Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Growing Disability Rates — the Gender Issue: The Dutch Case in an International Perspective

In the Netherlands, with its remarkably high disability rates, a new phenomenon seems to be emerging. Growing disability rates in the past few years have been exclusively caused by the growing inflow of women into the disability schemes. Comparing the Dutch situation internationally shows that roughly the same problem seems to exist in those countries in which there is a more general problem of large inflow into disability. Women are overrepresented in these arrangements. The Dutch literature shows that there are many factors (both work- and non-work-related) that contribute to a larger push of women towards disability. We conclude that the benefit system can be seen as a sort of "filter". If the filter is weak, many persons will enter disability. If the pressure on women to enter is larger (or the forces to stop women from entering disability smaller), then inflow risks for women will be higher.     

Individualised Support and Funding: building blocks for capacity building and inclusion

The paradigm in disability supports is shifting away from institutional services and professional control towards self-determination and community involvement of people with disabilities. The assumption that the best way to provide disability supports is for government to give money to agencies or services, rather than directly to people with disabilities and their support networks, is being challenged. This article reports on findings and themes from a Canadian study that investigated individualised funding projects from different parts of the world. Ten of fifteen of the most 'promising initiatives' were selected for more detailed study and analysis. Projects analysed were from Canada, the US, and Australia. Themes emerging from the study included the fact that values and principles mattered, a policy framework provided coherence and equity, infrastructure supports for individuals were separate from service system, the facilitator-broker role differed from case management, allocation of individualised funds was designed to be equitable and account able to the funder and person, and a 'learn as you go' philosophy maximised positive outcomes. This research project demonstrates that individualised support and funding, when embedded in the new paradigm of disability and community, builds capacity of individuals, families, and communities.     

Estimation of Metabolic Rate Constants in PBPK‐Models from Liver Slice Experiments: What Are the Experimental Needs?

A mechanistic model is presented describing the clearance of a compound in a precision-cut liver slice that is incubated in a culture medium. The problem of estimating metabolic rate constants in PBPK models from liver slice experiments is discussed using identifiability analysis. From the identifiability problem analysis, it appears that in addition to the clearance, the compound's free fraction in the slice and the diffusion rate of the exchange of the compound between culture medium and liver slice should be identified. In addition, knowledge of the culture medium volume, the slice volume, the compound's free fraction, and octanol-water-based partition between medium and slice is presupposed. The formal solution for identification is discussed from the perspective of experimental practice. A formally necessary condition for identification is the sampling of parent compound in liver slice or culture medium. However, due to experimental limitations and errors, sampling the parent compound in the slice together with additional sampling of metabolite pooled from the medium and the slice is required for identification in practice. Moreover, it appears that identification results are unreliable when the value of the intrinsic clearance exceeds the value of the diffusion coefficient, a condition to be verified a posteriori.     

Integrating Career and Personal Counseling

Career and personal counseling are inextricably intertwined. Career problems have a strong emotional component. Career indecision and procrastination may be better interpreted as zeteophobia, the fear of career exploration. Trait and factor theory pictures career counseling as unrealistically simplistic and leads neophytes to view it as boring. Training all counselors to integrate career and personal counseling would lead to better service for clients.     

Testing for state and local government job queues

Bivariate probit estimates with partial observability identify the factors influencing the worker’s decision to seek a state or local government job and the factors influencing the government’s decision to hire particular workers. The estimates routinely confirm the presence of a local job queue but confirm the presence of a state job queue only when the role of unionization is explicitly recognized. Our results suggest that the net benefits from local and state government employment are greater than those from private sector employment. The estimates also indicate that local governments disproportionately hire racial minorities relative to the local governments’ pool of applicants but indicate no such relationship for state governments. The authors thank Dale Belman, Jugal Ghorai, and Matt Higgins for help on this and related work. We also thank the referee and the editor for useful suggestions.     

Farmers,the Practice of Farming and the Future of Agroforestry: An Application of Bourdieu's Concepts of Field and Habitus

Abstract Agroforestry, the practice of raising crops and trees together in ways that are mutually beneficial, provides farmers with an alternative to more conventional farming practices. In this paper, we apply Bourdieu's concepts of “field” and “habitus” in an attempt to better understand the practice of farming and the role that agroforestry may have in farming systems. Analysis is based on qualitative and quantitative interviews of farmers and other key informants in two regions, Fox‐Wyaconda Watershed in northeast Missouri and Scott County in southeast Missouri. Within the field of farming, farmers emphasized the importance of economic, family and rental relations. Important habitus considerations include different interpretations of what constitutes farming and what constitutes forestry. Based on Bourdieu's theoretical framework, we offer three alternative paths of social change that may lead to more widespread utilization of agroforestry.