Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

The NTEE classification system: tests of reliability/validity in the field of higher education

An analysis of the field of higher education reveals a surprisingly large number of classification errors within the (US) National Taxonomy of Exempt Entities database. Of the nearly 4,000 non-profit entities coded within the universe of institutions of higher education, we estimate that approximately 60 per cent were incorrectly included (Type II errors). Institutions incorrectly excluded from the higher education universe (Type I errors) represent roughly 10 per cent of the institutions coded correctly. These errors result primarily from assigning codes on the basis of the names of organisations (for example, College Park Towers is classified as a college, when it is in fact a housing complex for senior citizens) and from trying too hard to assign codes in ambiguous situations. The consequences can be significant for the users of these data, and we recommend raising bright warning flags while simultaneously enlisting the help of the entire non-profit sector in improving the classification coding process.The authors are with The Andrew W. Mellon Foundation. In addition to our colleagues on the staff of the Foundation, we wish to thank Helmut Anheier, Ted Bozovich, Harvey Dale, Virginia Hodgkinson, Stephen Noga and Christopher Toppe for helpful suggestions.     

Hierarchy or co-operation: labour-management relations in church institutions

Aspects of industrial relations and internal co-ordination have been a major topic of empirical research in the German business enterprise sector. In contrast, there are practically no empirical investigations into labour-management relations in third sector institutions. The largest share of this sector in Germany is represented by the two Christian churches with presently about 900,000 employees. According to the notion of church officials, labour-management relations in these institutions are characterised by a specific normative concept which emphasises a trustful co-operation of all employees in the mission of the church. The major concern of our research project focused on the question whether the specific conditions of employment within church institutions favour more hierarchical or more co-operative forms of co-ordination and how employees and employee representatives perceive the ideal of the community of service (Dienstgemeinschaftsgedanke). The results of our research lead to the conclusion that church labour-management relations are characterised by a remarkable contrast between the participative or co-operative notion of the ideal of the community of service and present forms of hierarchical co-ordination inside church institutions.This article gives a selected overview of Beyer and Nutzinger (1991). The research was supported by the Hans-Böckler-Stiftung (Düsseldorf) and the University of Kassel.     

A probablistic analysis for an optimal screening problem

Summary We consider a lotL formed byN apparently similar unitsW ₁,…,W _N, where each of theW _i may come from one of two different populationsP ₁ andP ₂;T ₁,…,T _N denote the corresponding lifetimes. The units fromP _i undergo a failure of kindi and their survival function isS _i (t). We assume that the failure rate function are known and that the units fromP ₁ are ?substandard?: λ ₁ (t)≥λ ₂ (t), ∀t≥0. We want to putW ₁,…,W _N under a pre-operational test (burn-in test) in order to eliminate at least a great part of the substandard units and we face the problem of obtaining a rule for stopping the test under the assumption that, with the failure of a unit, it is possible to recognize the population from which the unit comes. Such a problem will be formalized as an optimal stopping problem for a suitably defined Markov process. Our study shall evidentiate some fundamental aspects of the problem and the role of the prior distribution of the (random) numberM ₀ of those units inL coming fromP ₁ (substandard). The latter distribution has a great influence on the form of the solution. This research was supported by the C.N.R. Project ?Statistica Bayesiana e Simulazione in Affidalità e Modellistica Biologica?.     

Informed decision making: the new paradigm

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.     

Physician executives' persuasive styles of communication in upward influence situations

This article examines the communicator style choices of physician executives when attempting to persuade a superior whose own style of communication is attractive and unattractive. In the November-December 1990 issue of Physician Executive, the author reported on persuasive strategies physician executives use to influence such targets of influence. Whereas the earlier study focused on what physician executives communicate to be persuasive, the present investigation treated the way physician executives communicate to persuade attractive and unattractive superiors. The results suggest that the way physician executives communicate in upward influence situations is affected by the way their superiors communicate with them.     

Study tour examines health care systems in Germany, Holland--Part II: The German system

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In the first report, the health care delivery systems of the United States, Germany, and Holland were compared. In this report, the German system is analyzed in greater detail.     

