This thesis examines why community care policies for adults with learning disabilities have proved so hard to implement in a sustained, equitable manner, and explores the apparent chasm between official policy and actual practice in the light of current theories of social policy implementation. It focuses specifically on the relationship between health and social services, and investigates the factors which affect the ability of these agencies to co-operate effectively in the provision of services to this client group. The study compares services in two areas of England. In each study area a series of semi-structured interviews were conducted with staff at all levels within statutory learning disability services, from senior health and social service managers to frontline practitioners. Interviews were taped and transcribed in full prior to coding. Analysis was informed by both grounded theory and discourse analytic methodologies, but is best summarised as a thematic content analysis. Findings suggest that three major factors affect inter-agency relations and impact upon policy implementation: the complexity of service structures; professional and cultural differences between health and social service staff; and the wide variation in the local interpretation of national policy. The implications of these findings for the future of learning disability services are discussed. In particular, the need for policy makers and implementers to pay greater attention to the creation of organisational structures which encourage, rather than hinder, cooperation across traditional agency boundaries is emphasised.

This thesis is concerned with the central rationale of feminism, and thus of feminist perspectives in criminology, to bring about change for women subject to the criminal justice system. It argues that any attempt to influence that system, to bring about change or reform, must be considered within the broader context of policy-making and programme development and their underlying assumptions and purposes, as well as in relation to specific contextually located histories. It does so by tracing the history of a particular feminist initiative in Canada - a community-based programme in Nova Scotia which offered feminist therapy and counselling to women in conflict with the law. It traces the processes of funding and evaluation for the federal government, and the differential experiences of the project and its clients, the researchers, and the funders. In so doing it considers the role of policy and programme development and of feminist attempts to reform and their failure to impact the lives of sentenced women; it examines the development of feminist methodology and contrasts it with mainstream correctional methodology and evaluation; it explores the development of feminist intervention and some of the problems inherent in such approaches and their appropriateness for women in the correctional system; and it examines the difficulties encountered in evaluating a feminist initiative. The views of the project and of its women clients are explored to assess the impact of the intervention, its benefits for the women, as well as its limitations. This analysis shows how the project, while successful in avoiding many of the problems of feminist intervention, was unable to sustain itself beyond the period of federal funding, while the evaluation itself proved to be a difficult process. The discrepancies between feminist ways of working and the dominant correctional models, the assumptions underlying programme development and evaluation, and the limitations of that approach are revealed as a series of over-lapping layers which impact on feminist endeavours.

This study examines the implicit assumptions underpinning reforms to the tax and benefit system by the Labour Governments since 1997. It questions whether individuals are income-maximising individuals responsive to changes in the costs and benefits associated with employment. The Working Families' Tax Credit and its replacements the Working Tax Credit and Child Tax Credit, elements of the Government's strategy for encouraging employment and reducing child poverty (HM Treasury, 2001), contain an unspoken acceptance of a particular 'rational economic man' model of behaviour. Recent sociological research around employment and parenting indicates that decision-making is more nuanced than the rational economic model allows. Duncan and Edwards (1999) suggest instead a 'gendered moral rationalities' model, placing specific socially negotiated moral understandings of children's needs at the centre of employment decisions, with financial incentives, a secondary concern. A central question of this thesis is therefore, do prior policy assumptions about employment and budgeting decisions accord with reality? How has the reform of the tax and benefit system affected decision-making around employment and family budgeting, and what has it meant for individuals and their families? Little longitudinal qualitative research has been conducted into the employment and family budgeting decisions made by families in receipt of tax credits and how these alter over time. Based on two waves of interviews with lone parent and couple families receiving income from the tax credit system this study, as such, contributes to the above debates about employment and budgeting behaviour. The study suggests there is a need to focus greater attention on the temporality of decision-making, as economic and social processes are themselves temporally situated. Participants sought a 'welfare balance' that reconciled their current commitments to care and material needs. Decisions shifted in response to changes in policy structures, notions of moral behaviour, caring responsibilities and financial needs over time.

Observation of deaf children in conversation with their teachers might lead one to believe they are behaving in a somewhat contrived way in comparison with their behaviour when communicating with their peers. Examination of the performance of deaf and hearing children on various reading tests has shown the deaf to be pursuing markedly different strategies from the hearing (e.g. word association). Such observations lead us to ask, is the linguistic behaviour of these children then simply a selection of 'special tricks' developed to cope with everyday demands? Or, if various measures of their language intercorrelate, can we assume the existence of a unitary linguistic competence? To answer this question and to investigate the validity of the measures chosen, a group of 50 profoundly deaf children from two schools for the deaf were studied (where necessary using, videorecordings) in 4 situations. These were a) in conversation with their teachers, b) in a referential communication game with their peers, c) their performance on the Edinburgh Reading Test and d) their writing. Since degree of hearing loss, age, sex and intelligence have been shown to be influential, we included these together with teacher ratings of oral proficiency, general ability, attitude to school, written ability and speech intelligibility. The results showed all language measures intercorrelated with varying degrees of significance. Multiple regression analysis showed that the -main measure taken from the conversation with teachers (namely, average length of turn) proved to be the most powerful predictor of reading. Written syntactic accuracy was the second most powerful predictor. Since reliable measures of deaf children's linguistic abilities are badly needed (especially in the wake of recent legislation advocating the education of deaf children in ordinary schools) the potential use of these measures is discussed. Since these language abilities are good predictors of each other, future research might investigate the possibility that concentrated teaching in one area of language use could have positive effects on other linguistic abilities.

