Vulnerable Members Of Community Research Articles

Building evaluation capacity in micro community organisations—more burden than benefit?

Building evaluation capacity in community organisations is promoted as a key means of creating an evaluation culture that will reorient organisations towards identifying and measuring outcomes, demonstrating achievements and enhancing accountability. Building evaluation capacity presents a number of challenges for micro-organisations, including limited resources for evaluation, a low existing evaluation skills base, and, an organisational culture and practice that does not align well with evaluation tools and techniques typically used to demonstrate program outcomes. The implementation of the Thriving Communities Healthy Families pilot project in Tasmania, a place-based health promotion intervention delivered through Neighbourhood Houses (NH), included an evaluation capacity building (ECB) component. The pilot project is used in this article as a case study to illustrate the tensions that arose for community development workers in the NH as they implemented a new program, and contended with the demands of developing their evaluation capacity. We found that while community development workers value evaluation and the importance of demonstrating program outcomes, the model of building evaluation capacity of the workers themselves was burdensome. Further, some workers perceived that evaluation activities impacted negatively on their primary role of supporting vulnerable community members. We conclude that, in very small community sector organisations, ECB requires an ongoing mentoring/relationship-building approach, rather than a traditional training approach. This has implications for how to fund ECB and raises questions on where best to focus ECB in these micro-organisations.

Implications of the 2011 Great East Japan Tsunami on sea defence design

After the 2004 Boxing Day tsunami, much of the world's effort to defend against tsunami concentrated on tsunami warning and evacuation. The 2011 Great East Japan Earthquake and Tsunami led to direct and indirect losses as well as the deaths of many vulnerable members of Japan's coastal communities. This event has resulted in Japan rethinking and revising its design codes for sea defence structures. The new guidance emerging from this process is a valuable resource for other countries re-evaluating their own current mitigation strategies and this paper presents details of this process. The paper starts with the history of sea defence design standards in Japan and explains the process of revision of design guidelines since 2011. Examples of sea defences that failed and have since been rebuilt, observed during the two Earthquake Engineering Field Investigation Team (EEFIT) missions of 2011 and 2013, are also presented. The paper concludes with a discussion of international approaches and their application to nuclear power stations in Japan and the UK.

Recovery oriented consumer focused practice: Emerging critical success factors in establishing a culture of collaboration to support our most vulnerable community members

Introduction: Consumer focused integrated care requires a whole of system paradigm shift for the myriad of community and government service providers that provide support to individuals who are impacted by severe and complex mental, physical and social health issues. Service providers often work in silos due to narrow and specific contractual obligations, and in competition due to ever diminishing government funding. Increasingly consumers most needing support are further marginalised, bounce between agencies and eventually disengage from a chaotic system. The Partners in Recovery (PIR) initiative provides a consumer centred, integrated, collaborative partnership approach to supporting some of our most marginalised and disadvantaged individuals in being active participants in their own recovery. PIR contracts were awarded in mid 2013 and the current funding concludes in June 2016. While PIR is still in its infancy, ConNetica is providing support to 7 PIR projects across Australia as either a local evaluation coordinator or expert adviser. This has enabled the collation of qualitative and quantitative data with identified critical success factors and key findings related to service collaboration, integration and recovery oriented practices. Description of practice and context: The PIR process supports individuals who have persistent and complex needs that are not being met through the traditional fragmented service provider structure. PIR places the individual consumer, with support from their families and carers, at the centre of a holistic, individualised and flexible process focused on maximizing recovery with the consumer actively participating in the development of their recovery plan. The positive impact of flexible funding available to meet the immediate and personal needs of consumers, usually not available through traditional avenues, cannot be underestimated. Through a collaborative and integrated consumer focused recovery model PIR ultimately encourages whole of system change. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116689– http://www.ijic.org/ Description of change implemented: The PIR initiative is coordinated through a lead agency, providing leadership and coordination to enable strategic partners to work together in the development of the governance structure, directly increasing engagement and collaboration. Consortium partners and stakeholders work together to develop and refine practices while support facilitators are based at host agencies, supervised by team leaders. Support facilitators work directly with consumers, assisting them to identify their current recovery needs and coordinating access to a range of services to ensure needs are met. Support facilitators aim to establish a system of collaborative active partnerships between service providers, extended beyond the traditional boundaries of mental health services. They become the conduit for consumers to take ownership of their own recovery, supporting them to access services, while leading practices that create a cultural shift in understanding of the need for collaboration and innovation within the service sector. Objective of the change and targeted population: The PIR process supports individuals who are experiencing severe and persistent mental health issues and have been unsuccessful in receiving a response from multiple agencies. Key goals of the initiative are to improve and sustain service collaboration and integration, and ensure provision of recovery oriented practice. Stakeholders engaged: Stakeholders include the consumers, their families and carers. Lead agencies include Medicare Locals and NGOs. Additional partners and stakeholders include the broader community sector, government mental health services, primary health care providers (physical and mental health) alcohol and other drug treatment services, income support services, education, housing and employment supports. Theory/Methods used: ConNetica has developed key measurement principles to assist each PIR consortia to develop and implement local evaluation plans. Action learning and a program logic framework enables needs assessment, process evaluation, outcomes evaluation and impact evaluation to be conducted using a range of data collection methods and tools. Service mapping, client experience of care and workforce development needs are part of the local evaluation process. Highlights: While relatively early in the process initial data indicates that consumers are benefiting from the client centred recovery process. A sense of hopefulness, increased confidence, engagement in identifying and achieving current goals and developing plans for the future has characterised consumer feedback. Support facilitators have generally identified greater collaboration across internal and external agencies and partners’ awareness of the PIR paradigm has increased propensity for reflection on alternative options to traditional processes. Challenges remain in engaging clinicians and some mental health services in the initiative, while there is an ongoing need for review of systems and processes, and ongoing education across all stakeholders. In some areas there is also a lack of services for consumers to access. Conclusions: Preliminary findings demonstrate that consumers benefit from the development of recovery focused consumer centric practices that require shared understanding and collaborative systems of practice. As with any change management process time is required to identify, refine and imbed practices across the broader sector that contribute to lasting systemic and cultural change.

