Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.     

Need,well‐being and outcomes: the development of policy‐thinking for children's services 1989–2004

This paper describes how government policy thinking about the well‐being of children and young people developed between the Children Act 1989 and the Children Act 2004. These two Acts are milestone statements about how services to children in England and Wales should be delivered. It is an account informed by the author's own experience as a government adviser on children's social care over much of this period and supporting documentation. It traces the strands of government policy thinking about how to deliver services for children from children in need to the articulation of the five Every Child Matters outcomes. It argues that attempts to achieve coordinated service planning for children and young people played a significant role in the formulation of shared objectives and the articulation of child outcomes. However, it argues that looking at real outcomes exposes how children in the UK do relatively badly compared with other rich nations. It questions whether we can realistically expect our services to deliver significantly improved outcomes given the impact of enduring inequality in our society. This paper is dedicated to the memory of David Lambert CBE, former Assistant Chief Inspector of the Social Services Inspectorate in London, who died suddenly on 7 October 2010. He lent me articles to assist me in writing this paper.     

Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

Chronic Child Abuse: The Characteristics and Careers of Children Caught in the Child Protection System

The introduction of the Quality Protects initiative in Englandand the focus on performance management has challenged socialservices departments to examine the systems, processes and outcomesfor children who have their name on a child protection register.Research indicates that approximately one-quarter of the situationsin which children are registered could be described as chronic—thatis, they remain on the child protection register for significantperiods of time, experience more than one period of registrationor suffer a further incident of significant harm whilst subjectto a child protection plan. In this article, the findings froma research study conducted into this group of vulnerable childrenare reported, focusing on the characteristics of the childrenand their families, and their careers in the child protectionsystem. The paper concludes with observations about the weakconceptualization of performance management and the need torecognize the complexity of the factors that influence children’scareers in the child protection system.     

Classroom sex composition and first-grade school outcomes: The role of classroom behavior

Using nationally representative data from the Early Childhood Longitudinal Study-Kindergarten Cohort (N = 21,409; 10,452 girls and 10,957 boys; mean age = 7.24 years), the association between first-grade classroom sex composition (CSC), measured as the percentage of female students, and end of the year academic (reading, mathematics) and socio-emotional (externalizing problems, internalizing problems, self-control, interpersonal skills) outcomes was examined. Using multilevel modeling techniques and controlling for prior achievement levels, CSC was positively associated with children’s reading achievement at the end of first grade; students performed better in reading in classes with a higher percentage of female students. CSC was also associated with three of the socio-emotional outcomes; controlling for prior levels, students in classrooms with a higher percentage of girls had better self-control and interpersonal skills and fewer internalizing problems. Classroom behavior mediated the effects of CSC on reading achievement and the socio-emotional outcomes. Implications for the composition of first-grade classrooms are discussed.     

Reconciliation with the Utility of Chance by Elaborated Outcomes Destroys the Axiomatic Basis of Expected Utility Theory

Expected utility theory does not directly deal with the utility of chance. It has been suggested in the literature (Samuelson, 1952, Markowitz, 1959) that this can be remedied by an approach which explicitly models the emotional consequences which give rise to the utility of chance. We refer to this as the elaborated outcomes approach. It is argued that the elaborated outcomes approach destroys the possibility of deriving a representation theorem based on the usual axioms of expected utility theory. This is shown with the help of an example due to Markowitz. It turns out that the space of conceivable lotteries over elaborated outcomes is too narrow to permit the application of the axioms. Moreover it is shown that a representation theorem does not hold for the example.     

Secondary school dropout and work outcomes in ten developing countries

This paper analyzes the impact of secondary school dropout on the work outcomes of young people in ten developing countries. Understanding such a phenomenon is important because it may affect work prospects, exacerbate income inequality and determine macroeconomic lasting effects given that the formation of a skilled workforce is a key element of economic development and growth.When accounting for endogeneity, we find that secondary school dropout decreases the probability of being employed in non-elementary occupations, suggesting that unskilled workers fail to meet the increasing demand for a skilled workforce. Secondary school dropout, indeed, hinders the accumulation of adequate levels of human capital and anticipates entry into the unskilled labor market.Thus, policy-makers should aim at the extension and efficacy of compulsory education to the secondary level to avoid future under-education problems to promote a skilled workforce and encourage economic development and growth in the long run.     

Stakeholder perceptions of contextual factors related to PBIS implementation in high need schools

Positive behavior intervention and supports (PBIS) is a thoroughly researched three-tiered framework for preventing and treating challenging behavior in schools. While more than 20 years of research contribute to the literature base, less is known about PBIS implementation in high-needs school settings, particularly those that serve students predominantly from low-income families and majority minority student populations across urban and rural districts. This study investigated the critical contextual factors of PBIS implementation from the stakeholder perspective. Specifically, we surveyed 161 participants including teachers, school staff members, and administrators who were PBIS team members and had received technical assistance in PBIS implementation. The completed surveys were analyzed with participants and their schools coded for district type, Title I funding, and position in order to determine how the perceptions of issues such as buy-in, administrator support, PBIS in secondary school settings, and poverty affect PBIS implementation and team needs. The factor analysis and resulting structure along with statistically significant results for each factor are presented along with implications.     

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Black gay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their White male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV-related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of young Black men who have sex with men (YBMSM) on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16 to 29. Cross-sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing, and health promotion behaviors. Closeness with the gay community was associated with greater pre-exposure prophylaxis (PrEP) knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.