Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

Medicaid nursing facility reimbursement in flux: effects of federal regulatory changes and prevailing fiscal conditions, 1978-1998

Basic concepts and trends are examined in Medicaid nursing facility reimbursements between 1978 and 1998, because Medicaid payment reform is a common budget reduction strategy pursued by state officials. Non-incremental changes in state rate-setting methods, as well as incremental changes in per diem rates and expenditures per recipient, are analyzed. In addition to substantial cross-state variation, results reveal clear trends in reimbursement policy characteristics over time. Not only do these track closely with changes in the federal regulatory environment, but they also track closely with prevailing fiscal and economic conditions. Given the serious ramifications reimbursement policy changes can have for nursing home residents and providers, it is imperative that the impact of federal disengagement from this policy area be understood.     

Effectiveness of addiction science presentations to treatment professionals,using a modified Solomon study design

OBJECTIVES: Knowledge of addiction research findings is critical for healthcare professionals who treat addicted patients. However, there is little information available about the instructional effectiveness of lecture-slide presentations in changing knowledge vs. beliefs of such professionals. DESIGN: A modified Solomon four-group experimental design was used to assess the instructional effectiveness (knowledge gain vs. belief changes) of three-hour addiction science workshops presented to health-care professionals by neurobiologically-trained academic researchers. Effectiveness of the workshops was assessed by a 28-item questionnaire on participant versus control group knowledge/beliefs on addiction. Six-month follow-up questionnaires measured "retention" of knowledge and belief changes. RESULTS: The workshop participants showed significant knowledge gain and belief changes, whereas the two control groups showed no change in knowledge or beliefs. After six months, knowledge gains decreased, but were still higher than pre-test scores. In contrast, belief changes on three subscales persisted over six months in 40 to 52 percent of the subjects. CONCLUSIONS: These results illustrate a successful continuing education model by which academic researchers who are skilled teachers present a three-hour lecture-slide workshop with extensive question-and-answer sessions on addictions. We conclude that motivated health-care professionals can experience important knowledge gains and belief changes by participating in such workshops. In contrast to the transient retention of knowledge, belief changes persisted surprisingly well for at least six months in about half the subjects. These results suggest that long-term changes in the professional orientation of these health-care workers are possible.