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.     

The Impact of Items and Anchors on Parent–Child Reports of Problem Behavior

Research has repeatedly demonstrated that parent and child reports of child behavior and emotional functioning often do not agree in terms of symptom severity or even symptom presence. Given the potential clinical impact that discrepant reports may have on the therapeutic process, a significant amount of research has addressed the factors influencing this observed discrepancy. Traditionally, this research has evaluated the impact of demographic factors on mean differences and obtained correlation coefficients between parent and child reports. The current research improves upon previous research in this area in two ways. First, the current research uses parent and child measures with identical rather than similar items as is commonly found in previous research. Second, the current research moves beyond identifying demographic influences on discrepant reports by explaining observed discrepancies in terms of differences in parent and child perceptions of typical child behavior.David Carlston and Benjamin Ogles are affiliated with Department of Psychology, Ohio University, Athens, USA.Funding for this project was provided by the Ohio Department of Mental Health.     

Applying Image Norms Across Super's Career Development Stages

D. E. Super's (1957) theory of career development has long been of interest to careers researchers (M. Savickas, 1994; S. C. Whiston & B. K. Brecheisen, 2002). Its insightful illustration of career stages has made it widely applied by careers practitioners. Image norms may influence the career decisions and developmental tasks inherent in each stage. An image norm is the belief that individuals must present or possess a certain image, consistent with occupational, organizational, or industry standards, in order to achieve career success. Understanding the effects of image norms across D. E. Super's (1957) career stages has important implications for individuals, organizations, and career counseling professionals.     

Determinants and Consequences of Social Trust*

This article provides an overview of social trust, examining its various aspects and components. Trust is best understood in a sociological sense by focusing on its important relational characteristic. Following this lead, the article discusses briefly how social trust relates to social capital and examines factors that shape the development of social trust, along with outcomes related to variations in trust, classifying them by analytical level (i.e., individual, community, group, organizational, and societal). The article concludes by assessing the strengths and weaknesses of existing research and by identifying some important questions that have not yet been adequately addressed.     

Household strategies in the face of resource scarcity in coastal Ghana: are they associated with development priorities?

In many developing regions, women and young girls spend several hours daily in the collection of natural resources. Still the link between these household resource strategies and stakeholder perceptions of development priorities remains unexplored. This project examines this association with survey data representative of the adult population from Ghana’s Coastal Region. Although natural resource scarcity and the sustainability of resource use represent key development challenges, there are others (e.g., energy, sanitation, employment, and educational opportunities). As such, even in the face of natural resource scarcity, individuals may place greater importance on other dimensions of development, especially if household resource strategies are perceived as relatively efficient. The analytical focus here is on water and the results suggest that gender roles shape household water collection strategies, while also shaping these strategies’ perceived opportunity costs. Specifically, Ghanian adults more often see drinking water provision as their primary development need when water sources are distant and/or when male household members collect water (particularly male heads). In the end, I argue that social science inquiry benefits by contextualizing social dynamics within environmental context, particularly within cultural settings in which human subsistence is intimately tied to the state of the natural environment.     

International guidelines and the inclusion of disabled people. The Ugandan story

Uganda has made much progress towards including disabled people in its mainstream development, particularly in the political agenda. The exact process by which this has been achieved and the relationship between this and international guidelines and legislation are not known. This study undertakes to examine this from two specific perspectives: (1) How do international documents relevant to disabled people relate to national legislation in Uganda? (2) What can this comparison, together with the perceptions of stakeholders, tell us about how the legislation and services could improve? International legislation and Ugandan legislation is reviewed and compared. Data from 5 semi‐structured key informant interviews and 6 focus group discussions involving a total of 38 people are collected and analysed. The themes arising from the data are related to the documents, legislation, policies and other relevant literature. The results examine the barriers to service provision; the role of change; the importance of representation; policy and legislation issues; and the effects of devolution. Five specific findings relate to how legislation and services can improve: more resources to increase access for disabled people; strong leadership and collaboration between Disabled People’s Organisations (DPOs) funding bodies and governments; awareness raising and training; representation from all impairment groups; and raising the profile of disabled people through further legislation.     

Generalized additive models for location, scale and shape

Summary.  A general class of statistical models for a univariate response variable is presented which we call the generalized additive model for location, scale and shape (GAMLSS). The model assumes independent observations of the response variable y given the parameters, the explanatory variables and the values of the random effects. The distribution for the response variable in the GAMLSS can be selected from a very general family of distributions including highly skew or kurtotic continuous and discrete distributions. The systematic part of the model is expanded to allow modelling not only of the mean (or location) but also of the other parameters of the distribution of y , as parametric and/or additive nonparametric (smooth) functions of explanatory variables and/or random-effects terms. Maximum (penalized) likelihood estimation is used to fit the (non)parametric models. A Newton–Raphson or Fisher scoring algorithm is used to maximize the (penalized) likelihood. The additive terms in the model are fitted by using a backfitting algorithm. Censored data are easily incorporated into the framework. Five data sets from different fields of application are analysed to emphasize the generality of the GAMLSS class of models.     

Factor analysis for ranked data with application to a job selection attitude survey

Summary.  Factor analysis is a powerful tool to identify the common characteristics among a set of variables that are measured on a continuous scale. In the context of factor analysis for non-continuous-type data, most applications are restricted to item response data only. We extend the factor model to accommodate ranked data. The Monte Carlo expectation–maximization algorithm is used for parameter estimation at which the E-step is implemented via the Gibbs sampler. An analysis based on both complete and incomplete ranked data (e.g. rank the top q out of k items) is considered. Estimation of the factor scores is also discussed. The method proposed is applied to analyse a set of incomplete ranked data that were obtained from a survey that was carried out in GuangZhou, a major city in mainland China, to investigate the factors affecting people's attitude towards choosing jobs.