Case Management in der ambulanten gerontopsychiatrischen Versorgung

In der vorliegenden Arbeit wird ein am Strengths-Modell orientiertes Case Management-Projekt zur Prozess- und Ergebnisoptimierung der bereits bestehenden ambulanten gerontopsychiatrischen Versorgungsstruktur untersucht. Dazu arbeitete eine Krankenpflegerin mit psychiatrischer Fachausbildung in einer Berliner Sozialstation auf Basis einer professionellen Beziehung für 4-6 Wochen bei Klientinnen mit gerontopsychiatrischen Problemlagen, erstellte ein Assessment, leistete notwendige Unterstützung zunächst selbst, vermittelte gestützt auf die eigenen Erfahrungen weiterführende Dienste, leitete diese Dienste an, zog sich dann aus dem direkten Kontakt mit den Klientinnen zurück und blieb beratend für die weiterführenden Dienste verfügbar. Zur Untersuchung des Projekts wurden qualitative und quantitative Verfahren eingesetzt. Zur Beschreibung der Inhalte wurden die für jede Klientin verfasste Dokumentation und die Ergebnisse von grob strukturierten Interviews mit der Case Managerin, angelehnt an eine reduzierte Form der Methode Grounded Theory, in einem iterativen Prozess analysiert. In einem zweiten Schritt wurde dann untersucht, inwieweit die einzelnen Arbeitsinhalte des Case Managements die sozial-räumlichdingliche Umweltanpassung und Proaktivität der Klientinnen unterstützten. Die Wirkungen des Projektes auf Kognition, Aktivitäten des täglichen Lebens (ADL), Instrumentelle Aktivitäten des täglichen Lebens (IADL), Stimmung sowie soziales und störendes Verhalten wurden mittels eines standardisierten Fragebogens mit einem quasi-experimentellen prospektiven Untersuchungsdesign analysiert. Zur Analyse der subjektiven Wirkung des Projektes auf Angehörige wurden in den Ergebnissen von grob strukturierten Interviews mittels eines iterativen Prozesses Themen identifiziert. Die Klientinnen (n=11) erhielten durchschnittlich 23 Stunden Case Management. Neben den typischen Case Management-Aufgaben führte die Case Managerin, basierend auf den Gewohnheiten, Interessen und Selbsteinschätzungen der Klientinnen, therapeutische und pflegerische Maßnahmen durch und unterstützte dabei die sozial-dinglichräumliche Umweltanpassung und Proaktivität der Klientinnen. Zusätzlich wurden Hauspflegerinnen von der Case Managerin individuell in der Wohnung von Klientinnen hinsichtlich der Kommunikation mit und Unterstützung der Proaktivität von Klientinnen angeleitet. Die Hauspflegerinnen führten die von der Case Managerin eingeleiteten Maßnahmen erfolgreich fort. Bei den Klientinnen zeigten sich signifikante Verbesserungen in Gedächtnis, Stimmung, IADL-Funktionen und Sozialverhalten, aber nicht in ADL-Funktionen und störendem Verhalten. Diese Verbesserungen wurden subjektiv von den Angehörigen (n=7) bestätigt. Zusätzlich empfanden Angehörige eine zeitliche aber keine psychische Entlastung. Mit diesem Projekt wurde gezeigt, dass ein zeitlich begrenztes klientenzentriertes Case Management kognitive, soziale und emotionale Funktionen von gerontopsychiatrisch Erkrankten verbessert, Angehörige zeitlich entlastet und dass Hauspflegerinnen bei entsprechender Anleitung die vom Case Management eingeleiteten Maßnahmen fortführen können. In Folgestudien mit größerem Umfang sollten diese Ergebnisse überprüft werden um dann zu entscheiden, ob dieser Ansatz geeignet ist, die ambulante gerontopsychiatrische Versorgung gemeindenah zu verbessern.

Continuation and discontinuation of local institution in community based natural resource management

Currently the push toward frontier areas, which until twenty years ago were still largely untouched by commercial agriculture, is taking place on a massive scale. This push is being driven not the least by global economic developments, such as the price increase of agriculture commodities like coffee and cocoa. In most cases the indigenous communities become trapped between the state monopoly in natural resource management and the competition for resources by external actors. In this processes the indigenous communities start to lose their access to resources. Another victim in this process is the environment where the natural resources are imbedded. International and national organizations working to conserve environment have became conscious of the important role that indigenous people could fulfill as partners in this endeavour. This partnership in struggle has produced a new discourse on the relationship between indigenous people and their environment. As a further consequence, programs were set up to develop what became known as Community Based Natural Resource Management (CBNRM) with its numerous variations. Based on a case study in a village on the eastern border of the Lore Lindu National Park in Central Sulawesi, this study questioned the basic assumption behind the concept of Community Based Natural Resource Management (CBNRM). Namely the assumption that communities living at the margin of forest are socially and culturally homogenous, still more or less egalitarian, and basically living in harmony with their natural environment. This study was inspired by the persistent critique – although still a minority – on the basic assumption the CBNRM from academicians and practitioners working through the Entitlement perspective. Another inspiration was the mounting critique toward the participatory approach. In its effort the study explore further the usefulness of certain approaches. One of the approach much relied on in this study was the local history of the community studied, through exerting oral and local written documents on local history, legends and local stories. These sources proofed quite capable in bringing the local history into the light. Another was the actor oriented approach, which later came to be supported by the concept of Social Pool Resources. The latter concept proofed to be useful as analytical instrument to integrate social institutions and the common pool resources, as a field of action for the different actors as human agencies.