Abstract A06: Project 4B: Developing a web-based bioethics and biobanking curriculum for biomedical and bio-behavioral researchers

Abstract Background: Participation in biobanking initiatives among individuals with familial risk for hereditary cancer (IFRs) and other vulnerable healthy populations, such as individuals from underrepresented multi-ethnic communities, is vital to further clinical and genomics research. Previous research conducted with the IFR population revealed unique concerns regarding confidentiality, loss of privacy, and discrimination that were discordant with researcher perceptions and attitudes. Focus groups conducted with vulnerable community members revealed major barriers to biospecimen donation, such as mistrust of researchers due to historical abuse and fears of cloning and invasive procedures. To address gaps in researcher understanding, the purpose of this project was to develop a novel training curriculum for researchers to improve their knowledge of IFR and other vulnerable populations' perceptions about biobanking. Methods: Previous research conducted with IFRs, vulnerable community members, and biomedical and bio-behavioral researchers provided the framework for identifying researcher learning preferences and key domains for the development of case studies. A “Project 4B: Bioethics and Biobanking Training for Biomedical and Bio-behavioral Researchers” website was created as a platform for this curriculum which includes Project 4B research results, five case studies and quizzes, definitions, resources, and associated publications. Researchers were recruited via email nominations to pilot test the training website. Researchers completed six evaluation forms – five forms for each of the case studies and one form for all other sections of the website. We evaluated the website in terms of: case study effectiveness, relevance, clarity of post-test questions, and accompanying dialogue animations. Researchers also evaluated website aesthetics (fonts, colors, and images) and other sections (resources, discussion forum, and publications). Results: A total of 14 researchers evaluated the website and five case studies under these domains: privacy and confidentiality, communication of personal results, communication of overall results, informed consent, and community mistrust and fear of cloning and genetic research. For each case study, the majority either strongly agreed or agreed that the case studies were easy to understand, adequately addressed the issues for that domain, and contained appropriate post assessment questions. Suggestions for improvement included providing more examples and more challenging post-test questions. Although the dialogue animations were perceived as interesting and novel by the majority of researchers, they agreed that these animations would not neither improve nor distract from understanding of case study content. Conclusion: Participation in biobanking among minorities and underserved populations is crucial to reducing cancer health disparities. One way to improve participation is to educate researchers about the concerns of these populations. A web-based bioethics and biobanking curriculum with animated case studies is a feasible and acceptable way to provide information to researchers about IFR and other vulnerable community members' participation in biobanking and biospecimen donation. Future plans will focus on incorporating the Project 4B website and curriculum with other educational organizations to ensure wider dissemination of material. Citation Format: Ivana Sehovic, Gwendolyn P. Quinn, Clement K. Gwede, Cathy M. Meade. Project 4B: Developing a web-based bioethics and biobanking curriculum for biomedical and bio-behavioral researchers. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A06. doi:10.1158/1538-7755.DISP13-A06

Affordable warmth interventions in North Lancashire: winner of the post award 'best for visual impact' at Public Health England 2013 annual conference.

