Recent state and federal legislation holds the promise of sweeping reform in special-education practices. In this article, Richard Weatherley and Michael Lipsky examine the implementation of Chapter 766, the dramatically innovative state special-education law in Massachusetts. They show how the necessary coping mechanisms that individual school personnel use to manage the demands of their jobs may, in the aggregate, constrain and distort the implementation of special-education reform. Their findings have serious implications for those seeking to introduce policy innovations in service bureaucracies of all kinds where the deliverers of service exercise substantial discretion in setting their work priorities.

This article presents the findings of a self-report study of the consequences of being an informal caregiver in Malaysia. The aim of this exploratory study was to examine Malaysian efforts in assisting informal caregivers, based on an analysis of the issues and concerns raised by the caregivers themselves. Data were obtained from a cross-sectional survey of informal caregivers in 2009. This sample comprised parents, spouses and/or adult siblings, and adult children, caring for their children, spouses or siblings and parents who were chronically ill and/or had a disability. Of 300 prospective participants, only 175 could be located (58%), but all those contacted agreed to participate. Respondents were randomly selected and interviewed using a structured questionnaire to identify the emotional, financial, social and physical issues consequent upon being a caregiver. Most respondents reported that their care-giving responsibilities had impacted their emotional, financial, social and/or physical well-being. Inadequate and/or uncertain income was by far the greatest concern followed in descending order by social, physical and emotional consequences. The one-way analysis of variance showed significant differences among the three categories of caregivers with respect to physical and emotional consequences. The findings show that care-giving has detrimental effects on the lives of informal caregivers, and that they are in significant need of social support to help them deal with care-giving tasks and responsibilities. Based on the findings, an integrated social support programme is proposed, tailored to the needs of informal caregivers.

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A study of social work-coordinated discharges from medical and surgical units at a 387-bed tertiary care hospital in Seattle, Washington examines social, medical and organizational factors associated with overstays. Social and medical variables included an absence of social supports, multiple diagnoses, and patient/family decision-making problems. Though organizational factors within and outside the hospital were identified, the most frequent systems delay was due to lack of post-hospital beds.