The cost of implementing a 2-1-1 call center-based cancer control navigator program

ObjectivesDetermine the cost of implementing a call center-based cancer screening navigator program.MethodsSocial service call centers in Houston and Weslaco, TX, assessed cancer risks and implemented cancer screening promotion and navigation. Micro costing was used to estimate the program costs. Staff logs and call records tracked personnel time and material costs, including a standard 30% overhead rate. Sensitivity analysis examined the effect of varying uncertain cost parameters. Scale effects were simulated for larger population coverage.ResultsThe total cost to recruit and navigate 732 persons, out of 2933 individuals who called the center was $215,847. The participant time cost was $19,503, and the personnel cost was $116,523. The cost per navigated participant was $295 (95% CI, $290.56–$298.07). The average cost per participant for recruitment and referral only, was $36 (95% CI, $34.9–$36.9). Average cost declines to $34 for recruitment and referral, and to $225 for recruitment, referral, and navigation when the number of participants increases to 15,000 individuals.ConclusionsExpanding 2-1-1 referral services with opportunistic cancer screening promotion takes advantage of existing infrastructure but requires substantial additional staff time, participant time, and budget. Cost estimation is the first step in a full economic evaluation and informs program planners and decision-makers on the resource and budgetary requirements of this innovative strategy for increasing cancer screening in low income communities.     

Cost of Including Males in a University Rubella Immunization Program: A Recommendation to Change a Discriminatory Policy

Abstract

Twenty-seven University of Rochester students developed clinical manifestations of rubella during 1976–77. Twenty-five were male and had not been immunized against this disease; 18 required infirmary care costing $4,876. On the basis of data for freshman males, a cost analysis demonstrates the feasibility of changing the university policy which encourages immunization only of females to encouragement of either selective or mass immunization of all males as well. Immunization during childhood with combined MMR vaccine is least expensive and should be encouraged. In certain circumstances, selective immunization of susceptible males may be less expensive than the present selective policy, which leaves males at risk.     

Estimating the Expense of a Mandatory Home- and Community-Based Personal Assistance Services Benefit Under Medicaid

Abstract

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability.

Design and methods: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS.

Results: New expenditures for PAS are estimated to be $1.4–$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).

Implications: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

A Mandatory Student Health Insurance Program at a Large State University

Abstract

A new compulsory-with-waiver health insurance plan at the State University of New York at Buffalo (SUN-YAB) was designed in 1976 after assessing available literature on students' insurance, morbidity, health care costs, attitudes, data from past SUNYAB insurance plans and health service statistics. Previous findings that the morbidity of this population is low is corroborated by the data available on the students considered within this project. Illnesses common to this age group are predominantly acute, and require a low rate of hospitalization. The new insurance program cost an unmarried single student $67.00 and was a success by several criteria. Approximately 5,000 more students were enrolled in the complusory plan than in the previous voluntary one. Among students interviewed, both those who enrolled and those who did not, felt that the idea of compulsory health insurance for students was a good idea. Virtually all full-time students in the university were covered by some health insurance.     

Implementing an Early Intervention Program for Residential Students Who Present With Suicide Risk: A Case Study

Abstract

Objective: This case study examined the effects of an early intervention program designed to respond to residential college students demonstrating risk for suicide. Participants: Participants were 108 undergraduates at a large northeastern public university referred to an early intervention program subsequent to presenting with risk factors for suicide between Fall 2004 and Spring 2011. Methods: Data were collected from archival records to examine quality of early intervention services, student retention, and grade point average (GPA) during the semesters prior to, during, and subsequent to the referral incident. Results: Program implementation was timely and responsive to student needs; students successfully completing the early intervention program remained in school and demonstrated small but significant rebounds in GPA the semester subsequent to the incident. Conclusions: There are benefits associated with the implementation of early intervention programs designed to respond to students manifesting risk for suicide, such as connecting the student to vital services and support networks.     

Medicaid State Plan Personal Care Services

Abstract

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999–2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Peep show establishments,police activity,public place,and time: A study of secondary effects in San Diego,California

DISORDERS OF SEXUAL DESIRE AND OTHER NEW CONCEPTS AND TECHNIQUES IN SEX THERAPY . (The New Sex Therapy, Volume II.). Helen S. Kaplan. New York: Brunner/Mazel, 1979; 257 pages; $17.50.