In 2012, Lancashire County Council launched a programme to improve public health, by reducing hospital admissions, and to decrease excess winter illness/ deaths among vulnerable households at risk of severe cold in Lancaster, Wyre and Fylde. Interventions included providing practical help and information together with preventative and remedial support services.Local needs assessments identified vulnerable groups, and services were commissioned to build their resilience to cold weather. Public health messages were communicated and immediate advice and practical support services were provided to the isolated and vulnerable throughout the winter. The project ensured that more long term sustainable measures are in place to protect those most vulnerable to the cold. As a result strong partnerships have been created for the future with several agencies. These include: District and City Councils; Care and Repair Wyre and Fylde; Home Improvement Agency Lancaster; Citizens Advice Bureaux; Age UK Lancashire; LESS Community Interest Company; North West Ambulance Service; Groundworks and New Progress Housing; Lancashire Fire and Rescue Service; Energy Inform; Food Banks; Help Direct; and Lifeline Pendant Alarms.INTERVENTIONThe programme initially used funds made available for local authorities to bid for through the Department of Health's 2011/12 Warm Homes Healthy People (WHHP) initiative. As funding was announced in December when winter was already upon us, there was little time for planning. There was also no requirement to monitor or evaluate the intervention.Despite this, North Lancashire monitored the interventions provided to support some of the vulnerable members of the community and found evidence of partnership working and benefits to the local population from the interventions delivered with WHHP money. This evidence prompted NHS North Lancashire to further invest approximately £150,000 in projects across the Primary Care Trust (PCT) footprint by securing significant funding for Affordable Warmth. Therefore, for the first time it was possible to plan ahead in 2012/13 prior to the winter months and offer preventative up-stream measures, rather than taking the usual reactive approach. A referral criterion was set identifying Care and Repair and the Home Improvement Agency as the single points of access for front line agencies. Historically, referrals from health staffwere few in number during previous initiatives. On investigation, it was found that front line staffhad limited time to explore what measures were available or where to refer to, so they rarely did so. Providing one contact number for each locality would ensure access to support and give staffconfidence that an assessment would be carried out to determine the level of support needed. For the purpose of the project, the definition of 'vulnerable' used to ensure funding reached those whose health and wellbeing would be most affected by cold, damp living conditions is identified below as:* A person who is receiving services such as:* personal care or nursing or support to live independently in his/her own home; or* social care services;* A person who is affected by the following conditions:* learning or physical disability;* physical or mental illness, chronic or otherwise, including those receiving treatment for cancer and palliative care; or* reduction in physical or mental capacity.* A person with a disability of the type listed below:* dependency upon others in the performance of, or a requirement for assistance in the performance of, basic physical functions; or* severe impairment in the ability to communicate with others; or* A person with an impaired ability to protect him/herself from assault, abuse or neglect.When planning the second phase of the intervention funded by NHS North Lancashire, the Affordable Warmth team was able to build on lessons learnt in the first interventions of 2011/12. …

The importance of family functioning, mental health and social and emotional well‐being on child oral health

To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1- to 12-year-old Australian children. The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure. The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4-7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income <$20 000 (P < 0.05). In order to address inequities in the experience of poor oral health, solutions that encompass social, economic and psychosocial dimensions will be required. Integrating intervention strategies that promote oral, healthy family functioning and the mental health of parents and children into existing systems reaching vulnerable community members may improve child oral health outcomes and reduce the unequal distribution of oral disease across the social gradient.

