Health visiting and district nursing in Victorian Manchester; divergent and convergent vocations

Community nursing and public health work provided many Victorian and Edwardian women in Britain with the opportunity of a career and professional training. Such work created contradictions, not least the tension between 'inherent' female skills and the role of learnt professionalism. This article discusses Manchester's neglected district nurses alongside the city's more well-studied health visiting scheme. Comparing these occupations in one city highlights continuities in origins and practice, but a clear divergence in terms of class and purpose. These differences provide historians with opportunities to reconsider the inherent tensions and varied identities of employed women in Victorian and Edwardian Britain.

Putting two and two together? Early childhood education, mothers’ employment and care service expansion in Chile and Mexico

In recent years, several middle-income countries, including Chile, Mexico and Uruguay, have increased the availability of early childhood education and care (ECEC) services. These developments have received little scholarly attention so far, resulting in the (surely unintended) impression that Latin American social policy is tied to a familialist track, when in reality national and regional trends are more varied and complex. This article looks at recent efforts to expand ECEC services in Chile and Mexico. In spite of similar concerns over low female labour force participation and child welfare, the approaches of the two countries to service expansion have differed significantly. While the Mexican programme aims to kick-start and subsidize home- and community-based care provision, with a training component for childminders, the Chilean programme emphasizes the expansion of professional ECEC services provided in public institutions. By comparing the two programmes, this article shows that differences in policy design have important implications in terms of the opportunities the programmes are able to create for women and children from low-income families, and in terms of the programmes’ impacts on gender and class inequalities. It also ventures some hypotheses about why the two countries may have chosen such different routes.

Ambition gone awry: the long-term socioeconomic consequences of misaligned and uncertain ambitions in adolescence

OBJECTIVE

The objective of this study was to investigate whether misaligned or uncertain ambitions in adolescence influence the process of socioeconomic attainment.

METHODS

Using 34 years of longitudinal data from the British Cohort Study (BCS70), we considered whether youth with (1) misaligned ambitions (i.e., those who either over- or underestimate the level of education required for their desired occupation), (2) both low occupational aspirations and educational expectations (low-aligned ambitions), and (3) uncertainty with regard to their future occupations (uncertain ambitions) at age 16 experienced more unemployment spells, lower educational attainment, and lower hourly wages in adulthood compared to youth with high occupational aspirations and educational expectations (high-aligned ambitions).

RESULTS

Youth who hold misaligned or uncertain aspirations show long-term deficits in employment stability and educational attainment, which in turn leads to lower wage attainments at age 34.

CONCLUSION

Misaligned and uncertain ambitions in adolescence compromise the construction of life paths and the realization of long-term educational and occupational goals.

Traditional vocations and modern professions among Tamil Brahmans in colonial and post-colonial south India

Since the nineteenth century, Tamil Brahmans have been very well represented in the educated professions, especially law and administration, medicine, engineering and nowadays, information technology. This is partly a continuation of the Brahmans' role as literate service people, owing to their traditions of education, learning and literacy, but the range of professions shows that any direct continuity is more apparent than real. Genealogical data are particularly used as evidence about changing patterns of employment, education and migration. Caste traditionalism was not a determining constraint, for Tamil Brahmans were predominant in medicine and engineering as well as law and administration in the colonial period, even though medicine is ritually polluting and engineering resembles low-status artisans' work. Crucially though, as modern, English-language, credential-based professions that are wellpaid and prestigious, law, medicine and engineering were and are all deemed eminently suitable for Tamil Brahmans, who typically regard their professional success as a sign of their caste superiority in the modern world. In reality, though, it is mainly a product of how their old social and cultural capital and their economic capital in land were transformed as they seized new educational and employment opportunities by flexibly deploying their traditional, inherited skills and advantages.

[Productivity costs of rheumatoid arthritis in Germany. Cost composition and prediction of main cost components]

OBJECTIVE

Identification of predictors for the productivity cost components: (1) sick leave, and (2) work disability in gainfully employed and (3) impaired household productivity in unemployed patients with rheumatoid arthritis (RA) from the societal perspective.

METHODS

Investigation of productivity costs was linked to a multicenter, randomized, controlled trial evaluating the effectiveness of clinical quality management in 338 patients with RA. The productivity losses were assessed according to the German Guidelines on Health Economic Evaluation. By means of multivariate logistic regression analyses, predictors of sick leave, work disability (employed patients, n=96), and for days confined to bed in unemployed patient (n=242) were determined.

