The Cass Review Interim Report ... reflections ...

 ... that may stand for themselves?

[ with my emphasis ]

Independent review of gender identity services for children and young people: 

Interim report

February 2022

Introduction from the Chair

"... the aim of the Review is to ensure that children and young people who are experiencing gender incongruence or gender-related distress receive a high standard of NHS care that meets their needs and is safe, holistic and effective." p.11.

 

"As with autism, the framework for assessment needs to become formalised so there are clearer criteria for diagnosis and treatment pathways which are shared more widely. These should incorporate not just whether the child or young person meets DSM-5 criteria for gender dysphoria, but how a broader psychosocial assessment should be conducted and evaluated, and what other factors need to be considered to gain a holistic understanding of the child or young person’s experience. Professional judgement and experience will still be important, but if the frameworks and criteria for assessment and diagnosis were more consistent and reproducible, there would be a greater likelihood that two different people seeing the same child or young person would come to the same conclusion." p.60.

"Assessment and management: All children and young people who are referred to specialist services should have a competent local multi-disciplinary assessment and should remain under active holistic local management until they are seen at a specialist centre." p.92.

[ and from: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ ]

"Dr Cass has now sent further advice on the core components of this model. You can read the advice in full here.

In summary, she has said:

  ...

• ‘The services should have an appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population’.

• ‘Staff should maintain a broad clinical perspective to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context’."

 

Seeds in 'architecture' iii

Prof. Younés describes 'three essential dualities': 

• IMAGE and WORD 
• TYPE and MODEL
• IMITATION and INVENTION

IMAGE and WORD 

Nursing has its historical images, that are continually presented, the lamp, hands imbued with care and support and others. The attraction to Hodges' model was through its similarity to mind-mapping, but with offering an foundational structure for reflection and critique (learning). So image has been there from the start.

Younés writes: "Within the dialectic of the visible (objects apprehended by the senses) and the invisible (ideas or forms apprehended by the mind), the image acts as a symbol when it supports the visibility of an idea." ... "Forms can be seen as structural potentials ..." p.238.

Younés classifies images (p.241), or the artistically factual through three divisions:

1. visual images (that would include icons and interface features)
   
2. mental images
3. verbal images (including metaphors and descriptions).
   

 "... the mind constructs a world within a world, and then reflects upon its own activity, as well as its own aesthetic appreciation of such activity."

I must stress the Younés context is architecture (and philosophy), but here extending to meaning I'm reminded of the way Hodges' model can span the arts and sciences, and original influences on why this model stood out for me through its facility for mind-mapping.

TYPE and MODEL 

 Here (p.242) Younés returns, not just to the origin, but the concept of origin through Form, the word and the type. Searching for universally shared purposes, within the permanences of human experience  this is health and social care too.

Taking in data, information, knowledge from assessment and other activities, this is usually contextualised - associated with a care domain. A return to the origin (nexus) of Hodges' model, the center is vital to retain balance and provide assurance in what we are doing, or not, and why.

"The architect imitates things as they have essential significance, but he or she does not copy any particular thing. This enables the layered transformation of natural models, without which the column would have always remained a tree. The form of the imitation is always different from that of the model. The roof is different from the forest's canopy. It is here that the pleasure of invention and the evaluation of the new enter, for it is within the recognized distance between the forest's canopy and the roof, that much of art occurs." p.244.

How times change in two decades. So many seek a roof, with architects having a recognized role in providing solutions post-natural disaster and political displacement of people. Not just homelessness, but homes that can cope, adjust to climate change. COVID has reminded us of the rejuvenating properties of nature, of the forest canopy, even that afforded by city centre gardens. 

We now see a roof not merely in physical terms, but social. As the night skies brighten we try to secure the canopy of the stars.

IMITATION and INVENTION 

Have we forgotten the contribution of positive role-models in learning? Imitation is the sincerest form of flattery and this throws up the constant educational dilemma of the theory - practice gap. Should we be exposed to practice without the guiding mentor represented in theory - that is also evidence-based?

There is an interesting exploration of SCOPE, DISCOURSE and NATURE: On Scope

"Thus a theory that is systemic aims at a certain level of completeness for it establishes the internal organization of architecture as a discipline, and it explains its external relations to other arts, to techniques, to social factors. Put differently, the interior individual realm concerns the intellectual freedom, the inner reflection of the architect-maker. The exterior individual pertains to the thoughts resulting from one architect reflecting upon another architect's work, as well as the individual architect's reflections on the suitability of her or his building to a context. The interior collective bears upon the conscious or unconscious content of culture which thrive within the images of of operative myths that inform architectural production. The exterior collective designates that commonly built sense regarding the suitability of architecture (decorum) within its milieu par excellence: the city. The above concerns the scope of an architectural theoretical system, on the urban, architectural, aesthetic, social, and practical levels." p.245-246.

