How much is enough? Willingness to participate in alcohol interventions

This study examined the willingness of drinkers to participate in alcohol interventions designed to cut down or stop alcohol use by degree of service-provider contact. One hundred fifty-six university students and staff who attended a campus health fair participated in an alcohol survey. Of the college drinkers, 73.7% reported they were willing to participate in one or more alcohol interventions with minimal provider contact, compared with 48.5% who said they would participate in programs with high provider contact. Respondents preferred minimal-contact strategies (use of nonalcoholic or low-alcohol beverages, information pamphlets, cash awards, television programs, and mailed instructions) to high-contact approaches. Men were significantly more willing (ps less than .05) than women to participate in nearly half (11 to 21) of the alcohol interventions. Three measures indicative of motivation to control drinking were significantly associated with greater willingness to participate in nearly all strategies. This study also suggested that drinkers who were highly motivated to control their drinking did not prefer minimal-contact interventions over high-contact interventions.     

When approved is not enough: development of a supervision consultation model

The dramatic increase in the literature that addresses family therapy training and supervision over the last decade has been predominantly in the area of theory, rather than practice. This article describes the development of a meta-supervisory learning context for approved supervisors and provides examples of interactions between supervisors that subsequently influenced both therapy and supervision. We delineate the assumptions that inform our work and offer specific guidelines for supervisors who wish to implement a similar model in their own contexts. We provide suggestions for a proactive refiguring of supervision that may have profound effects and benefits for supervisors and supervisees alike.     

Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare

Objective

High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures.

Methods

The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2346 youth aged 1.5- to 18-years-old and 1544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18-month follow-up.

Results

The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency.

Conclusions

To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.     

Good enough decision‐making? Improving decision‐making in adult protection

This paper examines decision‐making in adult protection based on arrangements operating in a local authority social services department and discussion generated in a specialist training intervention. The paper seeks to identify ways in which approaches to decision‐making can be made both more effective and more user centred. The need for good information for efficient and effective decision‐making is highlighted, along with the need for user involvement for the production of positive and valued outcomes. The paper looks at how user centred arrangements can be put into practice and discusses the potential for advocacy, outlining possible approaches for adult protection casework. With local authority social services departments struggling to implement No Secrets (2000), with adult protection a key social care competence and with the implementation of PCP and similar approaches a priority (Valuing People, 2001), it is important to improve decision‐making in adult protection in ways that are not only time and resource efficient, but place service users and their advocates at the centre of related processes.     

Schools alone are not enough: after-school programs and education reform in Boston

Boston's efforts to expand after-school programs and build their capacity to support the standards-based education reforms of the city's public schools are explored.     

Medical examinations for child sexual abuse in Scotland: good enough practice?

This questionnaire survey of a representative sample of practitioners in Scotland sought to establish speci?cally how widely guidance on child protection issued by the Scottish Executive Health Department was being followed by practitioners, NHS Trusts and health boards. It aimed to identify the medical practitioners involved and the range of current practice in child sexual abuse examinations throughout Scotland. The results suggest that the medical assessment of children who disclose sexual abuse is a low‐volume, highly specialized activity, practised by about one in ?ve paediatricians and forensic medical examiners in Scotland. Most (79%) are aged between 41 and 60 years; 59.8% have less than 10 years' experience in the ?eld; and the majority (86.3%) perform fewer than two examinations per week. Available guidance is comprehensive and uniform, highlighting the importance of joint specialist working, use of the colposcope for photodocumentation, training and continuing professional development in this specialized area of work. Despite this, the results of our survey of practitioners show that throughout Scotland, the care offered to children and the service provided to the courts are suboptimal. Copyright © 2004 John Wiley & Sons, Ltd.     

When naloxone alone isn't enough: Deaths in year after ED OD visits

When patients are treated for nonfatal opioid overdose in the emergency department (ED) and discharged, they have a high risk of death — 67% of the time from another overdose within the next year, and especially within the next two days — new research has found. Being offered medication such as buprenorphine, counseling and referral to treatment by the ED before discharge could reduce that risk, the researchers concluded.     

