JUST A MINUTE: THE EFFECT OF EMERGENCY DEPARTMENT WAIT TIME ON THE COST OF CARE

Wait times are rising in U.S. emergency departments (EDs). The longer a patient waits to be seen, the more their condition may worsen. Notably, patients in worse condition can cost more to care for. This study estimates the effect of ED wait time on the cost of care by exploiting the quasi-random assignment of patients to triage nurses in an instrumental variables framework. The results suggest that prolonging the wait of a patient who arrives with a serious condition by 10 minutes will increase the hospital's cost to care for the patient by an average of 6%. The magnitude of this effect dissipates (fading to zero) among patients who arrive with less serious conditions.(JEL D24, H41, I10)     

Conditionality in the context of housing-led homelessness policy: Comparing Australia’s Housing First agenda to Scotland’s “rights-based” approach

Homelessness services and policy have historically tended to be organised by an explicitly conditional logic, wherein people experiencing homelessness must prove their “housing readiness” before accessing settled housing. This model has been robustly challenged in recent decades by “housing-led” approaches that ostensibly eschew conditionality and prioritise the rapid rehousing of people experiencing homelessness. Various countries now include housing-led approaches in the national policy frameworks, including Australia, which overhauled its approach to homelessness in 2008, and Scotland, where a housing-led approach is supported by a legal right to housing for homeless households. Notwithstanding this policy shift, conditionality remains an enduring feature of responses to homelessness in both jurisdictions. This paper sheds light on this phenomenon by comparing the Australian experience with that of Scotland. We demonstrate how conditionality remains a feature of both jurisdictions; however, there is greater effort in Scotland to identify and minimise conditionality, whereas in Australia it is able to persist relatively unchallenged. We conclude with some reflections on what Australia can learn from Scotland’s relative success, highlighting the importance of a national-level policy framework and an adequate affordable housing supply.     

Where the wild things are! Do urban green spaces with greater avian biodiversity promote more positive emotions in humans?

Urban Ecosystems - Urban green space can help mitigate the negative impacts of urban living and provide positive effects on citizens’ mood, health and well-being. Questions remain, however,...     

The measurement of structural ageing – an axiomatic approach

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

     

How Runaway and Homeless Youth Navigate Troubled Waters: The Role of Formal and Informal Helpers

Most adolescents navigate the transition from adolescence to young adulthood with relative success. However, runaway and homeless youth experience formidable obstacles in their paths and engage in dangerous behaviors that threaten their well being and long-term prospects. This study is part of a larger exploratory research effort aimed at understanding how runaway and homeless adolescents navigate the troubled waters of their adolescence to make successful developmental transitions into young adulthood. The focus of this paper is to report findings related to the formal and informal helping resources that enable runaway and homeless youth to resolve difficulties, deal with hazards, and achieve some level of self-defined success in young adulthood. This study utilized a qualitative research design, and the primary data collection method was in-depth interviews with 12 formerly runaway and homeless young people. The constant comparative method was used to analyze the data. Evidence emerged regarding who provided help, the types of help provided, conditions that facilitated acceptance of help, and advice to helping professionals. The findings illustrate the experiences youth had with helpers that they found valuable and experiences they perceived as detrimental.     

How Runaway and Homeless Youth Navigate Troubled Waters: Personal Strengths and Resources

Little attention has been paid to how runaway or homeless adolescents are able to make successful transitions into adulthood. This article reports on partial findings from an exploratory study of the research question, “How do formerly runaway and homeless adolescents navigate the troubled waters of leaving home, living in high-risk environments, and engaging in dangerous behaviors, to make successful developmental transitions into young adulthood?” This qualitative study involved interviews with 12 formerly runaway or homeless youth. Data were analyzed using the constant comparative method. This paper reports on findings related to the personal strengths and resources that enabled youth to make successful transitions: learning new attitudes and behaviors, personal attributes, and spirituality. Recommendations for program development and intervention with homeless or at-risk youth are discussed.     

Power to the people—health PR people that is!

Inspired by the seminal typology of power first suggested by French and Raven, this study identified five types of power (Expert, Information Reward, Information Coercive, Advertising Coercive, and Influence Powers) that health public relations practitioners believed they have in media relations. This study also examined the effect of four variables, such as personal closeness with reporters, openness towards the media, perceived media job performance, and perceived expertise in the health field, on these five types of perceived power. The results suggested that public relations practitioners who highly evaluate themselves as an expert in health and as a competent media communicator, and who are personally close with reporters have greater Expert Power in media relations. Also, when practitioners are personally close to reporters, they are more likely to use Information Reward Power.     

A Preliminary Investigation of the Reinforcement Function of Signal Detections in Simulated Baggage Screening: Further Support for the Vigilance Reinforcement Hypothesis

The vigilance reinforcement hypothesis (VRH) asserts that errors in signal detection tasks are partially explained by operant reinforcement and extinction processes. VRH predictions were tested with a computerized baggage screening task. Our experiment evaluated the effects of signal schedule (extinction vs. variable interval 6 min) and visual field complexity (dial vs. baggage x-ray) on search behavior rates. There was a main effect for signal schedule [F (1, 20) = 14.0, p = .001, p_rep = 0.99], but no effects for field complexity or interaction. The VRH suggests that performance errors in visual screening work may be reduced through operant conditioning of search behaviors by intensive management of artificially planted signals.     

Foster family care review by judicial-citizen panels: an evaluation

The findings of this study are mixed. In general, after one year of judicial-citizen review, there is no clear indication that this alternative to internal case review has led to more positive outcomes for children in foster care. This finding should be heartening to public child welfare agency personnel whose motivation for accountability has been called into question by proponents of external foster care review. At least when compared with a new citizen review system, the already existing internal review system measured up quite well. Although the study did not indicate a clear pattern of more positive outcomes for the study group, there is evidence of some favorable characteristics of CRPs that may show promise for the future. With additional training in developing behaviorally measurable and time-limited parental objectives, citizen panels may be able to maintain some of their initial strength in this area. Increased involvement of juvenile court judges in cases where little or no progress is made could motivate some parents to meet specified objectives and speed up the process of terminating parental rights when no progress has been demonstrated within specified time periods. The data also indicate a need for some adjustment to the process used to involve parents in case reviews. Another potentially positive outcome was highlighted during interviews with the juvenile court judges and the DFCS staff in the three study counties. Many of these respondents believed that the process had the potential for moving children out of foster care more quickly than does the internal review process. In addition to this primary goal, however, respondents were excited about the potential for heightened community awareness and education as citizens come to understand more about the plight of foster children and family conditions that can lead to placement. Interviews with panel members themselves indicated a definite belief that the community needed to accept more responsibility for children in foster care. One panel member's comment reflects the general sentiment expressed by other respondents: "These are kids we used to call 'those kids,' but now they are 'our kids'." It is hoped that the judicial-citizen review process will help to create a community environment in which needed resources can be developed both to prevent placement and to provide more support for families and children when placement occurs. This is the sentiment of the three juvenile court judges and almost all DFCS staff members who were interviewed, when they asserted that they felt the CRP process should be continued and expanded statewide.(ABSTRACT TRUNCATED AT 400 WORDS)