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interior individual	exterior individual
interior collective	exterior collective

 

I started these three posts noting the addition of 'architecture' to titles, concepts, and 'stretching' disciplines. Also guilty here; in mitigation, I'm aware of how in the mid-late 1970s technical drawing as taught was to change radically in the digital wave.

Hodges' model provides a drawing board, with analogue and digital potential.

I will continue to draw upon the (inspirational) discipline of architecture, it informs and sustains thought, construction, meanings, language use, and effort here.

There is much more to glean from this paper, so I hope to revisit it in the future - with further annotations on my copy.

Over the years I have noted related items in the press (yes, I saved the following):

Designs for life: architecture in the disaster zone, FT Weekend.

and read - A Bed for the Night: Humanitarianism in Crisis

By David Rieff

See also: 

Seeds in 'architecture' i 

Seeds in 'architecture' ii

Younés, Samir. “Constructing Architectural Theory.” Philosophy 78, no. 304 (2003): 233–53. http://www.jstor.org/stable/3752046.

World Drowning Prevention Day

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I can learn to swim? Yes, you can - it's fun too!  Even if you can swim: Respect the water! Be aware - of water depth, the water's temperature and your body's reaction to cold, what lies beneath, and the effect of alcohol and substances, and that recent meal... Be safe - while having fun!
Local Community Knowledge of local risk	Policy Facilities Development aid/funding

I'm a critical thinker and no I don't carry a card ;-)

"One of us (PD) had a conversation recently with a new Director of Nursing (DoN) of a large hospital trust. They started to talk about “these new graduates today” and “what was wrong with them.” For shame, PD was just waiting for the usual tired diatribe about “university nurses” and what they “could not do” and why they were all “too academic” and so on ad nauseum. I could not have been more wrong. The DoN talked about “these new nurses” and how they did not seem to be critical thinkers who could question and challenge existing systems and practices. What I need, they said, are nurses who can advocate, challenge, step in to prevent incidents or patient deterioration, who can see better ways of doing things and make that happen. The last thing they need, they said, were nurses who could only tick boxes or follow algorithms and orders. To say this conversation was an eye-opening highlight in the oft-reported “decay” of critical thinking in nursing (Morrall & Goodman, 2013) was an understatement, especially since every university School of Nursing will swear blind that it produces nurses who are card-carrying “critical thinkers” and every hospital will testify that it encourages this, rather than erects barriers to prevent it (Cornell, Riordan, Townsend-Gervis, & Mobley, 2011). It is a real concern that so few Schools or health services even know how to ask the question, “How do we know?”, let alone answer it." p.2.

Darbyshire, P., Thompson, D. R., & Watson, R. (2019). Nursing schools: Dumbing down or reaching up? Journal of Nursing Management, 27(1), 1-3. https://doi.org/10.1111/jonm.12730

Still ready to help teach, share, collaborate - while still learning here ...

The mechanics of Continental and Policy Drift

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	continental drift
	Younger folks may not know Gloria Steinem & Dorothy Pitman Hughes. These pioneers fought for racial and gender rights…50 years ago. pic.twitter.com/a72MukErsM — LiLong ☮️ (@MimawMoon) July 21, 2022

... slow movement ...

Thanks to Prof Linda Gask who Retweeted LiLong.

Henrietta Lacks' 'immortal cells'

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Henrietta	'immortal cells'
Lacks	No consent No family knowledge Harm to trust of African American communities Damage to trust in medical research generally

Thanks to Ilaria Galasso, for reminding me about HeLa cells - Henrietta Lacks in a presentation at:

https://vitalcirculations.org/

15:00-15:30 Genetic data and the collective good: participants as leaders to reconcile individual and public interest | Ilaria Galasso

https://www.eventbrite.co.uk/e/vital-circulations-vital-data-symposium-tickets-365908681717

The Legacy of Henrietta Lacks

 

 

Reflecting on The Times Education Commission 2022

"At the Apple headquarters in Cupertino, California, Susan Prescott, vice-president of enterprise and education marketing, argued that economic prosperity depended on human ingenuity. “Creativity doesn’t mean ‘Have a music and an arts class’. Creativity means across disciplines, how can you bring in ways for kids to engage in the material differently? How do you bring in opportunities for kids to reflect their learning in new ways? How do you use it to get a different, broader view rather than the fact-based stuff?" p.58. (with my emphasis and below)

Included in the 12-point plan for education:

1 A British Baccalaureate

It would offer broader academic and vocational qualifications at 18, with parity in funding per pupil in both routes, and a slimmed-down set of exams at 16 to bring out the best in every child.

