The Risk of a Mortality Catastrophe

We develop a continuous-time model for analyzing and valuing catastrophe mortality contingent claims based on stochastic modeling of the force of mortality. We derive parameter estimates from a 105-year time series of U.S. population mortality data using a simulated maximum likelihood approach based on a particle filter. Relying on the resulting parameters, we calculate loss profiles for a representative catastrophe mortality transaction and compare them to the “official” loss profiles that are provided by the issuers to investors and rating agencies. We find that although the loss profiles are subject to great uncertainties, the official figures fall significantly below the corresponding risk statistics based on our model. In particular, we find that the annualized incidence probability of a mortality catastrophe, defined as a 15% increase in aggregated mortality probabilities, is about 1.4%—compared to about 0.1% according to the official loss profiles.     

Patients' race, ethnicity, language, and trust in a physician

We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of trust asking about expectations for specific physician behaviors, including referring to a specialist, being influenced by insurance rules, and performing unnecessary tests. Using a national survey, we find lower scores on indirect measures of trust in a physician among minority users of health care services than among non-Hispanic white users. In contrast, the direct measure of trust does not differ among non-Hispanic whites and nonwhites once we control for potential confounding factors. The results indicate that racial/ethnic/language-based differences exist primarily in those aspects of patients' trust in a physician that reflect specific physician behaviors.     

Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization

Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Two-location families

In a study of two-location families, we have seen that this lifestyle is not historically atypical. Male-determined two-location families have been established for economic and other reasons. The women-determined two-location family seems to be a relatively new pattern. We suggest that the Women's Movement has helped create a situation where it is possible for women to get more support than men for women-determined two-location families. The sustaining of intimacy in such marriages becomes problematic. Stress may be minimized when there is high career motivation in both parties, acceptance of the wife's career motivation by the husband, high incomes, geographical propinquity, and a long-term marital relationship.     

Changing the Future: The Story of Attachment with a Child with Special Needs

This article, initiated by personal experience, looks at parental fear of attachment to children with conditions which put them at risk, the experiencing of grief at the loss of the fantasy baby, and the acceptance by the parents which enables the attachment to proceed. Reference is made to attachment issues in the case of adoption, styles of attachment, and some notion of reconstruction in therapy with 'special needs' survivors where attachment has been insecure or the process has been attenuated by length of risk.     

Evaluating multisystemic efforts to impact disproportionality through key decision points

Working in four communities, Casey Foundation/Center for the Study of Social Policy (CSSP) Alliance on Racial Equity (the Alliance) have developed a Racial Equity Scorecard for measuring disproportionality at key decision points for use in impacting disproportionality in the child welfare system. The four communities include King County, Washington; Guilford County, North Carolina; Ramsey County, Minnesota; and Woodbury County, Iowa. Data from one site--Woodbury County, Iowa--are used as an example. This article provides the background and method for identification and measurement of key decision points in the child welfare system to track change effected by multisystemic approaches to reduce disproportionality. Interpretation of the results in the scorecard is provided and recommendations for future interventions based on the data are discussed.     

Democracy for whom? How criminal punishment marginalizes the political voices of Black and Brown Americans

U.S. racialized punishment practices have long harmed communities of color in sundry ways, including access to democratic processes. Synthesizing scholarship on punishment and democracy that centers the lived experiences and political subjectivities of Black and Brown Americans, we argue that criminal punishment is a powerful form of political marginalization that diminishes the political voices of Black and Brown Americans en masse and simultaneously amplifies the voices of White Americans. To illuminate how punishment (re)produces systemic racial inequities in democratic processes, we focus on two distinct but related marginalizations: disenfranchisement for a felony conviction and prison gerrymandering. These deep-rooted “colorblind” policies did not draw scholarly attention until recent decades, well after district boundaries and election outcomes across the country were impacted. To help understand that delay, we highlight the utility of applying an emancipatory, Du Boisian lens with an example from our past work. Looking to the future, we argue that DuBois's tenets should inform punishment scholarship regardless of methodology or data type. Doing so will help identify more hidden forms of political marginalization in a timely manner, enable scholars to investigate the potential multiplicative effects of those marginalizations, and increase the potential impact of that work beyond the academy.     

A Third Sector in the Third Millennium?

Three trends since the 1960s underscore the need for different ways of conceptualizing the new mixed economy in the human services. First, there has been an enormous increase in the number and types of nonprofit organizations, and greater dependence on governmental revenue. Second, extensive growth in privatization and commercialization in the human services. Third, this culminated in the convergence and blurring of sectoral boundaries. Numerous metaphors have been suggested to describe these new patterns, but more suitable concepts and theories are needed. Four theoretical frameworks are analyzed for an intersectoral study of organizations in the same industry: (1) political economy, (2) organizational ecology, (3) neoinstitutionalism, and (4) mixed, open systems. As analytic paradigms, these frameworks could supplement, complement, or be integrated with other research models for third sector studies, and could contribute to theory building and social policy.     

Physical victimization of rural methamphetamine and cocaine users

Substance use and physical violence often coincide, but little has been published on the correlates associated with receipt of partner versus nonpartner physical violence for rural users of methamphetamine and/or cocaine. In this study, participants' substance use, depression and past-year physical victimization were assessed. In separate logistic regression models, received partner violence in females was associated with age; alcohol, cocaine, and methamphetamine abuse/dependence; and number of drugs used in the past 6 months. In males, received nonpartner violence was associated with age, cocaine abuse/dependence, and being Caucasian. Findings suggest a relationship between stimulant use and received violence among rural substance users and a need for victimization screenings in settings where such individuals seek health care.