Disclosing health information breaches of confidence,privacy and the notion of the "treating team"

The authors utilise cases collected during a randomised population survey to illustrate some of the legal and policy issues concerning routine transfers of information between treating practitioners. Their analysis suggests that implied consent for many routine uses of health information should not be assumed. An important part of consent to health information disclosure is the patients' ability to tailor its scope and content. This requires that they should be provided with additional information. Introducing the measures advised into the clinical setting would bring health information-gathering practices closer to compliance with the collection principles contained in Australian information privacy legislation.     

To PPB or Not PPB – Budgeting in Victorian Local Government

Budgeting is an important element in a public sector organisation's accounting control system. There are a number of budgetary methods that could be used, each with an explicitly different focus. This article investigates possible reasons for Victorian local government selecting line item budgeting, planning programming budgeting (PPB) or a combination of the two. While program budgeting arguably failed in the USA, research shows it was adopted by local government. Australian researchers report similar findings, yet the introduction of program budgeting into local government has not been explored. Four reasons are postulated: (1) PPB will be adopted because of the complexity of the organisation; (2) PPB will be adopted because it is perceived as an aid to planning; (3) line item budgeting will continue to be used because users are familiar with this type of budgeting; and (4) management's support for the adoption of PPB will be a significant factor in its introduction. A questionnaire was distributed to all the local governments in Victoria and 60 percent were returned. The findings reported in this article confirm the reasons postulated.     

When Is a Gerrymander Not a Gerrymander: Who Benefits and Who Loses from the Changed Rules for Defining Parliamentary Constituencies?

Members of the British Labour party have, not for the first time, criticised the Boundary Commissions’ proposals for new constituency boundaries as gerrymandering. This represents a misuse of the term: the Commissions have produced recommended constituencies in the context of new rules for such redistributions that give precedence to equality of electorates across all seats and the boundaries of those constituencies have been defined without any reference to the likely electoral consequences. The Conservatives, who were responsible for the change in the rules to emphasise electoral equality, wanted to remove a decades‐long Labour advantage in the translation of votes into seats because of variations in constituency size, and the Commissions’ implementation of those rules has achieved that. A Labour advantage has been removed but not replaced by a Conservative advantage: in terms of electoral equality between the two, the playing field has been levelled. Labour's claim to have been disadvantaged by decisions on the electoral register is also examined; the disadvantage is probably only small.     

Immigrant Engagement in Participatory Budgeting in New York City

Participatory Budgeting (PB) is a welcome experiment in participatory democracy in New York City (NYC), one that could produce greater civic engagement of traditionally marginalized groups and more equitable resource distribution. By engaging immigrants, PB aims to affirm and elevate their voices, help develop their civic capacities, and promote their political participation and community empowerment. During the past four years, participation by immigrants (foreign-born residents) in New York City’s PB process (PBNYC) has steadily increased, growing from nineteen to twenty-eight percent of all PB voters. Yet, immigrant participation lags compared to their numbers, with great variation among PB districts. Using a mixed methods approach that incorporates surveys of and interviews with immigrant community members, staff at immigrant serving community-based organizations, and City Council staff, this article aims to parse out the logistical and affective barriers to participation immigrants face in PB districts and how PBNYC’s design attempts to circumvent said barriers and facilitate participation. Ultimately, our study reveals a complex mix of promising practices and structural constraints involved in working toward PB’s “inclusive” and “equitable” aims.     

Beware the razorwire: Psychology behind bars

Nearly 2 million people are incarcerated in federal, state and local correctional facilities in this country. Individuals with serious mental disorders increasingly fill these ranks. The roles psychologists and other mental health professionals adopt while working with this population can become an issue of silent consternation. As a point of departure, some (e.g., Levinson, 1985) have suggested that psychologists rightly function as institutional mediators of conflict, a virtual Marcus Welby of the collective correctional “psyche”. In practice, it is not uncommon for some clinicians to retreat from this approach and do little, or conversely, march in one hundred directions at once. The authors suggest that as psychology service delivery has matured in the past few decades this latter, well-intentioned but unrealistic position should be reconsidered. We suggest that greater depth and definition in the area of forensic psychology, coupled with recently developed ethical and professional standards of care, may serve to guide the clinician when providing services “behind bars”. Authors' Note: The views expressed in this article are solely those of the authors and may not reflect the opinions of the United States Department of Justice, Federal Bureau of Prisons, Texas Department of Criminal Justice, other state or local criminal justice agencies, or the University of Texas at Austin.     

Parental Smoking-specific Communication,Adolescents’ Smoking Behavior and Friendship Selection

In this study, we investigated whether parental smoking-specific communication is related to adolescents’ friendship-selection processes. Furthermore, we investigated whether adolescents and their best friends influence each other over time, and what role parents play in this process. In the present study we used data from the Family and Health project in which at baseline 428 full families participated. In this 2-year, three-wave longitudinal study data were available from fathers, mothers, early adolescents (aged M = 13.4 years, SD = .50), and middle adolescents (aged M = 15.2 years, SD = .60). The majority of the participating adolescents were of Dutch origin (>95%). There was an almost equal distribution of boys and girls, and adolescents with lower, middle, and higher educational levels were equally represented. Analyses were conducted by means of Structural Equation Modeling. Results demonstrate that a high quality of the smoking-specific communication is related to a lower likelihood of adolescent smoking, whereas the frequency is positively associated with adolescent smoking. Both the quality and frequency of parental smoking-specific communication were related to adolescents’ selective affiliation with (non-)smoking friends. The findings suggest that parental smoking-specific communication is associated with adolescent smoking directly but also indirectly by influencing the friends the adolescents will associate with.

A MANAGERIALIST STRIKES BACK

Abstract : In view of a rather one-sided recent debate, "managerialism" in bureaucracy calls for a defence. The alternate paradigm, which is said to turn on legal as opposed to economic rationality, has not been systematically dealt with by the anti-managerialists. The functions to which it refers have always in practice been only a small element of public sector activity. The new artifacts of administration are properly viewed as a public sector reflection of wider thought on organisations and quality of working life. They have some common origins with contemporary private sector practice rather than being derived by copying the private sector. Management and policy skills are not mutually exclusive; indeed the contrary is true. Finally, in relation to broadly accepted ethical norms, modern public administration compares well with that which has gone before.     

Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature

The prediction of suicide remains a major challenge for health care professionals in inpatient settings. A clearer identification of factors specific to inpatient suicide is required to improve both practice and research within this area. This paper provides an overview of the inpatient suicide literature to date focusing on two particularly salient themes: Long term and short term prediction of suicide. Since the concept of short-term suicide risk dominates clinical practice, issues in relation to dynamic risk factors are emphasized.     

Rational Management, Performance Targets and Executive Agencies: Views from Agency Chief Executives in Northern Ireland

The way in which central government services are delivered in both Britain and Northern Ireland has changed significantly since 1988. Executive Agencies have been created with the aim of improving the efficiency and effectiveness of service delivery, with changes being supported by an increasing focus on the rational management model as a basis for improving management in the public sector. This paper is a case study of nine agencies within the Northern Ireland 'family of agencies' and is the first study of its type in the UK. It presents the results of a series of interviews with agency Chief Executives that attempted to identify perceptions with respect to the development, use and impact of mission statements, objectives, targets and performance measures (components of a rational management approach). The main findings of the research include: Northern Ireland Chief Executives perceive an increased focus on quantification since agencification; this focus is viewed as helpful in providing a basis for improving management; systems in practice are considered to be much more flexible than a rigid management model would normally suggest; and, it is thought that the potential adverse consequences of such an approach can be managed.