a broader population of patients with kidney disease. Value-based care for kidney disease is increasingly relevant in light of the Advancing American Kidney Health initiative, which introduces new value-based payment models: the mandatory ESRD Treatment Choices Model in 2021 and voluntary Kidney Care Choices Model in 2022. In this review article, we summarize the emergence and impact of value-based programs on the quality and costs of kidney care, with a focus on federal programs. Key opportunities in value-based kidney care include shifting the focus toward chronic kidney disease, enhancing population health management capabilities, improving quality measurement, and leveraging programs to advance health equity.

Discipline and Inclusively Repress: The Hybrid Governance of Housing First Tenants

ABSTRACT Housing First is a popular model of homeless services that has transformed urban governance across the globe. Scholars have praised Housing First as voluntary care or criticized it as a disciplinary intervention. Both perspectives offer a partial account of Housing First case management. I extend those studies with interview-based research that conceptualizes U.S. Housing First as a hybrid form of homeless governance that exercises control through discipline and inclusive repression. Government authorities contract Housing First providers to reduce public expenditures by rehousing chronically homeless people. Case managers make disciplinary interventions until tenants are confronted with an eviction. At that point, service providers use inclusionary repression to sustain market exchanges by selectively disenfranchising tenants and rendering them pliable to disciplinary interventions in the future. This paper advances homeless scholarship by showing how, as a publicly subsidized property management service, U.S. Housing First buttresses urban housing markets through hybrid governance.

Strategies for old age and agency of the elderly in towns of the Low Countries in the Renaissance

AbstractContrary to what is sometimes assumed, the elderly in the distant past could not always rely on voluntary care. Therefore, some of them had to develop strategies to secure assistance during old age. We focus on towns in the Low Countries, where family ties were weak, and ageing individuals likely had to plan for old age. We show how members of the middling layers of society could use wills and retirement contracts to ensure care provided by both kin and non-kin, and also to secure living standards during their final years. By recording such contracts, the elderly remained in control of their lives, despite their advancing years.

The Anesthesiologist's Perspective and Experience in Global Congenital Cardiac Surgery: Results of a Survey of the Congenital Cardiac Anesthesia Society Membership.

Anesthesiologists are important components of volunteer teams which perform congenital cardiac surgery in low-resource settings throughout the world, but limited data exist to characterize the nature and breadth of their work. A survey of Congenital Cardiac Anesthesia Society (CCAS) members was conducted with the objective of understanding the type of voluntary care being provided, its geographic reach, the frequency of volunteer activities, and factors which may encourage or limit anesthesiologists' involvement in this work. The survey was completed by 108 participants. Respondents reported a total of 115 volunteer trips during the study period, including work in 41 countries on 5 continents. Frequent motivating factors to begin volunteering included invitations from charitable groups, encouragement from senior colleagues, and direct connections to individual locations. Discouraging factors included familial responsibilities, the need to use vacation time, and a lack of support from home institutions. The year 2020 saw a marked decrease in reported volunteer activity, and respondents reported multiple pandemic-related factors which might discourage future volunteer activities. The results of this study demonstrate the global reach of anesthesiologists in providing care for children having cardiac surgery. It also offers insights into the challenges faced by interested individuals, many of which are related to a lack of institutional support. These challenges have only mounted under the COVID-pandemic, leading to a dramatic downturn in volunteer activities. Finally, the survey reinforces the need for better coordination of volunteer activities to optimize clinical impact.

Imposed volunteering: Gender and caring responsibilities during the COVID-19 lockdown

