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.     

Reply to the Commentaries: Of Course,We Do Not Yet Know What it is All About,But Functional Contextualism is a Good Place to Start

In this reply to the commentaries, we note several points of disagreement with Johnson and Greenman on theoretical and empirical grounds. We are particularly surprised by their assumption that attachment has already been established as the key mechanism of change in couple therapy, as our present findings do not support this idea. We also elaborate on Gurman's functional contextualist views and describe why IBCT may be a particularly helpful model for training new couple therapists in a contextualist way.     

Reclaiming ourselves through Testimonio pedagogy: reflections on a curriculum design lab in teacher education

This article details one teacher preparation course centering Latin American Testimonio narratives of struggle/survival amid structural oppression for use in secondary curriculum. As our class of predominantly Latina/o students and two Latina instructors engaged Testimonio pedagogy, we fashioned a hopeful alternative to our own experiences of intergenerational oppression. While research indicates that the experiences and histories of pre-service Teachers of Color lend pedagogical strength and critical consciousness to teacher education, three Latina pre-service students highlight the ways in which Testimonio became more than a pedagogical approach. Testimonio’s collectivity, resistance, hope, and assertions of voice and dignity moved through them not as educators first but as (great-grand)daughters of oppressed though still-resilient People(s). Testimonio emboldened these Latina pre-service educators to recognize and validate their own inherited multiliteracies, (re)claim their connectedness to land, and articulate their visions for more equitable schooling. This work advances research into the essentiality of engaging race and ethnicity in K-12 and teacher education curriculum and pedagogy.     

Neither Real Americans nor Real Asians? Multigeneration Asian Ethnics Navigating the Terrain of Authenticity

Qualitative Sociology -     

Social Work Education and Clinical Learning

In response to a growing diversity of opinion regarding educational models and essential content in clinical social work education, this paper offers a perspective concerning graduate clinical curricula. Part I, the foundational piece of the paper, discusses the definition of clinical social work, social work’s core orientation and values, and influential contextual issues. The interrelated core orientations guiding knowledge and skill development are identified as the person-in-situation perspective and the concept of relationship. Based on this foundation, Part II identifies elements of a contemporary biopsychosocial knowledge base and essential clinical skills. This paper is intended to stimulate dialogue about a topic of importance to the profession and the clients it serves.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

Freedom of association in the Bangladeshi garment industry: A policy schizophrenia in labour regulation

The right to freedom of association is fundamental for the establishment of labour unionism as an institution. While the Government of Bangladesh requires enabling legal provisions for unionization in its garment industry, regulation to ensure the right to freedom of association has proved ineffective in upholding labour unionism. This article highlights the need for legislation capable of drawing on the complementary skills and resources of the Government, factory owners, labour unions and global brands to secure a sustained commitment and contribution towards the socio-economic and political dimensions of labour relations in Bangladesh's ready-made garment industry.     

Matched survival data in a co-twin control design

When using the co-twin control design for analysis of event times, one needs a model to address the possible within-pair association. One such model is the shared frailty model in which the random frailty variable creates the desired within-pair association. Standard inference for this model requires independence between the random effect and the covariates. We study how violations of this assumption affect inference for the regression coefficients and conclude that substantial bias may occur. We propose an alternative way of making inference for the regression parameters by using a fixed-effects models for survival in matched pairs. Fitting this model to data generated from the frailty model provides consistent and asymptotically normal estimates of regression coefficients, no matter whether the independence assumption is met.