Medicaid Home and Community-Based Services: How Consumer Access Is Restricted by State Policies

State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services.     

Nurse safety: How is safety climate related to affect and attitude?

Occupational accidents and injuries continue to be a critical concern for nurses, given the hazardous healthcare environment. This study advances the research on workplace safety by studying the process variables (i.e. job-related negative affect (JRNA) and job satisfaction) in explaining the relationship between safety climate and various safety criteria in nurses. Based on survey data from 326 nurses, our findings suggest that psychological safety climate is negatively related to JRNA, turnover intentions, safety workarounds, and workplace hazards. In addition, structural equation modelling indicated general support for a model in which psychological safety climate influences employee strain through job attitudes, including JRNA and job satisfaction. More specifically, job attitudes were found to mediate the relationship between psychological safety climate and turnover intentions, experience of hazards, and injuries. Safety workarounds did not significantly relate to injuries. The present study contributes to the ongoing improvement of interventions aimed at mitigating nurses’ injuries by integrating job attitudes into the safety climate–safety outcome framework.     

Sexual Assault Risks Among Gay and Bisexual Men

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men—and the potential benefits of focusing on alcohol consumption in risk reduction efforts.     

A New Test for Short Memory in Long Memory Time Series

This article considers short memory characteristics in a long memory process. We derive new asymptotic results for the sample autocorrelation difference ratios. We used these results to develop a new portmanteau test that determines if short memory parameters are statistically significant. In simulations, the new test can detect short memory components more often than the Ljung-Box test when these short memory components are in fact within a long memory process. Interestingly, our test finds short memory autocorrelations in U.S. inflation rate data, whereas the Ljung-Box test fails to find these autocorrelations. Modeling these short memory autocorrelations of the inflation rate data leads to improved model accuracy and more precise prediction.     

Introduction: “Where Would I Be Without You”

Where Would I Be Without You, the first and only poetry recording from Olivia Records, offers a glimpse into the powerful friendship and artistic collaboration between poets Pat Parker and Judy Grahn. Grahn and Parker met in Oakland, California in 1970, beginning an artistic collaboration and a powerful friendship that endured through Parker's death in 1989. Grahn's and Parker's work spread the good news of poetry; they were integral to how we lesbians imagined our voices in the world. The articles in this special issue reconsider and pay tribute to their work.     

Older Lesbians and Work in the Australian Health and Aged Care Sector

While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace.     

Original and Ongoing Dispossessions: Settler Capitalism and Indigenous Resistance in British Columbia

This paper draws on archival research and theoretical work to articulate the specific histories, processes, and structures of primitive accumulation in British Columbia. Such processes of accumulation appear differently here than in the comparably more well-theorized contexts of imperial colonialisms. As we highlight the agents and infrastructures of dispossession, our research also aims to foreground the importance of agents and infrastructures of resistance. Different dispossessions generate different antagonisms, and we argue that Indigenous subjects are situated antagonistically to capital not only as laborers partially or wholly subsumed into capitalist social relations, but as Indigenous peoples as such, whose Indigeneity has been ‘in the way’ of development from the 1850s onward. Private property requires before all else the deterritorialization of those whose relations with the land do not revolve around its commodification. Violence against Indigenous nations, and especially Indigenous women, is not incidental to capitalist development but is a prerequisite to capitalist subsumption in the settler-colonial context. In requiring the death of either Indigeneity or the person, capital constitutes Indigenous struggle as an antagonist, interrupting both the subsumption of labor and the circulation of capital (even as such struggles may also self-constitute themselves in a variety of ways).     

Dissemination to research subjects: operationalizing investigator accountability

Recent articles have argued from principles of bioethics for the right of research subjects to receive the results of the studies in which they have participated. We argue that accountability is a powerful tool of meso-level analysis appropriate to reasoning about answerability in research ethics, and that it captures the responsibility of researchers to disseminate study results to research subjects. We offer the following features of the research situation as relevant to the manner of dissemination to study subject, in addition to factors already proposed in the literature (risk and impact on health outcome): (a) features of the research subject in relation to identity, personal investment, disease, and community; (b) characteristics of the research study and field of inquiry in relation to certainty and significance; and (c) relationships among the research subjects and the healthcare workers involved in their care and in the research.     

A note on Marshallian and von Neumann-Morgenstern utility

The curvature of a decision maker's utility function is often used to measure his risk preference. In order to comprehensively describe an individual's decision making behaviour, however, it would also seem desirable to measure the gain in utility from an increase in wealth or income before accounting for risk. If a small increase in wealth leads to a large utility gain, then it could be said that the individual's aspiration to achieve the wealth increase would be high. This aspiration, however, may be more than offset by the risk involved in obtaining this extra wealth and the individual's attitude towards risk. In the following paper it is shown how the marginal utility of Marshall can be used in a measure of aspiration with this measure then combined with the usual measure of risk preference to explain the shape of any individuals utility curve. Using these measures, a general utility curve for all income or wealth classes is postulated.The author would like to thank Professor I. Horowitz for providing the inspiration that led to his note. Any errors are the responsibility of the author.     

Editorial

In recent years the imperative to involve service users and carers at every level of care, service and policy development has been extended to include involving users and carers in the training of health and social care professionals. Guidance on how this is to be achieved in practice is, however, limited. This paper describes work undertaken to explore how an Approved Social Work Programme in the north of England could involve service users and carers more fully and develop an integrated approach to service user and carer involvement in this and other social work programmes. Following a review of the literature in this area, the results of a series of meetings with individual and groups of service users and carers are presented, together with a survey of ASW programmes. It then goes on to consider the implications for service user and carer involvement in the new social work degree.