2 ‘Electives premium’

This should be offered for all schools to be spent on activities including drama, music, dance and sport and a National Citizen Service experience for every pupil, with volunteering and outdoor pursuits expeditions to ensure that the co-curricular activities enjoyed by the most advantaged become available to all.

3 New cadre of Career Academies

These would be elite technical and vocational sixth forms with close links to industry, mirroring the academic sixth forms that are being established and a new focus on creativity and entrepreneurialism in education to unleash the economic potential of Britain.

4 Significant boost to early years funding

The extra funding should be targeted at the most vulnerable. A unique pupil number would be given to every child from birth, to level the playing field before they get to school. Every primary school should have a library.

5 Army of undergraduate tutors

The students would earn credit towards their degrees by helping pupils who fall behind to catch up.

6 Making the most of tech

A laptop or tablet for every child, greater use of artificial intelligence in schools, colleges and universities to personalise learning, reduce teacher workload and prepare young people better for future employment.

7 Wellbeing at the heart of education

A counsellor should be placed in every school and an annual wellbeing survey of pupils carried out to encourage schools to actively build resilience rather than just support students once problems have arisen.

8 Bring out the best in teaching

The profession’s status and appeal would be increased with better career development, revalidation every five years and a new category of consultant teachers, promoted within the classroom, as well as a new teaching apprenticeship.

9 A reformed Ofsted

Ofsted should work collaboratively with schools to secure sustained improvement, rather than operating through fear, and a new “school report card” with a wider range of metrics including wellbeing, school culture, inclusion and attendance to unleash the potential of schools.

10 Better training

Teachers should be trained to identify children who have special educational needs, a greater focus should be placed on inclusion and a duty put on schools to remain accountable for the pupils they exclude to draw out the talent in every child.

11 New university campuses

New campuses should be created in 50 higher education “cold spots”, including satellite wings in further education colleges. In addition, pay and conditions in the FE sector should be improved and a transferrable credit system between universities and colleges created to boost stalled British productivity.

12 A 15-year strategy for education

The strategy should be drawn up in consultation with business leaders, scientists, local mayors, civic leaders and cultural figures, putting education above short-term party politics and bringing out the best in our schools, colleges and universities.

Obviously idealised but mapped here to Hodges' model the long-term - policy, strategic, funding, resource and workforce emphasis is apparent.

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7 Wellbeing at the heart of education reflection critical thinking, communication and creativity	2 ‘Electives premium’ (outdoors) ... 6 Making the most of tech 7 Wellbeing at the heart of education
2 ‘Electives premium’ (drama, music, dance) ...	1 A British Baccalaureate 2 ‘Electives premium’ (National Citizen Service experience) 3 New cadre of Career Academies 4 Significant boost to early years funding 5 Army of undergraduate tutors 8 Bring out the best in teaching 9 A reformed Ofsted 10 Better training 11 New university campuses 12 A 15-year strategy for education

What, if anything, is missing?

With its recommendations, the Commission is not intended to be prescriptive, specifying educational methods, methodologies and resources. But the aims and mapping above, point to the need to link education and health as per #7 Wellbeing at the heart of education. 

There is surely an avenue here - via the sustainable development goals, which the UK must also 'achieve'. Consider the following too:

"The system doesn’t measure creativity; it measures what you can remember of other people’s facts.” p.11.

"A British Baccalaureate at 18, an equally rigorous but broader qualification than A-levels with academic and vocational options under the same umbrella. Pupils studying for the academic Diploma Programme would take six subjects — three major, three minor — covering humanities and sciences as well as units on critical thinking, communication and creativity. Those on the Career-related Programme would combine learning (which could include BTecs or a T-level) with work experience. There would be the option for students to “mix and match” elements of both programmes to create the qualification that best suited them. All pupils would do an extended project, community service and some literacy and numeracy through to 18. Digital skills would be woven through the whole curriculum." p.95.

