Freedom to think – the value of multiple clinical narratives in women’s prisons†

Abstract

The merits of being multi-lingual are widely recognised. This paper considers the application of this metaphor to the conceptualisation of clinical work in a women’s prison. We suggest that sharing ‘languages’ from different theoretical orientations in open fora enables teams to build deep and nuanced understandings of clinical and systemic complexity, of particular value in secure settings. This discussion reflects the service model developed and used within HMP/YOI Holloway, a large women’s prison in London, which has recently been closed. We utilise a case example, with formulations and recommendations from several perspectives, to illustrate the value of maintaining a rich, inclusive discourse. We describe the benefits of such an approach to staff teams, to institutions and to those we serve, and consider the implications for organisation of services to maximise potential for change and recovery.     

The Competence-Related Abilities of Adolescent Defendants in Criminal Court

Increasing numbers of youths are being tried in criminal court because of statutory measures that have decreased the use of judicial review as the primary mechanism for transfer. The relative immaturity of adolescents suggests that transferred youths might have impaired competence-related abilities compared to adults. To test this hypothesis, we compared the competence-related abilities and developmental characteristics of a sample of direct-filed 16-17-year-olds charged in criminal court in the state of Florida (Direct File sample) to a sample of 18-24-year-old adults charged in criminal courts (Adult Offender sample) and to a separate sample of 16-17-year-olds charged in juvenile court (Juvenile Court sample). Results indicated that there were few differences between the Direct File youths and Adult Offenders. The differences that were observed suggested that the Direct Filed youths performed slightly better than the Adult Offender group and the Juvenile Court youths charged in juvenile court. These findings suggest that as a group, 16-17-year-old Direct File adolescents do not have significant deficits in competence-related abilities due to age or immaturity.     

The potential impact of private long-term care financing options on Medicaid: the next thirty years

This study analyzes the potential effect on the Medicaid program of private sector financing mechanisms for long-term care. The data are from the Brookings-ICF Long-Term Care Financing Model and include projections over the next thirty years. While private financing alternatives have some modest impacts on Medicaid expenditures and the number of Medicaid long-term care recipients, the data suggest relatively little change in the need for Medicaid. There will be substantial increases in Medicaid long-term care expenditures over time, and private sector options cannot change this much.     

Adolescent sexual activity and pregnancy: Socioenvironmental problems,physical health,and mental health

This paper examines the association between adolescent pregnancy and socioenvironmental, physical, and mental health problems in 1590 inner-city females aged 13–18 who use health clinics. Adolescents who have become pregnant, those who are sexually active but never have been pregnant, and those who are sexually inactive are compared. The sexually active youngsters come from more psychosocially disadvantaged backgrounds than their sexually inactive peers; the sexually active girls who become pregnant come from more psychosocially disadvantaged backgrounds than those who have never been pregnant. Despite this, the youths who have become pregnant do not have more current relationship problems, more stressful life events, or worse physical health than the never-pregnant sexually active youths. Although sexually inactive youths have the lowest rates of mental health problems, adolescents who have been pregnant have lower rates of anxiety and conduct disorder symptoms than those who are sexually active but never pregnant.Supported by the Robert Wood Johnson Foundation. Fieldwork conducted by Survey Research Associates.Research interests include adolescents and children, parenting, and families.Research interests include epidemiology of child and adolescent psychiatric disorder.Research interests include psychiatric epidemiology/deviant behavior.Research interests include mental health and statistical issues.Research interests include health behavior and mental health issues.     

Evaluating partnerships for community health improvement: tracking the footprints

Private-public partnerships are increasingly seen as an important mechanism for improving community health. Despite their popularity, traditional evaluations of these efforts have produced negative or mixed results. This is often attributed to weak interventions or an insufficient period of time to observe an impact. This study examines two additional possibilities--the need for a well-articulated shared vision and the governance and management capabilities of the partnership itself. We conducted a midstream process evaluation of twenty-five community partnerships associated with the Community Care Network (CCN) Demonstration Program. We examined how the roles of a common shared vision, strong governance, and effective management influence a partnership's ability to achieve its objectives. The findings, based on both qualitative and quantitative analyses, underscore the importance of membership organizations' perceived benefits and costs of participation and management capabilities to the partnership's progress toward a vision. Based on the qualitative data, six key governance and management characteristics are identified that separate the top performing partnerships from the lowest performing ones. We explore the implications of this research for future evaluations of public-private community health partnerships.