Interjurisdictional placement of children in foster care

As the population of children in foster care has increased and more children are freed for adoption, foster and adoptive families are needed in ever increasing numbers. One avenue for expanding the pool of families is through placement of children with families in other counties and states. This article considers the policy and practice implications of interjurisdictional placement in the context of foster care, adoption, and kinship care and suggests directions for interjurisdictional adoption practice and policy.     

Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.     

Can't do it alone: housing collaborations to improve foster youth outcomes

Research documents that youth transitioning out of the foster care system experience a variety of negative outcomes, including homelessness. Housing collaborations, which aim to comprehensively address resource and service needs for transitioning youth, including permanent connections, education, and employment, have resulted in innovative programming and forged new relationships among child welfare, social service and housing developers, and providers. This article describes the partners, models, and resources several collaborations used and their progress and outcomes; shares insights gained; and explores productive directions for future work.     

In sickness but not in health: self-ratings, identity, and mortality

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.     

Education and the changing shape of the income gradient in health

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however, consistently explored interactions between different features of socioeconomic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socioeconomic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover, education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy.     

Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two-part study. In Study 1, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3-month follow-up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6-month follow-up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psychosocial correlates of HIV transmission. We discuss implications of these results.     

Health belief factors and dispositional optimism as predictors of STD and HIV preventive behavior

Identifying factors predictive of youth's engaging in preventive behaviors related to sexually transmitted diseases (STDs) and HIV remains a prominent public health concern. The utility of the Health Belief Model (HBM) continues to be suggested in identifying preventive behaviors. This study sought to examine the full HBM, including self-efficacy, with regard to STD and HIV preventive behavioral intentions in college students. Self-efficacy was identified as the primary predictor for each of the behavioral intentions (condom use, STD testing, and HIV testing), whereas response efficacy was only predictive of testing intentions. Inconsistent with HBM assumptions, perceived HIV severity was negatively related to HIV testing intentions. Students who perceived HIV as high in severity were less likely to intend to obtain HIV testing. Overall, the utility of the HBM in predicting college students' sexual preventive behavior was unsupported. An argument for a change in the direction of research, away from the continued emphasis on the study of cognitive variables, is made.     

A national survey of alcohol screening and referral in college health centers

To determine the extent and nature of alcohol screening and referral services provided by college health centers, the authors conducted a state-stratified, random sampling of 25% of 327 4-year accredited US colleges and universities with health centers. Of the 249 survey respondents, 32% routinely screened students for alcohol use. Urban, public, and large institutions were most likely to screen routinely. Only 11.7% of the sample reported they used standardized instruments, predominantly the CAGE. The health centers used an average of 3.4 referral options, but only 27.5% offered students access to campus programs specifically designed for students who are substance abusers. Findings suggest that the majority of college health centers are not providing routine alcohol screening for students or using standardized screening instruments. In addition, students are often referred to services that may be inappropriate or ineffective in addressing the needs of college drinkers.