Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

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.     

A model for predicting dating violence: anxious attachment, angry temperament, and need for relationship control

Structural equation modeling (SEM) was used to test a model incorporating anxious attachment, angry temperament, and attempts to control one's partner as predictors of the severity and frequency of dating violence. To date, these concepts have not been clearly established as having direct or indirect effects on dating violence. It was hypothesized that anxious attachment and angry temperament would influence the need for and attempts to control one's partner which, in turn, would predict a person's actual use of force. College students (213 males; 199 females) completed measures assessing these constructs. Cross-validation was accomplished through using two successive freshmen samples. Statistics indicated the application of the model fit well to both samples. All specified paths were significant except for the direct path from anxious attachment to need for control in the second sample. While exploratory, this model seemed satisfactory for explaining potentially causal relationships of attachment, anger, and attempts to control one's partner leading to dating violence.     

Quality improvement in patient distribution at a major university student health center

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Hands: Visible and Invisible

Theoretical work in linguistics, mathematics, and physics has created changes in academic problem formulation. This meta-analysis presents the nature of the new academic environment using precepts from New Historicism to suggest connections with the New Economy. The marketplace is often the court of last appeal in conflict resolution. This can be as basic as determining a fair price for a goose in a farmers' market to the disposition of pension funds in an international merger. Economist Lawrence Summers provides insights into theory and practice. Game theory leads from John Nash's equilibrium point to modeling in economics. A University of Chicago economist discusses the application of market reforms to Chile. He worked with Chilean economists called The Chicago Boys. A call for unification, which includes economics, follows.     

Economic potential and entry into marriage and cohabitation

This article explores the relationship between economic potential and rates of entry into marriage and cohabitation. Using data from the 1990 census and the 1980-1992 High School and Beyond (Sophomore Cohort), we developed a method for explicitly estimating five time-varying measures of earnings potential. The analyses of union formation are based on an intergenerational panel study of parents and children, to which our measures of earnings potential were appended. The results indicate that all five measures of earnings potential strongly and positively influence the likelihood of marriage for men, but not for women. Earnings potential does not affect entry into cohabiting unions for either men or women.     

Social context and adolescent health behavior: does school-level smoking prevalence affect students' subsequent smoking behavior?

This paper examines the links between individual adolescent smoking behavior and actual and perceived smoking behavior in the individual's school cohort. We hypothesized that students enrolled in schools with higher smoking prevalence among students in their grade are more likely to smoke subsequently. We also expected perceived school-level prevalence of smoking to have a greater impact than actual prevalence because the former is a more direct measure of perceived norms. Adjusting for demographics, actual school-level prevalence at baseline (grade 7) was strongly associated with smoking frequency one year later. However, the association disappeared after adjusting for individual smoking frequency at baseline. School-level prevalence did not moderate the association between individual's baseline and subsequent smoking frequency. Perceived prevalence of smoking among grade 8 students and two measures tapping the behavior of smaller peer groups--cigarette offers and exposure to friends and other peers who smoke--were associated with increased risk of smoking.     

Gender and work orientations in conditions of job insecurity

This paper explores women's and men's work orientations in conditions of job insecurity, arguing that it is time to move beyond essentalist conceptions of work orientations and central life interests in order to understand the significance of paid work in people's lives. Data from a qualitative study are presented which show that the significance of paid work and the priority given to home and work are affected by experiences of job insecurity, changing domestic circumstances and stage in the life cycle and that this is the case for both women and men. Conversely, the significance of paid work can affect how job insecurity is experienced and its impact on individuals and their families. The assumption that men's work orientations are homogeneous and that work is their central life interest is not supported by the findings presented here and it is argued that the significance of work in men's and women's lives is more variable than has hitherto been recognized. To capture this variability it is time to move away from the acrimony of the debate over women's work orientations and notions of a central life interest which underpin it.     

Self-harm among adolescents with developmental disabilities. What are they trying to tell us?

Self-harm behavior exhibited by adolescents with developmental disabilities can be the most challenging behavior for caregivers and health care professionals to address. Past interventions have taken a behavioral approach and focused on functional analysis to guide assessment and treatment. However, self-harm behavior is becoming more recognized as a means of communication. Therefore, it is important for health care professionals and caregivers to listen to adolescents' attempts to communicate and try to understand the meaning of the behavior. Early assessment is crucial to understanding the meaning of the behavior, and early intervention is necessary to prevent escalation or chronicity. Thorough assessment guides interventions and must be implemented in the context of clients' families and social world, and the broader community. Establishment of trusting relationships among adolescents, their families, and health care professionals is imperative. This article discusses self-harm behavior from a psychosocial perspective related to prevalence, onset, purpose, maintenance, and escalation. It also introduces a comprehensive framework to guide assessment and intervention.