RESULTS

Mean annual costs of 970 EUR arose per person taking into consideration all patients (453 EUR sick leave, 63 EUR work disability, 454 EUR impaired productivity of unemployed patients). Disease activity, disease severity, and impaired physical function were global predictors for all of the cost components investigated. Sick leave costs were predicted by prior sick leave periods and the vocational status blue collar worker, work disability costs by sociodemographic variables (marital status, schooling), and the productivity costs of unemployed patients by impaired mental health and impaired physical functions.

CONCLUSIONS

Interventions such as reduction in disease progression and control of disease activity, early vocational rehabilitation measures and vocational retraining in patients at risk of quitting working life, and self-management programs to learn coping strategies might decrease future RA-related productivity costs.

Using propensity scoring to estimate program-related subgroup impacts in experimental program evaluations

This article discusses the use of propensity scoring in experimental program evaluations to estimate impacts for subgroups defined by program features and participants' program experiences. The authors discuss estimation issues and provide specification tests. They also discuss the use of an overlooked data collection design--obtaining predictions that program intake staff make about applicants' likely program assignments and experiences--that could improve the quality of matched comparison samples. They demonstrate the effectiveness of this approach in producing credible subgroup findings using data from a large-scale experimental evaluation of Job Corps, the nation's largest federal education and training program for disadvantaged youths.

Raising our sites: dissemination of supported education

In order to promote replication of supported education, an exemplary rehabilitation model for adults with psychiatric disabilities, funds were accessed through a Community Action Grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. Three communities in Michigan participated in a multistage process designed to maximize community ownership by encouraging local adaptations involving all stakeholder groups and providing technical assistance. The stages in the process were organizing the community for supported education development, acquiring knowledge about supported education basics, collecting information (needs assessment and barrier identification), and developing the plan. All three sites have begun implementation, providing services to adults with psychiatric disabilities who wish to pursue post-secondary education. The approach employed has applicability for other local communities.

Assessment in postgraduate dental education: an evaluation of strengths and weaknesses

This paper describes a study designed to evaluate assessment in postgraduate dental education in England, identifying strengths and weaknesses and focusing specifically on its relevance, consistency and cost-effectiveness.

METHODS

A four-phase qualitative method was used: a mapping of current career paths, assessment policy, and issues (phase 1); more detailed studies of the practice of assessment for a range of courses, and the systemic/management perspective of assessment (i.e. quality assurance) (phases 2 and 3), and analysis and reporting (phase 4). Data were analysed from documents, interviews, group consultations and observations.

RESULTS AND DISCUSSION

Five key issues may be distilled from the findings: (i) lack of formal assessment of general professional training; (ii) trainer variation in assessment; (iii) the extent to which assessments are appropriate indicators of later success; (iv) the relationship between assessment and patient care, and (v) data to assess the costs of assessment.

CONCLUSION

Current assessment procedures might be improved if consideration is given to: assessment which supports an integrated period of general professional training; training for trainers and inspection procedures to address variation; more authentic assessments, based directly on clinical work and grading cases and posts, and better data on allocation of resources, in particular clinicians' time given to assessment.

Funding security officer training: a creative approach

Forces to cancel the first basic security officers training program in Maine in 1989, the author relates how the Pine Tree Chapter members were able to obtain state vocational education funds to finance two highly successful classes.

The promotion of agricultural education for adults: the Lancashire federation of women's institutes, 1919-45

A recent article in Rural History illustrated how the Women's Institutes between the wars Were influenced by contemporary feminism. The argument of the article was that in seeking to change the material condition and status of countrywomen, and in effect, emulating craft trades union strategies, the WI movement sought to alter perceptions of women's labour in the home by enhancing their skills, encouraging co-operative endeavour and promoting an ‘active domesticity’. Furthermore, the domestic arena was extended to cover all aspects of rural life related to the home, garden, farm or allotment.

