Building a vertical provider system

There is probably no geographic area in the United States in which the health care environment is more turbulent than that of Southern California. Long before President Clinton's proposals began serious national debate on health care reform, a massive provider-driven realignment of the system was occurring in that region of the country. Multispecialty medical groups have generally led the way and have acquired ever larger managed care populations through merger and acquisition of other groups and practices. Hospitals, hampered by large fixed capital bases, have struggled to reinvent themselves as cost-effective and primary care-friendly environments in order to be attractive to managed care physicians. Almost ignored in this reconfiguration has been the university teaching hospital. This article discusses one attempt to reconcile contractually an integrated, capitated, and managed care-oriented health care system with an academic medical center in a strategic alliance.     

Belief in Public Efficacy, Trust, and Attitudes Toward Modern Genetic Science

Government and policymakers want to engage the public in a dialogue about the conduct and consequences of science and increasingly seek to actively involve citizens in decision-making processes. Implicit in this thinking is that greater transparency and public inclusion will help dispel fears associated with new scientific advancements, foster greater public trust in those accountable, and ultimately increase the acceptability of new technologies. Less understood, however, are public perceptions about such high-level involvement in science and how these map onto public trust and attitudes within a diverse population. This article uses the concept of public efficacy -- the extent to which people believe that the public might be able to affect the course of decision making -- to explore differences in trust, attentiveness, and attitudes toward modern genetic science. Using nationally representative data from the 2003 British Social Attitudes Survey, we begin by examining the characteristics of those who have a positive belief about public involvement in this area of scientific inquiry. We then focus on how this belief maps on to indicators of public trust in key stakeholder groups, including the government and genetic scientists. Finally, we consider the relationship between public efficacy and trust and attitudes toward different applications of genetic technology. Our findings run contrary to assumptions that public involvement in science will foster greater trust and lead to a climate of greater acceptance for genetic technology. A belief in public efficacy does not uniformly equate with more trusting attitudes toward stakeholders but is associated with less trust in government rules. Whereas trust is positively correlated with more permissive attitudes about technologies such as cloning and gene therapy, people who believe in high-level public involvement are less likely to think that these technologies should be allowed than those who do not.     

Do Intentional Efforts to Improve Boards Really Work? The Views of Nonprofit CEOs

Commentators on the effectiveness of nonprofit boards of directors usually find them wanting in a number of ways and urge that they reform themselves. A study to ascertain how many boards actually accept this advice and intentionally attempt to change the way they operate also examines what changes boards attempt to make, what provokes their efforts, and what outcomes result.     

Response distortion in adolescents who smoke: a pilot study

A wide range of data are obtained with self-report. Information obtained from persons using substances is generally reliable and valid, however, many studies show that some proportion of self-reports regarding substance use are inaccurate. This study examines self-reported response distortion in adolescents who received a brief intervention to reduce their smoking. Findings indicate that age and ethnicity of respondent may influence reported response distortion. Factors that appear to influence under- and over-reporting include social desirability and fear of repercussion. Response distortion does not appear to affect rated usefulness of the intervention, nor does intervention type appear to influence whether respondents thought the researcher wanted them to report less use. Results point to the need for further research regarding adolescents and response distortion.     

Nonprofits accommodate the information demands of public and private funders

In the absence of performance reporting standards, nonprofit organizations face difficulties in accommodating the varied and changing informational requirements of public and private funders. Clients, volunteers, management, and staff also use and demand performance information. The authors studied four human services organizations in Victoria, British Columbia, Canada, and their performance reporting across the management cycle, from planning through implementation and monitoring, to external reporting and auditing. The authors analyzed documentary evidence and conducted interviews with users of performance information. they conclude this article by proposing a set of general standards nonprofit organizations can use in performance reporting.     

Risk Perception and Experience: Hazard Personality Profiles and Individual Differences

The dominance of the "psychometric" paradigm and the consequent emphasis on personality profiles of hazards has resulted in little attention being given to individual variability in risk judgments. This study examines how far differences in experience of risk activities can explain individual variability in risk assessments. A questionnaire study (n = 172) was used to explore the relationships between experience and risk perceptions in relation to 16 risk activities. It was expected that these relationships would differ for voluntary and involuntary activities. Measures of experience included assessments of "impact" and "outcome" valence as well as "frequency." These three aspects of experience each related to risk assessment but their relationship depended on whether the risk experiences were voluntary or not. The results indicate the importance of developing more fine-grained ways of indexing risk experience.     

Beginning Practice in Child Protection: A Blended Learning Approach

Statutory child protection is arguably one of the most complex and challenging areas of work within the welfare sector. In the state of Victoria, Australia, the child protection service is delivered by a state government department, the Department of Human Services, employing over 900 staff. A significant proportion of its recruitment is achieved through employing new graduates from a diverse educational base (e.g. social work, psychology and welfare). This convergence of circumstances, inexperienced workers with a variety of professional education backgrounds, beginning work in a complex, highly scrutinised professional domain, creates a unique challenge for in‐service educators responsible for induction. The ‘Beginning Practice in Child Protection’ programme is an attempt to meet this challenge, employing multi‐modal learning resources, interactive skills based clinics combined with workplace learning opportunities structured to deliver just‐in‐time messages. In addition, on‐line ‘virtual vignettes’ that support learning at the employee workstation are utilised. Evaluation findings suggest this programme is successful in achieving its aims of a supported introduction to the work, increasing worker confidence and satisfaction while leading to quality knowledge and skills acquisition. This paper will establish the context for child protection practice in Victoria, describe the programme designed to address the need, before highlighting key messages arising from an independent evaluation.