What is missing is understandably the aforementioned tools to facilitate creativity, but let state this as follows and join the dots with wellbeing.

• We need to respect, support and encourage students to be and become curators of their lifelong learning and life chances. 
• The reference p.11 to students being measured on what they can "remember of other people’s facts" is a key statement. As a curator, students should be the marshal of their own 'memory palace' pushing the boundaries, their envelope as the lifelong learning (constant test-pilot) of what we hope is a long career - and not just while in 'work'.
  
• In the above mapping, we can see what is recognised in 'wellbeing'. Pupils need a foundation, they need the confidence and self-esteem to explore, express and explain any difficulties commensurate with their unique situation and identity. The importance of security (nationally, locally and personally) as the basis to address the social determinants of health are essential to integrate short and long-term policy aims and objectives, individual and collective success.

This is identified in the findings:

"Lee Elliot Major, a professor of social mobility at the University of Exeter, said there were 'bold and compelling reform' in the commission’s findings.

He welcomed the adoption of his recommendations for undergraduate tutors to help poorer pupils, adding: 'We need to consider radical reset to ensure that the education system fulfils the potential of all children.'”

https://www.thetimes.co.uk/article/times-education-commission-report-welcomed-by-tony-blair-john-major-qwc3b7ktx

The Times Education Commission 2022, 

https://www.thetimes.co.uk/society/education/education-commission

'Health career' - 'life chances'

Sept 2022: 'An introduction to evidence-based health care'

Are you aged 16-18 years, based in the UK or Ireland, and interested in studying a #healthcare-related subject at university?

Sign up here https://t.co/f6gSMgRtYa for 'An introduction to evidence-based health care', a free webinar we're hosting alongside @CochraneIreland pic.twitter.com/r7Kj5MbVZO

— Cochrane UK (@CochraneUK) July 14, 2022

Students 16-18 years old.

School leavers

A career in health care

'Health Career' - 'Life Chances'

The QUALCARE Scale - in Hodges' model

 Clearing yet another piece of notepaper from the 1990s, when I wrote (from the abstract):

"The QUALCARE Scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial."

 (extra note - 53 item Likert scale format.)

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PSYCHO-	PHYSICAL ENVIRONMENT MEDICAL MANAGEMENT
-SOCIAL ENVIRONMENT	(MANAGEMENT) HUMAN RIGHTS FINANCIAL

 

Phillips LR, Morrison EF, Chae YM. The QUALCARE Scale: testing of a measurement instrument for clinical practice. Int J Nurs Stud. 1990;27(1):77-91. doi: 10.1016/0020-7489(90)90025-e. PMID: 2312237.

I had encountered Hodges' model in 1987-88 [ Manchester Polytechnic College, now Manchester Metropolitan University, CPN(Cert.) course ], but the initial (and thus far only) website appeared in 1998 (-2015):

https://web.archive.org/web/19990501185433/http://www.p-jones.demon.co.uk/index.htm

Book review - "Human Landscapes: Contributions to a pragmatist anthropology"

'After Ethnos', a previous book review was an enjoyable challenge. As a nurse, you are, to a certain extent several disciplines all rolled into one, sociologist, psychologist, diplomat, anthropologist ... but After Ethnos and now Dreon's 'Human Landscapes' bring their own demands.

If it was experiment that attracted me to Tobias Rees's book, Dreon's title works on two levels.

Hodges' model anticipates different 'landscapes'. The model also provides a lesson in pragmatism (another post) with pragmatism identified as a method to research Hodges' model.

On health care education programmes, how often do we write of human nature, cognition, or cognitive processes, qualitative and quantitative, subjective and objective? How quickly do we present ourselves, and the readers of assignments with dichotomies, dualities, and polarities?

Just 40 pages in they are here in expected and welcome abundance. I clearly have some reading to do [ that's why it's a review! :-) ] and from reading, much to critique in my differentiation between phenomena and as concepts presented here on W2tQ.

