Acceptability of a stage-matched expert system intervention for domestic violence offenders

Most interventions for men who batter are standardized and "one-size-fits-all," neglecting individual differences in readiness to change. A multimedia expert system intervention based on the transtheoretical model (the "stage model") was developed as an adjunct to traditional court-mandated programs. The expert system assesses stage of change, decisional balance, self-efficacy, and processes of change and provides immediate individualized stage-matched feedback designed to increase readiness to end the violence. Fifty-eight male batterer intervention program clients were invited by agency staff to complete an expert system session and an evaluation of the program; 33 men were recruited at program intake and the remainder from ongoing groups. Responses to the intervention were very positive. For example, 87% of participants reported that they found the program to be easy to use, and 98% said it could probably or definitely help them change their attitudes or behaviors. Findings provide encouraging evidence of the acceptability of this stage-matched approach to intervention for domestic violence offenders.     

Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Effectively addressing mental health issues in permanency-focused child welfare practice

The purpose of this paper is two-fold: to highlight to the professional community the ongoing and shifting mental health needs of children exiting the child welfare system into permanent plans, dismissed from public caseloads yet still much in need of services, and, to present a model of one agency's integrated, outpatient intervention with promising preliminary data. The model offers a specialized; effective approach to the field to address the needs of families built by adoption and relative caregiving. The increasing number of adoptions, and relative and near-kin placements, mandate that competent, lifelong services to children and their permanent families correspondingly increase. This practice model poses one example of translating this responsibility into action, so that these children are discharged not just to one permanent family, but also with a plan for permanent competent support.     

The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS)

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.     

Babies, Budgets, and Birthrates: Work/Family Policy in Australia 1996-2006

Work/family reconciliation policies can be harnessed to diversepolitical agendas, ranging from feminist-inspired equality strategiesto coercive, neo-liberal programs. In Australia, such policieshave served a range of ends under different governments. Thisarticle focuses on developments since 1996 when the conservativecoalition parties led by John Howard were elected to government.It explores three policy domains that are central to Australia'swork/family agenda: family payments, maternity/parental leave,and child care. Changes in these areas are situated in the contextof the government's broader strategies concerning labor marketflexibility, tax reform, and declining fertility. The articleargues that there has been a substantial retreat from the "femocrat"strategies adopted under Labor in the 1980s and early 1990s.The general thrust of the Howard government has been to discouragelabor force participation of mothers of young children, withthe important exception of sole parents. In a number of areaspolicies are inconsistent, reflecting the government's ambivalenceabout whether to support women as home-based carers, wage earners,or both.     

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BackgroundClinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial.AimThe current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum.MethodsA subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N = 398) or in the 12 months following birth (N = 380) participated in the study.ResultsMultivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR = 0.09, 95%CI: 0.04–0.24) and the postpartum (adjOR = 0.07, 95%CI: 0.02–0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR = 0.26, 95%CI: 0.15–0.45; postnatal: adjOR = 0.14, 95%CI: 0.07–0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident.ConclusionThis study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.     

Judged Terror Risk and Proximity to the World Trade Center

In November 2001, a nationally representative sample of Americans (N = 973, ages 13–88), queried via WebTVs at home, judged the probability of five terror-related events (e.g., being injured in an attack) and three “routine” risks (e.g., being a victim of other violent crime), in the following 12 months. Judgments of terror risks, but not routine risks, were related to whether respondents were within 100 mi of the World Trade Center. This relationship was found only in the following demographic groups, and not their complements: men, adults, whites, and Republicans. These differential responses to risk have both theoretical and policy implications.     

Participation and opportunity: Redefining social security in Australia and New Zealand

Against a political background of shifting societal expectations about the role of social security in terms of mutual obligation and social responsibility, both Australia and New Zealand have conducted major social policy reviews within the past two years. Two of the central themes of the McLure Report (Australia) and the Pathways to Opportunity Report (New Zealand) are social participation and opportunity creation. This paper focuses on these issues from several perspectives. An outline of the motivations for reform and the concepts guiding it is followed by a summary of the reform strategies identified in each report. After a discussion of the similarities and differences in the changes implemented since the two reviews, the conclusion points to some of the potential problems raised by the critics of the reform proposals.     

Book Review: Who Cares?

Books reviewed in this article:
S. Danziger and J. Waldfogel, (eds.) Securing the Future: Investing in Children from Birth to College
B. Ehrenreich, Nickel and Dimed: On (Not) Getting By in America
N. Folbre, The Invisible Heart: Economics and Family Values
J. Heymann, The Widening Gap: Why America's Working Families Are in Jeopardy and What Can Be Done about It