Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

BAYESIAN SUBSET SELECTION AND MODEL AVERAGING USING A CENTRED AND DISPERSED PRIOR FOR THE ERROR VARIANCE

This article proposes a new data‐based prior distribution for the error variance in a Gaussian linear regression model, when the model is used for Bayesian variable selection and model averaging. For a given subset of variables in the model, this prior has a mode that is an unbiased estimator of the error variance but is suitably dispersed to make it uninformative relative to the marginal likelihood. The advantage of this empirical Bayes prior for the error variance is that it is centred and dispersed sensibly and avoids the arbitrary specification of hyperparameters. The performance of the new prior is compared to that of a prior proposed previously in the literature using several simulated examples and two loss functions. For each example our paper also reports results for the model that orthogonalizes the predictor variables before performing subset selection. A real example is also investigated. The empirical results suggest that for both the simulated and real data, the performance of the estimators based on the prior proposed in our article compares favourably with that of a prior used previously in the literature.     

Social identities and political cleavages: the role of political context

Summary. Using a novel method, the paper investigates the influence of social group identities on attitudes and on voting in a variety of political contexts. Examining the major regions of Britain, Canada and the USA, we find considerable national and regional diversity in the nature of social cleavages. For example, social class and race had widely different effects across societies, but within societies their effects on attitudes and on voting were very similar. However, despite that, age and religion had a similar effect on attitudes across societies; the effects on voting varied considerably. The significant within-country differences underline the importance of using region, rather than country, as the unit of analysis. More importantly, these results highlight the role of political context, especially competing cleavages and the structure of party competition, in the establishment of politically relevant social cleavages.     

How Welfare Policies Affect Adolescents' School Outcomes: A Synthesis of Evidence From Experimental Studies

Using data from 8 random assignment studies and employing meta‐analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low‐income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow‐up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment‐related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment.     

The Exclusion of Disabled People from Positions of Power in British Voluntary Organisations

Disabled people are excluded in various ways from a wide range of social privileges, activities and institutions. Voluntary and charitable organisations promote themselves as champions of disabled people in their struggle for access to the ordinary choices and opportunities of everyday life. This paper reports the findings of an empirical study which demonstrate that in voluntary agencies governed by able-bodied people, disabled people are excluded from positions of power and influence, and they experience the same sorts of barriers and constraints as those with which they are confronted in the wider world. Furthermore, the development of agencies governed by disabled people themselves is constrained by their lack of access to money, staff and other resources.     

Vulnerability and Agenda: Context and Process in Project Management

This paper explores how the project management role is conditioned by the context in which change is progressed. The argument draws on Pettigrew's (1985, 1987) contextual and processual view of change, a view which does not clarify the management implications of contextual variation. Using data from a two-stage research design combining diary and survey methods, four context dimensions are identified, concerning ‘interlocking’, ‘shifting sands’, ‘ownership’ and ‘senior management view’. For analytical purposes, two extreme contexts are characterized as exposing the project manager to high and low levels of ‘vulnerability’ respectively. Project management literature typically offers a rational-linear account of change, and concentrates on ‘content’ and ‘control’ agendas, concerning technical expertise on the one hand, and planning, budgeting and monitoring techniques on the other. Sociological analyses reveal the limitations of the rational-linear account, and focus on the political and cultural dimensions of the ‘process’ agenda. The data suggest how contextual variation affects the relative priority of these agendas. The management implications of these findings are explored, for project management selection, career progression, and the development of diagnostic skills and ‘agenda management’ strategies.     

The theoretical and empirical structure of general well-being

A comprehensive set of variables that have been supported as contributing to overall health and general well-being were analyzed to determine their simple structure using factor analysis and their relative contribution using Pearson correlation. The contributors to general well-being had been theoretically grouped into: emotions, beliefs, temperaments, behaviors, sittuations, experiences and health. The empirical factor structure was compared with the theoretical structure used to develop the variables. Stability was investigated by comparing results with those of another geographically separated group. All subjects were normally functioning working adults. The results demonstrated the feasibility and potential usefulness of using self-report questionnaires with multivariate procedures to measure components of the global general well-being concept.     

Student perceptions of the danger of drug use: a factor analysis.

Australian secondary school students from three Year levels were asked to rate the danger involved in various uses of alcohol, tobacco, inhalants, marijuana and other illicit drugs. These ratings were then factor analyzed for each Year level. The results showed a more refined discrimination among the older students, with type of drug and frequency of use being important considerations. Familiarity was a major consideration for the younger students. The cognitive factors derived from the data are consistent with expectations based on the gateway theory of drug use.     

Dutch tax simplification: Unique in an international setting?

The Dutch reformed individual income tax was implemented on January 1, 1990. The rationale of the tax reform is described, and the major changes are discussed and compared to developments abroad. As far as rate reduction and base-broadening are concerned, the Netherlands has followed the trend in international tax reforms. The Dutch tax reform process, however, focussed more on simplification than in other Western countries.