A longitudinal analysis of the distinction between for-profit and not-for-profit hospitals in America

Have changes in the hospital industry forced not-for-profit hospitals to become more like for-profit hospitals in measures of efficiency and community service? As a result, are not-for-profit hospitals moving away from their community service missions? In recent years researchers have asserted that the once-salient distinctions between not-for-profit and for-profit hospitals are quickly eroding and that this convergence threatens the community service that not-for-profit hospitals have historically provided. Neo-institutionalists explain that regulatory changes often force differing organization types to pursue similar strategies (Fligstein 1991, 1985; DiMaggio and Powell 1983). Guided by this theory, the present research analyzes if regulatory changes and the implementation of similar strategies result in not-for-profit and for-profit hospitals having similar efficiency and community service outcomes.     

Nonprofit and for-profit home care in Israel: clients' assessments

Clients' assessments of differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly were studied. No significant differences were found between nonprofit and for-profit providers with respect to organizational efficiency; speed of placement and replacement of home care workers; responsiveness to clients' complaints; and supervision of care plans, schedules, and service delivery. Systematic differences were found, however, in clients' perceptions of workers employed by nonprofit versus for-profit service providers. The differences related to the home care workers' adaptation to clients' needs and wants; how well workers delivered services; and how satisfied clients were with the services received. Indications are that the relatively high efficiency of nonprofit organizations can largely be attributed to the performance of their home care workers.     

Needs-led child and youth care: Main characteristics and evidence on outcomes

Needs-led child and youth care has three main characteristics: a continuous focus on clients' needs, client participation in the care process (including decision making), and practitioners' displays of needs-led attitudes and skills. The primary aim of this review was to establish whether there is evidence for using a needs-led approach when working with children and families in need. We performed a literature search to find reviews and outcome studies of child and youth care for school-aged children and their families which included the core characteristics of needs-led care, and related them to outcome measures. Only a few studies attributed positive outcomes of care to the attention given to clients' needs and goals. Most studies referred to participation in terms of clients' involvement or engagement. Higher levels of participation were associated with positive changes in child behaviors and parenting stress, client satisfaction, higher completion rates, safety for children, feelings of well-being and empowerment, and better service coordination. Significant professional attitudes and skills included listening to clients and working in active partnership with them. There is some proof for the relevance of core characteristics of needs-led child and youth care, although that evidence is limited by the lack of rigorous studies. This study indicates that needs-led child and youth care can make a difference. Future research should pay attention to the intertwinement of the characteristics of the needs-led approach in care.     

Leadership criteria in the Pacific Northwest of the USA 19972002

Abstract

There have been very little follow-up leadership behaviour studies. This study describes an investigation of the US insurance industry. Management behaviour was studied in the beginning and at the end of the five-year period 19972002. On the whole insurance managers in the Pacific Northwest in the hard market conditions of 2002 appear on average to have changed their leadership criteria evaluations only slightly: they appreciated staffing and managing by example more than their colleagues did previously in the soft market conditions of 1997. The empirical data were checked for company size and management level. According to three-way variance analysis the different time period (soft or hard market conditions) and company size seem to have affected three leadership criteria: insurance managers in big companies in 2002 seemed to rate organizing, delegating and mutual trust more highly than their colleagues did five years earlier. The study suggests hypothetically that in a soft market period (buyer's market) managers employ a more relationship-oriented leadership style and correspondingly adapt their leadership style to a more task-oriented approach in a hard market phase (seller's market).     

Abuse of children in day care centres: Characteristics and consequences

While day care sexual abuse cases share features in common with sexual abuse in other settings, many characteristics of abuse in day care settings merit special attention. These factors include the young age of the child victims, the involvement of multiple victims and multiple perpetrators, females as perpetrators, use of extreme threats, severity of the abuse, and in some instances ritualistic activities. Research findings support clinical impressions that children are negatively impacted by sexual abuse in day care. Consequences of abuse in day care include anxiety, excessive fearfulness, behavioural disturbances, sexual acting out and sleep disorders. Parents whose children are abused in day care centres also experience psychological distress with symptom profiles consistent with post-traumatic stress disorder. Abuse of children in day care settings warrants a specialized treatment approach. A major goal of treatment is to decrease symptomatology among all family members.     

