A process for the systematic review of community-based rehabilitation evaluation reports: formulating evidence for policy and practice

A methodological framework for conducting a systematic, mostly qualitative, meta-synthesis of community-based rehabilitation (CBR) project evaluation reports is described. Developed in the course of an international pilot study, the framework proposes a systematic review process in phases which are strongly collaborative, methodologically rigorous and detailed. Through this suggested process, valuable descriptive data about CBR practice, strategies and outcomes may be synthesized. It is anticipated that future application of this methodology will contribute to an improved evidence base for CBR, which will facilitate the development of more appropriate policy and practice guidelines for disability service delivery in developing countries. The methodology will also have potential applications in areas beyond CBR, which are similarly. evidence poor' (lacking empirical research) but 'data rich' (with plentiful descriptive and evaluative reports).

Working with involuntary clients: Perceptions and experiences of outreach social workers in Hong Kong

The outreach social work service is one of the dominant youth work approaches in dealing with delinquents and youths 'at-risk' in Hong Kong. Yet this approach presents particular challenges. Outreach social workers usually play an active role in initiating and establishing contacts with young people, yet young people are reluctant to engage with the outreach social workers and are resistant towards therapeutic change. To date, little is known about what strategies and techniques are most effective in dealing with client resistance in this context. The aims of this paper are to gain a better understanding of the common resistant behaviours that outreach social workers usually encounter in their day-to-day practice, and to investigate how the outreach social workers respond to their clients' resistance with reference to case examples given in the in-depth interviews. The findings of this study provide evidence that whilst client resistance is common in the outreach social work setting, social workers' patience as well as sensitivity are essential in resolving resistance and building up a rapport with clients.

The development of self-awareness and relationship to emotional functioning during early community reintegration after traumatic brain injury

Impaired self-awareness may affect clients' emotional status, engagement in rehabilitation and community reintegration following traumatic brain injury (TBI). The study aimed to investigate the relationship between self-awareness, emotional distress and community integration in adults with TBI during the transition from hospital to the community. Thirty-four rehabilitation clients with TBI were assessed in the week before and 2 months after discharge home. Measures of self-awareness and emotional functioning were administered predischarge and repeated at follow-up along with a measure of community integration. Nonparametric tests were used to compare levels of self-awareness and emotional distress pre- and postdischarge, their interrelationships and association with community integration. Self-awareness significantly increased following discharge, and a trend towards increased depression was found. There were no consistent relationships found between level of self-awareness, emotional functioning, and community integration. The development of self-awareness in the immediate postdischarge phase suggests this is an important time for clinical interventions targeting compensation strategies and adjustment to disability.

Investigation of the coping antecedents to positive outcomes and distress in multiple sclerosis (MS)

This study examined relations between stress and coping predictors and distress and positive outcomes in multiple sclerosis (MS). A total of 502 people with MS completed a questionnaire at Time 1 and, 3 months later, Time 2 (n= 404). Predictors included Time 1 illness (duration, number of symptoms, course), number of problems, appraisal and coping (acceptance, problem solving, emotional release, avoidance, personal health control, energy conservation). Dependent variables were Time 2 distress (anxiety, depression) and positive outcomes (life satisfaction, positive affect, benefits). Results indicated that as hypothesised, personal health control, emotional release and physical assistance were related to the positive outcomes, whereas avoidance was related to distress, and acceptance was associated with the positive outcomes and distress. Findings highlight the differential relations between coping strategies and positive and negative outcomes and the role of appraisal and coping in regulating distress and promoting positive psychological states while managing a chronic illness.

Poverty and the economic effects of TB in rural China

OBJECTIVE: To investigate the economic effects of illness on individual tuberculosis (TB) cases in rural China and to use a case-control study to show a strong TB-poverty link. SETTING: In 2002-2004 we studied 160 new smear-positive pulmonary tuberculosis (PTB) cases and 320 age- and sex-matched controls living in neighbouring houses in four rural counties of Henan Province. DESIGN: Cases and controls were interviewed 1-3 months after patients were diagnosed. We used matched multivariate logistic regression to compare cases with controls for poverty status using household income, household assets and relative wealth within the village. We conducted follow-up interviews of patients 10-12 months later to assess economic effects by collecting data on treatment costs, income losses, coping strategies and treatment completion. RESULTS: Poverty is strongly associated with TB incidence even after controlling for smoking and other risk factors. Excluding income losses, direct out-of-pocket treatment costs (medical and non-medical) accounted for 55.5 % of average annual household income, and most TB cases fell into heavy debt. The DOTS cure rate was 91 %. When DOTS was incomplete or not done, mortality was high. CONCLUSIONS: Poverty is both a cause and a devastating outcome of TB. Ongoing poverty reduction schemes in China must also include reducing TB.

The psychosocial impact of caregiving on young people who have a parent with an illness or disability: Comparisons between young caregivers and noncaregivers

Objective: To investigate the psychosocial impact of young caregiving by empirically validating prominent qualitative themes.. This was achieved through developing an inventory called the Young Caregiver of Parents Inventory (YCOPI) designed to assess these themes and by comparing young caregivers and noncaregivers. Method: Two hundred forty-five participants between 10 and 25 years completed questionnaires: 100 young caregivers and 145 noncaregivers. In addition to the YCOPI, the following variables were measured: demographics, caregiving context, social support, appraisal, coping strategies, and adjustment (health, life satisfaction, distress, positive affect). Results: Eight reliable factors emerged from the YCOPI that described the diverse impacts of caregiving and reflected the key themes reported in prior research. The factors were related to most caregiving context variables and theoretically relevant stress and coping variables. Compared with noncaregivers, young caregivers reported higher levels of young caregiving impact, less reliance on problem-solving coping, and higher somatization and lower life satisfaction. Conclusions: Findings delineate key impacts of young caregiving and highlight the importance of ensuring that measures used in research on young caregivers are sensitive to issues pertinent to this population.

Pedagogies and critical reflection: key understandings for transformative gender justice

It is widely acknowledged that quality pedagogy is central to improving the educational outcomes of all students. In improving the social and academic outcomes of boys, and more specifically disengaged boys, the productive pedagogies model has been presented as a way forward. In terms of drawing on this model in socially just ways; to facilitate a broadening, rather than reinscribing of boys' narrow constructions of gender identity, this paper illustrates the imperative of teachers interacting with key feminist understandings of masculinity. Organized around the four dimensions of productive pedagogy, the paper draws on ( predominantly Australian-based) seminal work in the sphere of masculinities and schooling to discuss key strategies and initiatives for improving boys' educational outcomes. Against this backdrop, the paper demonstrates the importance of two principle understandings. The first relates to teachers understanding masculinity through feminist lenses, as constructed, regulated and maintained through inequitable social processes and the second relates to teachers understanding pedagogy as critical and transformative practice. These understandings are presented as vital to enabling gender justice.