County Government Resources Associated with Dependent-Adult Abuse Investigations in Iowa

ABSTRACT

This study evaluated on a county level the association of Iowa's domestic dependent-adult abuse investigations with the location of adult protective services (APS) offices, rurality, government resources, felony charges and prosecutions, child abuse reports, and census demographics. In 2003, the rate of dependent-adult abuse investigations for Iowa was 0.70 per 1,000 population age 18 and older. Higher rates of child abuse investigations, felony prosecutions, sheriff's annual salary, and lower rates of child abuse substantiations are associated with higher rates of dependent-adult abuse investigations and substantiations.     

Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©

ABSTRACT

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Nursing Home Deficiency Citations for Safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.     

We've Looked at Care from Both Sides Now: The Effects of Alternative Evaluation Strategies on Study Conclusions

This study uses two studies about the role of managed-care programs in serving Medicaid long-term care clients in Florida to illustrate how different research designs can reach divergent conclusions. Two reports from different groups using essentially the same database to assess the impact of managed care on a group of older Medicaid clients served by a Nursing Home Diversion Program reached different conclusions. The report from Florida's Office of Program Policy Analysis and Government Accountability concluded that the Diversion program saved money, whereas the report from the Florida Policy Exchange Center on Aging at the University of South Florida reached basically the opposite conclusion. Both agreed that the capitation rate was too high. How the policy questions are framed and analyzed can affect the conclusions reached. A variety of factors can influence the apparent effects of programmatic interventions. Evaluations must take relevant confounding variables into account.     

Exploring the nutritional vulnerability of homeless men in a Canadian urban setting

Abstract

Homelessness, Aboriginal ethnicity, and nutritional vulnerability are key determinants of health. Substance abuse further compounds health risk. This study explored the nutritional vulnerability of homeless men, some of who were solvent-users, to assess nutrition-related chronic disease risk factors. Anthropometric data were used to calculate disease risk using body mass index. Diet was assessed using a 24-hr food recall and data were compared to Canada’s Food Guide recommendations. A significant proportion of participants had low intakes of vegetables and fruit and milk and alternatives. More than half of the participants met the intake recommendations for grain servings and meat and alternatives. Solvent-using participants consumed significantly higher intakes of vegetables and fruit, grain products, and other foods and beverages, than non-solvent using men. More than half of the participants were classified as overweight or obese. Healthy food consumption was influenced by lack of stable housing, reliance on charitable food, and substance abuse.     

Integrating political activism and a professional career

Psychodynaniic theories, once an essential part of social work education but recently neglected, have been reinvigorated in recent years through contributions from social constructionism, infant research, and intersub‐jectivity. These theories, with their emphasis on multiple perspectives, context, and collaborative relationships allow for important considerations of diversity as well as clients’ strengths and resilience, and can serve as formats for the broadest forms of change. In its contemporary form, psychodynamic theory offers a complex and rich understanding of human behavior and a direction for practice that is utterly consistent with social work values and interests.     

Minimizing Skin Color Differences Does Not Eliminate the Own-Race Recognition Advantage in Infants

An abundance of experience with own-race faces and limited to no experience with other-race faces has been associated with better recognition memory for own-race faces in infants, children, and adults. This study investigated the developmental origins of this other-race effect (ORE) by examining the role of a salient perceptual property of faces-that of skin color. Six- and 9-month-olds' recognition memory for own- and other-race faces was examined using infant-controlled habituation and visual-paired comparison at test. Infants were shown own- or other-race faces in color or with skin color cues minimized in grayscale images. Results for the color stimuli replicated previous findings that infants show an ORE in face recognition memory. Results for the grayscale stimuli showed that even when a salient perceptual cue to race, such as skin color information, is minimized, 6- to 9-month-olds, nonetheless, show an ORE in their face recognition memory. Infants' use of shape-based and configural cues for face recognition is discussed.