This article contributes to the sociology of care-relational justice by identifying, conceptualising and unpacking ‘imposed volunteering’ as a mechanism that shapes societal caring arrangements. Contemporary societies allocate care work disproportionately to women, ethnic minorities and working-class citizens, which exacerbates social inequalities. Distribution of caring responsibilities is a political question but often not recognised as such, because it is deeply immersed in everyday routines. Our study uses the context of the COVID-19 pandemic to dissect the distribution mechanisms that became unusually palpable when the lockdown of public welfare provision in Denmark relocated some forms of care work from professionals to volunteers. With the term imposed volunteering, we conceptualise the feeling of being coerced into taking on new caring responsibilities, which some women – and men – experienced during the lockdown. Drawing on a national, representative survey, we document that, compared to men, women carried out significantly more voluntary care work and organised voluntary work through informal personal networks rather than through formal civil society organisations to a significantly higher degree. We unpack the experience of imposed volunteering as it unfolded during the lockdown through qualitative case studies, and clarify how relational and institutional factors, such as gendered expectations and the sense of personal obligation, imposed volunteering. Our study illuminates the importance of public care, reciprocal caring relationships and care for carers, and demonstrates why the mobilisation of care work volunteers must take gendered implications into account if it is to be consistent with democratic commitments to justice, equality and freedom for all.

Animal Training, Environmental Enrichment, and Animal Welfare: A History of Behavior Analysis in Zoos

The modern zoo has been associated with two major behavioral welfare advances: (a) the use of training to increase voluntary husbandry care, and (b) the implementation of environmental enrichment to promote naturalistic behaviors. Both practices have their roots in behavior analysis, or the operant conditioning-centered, reward-based approach to behavioral psychology. Operant conditioning served as the foundation for the development of reinforcement-based training methods commonly used in zoos to make veterinary and husbandry procedures easier and safer for animals and their caregivers. Likewise, operant conditioning, with its focus on arranging environmental antecedents and consequences to change behavior, also provided a framework for successful environmental enrichment practices. In this paper, we outline the key individuals and events that shaped two of the cornerstones of the modern zoo: (1) the emergence of reward-based husbandry training practices, and (2) the engineering of environmental enrichment. In addition, we (3) suggest ways in which behavior analysis can continue to advance zoo welfare by (i) expanding the efficacy of environmental enrichment, (ii) using within-subject methodology, and (iii) improving animal-visitor interactions. Our goal is to provide a historical and contextual reference for future efforts to improve the well-being of zoo animals.

Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making.

Emergency department (ED) psychiatrists face the consequential decision to pursue involuntary inpatient psychiatric admission. Research on the relationship between patient characteristics and the decision to pursue involuntary psychiatric admission is limited. Using data from 2017 to 2018 at an urban Los Angeles hospital, we used generalized linear mixed effects models to compare patients who were involuntarily admitted to inpatient psychiatry to patients who were discharged from the ED. Of 2,448 patients included in the study, 1,217 (49.7%) were involuntarily admitted to inpatient psychiatry and 1,231 (50.3%) were discharged. After controlling for sociodemographic characteristics, admitted patients were more likely to have been brought in by police, have had an organized suicide plan or recent attempt, physical signs of harm, psychosis, depression or hopelessness, lack social support, have diagnoses of schizophrenia or bipolar disorder, and be administered injectable psychotropic medications. Stimulant use, a diagnosis of anxiety or developmental disorders, and recent medical ED utilization were associated with discharge. Psychiatrists pursued involuntarily psychiatric hospitalization based on factors potentially indicative of dangerousness, leaving patients, particularly those with recent substance use, without immediate access to treatment. Policies should focus on increasing follow up to high quality, voluntary outpatient mental health care.

'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study.

Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.

Business entity model development in the market-driven health sector

The business entity model development in the market-driven health sector must be carried out on a condition that the poor and other need a help are guaranteed the health service access. In this case, the Social Safety Net (JPS) concept is known. In addition, a lot of experts argue, including Anthony Culyer from the University of York stating that various public services in health services are still obliged to be provided by the government that determining the fair budget distribution. The financing system for the poor must still be maintained through various mechanisms, for example by: (1) the government subsidy through the central tax mechanism, local revenue, foreign assistance; or (2) from humanity fund. In order to develop a fund source for health services that lead to the mutual cooperation principle, the capable central or regional government can enact the regulations that order the community having a health service assurance. The health assurance membership is a mandatory, because the Indonesian culture is still unfamiliar with the disease risk management. Currently, the voluntary health assurance and Community Health Care (JPKM) entity tend to experience difficulties developing widely, especially in operating the low-income segment.