The Child Support Agency became operational in April 1993. The government hoped to introduce a system which would be clear and consistent and would deliver realistic amounts of child maintenance from more absent parents than under the old court and Department of Social Security systems. In so doing, the new system would reduce animosity between parents by removing child maintenance from any other divorce or separation negotiations and applying a fixed formula. However, it quickly became obvious that the new system for the assessment, collection and enforcement of maintenance for children was failing. This study adds to the debate about why the system failed by looking at what influenced government policy, both in the setting up of the Agency and in the changes introduced between April 1993 and April 1996. The study draws on evidence from politicians and political parties, the civil service, the voluntary sector and protest groups set up specifically to oppose the Agency. By outlining the attempts made by these various groups to influence the government and by closely examining the detail of the legislation and the formula used by the Agency, the study shows where the government responded positively to lobbying and whose influence was effectively ignored. The study also shows how the government managed to retain its commitment to reducing public expenditure and promoting "family values" as the basis of child support policy, but in practice failed to deliver on the main aims of the policy. Having analysed the failings of the system, the study concludes with some positive suggestions for improvement.

Cancer of the colon and rectum is a major cause of ill-health. Options for reducing the burden of the disease include primary prevention, screening for early stage asymptomatic disease and improvements in the treatment of symptomatic disease. If the policy objective is to make a major impact on mortality from the disease then screening appears to be the only technically feasible option. One indication of asymptomatic colorectal cancer is small quantities of blood mixed with faeces. Screening tests capable of detecting bleeding are currently being evaluated in clinical trials. Interim measures of the costs and disease yield of a screening programme using a faecal occult blood test imply that screening may offer good value for money but only if the intended mortality reduction from the disease is realised. There are various ways of 'fine-tuning' the screening programme to improve the balance of costs and benefits; information for making choices regarding important parameters such as the age range of the population to be offered screening are presented. Alternative screening tests are also evaluated and the results presented in terms of the cost-yield trade-off. The policy implications of the evaluation must be qualified at this stage since no proof of mortality reduction will be available until the conclusion of the ongoing trial. Nevertheless, under various assumptions about the impact of screening, the option appears to be an efficient way of reducing the health 'costs' of colorectal cancer.

The process of underdevelopment in Papua New Guinea is bringing rapid change for the mass of people as more areas are incorporated into the export oriented cash economy, with disruption of social and economic formations, growing inequality and deepening dependency. This is despite national objectives emphasising more equal development based on the needs of the rural majority. Health services have grown within the framework of underdevelopment and are characterised by an imported clinical model, hospital bias and inequality. The 1974-1978 health plan attempted, unsuccessfully, to reverse trends to urban, curative services and to develop basic rural services using the aid post system in particular. Aid post provision began after the second world war but has, until recently, suffered from relative neglect. Attempts to plan more effectively, and recent decentralisation, may provide the basis for the development of services following a primary health care approach. However, redistribution of resources to the rural majority remains problematic. The Southern Highlands province ranks lowest on most health indicators; as in the majority of rural areas morbidity and mortality patterns indicate the need for primary health care. The distribution and utilisation of health services within the province reflect the national situation, with emphasis on hospital and health centre treatment. Provincial objectives include spatial redistribution of health facilities to improve access and the pursuit of primary health care, focussed on aid posts. Among a number of problems found with aid posts, the orientation and attitudes of orderlies may be inimical to the community development approach of primary health care. The massive, externally-funded, economic development project in the province epitomises the dilemmas of change in the country. For health, as for so much in contemporary Papua New Guinea, the question is whether change will bring development or the extension of underdevelopment.

