School Choice and Accountability

School choice and accountability are both mechanisms initially designed to improve standards of education in publicly provided schools, although they have been introduced worldwide with alternative motivations such as to promote equality of access to “good” schools. Economists were active in the initial design of school choice and accountability systems, and continue to advise and provide evidence to school authorities to improve the functioning of the “quasi-market.” School choice, defined broadly, is any system in which parents’ preferences over schools are an input to their child’s allocation to school. Milton Friedman initially hypothesized that school choice would increase the diversity of education providers and improve schools’ productivity through competition. As in the healthcare sector and other public services, “quasi-markets” can respond to choice and competition by improving standards to attract consumers. Theoretical and empirical work have interrogated this prediction and provided conditions for this prediction to hold. Another reason is to promote equality of access to “good” schools and therefore improve social mobility. Rather than school places being rationed through market forces in the form of higher house prices, for example, school choice can promote equality of access to popular schools. Research has typically considered the role of school choice in increasing segregation between different groups of pupils, however, due to differences in parents’ preferences for school attributes and, in some cases, the complexity of the system. School accountability is defined as the public provision of school-performance information, on a regular basis, in the same format, and using independent metrics. Accountability has two functions: providing incentives for schools, and information for parents and central authorities. School choice and accountability are linked, in that accountability provides information to parents making school choices, and school choice multiplies the incentive effect of public accountability. Research has studied the effect of school accountability on pupils’ attainment and the implications for teachers as an intermediate mechanism.

Management of demographic equality of access to family intervention for psychosis in specialist community mental healthcare teams

Background/Aims UK mental health services must provide evidence-based psychological treatments, including family intervention, to every service user diagnosed with psychosis. Although healthcare managers are required to ensure equitable delivery of prescribed core treatments, in practice equality of access remains debatable. This study investigates equality of access to family intervention for psychosis. Subsequent treatment uptake and engagement are also examined. The role of healthcare records in equality management is considered. Methods Retrospective analysis of electronic medical records of 244 service users across four specialist early intervention teams in London in 2018 was undertaken using binary logistic regression and multiple linear regression. Bonferroni adjustment was applied to control for type 1 errors. Results Participants were found to have equal access to the nationally endorsed treatment across all demographic variables. Likewise, treatment uptake and engagement were equally distributed. Conclusions An overall compliance with national policies was shown, demonstrating that equal provision of core treatment for psychosis is achievable. As discrepancies in record keeping were shown to impede the data extraction process, suggestions were made for the management of electronic medical records in mental healthcare services.

Demographic Equality of Access to Cognitive Behavioural Treatment for Early Psychosis in Community Mental Healthcare in Greater London

Individuals experiencing psychosis have been described as one of the most stigmatised, disadvantaged and socially excluded groups in modern societies. Despite the development of evidence-based psychological treatments for psychosis, the access to such intervention remains debateable. In metropolitan areas, where clinical caseloads of mental health services should reflect the ethnic diversity of local populations, equal provision of recommended therapies might be further confounded, while empirical literature investigating this appears limited. The present study inspects equality of access to cognitive behavioural therapy for psychosis across four specialist healthcare teams located in Greater London. Subsequent acceptance and participation in treatment are also examined. A retrospective analysis of electronic medical records of 244 patients was conducted using binary logistic regression and multiple linear regression. Participants were shown to have received treatment offers equally across demographic variables. Likewise, once the treatment commenced, engagement was equally distributed. However, despite having equal access to the offered treatment, patients of Black ethnic group seemed less likely to accept such offer, hence appeared disadvantaged in terms of treatment provision. This study demonstrates that, in multicultural communities, equal access to core interventions for psychosis is achievable, however does not on its own merits ensure equitable treatment provision. Thus mental health services need to proactively focus on specific ethnic groups requiring further efforts to increase treatment uptake. Keywords: mental health, psychosis, cognitive behavioural treatment, diversity, equal access to healthcare

‘The man that got away’: Gender inequalities in the consumption and production of jazz

Jazz is remarkable among genres in emerging from marginalised communities to a position of status, and is also evidently male-dominated in terms of both audiences and musicians. Using the Taking Part surveys of cultural participation in England, we investigate the gender gap in jazz and how it compares with classical and rock. We find women are less likely to attend jazz concerts than men. We also report on a unique dataset of 983 musicians, and identify how the position of women in the jazz network differs from men. Women also feature lower recording productivity, an effect appearing to work directly rather than mediated by instrumental choice or period of birth. We argue that equality of access to cultural advantage requires that we attend to how gender inequalities operate within genres, both to inform measures for debiasing and also to uncover mechanisms of gender inequalities which may hold in other contexts.

Individual placement and support: cross-sectional study of equality of access and outcome for Black, Asian and minority ethnic communities

Aims and method To explore whether people from Black, Asian and minority ethnic (BAME) communities experience equality of access and outcome in individual placement and support (IPS) employment services. Cross-sectional data were analysed of all people with severe mental health problems who accessed two mature high-fidelity IPS services in London in 2019 (n = 779 people). Results There were no significant differences between the proportions of people who gained employment. The data strongly suggest that people from BAME communities are not differentially disadvantaged in relation to either access to or outcomes of IPS employment services. Clinical implications The challenge for mental health professionals is not to decide who can and who cannot work but, how to support people on their case-loads to access IPS and move forward with life beyond their illness.