Coordination in Social Service Systems: the Area Agency on Aging as a Case Study

It is the purpose of this research to examine the interactions between organizations and the work of coordinating agencies in influencing those interactions using social exchange theory. A model was developed, incorporating elements of exchange theory, and the components of that model examined in the community. Techniques of change and the outcomes of activities of the coordinating agency were examined in an effort to develop a case study of a coordinating agency\u27s activity in the community. Historically, social services were provided in the community through informal, often familial, networks. With the urbanization of society, social services have become more formalized and specialized with a remarkable increase in the number of individual agencies. Movement from a growth to a scarcity economy and new federalism as well as concern with duplication, overlap, and gaps in services have led to an interest in the coordination of these activities. The Area Agency on Aging, considered by many to be a forerunner to the Allied Services Act, was implemented in 1973 by the federal government for the purpose of coordinating services to the elderly in the community. The goal of the Area Agency is the development of a comprehensive coordinated community service system. The activities of six such coordinating agencies as well as the social service organizations in their areas were studied to determine the explanatory value of social exchange theory. Additionally, attitudes of service providers toward various tactics for community change as well as the perceived outcomes of coordinating agency activities were investigated. The study of the Area Agency on Aging as a coordinating agency in the community was accomplished in two waves of data collection. The first, consisting of indepth interviews with 84 individuals in six areas, took place from May through July of 1975. The second wave involved indepth interviews and a mailed survey. Data were collected from 191 individuals in 126 agencies in three areas, urban, rural and urban/rural mixed. The data were coded and analyzed by computer to determine trends and relationships. The interview schedules were analyzed for specific cases. These objective and subjective data were used to reconstruct this study of interaction and coordination. A model, Organizational Interaction Model, was derived utilizing social exchange theory. This model contains the elements of commodities: funding, information, access to influentials, clients, staff and technology; valuing criteria: integration, status, world view, autonomy, domain and power; and arenas of exchange: planning, contracts and letters of agreement, hearings and meetings, evaluation and monitoring, and client transfers. These elements were examined, and their explanatory value for activities in the community involving organizations and coordinating agencies was determined. Change techniques, involving varying types as well as levels of intervention, were studied in terms of their perceived appropriateness by community organizations. The data suggested changes in activities of coordinating agencies, social planners, and makers of policy. Perceived outcomes of coordinating agency activity over the past three years show positive impacts in the community generally, though individual impacts vary. Finally, the implications of these findings are discussed for coordinating agencies as well as local and federal policy makers, with suggestions for future research. Social exchange theory offers rich ground for the study of community service systems and the coordination of interactions within communities

An examination of the validity of the telecourse self-assessment prediction instrument : "Are telecourses for me?"

There is a need for a simple tool to assess the learner's match to distance delivery methods such as telecourse and modem classes. The concept of a prediction instrument is a practical approach to identifying the at-risk student in the distance delivery environment. The purpose of this study was to determine if the Telecourse Self-Assessment Predictor Inventory (TSAPI), entitled "Are Telecourses for Me?" predicted the likelihood of student success in a telecourse. The utility of this instrument was analyzed using descriptive statistical procedures to describe the relationship between the total TSAPI scores, the scores on each instrument item, and the two student success categories of completers and noncompleters. The study compared academic achievement with scores on the TSAPI of 133 students enrolled in Medical Terminology I MED051, Medical Terminology II MED052, Personal Health HE205, and Aging and Society HS220 telecourses at Chemeketa Community College from 1994 to 1995. The TSAPI did not predict student telecourse success in this study. Completion rates differed by gender, grade point average (GPA), and total credit hours but did not differ by instrument total scores or distribution of scores. Several individual instrument questions had some predictive value and needs assessment utility for both students and instructors. Only three of the instrument's 10 questions confirmed a positive relationship between the questions and prediction of student success. The categories explored by these questions were (1) independence in receiving directions from instructors, (2) expected time spent on telecourse compared to a traditional face-to-face class, and (3) student self-assessment of reading ability. Questions not found to predict success elicited responses concerning motivation for taking the class, the need for interactivity, technology anxiety, ability to come to campus, and organization of required course work. The key recommendation of the study was to develop an instrument that has greater utility in predicting student success. The results of the study support the premise that a short, easy-to-administer score prediction instrument would be valuable in assessing student needs and identifying the at-risk population in the distance learning environment

