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We identify the key social and political forces that brought about the Self Managed Attendant Service Direct Funding Pilot (SMAS-DFP). Attendant Services are services for people with physical disabilities (PWD) to assist with daily activities. Direct Funding means that individuals obtain funds through direct funding mechanisms and/or through third parties. Self-direction refers to consumers who know their attendant service needs and can instruct workers to meet these needs. Self-management refers to (PWD) who are employers under the law and are legally responsible for hiring, training, scheduling and paying their attendants. Our analysis of the success of the SMAS-DFP is based on pre-conditions and facilitating elements. The pre-conditions were the: (1) existence of social movements; (2) precedents to direct funding programs; (3) prior experience with the governance of attendant services; and (4) government health reform. Five elements facilitated the SMASD-FP: (1) a clear vision by the community; (2) a core group of leaders; (3) supporters of the SMAS-DFP came from inside and outside of the community; and (4) supporters provided key resources to be used and to deal with barriers. PWD successfully led the pilot (1994–1997) and continue to administer the expanded government program (began 1998).

Purpose – Medicaid funding for long-term services and supports (LTSS) is a key avenue for community access for people with disabilities and others. Between 1997 and 2009, the boundaries of community access were redrawn and redefined with the introduction of a series of 13 bills to change how Medicaid requires states to fund LTSS. Although they did not successfully pass into law, their presence is felt in the language of the Community First Choice (CFC) Option, part of the Patient Protection and Affordable Care Act (PPACA) of 2010. This chapter documents and analyzes the changes in the concept of community access as reflected across these bills and the CFC.

Methodology – The text of these 13 bills and the CFC were compared with attention to structure, order, and meaning. Documents were hand coded and electronically searched. Codes were entered into atlas.ti for comparison and analysis.

Findings – Four significant changes in the conceptualization of community access emerged: (1) who deserves access to community, (2) what community access entails, (3) why people deserve access to community, and (4) how community access should be organized. With the exception of the reasons why people deserve access to community, the expanded concept of community access illustrated across these bills is reflected in the text of CFC.

Originality/value of the chapter – This chapter contributes to the limited literature that documents and analyzes the historical development of community access across policy documents. In addition, it highlights the relevance of incremental analysis to understanding social change through the legislative process.

Purpose: This chapter problematizes the philosophical origins of direct funding models in a normative conception of independence that ignores and obscures the fundamentally relational nature of care work.

Approach: The study adopts a reflexive ethnographic methodological approach. In-depth, semistructured interviews were conducted with 19 participants variously involved with direct-funded attendant services (disabled “self-managers,” “attendant” employees, other members of self-managers’ support networks, and program staff). Additional data sources included the author's reflexive journaling and publicly available policy and program materials. The present analysis interrogated the impact of systemic constraints (i.e., limited funding) on the organization and management of attendant services.

Findings: The data illuminate how systemic constraints draw the interests of self-managers and attendants into tension, despite the affective relationality of the work they do together. The findings present four strategies self-managers adopt to maximize support hours, including: splitting shifts, strategic hiring, dynamic resource management, and supplementing remuneration. These findings suggest it is not vulnerability to each other that represents an ongoing concern for self-managers and attendants, so much as exploitation by a system that capitalizes on the oppression of both groups.

Implication/ Value: Disabled people and care workers have been and continue to be constructed as opposing interest groups. However, there is great potential in disabled people and care workers joining a united front to lobby for their common, often interrelated interests. Direct funding models are an important evolution of support services, but where they fail to attend to the relational nature of care work, we must continue to pursue more inclusive solutions.

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

The purpose of this paper is to propose a research model in which work engagement (WE) mediates the influence of work social support on job satisfaction (JS), in-role performance (IRP), creative performance (CP) and extra-role performance (ERP).

Data were collected from cabin attendants via three surveys two weeks apart and their pursers. The aforesaid relationships were assessed through structural equation modeling.

In general, there is support for the preponderance of hypotheses. Specifically, WE completely mediates the impact of coworker support on JS and IRP, while the impact of supervisor support on CP is completely mediated by WE. WE partly mediates the effect of coworker support on CP and ERP. Furthermore, the effect of supervisor support on JS, IRP and ERP is partly mediated by WE.

