Clinical social work education in palliative and end-of-life care: relational approaches for advanced practitioners

This paper describes the first post-Master's program in the US in end-of-life care for social workers. Developed at the Smith College School for Social Work, this program used innovative relational methods in student recruitment, curricular design, supervision, and leadership development, based upon input from the faculty, students, and field supervisors. Collaborations emerged with funders, agencies, and programs nationally. The program was based on a pedagogical stance that clinical work with dying people requires the capacity to be fully present- in individual, group, and family work; in interdisciplinary meetings; and in advocating for quality and equity of care-while attending to diverse and at-risk populations. Students deepened their clinical skills and took leadership in the field of end-of-life care.     

Protective supervision: An inquiry into the relationship between child welfare and the court system

Protective Supervision, in most states, is defined in statute as an option in which the child is allowed to remain in the home of high-risk parents under the authority of the court, with supervision provided by the child protection system. Protective Supervision provides states an option to fulfill the federal mandate, as expressed in its guidance on the Child and Family Services Review, to assure that children are safely maintained in their homes whenever possible and appropriate. Nevertheless, there is a paucity of published work on this option. Further, the relationship between child protection and the judicial system, implicit in Protective Supervision, is rarely examined. In response to this dearth of information, an exploratory study was undertaken in Minnesota, funded by the Minnesota Department of Human Services. Data were derived from focus groups in every region of the state, with both child protection and judicial system participants. This study offers insights into the complicated nature of the partnership between two complex systems — child welfare and the court system. Currently, there is wide variation in how Protective Supervision is understood and practiced. However, where there is mutual respect between child welfare and the courts, Protective Supervision offers a useful tool.     

Eliciting expert judgements about a set of proportions

Eliciting expert knowledge about several uncertain quantities is a complex task when those quantities exhibit associations. A well-known example of such a problem is eliciting knowledge about a set of uncertain proportions which must sum to 1. The usual approach is to assume that the expert's knowledge can be adequately represented by a Dirichlet distribution, since this is by far the simplest multivariate distribution that is appropriate for such a set of proportions. It is also the most convenient, particularly when the expert's prior knowledge is to be combined with a multinomial sample since then the Dirichlet is the conjugate prior family. Several methods have been described in the literature for eliciting beliefs in the form of a Dirichlet distribution, which typically involve eliciting from the expert enough judgements to identify uniquely the Dirichlet hyperparameters. We describe here a new method which employs the device of over-fitting, i.e. eliciting more than the minimal number of judgements, in order to (a) produce a more carefully considered Dirichlet distribution and (b) ensure that the Dirichlet distribution is indeed a reasonable fit to the expert's knowledge. The method has been implemented in a software extension of the Sheffield elicitation framework (SHELF) to facilitate the multivariate elicitation process.     

Hitting the target without missing the point: New Zealand’s immunisation health target for two year olds

ABSTRACT

The use of health targets as a form of performance measurement has become more prominent internationally as governments have sought to control public expenditure, produce greater efficiency and improve accountability. However, health targets have faced criticism for their potential to produce negative outcomes within a health system. This paper examines how a health target was used as a policy instrument within the New Zealand health system to improve immunisation coverage at two years of age. It explores how the immunisation health target was implemented within four case study sites and discusses the effectiveness of the health target as a policy instrument for improving immunisation coverage and addressing persistent immunisation inequities. Measuring and monitoring performance towards the immunisation health target improved accountability for immunisation coverage within the New Zealand health system and focused attention on improving immunisation coverage in a way that previous policy attempts had failed to do. Health targets may be an effective policy instrument for creating change within specific areas of a health system if their potential for dysfunctional consequences are taken into consideration at the outset.     

Predictors of Antisocial and Prosocial Behavior in an Adolescent Sports Context

This study examined antisocial and prosocial behavior of N = 439 adolescent athletes between 14 and 17 years of age (67 teams). Multi‐level analyses showed that team membership explained 20 and 13 percent of the variance in antisocial and prosocial behavior in the sports context, respectively. The team effects suggest that aggregating antisocial or prosocial adolescents within teams may partially explain differences in antisocial and prosocial behavior among athletes in the sports context. A trend was found toward a relation between higher levels of moral reasoning within teams, and less antisocial behavior in the sports context. Favorable moral atmosphere was positively associated with more prosocial behavior in the sports context. Finally, supportive coach–athlete relationships were associated with both less antisocial and more prosocial behavior in the sports context.     

The Development of Parenting Efficacy Among New Mothers and Fathers

Predictors of prenatal and postnatal parenting efficacy were examined in a sample of 115 primiparous mothers and 73 fathers in an effort to examine the association between preexisting parental characteristics and prenatal efficacy and the association between prenatal characteristics and postnatal efficacy when aspects of the current parenting context are taken into account. The most robust predictors of maternal postnatal efficacy included both prenatal efficacy, which significantly predicted postnatal efficacy independent of all other predictors including the current parenting context, and perceived infant temperamental reactivity as both a main effect and as buffered by social support. This was not the case for fathers, whose postnatal efficacy was primarily a function of their amount of involvement in parenting tasks and social support. The differential predictors of mother and father efficacy as well as their implications for future research are discussed.     

Spatially varying dynamic coefficient models

In this work we present a flexible class of linear models to treat observations made in discrete time and continuous space, where the regression coefficients vary smoothly in time and space. This kind of model is particularly appealing in situations where the effect of one or more explanatory processes on the response present substantial heterogeneity in both dimensions. We describe how to perform inference for this class of models and also how to perform forecasting in time and interpolation in space, using simulation techniques. The performance of the algorithm to estimate the parameters of the model and to perform prediction in time is investigated with simulated data sets. The proposed methodology is used to model pollution levels in the Northeast of the United States.     

The Impact of Maternal Characteristics and Sensitivity on the Concordance Between Maternal Reports and Laboratory Observations of Infant Negative Emotionality

The moderating role of maternal characteristics and maternal sensitivity on the concordance between maternal reports and laboratory observations of negative emotionality was examined. Participants were 90 primiparous mothers and their infants. Mothers completed questionnaires about remembered care from their own parents and their depressive symptoms prenatally, infant temperament (distress to novelty and distress to limitations), and depressive symptoms postnatally. Mothers and infants participated in a laboratory assessment of infant temperament (distress to novelty and limitations) and maternal sensitivity at 6 months postpartum. Several factors that moderate the degree of concordance between maternal reports and behavioral observations were identified, as predicted. Novelty concordance was higher when mothers reported having their emotional needs met in childhood and low prenatal depressive symptoms. Limitations concordance was higher when mothers were less sensitive during the observational tasks. Methodological and theoretical implications are discussed.     

Improving the accuracy of migration age detail in multiple-area population forecasts

Population projections are often required for many geographical areas, and must be prepared with maximal computer and minimal analytical effort. At the same time, realistic age detail forecasts require a flexible means of treating age-specific net migration. This report presents a migration projection technique compatible with these constraints. A simplified version of Pittenger's model is used, where future migration patterns are automatically assigned from characteristics of historical patterns. A comparative test of age pattern accuracy for 1970–1980 indicates that this technique is superior to the commonly used plus-minus adjustment to historical rates.