Effects of Disaster on Child and #8217;s Health

Disasters have the greatest effect on the most vulnerable groups, especially children. Millions of children worldwide are exposed to disasters both directly and indirectly. The most common problems of children are psychological problems, nutritional problems and infectious diseases at the time of disaster. Children are among the psychologically most vulnerable members of communities affected by disasters because they are not maturity to understand disasters’ effect. The children who exposed to harsh living condition in disasters are faced serious mental problems. Post-traumatic stress disorder, depression and anxiety affect large numbers of children and contribute to long-term psychological burden. Nutritional problems are the common problems of children in disaster. The ensuring of an adequate and balanced nutrition service is essential for the children who have impressed by disaster. There can be appearing health and nutrition problems for children especially at the age below five due to fall ensuring adequate and balanced nutrition during disasters. It is known that the risk of the communicable disease epidemics increases after disaster in developing countries because of poverty, lack of researches and inadequacy of infrastructure system. Lots of factors such as being in close touch with people so long time, inadequate hygienic behaviors causes to increase risk of communicable diseases among the vulnerable age groups such as children. A well-trained team for protecting the health of the children and resolving the problems to take place needs to be created before the disaster and respond quickly after the disaster.

Treating Culturally and Linguistically Isolated Koreans via Telepsychiatry

The Center for Pan Asian Community Services (CPACS), a community organization that provides culturally competent social and health services to immigrant, refugee, and racial-ethnic minority populations, identified a treatment gap within the population they serve. Korean clients with limited English proficiency experienced significant difficulty in accessing appropriate mental health services in the Atlanta area. CPACS approached the National Center for Primary Care at Morehouse School of Medicine to address this health care access problem. Barriers to providing treatment included a lack of Korean-speaking providers in the Atlanta area, which led to out-of-state collaborations using telepsychiatry services. Financial instability was another major barrier to the success of the program. We secured a grant from the Atlanta Clinical and Translational Science Institute (ACTSI) to test the feasibility of this project. Sixteen participants were recruited by CPACS in 2010 and 2011 to participate in this pilot program. The success of the program depended on strong collaborations with CPACS, which provided a culturally and linguistically competent facilitator trained to interact with program participants, and with the Asian Community Mental Health Services (ACMHS) in Oakland, California, which provides multicultural and multilingual behavioral health services to vulnerable community members in California. ACMHS offered a culturally and linguistically competent psychiatrist, who provided treatment via teleconferencing equipment. All participants received an initial telepsychiatry diagnostic assessment, followed by treatment recommendations that were given to the patient and the facilitator by the telepsychiatrist. Ongoing follow-up sessions were recommended by the telepsychiatrist at her clinical discretion. The number and frequency of the additional sessions were determined on the basis of individual needs of the participants, and the overall pilot program lasted for 20 weeks. The facilitator was available by telephone to any participants who needed assistance outside of the established telepsychiatry clinic hours. A majority of patients were female, married, and college educated. Most participants had lived in the United States for over ten years and described their physical health status as poor to fair. Patients showed improved outcomes in depression and anxiety. For example, a 43-year-old Korean female presented to the program with an eight-year history of anxiety complicated by complex psychosocial stressors related to her marriage and emigration to the United States. After engaging in treatment via telepsychiatry and receiving psycho-education regarding mental health treatment options, she responded well to antidepressant medication and supportive therapy provided in the telepsychiatry sessions and reported a dramatic decrease in overall anxiety symptoms. Similarly, there was a significant reduction in psychological distress, anxiety, and depression for the majority of patients who participated in the program. This project was designed to provide mental health services to a population that underutilizes and often avoids seeking such treatment. The preliminary findings are promising, despite the small sample. The significant improvement in symptoms of depression, anxiety, and psychological distress suggests that culturally informed telepsychiatry may be an effective method to increase utilization of mental health services in traditionally underserved minority populations. Although the findings are encouraging, there were some challenges in the implementation of this project. For assessment of language proficiency, many patients appeared to have greater English proficiency than they reported on initial assessment. These individuals with greater English proficiency may have continued in the program because they valued culturally competent providers in addition to language-proficient providers. Participants expressed greater comfort talking to an ethnically matched provider, even if they themselves spoke in English fluently. Furthermore, all screening tools used to evaluate treatment responses were self-report measures. It is possible that social desirability bias and other cultural factors influenced the patients, causing them to report greater symptom improvement than they actually experienced. Nevertheless, our findings show that there may be efficacy in treatment when issues of cultural competence and accessibility are appropriately addressed in mental health service provision to an underserved, minority population. In the future, we hope to expand these findings to larger populations and evaluate this model among other populations with unique cultural and linguistic needs.

The characteristics and experience of community food program users in arctic Canada: a case study from Iqaluit, Nunavut.

