The accessibility, predictors, and use of health care and social services among developmentally disabled elderly adults in Canada were examined using a nationally representative social survey. The first research hypothesis is that the independent variables will contribute significantly to the prediction of the dependent variables. A second hypothesis is that the slope of any given independent variable will not equal zero. The results of this research show that the illness (need) variables are the most predictive correlate of the utilization of health care and social services. The predisposing variables have secondary explanatory power, with the enabling variables accounting for the least amount of variance. The hypotheses were tested by step-wise multiple regression analysis using SPSS-X.

This study analyzed data from Dallas Public Schools and Dallas Youth and Family Centers (YFCs) to explore variables associated with referrals to and utilization of Youth and Family Centers. Data from students enrolled in third, eighth or tenth grade during the 1996-1997, 1997-1998 and 1998-1999 school years were analyzed to determine the reasons for YFC referral and utilization, and to compare standardized test scores and attendance. Of the 6956 students in third, eighth and tenth grades initially referred to YFCs during those three school years, 5173 (74.3%) made at least one YFC visit. The 5173 students made an average of 2.69 visits and accessed an average of 1.18 services per year. Medical visits accounted for 42.5% of YFC visits, and mental health visits accounted for 46% of YFC visits. Results of logistic regression analyses indicate a significant difference for utilization upon referral and continued use of the YFC when the constant is compared to a set of predictor variables. For both analyses, the predictor variables were Chapter I status, LEP status, reason for referral, gender, special education status, ethnicity, distance from home school to referral YFC, food stamp eligibility and referral source. While outcome data regarding attendance and scores on standardized tests was limited to records available, results suggest that mean reading scores for eighth graders were significantly higher during Year 1 for the group that accessed YFC services. School attendance was better for eighth graders who made continued use of a YFC. Use of medical services by third graders was associated with a gain in attendance rather than a slight loss for the third graders who did not access medical services upon referral. Results of this study were limited by missing data for several records. The competitive atmosphere of health care service delivery and the practical need to know about service delivery at the sites should make data management a priority.

The purpose of this study was to look at the factors that lead to disruption in the adoption of special needs children. Families that adopt special needs children may or may not be aware that they need post adoption services and may be reluctant to ask for them even when they are experiencing difficulty.

published_or_final_version / Public Administration / Master / Master of Public Administration

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessible / Information Science / MA (Public Health)

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2007. / The research focuses on the needs of Xhosa-speaking learners with Down syndrome. The needs of these learners are not known by the service providers. Different organisations base their service delivery to these communities on the needs of learners with Down syndrome from other cultures. It was therefore imperative for this study to discover the needs of Xhosa-speaking learners with Down syndrome from a disadvantaged background. The study involves a case study of two Xhosa speaking learners with Down syndrome. A major aim was to depict the quality of life of the learners with Down syndrome. This was done from an ecosystemic perspective. In the case study the needs of these two learners with Down syndrome in a Xhosa community are portrayed through the voices of their parents, educators, neighbours, and the two learners with Down syndrome. The following means of data production were used: interviews and observations. The parents, siblings of the learners with Down syndrome, and the learners with Down syndrome were seen as experts in the process.

