Bayesian analysis of screening data: Application to AIDS in blood donors

The rapid increase in the number of AIDS cases during the 1980s and the spread of the disease from the high-risk groups into the general population has created widespread concern. In particular, assessing the accuracy of the screening tests used to detect antibodies to the HIV (AIDS) virus in donated blood and determining the prevalance of the disease in the population are fundamental statistical problems. Because the prevalence of AIDS varies widely by geographic region and data on the number of infected blood donors are published regularly, Bayesian methods, which utilize prior results and update them as new data become available, are quite useful. In this paper we develop a Bayesian procedure for estimating the prevalence of a rare disease, the sensitivity and specificity of the screening tests, and the predictive value of a positive or negative screening test. We apply the procedure to data on blood donors in the United States and in Canada. Our results augment those described in Gastwirth (1987) using classical methods. Indeed, we show that the inclusion of sound prior knowledge into the statistical analysis does not yield sufficiently precise estimates of the predictive value of a positive test. Hence confirmatory testing is needed to obtain reliable estimates. The emphasis of the Bayesian predictive paradigm on prediction intervals for future data yields a valuable insight. We demonstrate that using them might have detected a decline in the specificity of the most frequently used screening test earlier than it apparently was.     

The Impact of the Within My Reach Relationship Training on Relationship Skills and Outcomes for Low‐Income Individuals

A federal grant was awarded to provide the Within My Reach healthy relationships curriculum to low‐income, at‐risk individuals involved with various social service agencies. The effectiveness of this curriculum was evaluated for 202 participants through measures of training and relationship outcomes pre‐, immediately post‐ and 6 months posttraining. Participants experienced high levels of training satisfaction; significant increases in knowledge, communication/conflict resolution skills, and relationship quality; as well as a trend in the reduction of relationship violence. An important implication of this research is that MFTs may broaden their service delivery to at‐risk individuals by collaborating with community agencies to adapt established relationship enhancement programs, evidence‐based tools, and principles that complement traditional couples therapy.     

A note on the distribution of the resistance of rank tests

Measurement of the effect of extreme observations on test statistics has been discussed by many authors. Test resistance to rejection (acceptance) is one of the most appealing methods. Using the distribution of the test statistic, the exact and asymptotic distributions of the test resistance to rejection (acceptance) are introduced. The usage of the distribution is emphasized in the case of the sign test and Spearman’s rho.     

Racial and Ethnic Diversity in Senior Centers: Comparing Participant Characteristics in More and Less Multicultural Settings

The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.     

Washington State's adoption of a child welfare practice model: An illustration of the Getting To Outcomes implementation framework

Despite a great need for evidence-informed practices in child welfare, very few child welfare systems have implemented evidence-based case management models state-wide. While the literature on implementation from the perspective of model developers and researchers is steadily increasing, there has been little attention to the process of implementation originating from the reverse direction, by community organizations themselves, or with regard to going-to-scale implementation in child welfare. The Getting to Outcomes (GTO) model, which was originally created to help organizations choose and implement prevention programs, is a promising guide for child welfare systems seeking to initiate system-wide implementation of evidence-based practices. The GTO framework provides a step-by-step guide for surveying a system, building motivation, training, and evaluation. This article will illustrate the state-wide implementation of Solution-Based Casework (SBC), an evidence-based model of case management, by Washington State's Children's Administration, following the GTO framework. Despite some barriers and obstacles, the GTO model proved to be feasible and to aide in the implementation of SBC. Implications for the GTO model as a framework for empowering community organizations to choose and implement relevant evidence-based practices will be discussed.     

Perfecting the Craft: Formative Assessment of a University–Agency Partnership for Social Work Education

The aim of this study was to identify strengths and weaknesses of a Title IV-E partnership for delivery of child welfare education in the United States. A formative assessment was conducted for a newly developed partnership between a public child welfare agency and seven institutes of higher education. Using a qualitative design, interviews were conducted with professionals from the agency and from each college/university, as well as with students enrolled in child welfare courses supported by the partnership. Findings address strengths and benefits of the partnership, lessons learned, and suggestions for enhancement of program administration, curricula, field placements, and recruitment and retention. Respondents described numerous benefits of the partnership, particularly its contribution to professionalism and commitment among child welfare workers, improving the field of child welfare, and promoting a focus on outcomes of safety, permanency, and well-being for children and families. A concern to be addressed in future research and practice was integrating opportunities for education and career advancement for persons currently on staff at the public agency. Recommendations are discussed for improving university–agency partnerships in child welfare and beyond.     

THE HOLOCAUST AS RECURRING REALITY: VICTIMIZATION THEMES AND JEWISH AMERICAN ETHNIC IDENTITY FORMATION

Drawing on sociological studies that document the regularity through which marginalized ethnic groups construct an ethnic identity, this article examines identity formation in the Jewish American context. A content analysis of 100 short stories written between 1946 and 1995 demonstrates how victim-oriented identities are created out of the more mundane experiences of everyday life. These stories, which were intended for consumption by Jewish American readers, describe daily life within the Jewish American community and, with surprising regularity, bring issues of victimization into the imagined experience for their readers. In addition, the analysis shows how Jewish American short story writers present the Holocaust, victimization, and anti-Semitism as contributing heavily to the processes of identity formation within the community. The discussion of the data concludes by arguing that, as the Jewish American community becomes further removed from the events of World War II, the Holocaust is becoming a more salient recurrent reality in the formation of a Jewish American identity that is increasingly tied to issues of victimization.     

State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.