Patterns of Strategic Change in Health Care: District Health Authorities Respond to AIDS*

The literature on strategic change is based mostly on research in the private sector. This paper suggests that change in public sector organizations is equally worthy of study and can offer novel insights. Findings from research into the development of services for HIV/AIDS in NHS health districts are used to illustrate six generic themes in strategic change processes. The first theme concerns the role of context in potentiating change, and in promoting a diverse response in different localities despite unifying government guidelines. A second theme introduces the initiators of change, the ‘product champions’, a less homogeneous group than is sometimes suggested. Although personal status, energy and pro-activity were shared characteristics, individuals differed in style and methods used to attain goals. Theme three highlights social movements as mediators of change. Consumerism has affected both private and public sector industry, but for HIV/AIDS the process has been particularly visible. The mobilising role of crisis comes next. A three phase model is suggested, linking ‘crisis-as-threat’ and ‘crisis-as-opportunity’ theories. A fifth theme concerns changes in organizational culture provoked by HIV/AIDS, and the role played by symbolism - often unpredictable and not easily manipulated by management. The last theme is organizational learning; how learning about HIV/AIDS diffused through the districts, and how well learning generalizes to other issues. In conclusion, it is argued that the study of processes of change in a public sector organization can contribute to general models of strategic change and help to develop organizational theory.     

Modeling American marriage patterns

"This article investigates the application of the three-parameter, Coale-McNeil marriage model and some related hyperparameterized specifications to data on the first marriage patterns of American women. Because the model is parametric, it can be used to estimate the parameters of the marriage process for cohorts that have yet to complete their first marriage experience. Empirical evidence from three surveys is reported on the ability of the model to replicate and project observed marriage behavior. The results indicate that the model can be a useful tool for analyzing cohort marriage data and that recent cohorts are showing relatively strong proclivities to both delay and forego marriage. Consistent with earlier work, the results also indicate that education is a powerful covariate of the timing of first marriage and that race is a powerful covariate of its incidence." Data are from the U.S. Current Population Survey for 1976 and 1985 and Cycle III of the National Survey of Family Growth for 1982.     

Children and Young People Living Through a Serious Family Illness: Structural,Interpersonal and Personal Perspectives

This study explores the experiences of children and young people in Britain living through a serious family illness. The study considers the interplay between social structures, social relationships and individual agency. We draw on data from the Millennium Cohort Study to estimate the number of children and young people affected nationally and on seven in‐depth interviews to understand young people’s experiences and the effects on their daily lives. Living through a serious family illness impacts on young people’s educational achievements, mental health and social relationships over long periods. Policy and service responses are suggested.     

The undying ideologies of race and gender: the zombie apocalypse in Telltale’s The Walking Dead: Season One

Telltale Games’ narrative-based The Walking Dead: Season One portrays Lee Everett, an African American male, fighting through the zombie apocalypse. In addition to providing an intriguing character, the game pushes back against racial stereotypes frequently seen and further establishes a zone of oppositional politics. In addition to race, TWD: Season One’s gender ideologies also open up spaces of counterhegemonic politics, specifically through its presentation of abortion. Overall, the seemingly “undying” ideologies of race and gender are reconfigured and questioned in the space of the zombie apocalypse, providing alternative visions of identity politics.     

The Construct of Grooming in Child Sexual Abuse: Conceptual and Measurement Issues

There have been claims that some child molesters engage in a “seduction stage” prior to committing abuse. These behaviors, commonly known as “grooming,” are understood as methods child molesters use to gain access to and prepare future victims to be compliant with abuse. However, there is a lack of consensus regarding exactly what this process entails and how it is clearly distinguished from normal adult–child interactions. It is important to devise an accurate definition of grooming for scientific, clinical, and forensic purposes. We critically evaluate the various definitions and reveal problematic heterogeneity. Furthermore, there are no methods of known psychometrics to validly assess grooming. We review the empirical literature regarding the occurrence of grooming and propose future directions for research.     

A comparison of linear and systems thinking approaches for program evaluation illustrated using the Indiana Interdisciplinary GK-12

Logic models are based on linear relationships between program resources, activities, and outcomes, and have been used widely to support both program development and evaluation. While useful in describing some programs, the linear nature of the logic model makes it difficult to capture the complex relationships within larger, multifaceted programs. Causal loop diagrams based on a systems thinking approach can better capture a multidimensional, layered program model while providing a more complete understanding of the relationship between program elements, which enables evaluators to examine influences and dependencies between and within program components. Few studies describe how to conceptualize and apply systems models for educational program evaluation. The goal of this paper is to use our NSF-funded, Interdisciplinary GK-12 project: Bringing Authentic Problem Solving in STEM to Rural Middle Schools to illustrate a systems thinking approach to model a complex educational program to aid in evaluation. GK-12 pairs eight teachers with eight STEM doctoral fellows per program year to implement curricula in middle schools. We demonstrate how systems thinking provides added value by modeling the participant groups, instruments, outcomes, and other factors in ways that enhance the interpretation of quantitative and qualitative data. Limitations of the model include added complexity. Implications include better understanding of interactions and outcomes and analyses reflecting interacting or conflicting variables.     

Probabilistic Risk Analysis and Terrorism Risk

Since the terrorist attacks of September 11, 2001, and the subsequent establishment of the U.S. Department of Homeland Security (DHS), considerable efforts have been made to estimate the risks of terrorism and the cost effectiveness of security policies to reduce these risks. DHS, industry, and the academic risk analysis communities have all invested heavily in the development of tools and approaches that can assist decisionmakers in effectively allocating limited resources across the vast array of potential investments that could mitigate risks from terrorism and other threats to the homeland. Decisionmakers demand models, analyses, and decision support that are useful for this task and based on the state of the art. Since terrorism risk analysis is new, no single method is likely to meet this challenge. In this article we explore a number of existing and potential approaches for terrorism risk analysis, focusing particularly on recent discussions regarding the applicability of probabilistic and decision analytic approaches to bioterrorism risks and the Bioterrorism Risk Assessment methodology used by the DHS and criticized by the National Academies and others.