Home care reimbursement for technology-dependent children: Its impact on parental distress

The distress of 52 parents with a technology-dependent child at home is measured using a standardized psychological inventory. Fifty-eight percent of these parents report enough symptoms to classify them as needing psychiatric intervention. Cost savings to third-party payers are accelerating the trend toward home care (rather than institutionalized care). Yet, these findings point to an underestimated cost to families in terms of parents' psychological well-being. One factor associated with less distress for mothers is having services reimbursed through the Medicaid Model Waiver Program, which provides a comprehensive plan for home care services. In contrast, services reimbursed by private third-party payers are more variable, placing greater financial strain and uncertainty on parents, which is associated with greater psychological distress. These results suggest the need for further study of the long-term impact on parents caring for technology-dependent children at home.Reprint requests to Barbara J. Leonard, R.N., Ph.D., Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, Box 197 UMHC, University of Minnesota, Minneapolis, MN 55455, (612) 625-3660.This study was supported in part by BRSG Number 2-S07-RR05448-25 awarded to the University of Minnesota, School of Public Health by the Biomedical Research Grant Program, Division of Research and Resources, National Institute of Health. Additional support was provided by the Department of Health and Human Services, State of Minnesota, Academic Computing Services and Systems, University of Minnesota and special project funds from the University of Minnesota School of Public Health.Barbara J. Leonard is an Assistant Professor and Chair of the Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, University of Minnesota, MN 55455. Her research interests include children with developmental disabilities, their parents, and siblings. She received her Ph.D. from the University of Minnesota.Janny Dwyer Brust is a Research Fellow in the Maternal and Child Health Major at the University of Minnesota. Her research interests include issues related to the care of chronically ill children and sexually abused children. She received her M.P.H. from the University of Minnesota.Joan Patterson is an Assistant Professor in the Maternal and Child Health Major and Associate Director of the Center for Children with Chronic Illness and Disability at the University of Minnesota. Her research interests include family adaptation to chronic illness and family stress and coping. She received her Ph.D. from the University of Minnesota.     

The Origins of the National Children's Bureau

SUMMARY. The gestation of the National Children's Bureau, originally the National Bureau for Cooperation in Child Care, is examined. Conference papers of 1954 give a flavour of the social concerns over children and their special needs when preparatory work on forming a Bureau was supported by the National Council of Social Service. It took a decade to reach formal inauguration and the concerns of 30 years ago are illustrated, confirming a commitment to knowledge based on information, research, and multi-disciplinary dissemination.     

Not one of the guys: The female researcher in a male-dominated setting

An important, but frequently overlooked, issue in qualitative research is how the status characteristics of the researcher affect the process of gaining access to, establishing, and maintaining rapport with respondents or informants in a setting. Some researchers may never succeed in achieving more than superficial acceptance from their respondents because of the status each researcher occupies. Female researchers studying male-dominated groups frequently find themselves in just such a position or do not attempt to gain entry in certain male-dominated settings. Sex-role expectations may hamper women's work in the field. Until recently, little attention was given to these issues.This paper discusses the dilemmas faced by female researchers in male-dominated settings. It begins by examining how the instructional fieldwork literature addresses this issue and finds that it generally does not. In addition, the literature's advice to novice fieldworkers, while perhaps appropriate for males, may be inappropriate for females, given stereotypical sex-role expectations. Novice female researchers must turn to accounts of experienced female researchers for discussions of problems they may encounter in field settings. The paper then turns to my study of a prosecutor's office. Similarities between my experiences and those of other female researchers are noted, and suggestions are made about how women in the field can manage and even overcome these problems.     

A COMPARISON OF FAMILY ADAPTATIONS TO HAVING A CHILD WITH CYSTIC FIBROSIS

The effect of Cystic Fibrosis (CF) on the structure and social climate of the family was examined with self-report scales and independent observations of family functioning. Families in which the child with CF was not the firstborn were found to be functioning more healthily than those in which the child was the firstborn. This was found on 7 of 10 family environment scales, a family hierarchy test, and on all three of the family system scales used by the independent observers (power, cohesion and closeness). Significant correlations between specific family variables and problem behaviors and social competencies were also found.     

