ABSTRACT
This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program's initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.
Subject(s)
Health Workforce , Social Work , Humans , Child , United States , Child Health , Students , New YorkABSTRACT
OBJECTIVE: To investigate the effect of different aspects of inequality on childhood immunisation rates in Nepal. The study hypothesised that social inequality factors (eg, gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility) affect the likelihood of children being immunised. DESIGN: Using gender of a child, age of mother, caste/ethnic affiliation, mother's socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility as independent variables, we performed bivariate and multivariate logistic regression analyses. SETTING: This study used data from the most recent nationally representative cross-sectional Nepal Demographic and Health Survey in 2016. PARTICIPANTS: The analysis reviewed data from 1025 children aged 12-23 months old. OUTCOME MEASURES: The main outcome variable was childhood immunisation. RESULTS: Only 79.2% of children were fully immunised. The complete vaccination rate of ethnic/caste subpopulations ranged from 66.4% to 85.2%. Similarly, multivariate analysis revealed that children from the previously untouchable caste (OR 0.58; CI 0.33 to 0.99) and the Terai caste (OR 0.54; CI 0.29 to 0.99) were less likely to be fully immunised than children from the high Hindu caste. CONCLUSION: Given Nepal's limited resources, we suggest that programmes that target the families of children who are least likely to be fully immunised, specifically those who are not only poor but also in financial crises and 'underprivileged' caste families, might be an effective strategy to improve Nepal's childhood immunisation rates.
Subject(s)
Poverty , Social Class , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Nepal , Socioeconomic Factors , VaccinationABSTRACT
State and other social service agencies as well as service providers are governed by laws that often provide unclear guidance regarding the rights of people with disabilities. Although some standards can be, and have been, developed to protect the rights of people with disabilities, all people with disabilities are not the same and therefore, each can require very different types of accommodations. Some aspects of disability rights must be individually based, including the requirement that people with disabilities receive educational services in the least restrictive environment and care in the most inclusive setting. The current interpretation of these mandates suggests that agency decisions rely on professional judgments. Unless professionals work with their clients, this reliance can serve to disempower those whom the law was intended to protect. Though much debated, the legal definition of a person with a disability is unclear. This article examines the concept of disability and that of the least restrictive environment as well as that of the "most inclusive setting," explains to whom they apply, discusses how they have been defined both in statutes and case law, and elaborates on the role of social workers as a result of the law's reliance on professional judgment in ascertaining client rights.
Subject(s)
Civil Rights/legislation & jurisprudence , Disabled Persons/legislation & jurisprudence , Environment , Humans , Prejudice , Public Policy , Social Work , United StatesABSTRACT
Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.
Subject(s)
Caregivers/legislation & jurisprudence , Policy Making , Private Sector , Public Sector , Centers for Medicare and Medicaid Services, U.S. , Long-Term Care/legislation & jurisprudence , United StatesABSTRACT
This article reviews the Supreme Court's interpretation of Title II of the Americans with Disabilities Act (ADA) and discusses its application for the frail older person. The parallels and differences between the societal ideas about, and the development of, community-based housing programs for younger populations of people with disabilities and for aging populations will be examined. This article explains how frail older people may be included in the ADA's definition of persons with disabilities. It then explains the Supreme Court's interpretation of discrimination in Olmstead v. L.C. ex rel Zimring (1999). Lastly, it examines the implications of the Olmstead decision for long-term care as it relates to housing for older people.