"... the conceptual framework for my approach to human nature is represented by cultural naturalism— that is, a nonreductive form of naturalism that assumes culture to be continuous with nature, rooted in the very organic and environmental conditions of human life, and yet irreducible to the mere association of preexisting resources." p.23

Human landscapes

"Nonetheless, even if we wish to focus on a theoretical analysis of the concept, the idea of human nature seems to display a tangle of problems, punctuated by distinctions that could be useful when treated as functional and connected to specific contexts, but which are actually turned into dogmatic oppositions. One first form of dualism concerns the opposition between the innate and the acquired, between the allegedly innate equipment existing on the genetic or neural level and the properties and ways of behaving this is assumed to give rise to. To give but one example, based on Chomsky’s influential hypothesis, the idea of a neural program for producing grammar encoded in our genes has been assumed to be an efficient (and sometimes sufficient) cause for specific linguistic practices. From this point of view, nurture, culture, and institutions seem to be something completely different from nature, since they supervene on an already fixed material substratum as an adjunct." pp.17-18.

"Taking this or that snapshot of a human could be a useful intellectual expedient in specific circumstances, but “[b]iologically all growth is modification and all organs have to be treated and understood as developments out of something else and as pointing forward to still something else” (Dewey 1985b, 32–33)." pp.19-20.

"I believe that the conceptual opposition between subjective and objective qualities is like a net with too wide a mesh, unable to catch the complexity of our interactions with the world. The problem, I would argue, is that this opposition often involves the idea that qualitative experience is a private, purely first-person experience, consequently posing problems of public access." pp.33-34.

"The section 2 will focus on the Pragmatists’ conception of experience as something broader and richer than cognition—because, in turn, cognition is understood as a specific phase within experience, responding to the needs and problems emerging from qualitative experience and ultimately returning to it. In this approach, perception through the senses and pure sense data are reframed within the context of inquiry, as features that are pointed out, discriminated, and isolated from a more holistic field of experience according to an
idea, namely, the anticipation of the possible consequences of an action or a certain assumption." pp.37-38.

Not sure why, but at one point, reading prompted consideration of: 'lived experience' and the role of peer support workers?

Starting the book, Dreon is (naturally) laying out the scope and structure of the book. Not just a preface but first chapter, and it looks like - the second. As I get more accustomed to Dreon's style (I'm a nurse remember) there are valuable lessons in laying out arguments, with more reward to follow I trust. I have a sense of a wall, not an impenetrable one, but one that is well argued - the blocks shifting into place - even if I cannot grasp their true significance to specialists in this field.

More to follow.

Dreon R. (2022) Human landscapes. Contributions to a pragmatist anthropology. Suny Press, Albany.

Many thanks to Roberta and Suny Press for my copy (confession to follow).

ERCIM News No. 130 Special Theme: "Assistive Technologies for a More Accessible and Inclusive Society"

Dear ERCIM News reader, 

Assistive Technologies for a More Accessible and Inclusive Society is the special theme of ERCIM News No.130, just published at https://ercim-news.ercim.eu/ 

ERCIM NEWS 130

This issue's Special Theme presents numerous contributions with studies in the field of assistive technology with different and complementary approaches. This special theme has been coordinated by our guest editors Christine Azevedo Coste (Inria) and Barbara Leporini (ISTI-CNR). 

 Thank you for your interest in ERCIM News. 

Feel free to forward this message to anyone who might be interested.

We are also happy if you follow us and talk about us on twitter @ercim_news and other social media. 

Next issue: No. 131, October 2022 Special Theme: "Ethical Software Engineering and Ethically Aligned Design". 

Submissions are welcome! See call for contributions. 

ERCIM News is published quarterly by ERCIM, the European Research Consortium for Informatics and Mathematics. With the printed and online edition, ERCIM News reaches more than 10000 readers. 

All 130 issues published published to date are available online. 

The last four issues have focused on Fighting Cybercrime, Quantum Computing, Smart and Circular Cities, and Privacy Preserving Computation. 

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Two policy initiatives related to Digital and eHealth - RCN

Dear eHealth forum members 

[c/o RCN]

We just wanted to alert you to two policy initiatives related to Digital and eHealth.

1. The Digital Nursing programme in England is seeking feedback on their consultation on having a Standard for Nursing Documentation. The draft standard and form to give feedback [by 21st July] are available on the NHS futures website (https://future.nhs.uk/DigitalNursesNetwork/view?objectID=36339504). 

You may need to register to access the site:

image: FutureNHS - Digital Nursing Programme

2. NHS England has just released their plan for Digital health and social care (https://www.gov.uk/government/publications/a-plan-for-digital-health-and-social-care/a-plan-for-digital-health-and-social-care).

With very best wishes

The eHealth forum committee

n.b. Closing date for feedback added in text.

 

PsychoPathology: Space, Social Perception, and Mental Disorders ...

