Layers of Listening: Qualitative Analysis of the Impact of Early Intervention Services for First-episode Psychosis on Carers' Experiences

Background Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims By analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS. Method Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking. Conclusions By focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

Energy efficiency and climate policy in the management of public spaces: public lighting

Public Lightning is an important part of municipality’s nighttime landscape. Lighting can be used to enhance public safety and security while improving the aesthetic appeal of the surrounding properties but with the current global financial crisis, such lighting systems must also be sustainable. Most climate policy efforts focus on the state and international level, however national governments won’t be able to meet their international commitments without local action. In Portugal, the Public Lighting is responsible for 3% of energy consumption. The problem is that the trend is to increase (about 4-5% per year) which represents very high costs for the municipal authorities. In terms of numbers are analyzed in this thesis 45 of 278 existent in Continental Portugal what represents only 16,2 % of the counties. This where the local authorities in Portugal that had a Sustainable Energy Action Plan (SEAP) that had been accepted and made available in the Covenant of Mayors website until the end of year 2013. It is important that the Covenant of Mayors will increase the local authorities awareness for energy efficiency and especially to public lighting because there is still a long way to go in terms of energy consumption reduction. In future works it would be interesting to see the payback of the EolGreen post in a real scenario due to lack of energy consumption from the grid it would allow to have a pretty high initial investment even with the maintenance that those technologies need.

From policy development to effectiveness and alignment: An analysis of the UK’s Higher Education Open Access policy landscape

The number of Open Access (OA) policies that have been adopted by universities, research institutes and research funders has been increasing at a fast pace. The Registry of Open Access Repository Mandates and Policies (ROARMAP) records the existence of 724 OA policies across the world, of which 512 have been adopted by universities and research institutions. The UK is one of the leading countries in terms of OA policy development and implementation with a total of 85 institutional1 and an estimated 35 funder2 OA policies. In order to understand and contextualise how OA policies are developed and how they can be effectively implemented and aligned, this brief looks at two areas. The first section provides an overview on the processes evolving around policy making, policy effectiveness and policy alignment. In particular, it summarises the criteria and elements generally specified in OA policies, it points out some of the relevant steps informing the development, monitoring and revision of OA policies, it outlines what OA policy elements contribute to policy effectiveness, and highlights the benefits in aligning OA policies. The second section revisits the issues previously discussed within the context of the UK institutional (universities) OA policy landscape.

Assessing the impacts of community participation policy and practice in Scotland and England

