OBJECTIVE: - Canadian literature on federal correctional institutions and prison living indicate a shortage inadequate and available healthcare services to meet the needs of the prison population, despite prisoners higher rates of health challenges (e.g. mental health, addictions, HIV/AIDS) in comparison to the general population. With fewer resources, concerns arise about the delivery, quantity, and quality of penal healthcare provision. Thus, the authors examines former prisoners\' experiences of, in comparison to government reports on, wait-times, and request processes for healthcare services, as well as issues of access, quality of interactions with healthcare professionals and the regulations and policies governing healthcare provision. The paper aims to discuss these issues.
METHODS: - The authors compare data gathered from interviews with 56 former-federal prisoners with publicly available Correctional Services Canada reports on healthcare delivery, staff-prisoner interactions, programmes and services, and overall physical and mental health to identify consistencies and inconsistencies between the government\'s and former prisoners\' understandings of penal healthcare.
RESULTS: - Discrepancies exist between prisoners reported experiences of healthcare provision and government reports. Prisoners are dissatisfied with healthcare provision in more secure facilities or when they feel their healthcare needs are not met yet become more satisfied in less secure institutions or when their needs are eventually met.
CONCLUSIONS: - Theories of administrative control frame the analyses, including discrepancies between parolee experiences and Correctional Service Canada reports. Policy recommendations to improve healthcare provision are highlighted.

Understanding service disposition pathways is critical to provide deeper insight into why certain subgroups of the population are at risk for recurrent Child Protective Services (CPS) involvement and may highlight disparities across groups or geographic areas. Using the Decision-Making Ecology Framework as a lens, the present study examines whether service disposition pathways are influenced by risk assessment, safety concerns, child age, maltreatment type, previous CPS involvement, and/or county-level structural vulnerability. We linked administrative data from New Mexico\'s Department of Children, Youth and Families (DCYF) to data from the American Community Survey. Multilevel models examining associations between case (N = 12,960) and county (N = 33) characteristics revealed that both case (age, maltreatment type, risk/safety assessments, previous CPS involvement) and county-level factors (transportation and housing) were associated with service disposition. Additionally, we observed considerable variation at the county level in both the provision of services and the relationship between risk assessment and service provision. By linking different factors of the decision-making process in child welfare cases to intervention strategies, the analysis reveals that the perception of risk can vary based on geographical context resulting in different outcomes for families who have similar risks but different county-level vulnerabilities.

UNASSIGNED: Parental mental health and substance abuse problems are found in reports of concern to child protection and welfare services. The aim of this study was first to investigate what characterized these reports and how they differed from reports with other types of concerns. Two hypotheses were tested. The first hypothesis was (i) if a report contains concerns about mental health and substance abuse problems, the likelihood of service provision was mediated by substantiation status. The second hypothesis was (ii) that the threshold for substantiation of such problems differed depending on child age, single parent status, and the presence of other child and parent related problems.
UNASSIGNED: The study was designed as a case file study which was carried out retrospectively (N = 883). A conceptual model was tested in two steps. First a mediation model with direct and indirect paths from reports of concerns through substantiation decision to service provision was tested. Then a second model was expanded to also include moderators for the indirect effects of reported concerns on substantiation decisions.
UNASSIGNED: A total of 33.1% of reports about substance abuse and 41.7% of reports about parental mental illness concerns were provided services. The first hypothesis was confirmed. There is a negative direct effect and a positive mediated effect of reported concern on service provision. The second hypothesis was not confirmed. We failed to identify any significant moderating effect of child age, single caregiver status, or number of child problems, upon the threshold for substantiation of mental health and drug abuse problems.
UNASSIGNED: The total effect of reports about mental illness and substance abuse upon service provision was low. Service provision in cases with suspected substance abuse and/or mental illness is highly dependent upon substantiation of that specific problem. Substantiation threshold is not impacted by other case characteristics. This is surprising because there are good theoretical reasons to assume that parental drug abuse and or mental illness are potentially more detrimental to child health, development and safety if the child is younger, if the parent is a single caregiver, and there are many other parallel concerns.

