Monitoring the health consequences of welfare reform

Recent changes in welfare legislation place responsibility for support of the poor on states, dramatically decrease funding, create work requirements, and impose a number of other restrictions. Many predict adverse consequences of "welfare repeal"; however, the legislation does not provide for monitoring the health consequences of these changes. This article summarizes the provisions of the Personal Responsibility and Work Opportunity Reconciliation Act, reviews initial criticism, and makes a series of suggestions for monitoring activities.     

Psychiatry and children in the child welfare system

The child welfare system is, for better or worse, an unavoidable associate of the child and adolescent psychiatrist. Although the child psychiatrist rarely plays an integral role in decision making about the children who are involved with the system, the authors point out that a large percentage of children maintained in and involved with the system have psychiatric and developmental disorders. When these children's difficulties are either minimized or unrecognized by child welfare workers, the interventions and treatment that the children receive may be inappropriate. Worse still, when the children's difficulties are improperly addressed, the vicissitudes of the system may further harm them. The authors propose several ways in which the child and adolescent psychiatrist can have an important reparative role and voice in child welfare systems.     

Parent protection in context.

S. Goldberg, J. E. Grusec, and J. M. Jenkins (see record 1999-15264-001) made a strong and interesting case for distinguishing parents' protective abilities from generalized responsiveness in the study of infant–parent attachment. The endorsement of a narrow approach in the study of attachment, however, should not occur at the expense of gaining insights about potentially complex processes underlying parent protection. Three issues are addressed in the commentary: (a) A parent's protective behavior needs to be understood in relation to a particular infant, (b) the family context needs to be examined as a backdrop for understanding parents' caretaking behavior and its effectiveness, and (c) the processes involved in the development of the infant–mother relationship may not necessarily be the same processes that underlie the development of the infant-father attachment relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based health centers in the context of education reform

The rapid proliferation of school-based health centers is taking place at the same time that school systems are seeking to improve their educational practices. Many different school reform models are being promulgated with modest success. Absence of connections between school reorganization and the provision of human services may lead to failure. The emerging community school model integrates quality education with effective health, mental health, and social services in "one stop" school centers that become student, parent, and community hubs.     

Minority populations in the child welfare system: the visibility hypothesis reexamined

The high thrombogenicity of synthetic biomaterials has limited their use for reconstructive microsurgery. Prime factors in the thrombogenicity of synthetic materials in contact with blood include gas nuclei at the blood gas interface as well as the inherent thrombogenicity of the materials themselves. Expanded polytetrafluoroethylene (ePTFE) vascular prostheses were denucleated by placement in acetone and ethanol followed by degassed saline or by placement in degassed saline subjected to hydrostatic pressure. Heparinized grafts were prepared by coating with tridodecylmethylammonium chloride (TDMAC), followed by immersion in heparin. Grafts were installed to reconstruct the femoral artery (1 x 10 mm) or as renal-iliac bypasses (1 x 50 mm) in rats. In the femoral artery reconstruction model, control grafts thrombosed within 10 minutes of implantation. All acetone denucleated femoral grafts remained patent for 60 minutes but were occluded at day 1. All pressure denucleated femoral grafts remained patent for 60 minutes, whereas six were patent at 1 month. In contrast, 11 of 15 heparinized femoral grafts were patent at 1 month. In the renal iliac bypass model, all control grafts were thrombosed within 10 minutes, whereas all heparin bonded grafts remained patent at 1 month. This finding confirms that removal of air from small diameter ePTFE grafts decreases acute thrombogenicity and that heparin bonding further decreases thrombogenicity, suggesting that clinically useful lengths of microvascular prostheses may be possible.     

The costs of healthcare worker respiratory protection and fit-testing programs

OBJECTIVE: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB). DESIGN: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study. SETtING: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB. RESULTS: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526). CONCLUSIONS: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.     

Measuring performance in child welfare: secondary effects of success

The Adoption and Safe Families Act of 1997 mandates the development of a system to rate the performance of state child welfare programs. The resulting system, built on broader efforts to measure outcomes for children and families who receive support and services from the child welfare system, will inform perspectives on family foster care in the next century. Drawing on findings from evaluations of recent reform initiatives in Alabama, North Carolina, and Ohio, this article suggests that performance measurement systems must be adaptable to changing circumstances, particularly when improvements in one area can affect standards and expectations in others.     