Voluntary support in a post-welfare state: Experiences and challenges of precarity

This paper examines voluntary sector care and support provision under a context of significantly reduced government funding. Whilst geographers have analysed the causes and aftermath ofausterity on different populations, our focus is on how managers of voluntary sector organisations have had to learn and evolve through bidding for non-statutory funding to sustain their core provision. Drawing on research with voluntary support organisations in the learning disability social care sector in England and Scotland, the paper examines the effects of the state’s continued reliance on the sector for core ‘public’ services whilst simultaneously withdrawing its funding. Using accounts from managers, the paper offers a particularly novel and potent example of voluntary sector precarity and the deepening unfinished and unsettled nature of care and support that has unfolded in the wake of austerity. Through the empirical research, attention is drawn to three levels of precarity that are experienced by those seeking to sustain voluntary support provision: voluntary sector organisation and structures, the voluntary sector workforce, and individual managers’ everyday emotional and affective experiences.

Punishment, support, or discipline? Taking stock of recent debates about homeless governance in neoliberal cities

AbstractAn interdisciplinary debate emerged in the 1990s about the nature of homeless governance in neoliberal cities. Contributions to this discussion have interrogated the form, function, and legitimacy of contemporary homeless management. Urban scholars have differentiated three techniques of homeless governance: punishment, support, and discipline. A subset of scholarship has defined punitive governance as an illegitimate act of repression that promotes urban revitalization by excluding the homeless from urban political economies, supportive governance as a legitimate act of voluntary or coercive care that helps the homeless survive a traumatic life experience, and disciplinary governance as an illegitimate act of production that fortifies urban political economies by including rather than excluding homeless individuals into bourgeois institutions. An emerging body of research demonstrates frontline workers coordinate these techniques of governance to pursue the aims of institutional elites. This article outlines the main points of contention in this debate, examines significant empirical findings that scholars have reported, and identifies salient knowledge gaps to be addressed in future research.

Construction of Ideal Remote Assessment Environments and the Impact of Self-Selected Music on Student Performance.

Remote online assessments require students to construct their own assessment environments, including selection of strategies (such as the use of music) to reduce stress. This study aimed to determine the impact of self-selected music on student performance during a remote online assessment and to identify factors important for constructing ideal assessment environments. Final year students were randomized to complete a voluntary remote online 2-hour care plan test. Those randomized to 'music' were required to play self-selected music during the assessment and those randomized to 'non-music' were asked not to play music. Prior to the assessment, perceived stress and resilience were measured. Performance between groups was compared and associations between stress, resilience, and performance determined. A post-survey identified music preferences/acceptability, and factors identified for ideal remote assessment environments. A total of 79 students completed the study (n=40 music, n=39 non-music). The median assessment score in the music group was 90% (range 58 to 99%) and 88% (range 58 to 99%) in the non-music group (not significant). No associations were found between scores and perceived stress or resilience. The majority of students randomized to music (62.5%) found it helpful. Thirteen categories of factors were identified to contribute to an ideal remote assessment environment with the most common being lighting, location, quietness, distractions, and seating/set-up. Findings support the notion that remote online assessment environments should not come as 'one size fits all' and many factors (including self-selected music) may influence a student's ability to perform to a high standard.

Long-Term Care Insurance Reform in Singapore

ABSTRACT In recent years, governments in rapidly aging countries have looked toward the implementation of public insurance schemes to help cover the costs of care for their aging citizenry. This article presents a comprehensive overview of long-term care insurance policy in Singapore. We discuss the successes and challenges of nearly two decades (2002–2019) of policy experimentation with a voluntary long-term care insurance scheme, which was replaced by mandatory social insurance in the 2019 reform. Various aspects of the new scheme, including mode of financing, eligibility criteria, benefit design, and potential impacts are assessed. The article concludes that, in the inherent tension between the breadth and depth of public long-term care social insurance coverage, Singapore has opted for breadth at the expense of depth.

The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders.

In the Canadian Province of British Columbia (BC), the BC Mental Health Act permits involuntary care for treating mental disorders. However, the Act has also been applied to provide involuntary care to individuals with a primary substance use disorder, in the absence of specific guidelines and legislation, and with insufficient understanding of perspectives of people who use drugs (PWUD) regarding this approach. As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory. Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks. Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.

