Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

Professional stances and personal values in the realm of transnational family reunification with older parents: social work practice in an emerging field

National rules for family reunification take place in an increasingly transnational context. Social workers in Switzerland, whether they work in services for migrants or for elders, are confronted with requests for transnational family reunification with older parents. Such requests, while relatively rare, elicit responses which must be viewed as largely founded on professionals' values and norms regarding the care of elders, family cohabitation, the influence of cultural factors, and examined against a backdrop of increasing suspicion of motives for migration—especially in fields where migration issues have not been at the forefront of professional debate and practice. The militant stance of some services for migrants can thus be contrasted with the relative inexperience of professionals active in social services for elders, who rarely encounter recent migrants. The latter are more likely to reflect their own private—and unexamined—views when advising clients in a field characterised by complexity and instability. The authors interviewed social workers and families in two Swiss cantons. Their results point to ways in which distinct professional cultures could enrich each other and provide social workers with tools to critically analyse their own practice in a very difficult field, the contours of which remain largely unexplored.     

The Continuum of Care System

Abstract

The Continuum of Care System is a Decision Support System designed to assist social workers responsible for identifying and selecting alternative living arrangements for children unable to remain in their own families. The Continuum of Care System consists of two software packages called MATCH and PROFILE. MATCH produces a rank-ordered list of prospective placement alternatives by statistically comparing an individual child to groups of children previously admitted into different residential facilities. PROFILE summarizes the characteristics and problems of children at each facility in the system.     

Interdisciplinary Practice in Developmental Disabilities

ABSTRACT

This article explores the development of interdisciplinary team practice within the field of development disabilities. Various interdisciplinary models are described, and the role of the social worker is specifically reviewed. As social workers practice as members of teams in a variety of contexts, a greater understanding of an interdisciplinary approach is warranted.     

Coming Out as “We 3”

Abstract

Using an academic letter format, I use a blended-method-ological approach of personal ethnography and qualitative case study to assess the three-partner, gay male relationship and the role of parental support. In working to understand better the relational “We 3,” I first provide an account of my relational experience with two other men. I discuss the process of our coming together and then make a methodological turn to provide insights from both e-mail and face-to-face interviews with one set of parents who have supported their gay son in his three-partner relationship. As I, personally, have not had an in-depth conversation with my own parents regarding this issue, I use the parental case study to bridge an academic conversation regarding the negotiation of what might be termed a second or relational coming out process with parents. Finally, I discuss how insights from the first, personal coming out process provided the parents with tools to keep the conversation going and to support their son's relational coming out as a “We 3.”     

Effects of Work Incentive Policies and Determinants of the Socioeconomic Status of Welfare Leavers in an Economically Disadvantaged Area

Abstract

This study explores how work incentive policies influence the socioeconomic status of welfare leavers. Logistic and ordinal regression methods were used to analyze 1999 statewide survey data on West Virginia WORKS leavers. This study found that people who had more months of eligibility remaining for TANF were more likely to have jobs than those with fewer months of eligibility. People who had been sanctioned for noncompliance with work requirementswere less likely to have jobs than those who had not been sanctioned. However, childcare assistance had a significant influence on the employment of welfare leavers. EITC was significantly associated with the expectation of high economic status. Policy implications are discussed.     

工业遗存地段再开发思路转变路径探讨

通过归纳我国工业地段与城市的演进规律,提出工业遗存地段应回归城市空间。基于此论点,针对再开发中出现的地段发展边缘化及工业文化特色的失忆的问题进行深入分析,提出当前时代背景下的工业遗存地段再开发的思路转变路径,以期为工业遗存地段再开发提供参考借鉴。     

Gay and Bisexual Men’s Experiences Using Self-Testing Kits for HIV and Rectal and Urethral Bacterial Sexually Transmitted Infections: Lessons Learned from a Study With Home-Based Testing

Abstract

Objectives: This study investigated the experiences of gay, bisexual, and other men who have sex with men (GBM) conducting HIV and sexually transmitted infection (STI) self-testing procedures. Methods: We analyzed mixed-methods data from 11 GBM who self-tested HIV-positive and 1,070 HIV-negative GBM who completed the HIV self-testing and STI self-sampling procedures. Results: Nearly all (99%) reported ease in urine-based STI self-sampling and most (90%) found rectal swab self-collection easy. Most (94%) checked their rapid-HIV self-testing results during the correct window (20-40 minutes), and nearly all (99%) trusted their HIV results. Conclusions: Recommendations for future self-testing procedures are provided based on findings from free-response data.     

Predictors of HIV Sexual Risk Behavior Among Men Who Have Sex with Men,Men Who Have Sex with Men and Women,and Transgender Women

ABSTRACT

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.     

Multiple comparisons of exponential location parameters with a control based on doubly censored sample under heteroscedasticity

In this article, a one-sample procedure for multiple comparisons of exponential location parameters with a control under heteroscedasticity is proposed. The observations are obtained by doubly censored samples. A one-sided and two-sided confidence intervals are used to perform such multiple comparisons. Statistical tables of critical values and an example of comparing four drugs in treating leukemia are provided.