Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.     

Planning for the delivery of special services in public schools : A multidimensional needs assessment framework

Public Law 94–142 requires that public school districts provide special service programs to handicapped and potentially handicapped children with diverse psychological, educational, and physical needs. In order for such programs to be developed and implemented in an appropriate and timely manner, procedures for assessment of pupil needs as well as assessment of school district resources that might address those needs, have been considered as important service delivery prerequisites. Toward that end, a Multidimensional Needs Assessment Framework, which has been developed by the authors and used in numerous public schools, is described in this paper. The Framework, which allows needs assessment to be seen as an integral part of the program planning process, requires that needs assessment and program planning activities occur in relation to three distinct, yet interrelated dimensions: Special Service Recipients, Special Service Resources, and Organizational Unit. Considerations necessary for design and implementation of needs assessment using the Framework are discussed, and suggestions for further development of the approach are noted.     

Evidence-based practice in community-based child welfare systems

The immaturity of the evidence base in some areas of child welfare practice demands that practitioners approach the development and refinement of practice in a systematic way that explicitly seeks to build on and learn from experience. The efforts of public child welfare agencies in Boston and Cleveland show that it is possible to draw on a broader base of knowledge and experience while responding to unique conditions and circumstances in each agency's community.     

Gender and work orientations in conditions of job insecurity

This paper explores women's and men's work orientations in conditions of job insecurity, arguing that it is time to move beyond essentalist conceptions of work orientations and central life interests in order to understand the significance of paid work in people's lives. Data from a qualitative study are presented which show that the significance of paid work and the priority given to home and work are affected by experiences of job insecurity, changing domestic circumstances and stage in the life cycle and that this is the case for both women and men. Conversely, the significance of paid work can affect how job insecurity is experienced and its impact on individuals and their families. The assumption that men's work orientations are homogeneous and that work is their central life interest is not supported by the findings presented here and it is argued that the significance of work in men's and women's lives is more variable than has hitherto been recognized. To capture this variability it is time to move away from the acrimony of the debate over women's work orientations and notions of a central life interest which underpin it.     

Assessing nontraditional couples: validity of the marital satisfaction inventory--revised with gay,lesbian, and cohabiting heterosexual couples

Thirty-one gay male couples and 28 lesbian couples were compared with 36 cohabiting heterosexual couples using the Marital Satisfaction Inventory-Revised (MSI-R), a multidimensional measure of relationship functioning intended for use with both traditional and nontraditional couples. Analyses of scales' internal consistency and factor structure supported the construct validity of this measure with nontraditional couples. Analyses of mean profiles on the MSI-R indicated that cohabiting opposite-gender and same-gender couples were more alike than different, and were more similar to nondistressed samples of married heterosexual couples from the general community than to couples in therapy. Implications of current findings for clinical assessment and intervention are considered, and directions for future research are proposed.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Does the road to muscle rejuvenation go through Notch?

The capacity of skeletal muscles to repair and regenerate declines during aging in humans, and this decline may lead to muscle loss and frailty. Conboy et al. show that injured muscles of aging mice are defective in Notch signaling, because up-regulation of the Notch ligand, Delta-1, is impaired. Delta-1 promotes proliferation of the satellite cells that repair damaged muscles, and Conboy et al. show that experimental activation of Notch signaling is sufficient to reverse the age-related decline in muscle regenerative capacity. Extension of these important findings to humans could lead to the development of new therapeutic approaches to maintain muscle function during aging.