Sustaining leprosy services in the changing context of health sector reform

National leprosy control programmes currently face a number of changes to the environment within which they operate. This paper examines the issues arising from these. It focuses, in particular, on those arising from changes in the structure of the health sector as a result of policies of health sector reform which are being considered or adopted in many developing countries. These include decentralization, financing strategies, greater role for the private and NGO sectors and the integration of vertical programmes. The paper is structured around a number of key steps in the development of a strategy for sustainability of appropriate leprosy services. These are the assessment of the epidemiological, social and health services context, development of programme objectives, planning of human and financial resources, development of the strategy, mapping the roles of potential actors, development of regulatory and incentive mechanism, action planning and managing change and, finally, re-evaluation of the programme objectives and service delivery organization. The paper stresses the importance of process in developing ownership of a strategy. It concludes with a set of key questions which it suggests need to be addressed by leprosy programme managers in the development of a proactive response to the changes.     

Review of Secondary traumatic stress and the child welfare professional.

Reviews the book, Secondary traumatic stress and the child welfare professional by Josephine G. Pryce, Kimberly K. Shackelford, and David H. Pryce (see record 2007-05981-000). This book offers a complete examination of an important and often overlooked issue in the field of trauma work—secondary traumatic stress (STS). The authors appear to have written this book in response to a relative dearth of literature in this area as it affects child welfare workers. The research summarized and cited in this book is current, making the book timely and well developed. The easy-to-comprehend writing style of the authors flows and allows readers to be easily drawn into the case scenarios provided. Any professional working in child welfare as a caseworker, investigator, or supervisor, will benefit from reading this book. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

African American children in the modern child welfare system: a legacy of the Flemming Rule

Children of color throughout America-and especially those who are African American-are disproportionately represented in the child welfare system. This article links this current child welfare condition to the most significant but little known ruling in the historical development of the modern child welfare system-the Flemming Rule. The Flemming Rule, although intended to be constructive, was negatively implemented in a way that has had long-term serious consequences for African American children and their families. Implications for future policies are discussed.     

The balance of prevention, investigation, and treatment in the management of child protection services

The planning, development, and review of child protection services and policies (management) is vitally important and yet to date has received very little consideration. This paper explores the balance between three components of child protection policy: prevention, investigation, and treatment. As part of a review of the management of child protection services in Wales, the authors examined the effectiveness of Area Child Protection Committees (ACPCs), which are multidisciplinary forums responsible for the local provision of child protection services. Thirty-eight (of 171) representatives were interviewed. The balance of the three components (prevention, investigation, and treatment) in policy making was explored. Overall, there was a substantial emphasis on investigation procedures, with very little consideration of prevention strategies, and treatment services virtually ignored. Treatment was described as a "gap" in the service consideration of ACPCs. The authors consider ways to shift the balance so that treatment and prevention services can be given more priority within a comprehensive child protection service.     

Guidelines for psychological evaluations in child protection matters.

Presents the American Psychological Association's (APA's) guidelines for desirable professional practice in child protection matters. The guidelines were developed primarily for psychologists conducting psychological evaluations in child protection matters. The guidelines build on the APA's Ethical Principals of Psychologists and Code of Conduct (APA, 1992) and are aspirational in intent. The term guidelines refers to pronouncements, statements, or declarations that suggest or recommend specific professional behavior, endeavor, or conduct for psychologists (APA, 1992). The guidelines are not intended to be either mandatory or exhaustive and may not always be applicable to legal matters. Their aspirational intent is to facilitate the continued systematic development of the profession and to help assure a high level of professional practice by psychologists. The specific goal of the guidelines is to promote proficiency in using psychological expertise in conducting psychological evaluations in child protection matters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Starting young: improving the health and developmental outcomes of infants and toddlers in the child welfare system

The number of infants and toddlers entering out-of-home care has increased dramatically in the past few years, yet few published reports examine their needs. This article describes a collaborative, multidisciplinary developmental follow-up program for infants and toddlers that builds on the community-based family support model described in the Family to Family Foster Care Reform Initiative. The children's health and developmental status, as well as the program's effectiveness, are highlighted.     

