Journal of health & social policy最新文献

Today, kinship care is equal part family tradition and social welfare policy. This volume explores the balance of the two and presents current practice challenges of formal and informal kinship care. It also addresses the seminal role of grandparents as kinship care providers. doi:10.1300/J045v22n03_01.

Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated.

The large discrepancy between epidemiological evidence and welfare administrative data regarding domestic violence prevalence among welfare recipients is an issue of major concern for social policy. This study sought to determine whether or not the discrepancy is due to under-reporting by all women or by certain types of women. Using survey and administrative data on a sample of June 2002 welfare recipients, characteristics of women whose abuse was known to their welfare caseworkers are compared to those of individuals who disclosed to survey researchers but not to welfare personnel. Statistically significant differences suggest that some subgroups, including African Americans and women with less education, rather than all women, may be less likely to disclose abuse to welfare caseworkers.

The purpose of this article is to offer a brief and concise history of relevant public welfare policies for a discussion of the effects of public welfare reform, and how it impacts families in ways not comprehensively understood. Social scientists' concerns about the potential for the families to be thrust into an "extreme poverty" status due to the forced workforce participation requirement and expiration of time limited benefits is discussed. A second concern regarding a "one size fits all" approach to work requirements for TANF recipients being unrealistic and insensitive is also discussed. The authors recommend a comprehensive multi-system analysis to determine the impact of welfare reform. There is also a recommendation that the workforce requirements should correlate to an assessment score based on the ability of welfare recipients to function in identified areas. Implications of maintaining a welfare reform policy status quo are identified.

Life circumstances and threatening ecologies disenfranchise families living in public housing development. Many are children who live with their grandparents in housing units, but are not on the lease. The grandparents and grandchildren experience health problems, are in poverty, and are not served by the child welfare system. Frequently, the children are forced to sleep in bedrooms with other individuals who may be inappropriate, subjecting them to potential sexual child abuse and other circumstances. Housing officials are compelled to remedy this problem and ensure that all residents of public housing are on the lease and are properly housed consistent with the U.S. Housing Act of 1932. National housing policy needs to be reformed to accommodate the needs of children who for a range of circumstances cannot live with their parents. doi:10.1300/J045v22n03_11.

Very little consideration has been given to the impact children's living situations can have on their educational performance. The relationship of family environment to the children's educational performance depends in part upon the experiences and intent of the mediating adults who frame, select, focus and interpret the experiences children have in ways that produce an appropriate attitude toward education. Because of changing family patterns, along with significant social and economic factors plaguing many families today, particularly African American families, a substantial number of children continue to grow up in circumstances that put them at risk for unstable family environments, low achievement, and school failure. These unstable family environments often lead to placements in families other than their biological families. Often times these placements are within the state foster care system and for some the placement is with a relative, known as kinship care. Kinship placement is seen as an alternative in maintaining some type of stable family environment for these children at risk. In view of the relatively high incidence of low school performance and other social issues of children at risk, the role of minority families in the education of their children has become a national interest. The issue being addressed in this article centers around specific family processing factors in kinship care environments and its impact on children's academic performance. doi:10.1300/J045v22n03_03.

Previous analyses of the inverse relationship between a nursing home's Medicaid census and its quality of care have been based on samples limited to specific geographic regions, for-profit entities, or only skilled care facilities. The present study uses national-level data from the 1999 National Nursing Home Survey to examine the association between the proportion of beds designated for Medicaid residents and nurse staffing ratios. The results indicate that homes which designate a higher proportion of their beds for Medicaid recipients maintain lower ratios of registered nurses and nurse's aides to residents, even when key facility characteristics are controlled. It was also found that nursing homes with a higher proportion of Medicaid beds offer lower nursing ratios regardless of their profit status or the difference between private pay rates and Medicaid reimbursement rates. Since lower nursing ratios have been previously linked to negative outcomes, these findings suggest that homes which rely more heavily upon Medicaid recipients may be using cost-cutting strategies which have negative implications for quality.

Domestic violence is known to have occurred in 40 to 70% of child welfare cases and has served in some capacity as the basis for removing the child from the birth home (Edleson, 1999). Kinship care is regarded as a growing option for many of these families. This conceptual article discusses the distinct ways that kinship care and domestic violence are linked. The authors discuss how silence, the rising incarceration of women, mistrust of the system, difficulty in securing services for survivors, and economic hardship create unique challenges that require attention at both the practice and policy levels. Policy interventions are proposed at the mezzo and macro levels. Recommendations include promoting the Family Violence Options under the TANF program. The article also discusses the unintended consequences the Adoption and Safe Families Act has in domestic violence situations. doi:10.1300/J045v22n03_05.

Objectives. The purpose of this study was to more fully understand the factors that motivate and influence kinship care provided by African American grandfathers who raise their grandchildren.
Methods. Data were gathered from a community sample of older men, age 65+, who were responsible for the care of at least one grandchild in a rural community in southeastern North Carolina. Fifty-four percent of the grandfathers were African American men who are the focus of the present analysis. Responses were analyzed using a qualitative content analysis mode and descriptive statistics.
Results. Five factors (obligation, lack of availability of other caregivers, family tradition, role modeling, care and concern) that influence their decision to assume the parenting role emerged and three areas (lack of resources, feelings of powerlessness, religious beliefs and spirituality) that impact their ability to continue providing care were identified.
Discussion. Findings indicate that practitioners seeking to understand kinship care and assist grandparents who are raising grandchildren must take into account the hardships these families face due to a lack of concrete services and the implications for mental health. Results affirm the need for special attention to grandfathers who provide kinship care. doi:10.1300/J045v22n03_12.