BackgroundCommunity food programs (CFPs), including soup kitchens and food banks, are a recent development in larger settlements in the Canadian Arctic. Our understanding of utilization of these programs is limited as food systems research has not studied the marginalised and transient populations using CFPs, constraining service planning for some of the most vulnerable community members. This paper reports on a baseline study conducted with users of CFPs in Iqaluit, Nunavut, to identify and characterize utilization and document their food security experience.MethodsOpen ended interviews and a fixed-choice survey on a census (n = 94) were conducted with of users of the food bank, soup kitchen, and friendship centre over a 1 month period, along with key informant interviews.ResultsUsers of CFPs are more likely to be Inuit, be unemployed, and have not completed high school compared to the general Iqaluit population, while also reporting high dependence on social assistance, low household income, and an absence of hunters in the household. The majority report using CFPs for over a year and on a regular basis.ConclusionsThe inability of users to obtain sufficient food must be understood in the context of socio-economic transformations that have affected Inuit society over the last half century as former semi-nomadic hunting groups were resettled into permanent settlements. The resulting livelihood changes profoundly affected how food is produced, processed, distributed, and consumed, and the socio-cultural relationships surrounding such activities. Consequences have included the rising importance of material resources for food access, the weakening of social safety mechanisms through which more vulnerable community members would have traditionally been supported, and acculturative stress. Addressing these broader challenges is essential for food policy, yet CFPs also have an essential role in providing for those who would otherwise have limited food access.

Assessing the past and the present role of the National Nuclear Regulator as a public protector against potential health injuries: The West and Far West Rand as case study

Recent national and international news media articles and television programmes, official public domain Government and peer reviewed academic reports drew the international and national public’s attention to the health risks and hazards and impacts pertaining to uraniferous waste from the gold mining industry within the Witwatersrand goldfields and the role of the National Nuclear Regulator (NNR) in this regard. The Dutch research organizations’ Wise and Somo’s recent report, entitled “Uranium from Africa – mitigation of uranium impacts on society and environment by industry and governments” found that that the lack of knowledge within institutions and lack of proper environmental management systems, both in industry and in the government, “render South Africa a poor example of environmental and human health protection….The government is failing.” It is especially the poor, the disempowered and the vulnerable members of mining communities that bear the highest risks and impacts. These communities have low adaptive capacity because of chronic and acute malnutrition and high HIV/Aids percentages. The World Health Organization (WHO) recently estimated that 34% of all childhood illness in the world (compared to 24% of all age illness) and 36% of deaths in children under age 14 are due to modifiable environmental factors. As with many illnesses, genes may create a loaded gun, but environment pulls the trigger. However, determining how impacts from gold mining waste within the West and Far West Rand as part of the Witwatersrand goldfields influence or determine human health is a challenge. This is due to the social, cultural and economic conditions (thus their broader well-being status) which influence the vulnerability of communities, and subsequently their resilience. The focus of the discussion will relate to this area and the NNR’s role – past and present – as public health protector in this area per se.

Subacute sclerosing panencephalitis in papua new guinean children: the cost of continuing inadequate measles vaccine coverage.

IntroductionSubacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence.Methodology/Principal FindingsAs part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002.Conclusions/SignificanceSSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities.

Prevalence of Mental Disorders and Suicidal Thoughts Among Community-Dwelling Elderly Adults 3 Years After the Niigata-Chuetsu Earthquake

BackgroundJapan is located in an area prone to natural disasters, and major earthquakes have occurred recently in rural areas where the proportion of elderly adults is high. Although elderly persons are vulnerable members of communities at a time of disaster, the prevalence of mental disorders among this population has yet to be reported in Japan. This study aimed to determine the prevalence of mental disorders and suicidal thoughts among community-dwelling elderly persons 3 years after an earthquake and to identify risk factors associated with their quality of life (QOL).MethodsFace-to-face interviews were conducted with 496 community-dwelling persons aged 65 years or older in areas of Japan where 2 major earthquakes had occurred during a 3-year period. The main outcome was diagnosis of a mental disorder or suicidality.ResultsDuring the 3-year period after the earthquake, 1.6% of men and 5.5% of women had received a diagnosis of major depression. There were no cases of posttraumatic stress disorder. Women were more likely than men to report suicidality (7.8% vs 3.8%, P = 0.075).ConclusionsThe prevalence of mental disorders was lower than that reported in previous studies. Despite the low prevalence of mental disorders, the percentage of community-dwelling elderly persons with subclinical mental health symptoms was high. The results indicate that appropriate public health and medical interventions are warranted after a natural disaster.

