“Would You Do That in Your Home?” Making Nursing Homes Home-like in Culture Change Implementation

Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.     

Educational Differences in Completed Fertility: A Behavioral Genetic Study of Finnish Male and Female Twins

Despite the large body of research on educational differences in fertility, how genetic and environmental influences may contribute to educational differences in completed fertility is not well understood. This study examines the association between educational level and completed fertility in a sample of Finnish male and female twins born between 1950 and 1957 with register-based fertility follow-up until 2009. The results show that poorly educated men and highly educated women are least likely to have any children and have lower completed fertility in general. Behavioral genetics analysis suggests that the association between education and having any children in both sexes is influenced by factors shared by co-twins and that these factors are genetic rather than common environmental. No evidence of a causal pathway between education and having any children independent of these shared influences is found. These findings suggest that familial factors may play a role in the process through which educational differences in completed fertility are formed.     

A Model for Implementing an Evidence-Based Practice in Student Fieldwork Placements: Barriers and Facilitators to the Use of “SBIRT”

ABSTRACT

This article reports on focus group data analysis that was used to understand initial, largely positive outcomes from a university-based initiative to disseminate and implement an evidence-based practice (EBP)—Screening, Brief Intervention, and Referral to Treatment for Substance Use (SBIRT)—into student fieldwork placements, which are usual care social work settings. Focus groups were conducted with three groups of stakeholders involved in the ongoing project: social work department faculty (n = 10), bachelor- and master-level social work students (n = 8), and social work fieldwork instructors (n = 6). Dimensional analysis of the focus group data yielded results indicating that dissemination and implementation of SBIRT was influenced by agency- and school-level factors and perceived fit between the EBP and individual professional identity, intrapersonal characteristics, and timing. The resulting model, developed through the focus group analysis, is offered and shows how these factors interacted and affected training, supervision, and use of the EBP. The model provides social work educational programs and agencies a working tool for diagnosing and proactively addressing barriers and breakdowns in the EBP implementation process. Future research that tests the model as a diagnostic tool and generates knowledge about its influence in developing competent evidence-based practitioners is indicated. Future focus groups in relation to this initiative are needed to better understand these barriers and facilitators in the EBP implementation process and their critical roles in the process of translating SBIRT into standard social work practice.     

Depression in Older Adults: A Meta-Synthesis

Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge—both quantitative and qualitative—has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.     

Normalized measures of concavity and Ross’s strongly more risk averse order

The Arrow-Pratt (A-P) definitions of absolute and relative risk aversion dominate the discussion of risk aversion and defining “more risk averse”. Ross (Econometrica 49:621–663, 1981) notes, however, that being A-P more risk averse is not sufficient for addressing many important comparative static questions. Consequently he introduces “a new and stronger measure for comparing two agents’ attitudes towards risk…”. Ross does not provide a corresponding measure of risk aversion. This paper uses a normalized measure of concavity to characterize the Ross definition of strongly more risk averse on bounded intervals. Other properties and uses of these normalized measures of concavity are also presented.     

Sexual deception as a social-exchange process: development of a behavior-based sexual deception scale

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.     

Using Fairness Models to Improve Equity in Health Delivery Fleet Management

Inefficiency and inequity are two challenges that plague humanitarian operations and health delivery in resource‐limited regions. Increasing capacity in humanitarian and health delivery supply chains is one option that has the potential to improve equity while maintaining efficiency. For example, the nonprofit organization Riders for Health has worked to increase capacity by providing reliable transportation to health workers in rural parts of sub‐Saharan Africa; with more motorcycle hours at their disposal, health workers can perform more outreach to outlying communities. We develop a model using a family of fairness function to quantify the efficiency and equity of health delivery as capacity is increased via development programs. We present optimal resource allocations under utilitarian, proportionally fair, and egalitarian objectives and extend the model to include dual modes of transport and diminishing returns of subsequent outreach visits. Finally, we demonstrate how to apply our model at a regional level to provide support for humanitarian decision makers such as Riders for Health. We use data from the baseline phase of our evaluation trial of Riders for Health in Zambia to quantify efficiency and equity for one real‐world scenario.     

Improving Humanitarian Operations through Technology‐Enabled Collaboration

Humanitarian supply chains involve many different entities, such as government, military, private, and non‐governmental organizations and individuals. Well‐coordinated interactions between entities can lead to synergies and improved humanitarian outcomes. Information technology (IT) tools can help facilitate collaboration, but cost and other barriers have limited their use. We document the use of an IT tool to improve last‐mile supply distribution and data management in one of many camps for internally displaced persons after the January 2010 earthquake in Haiti, and we describe other current uses of technology in camp management. Motivated by these examples and the interest among humanitarian organizations in expanding the use of such tools to facilitate coordination, we introduce a cooperative game theory model and explore insights about the conditions under which multi‐agency coordination is feasible and desirable. We also outline an agenda for future research in the area of technology‐enabled collaboration in the humanitarian sector.