Childhood abuse, whether physical or sexual, is a major public health issue. The most recent United States data from Child Protective Services (CPS) show that in 2013 there were 3.5 million referrals of child maltreatment involving 6.4 million children. Out of these cases, 18% were for physical abuse and 9% were for sexual abuse. However, researchers argue that CPS data grossly underestimate the prevalence of childhood abuse as most childhood abuse goes unreported. Indeed, to date, the true prevalence of childhood abuse remains unknown as research has been hampered by inconsistent definitions of abuse and wide variation in methodologies including measures for its identification and modes of administration of these measures. Although a health care visit presents an opportunity to identify a childhood abuse history, health care providers frequently fail to ask about it. The reasons doctors give for not asking about abuse include lack of training, not knowing how to ask, and lack of familiarity with practical methods for screening that can be used in primary care settings. There is little to no research on effective means for identifying childhood abuse histories, especially in the adolescent and young adult population, or on how different modes of administration of screens to identify childhood abuse compare to each other. The net result is that most childhood physical and sexual abuse is never identified and many victims do not get the needed services to help them heal. When unaddressed, childhood abuse has negative impacts on victims’ health and wellbeing over the life course. Prior studies of adults show that when compared with non-victims of abuse, victims tend to perceive their health as poorer and utilize more health care services including emergency room and urgent outpatient care. These studies also suggest that adult victims use less routine and preventive care than non-victims. Only two studies, conducted among widely different adolescent populations, have examined how adolescent victims perceive their health. Similarly, limited evidence examining perception of health is available for young adults. These studies found that victims perceive their health as poorer than non-victims. There have been no adolescent-specific studies of how victimization impacts adolescents’ utilization of health care. One study includes participants ages 15 to 98 years and only two studies focusing on this issue in samples primarily of young adults attending college have been published. These studies found that victims utilize more health care than non-victims. Therefore, we lack a sufficient body of evidence to come to clear conclusions of how childhood abuse affects self-perceived health in adolescents and young adults. The general lack of evidence about both how childhood abuse impacts perception of health and utilization of health care in adolescents and young adults indicates a need for further study. Given that little is known about how to best identify an abuse history in adolescents and young adults and the impact of abuse on perception of health and utilization of health care, this dissertation pursued three aims: (1) to review the literature comparing modes of administration of screens to identify adolescent and young adult victims of childhood physical and sexual abuse; (2) to investigate how different modes of administration of screens to identify adolescent and young adult victims of childhood physical abuse within a primary care health setting compare to each other, and; (3) to examine the association of a history of childhood abuse (defined as none, physical only, and sexual with or without physical) with perceived health status and the health care utilization patterns among adolescents and young adults. For aim 1, a comprehensive literature review was conducted via PubMed of studies, published between January 1st, 1994 and December 31st, 2014 that compared modes of administration of screens to identify a history of childhood physical and sexual abuse in adolescents and young adults. Only one study was found. This study compared paper and pencil questionnaire, computer assisted survey, and face to face structured interview in the identification of childhood physical and sexual abuse among young adults in a college setting. No significant difference in the proportion of childhood physical abuse or childhood sexual abuse was identified by mode of administration. The identification through this search of only one study – which was conducted among college students, with no studies done among adolescents – shows a significant gap in our knowledge regarding this issue. Given that understanding how to identify childhood abuse is a critical issue, this gap is disturbing and underscores the need for studies of identification of childhood abuse to be a research priority. For aim 2, a sample of participants, ages 12-24 years, receiving health services at the Mount Sinai Adolescent Health Center in New York City were randomized to one of four modes of administration to identify a history of childhood physical abuse. The four modes of administration of screens to identify childhood abuse were paper and pencil screen, Audio Computer Assisted Self Interview screen (ACASI), face to face structured screen and face to face unstructured interview. The full sample also completed measures to assess demographic characteristics and to screen for depression symptoms. Of the sample, 44.5% of the participants disclosed childhood physical abuse. There was a statistically significant difference in the proportion of childhood physical abuse identified according to mode of administration: face to face unstructured interview identified the highest proportion of childhood physical abuse victims, followed by face to face structured screen. After adjusting for age, gender, race/ethnicity, depression, living arrangement and last grade completed, the odds of identifying physical abuse was 1.6 (95%CI: 1.0, 2.7) and 4.5 (95%CI: 2.6, 7.8) greater for face to face structured screen and for face to face unstructured interview, respectively as compared to paper and pencil screen. ACASI and paper and pencil were similar to each other but inferior to the face to face methods. For aim 3, in addition to what was measured for aim 2, the sample completed measures on a history of childhood sexual abuse and perceived health and health care utilization. The sample was then categorized into three groups: no abuse, physical abuse only, and sexual abuse with or without physical abuse. The association of childhood abuse status with perceived health and health care utilization were examined. There was no statistical significant association between a history of childhood abuse status and perceived health. However, the odds of reporting a fair/poor perception of health among those reporting childhood abuse were at least 40% lower regardless of whether the abuse was physical (OR: 0.60; 95%CI: 0.3,1.2) or sexual (OR: 0.50; 95%CI: 0.2,1.1). No significant association was found between childhood abuse status and health care utilization. However, the odds of victims reporting using urgent care only versus routine care only were at least 10% lower regardless of whether the abuse was physical (OR: 0.50; 95%CI: 0.3, 1.1) or sexual (OR: 0.90; 95%CI: 0.4,1.9). The odds of reporting using both urgent and routine care versus routine care only was similar between victims and non-victims for physical abuse (OR: 1.0; 95%CI: 0.6, 1.5) and was 30% higher for victims of sexual abuse (OR: 1.3; 95%CI: 0.8, 2.2). The findings from the three aims examined identified significant gaps in our knowledge on childhood abuse among adolescents and young adults suggesting an urgent need for further research. While much research has focused on the impact of childhood abuse on health and well-being, aim 1 reveals that little is known about which mode of administration of screens to identify childhood abuse is most effective in the identification of childhood abuse in adolescent and young adults. Furthermore, we know even less about what modes of administration of screens might be practical in primary care settings, or what must be done to improve the level of screening for childhood abuse by physicians and other health care providers. Although the findings from aim 2 suggest that face to face modes of administration are most effective in screening for childhood physical abuse in primary care settings, further studies are needed to support these findings. In addition, there is a need for studies that examine what are the best methods to use to identify childhood sexual abuse in primary care settings. The findings from aim 3 suggest that adolescents and young adults with a history of childhood physical and sexual abuse, receiving health care at the Mount Sinai Adolescent Health Center, do not perceive their health as worse than non-victims nor do they appear to utilize health care differently from non-victims. These findings contrast with results from prior studies of perceived health status and health care utilization among adolescents and young adult childhood abuse victims. Understanding how abuse impacts both the perception of health and health care utilization will be crucial in the development of interventions to identify and support adolescent and young adult victims of childhood physical and sexual abuse.