Immigration reform,American style

This article reviews the background of the proposed Immigration and Reform Act (also known as the Simpson-Mazzoli bill), which seeks to overhaul US immigration law for the first time since 1952. This bill is consistent with President Reagan's hard line on border enforcement and mandates stiff penalties for those who transport illegal aliens for commercial advantage or private profit. It further offers Mexico preferential treatment in immigration (40,000 additional visas/year). It includes an amnesty program to offer legal status to qualified illegal residents. The bill directs the President to develop a secure national worker identification system and would create a large-scale temporary foreign agricultural program for perishable commodities. Agricultural workers' families would not be eligible to accompany them unless they also obtain temporary visas. Foreign temporary workers, employable only in cases where local domestic workers are not available, must be provided with wages and working conditions equal to those prevailing among domestic workers. Stiff penalties are stipulated for employers who fail to abide with the terms of the program. In the author's opinion, this bill fails to appreciate the global character of international migration and its complexity. It relects a fundamental ambivalence about a strictly controlled main gate versus a back door approach to immigration as well as the conflicting images of the US as a nation of immigrants versus the historical reality of American nativism and xenophobia. Needed are comprehensive initiatives whose mutually reinforcing components can address the multiple dimensions of the immigration problem within a framework that does not ignore workers who have contributed to the economic well-being of the US, regardless of their legal status.     

Proxies for birth control. Comment on Kelly and Cutright,Sociological Focus,April 1983

Kelly and Cutright (1983), using regression techniques, conclude that birth control is among the more important determinants of Swedish illegitimacy. To derive this conclusion, they use changes in the marital fertility of wives aged 35-39 as a proxy for birth control. They maintain that annual change in the marital fertility rate of wives aged 35-39 is not likely to be greatly influenced by annual change in factors other than birth control. The "argument" appears to derive from the "desired family size" model of childbearing--a basic assumption of social demography. In it simplest form it states that most couples do not practice birth control until they reach a preconceived goal, or desired family size. It thus implies that a change in family size preferences will most affect the birth control practices of the oldest reproductive age groups. The simple form of the model has been questioned by the failure of Western couples to reproductively compensate for a major proportion of their child deaths, by the proportions of Western couples who say they would have preferred larger families than they actually had, by the predictive inadequacy of family size preferences, and by suggestions that age may be the more important determinant of reproduction. As a result some demographers now concede its inadequacy. Others are trying to relax its assumptions, with as yet problematic success. Essentially every Western fertility decline to date has been characterized by an increasing concentration of childbearing in the youngest age groups. In discussing this pattern social demographers have maintained that it could only have come about by a decline in family size preferences. This then is the standard argument supporting Kelly and Cutright's proxy for birth control. The authorities who offer it generally ignore the difficulties with the desired family size model and simply assert without justification that couples do in fact conform to it. Data on the age patterns of chronic disease and on the reproductive effects of environmental stressors suggest that the modern age pattern of fertility could also be produced by a deteriorating environment. Kelly and Cutright are incorrect in asserting that factors other than voluntary birth control could not be responsible for changes in fertility at ages 35-39. At best they may argue that their proxy is uniquely definitive provided that the desired family size model can be saved and provided the health of Western populations has not been compromised by technological change. At issue is a debate between what Dunlap calls the human exemptionalist and the ecological world views.     

Illegal immigrants in Canada: recent developments

Immigration policies and their management in a country like Canada have long been an interesting and instructive study for other countries. 1) With borders naturally protected by great distance from almost all migrant routes; 2) with a long, undefended border with the US and a further 3000 kilometers to its border on the south; 3) with a parliamentary system capable of comparatively rapid legislative and administrative responses to problems; and 4) with a relatively small legal, and even smaller illegal, population Canada had historically "experimented" with novel, often quite creative, immigration policies and programs to both encourage and control the increases in its population. This paper summarizes what Canada did and is doing in response to am important item of public policy--the entry and presence of illegal migrants. Canada has experimented with 1) discretionary amnesty for long-term illegals with a capacity to be successfully integrated into Canadian life, 2) tighter border controls with the extended use of the visitor's visa, and 3) employer sanctions. To address the problem more substantively, however, requires detailed study and significant change, including legislative change.