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.     

Coercive controlling behaviors in intimate partner violence in male same-sex relationships:A mixed-methods study

Using mixed methods, we explored the role of coercive controlling behaviors in a high-risk sample of 126 men in violent same-sex relationships. Contrary to a prediction that separate factors of physical violence and coercive control might emerge, a simple principle components analysis supported that male same-sex relationship intimate partner violence (IPV) is essentially unidimensional. Qualitative narratives supported a single latent factor solution of violence, and that coercive controlling behaviors better detect IPV dynamics within the same violent encounters (i.e., weapon use), even when compared to profiles defined by physical violence. Narratives also highlighted gender-different tactics of coercion used, underscoring importance of context-based assessments.     

Assessing dust exposure in an integrated iron and steel manufacturing plant in South India

A study to monitor and estimate respirable particulate matter (RPM), toxic trace metal concentrations in the work environment was carried out in different sections of an integrated steel manufacturing industry. The average RPM concentration observed varied according to the section blast furnace was 2.41 mg/m;{3}; energy optimization furnace, 1.87 mg/m;{3}; sintering plant, 0.98 mg/m;{3}; continuous casting machine, 1.93 mg/m;{3}. The average trace metal concentration estimated from the RPM samples like iron, manganese, lead and chromium did not exceed ACGIH prescribed levels.     

Object-oriented design of a distributed agent-based framework for e-Procurement

Procurement is an important function in any manufacturing organization and it also has strategic business value attached to it. Hence, any improvements in the process would result in tremendous benefits. E-Procurement exploits the Internet and agent technologies to conduct procurement-related processes. In this paper, we design and develop a software agent-based framework for a typical e-Procurement process by decomposing it into three business processes: e-Negotiations, reverse auctions and e-Settlement. The artefacts of the system for each of the three business processes have been designed and developed using Unified Modeling Language (UML). A prototype of one of the processes, viz. reverse auction, has also been implemented.     

3D object recognition: Representation and matching

Three-dimensional object recognition entails a number of fundamental problems in computer vision: representation of a 3D object, identification of the object from its image, estimation of its position and orientation, and registration of multiple views of the object for automatic model construction. This paper surveys three of those topics, namely representation, matching, and pose estimation. It also presents an overview of the free-form surface matching problem, and describes COSMOS, our framework for representing and recognizing free-form objects. The COSMOS system recognizes arbitrarily curved 3D rigid objects from a single view using dense surface data. We present both the theoretical aspects and the experimental results of a prototype recognition system based on COSMOS.     

Children's facial and gestural decoding and encoding: Relations between skills and with popularity

This study examined preschool children's decoding and encoding of facial emotions and gestures, interrelationships between these skills, and the relationship between these skills and children's popularity. Subjects were 34 preschoolers (eighteen 4-year-olds, sixteen 5-year-olds), with an equal number of boys and girls. Children's nonverbal skill was measured on four tasks: decoding emotions, decoding gestures, encoding facial emotions, and encoding gestures. Children's popularity was measured by teacher ratings. Analyses revealed the following major findings: (a) There were no age or gender effects on performance on any of the tasks. (b) Children performed better on decoding than encoding tasks, suggesting that nonverbal comprehension precedes production. Also, children appeared better at facial emotion skills than gesture skills. There were significant correlations between decoding and encoding gestures, and between encoding gestures and encoding emotions. (c) Multiple regression analyses indicated that encoding emotions and decoding gestures were marginally predictive of popularity. In addition, when children's scores on the four tasks were combined via z-score transformations, children's aggregate nonverbal skill correlated significantly with peer popularity.Portions of this paper were presented at the meeting of the American Psychological Society, San Diego, CA, June, 1992. We thank the Child Study Center of Wellesley College, Janine Jarrell, Jennifer Mascola, and David Mills for their cooperation, and Carlene Nelson, Mark Runco, and Ed Stearns for statistical support. We also appreciate the valuable suggestions from Robin Akert, Annick Mansfield, the anonymous reviewers, and especially the guest editor.     

Optimal composite scores for longitudinal clinical trials under the linear mixed effects model

Clinical trials of chronic, progressive conditions use rate of change on continuous measures as the primary outcome measure, with slowing of progression on the measure as evidence of clinical efficacy. For clinical trials with a single prespecified primary endpoint, it is important to choose an endpoint with the best signal‐to‐noise properties to optimize statistical power to detect a treatment effect. Composite endpoints composed of a linear weighted average of candidate outcome measures have also been proposed. Composites constructed as simple sums or averages of component tests, as well as composites constructed using weights derived from more sophisticated approaches, can be suboptimal, in some cases performing worse than individual outcome measures. We extend recent research on the construction of efficient linearly weighted composites by establishing the often overlooked connection between trial design and composite performance under linear mixed effects model assumptions and derive a formula for calculating composites that are optimal for longitudinal clinical trials of known, arbitrary design. Using data from a completed trial, we provide example calculations showing that the optimally weighted linear combination of scales can improve the efficiency of trials by almost 20% compared with the most efficient of the individual component scales. Additional simulations and analytical results demonstrate the potential losses in efficiency that can result from alternative published approaches to composite construction and explore the impact of weight estimation on composite performance. Copyright © 2016. The Authors. Pharmaceutical Statistics Published by John Wiley & Sons Ltd.     

The relationship of work stressors, coping and social support to psychological symptoms among female secretarial employees

A conceptual framework is advanced that assumes that psychological symptoms emerge within multiple contexts, such as the workplace, and are influenced by the interplay of individual and situational risk and protective factors over time. This framework was utilized to examine the impact of work and work-family role stressors, coping, and work-related social support on psychological symptoms among 239 female, secretarial employees in the USA, using both cross-sectional and longitudinal structural equation models. Work stressors and avoidance coping were viewed as risk factors, and active coping and social support as protective factors. Work stressors contributed substantially to increased symptoms, primarily through a direct pathway in the cross-sectional model, but also indirectly to both Time 1 and Time 2 symptoms (4 months later) via pathways through active and avoidance coping. In both models, avoidance coping also predicted increased symptoms. Avoidance coping also served to partially mediate the relationship between work stressors and symptoms in the cross-sectional model, but not in the longitudinal model. Active coping was related to fewer psychological symptoms in both models, thereby reducing the negative effect of work stressors on symptoms. Likewise, work-related social support served an indirect protective function by contributing to lower levels of reported work stressors and greater use of active coping. Work stressors but not active coping mediated the relationship between social support and symptoms. Implications for future research and workplace interventions are discussed.     

Effects of Placement Changes on Health Insurance Stability Among a National Sample of Children in the Child Welfare System

ABSTRACT

Children in the child welfare system have entitlements to health insurance coverage—critical because of their considerable physical and mental health needs—based largely on their placement status. This study conducted path and transitions analyses on data from the National Survey of Child and Adolescent Well-Being (3,801 children followed-up for 3 years) to examine the interplay between placement changes and insurance stability. Children maintained in-home at Wave 1 had significantly lower odds of being insured (OR = 0.7); children transitioning from out-of-home placement to in-home care had significantly lower odds of maintaining insurance coverage (OR = 0.6). Child welfare workers working with children maintained in-home and those being reunified should safeguard the children's insurance status. Policy makers should consider extension of categorical eligibility to all children presenting to child welfare agencies in order to assure access to needed services for these vulnerable children.