Perspectives of Urban Growth Management and Sustainable Development In West Bank, Hebron District as a case Study

The main objective of this PhD research study is to provide a perspective on the urban growth management and sustainable development in Palestine, and more specifically in Hebron district as a case study. Hebron is located 36 km south of Jerusalem, with an overall population size of around 600,000 people living in a total area around1246km2. Hebron is the biggest Palestinian district that has 16 municipalities and 154 localities. The research discusses and analyzes the urban planning system, economical and environmental policies and the solution required to manage and integrate the development elements to develop a sustainable development plan for Hebron. The research provides answers for fundamental questions such as what kind and definition of sustainable development are applicable to the Palestinian case?. What are the sustainability problems there and how the Israeli occupation and unstable political condition affect the sustainable development in Palestine? What are the urban growth management and sustainability policies and actions required from government, public and privets sector in Palestine? The fast urban growth in Palestine is facing many problems and challenges due to the increase in the population size and the resulting impact of this increase including, but not limited to, the demand of new houses, need for more infrastructure services, demands on new industrial, commercial, educational and health projects, which in turn reduces the area of agricultural lands and threatens the natural resources and environment. There are also other associated sustainability problems like the absence of effective plans or regulations that control urban expansion, the absence of sufficient sustainable development plans at the national levels for the district, new job requirements, Israeli restrictions and occupation for more than 60 years, existence of construction factories near residential areas, poor public awareness and poor governmental funds for service projects and development plans. The study consists of nine chapters. Chapter One includes an introduction, study objectives, problems and justifications, while Chapter Two has a theoretical background on sustainability topic and definitions of sustainability. The Palestinian urban planning laws and local government systems are discussed in Chapter Three and the methodology of research is detailed in Chapter Four. As for Chapter Five, it provides a general background on Hebron District including demographical and economical profiles, along with recommendations related to sustainable development for each profile Chapter Six addresses the urban environment, sustainability priorities and policies required. Chapter Seven discusses and analyzes infrastructure services including transportation, water and wastewater. As for Chapter Eight, it addresses the land use, housing and urban expansion beside the cultural heritage, natural heritage with relevant sustainable development polices and recommendations. Finally, Chapter Nine includes a conclusion and comprehensive recommendations integrating all of urban and sustainability event in one map. Hebron has a deep history including a rich cultural heritage aged by thousands of years, with 47% of Hebron district population under 14 years old. Being the biggest Palestinian district, Hebron has thousands of industrial and economical organizations beside a large agricultural sector at Palestine level. This gives Hebron a potential to play major roles in developing a national sustainability plan, as the current urban planning system in Palestine needs urgent reform and development to fulfill the sustainability requirement. The municipalities and ministers should find permanent financial aid for urban planning and development studies so as to face future challenges. The Palestinian government can benefit from available local human resources in development projects; hence Palestinian people have sufficient qualifications in most sectors. The Palestinian people also can invest in the privet sector in Palestine in case businessmen have been encouraged and clear investment laws and plans have been developed. The study provides recommendations associated to the sustainable development in Palestine in general and Hebron, as a case study, in specific. Recommendations include increasing the privet sector as well as the public involvement in urban growth management, and stopping unplanned urban expansion, subjecting granting building permits of new projects to the no-harm environmental impact assessment, increasing the coordination and cooperation between localities and central bodies, protection and renovation of old cites and green areas, increasing the quality and quantity of infrastructure services, establishing district urban planning department to coordinate and organize urban planning and sustainable development activities. Also, among recommendations come dividing Hebron into three planning and administrative areas (north, central and south), and dividing the sustainable development and implementation period (2010 to 2025) into three main phases. Finally, the study strongly recommends benefiting from the same urban development plans in similar districts at national and international levels, also to use new technologies and information systems in urban planning process.

Climate-Adaptive Community Water Management for Food Security: Experiences from the UNDP Community Water Initiative

Facing the double menace of climate change threats and water crisis, poor communities have now encountered ever more severe challenges in ensuring agricultural productivity and food security. Communities hence have to manage these challenges by adopting a comprehensive approach that not only enhances water resource management, but also adapts agricultural activities to climate variability. Implemented by the Global Environment Facility’s Small Grants Programme, the Community Water Initiative (CWI) has adopted a distinctive approach to support demand-driven, innovative, low cost and community-based water resource management for food security. Experiences from CWI showed that a comprehensive, locally adapted approach that integrates water resources management, poverty reduction, climate adaptation and community empowerment provides a good model for sustainable development in poor rural areas.

Ecosystem services and adaptation for agriculture and food security: analysis of two decades (1991–2011) of financing by the Global Environment Facility

Investing in global environmental and adaptation benefits in the context of agriculture and food security initiatives can play an important role in promoting sustainable intensification. This is a priority for the Global Environment Facility (GEF), created in 1992 with a mandate to serve as financial mechanism of several multilateral environmental agreements. To demonstrate the nature and extent of GEF financing, we conducted an assessment of the entire portfolio over a period of two decades (1991–2011) to identify projects with direct links to agriculture and food security. A cohort of 192 projects and programs were identified and used as a basis for analyzing trends in GEF financing. The projects and programs together accounted for a total GEF financing of US$1,086.8 million, and attracted an additional US$6,343.5 million from other sources. The value-added of GEF financing for ecosystem services and resilience in production systems was demonstrated through a diversity of interventions in the projects and programs that utilized US$810.6 million of the total financing. The interventions fall into the following four main categories in accordance with priorities of the GEF: sustainable land management (US$179.3 million), management of agrobiodiversity (US$113.4 million), sustainable fisheries and water resource management (US$379.8 million), and climate change adaptation (US$138.1 million). By aligning GEF priorities with global aspirations for sustainable intensification of production systems, the study shows that it is possible to help developing countries tackle food insecurity while generating global environmental benefits for a healthy and resilient planet.