CHRISTIANITY, SOCIAL TOLERANCE, AND HOMOSEXUALITY: GAY PEOPLE IN WESTERN EUROPE FROM THE BEGINNING OF THE CHRISTIAN ERA TO THE FOURTEENTH CENTURY . John Boswell. Chicago and London: The University of Chicago Press, 1980; 424 pages; $27.50.

THE UNMENTIONABLE VICE: HOMOSEXUALITY IN THE LATER MEDIEVAL PERIOD . Michael Goodich. Santa Barbara, CA: Ross‐Erikson, 1979; 164 pages; $6.95.

TABU HOMOSEXUALITÄT: DIE GESCHICHTE EINES VORURTEILS . Gisela Bleibtreu‐Ehrenberg. Frankfurt a. M.: S. Fischer, 1978; 443 pages; DM 29.80.

AN ANNOTATED BIBLIOGRAPHY OF HOMOSEXUALITY (in two volumes). Vern L. Bullough, W. Dorr Legg, Barrett W. Elcano, and James Kepner. New York &; London: Garland Publishing, 1976; 405 and 468 pages; $88.

PORNOGRAPHY: THE CONFLICT OVER SEXUALLY EXPLICIT MATERIALS IN THE UNITED STATES . Greg Byerly and Rick Rubin. New York: Garland Publishing, 1980; 188 pages; $20.

SEXUALMEDIZIN IN DER PRAXIS . Wolf Eicher. Stuttgart &; New York: Gustav Fischer Verlag, 1980; 590 pages; DM 178.00.     

Alcohol-Related Problems Seen at the Student Health Services

Abstract

The number and types of alcohol-related problems seen by medical, nursing, and mental health professionals at the University of Massachusetts Health Services has been assessed since 1975 as part of a Demonstration Alcohol Education Project.

Medical outpatient clinic alcohol-related contacts using encounter forms completed on every outpatient visit during 1975 and 1976 revealed that 0.08% of approximately 92,500 visits annually were alcohol related, including 0.03% for chronic problems and 0.05% for acute problems (mainly contusions, lacerations, and fractures). Week-long contact surveys conducted in November 1976, and April 1977 recorded a much higher proportion of alcohol-related problems for over 60% of about 2,200 contacts each week. In November 1976, 1.4% of 1,346 reported visits were alcohol related, including 8.0% of contacts which occurred on weekends. In April 1977 2.7% of 1,582 reported visits were alcohol related, including 17.0% of weekend visits. No chronic alcohol problems were reported either week, and most of the acute problems involved traumatic injuries, such as contusions, lacerations, and sprains.

Mental health outpatient clinic alcohol-related contacts self-reported by students at the initial visit revealed that 5.8% of 1,179 initial visits between January 1976, and June 1977 were alcohol related, most involving their own alcohol use. Week-long contact surveys involving all 256 contacts during November 1976 and 192 contacts during April 1977 showed that 13.7% of contacts were for alcohol-related problems, over half due to alcohol abuse by someone else, such as a parent or boy/girlfriend.

The findings suggest that a significant proportion of students seen by student health services have acute rather than chronic alcohol-related problems, especially acute traumatic injuries and relationship problems.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Providing Employment Assistance to Students: The Role of Social Work Education

Abstract

This paper reports the results of a national survey of 130 graduate and undergraduate social work programs that was designed to learn what schools are doing to help students locate and secure employment after graduation. Less than half (43%) of the responding schools indicated that they have a formal program of employment assistance services. Size of student enrollment and size of faculty were the only factors that differentiated schools that offer employment assistance services from those that do not. The study's implications for social work education are discussed, and an employment assistance program model is presented.     

The Emergency Dental Service at Southern Illinois University/Carbondale

Abstract

The Student Emergency Dental Service (SEDS), a program of Allied Health and Public Services, Southern Illinois University at Carbondale (SIUC), began treating patients in January 1978. The purpose of the program is twofold. The main emphasis of SEDS is to treat patients with dental-related disorders of an emergency nature. The other purpose of SEDS is to help raise the level of dental knowledge among the student population so as to prevent the emergency situations from occurring.

The Student Emergency Dental Service is essentially an “emergency only” service, even though prevention is highlighted. Such an emergency service cannot compete with a comprehensive service in terms of providing total patient dental care. Hence, the SEDS program has some innate limitations a comprehensive service does not. It must work from certain guidelines. It cannot treat everyone, and the mode of treatment must be altered to aid the emergency patient. This creates dilemmas that will be addressed in this paper. The organization, accomplishments, and advantages and disadvantages of the SEDS program at Southern Illinois University are also discussed.     

