Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.     

On constructing ageing rural populations: ‘Capturing’ the grey nomad

The world’s population is ageing, with forecasts predicting this ageing is likely to be particularly severe in the rural areas of more developed countries. These forecasts are developed from nationally aggregated census and survey data and assume spatial homogeneity in ageing. They also draw on narrow understandings of older people and construct the potential impact of ageing (such as increased dependence on the health care system) as negative. The construction and reinforcement of such stereotypes have obscured public policy debate about ageing and also the rural. This paper considered how, through using a mixed method approach, narrow understandings of rural ageing could be extended and refined. Using a case study of grey nomads in rural Australia, the strengths and weaknesses of various research approaches were reviewed. The investigation concluded that both quantitative and qualitative data could be used to extend contemporary understandings of rural population ageing and move constructions of this phenomenon beyond an impending rural crisis.     

Involving Young People—Empowerment or Exploitation?

The principle that children should be heard as well as seen—that they have a right to be consulted over decisions affecting them and to have their views taken into account by the adults working with or for them—now has general currency. One consequence is that increasing numbers of children and young people are now appearing on conference platforms or are included on the executive councils of charities or participate in working parties. Such events are often effective, but sometimes they can be embarrassing or counter-productive to all concerned. Amanda Allard considers the lessons to be learnt from a successful initiative to involve young people in policy advocacy.     

A generalized estimating equation approach to modelling incompatible data formats with covariate measurement error: application to human immunodeficiency virus immune markers

The integration of technological advances into research studies often raises an issue of incompatibility of data. This problem is common to longitudinal and multicentre studies, taking the form of changes in the definitions, acquisition of data or measuring instruments of some study variables. In our case of studying the relationship between a marker of immune response to human immunodeficiency virus and human immunodeficiency virus infection status, using data from the Multi-Center AIDS Cohort Study, changes in the manufactured tests used for both variables occurred throughout the study, resulting in data with different manufactured scales. In addition, the latent nature of the immune response of interest necessitated a further consideration of a measurement error component. We address the general issue of incompatibility of data, together with the issue of covariate measurement error, in a unified, generalized linear model setting with inferences based on the generalized estimating equation framework. General conditions are constructed to ensure consistent estimates and their variances for the primary model of interest, with the asymptotic behaviour of resulting estimates examined under a variety of modelling scenarios. The approach is illustrated by modelling a repeated ordinal response with incompatible formats, as a function of a covariate with incompatible formats and measurement error, based on the Multi-Center AIDS Cohort Study data.     

Behavioral Language Interventions for Children with Autism: Comparing Applied Verbal Behavior and Naturalistic Teaching Approaches

The Analysis of Verbal Behavior - Several important behavioral intervention models have been developed for teaching language to children with autism and two are compared in this paper....     

A Framework of Asset-Accumulation Stages and Strategies

Based on a study with 298 low-income participants, we propose that asset accumulation occurs in 3 stages. In the first stage (reallocation), current resource inflows exceed current outflows. To do this, people reallocate resources from consumption or leisure. In the second stage (conversion), people may convert resources from liquid to illiquid forms. In the third stage (maintenance), people resist temptations to dissave. We theorize that people adopt psychological and behavioral strategies to achieve these objectives. Putting psychological and behavioral strategies together with the stages of reallocation, conversion, and maintenance results in 6 strategy groups. We provide real-world examples of each strategy group and discuss implications for encouraging account ownership among the unbanked, improving asset-accumulation programs, and improving financial education.     

'Your friends don't understand': Invisibility and unmet need in the lives of 'young carers'

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.