Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Instructions for Authors

Instructions for Authors

Instructions for Authors     

Many a slip between cup and lip. Process evaluation of a program to promote and support evidence-based public health practice

The main aims of this study are to document whether an intervention for promoting evidence-based public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.     

Discovering classes in microarray data using island counts

We present a new biclustering algorithm to simultaneously discover tissue classes and identify a set of genes that well-characterize these classes from DNA microarray data sets. We employ a combinatorial optimization approach where the object is to simultaneously identify an interesting set of genes and a partition of the array samples that optimizes a certain score based on a novel color island statistic. While this optimization problem is NP-complete in general, we are effectively able to solve problems of interest to optimality using a branch-and-bound algorithm. We have tested the algorithm on a 30 sample Cutaneous T-cell Lymphoma data set; it was able to almost perfectly discriminate short-term survivors from long-term survivors and normal controls. Another useful feature of our method is that can easily handle missing expression data.     

Preparing Social Work Doctoral Students for Teaching

The results of a national survey of 51 social work doctoral program directors indicate that, although the majority of doctoral programs include preparation for teaching as a program objective, they offer limited formal course work and few opportunities for supervised teaching experiences. The authors discuss the results of this survey and make recommendations for better preparing social work doctoral students for their roles as teachers.     

Letters to the editor

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self‐labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV‐seropositive men who have sex with men. The majority of participants (88%) identified as a “top, “ a “bottom, “ or “versatile. “ Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self‐labels, sexual behaviors of self‐label groups were greatly overlapping. Differences were found among self‐label groups in gay self‐identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self‐labels in addition to asking about sexual behavior.     

Is the Way Young People Drive a Reflection of the Way Their Parents Drive? An Econometric Study of the Relation Between Parental Risk and Their Children's Risk

This article aims to investigate parental influence on high-risk behavior by young people. Although research on the topic of perception of risk demonstrates that it is socially constructed, the role of the family in this construction has rarely been studied. Using a French national survey of more than 1,200 young drivers between the ages of 18 and 25, and their parents, we attempt to understand the transmission of risk within families. Our econometric study shows that parents influence both the practices and representations of their children. When parental norms and values are transmitted, they are by no means accepted in a wholly passive way. Indeed, the parental model is in competition with other models that originate from both inside the family (brothers and sisters) and outside it (instructors). Furthermore, parental influence decreases over time as young people become more experienced drivers and construct their own identity with regard to risk.     

The duration of unemployment in Russia

This paper uses longitudinal survey data to assess factors affecting the duration of unemployment in Russia. We examine four types of marginalised labour force participants, according to ILO guidelines and survey responses, and we estimate duration models for each type. It turns out that the sets of characteristics with the strongest effects on the duration are remarkably similar across the different unemployment definitions and model specifications. Therefore, despite the formidable practical measurement problems, problematic groups of individuals can actually be identified. Received: 27 January 1999/Accepted: 27 January 2000