Background: Community participation has become an integral part of many areas of public policy over the last two decades. For a variety of reasons, ranging from concerns about social cohesion and unrest to perceived failings in public services, governments in the UK and elsewhere have turned to communities as both a site of intervention and a potential solution. In contemporary policy, the shift to community is exemplified by the UK Government’s Big Society/Localism agenda and the Scottish Government’s emphasis on Community Empowerment. Through such policies, communities have been increasingly encouraged to help themselves in various ways, to work with public agencies in reshaping services, and to become more engaged in the democratic process. These developments have led some theorists to argue that responsibilities are being shifted from the state onto communities, representing a new form of 'government through community' (Rose, 1996; Imrie and Raco, 2003). Despite this policy development, there is surprisingly little evidence which demonstrates the outcomes of the different forms of community participation. This study attempts to address this gap in two ways. Firstly, it explores the ways in which community participation policy in Scotland and England are playing out in practice. And secondly, it assesses the outcomes of different forms of community participation taking place within these broad policy contexts. Methodology: The study employs an innovative combination of the two main theory-based evaluation methodologies, Theories of Change (ToC) and Realist Evaluation (RE), building on ideas generated by earlier applications of each approach (Blamey and Mackenzie, 2007). ToC methodology is used to analyse the national policy frameworks and the general approach of community organisations in six case studies, three in Scotland and three in England. The local evidence from the community organisations’ theories of change is then used to analyse and critique the assumptions which underlie the Localism and Community Empowerment policies. Alongside this, across the six case studies, a RE approach is utilised to examine the specific mechanisms which operate to deliver outcomes from community participation processes, and to explore the contextual factors which influence their operation. Given the innovative methodological approach, the study also engages in some focused reflection on the practicality and usefulness of combining ToC and RE approaches. Findings: The case studies provide significant evidence of the outcomes that community organisations can deliver through directly providing services or facilities, and through influencing public services. Important contextual factors in both countries include particular strengths within communities and positive relationships with at least part of the local state, although this often exists in parallel with elements of conflict. Notably this evidence suggests that the idea of responsibilisation needs to be examined in a more nuanced fashion, incorporating issues of risk and power, as well the active agency of communities and the local state. Thus communities may sometimes willingly take on responsibility in return for power, although this may also engender significant risk, with the balance between these three elements being significantly mediated by local government. The evidence also highlights the impacts of austerity on community participation, with cuts to local government budgets in particular increasing the degree of risk and responsibility for communities and reducing opportunities for power. Furthermore, the case studies demonstrate the importance of inequalities within and between communities, operating through a socio-economic gradient in community capacity. This has the potential to make community participation policy regressive as more affluent communities are more able to take advantage of additional powers and local authorities have less resource to support the capacity of more disadvantaged communities. For Localism in particular, the findings suggest that some of the ‘new community rights’ may provide opportunities for communities to gain power and generate positive social outcomes. However, the English case studies also highlight the substantial risks involved and the extent to which such opportunities are being undermined by austerity. The case studies suggest that cuts to local government budgets have the potential to undermine some aspects of Localism almost entirely, and that the very limited interest in inequalities means that Localism may be both ‘empowering the powerful’ (Hastings and Matthews, 2014) and further disempowering the powerless. For Community Empowerment, the study demonstrates the ways in which community organisations can gain power and deliver positive social outcomes within the broad policy framework. However, whilst Community Empowerment is ostensibly less regressive, there are still significant challenges to be addressed. In particular, the case studies highlight significant constraints on the notion that communities can ‘choose their own level of empowerment’, and the assumption of partnership working between communities and the local state needs to take into account the evidence of very mixed relationships in practice. Most importantly, whilst austerity has had more limited impacts on local government in Scotland so far, the projected cuts in this area may leave Community Empowerment vulnerable to the dangers of regressive impact highlighted for Localism. Methodologically, the study shows that ToC and RE can be practically applied together and that there may be significant benefits of the combination. ToC offers a productive framework for policy analysis and combining this with data derived from local ToCs provides a powerful lens through which to examine and critique the aims and assumptions of national policy. ToC models also provide a useful framework within which to identify specific causal mechanisms, using RE methodology and, again, the data from local ToC work can enable significant learning about ‘what works for whom in what circumstances’ (Pawson and Tilley, 1997).

Content analysis model to analyze facets of social mission of public library on the Facebook and in the websites

In this paper we present the development and the implementation of a content analysis model for observing aspects relating to the social mission of the public library on Facebook pages and websites. The model is unique and it was developed from the literature. There were designed the four categories for analysis Generate social capital and social cohesion, Consolidate democracy and citizenship, Social and digital inclusion and Fighting illiteracies. The model enabled the collection and the analysis of data applied to a case study consisting of 99 Portuguese public libraries with Facebook page. With this model of content analysis we observed the facets of social mission and we read the actions with social facets on the Facebook page and in the websites of public libraries. At the end we discuss in parallel the results of observation of the Facebook of libraries and the websites. By reading the description of the actions of the social mission, the general conclusion and the most immediate is that 99 public libraries on Facebook and websites rarely publish social character actions, and the results are little satisfying. The Portuguese public libraries highlight substantially the actions in the category Generate social capital and social cohesion.

