Learning the hard way: a pilot permanency planning program

California's Family Protection Act (FPA) is a forerunner of Public Law 96-272 and of the state's permanency planning efforts. The mechanisms for implementing judicial and administrative review and delivering new contract and in-agency services are discussed, as well as the criteria for receipt of services and the changing use of preventive services and foster care. The original implications of the chosen mechanisms and their evolution across seven years of permanency planning are reviewed.     

Psychoeducational groups with foster parents of sexually abused children

Psychoeducational groups for foster parents of sexually abused children were successfully delivered. Groups with nonrelative foster parents required less basic behavior management training than groups for foster parents related to the children in their care. Relative groups also required considerable attention to issues of visitation with birth parents. The groups helped foster parents improve their ability to care for sexually abused children. Participants were highly satisfied with the groups. Additional program development and research is clearly warranted.Ms. Winterfelt is in private practiceThe Project was supported by the Children's Bureau, ACF. DHHS.Copies of the training curriculum and videotape are available from Ms. Yeaton, Dept. of Psychiatry, Children's Hospital, 747 52nd Street.     

Mortality and Attrition Processes in Longitudinal Studies in Africa: An Appraisal of the Iford Surveys

This paper considers the impact of sample-attrition through dropouts on mortality analyses, using the pioneering IFORD survey of Yaounde (Cameroon). The essential issue in the IFORD surveys is the possibility that mortality of members of the cohort may differentially select some children, with specific underlying characteristics. The paper implements a method to assess the following three distinct concerns that may arise in the analysis of the IFORD data: (a) the estimation of the relationship between the covariates and the rate of occurrence of mortality or attrition over time; (b) the study of the interrelation between processes under a specific set of conditions during intervals between rounds for those children still alive and in the survey at the beginning of each interval; and (c) the issue of whether mortality and mortality differentials are affected when attrition is ignored. This approach accounts for sample-selection bias that may have resulted in the attrition process. The analyses provide insights into the debate, which has been ongoing since the late 1970s among students of African demography, regarding the selection problem in the IFORD surveys. Based on a multinomial survival modelling and bivariate probit with sample-selection framework, the results substantiate the belief that average levels and differentials of mortality would not have been different for children who dropped out from the survey than for those who remained in the survey. This is evidence that mortality estimates are virtually unaffected if attrition is ignored.     

Child welfare reform in the United States: findings from a local agency survey

Efforts to improve the public welfare and child welfare system sparked an unprecedented amount of federal legislation in the 1990s, including the Adoption and Safe Families Act of 1997 (ASFA), the Multiethnic Placement Act of 1994 and Interethnic Adoption Provisions of 1996 (MEPA-IEP), and welfare reform. Such reforms allow an unprecedented degree of flexibility, but little is known about their implementation. Researchers administered the Local Agency Survey to the first national probability sample of public child welfare agencies from 1999 to 2000. Findings indicate that ASFA has had the most effect on child welfare service delivery. Welfare reform has had less effect, and MEPA-IEP seems to have had little effect at all.     

Separate But Not Alone: Separation-Individuation Issues in College Students with Eating Disorders

It sometimes seems that the college experience is tailor-made for the development of eating disorders. Overwhelmed and bombarded by their feelings, college students often turn to behavioral means, like eating disorders, to cope. Contemporary research (e.g., Christenson et al., 1994) has shown that good and bad emotions alike can be managed by starvation, bingeing, overeating, purging, and/or obsessive exercise. For college students, many of the overwhelming feelings that are titrated by eating disorders are directly linked to the separation process. Adolescence has been called a second individuation. While Mahler et al. (1975) viewed separation-individuation as both a developmental stage and a lifetime's work, contemporary therapists often concentrate on the importance of early separation experiences. A postmodern perspective, however, recognizes the importance of connection as well as separation. Our culture is so focused on independence that many parents of college students do not recognize the importance of maintaining active contact with their older adolescents. It can be very helpful to view an eating disorder as representing a college student's attempt to negotiate separation and connection, dependence and autonomy. This article examines some of these dynamics and the implications for therapy with this population.     

Directed Steiner trees with diffusion costs

Given a directed arc-weighted graph G with n nodes, a root r and k terminals, the directed steiner tree problem (DST) consists in finding a minimum-weight tree rooted at r and spanning all the terminals. If this problem has several applications in multicast routing in packet switching networks, the modeling is not adapted anymore in networks based upon the circuit switching principle in which some nodes, called non diffusing nodes, are unable to duplicate packets. We define a more general problem, namely the directed steiner tree with a limited number of diffusing nodes (DSTLD), that enables us to model multicast in a network containing at most d diffusing nodes. We show that DSTLD is XP with respect to d, and use this result to build a \(\left\lceil \frac{k-1}{d} \right\rceil \)-approximation algorithm for DST that is XP in d. We deduce from that result a strong inapproximability property. In particular, we prove that, under the assumption that NP \(\not \subseteq \) ZTIME \([n^{\log ^{O(1)}n}]\), there is no polynomial-time approximation algorithm for DSTLD with ratio \(\varOmega \left( \frac{k}{d}\right) \). We finally give an evaluation of performances of an exact algorithm dedicated to the case \(d \le 3\).     

Listening to Words,Hearing Feelings: Links Between Eating Disorders and Alexithymia

Research suggests that eating disorders often involve difficulty with affect regulation and processing of emotions. Studies also show that many individuals with these difficulties suffer from alexithymia, or an impaired ability to use language to tolerate or process emotions. Many clients with eating disorders are highly verbal, able to talk about feelings and even have good insight into the causes of their behaviors. Yet their verbal and cognitive strengths may disguise their inability to use thoughts to manage their emotions. Such clients often have a lifelong experience of appearing more capable and competent than they feel. Self-criticism and negative self-image concretized in a negative body image are part of their eating disorder. Therapeutic exploration can increase anxiety and self-criticism, aggravating feelings of inadequacy and the concomitant need for self-soothing. Techniques that focus on affect regulation have been shown to be effective, yet a psychodynamic approach can be an important tool in such an integrative practice. In this article, clinical material and theory will illustrate some of the ways that incorporating an understanding of alexithymia into the work can enhance the use of both psychodynamic exploration of meaning and also tools to manage affect and change behavior.     

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.