Home Visitation Services

This paper provides the first evaluation of a home visiting program aimed at improving maternal and infant health among uninsured pregnant women: Doctor at Your Home (Doc@Home). This program was implemented in Mexico City, where the maternal mortality rate is particularly high. Doc@Home sends health promoters visit households looking for pregnant women without prenatal care and refer them to a health center for prenatal care consults. Doc@Home also provides information to pregnant women about the importance of prenatal care, healthy habits during pregnancy and advises women to be aware of typical complications that require emergency medical attention. Women who do not access care at a health care center within 48 hours of a referral are visited at home by a physician. The empirical approach takes advantage of the program's roll out. In particular, it uses variation in the time the program began operating in each Mexico City municipality to estimate a difference-indifferences model. I find that maternal mortality, low birthweight and prematurity rates are all substantially improved by Doc@Home. I find a 30 percent reduction in maternal deaths, a reduction of 15 percent of low birthweight's mean and a 14 percent reduction in premature births' mean. The mechanisms that drive these results are discussed in this paper.

Recent literature has highlighted the lack of studies concerning possible clinical interventions in cases of early eating disorders. We will report the case of a three-year-old girl who refuses and avoids food as a result of a medical problem affecting the mouth. Through the presentation of the various stages of assessment and intervention, the aim of this paper is to contribute to the development of verifiable and empirically based treatment, introducing innovative clinical work, which includes psychodynamic home intervention for the child. By means of empirical tools given to the parents to assess the psychopathological profile of the mother, the father and the child, and thanks to the use of observational procedures to highlight the features of feeding interaction, the paper aims to focus specifically on the appearance of this particular eating disorder and the need for all-round care of the child and her welfare, including targeted clinical interventions and specific treatment a...

Recent literature has highlighted the lack of studies concerning possible clinical interventions in cases of early eating disorders. We will report the case of a three-year-old girl who refuses and avoids food as a result of a medical problem affecting the mouth. Through the presentation of the various stages of assessment and intervention, the aim of this paper is to contribute to the development of verifiable and empirically based treatment, introducing innovative clinical work, which includes psychodynamic home intervention for the child. By means of empirical tools given to the parents to assess the psychopathological profile of the mother, the father and the child, and thanks to the use of observational procedures to highlight the features of feeding interaction, the paper aims to focus specifically on the appearance of this particular eating disorder and the need for all-round care of the child and her welfare, including targeted clinical interventions and specific treatment at home for the child. Conclusions: We believe that by providing a specific diagnosis, a subsequent clinical intervention to support the entire family unit can be worked out. In particular, it has been possible to reactivate a process of development that seemed to have stopped at the stage of weaning.

Dans cet article, nous nous centrons sur l’analyse des rapports sociaux dans le secteur des services aux personnes (santé, social), en lien avec les évolutions plus globales de l’économie et de la société contemporaine,  marquées par la tertiarisation et l’importance de l’échange et de l’usage, au-delà de la production. En nous appuyant principalement sur l’approche par Jean Gadrey de la spécificité du rapport social de service par rapport à celui de la production de biens (ainsi que sur des analyses sociologiques des rapports entre économie et société dans la société postindustrielle), nous analysons ce qui se joue au niveau microsocial dans les rapports triangulaires entre usagers, professionnels et institutions au sein du secteur des services aux personnes, en comparant les deux types de pratiques existantes aujourd’hui, « l’intramuros » et «l’extramuros ». Nous proposons ici quelques hypothèses exploratoires permettant d’éclairer des aspects souvent non pris en considération dans les discours et pratiques propres à ces secteurs. Nous distinguons ainsi une triangulation « basse » (ou microsociale) du rapport social et une triangulation « haute » (ou un rapport social élargi), dans laquelle les trois pôles sont en relation à un niveau plus global, déterminant les grandes orientations des services. Nous questionnons les jeux relationnels, les rapports privé-public, les différentes logiques, les dimensions culturelle et idéologique, les compétences, ainsi que les formes que prennent les régulations  et les rapports de pouvoir qui y sont à l’œuvre, dans les deux niveaux de triangulation étudiés. Et ce, avec une attention spécifique à la place des usagers au sein de ces rapports, aux expériences nouvelles porteuses de transformation sociale, et au rôle des pouvoirs publics.