Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model

We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n = 68) were compared to individuals assigned to a usual care condition (n = 61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.     

Clinical Social Work Practice with Former System Youth with Mental Health Needs: Perspective of Those in Need

The purpose of this study is to describe the types of programs and mental health services former system youth with mental health histories would be inclined to engage in to manage their mental health difficulties, along with the factors that might hinder them from engaging in these services. A series of closed and open-ended questions on potential programs and services were asked, as part of a larger study. Participants were former system youth; specifically 18?C30?year olds who were diagnosed with a mood disorder and were involved with public mental health and social services (e.g., public welfare, child welfare, juvenile justice) during childhood. Responses to the open-ended questions were categorized and percentages are reported from the yes/no items. Eighty-three percent and 76% reported that they would be enticed to come to a support group and panel discussion on mood disorders, respectively, while only 46% reported that they would attend a family support group. Talking with others who have had similar experiences, material possessions and creative expression were the most common responses regarding what would entice them to get involved. Further, peer disrespect, transportation, and daycare were common barriers to potential participation. As the field continues to build knowledge on system-wide strategies to improve agency-based mental health care for transitioning youth and young adults, new evidence-based approaches may benefit from listening to the specific needs, preferences, and suggestions of these youth themselves.     

An approach to design long-term monitoring and evaluation frameworks in multi-actor systems--a case in water management

Learning-by-doing and adaptive management require careful monitoring and evaluation of the outcomes of environmental policies and programs under implementation. Selecting relevant indicators is difficult, especially when monitoring over a longer period of time. Further challenges arise when policies are developed as a collaborative effort among multiple actors. This paper discusses an approach to design frameworks for long-term monitoring and evaluation in multi-actor systems. It uses Dynamic Actor Network Analysis (DANA) as an actor-sensitive method to reconstruct program theories. This is combined with elements of assumption-based planning to identify critical assumptions and associated indicators to incorporate the dynamic aspects related to long-term monitoring. An application of this approach is described for a case of water management in the Netherlands. Here, mapping multiple perspectives and identifying critical assumptions helped to broaden the scope of monitoring in important ways. Identifying associated indicators and expectations on their development in response to policy implementation proved more difficult. From this case, it can be concluded that the approach is feasible, useful, but also demanding. However, with continuing trends of networked governance and adaptive management, additional efforts to reflect these trends in monitoring and evaluation, through this and similar approaches, are needed.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Academic Performance of Subsequent Schools and Impacts of Early Interventions: Evidence from a Randomized Controlled Trial in Head Start Settings

The role of subsequent school contexts in the long-term effects of early childhood interventions has received increasing attention, but has been understudied in the literature. Using data from the Chicago School Readiness Project (CSRP), a cluster-randomized controlled trial conducted in Head Start programs, we investigate whether the intervention had differential effects on academic and behavioral outcomes in kindergarten if children attended high- or low-performing schools subsequent to the preschool intervention year. To address the issue of selection bias, we adopt an innovative method, principal score matching, and control for a set of child, mother, and classroom covariates. We find that exposure to the CSRP intervention in the Head Start year had significant effects on academic and behavioral outcomes in kindergarten for children who subsequently attended high-performing schools, but no significant effects on children attending low-performing schools. Policy implications of the findings are discussed.     

The relationship of intimate partner aggression to head injury, executive functioning, and intelligence

Measures of head injury, executive functioning, and intelligence were given to a community sample composed of 102 male perpetrators of intimate partner aggression (IPA) and 62 nonaggressive men. A history of head injury and lower mean score on a measure of verbal intelligence were associated with the frequency of male-perpetrated physical IPA as reported by male perpetrators and their female partners. Lower mean scores on a measure of verbal intelligence also predicted frequency of psychological IPA perpetration. Using the perpetrator subtypes outlined by Holtzworth-Munroe et al. (2000), analyses revealed that compared with other groups, the most severely aggressive subtypes (i.e., borderline-dysphoric and generally violent-antisocial) were the most likely to report a history of head injury and to have significantly lower mean scores on a neuropsychological test of verbal intelligence. The possible role of neuropsychological factors in IPA perpetration and implications for prevention and intervention programs are discussed.     

The Efron dice voting system

About 50?years ago, Efron noted some counterintuitive properties of the long-term behavior of contests involving dice. For instance, consider the 6-sided dice whose sides are labeled (4,4,4,4,0,0), (3,3,3,3,3,3), (6,6,2,2,2,2), and (5,5,5,1,1,1). Each die has a 2/3 probability of rolling a higher number than the next one in the list and the last has the same 2/3 probability of rolling a higher number than the first. The non-transitivity of games involving non-identical dice was popularized by Gardner (Sci Am, 223:110–114, 1970). Although Gardner and other authors have observed that non-transitive dice serve to illustrate the complexities of the theory of voting, it does not seem that much attention has been paid to the corresponding voting system. Our purpose in this article is to present this voting system and compare its properties with those of other voting systems. One of the most interesting properties is the fact that cancellation with respect to the Efron dice voting system can replace cancellation with respect to pairwise preferences in Young’s characterization of the social choice function associated with the Borda Count.     

Delirium: a very common problem you may not recognize

Older adults with multiple pre-existing conditions are admitted to hospitals with acute illnesses and injuries every day. Delirium is not recognized by clinicians across health care settings. With awareness of risk factors and knowledge of delirium, nurses can play a pivotal role in the early identification, treatment, and, most important, prevention of delirium in older adults. Nurses often display a lack of knowledge related to delirium and the complex symptoms that appear differently in the presence of other complicating co-morbid conditions in aging adults. Nurses play a crucial role in keeping patients safe and ensuring optimal outcomes, regardless of the setting. With the growing population of older adults and the expected increases in chronic illness and dementia, delirium is a problem nurses are likely to experience in all practice settings. Knowing what to look for facilitates recognizing the risk and acting early to minimize (or even prevent) delirium.     

Examining the interplay of an organization's prior reputation,CEO's visibility,and immediate response to a crisis

In one of only a few crisis communication research studies taking a relational approach, examining the effects of a company's prior reputation in publics’ responses to a given crisis situation, Lyons and Cameron (2004) found that both reputation and response profoundly affected publics’ attitude and behavioral intentions toward an organization involved in a crisis situation, using hypothetical, fictitious organizations and crises. Using actual organizations and crises, our research team designed a 2 (reputation: good vs. bad) × 2 (crisis response: apologetic vs. defensive) × 2 (CEO visibility in immediate crisis response: visible vs. invisible) within-subjects experiment (N = 102) to examine the variances in stakeholders’ attitudes and behavioral intentions toward a company after being exposed to online video that delivered a corporate crisis response. Findings were counter-intuitive: a defensive response to a crisis is as acceptable to crisis stakeholders as an apologetic response if the CEO is visible (or audible) in the response and if the pre-crisis company-stakeholder reputation is positive. Good reputation, defensive crisis response and CEO visibility in immediate response to a crisis resulted in the best stakeholder attitudes and purchase intentions.