REFUGEES AND RESETTLEMENT: A QUALITATIVE ANALYSIS OF REFUGEE INTEGRATION THROUGH SOCIAL & SUPPORT SERVICES

This dissertation studies refugee resettlement in the United States utilizing the Integration Indicator’s framework developed by Ager and Strang for the U.S. context. The study highlights the U.S. refugee admissions program and the policies in the states of Maryland and Massachusetts while analyzing the service delivery models and its effects on refugee integration in these locations. Though immigration policy and funding for refugee services are primarily the domain of the federal government, funds are allocated through and services are delivered at the state level. The Office of Refugee Resettlement (ORR), which operates under the Department of Health and Human Services, was established after the Refugee Act of 1980 to deliver assistance to displaced persons. The ORR provides funds to individual states primarily through The Refugee Social Service and Targeted Assistance Formula Grant programs. Since the inauguration of the ORR three primary models of refugee integration through service delivery have emerged. Two of the models include the publicly/privately administered programs, where resources are allocated to the state in conjunction with private voluntary agencies; and the Wilson/Fish Alternative programs, where states sub-contract all elements of the resettlement program to voluntary agencies and private organizations —in which they can cease all state level participation and voluntary agencies or private organizations contract directly from the ORR in order for all states to deliver refugee services where the live. The specific goals of this program are early employment and economic self-sufficiency. This project utilizes US Census, state, and ORR data in conjunction with interviews of refugee resettlement practitioners involved in the service delivery and refugees. The findings show that delivery models emphasizing job training, English instruction courses, institutional collaboration, and monetary assistance, increases refugee acclimation and adaptation, providing insight into their potential for integration into the United States.

Public and user participation in public service delivery: tensions in policy and practice

Social-scientific analysis of public-participation initiatives has proliferated in recent years. This review article discusses some key aspects of recent work. Firstly, it analyses some of the justifications put forward for public participation, drawing attention to differences and overlaps between rationales premised on democratic representation/representativeness and those based on more technocratic ideas about the knowledge that the public can offer. Secondly, it considers certain tensions in policy discourses on participation, focusing in particular on policy relating to the National Health Service and other British public services. Thirdly, it examines the challenges of putting a coherent vision for public participation into practice, noting the impediments that derive from the often-competing ideas about the remit of participation held by different groups of stakeholders. Finally, it analyses the gap between policy and practice, and the consequences of this for the prospects for the enactment of active citizenship through participation initiatives.

Application of a policy framework for the public funding of drugs for rare diseases

BACKGROUND: In many countries, decisions about the public funding of drugs are preferentially based on the results of randomized trials. For truly rare diseases, such trials are not typically available, and approaches by public payers are highly variable. In view of this, a policy framework intended to fairly evaluate these drugs was developed by the Drugs for Rare Diseases Working Group (DRDWG) at the request of the Ontario Public Drug Programs. OBJECTIVE: To report the initial experience of applying a novel evaluation framework to funding applications for drugs for rare diseases. METHODS: Retrospective observational cohort study. MEASURES: Clinical effectiveness, costs, funding recommendations, funding approval. KEY RESULTS: Between March 2008 and February 2013, eight drugs were evaluated using the DRDWG framework. The estimated average annual drug cost per patient ranged from 28,000 to 1,200,000 Canadian dollars (CAD). For five drugs, full evaluations were completed, specific funding recommendations were made by the DRDWG, and funding was approved after risk-sharing agreements with the manufacturers were negotiated. For two drugs, the disease indications were determined to be ineligible for consideration. For one drug, there was insufficient natural history data for the disease to provide a basis for recommendation. For the five drugs fully evaluated, 32 patients met the predefined eligibility criteria for funding, and five were denied based on predefined exclusion criteria. CONCLUSIONS: The framework improved transparency and consistency for evaluation and public funding of drugs for rare diseases in Ontario. The evaluation process will continue to be iteratively refined as feedback on actual versus expected clinical and economic outcomes is incorporated. © 2014 Society of General Internal Medicine.

The Potential of Tariff Policy for Climate Change Mitigation: Legal and Economic Analysis

This paper addresses a potential role that tariffs and tariff policy can play in encouraging countries to take part in a multilateral effort to mitigate climate change. It begins by assessing whether increasing tariffs on products from energy intensive or polluting industries amounts to a violation of WTO rules and whether protectionism in this case can be differentiated from genuine environmental concerns. It then argues that while lowering tariffs for environmental goods can serve as a carrot to promote dissemination of cleaner technologies, tariff deconsolidation is a legitimate stick to encourage polluting countries to move towards an international climate agreement. The paper further explores this view by undertaking a partialequilibrium simulation analysis to examine the impact of a unilateral unit increase in tariffs on the imports of the most carbon-intensive products from countries not committed to climate polices. Our results suggest that the committed importing countries would have to raise their tariffs only slightly to effect a significant decline in the imports of these products from the non-committed countries. For instance, a unit increase in the simple average applied tariffs on the imports of these carbon-intensive products in 2005 from our sample of non-committed exporting countries would reduce the imports of these products by an average 32.6% in Australia, 178% in Canada, 195% in the EU, 271% in Japan and 62% in the US, therebysuggesting the effectiveness of such a measure in pushing countries towards a global climate policy.