This study aims at analyzing Turkish health policy from a Primary Health Care perspective as pronounced in Alma-Ata, 1978. The Alma-Ata Declaration has long been regarded as a watershed in the health field and 134 countries, including Turkey, have endorsed the Declaration showing their support for the views expressed in the Document. However, although the international community gave its full support, in practice, different interpretations and implementation of the principles have emerged. Turkey, one of the countries where health has rarely occupied the agenda, has been undergoing radical reforms since the mid 1980s with the ultimate aim of achieving Health for all by the Year 2000 through Primary Health Care. There is full commitment at the national policy-making level to endorse policies coherent with the principles of Alma-Ata. However, not all policies adopted seem to be consonant with what was declared in Alma-Ata requiring a detailed analysis of the policies suggested and implemented. In the light of this, the aims of the study are: (1) to analyze Turkish health policy since the 1960s from a Primary Health Care perspective with the aim of exploring the Turkish response to Alma-Ata; (2) to explore the perceptions of Turkish health policy-makers about Primary Health Care and related issues; (3) to discuss the prospects for Primary Health Care in Turkey. Basic principles of the Primary Health Care approach as declared in Alma-Ata have been taken as a guideline in analyzing Turkish health policy and the perceptions of the Turkish health policy-makers. These principles and their implementation, or the way they are perceived, have guided the research in answering the question ''what are the prospects for Primary Health Care in Turkey?" The nature of the research, based on document analysis and semi-structured interviews, has necessitated a qualitative stance. It was concluded that the Turkish version of Primary Health Care differs from the Declaration in a number of ways. A number of possible reasons for this have been offered. The perceptions of the policy-makers on certain issues that are closely related with the Approach, inter alia, has been found as one of the most possible explanations behind the current situation and a need to alter the ascendant approach towards health issues in general has been emphasized.

Within a period of three months in 1994, up to one million people were killed as a result of war and genocide in Rwanda. Large numbers were physically and psychologically afflicted for life through maiming, rape and other trauma; over two million fled to neighbouring countries and half as many became internally displaced within Rwanda's borders. Post-genocide Rwanda is dramatically different from pre-genocide Rwanda; the genocide transformed the social, political and cultural landscape of Rwanda and undermined the trust that normally binds its people together. It was against this backdrop that I went to Rwanda in 1995 to engage in a process of action research with local stakeholders, in order to formulate, implement and evaluate a sustainable and effective police training programme. I was also able to reflect upon and research the issues of cultural transferability in a training context. This thesis therefore engages with both of those issues through a framework of the integrated theories of Weaver's `Colliding Icebergs' (1993) and Schein's Process Consultation (1987 and 1998). Weaver believes that entering another culture is similar to two colliding icebergs. The real clash occurs beneath the water where values and thought patterns conflict - the area that Schein describes as `Process' or, when deep-rooted and recurrent, `Structure', that is how things are done. The part of the iceberg that is above the surface would be described by Schein as the `Content' part of culture, that is what is done or the task that is to be achieved. This research describes how our team and other international community transfer agents initially concentrated on the Content aspects of their research and assistance programmes and ignored the Process and Structure elements. In some cases this limited focus had catastrophic effects as many aid workers failed to incorporate the implications of genocide into the design and implementation of their assistance programmes. This apparent lack of understanding of the psychological impact of genocide (Process and Structure) contributed to the distrust, and even outright hostility, of the Rwandan government and its people towards many of the international field operations in Rwanda. Whilst working with and developing this theoretical framework for over four and a half years, in a particularly complex and sensitive cross-cultural situation, I identified many strengths that supported this action research. The integrated theories enabled both researchers and practitioners to analyse the cross-cultural situation in which they found themselves in order to fully understand the context of their research and interventions. Additionally, transfer teams and their stakeholder colleagues were able to artificially accelerate the maturity of their crosscultural team, by making their own development part of their formal agenda (Content), rather than leaving it to chance. This research therefore confirms the importance of personal and organisational intercultural training prior to and during any cross-cultural training event and emphasises the need to analyse, and intervene appropriately, in Content, Process and Structure issues. This includes the importance of understanding the external environment that the culture under research finds itself in and the need to acknowledge the shifting and kaleidoscopic nature of ethnic differentiations and identities. It also stresses the importance of communication and, mutual reflection and learning by the `insider' and `outsider' of the culture in which the action research and training is to be carried out.

This thesis contains a survey of the mobility problems of blind people, experimental analysis and evaluation of these problems and suggestions for ways in which the evaluation of mobility performance and the design of mobility aids may be improved. The survey revealed a low level of mobility among blind people, with no significant improvement since a comparable survey in 1967. A group of self taught cane users were identified and their mobility was shown to be poor or potentially dangerous. Existing measures of mobility were unable to detect improvements in performance above that achieved by competent long cane users. By using newly devised measures of environmental awareness and of gait, the advantages of the Sonic Pathfinder were demonstrated. Existing measures of psychological stress were unsatisfactory. Heart rate is affected by physical effort and has been shown to be a poor indicator of moment-to-moment stress in blind mobility. Analysis of secondary task errors showed that they occurred while obstacles were being negotiated. They did not measure stress due to anticipation of obstacles or of danger. In contrast, step length, stride time and particularly speed all show significant anticipatory effects. The energy expended in walking a given distance is least at the walker's preferred speed. When guided, blind people walk at this most efficient pace. It is therefore suggested that the ratio of actual to preferred speed is the best measure of efficiency in mobility. Both guide dogs and aids which enhance preview allow pedestrians to walk at, or close to, their preferred speed. Further experiments are needed to establish the extent to which psychological stress is present during blind mobility, since none of the conventional measures, such as heart rate and mood checklists show consistent effects. Walking speed may well prove to be the most useful measure of such stress.