When is a Health Department not a Health Department? The Case of the US Department of Health and Human Services

Given the current policy debate over health reform in the United States, it is not possible to describe the organizational structure that might emerge from this process. This article explores five of the attributes that underpin the context for a discussion of the structure and operation of a health bureaucracy in the USA. First, ambivalence in the US society about a public commitment to health and a general scepticism about a significant public sector in this area. Second, separation within the system between types of activities (e.g. health research activities, provision of services, and financing of health efforts). Third, the health system operates in the context of a government with shared powers as well as federalism and an assumption that some issues belong to states, and sometimes localities, and not to the federal government. Fourth, difficulty in the US system when it attempts to focus on prevention activities. And fifth, the structure of HHS creates tensions between management initiatives and professional expertise and standards. The article concludes with a discussion of possible organizational alternatives.     

On the Complex Definition of Risk: A Systems-Based Approach

The premise of this article is that risk to a system, as well as its vulnerability and resilience, can be understood, defined, and quantified most effectively through a systems-based philosophical and methodological approach, and by recognizing the central role of the system states in this process. A universally agreed-upon definition of risk has been difficult to develop; one reason is that the concept is multidimensional and nuanced. It requires an understanding that risk to a system is inherently and fundamentally a function of the initiating event, the states of the system and of its environment, and the time frame. In defining risk, this article posits that: (a) the performance capabilities of a system are a function of its state vector; (b) a system's vulnerability and resilience vectors are each a function of the input (e.g., initiating event), its time of occurrence, and the states of the system; (c) the consequences are a function of the specificity and time of the event, the vector of the states, the vulnerability, and the resilience of the system; (d) the states of a system are time-dependent and commonly fraught with variability uncertainties and knowledge uncertainties; and (e) risk is a measure of the probability and severity of consequences. The above implies that modeling must evaluate consequences for each risk scenario as functions of the threat (initiating event), the vulnerability and resilience of the system, and the time of the event. This fundamentally complex modeling and analysis process cannot be performed correctly and effectively without relying on the states of the system being studied.     

使用优势视角培养案主的抗逆力 — 一种社会工作实务的新模式

本文主要讨论了在实务社会工作领域中运用优势视角去发现和评估案主的抗逆力的可能性和基本技术,其中涉及案主无处不在的优势、抗逆力的多重界定、优势视角的逆境观和抗逆力的展示,以及在运用优势视角评估案主的抗逆力的过程中如何准备问题激起案主对自己抗逆力的讲述,怎样对案主的回答做出反馈,如何记录案主的优势,帮助案主实现目标中需要坚持的生态原则,最后指出社会工作者运用这一新模式将有助于树立起自己与心理医生不同的职业形象,同时这一视角对于中国文化有着极大的适用性。因此在社会工作领域应该大力发展诸如"优势""抗逆力"这样的积极词汇,使之与现行的病态术语相抗衡,将社会工作引领到一个全新的方向。     

Linear and Nonlinear Valence Functions: A Behavioral Decision-Making Assessment

In Vroom's [45] original formulation of expectancy theory, the relationship between affect and perceived instrumentality was assumed to be linear. Others have suggested that such a relationship may be better modeled by a nonlinear, utility-type function [30]. The current research contrasts the predictive ability of two linear and four nonlinear functions. Using four levels of McClelland's [26] needs for achievement, affiliation, and power as instrumentalities, 101 subjects provided more than 12,900 decisions on the valences of jobs in a behavioral decision-making experiment. Nearly 40 percent of the subjects exhibited nonlinear valence functions. The results emphasize the need to specify the appropriate functional form of the valence component to enhance predictive accuracy and to prevent misspecification problems.     