The food multimix concept: new innovative approach to meeting nutritional challenges in Sub-Saharan Africa

Food insecurity, chronic hunger, starvation and malnutrition continue to affect millions of individuals throughout the developing world, especially Sub-Saharan Africa. Various initiatives by African governments and International Agencies such as the UN, the industrial nations, the International Monetary Fund, the World Bank and the World Trade Organisation to boost economic development, have failed to provide the much-needed solution to these challenges. The impact of these economic shifts and the failures of structural adjustment programmes on the nutritional well-being and health of the most vulnerable members of poor communities cannot be over-emphasised. The use of ad hoc measures as an adjunct to community-based rural integrated projects have provided little success and will be unsustainable unless they are linked to harnessing available local resources. The present paper therefore focuses on exploring alternative ways of harnessing the scant agricultural resources by employing a scientific approach to food-related problem-solving. The food multimix (FMM) concept offers a scientific contribution alongside other attempts currently in use by the World Food Programme, WHO and FAO to meet the food insecurity challenges that confront most of the developing world in the twenty-first century. It is an innovative approach that makes better use of traditional food sources as a tool for meeting community nutritional needs. The FMM concept employs a food-based approach using traditional methods of food preparation and locally-available, cheap and affordable staples (fruits, pulses, vegetables and legumes) in the formulation of nutrient-enriched multimixes. Developed recipes can provide > or =40% of the daily nutritional requirements of vulnerable groups, including patients with HIV/AIDS and children undergoing nutrition rehabilitation. The FMM approach can also be used as a medium- to long-term adjunct to community-based rural integration projects aimed at health improvement and economic empowerment in Sub-Saharan Africa.

Psychological Assessment of Children in Disasters and Emergencies

Children and adolescents are among the most vulnerable members of communities affected by disasters and emergencies. There is a tremendous need for a systematic post-disaster psychological assessment of children and adolescents in order to understand better post-traumatic symptomatology in children and to identify populations that require an early intervention. This article reviews psychological instruments that are suitable for screening children and adolescents in emergency and disaster contexts for four different types of post-traumatic responses: post-traumatic stress disorder; depression; anxiety disorders; and behavioural disorders. A description of each instrument and psychometric data are provided, along with recommendations on the most appropriate instruments to be utilised in different emergency environments and a summary of previous post-disaster evaluations that have used each type. In addition to selecting apposite instruments, other important issues that should be taken into account when conducting post-emergency mental health needs appraisals of children and adolescents are discussed.

Health, HIV Infection, Human Rights, and Injecting Drug Use

he epidemic of AIDS was first recognized in the 1980s. AIDS was soon shown to result from sexual or bloodto-blood transmission of the human immunodeficiency virus (HIV). In response to this epidemic, some called for draconian measures directed at populations deemed to be at highest risk arguing that this was a traditional public health approach to epidemics spread by dangerous microorganisms. Few were persuaded by this argument. An alternative approach based on the notion that only more vigorous attempts to protect human rights for all, but especially the most vulnerable members of communities, can ensure that the HIV epidemic is brought under control was also set forth. Although initially argued by some to be counter-intuitive, it has since come to be widely accepted as the most reasonable strategy. In almost all countries, populations at higher risk of HIV infection, including men who have sex with men, commercial sex workers and injecting drug users, have long been subjected to discrimination. There is now a wealth of empirical evidence drawn from numerous countries to demonstrate that prevention strategies based on respect for human rights allow authorities to engage more effectively with higher risk populations, thereby reducing high risk behavior and decreasing the spread of HIV.1 Protection of human rights for all, especially marginalized populations, has become a central is

Social administration digest

Social security and income maintenanceAs January had closed so February opened with anxiety about the effects of cuts in public expenditure on the most vulnerable members of the community. The position was outlined by the Child Poverty Action Group (CPAG) in Abandoned Social Priorities. Millions of families, the pamphlet said, faced an unjustified fall in living standards as a result of the decreased proportion of national resources being devoted to the poorest section of society. At the same time they faced increased costs of school meals and transport, prescription charges, rents and clothing. In addition, the Labour Member for Birkenhead pointed out in a letter to the Secretary of State for the Social Services that because they were not informed of their right to free welfare foods only 2.5 per cent of 1.5 million families which were eligible to receive them claimed that right. He estimated that this was saving the government £125 million a year. Further spending cuts, already announced, which would amount to £1,000 million in 1980–1 augured a harsh year ahead.