Management should make sure that the work environment consists of supportive supervisors and coworkers who are trained on how they can enhance the cooperation and collaboration among employees. Management should also create an employee platform where cabin attendants can contribute to service delivery process by sharing their experiences arising from passenger requests and problems.

The study extends and contributes to the current service research by assessing the impact of WE simultaneously on three performance outcomes. The study adds to current knowledge by investigating the mediating mechanism linking work social support to the attitudinal and behavioral outcomes. The study also controls the threat of common method variance with at least two procedural remedies, which have been rarely used in the current service research.

Medicaid home and community-based services (HCBS) support community living for three million disabled people in the United States. As a state-federal partnership, these programs are highly variable across states. Because eligibility determination and services differ from state to state, this Medicaid structure becomes a barrier for those HCBS users whose desired futures include cross-state moves.

I examine narratives of citizenship and personhood for Medicaid HCBS users circulating within policy arenas and explore tensions between these and the stories Medicaid HCBS users tell of their own lives. Specifically, I explore the degree to which narratives about Medicaid HCBS users include an affirmation of the right to cross-state movement. My analysis includes data from public statements from policy makers, legislative texts, organizational framings of Medicaid policy, and 18 semi-structured interviews with Medicaid PCA users who desired or pursued cross-state moves.

I conclude that institutional narratives of Medicaid HCBS users are an inadequate representation of the stories told by those who rely on this program and, in consequence, programs stemming from policy fail to offer services that would allow service recipients to pursue their objectives.

Medicaid HCBS policy is part of a broader story of disability rights progress over the last four decades, making its role as an obstacle to cross-state movement a bit of a paradox. This paradox points to the value of narrative analysis in calling attention to invisible contradictions and the need for institutional and organizational change.

Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates.

Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates.

Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women’s literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad.

Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality.

All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of “tied aid”, thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative.

Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women’s health are valuable. Canada’s midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women’s lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/.

There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well.

The purpose of this paper is to explore experiences of survivors of the mental health system regularly attending a mental health resource centre predominantly but not exclusively focussed on needs of the BAME community.

In total, 25 participants took part in a qualitative research study regarding their experiences of mental health and racism, alternative mental health support and struggles in the local black community.

Issues of race, place and space were central to the experiences of BAME mental health survivors. Participants emphasised the importance of place-based support in their everyday life, with the service provided engendering a sense of belonging conducive to coping with various struggles. Race and racism were also central to these daily struggles and the place of Liverpool 8 was at the core of notions of identity and belonging. The space within the centre provided a sanctuary from the combined discriminations and exclusions attendant on being BAME survivors of the mental health system.

Attention to matters of place and space appears crucial to the articulation of appropriate support.

Place is salient to understanding the intersecting identities/experience of racism and mental health discrimination, constituting the basis for a concept of placism; associated with exclusions from feeling safe and included in everyday public places (including within the black community) with the exception of the welcoming and unconditionally accepting space of the centre.

This paper is the first to inquire into place-based experiences of alternative black mental health support. Placism is a novel construct that merits further inquiry and theoretical development.

The purpose of this monograph is to present the first English translation of a unique French colonial report on women living under colonial rule in West Africa.

The issue begins with a discussion of the contribution this report makes to the history of social development policy in Africa, and how it serves the on‐going critique of colonisation. This is followed by the English translation of the original report held in the National Archives of Senegal. The translation is accompanied by explanatory notes, translator’s comments, a glossary of African and technical terms, and a bibliography.

The discussion highlights contemporary social development policies and practices which featured in identical or similar forms in French colonial social policy.

As the report demonstrates, access to basic education and improving maternal/infant health care have dominated the social development agenda for women in sub‐Saharan Africa for over a century, and will continue to do so in the foreseeable future in the Millennium Development Goals which define the international community’s agenda for social development to 2015. The parallels between colonial and post‐colonial social policies in Africa raise questions about the philosophical and cultural foundations of contemporary social development policy in Africa and the direction policy is following in the 21st century.

Though the discussion adopts a consciously postcolonial perspective, the report that follows presents a consciously colonial view of the “Other”. Given the parallels identified here between contemporary and colonial policy‐making, this can only add to the value of the document in exploring the values that underpin contemporary social development practice.