Relational ties of love – A psychosocial proposal for ethics of compassionate care in health and public services

Market-based freedom of choice and user autonomy occupies a prominent position on the policy-maker agendas in many countries, increasingly more so than equity of access or equality of opportunity. The essay discusses how the introduction of market logic and consumerism in public health care services relies on, and taps into, unconscious dynamics and fantasies of invincibility while ignoring precariousness of life and our infinite potential to experience vulnerability. This creates toxicity in organisations and corrupts the moral institutional fabric. Drawing on psychosocial approaches inspired by various strands of psychoanalysis, and the theory of affective attachments to social norms offered by Judith Butler, I propose an ethics of relationality and compassionate care for the unknown ‘other’, as a way of counteracting these developments.     

Disparities in access to family physicians among transgender people in Ontario,Canada

Background: Informed by the Gelberg-Andersen behavioral model for vulnerable populations, this study examined the prevalence of and factors associated with not having a family physician among transgender (trans) people in Ontario, Canada.

Methods: Data were drawn from a respondent-driven sampling (RDS) survey of trans Ontarians age 16 and above (n = 433) conducted between 2009 and 2010. All analyses were weighted using RDS II methods. Prevalence ratios were estimated using average marginal predictions from logistic regression models.

Results: An estimated 17.2% (95% CI, 11.0 to 22.9) of trans Ontarians (median age = 28.7, 77.3% White) did not have a regular family physician. In multivariable analyses accounting for other predisposing and need-related factors, transfeminine persons (trans women and non-binary persons assigned a male sex at birth) who were Indigenous and/or persons of color were less likely than other transfeminine persons to have a family doctor. In addition, trans persons who were homeless or had unstable housing were less likely to have a family doctor than those who were adequately housed.

Conclusions: These results provide the first quantitative evidence of health disparities by race and gender within a Canadian transgender population and suggest a social gradient in access to care within Ontario's “universal health insurance” system.     

How Does Residents’ Satisfaction with Community Services Influence Quality of Life (QOL) Outcomes?

Grzeskowiak et al. [Journal of Regional Analysis and Policy 33(2):1–36, 2003] conducted a study that empirically tested a model that integrates the relationships among determinants and outcomes of residents’ satisfaction with community services. We build on their model in attempt to explain how residents’ satisfaction with community services influence satisfaction with the community at large (community well-being) and satisfaction with life (quality of life). Specifically, we hypothesized and empirically demonstrated for the most part that satisfaction with a variety of community services (e.g., services related to housing, education, government, healthcare, employment, religion, public safety, retailing, transportation, and leisure) affect satisfaction with the community and life overall through satisfaction in a variety of life domains (e.g., family, social, leisure, health, financial, cultural, consumer, work, spiritual, and environmental domains).     

The Intensive Mental Health Program: Development and Structure of the Model of Intervention for Children with Serious Emotional Disturbances

In order to meet the challenging needs and behaviors of children with Serious Emotional Disorders (SED), a school and community based Intensive Mental Health Program (IMHP) was developed and evaluated. We describe the conceptual framework, treatment principles, and model for service delivery for psychological and educational interventions under the umbrella of the IMHP. The program illustrates a model of comprehensive services for children with SED.     

A Level of Care Instrument for Children's Systems of Care: Construction, Reliability and Validity

The Child and Adolescent Level of Care System/Child and Adolescent Service Intensity Instrument (CALOCUS/ CASII) is designed to help determine the intensity of services needed for a child served in a mental health system of care. The instrument contains eight dimensions that are rated following a comprehensive clinical evaluation. The dimensions are risk of harm, functionality, co-morbidity (psychiatric, substance abuse, development disability and medical), environmental stressors, environmental supports, the child's resiliency, and the child and family's willingness to engage in treatment. An algorithm connects the ratings to a level of care recommendation. The instrument specifies six levels of care defined flexibly enough to consider whatever services are available. The results of psychometric testing using raters with a broad range of clinical experience and training from four different systems of care around the country are presented. The testing demonstrates excellent reliability when rating vignettes. Using children and adolescents in live system of care clinical settings, the CALOCUS/CASII demonstrates reasonable validity when compared with the Child Global Assessment Scale, and the Child and Adolescent Functional Assessment Scale.     

对临床药学发展的几点思考

经过30余年的探索与实践,我国的临床药学发展已初具规模,其开展的必要性和重要性得到社会各界的肯定。但就开展程度而言,临床药学仍为一门年轻的学科,其内容和体系均凾待完善。在回顾过去,总结经验教训的基础上,我们有针对性地提出了一些关于临床药学体系建设的建议,期望对我国临床药学工作的全面开展有所帮助。     

The Australian Psychology Workforce 1: A national profile of psychologists in practice

Existing workforce data on Australian psychologists are limited and data that exist are problematic. An online survey instrument was developed to profile psychologists including demographics and work characteristics including setting, role, service location and client type. A total of 11,897 completed the survey (response rate 48%) and a subset of these (N = 9,330) who held full registration were included in the current investigation. Participant demographics show a high (75%) proportion of females in the workforce which is particularly evident in the younger age range. Participation in the workforce was high (68%), with main psychology jobs spread relatively equally between the public and private sectors. Over a quarter of participants held a second psychology position, with the majority of second jobs being in private practice. For both first and second jobs the largest proportion spend their time providing counselling and mental health interventions one‐to‐one to adults. One quarter provide services in non‐metropolitan regions, a higher rate than previously reported. Specific population groups such as culturally and linguistically diverse and indigenous clients were prominent in workloads. This study provides a comprehensive profile and provides a rich data source for further exploration of the characteristics of specific groups within the workforce.     

Evaluating the vermont system of care: Outcomes associated with community-based wraparound services

Evaluation of innovative community-based interventions is becoming a high priority for child and adolescent mental health service system research. The present study examined outcomes for a sample of Vermont children (N=27) experiencing emotional and behavioral problems and receiving individualized, wraparound services. One year after initiation of wraparound care, incidence of negative behaviors rated as placing a child at risk of removal from the community had decreased significantly, compliance behavior had increased, and a significant decline in Total Problem Behavior scores on the Child Behavior Checklist was observed. In addition, though 70% of the participants had previously required inpatient or residential treatment, 89% were maintained in the community after one year of services, and the total cost of services was less than that of out-of-state residential care. Although further comparative research is needed, this study suggests that for many of these children, wraparound services may be a more efficient intervention than long-term psychiatric hospitalization or residential treatment.