Journal of health & social policy最新文献

Objective: There has been a plethora of studies that evaluate the impact of deinstitutionalization of psychiatric services, but they have not examined whether this policy has had an impact on the broader community. The present study addresses this gap by evaluating the impact of the deinstitutionalization of psychiatric hospitals on the mental health of the general population in Canada.

Method: This research builds on an empirical analysis of 40 years of the process of deinstitutionalization of psychiatric services in Canada (Sealy and Whitehead 2004). An experimental design is simulated through the use of a derived construct, earlier vs. later deinstitutionalization, in order to test whether the policy of deinstitutionalization has achieved the goal of decreasing levels of psychological distress for people in the community. This study attempts to rectify some of the methodological limitations of past evaluations by standardizing the rates of deinstitutionalization among the provinces and taking into consideration the impact of the interaction among levels of perceived social support and the various social correlates of psychological distress. Cross sectional data from the 1994/95 (n = 16,989) and the 1998/99 waves of the National Population Health Survey (n = 14,682) are used to measure levels of psychological distress.

Results: Provinces that implemented this policy earlier have levels of psychological distress that are significantly lower than the provinces that implemented deinstitutionalization later. All high risk groups (people with lower levels of income and education, younger people, people living in urban areas) have significantly lower levels of psychological distress in 1998/99 (as compared to 1994/95) with the exception of single parents in the provinces that implemented deinstitutionalization earlier.

Conclusion: Based on the NPHS, the earlier implementation of deinstitutionalization is associated with lower levels of psychological distress of the community as compared to the provinces that implemented deinstitutionalization later.

This study focuses on the incidence of birth defects among children born to Haitian women in Florida. Analysis of comparative data collected by the Florida Birth Defects Registry indicates a disproportionate rate of birth defects among babies born to Haitian women. Sociocultural and economic characteristics of the Haitian community and their relationship to birth defects are explored. The implications of the findings for public policies that address prenatal care and childbirth- related problems are discussed.

Although health-based social movements organized by grassroots activists have a rich history in impacting health and social policy, few systematic studies have addressed their policy change efforts or effectiveness. In this article, the authors trace how four health-based social movements-the women's health movement, ACT UP, breast cancer, and needle exchange-influenced health and social policy legislation. The activists' efforts wrested control of "authoritative knowledge" that had once been the sole domain of "experts" with advanced medical training. They used this knowledge to empower "average" people with medical information, promote self help and engage in civil disobedience, which led to changes in healthcare delivery, drug testing and approval, and increased research funds for HIV/AIDS, breast cancer, and needle exchange. The activists' efforts led to other health-based social movements that are currently, or will become, issues for health and social policy analysts in the future.

The impact that parenting responsibilities have on the psychological well-being of African American grandparents raising grandchildren is an increasing concern in American society. Contemporary research studies indicate that African American grandparents who encounter a variety of challenges in raising their grandchildren are able to cope successfully with these situations if they derive a sufficient amount of psychological rewards from raising grandchildren (Giarrusso, Silverstein, & DuFeng, 2000). These rewards include increased gratification, feelings of usefulness, and increasing pride in their own abilities to meet new challenges (Fuller-Thomason & Minkler, 2000). This article will investigate how the coping resource factors of intergenerational solidarity, informal social support and spirituality enhance the psychological well-being of African American grandparents who are raising their grandchildren. doi:10.1300/J045v22n03_09.

This study examined the impact of welfare reform on African- American and Caucasian welfare recipients in Milwaukee, Wisconsin to determine if there were differences in their experience with employers and private welfare agencies. The study found that despite having higher education levels and higher job training completion rates, African-American welfare recipients did not fare any better than Caucasians in terms of employment. African-American welfare recipients were more likely to be required to take pre-employment tests and Alcohol and Other Drug Abuses (AODA) than were Caucasians.

The primary focus of this paper is to analyze the Mexican health care system and the forces driving its change. To facilitate this, the paper conducts an analysis of the key stakeholders in both the U.S. and Mexican health care systems. The Mexican system is dominated by an autocratic federal government that is gradually relinquishing its role as provider of health care in exchange for control of the reform efforts. The U.S. system is characterized by a relatively equal distribution of power among the key stakeholders, in which changes occur primarily through incrementalism. The results of the analysis indicate that the key differences lie in terms of relative stakeholder power and rate of change in the systems. Compared with the U.S.,Mexico is making rapid changes to its health care system and both countries are struggling with the same key issues: Cost, access, and quality.

The needs of biological relatives can often be overlooked because caseworkers are charged to act in the best interest of the child, meet the demands of foster parents and assume large court and paperwork responsibilities. Using a case study approach of a private therapeutic foster care agency located in Washington, DC, this study examines the needs of biological parents from the perspective of both the biological parents (n = 14) and child welfare workers (n = 14). It also addresses both systemic and personal barriers associated with the engagement and involvement of the biological parent. Findings are that there are varying levels of involvement of the biological parent; however, there is often confusion surrounding engagement practices absent reunification as a goal. This is especially relevant for kinship care where the goal of reunification is sometimes obscured by the placement of children with their families. Policy and practice implications are discussed with an emphasis on increasing the focus on biological relatives in the kinship care network. doi:10.1300/J045v22n03_08.

Orientation to the future, in the social science literature, is linked to social adaption and adjustment. This study examines the future outlook in African American kinship care families. The focus of the study was restricted to adolescents in the kinship care population and examined both youth's and parent figure's outlook for the future. Using the National Longitudinal Survey of Youth (NLSY97), the study describes the future orientation of African American youth who live with relative caregivers. It tests for differences in orientation to the future between kinship care parents and those with biological and other family types and tests the hypothesis of there being a significant difference in future orientation between youth and their relative acting as parent caregiver. Findings demonstrate significant variability in the future outlook of African American youth within kinship care families. The findings suggest that social workers and mental health practitioners who work with youth in goal setting behaviors should include the relative caregiver and the family in the counseling process. doi:10.1300/J045v22n03_02.

The KinNET project came into existence because of the need to support a growing number of grandparents and other relatives providing care for children within the foster care system. It was a demonstration project funded by the Children's Bureau designed to create a national network of support groups for older relatives-mostly grandparents-caring for children in and associated with the foster care system. Grandparents and other relatives are an invaluable resource to the child welfare system. However, these caregivers are also an overburdened population that needs creative and supportive interventions to enhance their capacity to provide quality care and reduce the risks to the children. In this intervention the support group approach was tested (a replication of the Brookdale Foundation model with project management from Generations United). Support groups often provide kinship caregivers with access to important emotional and community support, information and referral, relaxation, and respite. This article briefly describes the project, a profile of the caregivers (n = 102) and the children in their care (n = 226), and highlights from the survey data. In addition, we discuss the three key lessons learned from the project and make recommendations to better serve this population. doi:10.1300/J045v22n03_14.