Cognitive abilities and long-term care insurance: evidence from European data

Long-term care (LTC) is one of the largest financial risks faced by the elderly. Yet, it remains largely uninsured. This paper explores the relationship between cognitive abilities and private voluntary or supplementary long-term care insurance (LTCI) ownership as another possible factor contributing to the small size of the market. We used data from a European panel survey, which collects detailed information on both private insurance coverage and three indicators of cognitive abilities: numeracy, verbal fluency and memory skills. We find that memory, but not numeracy or verbal fluency, has a positive and statistically significant effect on the probability of owning private LTCI above and beyond other characteristics such as general education, family, risk factors, income and wealth. Fixed effects estimates show that a one-standard deviation increase in the recall measure score is associated with a 0.5 percentage point increase in the probability of holding insurance for the baseline sample and a 1 percentage point increase among the younger cohort. The findings suggest that cognitive limitations in LTCI decision-making are likely to be linked to information processing skills and can be an important factor affecting the expansion of the market that need to be taken into consideration in policy design.

Making a difference: workforce skills and capacity for integrated care

PurposeThe aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.Design/methodology/approachSemi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.FindingsAnalysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.Research limitations/implicationsThis study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.Practical implicationsMany of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.Social implicationsThis study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.Originality/valueThis paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

The rights of the child in voluntary care in Ireland: A call for reform in law, policy and practice

Voluntary care agreements form a significant part of child protection systems in many jurisdictions. From a children’s rights perspective, they enjoy numerous advantages over court-ordered removals of children. However, when loosely regulated, voluntary care agreements can give rise to significant concerns in respect of compliance with international children’s rights law. This paper will present findings from the Voluntary Care in Ireland Study, one of the first in-depth empirical examinations internationally of voluntary care agreements. It will present qualitative data on the system in operation in Ireland that indicates that voluntary care agreements are less adversarial, time-consuming and costly than court proceedings. This frees up resources for early intervention and facilitates a more collaborative relationship between parents and social services, making it more likely that children will remain at home or eventually return home from care. At the same time, the findings suggest that the voluntary care system currently operated in Ireland suffer from numerous flaws, including absence of independent oversight; unlimited duration; potential instability (since parents can withdraw consent at any time); weak mechanisms for child participation; and inferior resource allocation compared to court-ordered care placements. The paper examines legislative provisions from a number of comparable jurisdictions and makes recommendations designed to ensure that the voluntary care system in Ireland complies more strongly with principles of international children’s rights law.

Lay Voluntary Doula Caring for the Childbearing Woman and Her Partner

This study describes and illuminates voluntary lay doula caring during childbearing for the woman and her partner. The theoretical perspective is based on Eriksson's theory of caritative caring. Latent qualitative content analysis was chosen using semistructured interviews with a purposive sample of nine voluntary unpaid lay doulas in a Nordic nongovernmental organization. Caring as incubating, messaging, alleviating, and enabling offers a new understanding of doula care as tailored continuous caring to benefit the birth experience of both parents. This core of caring might also provide a mutual basis for collaboration between voluntary doula care and professional midwifery care.

‘Private Family Arrangements’ for Children in Ireland: The Informal Grey Space In-Between State Care and the Family Home

Abstract The literature on alternative care focuses overwhelmingly on formal, court-ordered placements; voluntary care placements are discussed less frequently. Least attention of all has been given to informal kinship care placements, where a child is cared for by relatives but is not formally in the legal care of state authorities. In Ireland, these placements, when facilitated by state authorities in lieu of a care order or voluntary care agreement, are known by professionals as ‘private family arrangements’. This article explores evidence which shows that the use of such arrangements is motivated partly by a concern for subsidiarity, and partly by necessity: they provide a source of placements in cases where regulatory requirements and a lack of resources would otherwise make the placement challenging or impossible. However, this strategy carries significant risks. Private family arrangements receive less support and oversight from state authorities than formal care placements, and family members providing care under this model have no legal rights or responsibilities in respect of the child(ren). This places the child(ren) in a precarious position and raises concerns regarding a lack of equity of care. The article will illustrate the impact of these concerns and make recommendations for reform.