Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Foster parenting: A developmental model

This paper proposes a developmental framework for foster parents and outlines four distinct growth stages. Such a framework can be of value to program administrators who are required to assess foster parent development during the crucial matching process. To draw a distinction between each developmental stage, specific instrumental tasks and indicators are outlined.     

Farming Patterns,Rural Restructuring,and Poverty: A Comparative Regional Analysis1

Abstract This study examines the contentions of two recent perspectives on rural economic organization and their implications for poverty. Building from (1) agrarian political economy and (2) the rural restructuring literatures, we present a comparative regional analysis of how farming patterns and other aspects of economic organization differentially affect poverty in rural areas. Data are based on 2,349 nonmetropolitan U.S. counties for the 1970–1980 period. Nonhired labor-dependent, family-operated farming (smaller and larger family farming) has relatively similar cross-regional effects on rural poverty. The effects of industrialized farming are more spatially variant, suggesting that this type of farming is integrated into regional political economies in different ways than are simple commodity units. However, farming patterns have only a small effect on rural poverty relative to other factors, such as the local employment structure, characteristics of the population, and geographic location. The results of this study highlight the need to move beyond the farm sector to understand both the dynamics of this sector and the socioeconomic consequences of rural restructuring. More broadly, the study underscores the importance of testing general sociological relationships under different spatial (e.g., regional) contexts.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Scheduling Updates of Probabilistic Risk Assessments: The Arkansas Nuclear One-Unit 1 Experience

This paper presents the results of a study that identified how often a probabilistic risk assessment (PRA)should be updated to accommodate the changes that take place at nuclear power plants. Based on a 7-year analysis of design and procedural changes at one plant, we consider 5 years to be the maximum interval for updating PRAs. This conclusion is preliminary because it is based on the review of changes that occurred at a single plant, and it addresses only PRAs that involve a Level 1 analysis (i.e., a PRA including calculation of core damage frequency only). Nevertheless, this conclusion indicates that maintaining a useful PRA requires periodic updating efforts. However, the need for this periodic update stems only partly from the number of changes that can be expected to take place at nuclear power plants–changes that individually have only a moderate to minor impact on the PRA, but whose combined impact is substantial and necessitates a PRA update. Additionally, a comparison of two generations of PRAs performed about 5 years apart indicates that PRAs must be periodically updated to reflect the evolution of PRA methods. The most desirable updating interval depends on these two technical considerations as well as the cost of updating the PRA. (Cost considerations, however, were beyond the scope of this study.)     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

Benefits of preventive dentistry in children: Cost factors and public policy

Dental caries in children is now recognized as a preventable disease. The use of fluoride and sealants has produced a major reduction in caries prevalence among school aged children in the United States and other countries. A portion of the child population who are educationally and socioeconomically disadvantaged are not fully receiving these benefits. Public policy, insurance and medicaid groups must be made aware of these preventative measures and strategies developed to implement them.     

The Effects of ROTC Program Participation on Socioeconomic Status and Life Satisfaction*

Using mail survey data based on a stratified systematic sample [N = 686] of 1983–1988 graduates of a medium-sized state university, this research evaluates whether ROTC program participation constitutes an independent source of human capital in civilian labor markets by comparing postgraduate earnings (annual income), prestige and authority, and life satisfaction of ROTC program participants with those of nonparticipants. The results revealed no statistically significant ROTC program participation effects, independent of subsequent military status. ROTC program participation paid off in terms of occupational prestige and authority for those on active duty, but not for those in national guard or reserve units. Neither ROTC participation nor current military status affected income or life satisfaction levels.     

A solution of the externality problem using strategic matching

This paper develops a Coase-like solution of the problem of inducing Pareto optimal behavior in the presence of reciprocal externalities. In place of Coasean direct compensation between the parties to an externality problem, actors strategically match each other's externality-producing activity, and thus induce counterparts to internalize the external benefits or costs of their actions. The analysis suggests a general framework for analyzing social interactions in the presence of reciprocal externalities. As an application of the theory, a solution of the duopoly problem is noted.We are indebted to L. Danziger, D. Samet, participants in faculty seminars at Bar-Ilan and New York Universities and at the University of Maryland, and two anonymous referees for helpful comments and discussions. All remaining errors are our own.     

HIV-infected woman. Illness cognition assessment.

1. Special attention is particularly important in addressing the mental health needs of HIV-infected women. These needs may involve issues such as concerns about present or future pregnancy; child-rearing, often as single parents; poverty, illicit drug use or addiction; and the potential lack of support services. 2. Diagnosis of HIV infection in women may be overlooked, as the clinical signs that routinely trigger the suspicion of HIV illness in men are often interpreted to reflect depression or psychological factors, such as stress or overwork, rather than raise the suspicion of HIV infection in women. 3. Understanding a woman's illness cognition is an important component of designing strategies that can enhance coping. The picture a woman generates regarding her illness is a composite of her experiences and responses, and determines to a large extent what she will do in response to her illness.