Navigating institutional change: An historical perspective of firm responses to pro-market reversals

We explore the strategic responses of multinational enterprises (MNEs) in the context of protracted institutional change. Analyzing the long-run trajectory of three British MNEs during the setting of Indian independence, we find that these firms engaged in a series of tactical and strategic responses to address uncertain institutional changes in the form of pro-market reversals. Our findings reveal how MNE responses are characterized by path dependence and path creation in that they are historically conditioned by patterns of previous decisions and actions. We demonstrate how tactical responses to earlier institutional changes coalesce to shape dominant strategic responses in later periods. Our paper contributes to a more holistic conceptualization of how MNEs strategize in response to pro-market reversals by integrating a business history lens.     

Building family functioning scales into the study of at-home income generation

This article describes testing of scales designed to measure the ways family members interact in a personal subsystem. The scales are intended to complement data about the managerial subsystem of a family and are to be used in conjunction with a regional research project focused on home-based work. The article includes conceptual underpinnings, construction of measures, and results of factor analysis of the measures administered. Suggestions for use of a family functioning scale in the context of a household that has a member working at home are explored in the final section.This article reports results from the Cooperative Regional Research Project, NE-167, entitled, At-Home Income Generation: Impact on Management, Productivity and Stability in Rural and Urban Families, partially supported by Cooperative States Research Service, U.S. Department of Agriculture, and the Experiment Stations at the University of Hawaii, Iowa State University, Lincoln University (Missouri), Michigan State University, Cornell University (New York), The Ohio State University, The Pennsylvania State University, Utah State University, and the University of Vermont.Her research interests include measuring household production, at-home income generation and rural families. She received her Ph.D. in Family and Consumer Economics from the University of Missouri-Columbia.Her research is primarily in poverty and divorce and the economic well-being of women and children. She received her Ph.D. from Oregon State University.Her research interests include entrepreneurship, especially as it relates to women and to international development. Her Ph.D. is from Cornell University.     

Different ways of knowing a child and their relations to mother‐reported autonomy support

We considered how different forms of child knowledge (i.e., mothers’ reports of taking their child's perspective, their accurate knowledge in the form of precise predictions of their child's ratings regarding distress/comforting and compliance/discipline situations, and their perceived knowledge) are differentially associated with mother‐reported autonomy support (i.e., providing meaningful rationales, providing choice, and acknowledging feelings; Koestner, Ryan, Bernieri, & Holt, 1984 ). Mothers and their children (141 dyads, M = 11 years old at Time 1) participated in a two‐wave longitudinal study with assessments made two years apart. The only form of knowledge that predicted changes in autonomy support was perspective‐taking. Autonomy support, in turn, indirectly predicted changes in distress/comforting accuracy through child‐reported self‐disclosure and directly predicted changes in perceived knowledge. These findings underline the importance of differentiating among forms of child knowledge in the study of socialization processes.     

The Role of Emigration in Foreign Aid Policies: The Case of Spain and Morocco

This article analyses the relationships between emigration and Official Development Aid (ODA) policies, taking the cases of Spain and Morocco as the backdrop to the study. It discusses the principal characteristics of both the Spanish state and non-governmental cooperation in Morocco, the underlying motivations of the principal stakeholders, and the way international cooperation policies now encompass the phenomenon of emigration. The paper compares the field of co-development, which encompasses a rather limited understanding of immigration, with ODA policies, in which immigration is an increasingly important agenda item for both the central government and the Spanish autonomous communities. The article then examines the relationship between migration and development, and considers necessary changes of perspective required to enhance the development and emigration policies in both Spain and Morocco. Lastly, we conclude with a series of recommendations, based on our analysis, aimed at Spanish and Moroccan stakeholders, both state institutions and non-governmental organizations.