Physician-assisted suicide in Oregon: a medical perspective

This Article examines the Oregon Death with Dignity Act from a medical perspective. Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The problem lies primarily with the Oregon Public Health Division ("OPHD"), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients. We make explicit suggestions for what OPHD would need to do to change that.     

Changing policy and practice in the child welfare system through collaborative efforts to identify and respond effectively to family violence

The Greenbook provides a roadmap for child welfare agencies to collaborate and provide effective responses to families who are experiencing co-occurring child maltreatment and domestic violence. A multisite developmental evaluation was conducted of six demonstration sites that received federal funding to implement Greenbook recommendations for child welfare agencies. Surveys of child welfare caseworkers show significant changes in several areas of agency policy and practice, including regular domestic violence training, written guidelines for reporting domestic violence, and working closely and sharing resources with local domestic violence service providers. Case file reviews show significant increases in the level of active screening for domestic violence, although this increase peaks at the midpoint of the initiative. These findings, coupled with on-site interview data, point to the importance of coordinating system change activities in child welfare agencies with a number of other collaborative activities.     

Legal Accountability in the Service-Based Welfare State: Lessons from Child Welfare Reform

Current trends intensify the longstanding problem of how the rule of law should be institutionalized in the welfare state. Welfare programs are being redesigned to increase their capacities to adapt to rapidly changing conditions and to tailor their responses to diverse clienteles. These developments challenge the understanding of legal accountability developed in the Warren Court era. This article reports on an emerging model of accountable administration that strives to reconcile programmatic flexibility with rule-of-law values. The model has been developed in the reform of state child protective services systems, but it has potentially broad application to public law. It also has novel implications for such basic rule-of-law issues as the choice between rules and standards, the relation of bureaucratic and judicial control, the proper scope of judicial intervention into dysfunctional public agencies, and the justiciability of "positive" (or social and economic) rights.     

Mining Electronic Health Records Data: Domestic Violence and Adverse Health Effects

Intimate partner violence (IPV) often culminates in acute physical injury, sexual assault, and mental health issues. It is crucial to understand the healthcare habits of victims to develop interventions that can drastically improve a victim’s quality of life and prevent future abuse. The objective of this study is to mine de-identified and aggregated Electronic Health Record data to identify women’s health issues that are potentially associated with IPV. In this study we compared health issues of female domestic abuse victims to female non-domestic abuse victims. The Domestic abuse population contained 5870 patients, while the Non-Domestic Abuse population contained 14,315,140 patients. Explorys provides National Big Data from the entire USA. Statistical analysis identified 2429 terms as significantly more prevalent among victims of domestic abuse, compared to the general population. These terms were classified into broad categories, including acute injury, chronic conditions, substance abuse, mental health, disorders, gynecological and pregnancy related problems.     

Monitoring the uninsured: a state policy perspective

Because states have primary responsibility for the implementation of public health insurance programs, states need timely, good quality data to evaluate programs, monitor trends in the number and characteristics of the uninsured, and better understand the dynamics of health insurance coverage. This article provides a synthesis of the data sources available to states for monitoring rates of health insurance coverage. Information was collected through a comprehensive review of state and national health surveys and in-depth interviews with state analysts in all fifty states. Our findings suggest that national surveys do not meet states' needs for data, and in response, states have initiated their own household surveys. We provide information on thirty-six household surveys that are used to estimate state levels of health insurance coverage. We recommend that national and state efforts be better coordinated to facilitate efficient use of resources to achieve good state-level date.     

Ideology and campaign activity at three levels of government

This article examines the relationship between self-designated political ideology, opinions on twenty-one issues, and campaign activity at local, state, and national levels. The samples examined include delegates to the 1984 Party Conventions in eleven states. Generally, the findings indicate that ideology and issue position are most strongly associated with activity in national campaigns. Among Democrats liberalism is associated with national activity, whereas among Republicans those who are conservative are most active in national campaigns. Some important intraparty differences are found between local campaign activists and national activists. For example, among Democrats local campaign activists are much more conservative than national activists on several issues.     

Industrial structure of the federal sector: Evidence from bureau market share data

This paper examines the industrial organization of the federal sector by measuring the variation of bureau market shares of appropriations. The two measures employed are rank-shift analysis (turnover) and the Hymer-Pashigian index of market share instability which have been used to indicate the level of competitiveness within private sector industries. The results of both the rank-shift and market share instability analyses strongly suggest that there is considerable competition among bureaus within the federal sector. These results are consistent with the hypothesis and existing evidence that bureaus engage in nonprice competitive strategies.     

Parents' perception of adolescent behavior problems

Fifty-seven parents, usually mothers, rated their adolescent sons and daughters on the Walker Checklist at the time of their initial clinic appointment. Parents perceived this group of adolescents as more disturbed than the elementary school age normative group on three of the scales, Immaturity, Acting Out, and Distractibility. The results support an increase in behavior problems at adolescence which is more marked for the younger females and younger males. Neither gender nor age, separately, determines the degree of behavioral disturbance, with one exception. The scores of both the younger and older male groups are significantly higher than the scores of their corresponding female groups on the school-related Distractibility scale.Received her Ph.D. from University of Washington 1959. Interests are adolescent development, personality, and evaluative research.Community Practice student in the Adolescent Clinic.     

The spectrum of sexual abuse in daycare: An exploratory study

Findings from an exploratory study of 48 children sexually abused in daycare centers and daycare homes are presented. About two thirds were female and one third male. Approximately half of victims were maltreated by a single perpetrator and about half by more than one perpetrator, in the latter instance almost always by both men and women. On average, the children were subjected to 5.3 types of sexual abuse, experienced 2.1 different sorts of threats to obtain their cooperation or prevent disclosure of their victimization, and suffered from 3.7 symptoms regarded as sequelae of sexual abuse. Differences in the characteristics of offenders, victims, the sexual abuse, threats, and sequelae were found based upon the daycare context, that is, whether children were victimized in a center with multiple perpetrators, a center with a single perpetrator, or a daycare home.