Supporting Ultra Poor People with Rehabilitation and Therapy among families of children with Cerebral Palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial

Introduction Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. Material and methods This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months. Conclusion This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families.

Community-based workers’ capacity to develop inclusive livelihoods for youth with disabilities in Botswana

Background: Youth with disabilities encounter multiple barriers to livelihood opportunities and socio-economic inclusion. Research focusing on identifying and evaluating evidence-based strategies that may facilitate their transition into socio-economic participation is limited.Objectives: The study undertook to contribute knowledge and evidence to inform inclusive socio-economic development of youth with disabilities and capacitation of community-based workers engaged in implementing the livelihood component of community-based rehabilitation programmes advocating for inclusive development.Method: This qualitative exploratory case study used the International Classification of Functioning, Disability and Health: Children Youth Version to analyse community-based workers’ knowledge and experience of the rural and peri-urban communities in which they worked in Botswana. It further analysed their activities, strategies and recommendations in response to environmental factors impacting the livelihood opportunities of youth with disabilities. Data were generated through semi-structured interviews, following a life history and phenomenological approach. Data were analysed inductively using thematic content analysis.Results: Community-based workers showed sufficient knowledge and experience of barriers and enablers in health, education and training, social development, employment and governance that facilitated or obstructed access to livelihood opportunities for youth with disability. Identifying more barriers than enablers, community-based workers adopted innovative strategies to sustain and strengthen their practices and activities in the livelihoods domain. They contributed recommendations, mainly aimed at government.Conclusion: Community-based workers have the capacity to provide valuable evidence and design strategy to facilitate the socio-economic inclusion of youth with disabilities. They are particularly adept at intervening at local levels but do not have sufficient confidence or capacity to mobilise supportive community structures or to exert influence at the level of policy formulation, decision-making and implementation.

Protection of participants in a proposed treatment-based alternative to prison for men who have sexually assaulted an adult

<p>This thesis examines the proposed “treatment track” for men who have sexually assaulted an adult. The treatment track would offer community-based rehabilitation as an alternative to imprisonment when a perpetrator pleads guilty and is assessed as suitable for entry. It has the potential to increase reporting of sexual assaults of adults, decrease attrition in the processing of those complaints, provide a less distressing experience for complainants, and reduce reoffending. The treatment track has broad public support in principle, but work is required to develop the idea into a model and assess its feasibility. In this thesis, I consider whether the treatment track – as part of the criminal justice process – could offer sufficient protection for the liberties of its potential and actual participants. I use Roberts’ discussion of penal minimalism as a theoretical framework, which has not been applied to alternative ways of resolving offending before. I conclude that the treatment track could not yet fulfil the requirements of penal minimalism. Overall, the thesis advances the development of fair and effective alternative resolutions of serious offending. It does this by considering how one such alternative could be designed so that it respects fundamental liberties, developing sentencing theory to make it applicable to this new context, and by proposing an empirical research agenda guided by the requirements of penal minimalism. The thesis argues the following: The first condition of penal minimalism is that the state’s preventive duty should be exercised only where there is sufficiently serious harm to warrant intervention by the criminal justice process. In this context, it must be established that sexual recidivism is a serious enough problem to warrant intervention with legally-mandated, potentially intrusive treatment and risk management measures. Official conviction rates suggest no pressing need for more widely available treatment to reduce recidivism by men convicted of sexually assaulting an adult. I argue, however, that the self-report literature on undetected perpetration and the under-reporting and attrition figures in sexual cases indicate that repeat sexual violence perpetration (both by men whose offending currently results in a conviction and those whose offending has not been formally detected) is a serious problem requiring intervention, thus fulfilling the first condition of penal minimalism. The second condition of penal minimalism is that the proposed reform is likely to be effective in preventing the identified harm. I argue that the treatment track could reduce sexual recidivism if it achieved either of two things. First, it could bring into the criminal justice process perpetrators of sexual violence who are likely to reoffend without intervention and with whom there would not otherwise be any intervention to reduce their risk of reoffending. Secondly, the treatment track could reduce reoffending by men who would currently be convicted of a sexual offence and imprisoned, more effectively than current sentencing and correctional practice. I synthesise the various relevant bodies of empirical evidence to try to answer these questions, highlighting the wide gaps in knowledge that mean it cannot be concluded that the treatment track would be effective in reducing sexual reoffending. The third condition of penal minimalism is that the proposed reform should not infringe unduly on the liberties of the accused/offender. I focus on whether the treatment track could be designed to be equivalent in severity to the sentence of imprisonment that would otherwise be imposed. I develop the theory on the principle of proportionality to accommodate resolutions such as the treatment track which are restorative and/or treatment-based, and argue that it is possible for the treatment track and a sentence of imprisonment to be of equivalent severity. I then consider whether, despite equivalence in severity, the treatment track could coerce potential participants into pleading guilty and accepting psychological treatment, both interferences with their liberty.</p>