Caring is not enough: the importance of Internet skills for online privacy protection

This article explains Internet users’ self-help activities in protecting their privacy online using structural equation modeling. Based on a representative survey of Swiss Internet users, it reveals past experiences with privacy breaches as a strong predictor of current protective behavior. Further, in line with the ‘privacy paradox’ argument, caring about privacy (privacy attitudes) alone does not necessarily result in substantial self-protection. Most strikingly, however, general Internet skills are key in explaining users’ privacy behavior. These skills enable users to reduce risks of privacy loss while obtaining the benefits from online activities that increasingly depend on the revelation of personal data. Consequently, Internet skills are an essential starting point for public policies regarding users’ self-help in privacy protection.     

The 1999 Small Employer Retirement Survey: building a better mousetrap is not enough

As of 1995, there were 5.3 million small-employer firms (100 or fewer employees) in the United States. These small firms employed 38.0 million individuals, representing 38 percent of all employment. Therefore, low retirement plan coverage among small employers directly affects a sizeable fraction of the national work force. There are a number of reasons why more small employers do not offer retirement plans. Cost and administration-related issues do matter, but for many small employers these take a back seat to other issues. For some, the main driver is the financial reality of running a small business: Their revenue is too uncertain to commit to a plan. For others, the most important reasons for not sponsoring a plan are employee-related, e.g., the workers do not consider retirement savings to be a priority, or the employer's work force has such high turnover that it does not make sense to sponsor a plan. Many nonsponsors are unfamiliar with the different retirement plan types available to them as potential plan sponsors, especially the options created specifically for small employers. For example, most nonsponsors said they have never heard of (36 percent) or are not too familiar with (20 percent) SIMPLE plans for small businesses. Fifteen percent of small employers report that they are very likely to start a plan in the next two years, while 24 percent say this is somewhat likely. Nonsponsors report that the two items most likely to lead to serious consideration of sponsoring a plan are an increase in profits (69 percent) and business tax credits for starting a retirement plan (67 percent). Major drivers of low retirement plan sponsorship among small employers are who they employ and the uncertainty of revenue flows. While issues of administrative cost and burden matter, they are only part of the puzzle. Therefore, the solution is not simply "build it and they will come," by creating simpler and simpler retirement plans geared to small businesses. Rather, it is build it and they will come once the business reaches a certain level of profitability and stability, and once retirement planning and saving are more of a priority for the small employer's workers.     

One world is not enough: the structured phenomenology of lifestyle migrants in East Asia

The paper is based on original empirical research into the lifestyle migration of European migrants, primarily British, to Thailand and Malaysia, and of Hong Kong Chinese migrants to Mainland China. We combine strong structuration theory (SST) with Heideggerian phenomenology to develop a distinctive approach to the interplay between social structures and the lived experience of migrants. The approach enables a rich engagement with the subjectivities of migrants, an engagement that is powerfully enhanced by close attention to how these inner lives are deeply interwoven with relevant structural contexts. The approach is presented as one that could be fruitfully adopted to explore parallel issues within all types of migration. As is intrinsic to lifestyle migration, commitment to a better quality of life is central to the East Asian migrants, but they seek an uncomplicated, physically enhanced texture of life, framed more by a phenomenology of prosaic well‐being than of self‐realization or transcendence. In spite of possessing economic and status privileges due to their relatively elite position within global structures the reality for a good number of the lifestyle migrants falls short of their prior expectations. They are subject to particular kinds of socio‐structural marginaliszation as a consequence of the character of their migration, and they find themselves relatively isolated and facing a distinct range of challenges. A comparison with research into various groups of migrants to the USA brings into relief the specificities of the socio‐structural positioning of the lifestyle migrants of the study. Those East Asian migrants who express the greatest sense of ease and contentment seem to be those who have responded creatively to the specific challenges of their socio‐structural situation. Often, this appears to have been achieved through understated but active involvements with their new settings and through sustaining focused transnational connections and relationships.