However, as time passed between the wars, less interest was shown in agricultural work outside the home, and, as Morgan states elsewhere, the agricultural ‘side’ of the movement became ‘severely diminished’. Whilst one might not seriously quarrel with this statement with reference to some periods of WI history, it is, nevertheless, a somewhat reductive approach to have taken when considering the interwar period. During that time, there is evidence to suggest that in some regions at least, WI members maintained more than a passing interest in agriculture per se. This was not simply in relation to the production and preservation of food, but rather as a means of maintaining the influence of women in rural policy making. This interest can be best detected in the educational sphere, from the promotion of classes in a wide range of agricultural activities and demonstrations at agricultural and horticultural shows, to WI membership of local agricultural education committees. Furthermore, the National Federation of Women's Institutes (NFWI) fought in many ways to maintain the agricultural ‘side’ of the movement because it was an integral part of its wider mission to educate countrywomen, particularly those who were destined to live and work in the Empire

Human capital development in an emerging economy: the experience of Shenzhen, China

Human capital refers to the skills, knowledge and values that individuals acquire in formal schooling, in the workplace and in other settings that raise their productive capacity. In an increasingly global economy, investment in human capital is seen as one of the major strategies for enhancing the economic competitiveness of firms and nations and a major factor in determining the extent of economic polarization among social groups and nations.

Benefits and costs of supported employment from three perspectives

Administrators, consumers, and policy makers are increasingly interested in supported employment as a way of helping persons with severe mental illness get and keep competitive jobs. However, in an atmosphere of increased expectations for performance and declining public financing, administrators want to know the costs and benefits of different approaches before they reallocate scarce treatment or rehabilitative dollars. This article discusses the net benefits of two approaches to supported employment that were compared in a randomized trial: Individual Placement and Support (IPS) and Group Skills Training (GST). The authors analyze costs and benefits from societal, government, and consumer perspectives. Although a previous analysis showed that IPS participants were significantly more likely to find work, worked more hours, and had higher earnings, net benefits of the two programs were not significantly different. The authors also discuss some of the strengths and weaknesses of cost-benefit analysis in mental health care and suggest future directions for policy and research.

Two-generation programs: design, cost, and short-term effectiveness

Two-generation programs are relatively new attempts to deal with the nation's social ills. In two-generation programs, services such as early childhood educational programs are offered to children to help them get the best possible start in life, while, at the same time, parents are offered training to help enhance their parenting skills, and education, literacy, or job training to help them become economically self-sufficient. These multistrategy programs are relatively new additions to the broad array of programs designed to serve children and families, but many have already been the subjects of fairly sophisticated evaluations. This article describes two-generation programs and how they differ from earlier single-focus approaches to serve children and families. In-depth descriptions of six premier two-generation programs are used to illustrate the variability in content and costs of these programs. The short-term results of these six programs are reviewed and indicate mixed and modest results in promoting the development of children and improving the parenting skills and economic self-sufficiency of parents. The results suggest several lessons, and the article concludes with recommendations for program improvement and future research.

Rehabilitative day treatment vs. supported employment: I. Vocational outcomes

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

[More than 25 years of successful occupational rehabilitation of handicapped patients]

Over the past 25 years, the German Berufsförderungswerke (vocational retraining centres) have successfully retrained more than 122,000 disabled individuals. Even in economically difficult times, over 80% of the former rehabilitees have succeeded in securing lasting gainful employment, with good to very good opportunities also for those with additional disadvantage. The vast majority of the retrainees have found training-related and disability-adapted employment, and a great portion have been able to improve their occupational position. These facts provide convincing evidence of the successful work of the vocational retraining centres. Investment in rehabilitation, hence, is economically meaningful and profitable.

Rehabilitation innovations in Central America

In an extensive qualitative research project sponsored by the Partners of the Americas (32 professional and lay people from Panama, Costa Rica, Nicaragua, Honduras, El Salvador, Guatemala, Belize, the United States and the Dominican Republic) employment opportunities were examined for disabled youth in Central America. Despite economic and attitudinal barriers field researchers found innovations in financing, special education and rehabilitation programming, job development and job placement alternatives for those who live with disability in Central America.

Transitional employment training for SSI recipients with mental retardation

Transitional employment training is a promising method for assisting persons with mental retardation to gain and hold regular marketplace jobs. The Social Security Administration (SSA) has concluded a large scale demonstration project in which this training was provided to recipients of Supplemental Security Income (SSI) with mental retardation. This article introduces the concepts and practices of transitional employment and presents findings of the SSA demonstration derived from observation of demonstration operations. A followup article will discuss the effects of the demonstration services on the employment, earnings, and SSI payments of the trainees, as derived from analysis of SSI administrative records and other quantitative data.