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.     

Titin--springing back to youth?

Mutations in the muscle protein titin have been linked to dilated cardiomyopathy, a condition in which the heart chambers are enlarged and blood is ineffectively pumped, in humans and in animal models. This protein, which is a component of sarcomeres, provides essential scaffolding for other muscle proteins and acts as a spring to confer passive elasticity on the cardiomyocyte. Several titin isoforms exist, and they display varying size and degrees of elasticity. We review two interesting reports that show how variations in titin isoforms might be implicated in cardiac failure.     

Interparental Conflict and Preschoolers' Peer Relations: The Moderating Roles of Temperament and Gender

The relations between destructive interparental conflict (IPC) and three‐ to six‐year‐olds’ (N = 62) peer relations were examined as a function of child temperament and gender. Regression analyses indicated that effortful control moderated the relations of IPC with children's amount of peer interaction as well as with their problematic relations with peers. Specifically, high IPC was associated with low amount of interaction and high problematic relations for preschoolers low in effortful control, but it was related to high amount of interaction and low problems for those high in effortful control. Additionally, gender differences in the relations between IPC and the amount of peer interaction indicated that IPC was negatively related to the amount of interaction for girls but positively related to the amount for boys. The findings highlight the need for examining individual differences in the relations between IPC and the development of early peer relations.     

Household Context,Generational Status,and English Proficiency Among the Children of African Immigrants in the United States1

This study examines how household and parental-level determinants affect English proficiency among the children of African immigrants in the United States. Within immigrant families, the study finds that children’s level of proficiency has a stronger positive association with the proficiency of their mothers than with that of their fathers. Children’s level of English proficiency significantly increases as the number of other English-proficient children within their household increases. These impacts are stronger on the proficiency levels of first compared to second-generation children. Levels of proficiency are, however, lowest among children in families from Portuguese-speaking countries followed by their counterparts in families from countries where indigenous languages and Arabic are dominant. Although proficiency levels generally improve with increasing generational status, these improvements are smallest for children in families from Portuguese-speaking countries. Except for children in families from English-speaking countries, the largest improvements to proficiency with increasing generational status were observed among children in families from indigenous language backgrounds.     

Modeling Endogenous Mobility in Earnings Determination

ABSTRACT

We evaluate the bias from endogenous job mobility in fixed-effects estimates of worker- and firm-specific earnings heterogeneity using longitudinally linked employer–employee data from the LEHD infrastructure file system of the U.S. Census Bureau. First, we propose two new residual diagnostic tests of the assumption that mobility is exogenous to unmodeled determinants of earnings. Both tests reject exogenous mobility. We relax exogenous mobility by modeling the matched data as an evolving bipartite graph using a Bayesian latent-type framework. Our results suggest that allowing endogenous mobility increases the variation in earnings explained by individual heterogeneity and reduces the proportion due to employer and match effects. To assess external validity, we match our estimates of the wage components to out-of-sample estimates of revenue per worker. The mobility-bias-corrected estimates attribute much more of the variation in revenue per worker to variation in match quality and worker quality than the uncorrected estimates. Supplementary materials for this article are available online.     

Validation of a Multi‐Dimensional Measure of Strategy Development Processes

In this paper, we present evidence on the measurement properties of an instrument that assesses six dimensions of organizational strategy development. These dimensions are labelled planning, incrementalism, cultural, political, command and enforced choice. Using data from 5332 managers, results indicate the instrument has acceptable reliability and validity. Exploratory factor analysis confirms its underlying structure. Generally, the sub‐scales have acceptable internal reliability and inter‐rater reliability at the organizational level (n = 770 organizations). Further, using data aggregated at the organizational level, the sub‐scales are judged to have acceptable validity from the pattern of correlations amongst the six dimensions and with other variables.     

The Continued Importance of Quality Parent–Adolescent Relationships During Late Adolescence

The quality of adolescents' relationships with residential parents has been found to predict many different health and behavioral youth outcomes; strong associations have also been found between these outcomes and family processes, and between relationship quality and family processes. Data from Rounds 1–5 of the National Longitudinal Survey of Youth, 1997 were used to examine hypotheses about the influence of the parent–adolescent relationship on subsequent adolescent mental well‐being and delinquency, as mediated by family processes. Using structural equation modeling, we found that the influence of a positive residential parent–adolescent relationship on better mental well‐being and fewer delinquency was entirely mediated by family routines, parental monitoring, and parental supportiveness, net of sociodemographic controls.