Dilemmas in provision of urban mental health services for latency age children

Urban mental health facilities are increasingly overwhelmed by the sheer number of cases, at a time when federal, state and local funding cutbacks are greater than ever before. Additional to the numbers of cases needing care, is a growing number of cases presenting overwhelming social problems, i.e., emotional and medical pathology, economic deprivation, and substance abuse, with resultant family violence and child abuse. The case-loads in mental health agencies have become almost indistinguishable from those on the roles of child protection, juvenile justice, and child welfare agencies. Mental health service is near to impossible to provide, prior to major environmental manipulation, via educational planning, and frequent placement of children in day treatment programs, day care, or securing of in-home assistance, via home-maker services. These needed referrals take inordinate time, given the unresponsive, poorly coordinated bureaucracies providing such services. Many of the families seen are burdened by overwhelming social pathology, e.g., poverty, huge numbers of children per family, single-parenthood, drugs, and neighborhood violence. Treatment is increasingly difficult to provide, given the poor access to child serving systems, by parents and professionals, alike. Token services and worker burn-out in response to overwhelming difficult cases and excessive assignments, suggest a situation of crisis proportion. Clearly coalitions must be formed by over-burdened professionals, to better educate governing bodies, politicians, boards and administrators, and parents regarding this growing crisis. Professionals, battle-weary, are retreating from agency practice, simultaneous with agency cut-backs of staff and service. Agency administrators are cowed by local and state directives regarding budgetary cuts, and the situation worsens daily, as overburdened line staff struggle with an impossible challenge. Some sort of advocacy and social action must be taken by leaders in the field, to better inform and educate those responsible for budgetary allocations. Latency age children are among the most vulnerable, caught in deteriorating schools and neighborhoods, living with incredible daily violence, and pressures from drug dealers, pushers, adolescent gangs, and inadequate supports in their homes. This group of children is being pushed to become the violent adolescents of tomorrow. Major innovations and changes in delivery of services is necessary in health and mental health agencies serving this at-risk population. Proposed is a school based model of practice to provide access, coordination and collaboration of needed services.This paper was presented at the National Health Policy Forum, National Academies of Practice, April 1992.Ph.D. Specialization in the treatment of Children and Adolescents, Ph.D. Program.     

Managing from the Inside Out: Drawing on 'Receptivity' to Explain Variation in Strategy Implementation

With the rise of 'New Public Management' (NPM), government policy has encouraged public-sector organizations to downsize and outsource their services. There is, however, local variation in the use of outsourcing – this is 'managing from the inside out'. This paper draws on the notion of receptivity for organizational change to explain variation in strategy implementation. Four receptivity factors are identified which seem to explain the success of two contrasting English local government outsourcing strategies: ideological vision, leading change, institutional politics and implementation capacity. The organization level of change is interconnected with two other levels of change (the public service and environment levels) to illustrate the dynamic nature of change.     

Leadership research and cognitive neuroscience: The state of this union

Advances in cognitive neuroscience and other approaches to understanding human behavior from a biological standpoint are only now beginning to filter into leadership research. The purpose of this introduction to the Leadership Quarterly Special Issue on the Biology of Leadership is to outline the organizational cognitive neuroscience approach to leadership research, and show how such an approach can fruitfully inform both leadership and neuroscientific research. Indeed, we advance the view that the further application of cognitive neuroscientific techniques to leadership research will pay great dividends in our understanding of effective leadership behaviors and as such, a future symbiosis between the two fields is a necessity.     

Global Health Volunteering; Understanding Organizational Goals

This paper examines the goals of organizations that sponsor short-term volunteer trips in global health, whether they be NGO’s, faith-based, educational, or corporate organizations. Results from a U.S.-based national survey of 177 such organizations and 27 interviews with trip organizers suggest that organizations often sponsor volunteer trips to achieve goals that are quite different from the improvement of health outcomes in poor countries. While providing health services is often cited as the most important goal, volunteer activity is also considered important in enhancing the organizations’ reputation, recruitment and retention, and financial well-being. The prominence of other goals has the potential for diverting resources and focus from what is presumably the primary purpose of serving host communities in the most effective manner possible.     

Analysis of Cultural Indicators: A Comparison of Their Conceptual Basis and Dimensions

Multiple organizations and institutions have been resorting to indicators on diverse aspects of culture (e.g., creativity, social cohesion, cultural vitality, economic participation), according to their particular purposes and views of what is to be measured. This paper presents results from a research report of a qualitative study that analyzed 35 papers on cultural indicators found via Internet, based on four categories: purpose, assumptions about culture, concept of culture they sustain, and dimensions of indicators considered. Results show that even when the importance of culture is widely recognized in the papers, most of them propose indicators without having solid theoretical foundations, and with an emphasis on the relation between culture and economy. Also, most of the documents do not have a definition of culture or present an instrumental conceptualization of it, where culture is valued not as an end in itself but as a resource than can serve to development.     

Exit or Voice? The Recent Drivers of Kosovar Out‐migration

A remarkable out‐migration from Kosovo occurred after the winter 2014/15, raising urgent questions about its underlying drivers and implications for both Kosovo and the destination countries. This article aims at providing a better understanding of key migration triggers and some particularities of the phenomenon. We link our empirically found migration drivers to Hirschman's ( 1970 ) famous exit, voice or loyalty scheme by asking in how far the exit must be understood as the explicit alternative to voicing dissatisfaction with the current situation in the country. According to our results, the recent Kosovar out‐migration is a clear response to weak governance and thus goes beyond the widespread ‘migration‐cum‐remittances’ livelihood practice. In this sense it could be interpreted as a revolt against the political system. With view to policy implications for destination countries, we point at legal travel and migration opportunities as the better solution to channel both voice and exit.     

Estimation of the cumulative incidence function under multiple dependent and independent censoring mechanisms

Competing risks occur in a time-to-event analysis in which a patient can experience one of several types of events. Traditional methods for handling competing risks data presuppose one censoring process, which is assumed to be independent. In a controlled clinical trial, censoring can occur for several reasons: some independent, others dependent. We propose an estimator of the cumulative incidence function in the presence of both independent and dependent censoring mechanisms. We rely on semi-parametric theory to derive an augmented inverse probability of censoring weighted (AIPCW) estimator. We demonstrate the efficiency gained when using the AIPCW estimator compared to a non-augmented estimator via simulations. We then apply our method to evaluate the safety and efficacy of three anti-HIV regimens in a randomized trial conducted by the AIDS Clinical Trial Group, ACTG A5095.