Critique of deinstitutionalisation in postsocialist Central and Eastern Europe

In this paper, we explore critically deinstitutionalisation reform, focusing specifically on the postsocialist region of Central and Eastern Europe (CEE). We argue that deinstitutionalisation in postsocialist CEE has generated re-institutionalising outcomes, including renovation of existing institutions and/or creation of new, smaller settings that have nevertheless reproduced key features of institutional life. To explain these trends, we first consider the historical background of the reform, highlighting the legacy of state socialism and the effects of postsocialist neoliberalisation. We then discuss the impact of ‘external’ drivers of deinstitutionalisation in CEE, particularly the European Union and its funding, as well as human rights discourses incorporated in the UN Convention on the Rights of Persons with Disabilities. The analysis is supported by looking at the current situation in Hungary and Bulgaria through recent reports by local civil society organisations. In conclusion, we propose some definitional tactics for redirecting existing resources towards genuine community-based services

Questioning inclusion: the education of Roma/traveller students and young people in Europe and England: a critical examination.

This article deals with issues pertinent to the ‘inclusion’ of Roma/Traveller children and young people in Europe and, in particular, England. It discusses some key issues that pertain to the inclusion of Roma/Traveller groups in society and it critically presents some key policies that have been advanced to tackle educational and social exclusion of these groups. The aim in this article is to explore the impact these approaches have had thus far and to unravel some of the contradictions, inconsistencies and tensions that permeate them. The critical examination of such approaches is principally located within the context of the United Kingdom, but relevant policies and initiatives that have been introduced by supra-national European organisations are also discussed in order to inform the reader about the wider context in relation to the issues many Roma/Traveller groups face. Inclusion does not operate in a vacuum. It is argued that a set of structural and ideological factors that impact on inclusion need to be identified and linked to a renewed and enriched inclusion approach. In fighting exclusion, holistic and sustained approaches are necessary, which cut across social, political, economic and cultural domains and extend well beyond the formal education of one group (the Roma/Travellers)

Childhood exposure to environmental adversity and the well-being of people with intellectual disabilities

People with intellectual disabilities have poorer health than their non-disabled peers. They are also more likely to be exposed to a wide range of environmental adversities in childhood. Research undertaken in the general population has demonstrated that exposure to environmental adversity in childhood can have an adverse impact on health and well-being across the life course. Recently, research in this area has added new breadth and depth to our understanding of: (1) the extent to which cumulative exposure to environmental adversities across the life course, but especially in early childhood, can reduce health and well-being; (2) the social, psychological and biological mediating pathways through which environmental adversities may impair health; (3) the processes associated with resilience and vulnerability in the face of exposure to adversity; and (4) the social significance of these effects in accounting for the magnitude of the inequalities in health that are apparent both between and within populations. This new knowledge is making a significant contribution to the development of social policies that seek to combine health gain with the reduction in health inequalities. This paper attempts to apply this knowledge to research aimed at understanding and improving the health and well-being of people with intellectual disabilities

Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence

Background: The term ‘Traveller Communities’ refers to a complex population group encompassing Romani Gypsies, Irish Travellers, Welsh Travellers, Scottish Travellers, Roma, New Travellers, Travelling Showpeople, Circus People and Boat Dwellers. A lack of reliable demographic data combined with nomadic lifestyles leads to potential invisibility in health service planning and results in unmet needs.Outreach has been utilised as a key strategy to engage Traveller Communities in health improvement interventions. Aim: To synthesise the evidence on outreach programmes to improve the health of Traveller Communities. Design: Scoping, economic and realist reviews were employed with the following objectives: (1) to quantify and classify the evidence concerning Traveller Communities’ health; (2) to estimate the costs of different types of outreach and determine which might be considered cost-effective and (3) to develop explanations of how, for whom and in what circumstances outreach works best. Methods: Comprehensive searches of electronic databases and grey literature were undertaken using a broad search strategy to identify publications relevant to Traveller Communities and health. The following databases were searched: Web of Knowledge, MEDLINE, The British Library’s Electronic Table of Contents (Zetoc), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, British Humanities Index, PsycArticles, Allied and Complementary Medicine Database (AMED), ProQuest Nursing and Allied Health Source, International Bibliography of the Social Sciences (IBSS) and Sociological Abstracts. Searches were conducted between August 2011 and November 2011. No restrictions on inclusion were imposed according to type of journal, publication date (up to the date of searching) or country of research or practice. Foreign-language publications were excluded. This formed a core literature base to be drawn on by the different arms of thereview. Expert hearings involving Traveller Community members and outreach workers were also undertaken to refine and validate emerging findings. Findings: Two hundred and seventy-eight articles were included in the scoping review, which highlighted the emergent nature of the evidence on outreach interventions for Traveller Communities. While much research describes the needs of Traveller Communities, as yet there has been little response to this in the form of discussion and evaluation of outreach and other interventions that might improve their health. From an economic perspective, the data available suggest that the cost of providing mobile services to travellers is high; improving accessibility of services and signposting Traveller Communities is cheaper and may be equally effective. The realist synthesis generated an explanatory framework of why outreach might lead to certain outcomes depending on the particular circumstances. The extent to which workers are trusted by the Community and whether or not the intervention focus is negotiated both have clear impacts on intervention success. Individuals engage differentially with outreach interventions, leading to participation, behaviour change or social capital improvement outcomes. Conclusions: Outreach workers need clarity about the purpose of their intervention, in terms of degrees of engagement (leading to the three outcome categories above). Where outreach aims to promote attendance at one-off events such as screening, the worker may not need to have long-established links with the Community. Changing behaviour or developing social capital, on the other hand, is a challenge that needs to build explicitly on long-established, trusting relationships. Any flexibility built into the intervention in terms of negotiating intervention topic can contribute significantly to the outcome. While true engagement with an issue must not be assumed from participation at an event, these events can be used as part of longer-term trust-building strategies. These synthesis approaches offer maximum translational potential for other marginalised groups. There is a need for more theoretically informed evaluations of engagement initiatives, in order to develop transferable lessons around how and for whom interventions work in different contexts. Further research is needed to test the explanatory potential of the framework in other socially excluded groups. Funding: The National Institute for Health Research Public Health Research programme