The mandate for investigational cancer therapies

The heated national health care reform debate of the summer of 1993 has now simmered down, but pieces of the debate are still percolating along at the state level. Within the past year, numerous states have introduced bills that would mandate insurance coverage for investigational cancer therapies--in particular high-dose chemotherapy and bone marrow transplant for breast cancer. The problem with these initiatives, well-intended though they may be, is that they threaten to spread unproven technologies at a rapid rate and at the same time miss the opportunity to collect data that would prove the safety and effectiveness of the methods. The author explores these issues and suggests how managed care companies can play a more aggressive role in parrying the threat.     

Lifestyle Options and Economic Strategies: Subsistence Activities in the Mississippi Delta1

Abstract "Subsistence" and "informal economy" are contrasted in their utility as sociological concepts and their ability to explain a variety of activities in two rural Mississippi Delta communities. Literature on subsistence stresses that the desired outcome of participation is not an increase in income but the social rewards of participation itself. Two underlying dimensions of participation in these activities are documented through the literature and through a confirmatory factor analysis of empirical data: life-style choice and economic strategy. These were constructed into indexes and examined individually and in combination as dependent variables using regressors at the community, household, and individual levels. Community ties were weakly associated with participation in such activities. Whites and those with higher incomes participated more in lifestyle choice oriented activities. Participation in general was statistically related to households needing less weekly income and being of larger size. Potential connections with persistent rural poverty are discussed.     

Evaluating community initiatives

The increasing emphasis on using research evidence as a basis for policy and practice change has led the Joseph Rowntree Foundation to consider better methods of evaluation. A theories of change approach has been found to be particularly valuable.     

Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

Can a Click be a Word?: Infants' Learning of Non‐Native Words

Forms that are nonlinguistic markers in one language (i.e., “tsk‐tsk” in English) may be part of the phoneme inventory—and hence part of words—in another language. In the current paper, we demonstrate that infants' ability to learn words containing unfamiliar language sounds is influenced by the age and vocabulary size of the infant learner, as well as by cues to the speaker's referential intent. When referential cues were available, infants at 14 months learned words with non‐native speech sounds, but at 20 months only those infants with smaller vocabularies succeeded. When no referential cues were present, infants at both 14 and 20 months failed to learn the same words. The implications of the relation between linguistic sophistication and non‐native word learning are discussed.     

Beyond Contact? Policy approaches to work with families of looked after children in four European countries

In England, placement within the looked after system is not viewed as a desirable long‐term solution for most children, and policy has prioritised continued contact with parents, and swift return home, wherever possible. This review examines policy approaches to work with families of looked after children in England and in three other European countries: Denmark, France and the Netherlands, aiming to identify areas for shared learning in relation to this challenging area of policy and practice. The research highlights relationships between care populations and policy understandings of the purpose of work with families, including understandings of children's and/or parents’ rights.