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 Decline of Barriers to Immigrant Economic and Political Rights in the American States: 1977–20011

State governments exercise significant powers to regulate the economic and social activities of resident aliens. We review the laws of the six leading states of immigrant settlement regulating access of noncitizens to 23 occupations, updating existing studies from 1946–77. Citizenship requirements for these occupations have plummeted, a change we attribute to federal court decisions, advisory opinions of state attorneys general, and state legislative and administrative action. There are numerous additional citizenship requirements in the statutes of the six states, although these appear to be poorly enforced. The authority of states to regulate their political communities is the most important remaining constitutionally valid basis of citizenship requirements. States define their political community broadly, leading to questionable exclusions of noncitizens from important activities.     

What is good taste good for?

Bourdieu afflrme que le capital cultural est utile lorsque Ton veut obtenir une situation de classe supérieure, particuliérement dans certains secteurs, et n'est en fait qu'une seule chose: une culture de condition supérieure. Mais son argument, établit pour une France centralisée, est moins valable pour le Canada plus subdivisé. Cet article étudie les idées de Bourdieu sous tous leurs aspects pour un échantillon quota de Torontoniens. Les résultats suggèrent qu'un capital culturel de condition supérieure existe à Toronto, mais qu'il a peu d'effet sur les relations de classe au travail, ou le véritable capital culturel dirige la culture d'entreprise qui domine les entreprises privées. La culture d'entreprise est aussi repartie en classes et pourrait jouer un role dans la reproduction de classes qui est tres similaire a ce que Bourdieu revendique comme culture de condition supérieure.
Bourdieu argues that cultural capital is useful in gaining higher class location, especially in some sectors, and is essentially a single thing: high status culture. But his argument, developed for centralized France, is less suitable for more subdivided Canada. This paper explores Bourdieu's ideas through a quota sample of 40 Torontonians. Results suggest that high status cultural capital does exist in Toronto, but has little part in class relationships at work, where the true cultural capital is command of the business culture which dominates private enterprises. Business culture is also class stratified, and may play a role in class reproduction which is quite similar to that which Bourdieu asserts for high status culture.     

Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Books at JSTOR: An Interview with Bruce Heterick

In August 2012, Marilyn Geller interviewed Bruce Heterick, vice president at ITHAKA, which includes JSTOR and Portico. Heterick discusses the addition of e-books to the JSTOR platform (Books at JSTOR), the impact of e-books on academic library services, and the future of e-books in the realm of scholarly communications.     

Building Health Insurance Literacy: Evidence from the Smart Choice Health Insurance™ Program

With the passage of the Patient Protection and Affordable Care Act (ACA) of 2010, the health insurance literacy of Americans became a critical issue. In response, a consumer education program was created and tested by university researchers and educators associated with Cooperative Extension. This article draws extensively on the emerging literature on health insurance literacy and on data from participants in the Smart Choice Health Insurance? program. The intent of the study was to understand socio-demographic and environmental variables that predict initial health insurance literacy and gains in health insurance literacy. A standardized instrument measuring health insurance literacy was used to collect the data. Multivariate analysis showed higher income consumers demonstrated greater initial health insurance literacy scores compared to middle income consumers, whereas younger, male and lower educated consumers reported lower initial health insurance literacy. After participating in the Smart Choice Health Insurance? program, consumers who made greater gains in their health insurance literacy tended to be female, higher income, and consumers residing in states that showed supportiveness of the ACA. The findings highlight the importance of considering sociodemographic characteristics in program design and delivery, as well as how contextual issues, such as the political environment, might impact the delivery of educational efforts. Findings from the analyses help inform ways to adapt and tailor educational opportunities that focus on health insurance literacy for a range of consumers.     

A Quantitative Analysis of the Effects of Postsecondary Institution Conversions from Not-For-Profit to For-Profit

This study highlights the changes that have occurred at postsecondary institutions after conversion from not-for-profit to for-profit control. Using Delta Cost Project Data and a pre-post study design with a control group of not-for-profit institutions that did not convert, comparisons are drawn. The findings suggest that institutions that convert experience greater enrollment growth, a decline in fulltime employment levels per full time equivalent (FTE) student, no change in average expenses per FTE student, a decrease in total revenue, a decrease in Pell Grants received, a decrease in tuition and fees revenue, and a decline in average subsidy per student post conversion. These findings are critical to the creation of informed policy decisions regarding institutional conversions.