Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

FAMILY INTERVENTION IN A CASE OF MULTIPLE PERSONALITY

The authors report a case of multiple personality in which therapy was directed at the marital couple, rather than focusing on the multiple personality per se. The symptoms of the individual are seen as a disturbance in the family homeostasis and were treated from that standpoint. The functions of the symptom in the areas of impulse discharge, superego operation, boundaries of closeness-distance, and self-object representations for the couple and family are discussed.     

INTERVENTION PLANNING FOR THE FAMILY OF THE AUTISTIC CHILD: A MULTILEVEL ASSESSMENT OF THE FAMILY SYSTEM*

The clinician working with the family of an autistic child may need to assess the family at several levels. The first level requires an assessment of the behavioral deficits and excesses of the child. The next level examines the family in terms of their behavioral skills and the impediments that occur when they implement behavior change programs. The third level involves assessing the family unit to identify obstacles to change. While many well-functioning families may be stressed by the crises that arise in raising an autistic child, other families are predisposed to dysfunction regardless of the presence of the child.     

Queer Chicano Families: The Importance of Converging Literature on Queer Families,Chicano Families,and Chicano Queers

Despite growing literature on Latino families and Latino queer identities, there has been relatively little empirical research on Latino same‐sex families. Likewise, emerging empirical research on gay and lesbian couples tends to focus on the experiences of middle‐class, well‐educated, White couples. I argue that combining theoretical and empirical works on sexuality, Chicano studies, and queer studies can assuage this lack of diversity in each body of literature. This work first examines current literature on Latino families, with a focus on Latino familism. This is followed by a brief examination of current literature on queer Chicanos. Lastly, it will discuss queer families and the lack of current literature on Latino same‐sex couples, in order to present a course of action for further research on the intersectional social location of queer Chicano families.     

Characterizing the systems of support for families of children with disabilities: A review of the literature

ABSTRACT

During early childhood, children require major support that is tailored toward their specific needs. For children with disabilities, families play a crucial part in providing the needed services. However, families often lack the knowledge, resources, and skills that would help them in overcoming challenges that arise while raising a child with disability. Although much research has focused on defining the needs of families with children with disabilities and the impact of disability on the family system, many questions remain. A comprehensive perspective is needed to identify the types of support families provide to the child with a disability, the impact of providing that support on family members, the support systems that are available to families, and the impact of support on society. This review consolidates the empirical research to date on family support during early childhood and outlines areas of research that need further exploration.     

Relationship satisfaction and sexual satisfaction: a longitudinal study of individuals in long-term relationships

This study examined the association between relationship satisfaction and sexual satisfaction over time to provide evidence about possible causal explanations for the association between two variables. Eighty-seven individuals in long-term relationships completed measures of sexual satisfaction and relationship satisfaction at 2 times 18 months apart. There was only limited evidence, based on exploratory analysis, to support either the hypothesis that changes in a relationship satisfaction lead to changes in sexual satisfaction or the hypothesis that changes in sexual satisfaction lead to changes in relationship satisfaction. However, sexual satisfaction and relationship satisfaction wer found to change concurrently. The quality of intimate communication accounted for part of the concurrent changes in relationship satisfaction and sexual satisfaction. I discuss the results in terms of the need to develop more complex models depicting the longitudinal associations between relationship satisfaction and sexual satisfaction.     

Long-term economic consequences for women of delayed childbearing and reduced family size

Using data from the Panel Study of Income Dynamics, this study explored the association among delayed childbearing, completed family size and several measures of the economic well-being of women age 60 and older in 1976. By retirement age women who bore their first child at age 30 or older are significantly better off economically than either average-age childbearers or the childless. Economic well-being also appears to be related to family size among late childbearers. At retirement age the delayed childbearer with only one or two children appears better off than all other women. Thus, late childbearing and small family size appear associated with the highest standard of living for these women. This study also relates the experience of this early cohort of women to that of more recent birth cohorts.     

The Effects of the Political Environment On Public Relations in Bulgaria

The purpose of this article is to examine the relationship between Web characteristics and perceptions toward relational components. A 2 (low interactivity and high interactivity) x 2 (text-oriented and multimedia-oriented) between-group experiment was designed with 197 participants to investigate this question. The outcomes showed that interactivity has significant effects on relationship building. However, the interaction effects between interactivity and medium arrangement suggest that nonessential arrangement of interactivity and multimedia did not enhance positive perceptions of relationships with the organizations. Interactivity, however, showed that the main effect, multimedia orientation, did not. The application of interactivity on the Web was discussed for better relationship building.