Non-attendance for health care: When rational beliefs collide

Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests ‘positive choices’ for such non‐attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's ‘cognitivist theory of action’ is used to conceptualise non‐attendance as both a rational and irrational choice, from different perspectives. Because the perspective of non‐attendees has been marginalised, the paper also suggests a typology of instrumental and non‐instrumental ‘strong reasons’ for rational non‐attendance. This may help groups such as professionals to understand and accept that non‐attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non‐attendees is needed to show respect for non‐attendees' moral agency and to begin to repair relationships with these individuals, who may seek help from health professionals in the future.     

Multiple Public Service Performance Indicators: Toward an Integrated Statistical Approach

Public service organizations usually produce multiple outputs,measured on different scales, giving rise to a suite of performanceindicators. The traditional approach to statistical analysisof organizational performance has been to develop a separateregression model for each performance indicator. This piecemealapproach, the article argues, may discard valuable information,as it ignores potentially important relationships between individualperformance measures. We therefore propose modeling an organization'sperformance measures simultaneously, using the methods of seeminglyunrelated regressions. The approach implicitly introduces alatent organizational variable into the regressions and maytherefore economize on the need to assemble explicit measuresof organizational characteristics. The method is illustratedusing an example from English public hospitals.     

Gambling in young adolescents

A questionnaire was used to investigate gambling in British adolescents. Responses from fifty 13- to 14-year-olds were analyzed. Gambling was found to be very pervasive (90% of subjects reported at least some gambling activity). Males gambled more than females, both in absolute terms and as a proportion of income. Income was found to have some influence on gambling behavior, but the effects of intelligence and social class were nonsignificant. Slot machines were the commonest form of gambling in both sexes.The willing cooperation of the teacher and students concerned is gratefully acknowledged. This paper is based on a report submitted by the first author in partial fulfillment of the requirements for the BSc degree at the University of Exeter. Some of the data were presented to the conference of the British Psychological Society Developmental Section, held in Exeter in September 1986, and to the colloquium of the International Association for Research in Economic Psychology, held at Aarhus, Denmark, in September 1987.     

From child rescue to family protection: The evolution of the child protective movement in the United States

The child protective movement, an offshoot of animal protective work, initially adopted a punitive, law enforcement emphasis. Under the leadership of the Massachusetts Society for the Prevention of Cruelty to Children, anti-cruelty work took on a broader focus based on prevention rather than punishment. The new approach stressed the need to maintain and enrich family life through broad social supports, relying on family casework and social reform. “Normal family life,” a vaguely denned but firmly middle-class notion, was established as the ideal to which social agencies should subscribe in their drive to protect children and insure an orderly society. Child protection, formerly isolated from the child welfare movement, gradually became a part of it.     

Personnel policies and the age structure of an occupation: the case of the academic labor market

Population projection techniques are used to project the size and age structure of the academic labor force. Age specific coverage data from Teachers Insurance and Annuity Association are used to proxy academic employment. Hiring, quit, retirement and death rates are calculated for 1981 and 1982. Projections of the future academic labor force are made holding these rates constant. The results show the importance of these entry and exit rates and also indicate how these rates can fluctuate from year to year.Estimates of the future demand for teachers are used to determine a target rate of growth of the academic labor force. Alternative personnel policies are incorporated into the projections. This analysis indicates that the personnel policies chosen to meet the desired labor force size have substantially different effects on the age structure of the labor force.The authors wish to acknowledge the cooperation of the Teachers Insurance and Annuity Association in providing the data used in this study and specifically Francis King for his assistance and encouragement. Helpful comments on this paper were provided by John Dutton, Ronald Schrimper, Jack Wilson, and Bryan Boulier.     

Community: Toward an integration of research,theory, evaluation,and public policy considerations

This article presents a paradigm for the analysis of communities and investments designed to improve them. Its fundamental objective is to provide the researcher, the theoretician, the evaluator, and the public policymaker with a common analytic framework. Direct and indirect effects of investment programs (e.g., in education, economic development, and health) can be documented longitudinally, and the community analyzed as an independent, dependent or mediating variable. The roots of this approach in social science and policy theory are explored. Five concepts (Status, Change, Interaction, Duality of Interaction and Change, and Viability) are incorporated. Community is operationally defined to include fifteen sectors whose interactions and changes can be studied systematically over time. This approach can help to clarify how a community, its people, culture, and institutions, and the outside world both influence and are influenced by investment programs.     

Looking Forward Not Looking Back: The Evaluation of Community Living

This article outlines the development of evaluative methods within the field of mental handicap services. It suggests that evaluators have too often taken for granted the tacit assumptions underlying service models, using these to determine the criteria for evaluating success. It argues that evaluators should be more explicit about the values they adopt, and what patterns of life services should be enabling people to achieve. By more closely linking evaluation criteria to what people with a mental handicap should achieve, evaluation can become more effective in promoting positive change in service models. The article describes an approach developed by the authors for the evaluation of the 'All-Wales Strategy for the Development of Services for Mentally Handicapped People'.     

Parallel process and the forced termination of a milieu group

Parallel process has been observed in the social work and psychiatric literature as an element in the psychodynamics of individual treatment and supervisory relationships. This paper suggests that it is present during group treatment as well and examines its emergence during the termination phase of a milieu group. A review of the literature on both parallel process and termination with groups is presented. It is noted that the conditions necessary for the emergence of parallel process are exactly those found during the termination period of group treatment. Clinical illustrations from the forced termination of a milieu group are presented, documenting a variety of parallel processes which were observed. The dynamics of these processes are examined. Potential indicators of parallel process are discussed, as well as implications for both treatment and supervision.