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Objectives -To evaluate the impact of the Health Education Authority's 20 hour Look After Your Heart health promotion course on a large group of retired women.

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In the rehabilitation of chronically mentally ill patients, social impairments and multiple disabilities necessitate the use of comprehensive and complex services encompassing many areas of life. It is suggested that quality of life (QoL) can be used as an organizing framework for long-term care. Subjects in the present study included staff and patients from a rehabilitation unit that offers individualized long-term care, day services, inpatient and outreach facilities. Using subjective indices, staff and patient perceptions of QoL were compared across several life domains. Significant differences between the 2 groups were found in several areas, including leisure activities, law and safety, and health. The implications of these findings for long-term care are discussed.

There is a paucity of research concerning service usage and needs of female long-term psychiatric patients. A series of studies comparing the provisions for chronically mentally ill men and women in a south London community-focused rehabilitation and continuing care service indicate marked differences in the services received by men and women, and raise questions concerning whether the needs of female patients are adequately served. As a group the women had been in contact with services for longer, had received less intensive input from services, and it appeared that the services had been less responsive to their changing needs. Among those in high contact with the services, the functioning of men and women did not differ, yet women were over-represented in workshops designed for those functioning at a lower level. Women over 45 years of age seemed to be particularly badly served by the organised activities offered.

Mental health services are organized and financed in very different ways across Europe; nevertheless there are a number of common trends and issues. In this paper we deal with some of those issues which influence the quality of services to those with long-term and severe mental health problems and disabilities. The most obvious trend has been the rundown of psychiatric beds particularly in the large mental hospitals and this in its turn has given rise to the problem of providing alternative services. Throughout Europe people are striving, with mixed success, to establish new services that are community orientated, provide reasonable levels of clinical care with some continuity and coordination, and ensure that the individuals served have appropriate accommodation and day-time activities. While there are some excellent services, there are even more services throughout Europe struggling to solve common problems. We have tried to draw some lessons from their efforts.

This paper describes a study to examine the effectiveness of self-assessment as a method of monitoring, evaluating and enhancing quality of service provision in day care settings. One hundred and nineteen providers of group (centre based) day care and 120 providers of family day care took part. Self-assessment materials, designed to help providers evaluate, monitor and enhance the quality of their provision, were produced. These materials combined the views of stakeholders concerning the nature of quality day care with an extensive review of the day care research literature. Presentation of the material was determined by a social learning theory interpretation of an experiential learning paradigm. Results of the evaluation study suggest that to implement self-assessment procedures effectively, some day care providers may require support from an experienced facilitator or mentor. The implications for developing self-assessment procedures for use by day care providers are discussed. RESUMEDans cet article, nous dtudions l'efficacitd de l'auto-dvaluation comme m~thode de contrOle, d'dvaluation et d'amdlioration de la qualitd du travail r&lisd dans les diffdrents syst~mes de garde. Cent dix neuf personnels de structures collectives (creches) et cent vingt assistantes maternelles ont pris part ?~ cette dtude. Nous avons cr~ un mat&iel d'autodvaluation visant ?t aider les personnes concern~es ?~ dvaluer, contr~ler et amdliorer la qualitd de leur travail. Le mat&iel a dtd con¢u en tenant compte ?~ la fois des opinions des diffdrents personnels impliquds sur ce que signifie la qualitd et de l'analyse de la littdrature scientifique sur ce sujet. La prdsentation du matdriel a ~t~ determin~e ~ l'aide d'une interprdtation de la thdorie de l'apprentissage social. Les rdsultats de cette ~tude sugg~rent que pour appliquer les procddures d'auto-dvatuation de mani~re efficace, l'aide d'un expert ou d'un mentor est quelquefois ndcessaire ?z certains personnels. Les implications pour le ddveloppement de procddures d' auto-dvaluation ?l l'usage des personnels de la petite enfance sont discutdes. ZUSAMMENFASSUNG Prdsentiert wird eine Studie Unterst~itzung eines Mentors ben6tigen, um die Instrumente zur Selbstevaluation erfolgreich einzusetzen, Konsequenzen fiir die Entwicklung von Methoden zur Selbstevaluation in Tageseinerichtungen werden diskutiert. RES UMENEn este articulo se describe una investigaci6n que estudia la eficacia de la autoevaluaci6n como mdtodo de seguimiento, valoraci6n y mejora de la calidad de los servicios ofrecidos en todos los tipos de jardin de infancia. En este estudio participaron 119 experiencias educativas desarrolladas en centros diurnos y 120 en las que participaba la familia. Se crearon materiales de auto-evaluaci6n con el objetivo de ayudar a los educadores a valorar y mejorar la calidad de sus servicios. Estos materiales reunian, por un lado, las opiniones de las personas implicadas sobre los fundamentos de una atenci6n infantil de calidad y, por otro, inclufan un amplio andlisis sobre las investigaci...

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