Organizational identification and workplace behavior: More than meets the eye

Organizational identification is a theoretically profound and practically important construct. It fundamentally transforms the relationship between employees and their work organizations, because highly identified employees integrate their organizational memberships with their sense of who they are. This transformation enhances highly identified employees’ work performance and contributions to the organization. However, despite considerable research on the benefits of organizational identification for employee behavior, theorizing about this effect and its underlying mechanisms remains underdeveloped. In particular, there has not been sufficient theoretical development regarding the specific types of work behaviors that follow from organizational identification, the psychological mechanisms that underlie these behavioral consequences, or observers’ evaluations of these behaviors and those enacting them. To address these issues, we present a framework of the behavioral consequences of organizational identification as well as observers’ reactions to them. Our framework highlights two distinct motivational orientations that underlie organizational identification, one that reliably leads to conformist work behaviors and one that may lead to deviant work behaviors that violate the status quo to advance organizational interests. Moreover, our framework highlights that reactions to these behaviors will differ depending on the organization’s emphasis on means versus ends. Overall, we emphasize that the benefits of organizational identification for work behavior are not as straightforward or as widely recognized as implied in prior research.     

De novo Families: Lesbian Motherhood

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants’ experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant “lesbian mother” role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances.     

Worried,concerned and untroubled: antecedents and consequences of youth worry

Using a pattern‐based approach, worry was explored in relation to military youths' developmental and contextual characteristics, and pivotal outcomes (depressive symptoms, self‐efficacy, well‐being, coping styles, academic performance and deployment adjustment). Data were collected from parents and adolescents, age 11 to 18, living in the USA (n = 273 families). Variations in individual characteristics (age and gender), military family factors (rank, recent deployment, parents' resilient coping abilities) and family relational characteristics (parents' marital status, warm parenting, marital quality) were related to heterogeneous worry typologies. Depressive symptoms, self‐efficacy and well‐being, varied across the worry typologies. Implications are drawn from these findings for identifying potential interventions that can be accessed to modify these worry patterns and limit their harmful effects.     

Promoting quality parent–child visits: the power of the parent–foster parent relationship

Parent–child visits for children in foster care are often fraught with tension, particularly between foster parents and parents. Qualitative interviews with 42 social workers, foster parents and parents revealed more positive relations when foster parents recognized parent fears and shared power over parenting decisions with them. Social workers can support the process by clarifying visiting expectations and encouraging foster parents to reach out to parents.     

Fathers Facing Advanced Cancer: An Exploratory Study

Adults who are living with cancer while raising young children are faced with distinct challenges particularly when that cancer is advanced. While the literature examining parental cancer continues to grow, very little has focused on families facing advanced cancer and the father’s perspective is nearly absent. To address these gaps, grounded theory methods were used to study the experiences of 11 fathers living with advanced cancer while raising minor children. The participants were all married with between one and six children living in their household. Semistructured, in-person interviews revealed concerns for their children permeated the “ordeal” and these fathers described the ongoing challenge of “teeter-tottering between hope and despair.” The fathers used key protective strategies to counterbalance the weight of the barriers to achieve resilience throughout the cancer experience. Primary barriers were characterized as physical impairments, uncertainty, and financial strain. Fathers described relying on flexibility in their roles as fathers, open communication patterns, use of supportive resources, and the ability to find meaning in their experiences as crucial to fostering resilience. Recommendations include interdisciplinary family centered interventions that consider gendered parental roles as well as financial burden.     

An ecological systems approach to understanding social support in foster family resilience

Families who care for children in the foster care system often experience challenges related to the system, accessing services and supports, and managing relationships. Despite these challenges, many families thrive because of unique attributes and strengths that contribute to experiences of resilience. Using an ecological framework, this study examined social support among resilient foster families to better understand how foster caregivers experienced positive reciprocal transactions across systems. As part of a larger study, in‐depth narrative interviews were conducted to examine the process of resilience for families who foster. Findings revealed that families accessed and benefited from social support on micro‐level, meso‐level and macro‐level. Understanding how families cultivated social support across multiple levels offers implications for practice and policy when considering how best to retain and support families who care for vulnerable children.