Journal of health & social policy最新文献

Medicare is an underutilized payment source for home-delivered health care services for homebound elderly. An innovative service provision for home health care, Mobile Medical Care Units (MMCU), is presented. MMCU consist of a multidisciplinary team of health care professionals who are responsible for following the health care needs of their elderly patients on a continuous long-term basis across settings. This comprehensive care has significant impacts on homebound elderly and the health care industry. MMCU have the potential to be covered more inclusively by primary or supplemental health insurance plans, including Medicare, Medicaid, and HMO's, or by special funding from state aging departments.

Low-income families face an enormous burden to achieve economic security since the deterioration of a guaranteed safety net. Health insurance coverage is uneven, affordable childcare falls short of demand, and wage earnings insufficiently support family needs. This analysis focuses on recent trends in family formation, the impact of policy changes on families of color and of immigrant status, and explores the daily challenges and coping strategies low-income families use to survive despite insufficient resources. Four key findings emerge from this body of knowledge: (1) Low-income families experience severe hardships when relying on cash assistance, work, or a combination of both; (2) Low-income families are resilient and resourceful; (3) Low-income families face significant barriers to using public and private services along with increasing earnings from work; and (4) The quality of life for families of color and immigrant families is directly affected by employment and service sector practices. Future research needs to focus on identifying the critical unmet needs of low-income families.

Obesity has become a major public health problem in America. Nearly two-thirds of adults are either overweight or obese. This problem is large enough to begin to rival health problems associated with cigarette smoking. Epidemiological evidence suggests that obesity is associated with heart disease, diabetes, and other diseases that can lead to morbidity and even premature death. This paper examines the magnitude of the problem and then suggests several solutions from societal and social work perspectives.

This paper is an examination of how Inoculation Theory can be applied in the prevention of sexual harassment in the medical setting. The basic tenet of the theory is the study of the processes through which we withstand and oppose attitude transformation during social interactions that may influence or change our attitudes. More importantly, this paper analyzes sexual harassment as a pervasive phenomenon in the medical setting. As such, it defines what sexual harassment is, explains the prevalence of sexual harassment between the physician and the patient, describes some of the general studies conducted in medical settings, provides a case scenario of doctor-patient sexual harassment, and identifies some key consequences to doctors, patients, and society.

This article explains selected historical acts and events that continue to impact comtemporary Native American ethnic identity, social policy, and social services delivery. Although cultural competence is increasingly encouraged in social work education, the events of history usually do not appear as partial explanations for current phenomena. For those who work with Native American populations, understanding this history is a critical piece in the process of acquiring cultural competence. These selected historical events provide at least partial understanding of some contemporary issues which are sometimes presented to social workers and other social services professionals who work with Native populations.

Inner-city trauma centers often provide care for disproportionately indigent populations who are victims of violence. Many of these victims of violence often return to the trauma center with more violent injuries. Research has shown that a majority of these individuals who return to the trauma center for care are expensive to treat, are uninsured and have significant social problems. Two potential policy approaches are discussed: (1) the use of violence prevention programs to attempt to reduce violence in the immediate community and subsequently reduce the number of victims of violence who are treated in trauma centers and (2) the use of aftercare and discharge models that form an alliance between the trauma center and social service providers in the community. Nontraditional interventions will require the collaboration with hospital departments (emergency medicine, surgery, trauma, social work) and outside agencies, such as the courts and probation and parole. Case management, discharge planning, continuous care treatment teams, and violence intervention models offer positive alternatives to the current method of addressing the multiple problems of victims of violence who frequent the ED.

With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community- based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs.

Most research has focused on the individual characteristics of homeless young people, yet contextual factors such as service delivery are crucial to understanding this population's pathways in and out of home or stable accommodations. The limited research that has examined service delivery has documented the importance of providing appropriate services. To understand the pathways that enable young people to exit homelessness and become safely housed, we discuss the need for better descriptive and evaluation information that accurately reflects the perspectives of service providers and clients.

This study explores the impact of managed care on the substance abuse service system by reviewing the current status of the programs that were among the elite service providers in 1988. A survey was conducted assessing the status of the one hundred centers touted as the 100 best treatment centers for alcoholism and drug abuse (Sunshine& Wright, 1988). Findings include the following: Almost a third of these centers (31%) are no longer providing services, the majority of the programs who reported data continue to provide services primarily at a residential level of care (92%); however occupancy rates have dropped, the number of annual inpatient admissions have risen, and the length of treatment episodes has significantly decreased. In 1988, almost all (97.5%) facilities adhered to the 28-day treatment regiment, as evidenced by average treatment episodes of 26 days or longer. However, in 2001, the majority of programs (57.5%) reported treatment episodes of 25 days or less. While these facilities represent a fraction of the number of facilities that provide substance abuse services, they do exemplify elite programs that should be insulated from economic troubles, and help to document the changes that have occurred in the delivery system. Awareness of these changes is important for every social worker that advocates for substance abuse services.