Exposure to Parent and Peer Alcohol Use and the Risk of Drinking Onset and Escalation Among Adolescents

Although the rate of alcohol use among adolescents has declined, it remains their drug of choice. Parent and peer alcohol use are powerful risk factors for youth alcohol use. However, questions remain about how these factors influence underage drinking. The present study investigates the relationship between exposure to parent or peer alcohol use and two stages of adolescent drinking—onset and escalation—overall and at five age points during adolescence. Participants were 9348 adolescents in Waves I (WI) and II (WII) of the National Longitudinal Study of Adolescent Health, whose parents completed interviews at WI, and who identified themselves as either non-drinkers or experimental drinkers at WI. Reports of WII alcohol use were used to measure onset among WI non-drinkers and escalation among WI experimenters. Risk ratios were calculated to assess the overall impact of exposure to parent or peer alcohol use on onset and escalation, and at five age points (i.e., ≤?13, 14, 15, 16, and ≥?17). Findings show that exposure to either parent or friend alcohol use increased the risk of onset and escalation. Age-based analyses reveal a more nuanced relationship, showing variability in the nature and strength of influence by stage of drinking and by age. This study highlights the relevance of both parent and peer modeling on youth drinking throughout adolescence. Implications in advancing prevention and treatment include parental education about the impact of their own behaviors and the importance of monitoring teens’ friendships.     

Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

Emerging paradoxes in executive leadership: A theoretical interpretation of the tensions between corruption and virtuous values

The recent mini scandal surrounding questionable on-line postings of John Mackey, the founder and CEO of Whole Foods Market Inc., raises once again ethical challenges related to contemporary business leadership. Given his visible commitment to environmentally sound strategies and other responsible business practices, Mackey’s actions epitomize the irony and paradox that can surround executive leadership ethics. While this essay acknowledges the potential role of stricter legal constraints, punishments for offenders, decentralized governance systems, and rationalized structures that help prohibit power abuse, it views such rationalistic considerations alone to be inadequate. Rather, the authors suggest that the promotion of authentic virtuousness is an often overlooked yet indispensable part of any meaningful long term ethical leadership process.     

Can Case Management Contribute to Effective Use of Small Self‐Directed Support Packages for People with Disabilities?

While self‐directed support for people with disabilities and their families represents a welcome shift toward self‐determination and increasing control, the risk of managing with insufficient funds remains. This article examines whether different types of case management can mitigate that risk by providing support when people have only a small direct funding package. It applies the question to an evaluated program of self‐directed support in Queensland, Australia that allocated A$4000 with one of two approaches to case management: program‐focused or organizationally oriented. Case management contributed to the effective use of limited budgets and addressing goals when it promoted choice and control, built relationships, and enabled flexible fund use. Program‐focused case management seemed to be less constrained in enhancing social participation than organizationally oriented case management, which tended to restrict some participatory opportunities. These findings are consistent with earlier research, which indicated that case management can interfere with participation. Even in the context of a small funding allocation, a case management approach that promotes flexibility and person‐centered planning, control over funding, and capacity building can improve the effectiveness of self‐directed support; however it does not overcome the inherent limitations of insufficient funds for adequate support, or the cost of case management itself.     

Towards better preparation and support for health and social care practitioners conducting specialised assessments in remote Indigenous contexts

Remote health professionals encounter many challenges associated with delivering care in poorly serviced remote locations and working across cultures. Despite an identified need for the assessment practices of health and social care professionals to accommodate cultural differences, and for staff training in the area, deficits in preparing the remote workforce for assessment remain. This paper combines the results of two qualitative studies to consider current and improved approaches to preparing and supporting staff for conducting assessments in remote and Indigenous settings. Study A focused on aged care assessment practices within the remote Aboriginal context of Central Australia, and Study B focused on the practice for assessing cognition among Aboriginal Australians in the Northern Territory. Our secondary analysis of these combined data sets provides valuable information to improve planning of approaches to preparing staff for assessments in these contexts. We report themes relating to three categories: the assessment workforce, current approaches to preparing assessment staff, and cross‐cultural knowledge/skill. We discuss which areas require more detailed attention to prepare staff for this work – such as critical reflection and cultural safety – as well as how this may best be achieved – such as through the inclusion of cultural supervisors in practitioners' supervision models, and in follow‐up components to workshop models.     

Two‐generation preschool programme: immediate and 7‐year‐old outcomes for low‐income children and their parents

Preschool children living in low‐income families are at increased risk for poor outcomes; early intervention programmes mitigate these risks. While there is considerable evidence of the effectiveness of centre‐based programmes in other jurisdictions, there is limited research about Canadian programmes, specifically programmes that include children and parents. The purpose of this study was to evaluate a single‐site, two‐generation preschool demonstration programme for low‐income families in Canada. A single group, pre‐test (programme intake) /post‐test (programme exit) design with a 7‐year‐old follow‐up was used. Between intake and exit, significant improvements in receptive language and global development were found among the children, and significant improvements in self‐esteem, use of community resources, parenting stress and risk for child maltreatment were found among the parents. These positive improvements were sustained until the children were 7 years old. Public investment in two‐generation preschool programmes may mitigate risks for suboptimal child development and improve parental psychosocial outcomes.