Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

The role of the health care leader. Past, present, future

Strong, effective communication may be the single most important key to success for any type of executive. Leaders of health care organizations must be able to promote ideas that others will implement, help staff see the value of their work, and have the vision to overcome limitations that stand in the way of progress.     

Quality of Life Indexes for National Policy: Review and Agenda for Research

A number of governments and public policy institutes have developed Quality of Life Indexes – statistics that attempt to measure the quality of life for entire states or regions. We develop 14 criteria for determining the validity and usefulness of such QOL indexes to public policy. We then review 22 of the most-used QOL indexes from around the world. We conclude that many of the indexes are successful in that they are reliable, have established time series measures, and can be disaggregated to study subpopulations. However, many fall short in four areas: (1) indexes vary greatly in their coverage and definitions of domains of QOL, (2) none of the indexes distinguish among the concepts of input, throughput, and output that are used by public policy analysts, (3) they fail to show how QOL outputs are sensitive to public policy inputs, and (4) none have examined convergent validity against each other. We conclude that many of these indexes are potentially very useful for public policy and recommend research to further improve them.     

Dialectical behavior therapy for patients with borderline personality disorder.

This study examined the effectiveness of dialectical behavior therapy (DBT) in the treatment of people diagnosed with borderline personality disorder (BPD). The frequency of self-injurious behaviors of 15 women hospitalized on a DBT unit was traced over a 4-week period. Data on self-injurious behaviors and the use of the DBT approach were collected from a review of incident reports and patients' charts. The self-injurious behaviors decreased by almost 50%. In addition, four RNs, who were involved on the DBT unit both before and after the institution of the treatment approach, were interviewed. Semi-structured interviews were conducted to determine the nurses perceptions of the effectiveness of DBT. Their responses were uniformly positive. The most commonly occurring phrase was "it works."     

Internal family systems therapy for children in family therapy

This article presents a developmentally supported implementation of Internal Family Systems Therapy for school-age children and their families. Relevant developmental characteristics of children are described. Suggestions for working with parents, child-oriented interventions, and a case example are presented.     

COMPETITIVE FRAMING PROCESSES IN THE ABORTION DEBATE: Polarization-vilification, Frame Saving, and Frame Debunking

This article investigates how frame alignment processes are employed by a social movement organization in competitive response to a countermovement. Though the battles between feminist organizations such as NOW and conservative opposition are waged in many arenas, we focus exclusively on the ideological clash around abortion. After briefly describing the context of encounters, we examine the challenges launched against perceived threats to reproductive rights using New York State NOW chapter newsletters spanning 1970–1988. We identify three rhetorical strategies used by NOW to counterframe the debate for its members. polarization-vilification, frame debunking, and frame saving. Our findings suggest that in the face of opposition, framing strategies are modified with the goal of mobilization.     

A Simulation Study of Work-in-Process Inventory Drive Systems and their Effect on Operational Measurements

This simulation study compares three operational measures of performance through the exploration of three work-in-process (WIP) inventory drive systems and their associated inventory buffer characteristics. The three drive systems under study are a push, a pull and a hybrid push-pull system. While these systems have many aspects in common, their buffer management systems do not. The data analysis was based on information gathered from three computer-simulated flow shop assembly lines all operating in the same environment. Hypotheses concerning the operational performance measurements were established, independent variables were controlled and manipulated and a conclusion was drawn as to which system would afford the operation optimum results. While inventory has traditionally been considered and is currently being shown as an asset from an accounting point of view, it is obvious from the findings of this study, that excess WIP inventory, above the minimal requirements for production, may have a negative effect on the operational measurements evaluated.     

Sociocultural Contexts of Time to First Sex Among Hispanic Adolescents

This investigation examines the sociocultural influences on risk of first sex among a representative sample of Hispanic (primarily of Mexican origin) teens living in Los Angeles County. Teen acculturation (measured as language of interview) moderates the effects of gender on risk of sex, with less acculturated teens exhibiting the greatest gender difference. Teens living with both biological parents have significantly lower risk of sex and the effect of family acculturation (measured as generational status) operates through teens' language of interview. Neither measure of parent‐youth relationship (socioemotional support, parental control) is significant. Hispanic teens living in low‐density Hispanic neighborhoods have significantly higher risk of sex than do teens living in neighborhoods with higher levels of ambient hazards. The results highlight the importance of characterizing sociocultural influences at multiple levels of aggregation.     

The influence of riparian corridor width on ant and plant assemblages in northern Sydney,Australia

Protecting riparian corridors is a commonly applied environmental policy in urban landscapes. However, empirical data demonstrating their efficacy for biodiversity conservation outcomes is scarce. In this study we investigated whether riparian corridor width influences the diversity and community structure of ant (Hymenoptera: Formicidae) and vascular plant assemblages therein. Eighteen corridors of differing widths were selected from within the Ku-ring-gai Local Government Area, Sydney Australia. Ants were sampled using pitfall traps positioned within rectangular vegetation transects (30 × 10 m). Both ant and plant species richness, when standardised for sampling effort, were unrelated to riparian corridor width. However, significant compositional differences between sites were evident with increased width up to ~50 m. Narrow corridors contained greater abundances of opportunistic ant species and higher proportions of exotic plants. We interpret this to be the result of the greater disturbance/edge influence derived from adjacent upland urban environments. Site beta diversity did not increase with corridor width, suggesting that the exclusion of novel upslope habitats in narrow riparian corridors is not a significant cause of community assemblage modification at these sites. To minimise the impact of deleterious edge effects on ant fauna, environmental managers should seek to retain riparian corridors wider than ~50 m. However, we observed substantial between-site variability of biotic assemblages, irrespective of corridor width. Therefore we recommend that environmental management practice needs to take a catchment-wide approach and consider other parameters that may contribute to riparian health so as to optimise the protection of riparian biodiversity.     

Strategic planning for social and political change

Formalized planning is currently applied to planning for operations and capital investment, planning for products and markets, and occasionally for manpower. However, there is little evidence that companies are producing formal plans and programmes to deal with social and political change. Unfortunately, public opinion is moving against business, action groups inside and outside companies are challenging the authority of management, and public officials and politicians are already framing new laws and regulations. Unless managers begin to get more involved in the framing of these controls they are likely to find laws enacted and enforced by people who have little knowledge or sympathy with business. In this article the author points up the necessity to assess the social and political challenge to their business, and formulate and implement social and political strategies and plans aimed at ensuring the survival and prosperity of their organisations.