Training indigenous workers in mental-health care

This article develops issues raised in H`ans Buwalda's article, ‘Children of war in the Philippines?s. It considers the training of indigenous workers in mental-health care in areas of recent or continuing armed conflict. It explores the possibilities of combining Western therapeutic techniques with local and culturally appropriate ways of working. It stresses the need to acknowledge and address the emotional impact of the work and participants' own concerns, and discusses the kind of support which workers need. It looks at teaching methods and course content, with a view to creating a safe atmosphere and an interesting programme, taking into account cultural considerations. Finally it suggests ways of developing models of training for the future.     

Adoption of retrospective Medicare maximization billing practices by state Medicaid home care programs

Home care services funded by Medicare and Medicaid grew rapidly throughout most of the 1990s. During this period some state Medicaid programs transferred costs for home care claims to the Medicare program to reduce their liability and increase beneficiary access to Medicare coverage. This article reports the findings of the first national study of these Medicare maximization billing practices for home care services. Primary data were collected to determine which states conduct retrospective Medicare billing practices and the amounts recovered from Medicare. Our analysis indicates that seven states recovered as much as dollar 265 million from Medicare in state and federal dollars during the 1990s. Ratios of recovered expenditures-to-costs incurred for retrospective billing practices conducted in Connecticut, New York, and Massachusetts are between 5:1 and 7:1. While retrospective billing practices may aid states in reducing Medicaid outlays and potentially help dual Medicare beneficiaries gain coverage for their home care claims, they increase Medicare expenditures for home care at a time of concern for the long-term financial viability of Medicare and illustrate the need for reforming our national long-term care financing policy.     

Gender Differences in Rates of Depressive Symptoms Among Low-Income,Urban, African American Youth: A Test of Two Mediational Hypotheses

The present study tested for gender differences in depressive symptoms in a sample of 622 low-income, urban, African American adolescents. Results indicate that adolescent girls in this sample were significantly more likely to endorse depressive symptoms than were boys. To examine possible explanations for this gender difference, 2 variables were tested as mediators of the relation between gender and depressive symptoms: (1) interpersonal stressors and (2) ruminative coping. Results indicate that ruminative coping, but not interpersonal stressors, mediated the relation between gender and depressive symptoms in this sample. Possible explanations for these findings, in light of the common and unique experiences of low-income, urban youth of color, are explored.     

Threats to Perceptions of Fairness in the Termination of Parental Rights

Termination of parental rights (TPR) proceedings are among the most important family court activities. This study contributes to knowledge of the TPR process by illustrating practices employed in TPR proceedings and considering ways that certain practices can hinder perceptions of fairness. TPR court records from one state were analyzed using inductive coding procedures. The analysis identified nine categories of threats to perceptions of fairness in the TPR process. Findings have implications for procedural justice and the legitimacy of child welfare practice.     

The re-occurrence of violations in occupational safety and health administration inspections

How well do firms in the United States maintain compliance with occupational safety and health administration (OSHA) standards after being cited for a violation? How and why does this vary among standards? This paper identifies serious violations of 91 frequently cited standards at manufacturing plants during 1992–2002 and tracks compliance with that standard in later inspections over 10 years. While formal measures of Repeat violations are quite low, we find considerably higher re-violation rates for some standards once we look separately at how often health standards are cited in later health inspections and safety standards cited in later safety inspections. Characteristics of the standards affect re-violation rates, but not always in the expected direction. Standards whose violations are rated as more hazardous or which received higher initial penalties tend to have more re-violations. These findings could reflect inspector behavior, with those standards getting more attention and thus being cited more frequently. When, as in the case of OSHA and other enforcement agencies, we know about violations only when inspectors cite them, we need to consider bureaucratic behavior as well as employers' incentives.