Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

The Sandwich Generation: Dependency, Proximity, and Task Assistance Needs of Parents

This study was designed to determine the extent of sandwiched families and the impact of dependency and proximity to task assistance provided to parent(s). Data were collected in Idaho, Oregon, Utah, and Michigan from a random sample of 40–65-year-old respondents. Fifteen percent are sandwiched between needs of aging parents and financially dependent children. Respondents are much more likely to be providing assistance to mothers than fathers. Parents are most likely to live near, but not necessarily with, the respondent. Spouses and partners' parents, however, are likely to live farther away. Task assistance provided most often to aging parent(s) includes help with transportation and shopping; financial assistance was reported least often. Income of respondent and dependency and proximity of parents are significantly related to providing assistance to parents. This study offers a unique glimpse at the relationships between personal characteristics, dependency, proximity, and task assistance issues as they pertain to the sandwich generation.     

A model for short-term group therapy on a children's inpatient unit

The paper describes the group therapy model which has evolved over the past two years on the Child Psychiatry Inpatient Unit of North Carolina Memorial Hospital. It begins with a brief review of the literature concerning group therapy with latency-aged children. The setting and patient population are described. Vignettes from group sessions are used to illustrate techniques which have evolved to deal with this particular setting and population. These include a leadership style characterized by much clarification, modeling, and limit setting; extensive focus on beginning and terminating; clearly defined behavioral limits; the use of time out; and use of play materials requiring little skill or attention as anxiety binders as well as projective media; and observation and supervisory discussions open to all members of the treatment team. The paper concludes with a discussion of the potentials and limitations of group therapy in such a setting. The thesis is that this model is effective in diagnosing developmental levels, in developing interpersonal skills, in substituting verbalization for action, and in mastering separation anxieties, though the setting limits the extent to which controlled regression, transference, and group pressures can develop and be used to produce change.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

The Incidence of Crime on Industry‐Level Foreign Direct Investment: An Assessment of OECD Member Countries*

In this article, we assess whether the incidence of crime helps to explain the variation in sectoral FDI flows. Using a panel of 29 Organization of Economic Co‐operation and Development (OECD) countries for the period 2003–2012, we employ a generalized method of moments (GMM) estimation strategy due to the potential for endogeneity between our variables of interest. Our results indicate that crime deters investment to the service sector. In particular, this effect is observed in the following service industry subsector: financial services. Policymakers interested in boosting FDI in the affected sectors should be concerned with policies that focus on the reduction of criminal activities.     

Bridge Leadership: Gendered Consumerism and Black Women’s Political Power within Early 20th Century “Don’t Buy” Campaigns

This research surveys the literature around black consumerism and social movements, exploring the “Don’t Buy Where You Can’t Work” (DBWYCW) campaigns of the 1920s-1940s. The author examines the integral roles women played (as organizers, agitators, and beneficiaries) in various economic boycotts within the context of Belinda Robnett’s theory of bridge leadership, with a particular focus on consumerism as a major vehicle through which African-American women engaged in movement work during the DBWYCW campaigns. This article challenges the erasure of women’s leadership by reframing “Don’t Buy” as a women’s movement. Applying Robnett’s bridge leadership theory to different eras, regions, and movements, we see how the Great Depression combined with activism in the gendered sphere of consumerism and facilitated the activism of black women. This paper also expands Robnett’s conceptualization of professional and indigenous bridge leaders by identifying urban working class women within the “Don’t Buy” movement who fit these leadership categories.