Macroeconomic rates of return of public and private investment : crowding-in and crowding-out effects

Using annual data from 14 European Union countries, plus Canada, Japan and the United States, we evaluate the macroeconomic effects of public and private investment through VAR analysis. From impulse response functions, we are able to assess the extent of crowding-in or crowding-out of both components of investment. We also compute the associated macroeconomic rates of return of public and private investment for each country. The results point mostly to the existence of positive effects of public investment and private investment on output. On the other hand, the crowding-in effects of public investment on private investment vary across countries, while the crowding-in effect of private investment on public investment is more generalised.

Performance analysis of brazilian public and philanthropic hospitals

This paper presents the results of a research that aimed at identifying optimal performance standards of Brazilian public and philanthropic hospitals. In order to carry out the analysis, a model based on Data Envelopment Analysis (DEA) was developed. We collected financial data from hospitals’ financial statements available on the internet, as well as operational data from the Information Technology Department of the Brazilian Public Health Care System – SUS (DATASUS). Data from 18 hospitals from 2007 to 2011 were analyzed. Our DEA model used both operational and financial indicators (variables). In order to develop this model, two indicators were considered inputs: Values (in Brazilian Reais) of Fixed Assets and Planned Capacity. On the other hand, the following indicators were considered outputs: Net Margin, Return on Assets and Institutional Mortality Rate. As regards the proposed model, there were five hospitals with optimal performance and four hospitals were considered inefficient, upon the analysis of the variables, considering the analyzed period. Analysis of the weights indicated the most relevant variables for determining efficiency and scale variable values, which is an important tool to aid the decision-making by hospital managers. Finally, the scale variables determined the returns on production, indicating that 14 hospitals work with scale diseconomies. This may indicate inefficiency in the resource management of the Brazilian public health-care system, by analyzing this set of proposed variables.

External linkages, innovation and the small and medium sized enterprise: the role and effectiveness of public technology policy in Portugal.

Doutoramento em Economia.

Inter-industry analysis and monetary policy evaluations in the Korean flow of funds accounts

This study mainly aims to provide an inter-industry analysis through the subdivision of various industries in flow of funds (FOF) accounts. Combined with the Financial Statement Analysis data from 2004 and 2005, the Korean FOF accounts are reconstructed to form "from-whom-to-whom" basis FOF tables, which are composed of 115 institutional sectors and correspond to tables and techniques of input–output (I–O) analysis. First, power of dispersion indices are obtained by applying the I–O analysis method. Most service and IT industries, construction, and light industries in manufacturing are included in the first quadrant group, whereas heavy and chemical industries are placed in the fourth quadrant since their power indices in the asset-oriented system are comparatively smaller than those of other institutional sectors. Second, investments and savings, which are induced by the central bank, are calculated for monetary policy evaluations. Industries are bifurcated into two groups to compare their features. The first group refers to industries whose power of dispersion in the asset-oriented system is greater than 1, whereas the second group indicates that their index is less than 1. We found that the net induced investments (NII)–total liabilities ratios of the first group show levels half those of the second group since the former's induced savings are obviously greater than the latter.

An Analysis of the Factors that Influence Regional Economic Development Cooperation

This dissertation is a comparative case study of regional cooperation in the field of economic development. In the 21st century global economy, proponents of regionalism have put forth fresh arguments for collective action. A regional approach to economic development activity presents a classic social dilemma: How can local officials collectively improve the economic prospects of a region, and remain autonomous to act in the best interest of the local community? This research examines the role of social capital in overcoming this social dilemma. Three (3) comparable Metropolitan Statistical Areas (MSAs) form the empirical basis of this research. The Houston MSA, the Atlanta MSA and the Miami MSA present distinct variations of regionalized economic development activity. This dissertation seeks to explain this disparity in the dependent variable. The hypothesis is that accrued social capital is crucial to obtaining economic development cooperative agreements. This qualitative research utilized secondary demographic and economic databases, survey instruments, interviews, field observations, and a review of legislative and administrative decisions to formulate a clear understanding of the factors influencing the current state of regional economic development cooperation within each region. The study concludes that the legislative and executive decisions of state government exert inordinate influence on the capacity of local officials to cooperate regionally for economic development purposes.