What to Do When Stakeholders Matter: The Case of Problem Formulation for the African American Men Project of Hennepin County, Minnesota

We propose a series of stakeholder analyses designed to help organizations—especially governments—think and act strategically during the process of problem formulation in order to advance the common good. Specifically, we argue that at least five sets of analyses are necessary, including the creation of (1) a power versus interest grid; (2) a stakeholder influence diagram; (3) bases of power–directions of interest diagrams; (4) a map for finding the common good and structuring a winning argument; and (5) diagrams indicating how to tap individual stakeholder interests to pursue the common good. What the analyses do is help to transform a seemingly "wicked problem"—for example, how to produce better outcomes for African American men aged 18–30—into something more tractable, and therefore amenable to collective action. In other words, stakeholder analysis can be used to link political rationality with technical rationality so that support can be mobilized for substantive progress.     

The Prevalence of Mental Illness Among Inmates in a Rural State

A limited number of recent empirical studies suggest that inmates suffer from high rates of serious mental illness. Different explanations are offered depending on the type of institution: jail or prison. The literature is based largely on urban samples and does not offer comparisons of rates across types of institution within a single study. The present study examined a random sample of 213 jail and prison inmates in a rural state using the Diagnostic Interview Schedule (III-R). Among jail inmates there was little evidence of high rates of serious mental illness, suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas. Among prison inmates, however, high rates of mental disorders were found, supporting previous findings in urban and rural jurisdictions. Implications of the findings are discussed in the context of a consolidated correctional system.     

The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

A NOTE ON AMERICA'S "CLOACAL" JAILS

A large literature points to the abominable condition of American jails. Comparison of national surveys of jail conditions conducted in 1972 and 1978 indicates that what little improvement has occurred is minimal compared to remaining problems. A number of factors have prevented state-set standards from achieving widespread improvement in local jail conditions: high costs, local autonomy and lack of credible threats for forcing compliance. The failure of New York State to implement adequate health standards illustrates the limitations of the standards approach. Other approaches, such as strategies for replacing local jails with regional facilities, deserve the attention of policy researchers.     

Lineup Identification by Children: Effects of Clothing Bias

This study examined effects of clothing cues on children's identification accuracy from lineups. Four- to 14-year-olds (n = 228) saw 12 video clips of individuals, each wearing a distinctly colored shirt. After watching each clip children were presented with a target-present or target-absent photo lineup. Three clothing conditions were included. In 2 conditions all lineup members wore the same colored shirt; in the third, biased condition, the shirt color of only one individual matched that seen in the preceding clip (the target in target-present trials and the replacement in target-absent trials). Correct identifications of the target in target-present trials were most frequent in the biased condition, whereas in target-absent trials the biased condition led to more false identifications of the target replacement. Older children were more accurate than younger children, both in choosing the target from target-present lineups and rejecting target-absent lineups. These findings suggest that a simple clothing cue such as shirt color can have a significant impact on children's lineup identification accuracy.