Protection of participants in a proposed treatment-based alternative to prison for men who have sexually assaulted an adult

<p>This thesis examines the proposed “treatment track” for men who have sexually assaulted an adult. The treatment track would offer community-based rehabilitation as an alternative to imprisonment when a perpetrator pleads guilty and is assessed as suitable for entry. It has the potential to increase reporting of sexual assaults of adults, decrease attrition in the processing of those complaints, provide a less distressing experience for complainants, and reduce reoffending. The treatment track has broad public support in principle, but work is required to develop the idea into a model and assess its feasibility. In this thesis, I consider whether the treatment track – as part of the criminal justice process – could offer sufficient protection for the liberties of its potential and actual participants. I use Roberts’ discussion of penal minimalism as a theoretical framework, which has not been applied to alternative ways of resolving offending before. I conclude that the treatment track could not yet fulfil the requirements of penal minimalism. Overall, the thesis advances the development of fair and effective alternative resolutions of serious offending. It does this by considering how one such alternative could be designed so that it respects fundamental liberties, developing sentencing theory to make it applicable to this new context, and by proposing an empirical research agenda guided by the requirements of penal minimalism. The thesis argues the following: The first condition of penal minimalism is that the state’s preventive duty should be exercised only where there is sufficiently serious harm to warrant intervention by the criminal justice process. In this context, it must be established that sexual recidivism is a serious enough problem to warrant intervention with legally-mandated, potentially intrusive treatment and risk management measures. Official conviction rates suggest no pressing need for more widely available treatment to reduce recidivism by men convicted of sexually assaulting an adult. I argue, however, that the self-report literature on undetected perpetration and the under-reporting and attrition figures in sexual cases indicate that repeat sexual violence perpetration (both by men whose offending currently results in a conviction and those whose offending has not been formally detected) is a serious problem requiring intervention, thus fulfilling the first condition of penal minimalism. The second condition of penal minimalism is that the proposed reform is likely to be effective in preventing the identified harm. I argue that the treatment track could reduce sexual recidivism if it achieved either of two things. First, it could bring into the criminal justice process perpetrators of sexual violence who are likely to reoffend without intervention and with whom there would not otherwise be any intervention to reduce their risk of reoffending. Secondly, the treatment track could reduce reoffending by men who would currently be convicted of a sexual offence and imprisoned, more effectively than current sentencing and correctional practice. I synthesise the various relevant bodies of empirical evidence to try to answer these questions, highlighting the wide gaps in knowledge that mean it cannot be concluded that the treatment track would be effective in reducing sexual reoffending. The third condition of penal minimalism is that the proposed reform should not infringe unduly on the liberties of the accused/offender. I focus on whether the treatment track could be designed to be equivalent in severity to the sentence of imprisonment that would otherwise be imposed. I develop the theory on the principle of proportionality to accommodate resolutions such as the treatment track which are restorative and/or treatment-based, and argue that it is possible for the treatment track and a sentence of imprisonment to be of equivalent severity. I then consider whether, despite equivalence in severity, the treatment track could coerce potential participants into pleading guilty and accepting psychological treatment, both interferences with their liberty.</p>