Battling balfour: ‘White Diplomacy’, the Russian Orthodox Church and the establishment of a Jewish State in Palestine1

ARCHITECTS OF YIDDISHISM AT THE BEGINNING OF THE TWENTIETH CENTURY. A STUDY IN JEWISH CULTURAL HISTORY, BY EMANUEL S. Goldsmith. Rutherford, Madison, Teaneck, Fairleigh Dickinson University Press and London, Associated University Presses, 1976. 309 pp. Illus. Bibl. Index. US $15.00, £7.50.     

Health Services Utilization Among Graduate Students: Patterns of Use,Access, and Satisfaction

Abstract

Utilization of health services by graduate students has been a neglected area of college health research. This paper describes the access problems and utilization patterns of a systematic random sample of the graduate student population at the University of Mississippi.

Survey methodology was used to assess sociodemographic, health status, and attitudinal characteristics of the study sample. In addition to type and number of visits for various health services, other utilization-related items included access to and satisfaction with care, and information received about these health services.

The results indicated that graduate students and their dependents were reliant to a large degree on local health care. Inadequacy of information was viewed as a major problem relating to access. Satisfaction with care appeared to be a function of the quality of care received.     

The search for Jewish identity in Russia∗

A NARROW PERSPECTIVE ON SOVIET DISSENT

DISSENT IN THE USSR. POLITICS, IDEOLOGY, AND PEOPLE, ed. by Rudolf L. Tökés. Baltimore and London, The Johns Hopkins University Press, 1976. xiv, 453 pp. Index. $4.95, £3.50 paperback.

SOVIET JEWISH SCHOOLS

JEWISH SCHOOLS UNDER CZARISM AND COMMUNISM: A STRUGGLE FOR CULTURAL IDENTITY, by Zvi Halevy. New York, Springer, 1976. 239 pp. $14.50.

>THE SOVIET JEWISH EMIGRATION MOVEMENT

COURTS OF TERROR. SOVIET CRIMINAL JUSTICE AND JEWISH EMIGRATION, by Telford Taylor, Alan Dershowitz, George Fletcher, Leon Lipson and Melvin Stein. New York, Alfred A. Knopf, 1976, xi + 187 pp. Illus. Appendices. $6.95.

LE GRAND RETOUR, by Christian Jelen and Léopold Unger. Paris, Albin Michel, 1977, 348 pp. Illus. Bibl.

FROM MOSCOW TO JERUSALEM. THE DRAMATIC STORY OF THE JEWISH LIBERATION MOVEMENT AND ITS IMPACT ON ISRAEL, by Rebecca Rass with the collaboration of Morris Brafman. New York, Shengold, 1976. 256 pp. $8.95

TWO NAZI SATELLITES, SLOVAKIA AND BULGARIA

THE PARISH REPUBLIC: HLINKA'S SLOVAK PEOPLE'S PARTY 1939–1945, by Yeshayahu Jelinek. Columbia University Press, 1976. viii, 206 pp. Bibl. Index. (East European Monographs, No. XIV.) $18.75, £7.20.

BULGARIEN — LAND OHNE ANTISEMITISMUS, by Wolf Oschlies. Erlangen, Ner Tamid Verlag, 1976. 168 pp. Illus. Docs. DM 18.80.

AN UNSATISFACTORY STUDY

THE SOVIET UNION AND BLACK AFRICA, by Christopher Stevens. London, New York, Macmillan, 1976. xii + 236 pp. Appendices. Bibl. Index. £10.00.     

Estimating development cost of an interactive website based cancer screening promotion program

ObjectivesThe aim of this study was to estimate the initial development costs for an innovative talk show format tailored intervention delivered via the interactive web, for increasing cancer screening in women 50–75 who were non-adherent to screening guidelines for colorectal cancer and/or breast cancer.MethodsThe cost of the intervention development was estimated from a societal perspective. Micro costing methods plus vendor contract costs were used to estimate cost. Staff logs were used to track personnel time. Non-personnel costs include all additional resources used to produce the intervention.ResultsDevelopment cost of the interactive web based intervention was $.39 million, of which 77% was direct cost. About 98% of the cost was incurred in personnel time cost, contract cost and overhead cost.ConclusionsThe new web-based disease prevention medium required substantial investment in health promotion and media specialist time. The development cost was primarily driven by the high level of human capital required. The cost of intervention development is important information for assessing and planning future public and private investments in web-based health promotion interventions.