An intervention framework for collaboration

This paper provides an intervention framework for collaboration to improve services. When collaboration is an intervention, its development and effectiveness depend on intervention logic. Intervention logic requires a precise conceptualization of collaboration. This conceptualization emphasizes its vital and unique components. It includes a developmental progression in which collaboration is contrasted with companion concepts. It also includes progress benchmarks, outcome measures, and logic models. These models depict relations among the benchmarks and outcomes, and they identify the mediating and moderating variables that account for collaboration's development and effectiveness. These models are designed to improve planning, evaluation, and their relations. This intervention framework for collaboration contrasts sharply with other conceptualizations and strategies. Although its aim is to unify and improve collaboration policy and practice, its inherent selectivity is an obvious limitation. [PUBLICATION ABSTRACT

American welfare strategies: Three programs under the social security act

In the United States, a single piece of legislation, the Social Security Act, is the major vehicle through which the cash assistance to citizens is provided. This act contains many subprograms, programs so different in concept, administration and programmatic implication that many people do not know that the same piece of legislation makes them all possible. In this paper three programs—“social security,” “unemployment compensation,” and “public assistance”—are examined in a sociohistorical, sociocultural context. The roots of these programs are analyzed, their current operations outlined, and the policy problems currently confronting them are detailed. The ways in which the programs relate to the political mythology of the society is seen as important. Because of the continual conflicts arising out of the administration of public assistance, three special cases involving that program are mentioned.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45457/1/11077_2005_Article_BF01727600.pd

Social Work Theories and Practice with Battered Women: A Conflict-of-Values Analysis

In the 1970s, wife abuse became a concern of sociologists, feminists, and family theorists. The new perspectives they brought to the problem, which focused more on social factors than on individual pathology, challenged social workers to examine how their practice and assumptions perpetuated the problem. This article investigates how the social work literature has been affected by new theories of domestic violence and analyzes the impact that these theories have had on practice with battered women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67024/2/10.1177_088610998700200205.pd

An argument against the focus on Community Resilience in Public Health

Background - It has been suggested that Public Health professionals focus on community resilience in tackling chronic problems, such as poverty and deprivation; is this approach useful? Discussion - Resilience is always i) of something ii) to something iii) to an endpoint, as in i) a rubber ball, ii) to a blunt force, iii) to its original shape. “Community resilience” might be: of a neighbourhood, to a flu pandemic, with the endpoint, to return to normality. In these two examples, the endpoint is as-you-were. This is unsuitable for some examples of resilience. A child that is resilient to an abusive upbringing has an endpoint of living a happy life despite that upbringing: this is an as-you-should-be endpoint. Similarly, a chronically deprived community cannot have the endpoint of returning to chronic deprivation: so what is its endpoint? Roughly, it is an as-you-should-be endpoint: to provide an environment for inhabitants to live well. Thus resilient communities will be those that do this in the face of challenges. How can they be identified? One method uses statistical outliers, neighbourhoods that do better than would be expected on a range of outcomes given a range of stressors. This method tells us that a neighbourhood is resilient but not why it is. In response, a number of researchers have attributed characteristics to resilient communities; however, these generally fail to distinguish characteristics of a good community from those of a resilient one. Making this distinction is difficult and we have not seen it successfully done; more importantly, it is arguably unnecessary. There already exist approaches in Public Health to assessing and developing communities faced with chronic problems, typically tied to notions such as Social Capital. Communityresilience to chronic problems, if it makes sense at all, is likely to be a property that emerges from the various assets in a community such as human capital, built capital and natural capital. Summary - Public Health professionals working with deprived neighbourhoods would be better to focus on what neighbourhoods have or could develop as social capital for living well, rather than on the vague and tangential notion of community resilience.</p

Striking coincidences: How realists should reason about them

Many metaethicists assume that our normative judgments are both by and large true, and the product of causal forces. In other words, many metaethicists assume that the set of normative judgments that causal forces have led us to make largely coincides with the set of true normative judgments. How should we explain this coincidence? This is what Sharon Street (2006) calls the practical/theoretical puzzle. Some metaethicists can easily solve this puzzle, but not all of them can, Street argues; she takes the puzzle to constitute a specific challenge for normative realism. In this article I elucidate Street’s puzzle and outline possible solutions to it, framed in terms of a general strategy for reasoning about coincidences. I argue that the success of Street’s challenge crucially depends on how we set the ‘reference class’ of normative judgments that we could have endorsed, assuming realism. I conclude that while the practical/theoretical puzzle falls short of posing a general challenge for normative realism, it can be successful as a selective challenge for specific realist views

The social meaning of social indicators

While new modes of data processing have provided reams of data, there has been relatively less effort in seeking to comprehend the social meaning of results of empirical work. A set of previously developed indicators of urban social structure is here examined for its link to theory, and to the social structure of the city itself. The original indicators (size, social class, racial composition and community maturity) were empirically derived. In this paper, each is taken in turn, and explored with respect to several possible social meanings. Size, for example, is considered to be itself an indicator, and an imperfect one, for system complexity; percent non-white is seen to be itself an indicator for a slowdown in the mobility process, or a slower social metabolism. These and other results are suggestions, with illustrations, but not conclusive support, from other than the original data. While it is hoped that the theoretical suggestions may themselves be of interest, it is also hoped that approach itself can indicate the fertility and usefulness of going back to theory once empirical measures have been developed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43687/1/11205_2004_Article_BF00304121.pd

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

New strategic perspectives on social policy/ Tropman

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