INSTITUTIONAL LAYERING IN GOVERNING HEALTHCARE QUALITY

Since the 1980s, regulated markets and New Public Management have been introduced in the public sector across the world. How they have affected existing governance mechanisms such as self‐regulation and state regulation has remained largely unexplored, however. This article examines the origins and consequences of institutional layering in governing healthcare quality. Dutch health care, where a market‐based system has been introduced, is used as a case study. The results show that this market‐based system did not replace but modified existing institutional arrangements. As a result, hospitals have to deal with the fragmentation of quality demands. Using the concept of institutional layering, this study shows how different arrangements interact. As a consequence, the introduction of a certain policy reform will work out differently in different countries and policy sectors. Our ‘archaeological’ study in this layering can be seen as an example of how such incremental change can be studied in detail.     

The Challenges to Cooperation Posed by the Nexus of Terrorism and Organized Crime: Comparing the Situations Between the Andean and the Sahel Regions

The recent conflict in the Sahel area is another case where the nexus of terrorism and organized crime causes challenges to the international community. Comparing the situation with that of the Andean region brings forth the challenges faced when dealing with this type of conflict: the states’ weak presence in the remote regions, the insurgents’ ability to offer income and “security” to the people, immediate threat to international investments, unresolved political/regional issues, the marriage of convenience of insurgents/terrorists and organized crime, internal divisions of the insurgent groups and also ideologies surviving or suffering after the elimination of their leaders.     

Is Russia a militocracy? Conceptual issues and extant findings regarding elite militarization

The dominant paradigm for understanding contemporary Russia holds that Vladimir Putin's tenure in office has been accompanied by a massive influx of former KGB and military personnel – so-called “siloviki” – into positions of power and authority throughout the polity and economy. Claims of extensive elite militarization, however, are largely based on the analyses of only one research program and, moreover, the validity of the estimates produced by that research program is open to question on numerous grounds. In this article, we review existing research on elite militarization in Russia; discuss a series of conceptual and empirical issues that need to be resolved if valid and meaningful estimation of military–security representation is to be achieved; introduce new findings; and evaluate the totality of existing evidence regarding whether the Russian state under Putin deserves to be labeled a militocracy. We find that the most straightforward reading of existing data indicates that the percentage of siloviki in the political elite during Putin's first two terms as president was approximately half of that which has been widely reported in both scholarship and the media, and also declined during the Medvedev presidency. In addition, our analysis of a broader cross section of the elite estimates military–security representation during the Putin presidency to have been lower still. Overall, existing data paint a less alarming picture of the depths to which siloviki have penetrated the corridors of power since 2000 than has been commonly portrayed and thereby cast doubt on Russia's status as an “FSB state.” On the other hand, past trends also provide some basis for expecting that the numbers of siloviki will once again rise during Putin's current presidential term.     

Adolescent Co-occurring Disorders Treatment: Clinicians' Attitudes,Values, and Knowledge

This study examined community-based clinicians’ (N = 294) attitudes, background/experiences, values, and knowledge relating to issues of co-occurring disorders, which occur at a high rate among adolescents involved in the juvenile justice system. Study results reveal that clinicians self-rate their clinical values and attitudes at or above the expected level of competency, but they concede that their skill and knowledge levels are not adequate. Comparison measures reveal that employment setting conditions, geographic region, hours worked per week, and strongly held convictions about the importance of integrated mental health and substance use disorders service delivery distinguish clinicians’ co-occurring disorders knowledge levels. Implications are offered.     

“Making It”: Understanding Adolescent Resilience in Two Informal Settlements (Slums) in Nairobi,Kenya

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection–risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12–19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15–19 years) than younger (12–14 years) adolescents. Models for prosocial behavior and models for antisocial behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.     

Internalizing Symptoms: Effects of a Preventive Intervention on Developmental Pathways from Early Adolescence to Young Adulthood

This study examined the mediated and moderated effects of a universal family-focused preventive intervention, delivered during young adolescence, on internalizing symptoms assessed in young adulthood. Sixth grade students (N=446; 52% female; 98% White) and their families from 22 rural Midwestern school districts were randomly assigned to the experimental conditions in 1993. Self-report questionnaires were administered at seven time points (pre-test to young adulthood-age 21) to those receiving the Iowa Strengthening Families Program (ISFP) and to the control group. Results showed that growth factors of adolescent internalizing symptoms (grades 6-12) were predicted by ISFP condition and risk status (defined as early substance initiation). Moderation of the condition effect by risk status was found, with higher-risk adolescents benefitting more from the ISFP. Results also supported the hypothesis that the ISFP's effect on internalizing symptoms in young adulthood was mediated through growth factors of adolescents' internalizing symptoms; risk moderation, however, was only marginally significant in young adulthood. The relative reduction rate on clinical or subclinical levels of young adult internalizing symptoms was 28%, indicating that for every 100 young adults displaying clinical or subclinical levels of internalizing symptoms from school districts not offering an intervention, there could be as few as 72 displaying those levels of symptoms in school districts that offered middle school prevention programming. These findings highlight how the positive effects of family-focused universal interventions can extend to non-targeted outcomes and the related potential public-health impact of scaling up these interventions.     

