Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Job displacement effects of Canadian immigrants by country of origin and occupation

"Some previous Canadian studies have shown that considering the labor market as a whole and also pooling all immigrants as a group, immigrants do not have any job displacement effects on the Canadian born. This study presents some new evidence. It disaggregates immigrants by country of origin and by occupation groups and provides an analysis of job displacement effects of immigrants on the native-born Canadians by these dimensions. The study finds that (1) U.S. immigrants and the Canadians are substitutes [for] competing groups in the labor market and the effect is quite significant; (2) Canadians and Europeans are competing groups in certain occupations, while they have complementary skills in others; and (3) immigrants from the Third World and the Canadians are slightly competing groups in certain occupations."     

Comparing measures of poverty and relative deprivation: an example for Belgium

This paper presents three different poverty standards. A first approach takes the disposable income as an indicator of poverty. A second approach uses the Leyden approach. Finally an aggregate index of deprivation, based on the observation of consumption events, is constructed through a particular econometric procedure proposed by Desai and Shah (1988). These alternative measures are then compared on a sample composed of 6380 Belgian households. Such an analysis can be expected to provide some further insight into the problem of measuring poverty, which has been the subject of a recent controversial debate.We thank the participants of the Second Annual Meeting of the European Society for Population Economics, June 23–25, 1988, Mannheim (FRG), L. Gevers, J. Lindsey, P. Pestieau, B. Sak, K. Van den Bosch and two anonymous referees for their comments and suggestions.     

The social implications of population displacement and resettlement: an overview with a focus on the Arab Middle East

"Recent decades have witnessed a global increase in the collective displacement of populations as a result of natural disasters, wars and development projects. The social implications of displacement, and its corollary process of resettlement, are explored in this article, with a focus on the Arab world....[The author suggests that] an approach which emphasizes the relation between the causes and consequences of displacement, examines cases in their historical contexts, and selects the appropriate unit of analysis is essential in developing an adequate framework of analysis."     

Residential segregation in Australian cities: a literature review

"In this review of literature dealing with the postwar immigrant experience in urban Australia, some of the key interpretations of residential segregation are assessed. The article focuses on studies which have examined ethnic clusters formed by southern Europeans in Sydney and Melbourne and more recently by Indochinese refugees. Much of the analysis to date has been based on measuring static residential patterns rather than social interaction, and the need to question the significance of ethnic concentrations which sometimes characterize the early stages of immigrant adaptation is suggested."     

The design of organizations and the right to act

Recent innovations in the structure of formal organizations suggest possible directions for the design of schools to bring about high achievement. The structure of output-driven in contrast to administratively-driven schools is described, and designs are described which address both the goal of high achievement and the goal of reduced inequality.An earlier version of this paper was presented as the author's Sorokin Lecture at the annual meeting of the Eastern Sociological Society, Boston, March 1993.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.     

Reformulating the development theory of welfare

Industrialization, technological change and overall economic development are often cited as important factors in the development of welfare states. This article examines the importance of cycles in economic activity and cycles in technological innovation to enhancing our understanding of welfare. The history of technological change in health-care services is used to illustrate the argument.