PHYSIOTHERAPY SERVICE WITHOUT STANDARDIZED OPERATING PROCEDURES FROM PHYSIOTHERAPIST’S PERSPECTIVE: A CASE STUDY

Background: Treatment variations have been considered as a sign of an inappropriate healthcare service whether due to the underuse or the overuse of resources. To reduce these variations, establishing and implementing well-developed standardized operating procedures (SOPs) and evidence-based standardized clinical guidelines is required. A rehabilitation unit for children with disabilities in Makassar did not implement any SOPs or standardized clinical guidelines in their service and treatment. This conduct may have an adverse effect on physiotherapists’ professionalism.Aims: The study aimed to explore the possible impact of community-based rehabilitation (CBR) practice with no SOPs and evidence-based standardized clinical guidelines on the physiotherapists. Method: This study was a qualitative case study. The CBR unit was observed for 278-hours and the study conducted three semi-structured interviews. Three physiotherapists voluntarily participated in the study. Open, axial, and selective coding were conducted to encode the interview findings. The findings from observation encoded interview, field, and self-reflective notes were triangulated, analyzed thematically, and illustrated by the explorative model.Results: Working with no SOPs and guidelines was associated with variations in procedures by physiotherapists, irregularity in their treatment choices, liability feeling toward errors making, and Low self-confidence in their professionalism.Conclusion: Working without SOPs and guidelines was associated with psychological exertion of the physiotherapists. They showed uncertainty in their professional capabilities as a physiotherapist. It is recommended for YPAC Makassar city to develop SOPs and evidence-based standardized clinical guidelines for their organization.Keywords: children, community-based rehabilitation, disability, guidelines, standard-operating procedure

Investigation on the Operation Status of Community-Based Rehabilitation Station in a District of Chongqing

Objective. Investigate and analyze the current operation status of the community-based rehabilitation station in a district of Chongqing to provide some reference schemes for improving the construction of the community-based rehabilitation system for Chongqing. Methods. Self-designed questionnaires were issued to 36 community-based rehabilitation stations in a district of Chongqing to investigate the human resources status, service projects, service methods, and other aspects of the community-based rehabilitation stations. Results. The community-based rehabilitation station lacks the participation of medical rehabilitation personnel, and only 33.3% of the community-based rehabilitation stations are composed of multidisciplinary human resources of medical and community staff. Community-based rehabilitation services focus on supply education and publicity (86.11%), and rehabilitation treatment services are not fully involved in the community-based rehabilitation service (44.44%). The methods of community-based rehabilitation services are mainly posters and other publicity activities (94.44%), and the community-based rehabilitation service methods are not highly goal-oriented. Conclusion. The survey found some problems to be improved in the construction and operation of grass-roots community-based rehabilitation stations in Chongqing. Community-based rehabilitation stations should enrich the human resources and technology of medical rehabilitation, become an extension of the restoration of community health institutions, and promote the high-quality development of community-based rehabilitation.

Doing gender as an offender: A criminological analysis of offender narratives, and the interrelationship between masculinities and child sexual abuse

<p>Masculinity is a powerful construct that transcends other aspects of male existence and dictates codes of conduct accordingly. Masculinity describes a plurality of roles, norms and expectations that regulate the behaviour of men. Within criminology, many theorists have established an association between threatened masculinity and sexual violence perpetrated against adults. Comparatively little attention has been paid to the relationship between masculinity and sexual violence perpetrated against children. What research there is, suggests that men who sexually abuse children may offend as a way of overcompensating for perceived masculine inadequacies that have arisen as a result of chronic experiences of powerlessness. This thesis is based on semi-structured, in-depth interviews with men who have sexually offended against children. Twenty men were recruited from community-based rehabilitation programmes around New Zealand. Transcripts of these interviews — as well as client records and results of a Q-sort task — were analysed to identify ways in which these men achieve, negotiate or defy normative gender expectations. A mixture of thematic and narrative analysis was used to interpret the data, revealing four prominent themes: powerlessness, entitlement, risk-taking and rigid thinking. Within each broad theme, several other factors were identified. For the theme of powerlessness these were: distorted perception, idealistic or nostalgic views of childhood, previous experience of trauma or abuse, an inability to seek help, experiences of humiliation or rejection, and perceived masculine failings. For the theme of entitlement these were: a propensity for resentment and blame, narratives of nice guys relegated to the friend zone, and valuing of hypermasculinity. For the theme of risk-taking these other factors were: narratives of boredom or addiction, as well as the existence of obsessive or compulsive tendencies. For the theme of rigid thinking these were: inconsistent or illogical cognitive patterns, poor or inappropriate boundary setting, and inflexible or unattainable religious ideals. Overall, the results lend support to current theories of powerlessness and show that men’s sexual offences against children can be interpreted as overcompensatory behaviour occurring within the spectrum of normative masculinities. These findings highlight the need for rehabilitation to consider offenders’ masculine identities as a point of treatment focus. It is argued that society must challenge the rigid and unattainable nature of hegemonic masculinity because of its potentially harmful consequences for men, women and children. It is hoped that the content of this thesis can contribute to academic knowledge about ‘doing gender as an offender’.</p>