In the Philos-L "The Liverpool List" I noticed this (online) issue of Psychopathology and was drawn to its themes, especially that of space.

TABLE OF CONTENTS

129. Space, Social Perception, and Mental Disorders: Phenomenological and Empirical Approaches
Bader, O.; Bizzari, V.; Fuchs, T.
https://www.karger.com/Article/FullText/524754 (Open Access)

132. Scale for Space and Time Experience in Psychosis: Converging Phenomenological and Psychopathological Perspectives
Arantes-Gonalves, F.; Wolman, A.; Bastos-Leite, A.J.; Northoff, G.
https://www.karger.com/Article/FullText/519500

143. Alterations in the Experience of Time, Space, and Intersubjectivity and the Interaction with Pre-Existent Psychopathology during the COVID-19 Pandemic
Lau, I.; et al.
https://www.karger.com/Article/FullText/522345

156.  Reopening Selves: Phenomenological Considerations on Psychiatric Spaces and the Therapeutic Stance
Thoma, S.; Schwnzl, I.; Galbusera, L.
https://www.karger.com/Article/FullText/517888

168. Borderline We-Space? The Phenomenology of the Background of Safety in Borderline Personality Disorder
Van Duppen, Z.; Schmidt, P.; Lowyck,B.
https://www.karger.com/Article/FullText/520860

179. Borderline Personality Disorder, Lived Space, and the Stimmung
Lo Monte, F.; Englebert, J.
https://www.karger.com/Article/FullText/521182

190. Background Feelings of Belonging and Psychological Trauma
Wilde, L.
https://www.karger.com/Article/FullText/518327

201. Interpersonal and Intersubjective Alienation in Social Stigmatization and Depression
Paskaleva-Yankova, A.
https://www.karger.com/Article/FullText/519253 (Open Access)

211. Gestalt Perception and the Experience of the Social Space in Autism: A Case Study
Bader, O.; Fuchs, T.
https://www.karger.com/Article/FullText/524562 (Open Access)

Edited - removed active links, affiliations, spurious text codes/line breaks, added one et al.

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psycho- space Intra- Interpersonal Intersubjective	-pathology space empirical
social perception 'We-space'?	space 'We-space'?

New WHO Quality Toolkit - 'Take ii"

Further to last months post, I've worried at times about the axes of Hodges' model and their status and function. Can I let the axis stand for itself?

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Do I expand (explode) the conceptual labels?

self - INDIVIDUAL - person

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relationship - family - GROUP - community - population

There seems to be an asymmetry, when you traverse the axis - and its horizontal counterpart; from wherever you start. Perhaps, I worry too much as if the axis was regular then the generic property of the model overall would be diminished. Is this an axis at all?

The website for the Quality Toolkit at: https://qualityhealthservices.who.int/quality-toolkit

- explains the toolkit's scope that includes:

"This new online resource is a user-friendly toolkit to support action on improving the quality of health services at every level of the health system, from national and district to facility and community levels."

I have only scratched the surface here and hope to revisit again - in more detail. Please see below for reflections on the levels by which the toolkit can support action to improve the quality of health services. I have tried to suggest proximity and distance between the SOCIOLOGICAL and POLITICAL (policy). Perhaps, what is a 'clinic' has a name, that it is known by - a key part of the community. The community is closer to the people - to the would-be users of the facility. You can appreciate(?) here the challenge of getting the local community involved in their services. What is 'NATIONAL' should not be remote. Can people compare and contrast with what they are offered? 

 

On the website I note there are video presentations also. The prospect of regular updates for the toolkit is also welcome.

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psychological access 'My' clinic Trust, I feel safe) (feeling safe) Tell others - my experience..	physical access clinic (appearance, facilities, safety) controlled environment (cleanliness, sterile.., or more social)
'the centre' COMMUNITY DISTRICT national	facility (policy translation / coherence?) community district NATIONAL

Original source: Jules Storr, Independent Consultant, S3 Global & working with WHO as part of the Quality Toolkit development team - via HIFA

Previously: New WHO Quality Toolkit

'Take II'? Quality means getting it right first time (even as you persist in what you are doing - your aspirations and quality improvement). Vitally, this means you, the team make a positive impression for the person, the individual, client .. carer, group. 

If they need to - they will recognise their own ability, knowledge, follow advice, they will come back, they leave not to return soon as they can now self-care and care for others in their home, community ...

 Please note: This post and that previous is not intended to denote endorsement of Hodges' model.