This study examined disabled people’s access to independent living in Scotland and Norway. At the time of the field work for this research in 2012, the literature revealed no comparable social enquiry combining the concepts of citizenship, independent living and governance. Within disability studies, independent living denotes a perspective that recognises the interconnected nature of life areas that affect lived experiences of disablement and inclusion of disabled citizens. From the independent living movement, Centres for Inclusive Living emerged as unique governance structures with full service-user involvement and run by disabled people for disabled people. This study focused upon to what extent the organisational governance structures in the Glasgow Centre for Inclusive Living (GCIL) and Uloba Centre for Independent Living (Uloba) in Norway facilitate or impede disabled people’s access to independent living. The methodology adopted a mixed methods approach. The central method involved organisational case studies with GCIL and Uloba. This enabled an in-depth qualitative exploration through semi-structured interviews with the case study employees, service-user/co-owners and key experts within each country. In addition, an online survey was distributed to other organisations that operated within the disability field. The analytical framework used an integration of the social relational model of disability (Thomas, 1999) and meso level governance analysis (Lowe, 2004). The social relational model of disability provided structural (macro) and agency (micro) level interpretations and an emphasis on psychosocial elements of disability. It also enabled the synergy of a theory of impairment alongside a theory of disability. Meso (organisational) governance analysis focused attention on the connections between organisations in society. This focus revealed the lateral relationships with other meso level bodies, macro institutions and micro individual action. Research participants prioritised the areas of peer support, accessible housing and personal assistance. Peer support was found to take both informal and formal manifestations and acted as a foundation for the other two areas of independent living. The findings highlighted that Centres for Inclusive Living provide facilitation for access to independent living across macro, meso and micro tiers of society. In particular, empowerment, peer support and user led governance formed key strategies that enhanced disabled people’s access to independent living in Scotland and Norway.

The purpose of this study was to identify to what degree specific factors influence the level of satisfaction experienced by foster parents whose foster children are recieving mental health services from agencies that they have been referred to by a Coming of Age Foster Family Agency.

This project focused on immigrants' perceptions of social services and social workers. The study employed the post positivist paradigm. The project was conducted with legal and illegal immigrants who received services at Bilingual Family Counseling Service in the city of Ontario, CA. The study found that the immigrants' perceptions about social service agencies and social workers were multi-determined by at least three elements: knowledge, experiences, and attitudes. The dynamic interaction between experiences and attitudes shaped the immigrants' perceptions. Most of the respondents had a positive attitude toward social workers and social services agencies.