Cultural and Spiritual Constructions of Mental Distress and Associated Coping Mechanisms of Tibetans in Exile: Implications for Western Interventions

The Tibet-TPO project in Dharamsala, North India aims to provideculturally sensitive psychosocial support to Tibetan refugees.In this study we have examined the cultural and spiritual constructionsof mental distress of Tibetan exiles from a secondary analysisof previously published data. Tibetans refugees' constructionsof mental distress were intimately linked to cultural, religiousand political factors. Family and religious support were regardedas key coping strategies, yet many new refugees lacked bothfamily support and detailed knowledge and understanding of TibetanBuddhism. Not all of those interviewed were positive about ‘westernapproaches’ to dealing with mental distress, but thoseusing the service seemed to do so in a pragmatic and integrativeway. We conclude that culturally sensitive psychosocial supportcan usefully ‘fill a gap’, especially for new refugeeswho lack both family support and access to, or understandingof, traditional religious coping mechanisms.     

Fostering rational regulation of patient safety

After decades of inattention to the problem of medical injuries, patient safety is now occupying a prominent place on the health policy agenda and garnering renewed regulatory interest. Health care providers' behavior, with respect to patient safety and health care quality improvement, is now being shaped by top-down regulation through statutes and administrative agency oversight, as well as bottom-up drivers such as tort litigation and the forces of the consumer-driven health care market. Patient safety today exemplifies that eclectic mix of regulation that can occur when a new problem is exposed to the general public; it also demonstrates the difficulties of coordinating regulatory signals from multiple sources and regulating incomplete information. This article reviews the evolution of the regulatory environment for patient safety, examines some of the tensions and challenges that currently define patient safety oversight, and suggests strategies for more rational and responsive regulation.     

An Implicit Contract Theory of Intergovernmental Grants

A central puzzle in the economic analysis of intergovernmentalgrants in a federal polity is the conflict between the predictionsof the standard theory and empirical observation. Standard theoryhas no explanation for the widely observed fact that "moneysticks where it hits," that is, for the "flypaper effect" fromspecific, non-matching grants. This effect is observed whengrants that apparently are the economic equivalents of generalrevenue grants have the consequences to be expected from matchingspecific grants. We propose a resolution. Most grants are accompaniedby an implicit as well as an explicit contract between grantorand recipient. The purpose of these contracts is to influencethe behavior of the recipient, by making the size of the streamof grants conditional upon the recipient's responses to thewishes of the donor.     

Between logframes and theory of change: reviewing debates and a practical experience

Theory of Change (ToC) is an emerging methodology in the practice of development programmes, often contrasted with the dominant logical framework. This article reviews current debates around ToC before identifying five aspects that are appreciated in practice. It appears that these aspects mostly cover areas where the logical framework is not – or is no longer – meeting the needs of practitioners. Subsequently, the article analyses experiences in ToC training for NGO staff and concludes that ToC can address shortcomings of the logical framework – if only by going back to some of the roots of the logical framework.     

Discovering Directions for Change in Higher Education Through the Experiences of Senior Women Faculty

The Women in Science and Engineering Leadership Institute (WISELI) at the University of Wisconsin–Madison, an NSF-funded ADVANCE Institutional Transformation project, employed the “discovery interviews” method to characterize the experiences of senior women faculty in science and engineering on campus. This method allowed WISELI to reach its aims of (1) gaining information from senior women that would inform the programs developed by WISELI, and (2) building relationships among the senior women and WISELI. The discovery interview process also had some unintended consequences, including creation of an expectation of advocacy that exceeded the original intent of the project. This method was well-matched to the needs of WISELI as a change agent at the UW-Madison, and has contributed a great deal to its Institutional Transformation efforts, primarily by changing WISELI’s perceptions of what leadership means to senior women faculty.