Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

The Impact of Items and Anchors on Parent–Child Reports of Problem Behavior

Research has repeatedly demonstrated that parent and child reports of child behavior and emotional functioning often do not agree in terms of symptom severity or even symptom presence. Given the potential clinical impact that discrepant reports may have on the therapeutic process, a significant amount of research has addressed the factors influencing this observed discrepancy. Traditionally, this research has evaluated the impact of demographic factors on mean differences and obtained correlation coefficients between parent and child reports. The current research improves upon previous research in this area in two ways. First, the current research uses parent and child measures with identical rather than similar items as is commonly found in previous research. Second, the current research moves beyond identifying demographic influences on discrepant reports by explaining observed discrepancies in terms of differences in parent and child perceptions of typical child behavior.David Carlston and Benjamin Ogles are affiliated with Department of Psychology, Ohio University, Athens, USA.Funding for this project was provided by the Ohio Department of Mental Health.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

Can we remember differently? A case study of the new culture of memory in voluntary organisations

This article analyses the positive contribution that Slovenian voluntary, non–governmental organisations, users' organisations and community–based services in the field of mental health have made to the 'new culture of memory' of helpers and users. The conceptual differences between Slovenian psychiatric (institutional) treatment and voluntary community care are presented through the case study of Clare, a young woman who was diagnosed as a chronic schizophrenic. This example shows the importance of community care in voluntary organisations for the reduction of disability associated with mental disorders. The development of the new culture of memory in voluntary organisations and community–based services is not only the 'narrative turn' within social welfare, but also symbolises the 'implicit turn' in the relationship between the helper and the user. The real challenge of the new culture of memory in the process of help to disabled people (in respect of individuals working through traumatic memories) is that the helper can bear and support the user on a daily basis. During the process of their relationship, the deep implicit relational memories of both become activated and influence the change within the user as well as the helper.     

Child‐Care Usage and Mother‐Infant “Quality Time”

Mothers' time‐use patterns were compared in families in which infants spent more than 30 hours per week in child care (In‐Care group; n= 143) versus 0 hours per week (At‐Home group; n= 183) from birth to 6 months of age. In‐Care group mothers spent about 12 fewer hours per week interacting with their infants, for about 32% less time; fathers of these infants were more involved in caregiving. The groups did not differ in the quality of mother‐infant interaction. In the In‐Care group, quantity of interaction was related to greater separation anxiety and concerns about effects of maternal employment. Time‐use data were not related to child outcomes at 15 months of age. Results suggest that the effect of extensive time spent apart on the quantity and quality of mother‐infant interaction may be smaller than anticipated.     

The Boston Area Diary Study and the Moral Citizenship of Care

This paper describes the theoretical foundations, empirical findings, and practical and philosophical implications of the Boston Area Diary Study (BADS), a study of the caring behavior of 44 participants over one calendar year. In particular, the paper presents an identification theory of care and discusses how it shaped the conceptualization, collection, and analysis of the data in a year-long diary study of daily voluntary assistance. The findings from the BADS (1) theoretically confirm the identification theory of care; (2) methodologically capture how individuals perceive and carry out caring behavior as a unity; and (3rpar; empirically document the existence of a moral citizenship in America that is substantially more vigorous than is implied by the usual indicators of civic and political citizenship.     

民族自治地方农村养老问题与对策初探——以黔东南州锦屏县为例

民族自治地方农村养老工作与构建社会主义和谐社会、社会主义新农村建设、“三农”问题等紧密相关，养老工作能否解决好直接影响到农村的社会稳定、社会的和谐发展和“三农”问题的解决。民族自治地方农村经济相对落后、经济发展不平衡、人口分布不均衡、农村老年人口日益增多、农民工大量外出等现实，给传统养老方式带来了历史性的冲击。这要求建立具有时代特色和地方特色的养老方式。本文在进行充分的实地调查、分析黔东南苗族侗族自治州锦屏县农村现行的养老方式现状、养老方式存在问题的基础上，结合当地实际情况和借鉴其他地方的成功养老方式，提出具体可行的对策。     

Child Care “Packaging” Among TANF Recipients: Implications for Social Work

This article reports the results of a study that examined the ways in which current and recent TANF recipients assembled or “packaged” their child care arrangements among formal and informal providers. The findings are drawn from in-person, in-depth interviews with current and former welfare recipients. The study found that most of the respondents used multiple providers within the category of informal child care for reasons including availability, the use of a network of social acquaintances as a problem-solving resource, the need to accommodate irregular work hours, and personal trauma that contributed to a distrust of strangers in formal settings. The findings can affect the efficacy of practice with TANF recipients by contributing to social workers’ understanding of the context of decision-making regarding child care.     

Work/Care Regimes: Institutions,Culture and Behaviour and the Australian Case

Increasingly around the industrialized world, labour markets rely upon the paid work of women, many of whom have dependents. Such changing patterns of paid work by women — and by men — are located within work/care regimes that are more or less hostile to the needs of paid workers who care for others. This article sets out a model of work/care regimes and locates the Australian case within international and historical contexts. In Australia, the unchanging normative male worker archetype dominates institutions of work and care, while the cultures of motherhood and fatherhood remain stoically resistant to renovation. In the meantime, the behaviour of working women runs ahead of these unchanging cultures and institutions, creating a policy interest in ‘reconciling’ work and care, but a failure to provide it. The reasons for this failure are outlined.