Assessment of Patient Classification in Appointment System Design

This paper investigates two approaches to patient classification: using patient classification only for sequencing patient appointments at the time of booking and using patient classification for both sequencing and appointment interval adjustment. In the latter approach, appointment intervals are adjusted to match the consultation time characteristics of different patient classes. Our simulation results indicate that new appointment systems that utilize interval adjustment for patient class are successful in improving doctors' idle time, doctors' overtime and patients' waiting times without any trade‐offs. Best performing appointment systems are identified for different clinic environments characterized by walk‐ins, no‐shows, the percentage of new patients, and the ratio of the mean consultation time of new patients to the mean consultation time of return patients. As a result, practical guidelines are developed for managers who are responsible for designing appointment systems.     

Conceptual Model and Map of Psychological Abuse of Older Adults

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.     

Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

Timing of the transition to nonvirginity among unmarried adolescent women

This article focuses on differences between teenagers who became sexually active in early adolescence (15 or younger) and those who did so in late adolescence (16–19). It reviews research on adolescent sexual behavior and summarizes findings on factors associated with adolescent coitus. The few findings on the meaning of first coitus are also noted. A study which used a sample of already-pregnant adolescents is presented in detail. While few differences between those who first had coitus during early adolescence and those who had it later were significant, most were in the predicted direction, and none were contrary to the hypotheses. A major significant difference concerned the relationship between sex and love; those who found the two related tended to start their sexual careers later than those who did not. Policy implications of research findings are discussed, especially those relevant to sex education.This research was supported in part by Grant No. HD 11099 NICHD, and in part by Grant No. 78-499, Charles Stewart Mott Foundation.This article is a revision of a paper presented at the Annual Meetings of the Society for the Study of Social Problems, August 26, 1980, New York, N.Y.     

Child care policy: A need for greater advocacy

While some scholars have recognized the importance of child care to families in the United States (Kamerman, 2001; Waldfogel, 1998), child care has not been viewed as a core social policy concern in the United States. In this article, we provide an overview of child care needs in the U.S. followed by an analysis of three major federal programs that shape U.S. child care policy. The first, the Child Care Development Fund (CCDF), provides financial child care supplements to low-income parents to enable them to engage in paid labor. The second policy, The Family Medical Leave Act (FMLA), is technically a universally applicable policy enabling people to care for a family member in need, including all parents who choose to spend a few weeks of unpaid leave with a newborn child. The third is the U.S. tax policy, including child care exemptions, deductions and credits. We suggest that, though all of these policies exist to help families care for children, they fail the children and families that they are purportedly designed to help. We then discuss the crucial role that professionals who work with families and children can play in shaping U.S. child care policies.     

Conceptual model and map of psychological abuse of older adults

Psychological abuse of older adults is a hidden and pervasive problem that is not well conceptualized nor well measured. Goals. The goals were to (a) conceptualize psychological abuse using three-dimensional concept maps, and (b) develop theoretical models. Methods. Statements describing the construct were generated by local and national panels. These were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. Results. The concept maps guided development of theoretical hierarchies. Significance. Theoretical models may help to develop measures to estimate prevalence better and may enable more precise screening for triage into appropriate interventions.     

A Factor Analysis Approach Toward Reconciling Community Vulnerability and Resilience Indices for Natural Hazards

The concepts of vulnerability and resilience help explain why natural hazards of similar type and magnitude can have disparate impacts on varying communities. Numerous frameworks have been developed to measure these concepts, but a clear and consistent method of comparing them is lacking. Here, we develop a data-driven approach for reconciling a popular class of frameworks known as vulnerability and resilience indices. In particular, we conduct an exploratory factor analysis on a comprehensive set of variables from established indices measuring community vulnerability and resilience at the U.S. county level. The resulting factor model suggests that 50 of the 130 analyzed variables effectively load onto five dimensions: wealth, poverty, agencies per capita, elderly populations, and non–English-speaking populations. Additionally, the factor structure establishes an objective and intuitive schema for relating the constituent elements of vulnerability and resilience indices, in turn affording researchers a flexible yet robust baseline for validating and expanding upon current approaches.     

The diagnosis of borderline personality disorder and adopted adolescents: A cautionary note

Patients with Borderline Personality Disorder and adopted emotionally-disturbed adolescents share many personality and psychodynamic characteristics: problems with object loss, separation and abandonment, identity disorders. Emotionally-disturbed adopted adolescents are likely to receive a BPD diagnosis because of 1. unknown genetic or constitutional components, 2. defects in early mothering or chaotic parenting seen in late adoptions, 3. possible misdiagnosis, 4. psychodynamic similarities. Authors caution against the possibility of misdiagnosis because of this environmental reinforcement provided by an adopted status.     

Clinically Significant Effects of Group Cognitive Behavioral Therapy on Spouse Caregivers' Mental Health and Cognitive Functioning: A Pilot Study

The objective of this pilot study was to investigate whether group cognitive behavioral therapy (CBT) resulted in clinically meaningful improvements in caregiver mood, burden, and cognition. We screened 97 caregivers in Toronto, Canada, of whom 25 with DSM-IV disorders began the 13-week CBT intervention, and 12 completed therapy and the 3-month follow-up. Each caregiver experienced clinically significant improvement on at least 2 of the following outcomes: diagnostic criteria, mood, attention, memory, and caregiver burden. Despite effectiveness, the challenges of recruiting distressed caregivers for therapy suggest that CBT might be most useful as part of a stepped care model of treatment.