Controlling health care costs: An evaluation of strategies

There has been much discussion about the factors underlying inflation in the health care sector and the means to moderate increases in health expenditures. This paper identifies various costcontainment strategies and synthesizes research findings that may be helpful in evaluating their effectiveness. The review demonstrates the complexity of the issues and relationships that must be confronted and understood in cost containment. The delivery system is shown to be not well-suited to improving efficiency and restraining health care expenditure. Any single strategy, whether it involves restructuring the market or more direct regulation, cannot in itself accomplish the combination of expenditure control and adequacy of services that is socially desirable. A number of mutually reinforcing strategies are required. Finally, more empirical and analytical information on incentives, provider and regulatory decisionmaking, costs of regulation, and the dynamics of negotiation, is essential for the design of an effective costcontainment program.     

Trajectories of gender role orientations in adolescence and early adulthood: a prospective study of the mental health effects of masculinity and femininity

Adolescence is the segment of the life course when gender differences in mental health emerge and gender becomes a more salient factor shaping orientations toward oneself and views of one's place in the social world. This study uses mixture modeling, to identify trajectories of masculinity and femininity between ages 12 and 25, and OLS regression, to examine the effects of those trajectories on mental health in young adulthood (measured as depressive symptoms and alcohol problems at age 25). Four waves of prospective data from the Rutgers Health and Human Development Project are used; respondents (n = 447) are age 12 at Wave 1 (1979-81), 15 at Wave 2 (1982-84), 18 at Wave 3 (1985-87), and 25 at Wave 4 (1992-94). Results indicate that having relatively high and increasing levels of masculinity over adolescence decreases depressive symptoms in early adulthood for both males and females. Reflecting the privileging of males over females, the findings suggest that masculinity, but not femininity, is a central axis on which advantages and disadvantages across some dimensions of mental health accumulate over adolescence.     

Career Maturity: The Construct's Validity,Vitality, and Viability

Career maturity is a useful construct for studying adolescents, but it has limits. Professional counselors need to integrate personality and decision-making style into research on career maturity as well as give more than a passing nod to developmental theory. They cannot study career development at the individual level alone; context matters and is an integral part of career development. The amount of variance in individual career development accounted for by context and change may be so great that longitudinal research on individuals may not be worthwhile.     

The self and mental health: self-salience and the emergence of internalizing and externalizing problems

How do schemas about self-salience--the importance of the self versus the collective in social relations--affect mental health? We propose that self-salience shapes the likelihood of experiencing internalizing or externalizing problems. Schemas that privilege others over the self increase the risk of internalizing symptoms, including depressive symptoms and anxiety, whereas those that privilege the self over others predispose individuals to externalizing behaviors of antisocial behavior and substance abuse. Furthermore, we propose that these schemas contribute to the gender differences that exist in these problems. We test these predictions with data from adolescents, the stage at which these problems and the gender differences in them arise. Results show that self-salience underlies both internalizing and externalizing problems. In addition, schemas about self-salience help explain the gender differences found in mental health problems.     

The Impact of Managed Care on Field Instruction

Managed care is changing the provision of services to clients and the availability of field placements for students. This exploratory study, reporting on an October 1996 survey of social work field directors nationwide, confirms that placements have been lost because of managed care. Yet, it also notes that schools and agencies are reassessing their relationship and can collaborate to create different learning opportunities in the new environment. The findings have implications for deans, program directors, field directors, and regional and national organizations (such as the Council on Social Work Education) in the areas of revising the curriculum, confronting student expectations, and establishing new relationships with agencies.     

An examination of pathways from childhood victimization to violence: the role of early aggression and problematic alcohol use

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, we examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Structural equation models, including controls for race/ethnicity, socioeconomic status, parental alcoholism, and parental criminality, revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. Interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence.     

Spiritual issues in family therapy: a graduate-level course

With the advent of the biopsychosocial approach in family therapy, the domain of spiritual issues is increasingly being recognized as important to families. This article will describe a graduate-level seminar on Spiritual Issues in Family Therapy at the University of San Diego that offers family therapy students the opportunity to examine issues of spirituality, religion, and meaning and their place in therapy. One premise of the course is that research has demonstrated that most clients consider their spiritual life to be relevant to personal problems and would prefer a therapist who is comfortable with such topics. The goals of the course include (1) training in opening a dialogue with individuals and families about spiritual issues and discerning when referral may be appropriate; (2) expanding an awareness of wisdom traditions through use of comparative religions material; and (3) identifying from current practice many of the spiritual issues that may arise in the clinical setting.     

An International Perspective of Field Instruction

Abstract

Social work educators and practitioners have long debated several issues confronting field instruction. For example, they have addressed the structure of field placement, school versus agency-based supervision, remuneration to agencies that accept student placements, and the use of employer agencies as field settings. Because problem-solving increasingly involves working with people in nations other than the United States, it is important to gain an international perspective on field instruction issues. To this end, an international study was conducted to examine social work field instruction and the educational context in which it occurs. This article reports the findings of that study, which involved 51 countries. The universality of field instruction as an integral part of educational program, is apparent, as are the similarity of issues, problems, and proposed solutions Moreover, the findings indicate areas in which social work education has greater international consistency than education for the professions within national and regional boundaries, whereas other areas are influenced more by national and regional factors than by a universal social work professional culture.     

城市升级进程中社会公德意识现状与思考

强化公民社会公德意识是城市升级、社会转型的重要条件。针对当前我国公民社会公德意识建设中存在的问题，应从完善道德评价和奖惩制度、营造良好的社会公德环境、培育公民的公民意识与主人翁意识、培育公民的公民意识与主人翁意识、加强对公民社会公德意识的教育等几方面不断强化公民社会公德意识。     

An Examination of Foster Parent Unionization: The Washington State Experience

In 2006, the Washington Federation of State Employees charted new territory by initiating an effort to unionize foster parents. Using a case study approach, we describe the development of this unique alliance, perspectives of stakeholder groups, and the social and economic conditions surrounding the organizing effort. Implications for policy and community practice are discussed.