Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Improving staff nutritional practices in community-based group homes: evaluation, training, and management.

We evaluated the effectiveness of a staff training and management package on nutritional practices in two community-based group homes serving adults with developmental disabilities. Food storage, menu development, and meal preparation were trained in a multiple baseline format, followed by supervisor feedback. All staff behaviors increased after training and were maintained for up to 1 year. Biological indices reflected collateral improvements in the health of consumers, and surveys of staff and parents established social validity.     

Religiousness, Health, and Health Behavior in Public-Use Data of the National Center for Health Statistics

Studies of religiousness and health-related variables in large, population-based cross-sectional or, preferably, longitudinal studies, which are often prohibitively expensive, are important to complement findings from the more commonly performed studies. Inadequately known among social science researchers, the national health surveys of the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) offer large, high-quality data sets to the public at no or nominal cost and hence offer important opportunities for research in the area of religion and health, religion and reproductive behavior, sociology of religion and psychology of religion. This report provides an overview of the data sets and a bibliography of prior research using these data, which is intended to suggest how the data of NCHS may be further exploited by researchers of religiousness and health.

Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

人才伦理学刍议

人才伦理是使人才之所以成为人才的各种伦理要素的总和;人才伦理既是人力资源管理理论的重要内容,也是伦理学特别是人才伦理学的研究对象。人才伦理学的内容主要包括以下五个方面：德与才的关系、人才的道德素质、人才的道德标准、人才的道德环境、人才的道德作用。德与才的关系是人才伦理学所要处理的基本关系,“德才兼备”是人才伦理学的核心范畴。提高人才的道德素质,是人才伦理学所确立的最高目标。人才伦理研究要揭示各类人才在道德要求和道德素质上的共同性和特殊性,为新世纪新阶段我国人才培养工作确立新的人才伦理原则和道德标准。     

Experimental assessment of tinnitus aurium

A 32-year-old male volunteer with an eight year history of chronic unilateral tinnitus (ear-ringing) participated in a behavioral assessment strategy that included a series of measurement and modification procedures. A psychophysical matching technique was employed throughout a planned combination of procedures to assess and manipulate the intensity or loudness of tinnitus responses. Following baseline assessment, measurements were conducted at varying times of the day, concomitant with exposure to music, during progressive relaxation training, and under conditions of caffeine consumption. The value of careful assessment to describe cues and conditions associated with tinnitus and its reduction are discussed with implications for behavior treatment design and evaluation.     

EFFECTS OF A VOICE OUTPUT COMMUNICATION AID ON INTERACTIONS BETWEEN SUPPORT PERSONNEL AND AN INDIVIDUAL WITH MULTIPLE DISABILITIES

We evaluated a means of increasing staff members' interactions with an individual with multiple disabilities through use of a voice output communication aid (VOCA). When activated, the VOCA allowed the individual to communicate through synthesized speech. Results indicated that staff members interacted with the individual more frequently when she had access to the VOCA, suggesting that VOCAs may represent an alternative to more traditional staff management programs for increasing interactions.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

军队初级指挥官PM领导行为类型的研究——与中、日企业领导行为的比较

本研究采用日本三隅二不二教授的PM领导行为理论 ,用中国修订版的PM量表对 2 64名初级军官的领导行为类型进行了评定 ,并与对中、日企业界的有关研究结果进行了比较 ,目的是研究初级军官所特有的领导行为特征以及与其相对应的情境因素。研究结果显示 :①在军事组织中 ,PM型是较理想的领导类型 ,其次为P型。这与中、日企业的结果有所不同。②方差分析结果表示 ,在与领导行为类型相关的八项情境因素中 ,初级军官在工作激励、连队满意度、团队精神和会议成效等因子上高于中、日企业界 ;但在心理卫生、对待遇满意度、信息沟通和绩效规范等因子上均低于中国企业界。③ χ2 分析结果显示 ,三种组织与四种PM行为类型之间在六项情境因素上的差异显著 ,提示三种组织在领导行为和情境因素上各有其特点 ;另外 ,与军事指挥官领导行为类型关系最为密切的是工作激励因素和团队精神 ,这是军事集团突出的特征之一。④中、日企业界在会议成效和信息沟通两因素上的差异较大 ,反映了两国在企业管理方面不同的特点。     

The value of stress-management interventions in life-threatening medical conditions

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.