What about the kids? Parenting and child adjustment in the context of couple therapy.

Little research examines parenting and children's adjustment when couples engage in therapy. We examined how couples with and without children improve with couple therapy and whether they also report improvements in parenting and child adjustment. With up to twenty six sessions of couple therapy, 134 couples, 68 of whom had children, showed improved marital satisfaction during treatment, which was ultimately maintained over the 2-year follow-up, regardless of whether they had children. Couples married relatively longer, both with and without children, evidenced greater improvement. Couples with children reported less conflict over child rearing and better child adjustment during treatment, but only improvements in the former were maintained. Conflict over child rearing mediated the relationship between marital distress and child adjustment over therapy and the 2-year follow-up. These preliminary results suggest that couples in therapy may decrease their conflict over child rearing during treatment and they may be able to maintain these gains for at least two years following treatment; moreover, over the course of treatment, this decreased conflict is tied to improved child adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child protection or professional self-preservation by the baby nurses? Public health nurses and child protection in Ireland

In Fura-2 loaded-single guinea pig adrenal chromaffin cells, muscarine, nicotine and KCl all caused an early peak rise in intracellular Ca concentration ([Ca2+]i) followed by a sustained rise. In Ca(2+)-free solution, muscarine, but neither nicotine nor KCl, caused a transient increase in [Ca2+]i, which was partially reduced by preceding application of caffeine or by treatment with ryanodine plus caffeine. In voltage-clamped cells at a holding potential of -60 mV, the muscarine-induced [Ca2+]i rise, especially its sustained phase, decreased in magnitude. Intracellular application of inositol 1,4,5-trisphosphate caused a transient increase in [Ca2+]i and inhibited the following [Ca2+]i response to muscarine without affecting responses to nicotine and a depolarizing pulse. Muscarine evoked membrane depolarization following brief hyperpolarization in most cells tested. There was a significant positive correlation between the amplitude of the depolarization and the magnitude of the sustained rise in [Ca2+]i. Muscarine-induced sustained [Ca2+]i rise was much greater in the current-clamp mode than that in the voltage-clamp mode. The sustained phase of [Ca2+]i rise and Mn2+ influx in response to muscarine were suppressed by a voltage-dependent Ca2+ channel blocker, methoxyverapamil. These results suggest that stimulation of muscarinic receptors causes not only extracellular Ca2+ entry, but also Ca2+ mobilization from inositol 1,4,5-trisphosphate-sensitive intracellular stores. Voltage-dependent Ca(2+)-channels may function as one of the Ca2+ entry pathways activated by muscarinic receptor in guinea pig adrenal chromaffin cells.     

Fathering in family context and child adjustment: A longitudinal analysis.

This study focuses on relations between fathers’ behavior in family context and children’s adjustment, including the roles of paternal depressive symptoms, paternal marital conflict behaviors, paternal parenting, and children’s emotional security. Participants included 235 families with a six-year-old child, with families followed longitudinally each year for three years. In terms of fathers’ adjustment, paternal problem drinking was related to paternal negative marital conflict behaviors and decreased positive parenting, which was associated with children’s externalizing and internalizing problems. Fathers’ depressive symptoms were directly related with children’s internalizing problems. Children’s emotional security was an intervening variable in relations between father’s behavior in family context and children’s development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of intraindividual temperament in the context of mother–child dyads: P-technique factor analyses of short-term change.

In this study temperament is examined from a longitudinal, within-individual perspective in order to investigate short-term change and to discover if there are identifiable patterns to temperament changes. For approximately 100 consecutive days five mothers completed modified versions of the Dimensions of Temperament Survey (DOTS), reporting on their 2-year-old children's behavior and on their own behavior. Within-individual patterns of change were identified for both mother and child data sets by P-technique factor analyses. Within-dyad mother and child solutions were more similar than were solutions across either mothers or children. Patterns identified were quite similar to the five-factor structure found with the DOTS in previous cross-sectional studies, although slight departures from this structure suggest new insights into temperament processes at the individual level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)