Associations Between Fifth Graders’ Gender Atypical Problem Behavior and Peer Relationships: A Short-Term Longitudinal Study

An accruing body of evidence supports associations between self-perceived gender typicality and peer relationship difficulties; however, researchers have yet to evaluate peers' perceptions of problem behaviors to gain insight into the social correlates of gender typicality. A short-term longitudinal study was conducted to evaluate associations between gender atypical problem behavior and subsequent peer relational difficulties for 2,076 fifth graders (M age= 10.27; 53% female). Peer nomination methodology was used to assess participants' classroom peer relationships, problem behaviors, and social-emotional characteristics. Findings showed that youth characterized by gender atypical, compared to gender typical, problem behavior (withdrawn boys/aggressive girls vs. withdrawn girls/aggressive boys, respectively) evidenced higher levels of subsequent peer difficulties; moreover, participation in a mutual friendship was associated with decreased risk for peer relationship maladjustment, particularly among youth characterized by gender atypical problem behavior. Results further revealed that, compared to friendless youth, friended youth earned higher prosocial and peer liking scores and, for withdrawn youth, lower emotional sensitivity scores. The present research contributes to our understanding of the potential short-term consequences of youth's gender atypical problem behavior. Findings underscore the need for supplemental conceptualizations of gender typicality as well as multifaceted interventions designed to promote the acceptance of gender nonnormativity, support the development of adaptive peer relationships, and reduce the occurrence of problem behaviors.     

A Prospective Study of Mexican American Adolescents’ Academic Success: Considering Family and Individual Factors

Mexican American youth are at greater risk of school failure than their peers. To identify factors that may contribute to academic success in this population, this study examined the prospective relationships from 5th grade to 7th grade of family (i.e., human capital [a parent with at least a high school education], residential stability, academically and occupationally positive family role models, and family structure) and individual characteristics (i.e., externalizing symptoms, bilingualism, gender, and immigrant status) to the academic performance of 749 Mexican American early adolescents (average age = 10.4 years and 48.7% were girls in 5th grade) from economically and culturally diverse families as these youth made the transition to junior high school. Results indicated that while controlling for prior academic performance, human capital and positive family role models assessed when adolescents were in 5th grade positively related to academic performance in 7th grade. Further, being a girl also was related to greater 7th grade academic success, whereas externalizing symptoms were negatively related to 7th grade academic performance. No other variables in the model were significantly and prospectively related to 7th grade academic performance. Implications for future research and interventions are discussed.     

Ethnic Microaggressions and the Depressive and Somatic Symptoms of Latino and Asian American Adolescents

Ethnic microaggressions are a form of everyday, interpersonal discrimination that are ambiguous and difficult to recognize as discrimination. This study examined the frequency and impact of microaggressions among Latino (n = 247) and Asian American (n = 113) adolescents (M (age) = 17.18, SD = .75; 57 % girls). Latino adolescents reported more frequent microaggressions that dismiss their realities of discrimination and microaggressions characterized by treatment as a second class citizen than Asian Americans, but similar levels of microaggressions that highlight differences or foreignness. There were no ethnic differences in the extent to which adolescents were bothered by microaggressions. Moreover, even supposedly innocuous forms of discrimination are associated with elevated levels of anxiety, anger, and stress, which may increase feelings of depression and sickness. Microaggressions should be recognized as subtle discrimination that send messages about group status and devaluation, and similar to overt discrimination, can evoke powerful emotional reactions and may affect mental health.     

Characterizing the Self-System over Time in Adolescence: Internal Structure and Associations with Internalizing Symptoms

The longitudinal effects among self and identity processes, and between these processes and internalizing symptoms, are not well understood. As a result, the present study was designed to ascertain the over-time effects among identity commitment, reconsideration of commitments, and self-concept clarity, as well as to map the interplay of these self and identity processes with anxiety and depressive symptoms in early adolescence. A sample of 923 Dutch adolescents (mean age 12.4 years at Time 1; 49.3% female) participated at each of five annual assessments. Multivariate growth curve and cross-lagged panel models indicated that the association between self-concept clarity and commitment was bidirectional, that reconsideration occurs based on problems or dissatisfaction with self-concept clarity and with identity commitments, and that self-concept clarity (but not commitment or reconsideration) temporally precedes depressive and anxiety symptoms. Results are discussed in terms of the structure of the self-system and its associations with internalizing symptoms.