Unmet needs in self-directed HCBS programs

ABSTRACT

Unmet need for long-term services and supports has been linked to a variety of harmful health outcomes. One suggested strategy for ameliorating unmet need is to give participants control of a budget and let them construct individualized plans. The evaluation of the Cash and Counseling controlled experiment (CCDE) documented a marked reduction in unmet need when compared to traditional agency-based solutions, but it also showed significant unmet needs remained. This paper reanalyzes 76 case studies from the CCDE to, for the first time gain an understanding of what those unmet needs are, who sees them, and what participants, caregivers and support brokers think might reduce this problem. Using a collective or multiple case study approach to understand this phenomenon, unmet needs were sorted into five categories using real life experiences of respondents. Unmet needs for assistance in managing the employer and budget tasks of self-direction were also captured.This paper discusses situations where the clinician researchers documented needs that were not expressed by the care recipients and provides a picture of where and why unmet needs remain.The paper concludes with strategies for reducing unmet needs and training future social workers.     

Network centralization with the Gil Schmidt power centrality index

Network centralization is a network index that measures the degree of dispersion of all node centrality scores in a network from the maximum centrality score obtained in the network. The Gil Schmidt power centrality index was developed for use in describing the political networks of Mexico, Gil and Schmidt [Gil, J., Schmidt, S., 1996a. The origin of the Mexican network of power. In: International Social Network Conference, Charleston, SC, USA, pp. 22–25; Gil, J., Schmidt, S., 1996b. The political network in Mexico. Social Networks 18, 355–381]. Upper bounds for network centralization, using the Gil Schmidt power centrality index, are derived for networks of fixed order and for when the network is bipartite, such as can arise from two mode data. In each case the networks that have maximum network centralization are described.     

Role strain among working parents: Implications for workplace and community

This study examined work-family interference experienced by working parents in a sample of 1888 employed adults. Role strain was examined using a multidimensional model that included family-related and work-related demands and resources. Multiple regression analyses revealed that having children under the age of six, more demanding jobs, less satisfactory child care arrangements, and less workplace support contributed significantly to higher levels of role strain. Utilization of workplace programs and benefits such as Dependent Care Accounts, Child Care Resource Guides, Parent Information Fairs, and adjusted work schedules did not significantly impact levels of work-family interference. Moreover, work and family resources were not found to have greater benefit for employees with more demanding work and family situations than for those with less demanding situations. These findings demonstrate the limited buffering ability of certain workplace and family resources, and the importance of identifying work-site as well as community-based programs and policies that have the greatest potential to assist working parents and their children. Cette étude éxamine l'intrusion travail-famille d'une expérience vécue de parents qui travaillent parmi un groupe représentatif de 1888 adultes avec emploi. La tension de rôle est éxaminée par le biais d'un modèle multidimensionnel comprenant des éxigences et ressources se rapportant à la famille et au travail. Les analyses de régression multiples démontrent que les attributs suivants contribuent de manière significative à des niveaux plus élevés de tension de rôle: avoir des enfants de moins de six ans, avoir un poste plus éxigeant, des écoles maternelles moins satisfaisantes et moins de soutien dans les lieux de travail. L'utilisation de programmes et des bénéfices de travail comme les comptes de 'Dependent Care' (c'est àdire les comptes accordant aux parents certains avantages fiscaux) des guides de ressources de crêches, des foires de renseignement pour les parents, et des horaires de travail adaptables aux besoins du travailleur, n'affectent pas significativement les niveaux de l'intrusion de travail-famille. En outre, les ressources ayant rapport au travail et à la famille ne se revelent pas plus bénéfiques pour les employés ayant une situation plus éxigeante que pour ceux dont la situation est moins éxigeante. Ces résultats démontrent la capacité protectrice limitée des certaines ressources du lieu de travail et de la famille, ainsi que l'importance d'identifier des programmes et une politique à base communitaire qui aient le potentiel le plus grand d'accorder de l'assistance aux parents qui travaillent et à leurs enfants.     

Ranking Rates of Return to Education: Legitimacy and an Explicit Diagnostic

Rankings of internal rates of return to education have significantly influenced education expenditures within developing countries and lending priorities of multilateral institutions. It is widely suspected, however, that estimated education returns are subject to systematic bias. The direction and magnitude of this bias are hotly contested. This paper demonstrates that in the presence of systematic bias, idiosyncratic properties of the internal-rate-of-return mapping may cause a ranking reversal. An explicit analytical test of return-ranking legitimacy is developed and applied to select African and Asian countries.     

Managing Risks in Multiple Online Auctions: An Options Approach*

The scenario of established business sellers utilizing online auction markets to reach consumers and sell new products is becoming increasingly common. We propose a class of risk management tools, loosely based on the concept of financial options that can be employed by such sellers. While conceptually similar to options in financial markets, we empirically demonstrate that option instruments within auction markets cannot be developed employing similar methodologies, because the fundamental tenets of extant option pricing models do not hold within online auction markets. We provide a framework to analyze the value proposition of options to potential sellers, option‐holder behavior implications on auction processes, and seller strategies to write and price options that maximize potential revenues. We then develop an approach that enables a seller to assess the demand for options under different option price and volume scenarios. We compare option prices derived from our approach with those derived from the Black‐Scholes model ( Black & Scholes, 1973 ) and discuss the implications of the price differences. Experiments based on actual auction data suggest that options can provide significant benefits under a variety of option‐holder behavioral patterns.     

Parent‐Adolescent Language Use and Relationships Among Immigrant Families With East Asian,Filipino, and Latin American Backgrounds

This study examined differences in the quality of relationships between immigrant parents and their adolescent children as a function of the languages with which they speak to one another. Over 620 adolescents with East Asian, Filipino, and Latin American backgrounds completed measures on parent‐adolescent language use and relationships. Adolescents who spoke in different languages with their parents reported less cohesion and discussion with their mothers and fathers than did their peers who spoke the same language with their parents. Adolescents who mutually communicated in the native language with their parents reported the highest levels of cohesion and discussion. Longitudinal analyses indicated that whereas language use did not predict differential changes in parent‐adolescent relationships over a 2‐year period, the quality of relationships did predict changes in language use. The associations between language use and relationships generally existed regardless of the families' ethnic and demographic backgrounds, and these associations did not vary across families of different backgrounds.     

The Objects of Sociology: A Response to Breslau's "Sociology After Humanism"

Daniel Breslau's essay opens up a valuable space in seeking to align the sociologically impure objects explored in science studies with the practice of a pure sociology. I challenge Breslau's conclusion that the latter can swallow the former and proceed with business as usual. Contrary to Breslau, I argue that confronting head-on the impure objects of science studies can indeed represent a new beginning in sociology as a discipline. I also correct Breslau's misreading of my work as "symmetrical humanism."     

Client Perceptions of Professional Helpers

A questionnaire was administered to 77 employees of a large commercial organization and 61 paramedical workers to ascertain which of a number of professionals were likely to be approached for help with particular types of problems. The findings for this study indicated that for both groups social workers were the most preferred professionals by most subjects for most problems, although there were important and interesting preferences for other professionals also.