Journal of Applied Behavioral Science最新文献

Demographic shifts, the further commercialization of the health and human services industry, and various economic trends point to a restructuring of the systems delivering services to the aged. Emerging are approaches that offer a broad range of services under the auspices of separate organizational entities. Called continuums of care, such organizational forms use single points of entry as mechanisms to control access to the array of available services. Using the life care community as the prime example, this article examines the operations of single-point entry organizations. The authors also explore the implications of such structures for the health and human services industry, noting their potential for stratifying the aged along the dimensions of health and income.

Faced with industrial decline, American managers have begun searching for strategies for increasing productivity. Recent attention has focused on Japanese management practices, particularly on quality circles (QCs). Drawing upon social science research, this article evaluates the assumptions behind QCs implemented in the United States. The authors present a conceptual analysis that indicates possible reasons for the differing rates of success for QCs in Japan and the U.S. The article also makes suggestions for the effective implementation of American QCs.

This article examines the responses of states, localities, and the private sector to recent attempts by the federal government to realign domestic responsibilities for the provision of human services. In exploring this issue, the author conducted a study of agencies assisting the developmentally disabled in Greater Richmond, Virginia. The author finds that the nation is experiencing a fundamental paradigm shift--a reconceptualization of structure, goals, and responsibilities--with respect to social welfare, with new public-private sector partnerships emerging to meet human needs.

Organizational theorists have argued that formal and informal support systems cannot exist in strong form in the same society. In this article, the author argues that such theories fail to consider the complementary of these two systems and the necessity of both for the completion of most tasks. A study of tasks performed for nursing home residents found that the formal organization assumed those tasks that could be standardized and deemed legitimate for Medicaid funding, while the others were either maintained by informal support groups or lost altogether. A study of the influence of informal support groups on mortality rates found that such groups played an important role in reducing death in older persons resulting from causes associated with nontechnical matters. In conclusion, the author finds that formal groups can best manage tasks that require technical knowledge or that can be reduced to simpler, routine components, whereas informal groups can better manage tasks requiring everyday knowledge and characterized by many contingencies or unpredictability. The author stresses that both formal and informal support must be provided when serviing older people.

The growing reliance of voluntary nonprofit organizations on governmental funds ties their future to the fate of the welfare state. A mixed, three-sector, social service economy has blurred organizational differences and made a more rational division of responsibility unlikely. This article suggests that the traditional roles of voluntary agencies can still be reformulated to suggest a more realistic view of their distinctive areas of competence and vulnerability. To avoid goal deflection in the future, the author concludes that voluntary agencies must cope effectively with the dilemmas of entrepreneurialism and vendorism.

Among persons with chronic renal disease, limited encouragement to use self-care treatment options and easy access to disability income benefits tend to reinforce the concept of disability rather than foster rehabilitation goals. More than 80% of all chronic renal disease patients on dialysis therapy receive treatment in facilities at which they become highly dependent on medical staff, and estimates of unemployment among persons aged 21-59 years suffering from this disease range from 60% to 75%. The authors' data indicate that patients who receive dialysis treatment within facilities experience negative effects on their perceived health status and health locus of control as compared to patients who practice self-care dialysis at home. Although many factors contribute to unemployment among dialysis patients, the availability of disability income benefits seems to act as the most important deterrent to employment. Increasing the emphasis on the rehabilitation of this chronically ill population will require a movement away from disability labeling by providers of care and the patients themselves, as well as adjustment in the dialysis reimbursement system and in the eligibility requirements for disability compensation.