Journal of health & social policy最新文献

Social marketing techniques have enhanced the success of programs designed to improve the health outcomes of individuals or communities when adopting new health behaviors. Current research suggests, however, that behavior change models, when added to social marketing techniques, could result in even greater success in changing health behaviors and health outcomes. This retrospective analysis of the results of a Public Access Defibrillation (PAD) Trial, designed to improve a community's response to cardiac arrest, tests this proposition. Data from one of the 24 participating PAD Trial sites were analyzed and interpreted from a social marketing and behavior change model perspective, to assess the success in changing a community's response to cardiac arrest victims in 61 residential buildings that participated in the PAD Trial in New York City (NYC). The findings suggest that to improve the success of community-based, emergency response systems to cardiac arrest victims, health programs must first assess the community's awareness of the health problem and their willingness to change behaviors before designing and implementing social marketing programs for health behavior change.

Few studies have examined the impact of government support and policies on immigrant services within ethnic enclaves. This paper seeks to address this gap and examines the structure and challenges of ethnic community based organizations (CBOs) that serve low income immigrant populations and the impact of government support and policies on these CBOs. The study utilized case study and ethnographic methodologies and examined 2 Chinese and 2 Vietnamese CBOs in the San Francisco Bay Area. The findings show that ethnic CBOs critically depend on government fiscal support for survival. In exchange for fiscal support, ethnic CBOs represent public assistance and legitimacy interests for government in immigrant communities. However, culturally proficient and community leadership resources of ethnic CBOs can serve as bargaining chips to secure government funding, reduce compliance to government demands, and advance immigrant community interests. Nevertheless, in times of government fiscal crisis, ethnic CBOs and immigrant services tend to be most vulnerable to budget cuts due to lack of political voice. In sum, government-community collaboration through ethnic CBOs has a central role to play in facilitating and strengthening health and human services for rapidly growing, culturally diverse immigrant populations. These collaborative efforts in immigrant services are vital to cultivating healthy immigrant human capital and multicultural communities across the United States.

No statistician, social scientist or tarot card reader is needed to attest that the gap between the rich and poor in America is increasing. Further, most Americans don't care that much about it. There are also more rich people today living in the U.S. and there are more people living in poverty. Between 2000 and 2002, the number of Americans living in poverty increased by nearly 3 million to 34.6 million. Of these, 12% (or about one half a million persons) are living extreme poverty and many are children, with 16.7% likely to be poor (National Association of Social Workers, 2003).

Using physical restraints, urethral catheterization, pressure ulcers, psychotropic medication use, and contractures as quality indicators, this research examines whether the quality of nursing homes is associated with private-pay census. The primary data source was the 2000, 2001, and 2002 Online Survey Certification And Recording (OSCAR) data, which is nationally representative data containing information for approximately 17,000 nursing homes. The results of this study suggest that physical restraint use and psychotropic medication use have both a correlative and predictive relationship with private-pay census. Catheterization, pressure ulcers, and contractures are less important. The results of this study are important in two ways. First, the cross-sectional results show that the higher quality nursing homes are likely to have a higher private-pay census. Second, the change score analyses show that nursing homes can increase their private-pay census by increasing quality.

The impact of states' small group market reforms on uninsurance rates was examined. Reform status was quantified on five reform dimensions: Access Improvement, Premium Reduction, Premium Differential Reduction, Continuity of Coverage, and Enhancing Valued Plan Features. These reform indices were calculated based on actuarial judgment of the market impact potential of each regulation. Regression analysis showed no association between uninsurance rates and the depth of reforms on any dimension, while controlling for income, foreign-born population, black population, and employment in the smallest businesses. Possible reasons for the lack of impact are discussed.

This review of promising programs to address the challenges facing low-income families living in distressed neighborhoods reveals three key themes: (1) Earnings and asset development programs are used to increase the economic self-sufficiency of low-income families and include: place-based employment programs, a focus on good jobs, the use of work incentives, programs that promote banking, car and home ownership, and the use of the Earned Income Tax Credit; (2) Family strengthening programs are used to improve health and educational outcomes, as well as link families to needed support and benefit services and include: nurse home visitation, parenting education, early childhood educational programs, and facilitating the receipt of support services; and (3) Neighborhood strengthening programs are used to improve features of the neighborhood, collaboration among service providers, and resident involvement in neighborhood affairs and include: the use of community development corporations, comprehensive community initiatives and community organizing strategies.

This review of promising practices for meeting the multiple needs of low-income families in poverty neighborhoods reveals four main themes: (1) The challenges facing low-income families living in poverty neighborhoods are not discrete-but are multidimensional; (2) Integrated family and neighborhood strengthening practices, such as the Making Connections (MC) Initiative (funded by the Annie E. Casey Foundation), and the Harlem Children's Zone (HCZ), represent innovative strategies to address the multifaceted issues facing low-income families living in poverty neighborhoods; (3) The organizational structure, challenges and successes of the MC and HCZ provide insight into the nature of integrated family and neighborhood approaches; (4) A framework for the design of an integrated family and neighborhood program includes a focus on internal organizational processes, neighborhood processes, and external processes. This framework can assist social service agencies in moving their services toward a more integrated family and neighborhood approach.

It has long been recognized that children and adults living in poverty are at risk for a number of negative outcomes. As inequality in the distribution of wealth, income and opportunity has grown in the U.S. during the post-welfare reform era, impoverished children and their families have tended to become increasingly concentrated in urban low-income neighborhoods. Research evidence demonstrates that living in these neighborhoods affects family well-being in several key areas: economic and employment opportunity, health and mental health condition, crime and safety, and children's behavioral and educational outcomes. Using the neighborhood indicator approach, public and nonprofit social service agencies will be better positioned to develop a comprehensive and integrated service delivery model at the neighborhood level by using neighborhood assessment to locate services and utilize neighborhood intervention strategies.

With states facing their worst financial crisis since World War II, Medicaid programs across the nation are facing a period of significant stress. Medicaid expenditures are a major part of most states' budgets, which make them an important target when policy makers and legislators are faced with budget deficits. This study compares programs across states and identifies major reform trends being used by state officials as they try to balance the needs of their Medicaid recipients with the realities of budget shortfalls. Our research illustrates that the short-term view prevails: many states have relied heavily on one time funding sources, such as tobacco settlement monies in conjunction with traditional cost controlling mechanisms (e.g., freezing provider reimbursement rates, reducing program eligibility levels, requiring prior authorization for services) as their means of addressing the current crisis.

States play a principal role in designing and implementing publicly funded long term care programs. They are in a key position to determine what setting, from whom, and under what philosophy of care individuals can access long term care. State long term care systems have evolved over the past 25 years to support increased availability of community based care for older individuals. States have pursued three broad strategies to increase availability. One set of strategies aims to increase capacity through expanding the supply, public funding and eligibility for a wide array of home and community based services (HCBS). A second set of strategies seeks to constrain institutional growth in order to increase the dollars available for HCBS. Managed/capitated long term care is a third strategy that is a hybrid of the other two approaches. Empirically, increased capacity through use of Medicaid and Medicare resources and growth in the supply of community based care providers, combined with moderation of institutional bed supply, are associated with enhanced access and expenditures for community based long term care. The effectiveness of capitated or managed systems of care varies by model and in some cases is still under study. State fiscal resources are key to the ability to support community based care for the elderly. Targeted federal support may be critical to the continued expansion of community based care, given heterogeneity in state resources, coupled with an increasing demand for long term care.