Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

Toward Improved Communication about Wildland Fire: Mental Models Research to Identify Information Needs for Natural Resource Management

The management of natural- and human-induced wildland fires is an intricate process that must balance two considerations: that of fire as a necessary natural disturbance and that of the risks that fire poses. Reconciling tradeoffs between these risks and benefits is contingent upon informed, directed, and two-way communication between wildland fire managers and stakeholders. In an effort to aid with the design of such a communication effort, this study used mental models research to determine the unique wildland fire information and decision-making needs of stakeholders living at the wildland-urban interface of a fire-prone area. While the analysis revealed many similarities in how stakeholders conceptualized the risks and benefits of wildland fire, many misconceptions and important gaps in understanding on the part of both expert and nonexpert respondents were identified.     

Gambling-related problems across life domains: an exploratory study of non-treatment-seeking weekly gamblers

This study uses content analysis to provide a qualitative exploration of how life roles are affected by frequent (i.e. at least weekly) gambling, based on in-depth interviews with a community sample of 161 non-treatment-seeking frequent gamblers. Over half (51.6%) of the participants indicated problems associated with gambling and 131 examples were identified. The majority of problems were relational (50.4%), followed by financial (19.8%), work (13.7%), and school related (8.4%). Slightly less than half of participants (41.7%) reported losses due to gambling and 92 examples were provided. The most frequently reported loss was identity related (54.3%), which included self-esteem/shame (38.0%), estrangement from family (34.0%), estrangement from friends (16.0%), and estrangement from work colleagues (6.0%). Additional losses included health (29.3%) and financial (8.7%). Almost two-thirds of participants (64.6%) reported difficulty concentrating in family (18.4%), work (16.8%), and school (9.6%) activities, whereas general concentration problems comprised an additional 48.8% of the examples provided. Half of participants (49.1%) discussed behavioral withdrawal due to gambling, which included withdrawal from work (44.3%), relationships (24.5%), school (15.1%), and personal (6.6%) activities. These findings paint a complex picture of how gambling interferes with different life roles for some frequent gamblers, identifying important areas for future research and practice.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

The Incidence of Crime on Industry‐Level Foreign Direct Investment: An Assessment of OECD Member Countries*

In this article, we assess whether the incidence of crime helps to explain the variation in sectoral FDI flows. Using a panel of 29 Organization of Economic Co‐operation and Development (OECD) countries for the period 2003–2012, we employ a generalized method of moments (GMM) estimation strategy due to the potential for endogeneity between our variables of interest. Our results indicate that crime deters investment to the service sector. In particular, this effect is observed in the following service industry subsector: financial services. Policymakers interested in boosting FDI in the affected sectors should be concerned with policies that focus on the reduction of criminal activities.     

Bridge Leadership: Gendered Consumerism and Black Women’s Political Power within Early 20th Century “Don’t Buy” Campaigns

This research surveys the literature around black consumerism and social movements, exploring the “Don’t Buy Where You Can’t Work” (DBWYCW) campaigns of the 1920s-1940s. The author examines the integral roles women played (as organizers, agitators, and beneficiaries) in various economic boycotts within the context of Belinda Robnett’s theory of bridge leadership, with a particular focus on consumerism as a major vehicle through which African-American women engaged in movement work during the DBWYCW campaigns. This article challenges the erasure of women’s leadership by reframing “Don’t Buy” as a women’s movement. Applying Robnett’s bridge leadership theory to different eras, regions, and movements, we see how the Great Depression combined with activism in the gendered sphere of consumerism and facilitated the activism of black women. This paper also expands Robnett’s conceptualization of professional and indigenous bridge leaders by identifying urban working class women within the “Don’t Buy” movement who fit these leadership categories.