While Direct Seeded Rice (DSR) has numerous potential benefits to smallholder farmers in the Eastern Gangetic Plains of South Asia, it\'s out-scaling has been limited by both a lack of demand by farmers and limited supply of DSR services by machinery owners. This contrasts with the comparatively more rapid scaling of zero tillage wheat in the region. This trend is yet to be fully explored, particularly when focus has been placed almost exclusively on understanding DSR adoption though the lens of farm-level agronomic, economic and environmental performance. Given that limited DSR service provision is likely to be governed outside of these considerations, this study explores with zero tillage drill owners the decision processes they apply in deciding how to use their zero tillage drills. Respondents highlight a complex web of interrelated considerations that highlight the additional complexities of DSR as compared to existing practices. Using a novel \'Decision-making Dartboard\' qualitative framework, these complexities are unpacked and a set of potential changes to the assumed theory of change for DSR scaling are identified, including considerations for selection of potential DSR service providers and responsibilities for promotion and extension of DSR to overcome the prevalent negative perceptions of DSR held broadly across the communities explored. The proposed framework and analysis process are also potentially useful for exploration of other farmer decision making processes more broadly.

BACKGROUND: Poor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. However, studies of transitions in mental health care are commonly difficult to administer and little is known about the determinants of successful transition. The persistence of health inequalities related to access, care, and outcome is now well accepted including the inverse care law which suggests that those most in need of services may be the least likely to obtain them. We sought to examine the pathways and determinants of transition, including the role of social class.
METHODS: A retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland.
RESULTS: We identified 373 service users eligible for transition. While a high proportion of eligible patients made the transition to adult services, very few received an optimal transition process and many dropped out of services or subsequently disengaged. Clinical factors, rather than social class, appear to be more influential in the transition pathway. However, those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively.
CONCLUSIONS: Despite the importance of a smoother transition to adult services, surprisingly, few patients experience this. There is a need for stronger standardised policies and guidelines to ensure optimal transitional care to AMHS. The barriers between different arms of psychiatry appear to persist. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered.

OBJECTIVE: The study sought to identify the characteristics of community-dwelling older people supported by community mental health teams (CMHTs) in England and, in particular, to determine whether there is a common threshold for CMHT entry and/or a core client group.
METHODS: Data were collected about a random sample of 15 CMHTs\' caseloads, including information about their sociodemographic characteristics, physical health, dependence, mental health, risks and service receipt. The sample was divided into 16 subgroups of people with similar needs for care (case types), and differences between teams were explored.
RESULTS: Information was obtained for 1396 patients. Just under half had a functional mental health problem, slightly over a third an organic disorder, seven per cent both, and nine per cent no diagnosis. Considerable variation was found in teams\' caseloads, and there was no evidence of a common caseload threshold. Two of the commonest case types represented people with functional diagnoses who were independent in activities of daily living (ADL) and had no/low levels of challenging behaviour. Another representing people with organic/mixed diagnoses, ADL dependence, challenging behaviour and at least one medium risk was also fairly common. The two case types that represented patients with the most complex needs accounted for more than a quarter of some teams\' caseloads but less than a tenth of others.
CONCLUSIONS: It is wrong to assume that CMHTs all have similar caseloads. Commissioners must ensure that the network of services provided can meet the needs of all eligible patients, whilst more research is required on who such teams should target.

OBJECTIVE: To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix.
METHODS: Data were collected about the services provided to a random sample of patients from 15 CMHT caseloads, including contact with CMHT staff, other specialist mental health and social care services. The relationship between patients\' needs and service receipt was explored.
RESULTS: Information was obtained for 1396 patients. Average time on CMHT caseloads was 11.6 months, but there were marked between-team differences. The proportion of re-referrals also varied from under a tenth to over half. People with functional mental health problems and complex needs were most likely to be long-term CMHT clients. The proportion of patients seen by a consultant in the previous 6 months ranged from approximately a fifth to almost all. Differences with respect to contact with other qualified practitioners were less marked. Older people with functional disorders, challenging behaviour and at least one medium risk had the most regular contact with CMHT staff. Risk of self-harm, delusions and paranoia increased the likelihood of consultant involvement. Support workers were more likely to see people at risk of self-neglect. The receipt of other services, including day hospitals and inpatient care varied greatly.
CONCLUSIONS: Considerable diversity was found in the length, nature and frequency of services provided to patients with different needs. Differences between teams were not wholly explained by case mix.