吉林省新型农村合作医疗现状与应对策略

农民的健康问题关系到保护农村生产力、振兴农村经济、维护农村社会和谐发展和稳定的大局,对提高全民族素质具有重大意义。吉林省新型农村合作医疗（简称新农合）基本解决了农村居民因病致贫、因病返贫问题,广大农民主动就诊意识明显提高,＂小病拖,大病扛＂的现象得到了缓解,但还存在一些问题需要尽快采取措施加以解决。一是要加大宣传力度,让广大农民充分了解新农合的好处;二是要加强对新农合基金的管理;三是要科学调整补偿方案,提高补偿比例;四是要加快信息化建设,提高管理效率和水平;五是要大力加强农村卫生服务体系建设;六是要健全农村医疗保险制度。     

A SECOND CHANCE FOR CHILDREN AND FAMILIES: A MODEL STATUTE TO REINSTATE PARENTAL RIGHTS AFTER TERMINATION

There are more than half a million children in foster care in the United States. Some of these children are adopted into loving families, but many are considered hard to adopt and never find a permanent family. Research suggests that the outlook for the teens who exit or age out of foster care without a permanent home or a meaningful adult relationship is bleak. They are more likely to face homelessness, joblessness, drug addiction, early pregnancy, mental health problems, and prison time. With such grim statistics, states should explore every possible permanent family resource for youth in foster care. This Note proposes that, in limited circumstances, it is in the best interest of the child to vacate a final order of termination and reinstate parental rights. It calls for states to adopt a model state statute based on the five state statutes currently in place that already allow for the reinstatement of parental rights.     

Foster children＇s right to family： A description and analysis of the legislative approach in Sweden

This paper emphasizes the foster children＇s right to family life and investigates whether change of custody and guardianship to foster parents is a successful option to achieve this right. Using CRC as the base for my definition of the right to family I will include the right to continuity, well-being and a family environment in the understanding of the term ＂right to family＂ in this article. These rights may, primarily, be fulfilled by the child＇s parents, and, if necessary for the best interest of the child, be complemented or substituted by foster or adoption parents. The analysis of different solutions concerning state interventions will base on Swedish law. In Sweden, a child in need of help or assistance as a result of abuse, neglect, or other inappropriate behavior in the home setting may be helped by the Social Welfare Committee-voluntarily or by a court order-in the child＇s home or a foster home. Other alternatives contain judicial involvement by changing custody and guardianship or making a decision for adoption. Since many years ago, the most commonly used alternative for children needing long term placements outside their homes in Sweden has become foster care. This development of many long-term placements has been criticized for not fulfilling the needs of the children, especially their needs for family continuity, stability and well-being. As a consequence, an amendment to the Social Services Act 200l was enacted in 2003 which states that the Social Services Committee shall consider the ＂permanence＂ of foster care by changing custody and guardianship to the foster parents three years later since a child starts in foster care, and every six months thereafter, as long as the child remains in the foster parents＇ care. Assuming that the foster parents are fit and willing to become custodians and guardians, and the child views the foster home as his or her home, the District Court can decide to change the custody and the guardianship to the foster parents. The assessment is to be based solely on the best interest of the child, and not on the fitness or wishes of the original custodian. However, can changing the custody and guardianship assist foster children＇s right to family？ This paper elaborates on this question by describing a legal reform in Sweden.     

Parents’ Perspectives on Family‐centered Care in Juvenile Justice Institutions

Family‐centered care during adolescent detention aims to increase parental participation in an attempt to optimize treatment outcomes. However, little is known about parents’ needs in family‐centered care. To fill this gap, we interviewed 19 purposefully selected parents of detained adolescents using a semi‐structured topic list. Although needs differed between parents, they were generally interested in activities that included spending time with their child. It is important for parents to receive timely information about their child's condition and treatment, detention procedures, and activities in the facility. The outcomes demonstrated that parents expected a two‐way communication based on respect and reliability.     

The clinician–patient working alliance: is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees?

Persistent psychiatric symptoms can serve as a major barrier to the successful reintegration of parolees with mental illness. Thus, it is important to identify factors that might impact their mental health recovery, such as low adherence to their treatment regimen. The strength of the clinician/patient working alliance has been found to be significantly associated with psychiatric medication adherence in prior research, but this relationship has not been assessed in a parolee population. Logistic regression analysis was used to determine if patient-rated working alliance was a significant predictor of low psychiatric medication adherence while taking into account alcohol/illegal drug use, age, and ethnicity in a sample of recently released parolees with mental illness (N = 49). Patient-rated working alliance, age, and ethnicity were not significant predictors of low adherence. Alcohol/illegal drug use during the follow-up period was associated with a significantly increased likelihood of meeting the criteria for low medication adherence (OR = 8.36; 95% CI = 1.60, 43.66). While working alliance was not found to be a significant predictor of medication adherence in this study, further research is needed to examine how substance misuse impacts the clinician–patient working alliance in this population.     

Older Youth in Extended Out-of-home Care

The purpose of this study is to examine the permanency experiences of older youth, age 18–21 in out-of-home placements and placement characteristics that influence age of exit from child welfare. Findings suggest a difference between age groups with more 18-year old youth exiting to emancipation than youth who exit at age 21. A higher number of spells in care and a higher number of placement changes during the last spell were associated with exit to emancipation. Additional study findings suggests that youth who leave care before the age of 21 may be more vulnerable than youth who stay through age 21. Implications for practice are discussed.     

Evaluating integrative services in edge-of-care work

Children living on ‘the edge-of-care’ are typically known to local safeguarding authorities and are considered likely to face risks to their safety. Many are subject to a child protection plan and/or involved in ‘pre-proceedings’ processes. A growing number of their parents face (un)diagnosed mental health difficulties as well as economic and social precarity. This article draws on a mixed methods evaluation of a pilot service in the East of England offering a therapeutically led attachment-based intervention for families. The service cross-cuts health and social care, allowing psychologists and psychotherapists to work alongside social workers and other practitioners. The evaluation examined psychological and safeguarding outcomes and explored practitioner perspectives. A key outcome was that 85.4% of families were enabled to remain, or reunite with their child, compared with an estimated 50% of ‘edge-of-care’ cases nationally. This supports the need for similarly oriented interventions that could help lower the incidence of child removals.     

Transferring custody from birth parents to foster parents – an ambiguous matter

In this study, we analyse 32 district court decisions regarding custody transfers from the birth parents to the foster parents in Sweden. When a child has been in foster care for three years, in order to enhance stability for child, the local social welfare committee considers a transferral of custody to the foster parents following an application to the district court. Although all but one of the decisions in our study favoured a custody transfer, the courts acknowledge different reasons for this. Specifically, there is vagueness about whether or not functioning contact between the child and birth parents is a hindrance in custody transfer. Our findings stress the need for clarification in the law regarding the criteria for custody transfer in order to reach a more unified judgment. Furthermore, the district courts do not sufficiently acknowledge children’s views, and we suggest that children and young people should be made more visible in the decision-making process.     

Integrating Behavioral Health Care and Primary Care: Application of a Clinical and Economic Model in Culturally Diverse Communities

Although mental illness treatment protocols exist, the organization and financing of screening and treatment services inhibit access. These challenges are compounded for refugees, immigrants, and other groups vulnerable due to their ethnicity, race, or culture. By creating a system-wide, collaborative, integrated model that recognizes and addresses critical clinical and economic aspects in the delivery of services, high quality, evidence-based care can be made available to groups susceptible to the burdens of mental illness. Clinically and financially aligning primary and specialty care offers a viable alternative for improving access and quality of mental health services to vulnerable populations.