Border crossings: investigating the comparability of case management in a service for older people in Berlin

Case management, a coordinating process designed to align service provision more closely to the identified needs of people requiring assistance in the context of complex care systems, is an example of those policies and practices that cross the borders of different national welfare systems, ostensibly to resolve the same or similar problems in the adopting country. Developed in the USA, case management was re-named 'care management' upon adoption in the UK as part of the community care reforms of the early 1990s, reforms which have framed my professional life in English local authority adult social care services ever since. In 2007, a temporary research fellowship (TH Marshall Fellowship, London School of Economics) enabled me to spend four months in Berlin studying a citywide case management service for older people in the context of German long-term care policy and legislation. This experience sits at the core of this thesis which addresses the extent to which the study of a specific case management service for older people in Berlin can illuminate how case management translates across differing national welfare contexts, taking into account the particular methodological challenges of cross-national research. Drawing on both cross-national social policy and translation studies literatures and adopting a multi-method case study approach, the central problems of determining similarity and difference, equivalence and translation form the core of the thesis. Informed by a realist understanding of the social world, the study took a naturalistic turn in situ that fore-grounded the more ethnographic elements in the mix of documentary research, semi-participant observation and meetings with key informants that formed my data sources and were recorded in extensive field notes. The data were analysed to trace how case management was constructed locally in relation to both state and federal level policy and legislation, and then comparatively re-examined in the context of the key methodological problems identified above in relation to understandings of care management in England as reported in the literature, in order to further explore the question of comparability of case management across different welfare contexts. The research clearly demonstrates how institutional context both shaped and constrained the adoption of case management in Berlin, and highlights a need in comparative research for close contextual examination of the apparently similar, with a focus on functionally equivalent mechanisms, to determine the extent to which case management can be said to be similar or different in different contexts, particularly where English words and expressions are directly absorbed into the local language. Relating the case study to findings from earlier studies of care management in England highlights the extent to which care management in England is itself a locally shaped and contextualised variant of case management as developed in the USA that matches poorly to the variant in Berlin. Indeed problems discovered in the research site constructing definitional boundaries for case management in practice mirror issues in the wider literature and raise questions about the specificity of the original concept itself. Nonetheless, the study shows that, despite the multiple asymmetries of equivalence and difficulties of translation, there are sufficient points of similarity for cautious potential lessons to be drawn from Berlin, particularly with regards to policy changes on the horizon in England, but also in the other direction with regards to how case management in Berlin may also be re-shaped following recent reforms to German long-term care legislation

Patient attitudes to sternotomy and thoracotomy scars

Young adults with congenital heart defects expressed dissatisfaction with their surgical scar. The impact extended to their social life and ability to form close relationships, and has implications for holistic practice. Presented at Association for European Paediatric Cardiology conference in Munich

Detection and Forensic Evidential Value of Tattoos Identified Using Alternative Light Sources

Tattoos have been used for over 5,000 years as a means of differentiating one person from another. However, different types of tattoos have increased in popularity over the last decade and are continuing to gain attention. A tattoo can be either temporary or permanent and can be on any area of a person's anatomy. Previously, tattoos have been ignored as a valuable biometric feature in human identification as they are not specific to one individual compared to favoured evidence such as DNA. Additionally, developments in technology are resulting in new ways to cover-up and remove traces of tattoos, causing intelligence gaps in the identification procedure. There has been limited research conducted on the use of tattoos in human identification processes. This study investigated the influence of burning and decomposition upon temporary and permanent tattoos as a means of visualisation in a forensic identification context

Employment and advice regarding careers for adults with congenital heart disease

Aims: To compare the rates of employment, and advice offered concerning careers, in adults with congenital heart disease and controls. To assess the impact of the severity of the congenital cardiac malformation on the chances for employment. Methods: We solicited responses from 299 adults with congenitally malformed hearts, asking them to answer questions from a questionnaire posed at interview by a trained nurse. The adults were asked to give an identical questionnaire to a friend to act as a control. We received responses from 177 of the controls. Results: The responses showed that 51 of 156 (33 per cent) adults with congenital heart disease were unemployed, and 37 of 151 (25 per cent) had been unemployed for more than a year. This is significantly more than 25 of 156 (16 per cent) matched controls unemployed, and 5 of 151 (3 per cent) controls unemployed for more than a year. Almost one-fifth of the adults with congenital heart disease (19 per cent) had received advice regarding their career which they found helpful, which is significantly fewer than the 31 per cent of controls. More (42 per cent) had been given advice against certain occupations than controls (11 per cent). Receiving career advice was significantly associated with employment in the population with congenitally malformed hearts, with almost three-quarters (73 per cent) of those given advice being employed compared to 46 per cent of those not given advice. This pattern was not seen in controls. The severity of the congenital cardiac malformation did not significantly affect the rates of unemployment. Conclusions: Whatever the severity of their disease, adults with congenitally malformed hearts are more likely to be unemployed than matched controls. They are less likely to receive useful advice regarding potential careers, and find the advice given less helpful, than controls, although receiving suitable advice is associated with being employed in the population with congenital cardiac disease

What type of environmental assessment and modification prevents falls in community dwelling older people?

What you need to know • Evidence suggests that environmental interventions can prevent falls in older people at high risk of falls, but they have little or no benefit in people at low risk • Offer environmental assessment and modification led by an occupational therapist to people over 65 who have had a fall in the past year, use a mobility aid, need assistance with any activities of daily living, take psychoactive medications, or are concerned about falling • Environmental assessment and modification encompasses a comprehensive, validated functional assessment of the individual in their home environment, a joint problem solving approach, and follow-up as require