The application of John Rawls' principles of justice to health care distribution in the United States

The principles of justice developed by John Rawls and articulated in his work A Theory of Justice, published in 1971, were used as the evaluative tool in assessing health care distribution in the United States. A model for using Rawls' theory was developed emphasizing the role of the 'least advantaged' as the focal point for evaluating the fairness of the health care distribution system. In the United States the classes of least advantaged were found to be unfairly treated using Rawls' second principle of justice. The implication for social policy of applying Rawls' principles of justice to the health care delivery system in the United States is that a different means of distribution needs to be instituted, as the present distributive model is unable to guarantee just minimums of care for those in society who are least advantaged. To clarify this conclusion, the United States model of health care delivery was compared to the socialist model of Sweden and the mixed model of Canada. Application of Rawls' principles to the health care distribution system demonstrates that these principles can be used in a concrete manner to measure the justice of social policies

National Eldercare System Project: A National Study Comparing Successful Community-based Systems of Care for Older People

The purpose of this project was to compare three different models of building and strengthening community-based systems of care for older adults. Models were distinguished by the type of organization that took the lead in developing the system of services: Area Agency on Aging, acute care hospital, and residential facility. Specific questions addressed in this project were: (1) What conditions in a local community give rise to a community-based system of care (CBSC) for older adults? (2) What are the necessary steps in planning and designing CBSCs? (3) How are successful CBSCs established and maintained? (4) How does the type of lead organization influence a CBSCs accessibility, responsiveness, and effectiveness? (5) To what extent and under what conditions can successful CBSCs be replicated? Answers to these questions were meant to assist leaders in new communities wishing to develop CBSCs for older adults in their own locales

Prevalence and Risk Factors for Urinary Incontinence in Overweight and Obese Diabetic Women: Action for Health in Diabetes (Look AHEAD) study

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P \u3c 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P \u3c 0.001). Women with a BMI of ≥35 kg/m2 had a higher odds of overall and stress incontinence (55–85% higher; P \u3c 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40–80% increased risk; P \u3c 0.01) and urinary tract infection in the prior year (55–90% increased risk; P \u3c 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI ≥35 kg/m2) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort

The Effects of Marihuana Extract Distillate on Eating Behavior of Rats

Since hunger drive is often used as a motivating factor in animal learning experimentation, it was decided to determine the effects of marihuana extract distillate on the eating behavior of rats. Carlini and Kramer (1965) found marihuana extract injections to have a faciliatory effect upon maze performance. They suggested that facilitation could have resulted from and increase in hunger drive. However, if the dosage level is high, this effect may last for a short time and be followed by a disinterest in food. Scheckel et al. (1968) report that some monkeys, at very high dosage levels of tetrahydrocannabinol starved to death in post-drug depressions. Human studies indicate some increased hunger or taste enhancement (Grinspoon, 1968; Hollister, et al., 1968; Ames, 1958). Ss were 20 male and 20 female adult Sprague-Dawley albino rats, maintained in home cages with ad-lib food and water. Each animal was assigned to one of five groups so that each group contained four males and four females. Each group received one dosage level of the drug throughout the entire experiment. Three dosage levels and two controls were used. Food deprivation levels of ad-lib, 12, 24, and 48 hours were assigned according to a balanced Latin square design. The drug, marihuana extract distillate, was administered through an intraesophogeal tube and hypodermic syringe. The study was divided into two parts, each of four weeks\u27 duration. In the first, after administration of the frug, the animals immediately were placed into a cage with a known amount of food present. The food was weighed after three and 24 hours to determine the amount of food eaten. The second experiment in the study repeats all proc3edures except animals were not given food until 1/2-hour after the drug was administered. Results show an inverse relationship between dosage level of marihuana extract distillate and amount of food eaten. Effects of dosage level, hours of deprivation, sex, latency of food preparation, and the possibility of tolerance or increased sensitivity to the drug are discussed