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. 相似文献
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. 相似文献
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). 相似文献
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. 相似文献
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. 相似文献
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. 相似文献
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. 相似文献