Evaluations of utility residential conservation programs in the Pacific Northwest: A critical review

Pacific Northwest utilities have sponsored the nation's earliest and most thorough residential conservation programs. The Northwest region also leads in the quality, quantity, and usefulness of utility-sponsored program evaluations. This article critically reviews the methods and findings of four major Northwest utility program evaluations. Recommendations for future evaluation and program management efforts also are discussed.     

Selecting child care workers for adolescents: the California Psychological Inventory

The findings of this study suggest that the CPI can be used to identify characteristics of desirable CCWs for emotionally disturbed adolescents. They include the ability to make intelligent decisions and exert reasonable leadership (Do); to be effective in dealing with others (Cs); to be outgoing and enterprising (Sy); to be socially poised (Sp); to be assertive and self-assured (Sa); to be broad-minded and accepting of different people and values (To); and to be direct, active, and realistic (low Fe). These seven scales of the CPI showed significant difference between the most desirable (Group D) and the unacceptable (Group U) CCWs. Discriminant analysis revealed that selection of the most desirable CCWs can be achieved by using only five of the scales: high Do, Sp, Sa, To, and low Fe; this process identified the most acceptable and unacceptable employees over 85% of the time. If the CPI is used as an adjunct to interviews and adequate reference checks, this multi-evaluative process can greatly improve the likelihood of selecting the best potential CCW candidates. Since CCWs play a direct role with the young people in their charge, and the most effective treatment for disturbed youths can be carried out by the most effective CCWs, the selection process of CCWs becomes a critical factor in the development of any program for emotionally disturbed adolescents.     

Insights into the black box of child care supply: Predictors of provider participation in the Massachusetts child care subsidy system

The United States child care subsidy system relies on the voluntary participation of private providers in the market in order for low-income families to access otherwise unaffordable care. However, with few states able to pay child care providers subsidy payment rates at market value (National Women's Law Center, 2015) and increasing pressure for providers to improve their quality of care (Child Care and Development Fund [CCDF] Program, 2016), there is concern at the federal level regarding the supply of providers willing to participate in the subsidy system (CCDF Program, 2016; Schumacher, 2015). Using administrative data from Massachusetts, this study examines the factors associated with provider participation in the child care subsidy system. Findings from logistic regression analyses indicate that lower administrative capacity, higher private pay prices (in comparison to the subsidy payment rate), and higher local market household income may limit or reduce opportunities for participation in the subsidy system. Results also suggest that for-profit providers are not avoiding participating in the subsidy system, but may find participation challenging if subsidy payment rates are too low (compared to private pay prices). Additionally, although the total pool of accredited providers is small, accredited providers have greater odds of participation compared to non-accredited providers, indicating that families may have some access to quality care. These findings suggest that states should focus on identifying 1) ways to ease administrative impediments to entry into the subsidy system, 2) effective provider recruitment tactics, and 3) monetary/non-monetary incentive structures that can build a large and diverse supply of high quality subsidized care.     

Reclaiming complexity: beneath the surface in residential child care

ABSTRACT

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff.     

Beyond development impact: gender and care in the Pacific Seasonal Worker Programme

ABSTRACT

Close to 17,320 workers participate in the Seasonal Worker Programme, a temporary migration scheme between Australia and selected island countries in the Pacific. This article looks at the ways in which seasonal migration affects the social lives of migrants from Tonga and Vanuatu, in their households and communities. It explores the various barriers that women face as a result of this scheme, highlighting, in particular, imbalances in the gendered division of labour caused by the absence of males due to migration. It argues that focusing solely on the economic development discourse of seasonal labour programmes is problematic because it fails to take into account the normative dynamics and general context of seasonal workers. Such an approach also fails to take into consideration the rights of migrants to live with their families, and not to have to make choices that are shaped by physical separation from their families and communities. The article concludes with recommendations for policy reform that address the existing gender inequalities of seasonal worker programmes in the Pacific by putting work, care, and the everyday maintenance of the seasonal worker household at the centre of its analysis.     

Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.     

Needs and preferences for employer supported child care: A feasibility study

Employees of a large suburban health care center were asked to identify their needs and preferences for child care, and existing fringe benefits that they would be willing to give up in order to obtain employer supported child care services. Results indicate that a majority of the 41 employees in the sample with children under 12 years of age experience problems relating to child care and that those problems affect their work performance. There is no clear preference for type of child care, however, and employees are unwilling to give up existing fringe benefits to obtain child care services. Results are discussed with implications for provision of employer supported child care that is sensitive to the individual needs of employees.Terese Dressel is a clinician/consultant with the DuPage County Health Department, 111 North County Farm Road, Wheaton, Illinois 61087. The research reported was conducted as part of her Masters thesis in the Department of Human and Family Resources, Northern Illinois University.Michael Martin is an Associate Professor in the Department of Human and Family Resources, Northern Illinois University, DeKalb, Illinois 60115. Research interests include child maltreatment and family violence.     

Protecting the rights of the child in romania: Childrens rights perspectives on romanias 1997 child care reforms

This article analyses the reforms to Romanias child care legislation introduced in 1997. It uses two perspectives on childrens rights to link the changes to the United Nations Convention on the Rights of the Child. The first perspective reviews the new legislation in terms of childrens rights to provision, protection, and participation, paying particular regard to the wider economic and social policy context of the reforms; the second looks at the new laws in terms of the implications of childrens rights for the family, the community, the state, and the international community. Throughout the discussion, attention is drawn to changes in social work management and practice which will be required to make a reality of the new legislation. The article then considers the way in which the discourse of childrens rights has been used to justify changes to the law on inter-country adoption. It is argued that the new legislation has actually secured the place of inter-country adoption in Romania whilst professing to give priority to domestic alternatives, and that reference to childrens rights has been used to justify and disguise this outcome. The discussion thereby highlights the vulnerability of the childrens rights discourse to the demands of international politics.     

Planning for group child care services: the "limited rationality" approach

In the planning of services, the group child care agency faces many of the same issues as other human service organizations. The author analyzes one effort to improve the quality of service planning in two states through the training of key actors from group child care agencies. The experience led to conclusions about the risks of change and the usefulness of the rational model of decision making. Recommendations are offered for the introduction of planning concepts to key actors in agencies.     

Dilemmas in child care practice and the role for state sponsored social workers

Since the publication of Messages from Research (Department of Health, 1995) there has been intense and extensive debate about the limitations and implications of this summary for contemporary child care practice (Duxbury, 1997; Hughes, 1996; Parton, 1996; Littlechild, 1998; White, 1998). Unsurprisingly, in such a highly contentious arena, there is little consensus as to the appropriateness of the analysis or the recommendations contained in the report, particularly the overview to the research summaries. This short article seeks to add to the debate through the use of case study material to articulate social work practice dilemmas that the author has experienced; practice dilemmas that render problematic some of the assertions contained in Messages from Research. In doing so the author does not seek to undermine the importance of research for practice, as we seek to articulate an appropriate theoretical base for professional interventions in the lives of children and families, but to question whose interests are served by what can be seen as the selective representation of findings. As Stevenson (1991) states, we need to explore and understand what personal, professional and organisational processes may impede the implementation of research in practice within the child care arena. It might also behold us to ask what political or social processes may also impact on the way/s in which research for practice are 'produced' and/or 'consumed'. Overall, the author wishes to engage with, and stimulate further debate around, a core issue for practitioners and students as they explore the contemporary statutory social work role with children and their families.     

Toward a standard of care for child ADHD: implications for marriage and family therapists

In this article, we briefly review the etiology of Attention Deficit Hyperactivity Disorder (ADHD) and describe the most current scientifically supported theory about the nature of this disorder. Based on the research literature, several organizations have established standards of care for its diagnosis and treatment, which involves a multimodal strategy for treatment at the biological, individual, family, school, and community levels. Assessment and treatment guidelines are provided for Marriage and Family Therapists (MFTs), and specific areas of competency are proposed for MFTs who are working with children who have ADHD.