'Managing scarcity'- a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany

OBJECTIVES: In Germany, healthcare for people lacking legal residency status and European Union citizens without health insurance is often provided by non-governmental organisations. Scientific studies assessing the situation of the patients with chronic diseases in this context are scarce. We aimed to characterise medical care for chronically ill migrants without health insurance and outline its possibilities and limitations from the treating physicians' perspective. DESIGN: Qualitative semi-structured interviews; qualitative content analysis. SETTING: Organisations and facilities providing healthcare for uninsured migrants: free clinics, medical practices and public health services. PARTICIPANTS: 14 physicians working regularly in healthcare for uninsured migrants. RESULTS: Delayed contact to the healthcare system was frequently addressed in the interviews. Care was described as constrained by a scarcity of resources that often impedes adequate treatment for many conditions, most pronounced in the case of oncological diseases or chronic viral infections (HIV, hepatitis). For other chronic conditions such as cardiovascular diseases or diabetes, some diagnostics and basic medications were described as partially available, while management of complications or rehabilitative measures are frequently unfeasible. For the patients with mental health problems, attainability of psychotherapeutic treatment is reported as severely limited. Care is predominantly described as fragmented with limitations to information flow and continuity. Which level of care a patient receives appears to depend markedly on the respective non-governmental organisation and the individual commitment, subjective decisions and personal connections of the treating physician. CONCLUSIONS: Restrictions in medical care for uninsured migrants have even more impact on chronically ill patients. Volunteer-based care often constitutes an inadequate compensation for regular access to the healthcare system, as it is strongly influenced by the limitation of its resources and its arbitrariness

Moving into Adulthood: Implementation Findings from the Youth Villages Transitional Living Evaluation

The Youth Villages Transitional Living program is intended to help youth who were formerly in foster care or juvenile justice custody, or who are otherwise unprepared for adult life, to make the transition to independent living. Youth Villages, which serves emotionally and behaviorally troubled young people, operates a number of programs in addition to Transitional Living.All of its programs are based on a set of core principles that emphasize treatment planning, systematic assessment of participating youth, and delivery of only evidence-informed practices within a highly structured supervisory system. Transitional Living clients receive intensive, individualized, and clinically focused and communnity-based case management, support, and counseling from staff who carry caseloads of about eight clients each. Youth eligibility is determined through an extensive recruitment and assessment process. Once youth are enrolled, Transitional Living staff continue to assess them to identify needs and work with them to develop goals, which become the basis of required weekly meetings. Over nine months, on average, program participants get support for education, housing, mental or physical health, employment, and life skills. This support is provided in a variety of forms, including action-oriented activities that involve completing a specific task during a weekly session or through more traditional counseling techniques.The Transitional Living Evaluation is focused exclusively on the program in Tennessee, although Youth Villages also has Transitional Living programs in six other states

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed

Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET‐DD) study, a collaborative study carried out in 14 countries

Aims To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. Methods People with diabetes aged 18–65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. Results A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (PPPPP<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0–29.6%). Conclusions Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes

Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information

Analyzes variations in Medicare payment and coverage among hospitals, nursing homes, assisted living facilities, and hospices; "bed-hold" and "reserved-bed" revenue streams; and other factors that may shape decisions to transfer residents to hospitals

Factor structure and construct validity of the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer)

Background: The ASCOT-Carer is a self-report instrument designed to measure social care-related quality of life (SCRQoL). This article presents the psychometric testing and validation of the ASCOT-Carer four response-level interview (INT4) in a sample of unpaid carers of adults who receive publicly-funded social care services in England. Methods: Unpaid carers were identified through a survey of users of publicly-funded social care services in England. 387 carers completed a face-to-face or telephone interview. Data on variables hypothesised to be related to SCRQoL (for example, characteristics of the carer, cared-for person and care situation) and measures of carer experience, strain, health-related quality of life and overall QoL were collected. Relationships between these variables and overall SCRQoL score were evaluated through correlation, ANOVA and regression analysis to test the construct validity of the scale. Internal reliability was assessed using Cronbach’s alpha and feasibility by the number of missing responses. Results: The construct validity was supported by statistically significant relationships between SCRQoL and scores on instruments of related constructs, as well as with characteristics of the carer and care recipient in univariate and multivariate analyses. A Cronbach’s alpha of 0.87 (7 items) indicates that the internal reliability of the instrument is satisfactory and a low number of missing responses (<1%) indicates a high level of acceptance. Conclusions: The results provide evidence to support the construct validity, factor structure, internal reliability and feasibility of the ASCOT-Carer INT4 as an instrument for measuring social care-related quality of life of unpaid carers who care for adults with a variety of long-term conditions, disability or problems related to old age

Moving Ahead: Factors contributing to successful transition of people with intellectual disabilities from congregated to community-based residential options in two regions in Ireland

This report details the findings of a research project entitled Moving Ahead. The project aimed to examine factors that contribute to the successful transfer of people with intellectual disabilities from congregated to community-based living in two regional areas in Ireland. It was undertaken by a team of researchers from Ireland and the UK, led by Dr. Christine Lineha

Therapeutic leave from secure mental health inpatient services::a review

I am delighted to have been invited to contribute a paper to this liber amicorum for Prof. dr. Frans Koenraadt in honour of his lifetime’s contribution to clinical and theoretical advances in forensic psychology, law, mental health, and education. I first had the pleasure of meeting Frans in Toronto when both he, I, and Lydia Dalhuisen, Frans’ then PhD student, were all presenting work on firesetters and firesetting. Our mutual interest led to further contact and an invitation was extended to me to join the examination panel for Dr Dalhuisen’s PhD thesis defence in Utrecht, a fascinating experience for me since it is not our tradition in the UK to conduct such a public defence. Since then, I have read with great interest and admiration the outputs of the PhD. It was my impression that Prof. Koenraadt provided a highly constructive and flexible educational experience which allowed the PhD room to breathe and grow. My acquaintance with Frans has been short, but I can say with sincerity that his natural curiosity, intellectual openness, and willingness to share his vast accumulated knowledge should serve as a model for us all. In this spirit of sharing, my colleague, EmilyMay Barlow, and I have chosen to address an issue which we feel passionate about. It is also an issue that lies firmly in those intersections between law, criminality, psychology, risk, and clinical practice in which Prof. Koenraadt excels. That issue is the use of therapeutic leave by patients in secure, forensic mental health care

Decreasing Caregiver Stress

Stress is both critical and personal experience and has significant effects on caregivers’ physical, mental, and social well-being. The nature of caregiving and the responsibility to work and serve individuals at their illness conditions are very personal encounters that often result in adverse effects on the health and well-being of caregivers (Frederick, 2016). A decrease in stress experience can lead to the satisfaction of caregiver roles and improvement of patient’s quality of life (Choi, Jisun & Boyle, Diane, 2013; Yada, Nagata, & Inagaki, 2014). This scholarly project determined that evidence-based stress management interventions have decreased the perceived stress in caregivers. The scholarly project identified low levels of stress among research participants, and how evidence-based interventions decreased caregiver stress by increasing their knowledge and awareness of evidence-based stress management interventions. The results of this scholarly project agree with the literature that caregiver stress experience can be decreased through the implementation of evidence-based stress management interventions (Blom, Zarit, Groot Zwaaftink, Cuijpers, & Pot, 2013). It is significant to implement evidence-based stress management interventions to decrease perceived stress among caregivers