Improving large-scale implementations by applying research and data analysis: A case study on First 5 LA's implementation of PCIT in Los Angeles County

This paper presents the case of First 5 LA's 5-year countywide implementation of the Parent–Child Interaction Therapy (PCIT) program. Enthusiasts of PCIT point to it as a high-quality parenting program with the potential to positively influence child behavior, reduce recidivism into the child welfare system, and increase caregiver's confidence and self-esteem. In September 2012, First 5 LA, an independent County agency in Los Angeles that advocates on behalf of parents with young children, began a $20 million countywide implementation of PCIT. The collaborative effort between First 5 LA, the Los Angeles County Department of Mental Health, the Los Angeles County Department of Children and Family Services, and the University of California, Davis demonstrates the role that research and data analysis can play in improving large-scale implementations. The authors of this paper were contracted to conduct an evaluation of the implementation of the countywide PCIT program, and preliminary outcomes were analyzed after the first round of data collection in early 2015. This paper will discuss this case and provide examples of how research and data analysis were used effectively to make key improvements to the design and implementation of the program. The paper will then discuss bureaucratic challenges and constraints with the collaborative use of research and data. The paper will conclude with some recommendations on how research and data can effectively be used to influence policy implementation in large-scale implementations involving collaboration among multiple organizations.     

The Contingencies of Societal Accountability: Examining the Link Between Civil Society and Good Government

Corruption interferes with and distorts the processes of political decision making and implementation, often to the disadvantage of the already disadvantaged. Yet our understanding of the factors that might propel a political system from lower to higher levels of probity remains speculative. This article examines the role of one category of actors often touted as an important countervailing force to political power: civil society. Existing case study research provides evidence that civil society can play a decisive role in holding public officials accountable, but that the success of such societal accountability is contingent upon a number of favorable contextual and institutional conditions. The analyses presented here use panel country data to examine whether the strength of civil society affects corruption. The results corroborate the findings of existing case studies; a vibrant civil society mitigates corruption but only provided that conditions such as political competition, press freedom, and government transparency exist in the country.     

Control versus consent in long-term care case management programs: implications for public policy

Case management programs for long-term care include the dual public policy goals of providing access to services and ensuring the efficient and effective application of public funds. We will use a paradigm for social policy development that proposes a conflict between control and consent motives of social policy makers. Illustrations of the limitations and positive elements of control versus consent as applied to case management will be presented.

We will discuss how the tension between these approaches can be used to develop policy that balances the goals of access and cost-effectiveness.     

Risk factors and consequences of unwanted sex among university students: hooking up, alcohol, and stress response

This is the first study of unwanted sexual experiences in the collegiate "hooking-up" culture. In a representative sample of 178 students at a small liberal arts university. Twenty-three percent of women and 7% of men surveyed reported one or more experiences of unwanted sexual intercourse. Seventy-eight percent of unwanted vaginal, anal, and oral incidents took place while--"hooking up,"--whereas 78% of unwanted fondling incidents occurred at parties or bars. The most frequently endorsed reason for unwanted sexual intercourse was impaired judgment due to alcohol. The most frequently endorsed reason for unwanted fondling was that it happened before the perpetrator could be stopped. Of those affected by unwanted sexual intercourse or unwanted fondling, 46.7% and 19.2% reported unwanted memories, 50% and 32.7% reported avoidance and numbing responses, and 30% and 26.9% reported hyperarousal responses, respectively. A preliminary model of unwanted sex and collegiate social dynamics is proposed to provide a heuristic for further research.     

Parent and Metabolite Opioid Drug Concentrations in Unintentional Deaths Involving Opioid and Benzodiazepine Combinations,,

Effects of benzodiazepines on postmortem opioid parent and parent/metabolite blood concentration ratios were determined for fentanyl‐, hydrocodone‐, methadone‐, or oxycodone‐related accidental deaths. These opioids are partially metabolized by the CYP3A4 enzyme system, which is also affected by diazepam and alprazolam. Opioid/metabolite combinations examined were as follows: fentanyl/norfentanyl, hydrocodone/dihydrocodeine, methadone/EDDP, and oxycodone/oxymorphone. Parent opioid concentrations were analyzed for 877 deaths. Parent/metabolite concentration ratios were analyzed for 349 deaths, excluding cases with co‐intoxicants present known to interfere with opioid elimination. Alprazolam in combination with diazepam significantly decreased median hydrocodone concentrations by 48% (p = 0.01) compared to hydrocodone alone. The methadone parent/metabolite concentration ratio was reduced by 35% in the presence of diazepam compared to methadone alone (p = 0.03). Benzodiazepines did not statistically significantly affect fentanyl or oxycodone concentrations. Possible factors affecting opioid concentrations and possible toxicity development, including any differential effects on specific opioids, should continue to be explored.