Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Foster parenting: A developmental model

This paper proposes a developmental framework for foster parents and outlines four distinct growth stages. Such a framework can be of value to program administrators who are required to assess foster parent development during the crucial matching process. To draw a distinction between each developmental stage, specific instrumental tasks and indicators are outlined.     

Farming Patterns,Rural Restructuring,and Poverty: A Comparative Regional Analysis1

Abstract This study examines the contentions of two recent perspectives on rural economic organization and their implications for poverty. Building from (1) agrarian political economy and (2) the rural restructuring literatures, we present a comparative regional analysis of how farming patterns and other aspects of economic organization differentially affect poverty in rural areas. Data are based on 2,349 nonmetropolitan U.S. counties for the 1970–1980 period. Nonhired labor-dependent, family-operated farming (smaller and larger family farming) has relatively similar cross-regional effects on rural poverty. The effects of industrialized farming are more spatially variant, suggesting that this type of farming is integrated into regional political economies in different ways than are simple commodity units. However, farming patterns have only a small effect on rural poverty relative to other factors, such as the local employment structure, characteristics of the population, and geographic location. The results of this study highlight the need to move beyond the farm sector to understand both the dynamics of this sector and the socioeconomic consequences of rural restructuring. More broadly, the study underscores the importance of testing general sociological relationships under different spatial (e.g., regional) contexts.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Scheduling Updates of Probabilistic Risk Assessments: The Arkansas Nuclear One-Unit 1 Experience

This paper presents the results of a study that identified how often a probabilistic risk assessment (PRA)should be updated to accommodate the changes that take place at nuclear power plants. Based on a 7-year analysis of design and procedural changes at one plant, we consider 5 years to be the maximum interval for updating PRAs. This conclusion is preliminary because it is based on the review of changes that occurred at a single plant, and it addresses only PRAs that involve a Level 1 analysis (i.e., a PRA including calculation of core damage frequency only). Nevertheless, this conclusion indicates that maintaining a useful PRA requires periodic updating efforts. However, the need for this periodic update stems only partly from the number of changes that can be expected to take place at nuclear power plants–changes that individually have only a moderate to minor impact on the PRA, but whose combined impact is substantial and necessitates a PRA update. Additionally, a comparison of two generations of PRAs performed about 5 years apart indicates that PRAs must be periodically updated to reflect the evolution of PRA methods. The most desirable updating interval depends on these two technical considerations as well as the cost of updating the PRA. (Cost considerations, however, were beyond the scope of this study.)     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

Robustness of testing the equality of two slopes in simple linear structural relationships

The usual test of the equality of two slopes in a simple structural relation-ship is the test formed from the normal approximation using the Fisher information matrix, assuming two explanatory variables are independent. This paper examines the robustness if the explanatory variables are, in fact, dependent. A more efficient estimator is derived for a matched pair situation.     

Comparison of three estimators of the number of species

We consider estimation of the number of cells in a multinomial distribution. This is one version of the species problem: there are many applications, such as the estimation of the number of unobserved species of animals; estimation of vocabulary size, etc. We describe the results of a simulation comparison of three principal frequent-ist' procedures for estimating the number of cells (or species). The first procedure postulates a functional form for the cell probabilities; the second procedure approxi mates the distribution of the probabilities by a parametric probability density function; and the third procedure is based on an estimate of the sample coverage, i.e. the sum of the probabilities of the observed cells. Among the procedures studied, we find that the third (non-parametric) method is globally preferable; the second (functional parametric) method cannot be recommended; and that, when based on the inverse Gaussian density, the first method is competitive in some cases with the third method. We also discuss Sichel's recent generalized inverse Gaussian-based procedure which, with some refine ment, promises to perform at least as well as the non-parametric method in all cases.     

Benefits of preventive dentistry in children: Cost factors and public policy

Dental caries in children is now recognized as a preventable disease. The use of fluoride and sealants has produced a major reduction in caries prevalence among school aged children in the United States and other countries. A portion of the child population who are educationally and socioeconomically disadvantaged are not fully receiving these benefits. Public policy, insurance and medicaid groups must be made aware of these preventative measures and strategies developed to implement them.