Medical Democracy in a Health Systems Agency: The Role of Staff

The performance of consumers or laypersons in government programs has been studied extensively, usually from the standpoint of the control exercised by providers or other professionals, or correlative, what consumers need in order to be on an equal footing with the experts. At stake is lay control -i.e., democracy. This case study of one Health Systems Agency (HSA) in contrast, focuses attention on the crucial role of the HSA staff in the democratization of health care. Outcomes, such as cost-containment and allocation of resources, can be examined in terms of the staff\u27s interests and the constraints of its multi-leveled environment. From this perspective, the recruitment, selection, socialization, promotion, training and control of consumers are seen as important factors in the decisions made by the HSA, and these factors are seen as being greatly influenced by staff members as they seek to achieve a balance of outcomes. The balance of outcomes may include certain material and professional interests of the staff itself. In this process, lay control becomes subordinated

Social Services in the Iron Cage

Interview and documentary data from a study of a voluntary job placement agency revealed that counselors were effectively weeding out the hard-to-place clients. These clients were the target population of the agency and its funded programs. The clients who were weeded out tended to be younger, with less education and less work experience. Weeding out was accomplished by discouraging unrealistic clients, and by not retrieving clients who were insufficiently motivated to keep in touch with the counselor. This marked a change in the counselors\u27 practice compared with an earlier period, and appeared to be in conflict with the agency\u27s mission, the counselors\u27 altruistic orientation, and the expressed intent of the government-funded programs. The change in practice was associated with increased dependence of the agency and its counselors, and with the increasing demands for bureaucratic accountability from funding organizations. The findings suggest that as social services are increasingly funded by government, the agencies and practitioners find themselves in the iron cage of bureaucratic rationality and accountability, less able to hold to their organizational purposes and to enact their altruistic values

A Perspective on Differential Services in Counseling: Altruism and Likeness

In this exploratory study using a small sample, an attempt is made to understand the differential services provided by vocational counselors in a non-profit agency, a setting in which a strong identification with clients is encouraged. The services are measured and the unequal measures of service are related to the degree to which the client is seen as an image of the counselor in certain respects. Counseling is viewed as an altruistic occupation and the differential services are analyzed in this context. In general, it is suggested that the differential counseling and psycho-therapeutic services noted by other writers all reflect a kind of likeness between counselor-therapist and client-patient, that the relationship is somewhat narcissistic, and that while the kinds of likeness observed may be quite varied, they can be classified as reflecting biological, psychological, and social factors

Multicultural Education: More than the Acknowledgement of Black History Month

I remember clearly as a child, in the early nineteen sixties, the only African American mentioned in my school was Crispus Attucks. For a long time I thought there was only one black man that fought in the entire revolutionary war. From the big old musty textbooks we were given to study it was obvious very few black people had accomplished anything worth writing about. I hated history. I thought its only concern were old dead white men. Understandably, I did not do well in history. Since 2005, enrollment in public schools has increased, but “Black males continue spiraling down the achievement ladder” (Whiting 2006). All children need to see themselves in the context of what they are learning (Stiler & Allen, 2006). They need to know that many of the things that affect current day thinking and living have emerged from an amalgamation of peoples. It is important for the students’ self-esteem and often can mean the difference between ritual compliance and full engagement (Baker, 2005)

Perceptions of teachers at select middle schools on the role of teachers in shared decision making and its relationship to customer focused education

This study investigated perceptions of teachers at select middle schools on the role of teachers in shared decision making and its relationship to customer-focused education. While state legislatures have mandated such involvement, methods for implementation and extent of teacher involvement have been left to administrators in local school districts and at building levels. A nonexperimental descriptive research design, using two previously developed surveys, Customer Focused Education (Pando, 1993) and Shared Decision Making (Pikes, 1992), was used in this study. In addition, a researcher-designed demographic questionnaire was used to collect information on personal and professional characteristics of the teachers. A total of 321 teachers in 10 middle schools in a single area of the Detroit Public Schools was asked to participate in the study by completing a survey packet. Of this number, 113 completed and returned their surveys for a response rate of 35.2%. The major conclusions indicated that teachers in middle schools perceived students should be treated as valued customers. Middle school teachers wanted to be included in the decision making process at the building level. However, if middle school teachers want to be involved in shared decision making to serve the customer focus of their schools, they needed to become proactive in their approaches and actions in their local schools. Shared decision making with a customer focus provides teachers with some control over their work lives. Teachers, who were positive about customer focus in education, were more likely to be involved in making decisions about the curriculum in their schools. Effective communication must be in place for this process to be successful. As it is now, middle school teachers\u27 personal and professional experiences were unrelated to their perception of customer focus education. As it should be middle school teachers wanted to be included in administrative, organizational, curricular, and personnel decisions

Parent-adolescent relationships, sibling ordinal status, and adolescent adjustment [abstract]

Abstract only availableInvestigating the possible moderating affects of sibling ordinal status, researchers tested how differences in parent-child communication and trust between first-born and later-born children influence adolescent depressed mood and problem behavior. This study hypothesized that first-born adolescents will trust and communicate more with parents than later-born siblings, and that sibling-ordinal status will act as a moderator in the relationship between trust and communication and child problem behavior and depression The sample consisted of 57 7th graders (25 first-born; 32 later-born) and 61 10th graders (32 first-born; 29 later-born). Participants completed measures of trust and communication, problem behavior and depressed mood. Ratings of trust and communication were highly correlated, r(118) = .71, pMcNair Scholars Progra

Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion

Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long‐term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important

Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion

Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long-term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important