Health workforce redesign in Australia: implications for health care professional liability and the provision of professional indemnity insurance

The Productivity Commission's research report entitled Australia's Health Workforce, which was commissioned by the Commonwealth Government and released in January 2006, has been key to recent health workforce policy development. Many of the Productivity Commission's proposals have been endorsed by the Council of Australian Governments and a National Health Workforce Taskforce established to drive change. Surprisingly, the report gave little attention to medico-legal factors that may impact upon workforce supply and consequently may represent a barrier to workforce redesign. This column examines the implications of health workforce redesign and in particular the potential impact of task substitution and task delegation on professional liability and the provision of professional indemnity insurance for private sector health care professionals in Australia. It also identifies and addresses some other medico-legal issues not considered in the report.     

Race and Gender Recidivism Differences Among Juvenile Mental Health Court Graduates

Grounded in the theory of therapeutic jurisprudence, this research explores whether recidivism differs by race, ethnicity, or gender among juvenile mental health court graduates (N = 63). Mean number of pre‐program offenses were compared to the mean number of offenses committed by program completion. Results showed statistically significant reductions in recidivism by both males (p < .001) and females (p < .003). Racial and ethnic minorities demonstrated larger reductions when compared to Whites (p < .001 for Hispanics and p < .01 for combined ethnicities). These results contribute to the literature on effective intervention models for diverse juvenile offender populations.     

Networking in the Shadow of the Law: Informal Access to Legal Expertise through Personal Network Ties

Civil legal problems are common in everyday life, but the costs of obtaining legal representation create barriers to legal action and contribute to disparities in access to justice. Some individuals, however, may have informal access to legal assistance through personal network ties with lawyers, enhancing their responses to justiciable problems. In this study, we draw from theories of social capital and network formation to examine the distribution and mobilization of network‐based legal expertise. Using nationally representative survey data, we find that network‐based access to lawyers is widespread, and most people who have ties to lawyers expect to informally mobilize legal assistance when facing a problem. But people who are most likely to afford formal legal representation are also most likely to have informal access to lawyers. Thus, while informal access to lawyers may shape responses to legal problems, it may also exacerbate inequalities in experiences with civil justice events.     

Fifty years as the fourth pillar of public administration: A polycentric extension of the social equity framework

While public consideration of social equity pre-dates Minnowbrook (Blessett et al., 2019; Burnier, 2021), the field formally recognized social equity as its fourth pillar after the conference (Frederickson, 1971). The National Academy of Public Administration (NAPA, 2000), Svara and Brunet (2004, 2005), and Johnson and Svara (2011) outlined a unified social equity framework along four dimensions: procedural fairness, access, quality, and outcomes. We build on this important work by offering a polycentric extension, which considers what social equity means when government programs are often place-based and delivered in an intergovernmental context with multiple decision-making units across spatial levels (e.g., state, city, neighborhood) simultaneously. Using the Community Development Block Grant as an example, we demonstrate the importance of careful consideration of geographic levels in the delivery of public goods for understanding the program's social equity implications. The polycentric framework can be a useful tool for evaluating the social equity of policies.     

Intergenerational Continuity in Depression: The Importance of Time-Varying Effects,Maternal Co-morbid Health Risk Behaviors and Child’s Gender

Intergenerational continuity in depressive symptoms is well established between mother and child, but there are still important facets of this relationship that are underexplored. We examine intergenerational continuity in depressive symptoms between mother–child dyads as a flexible function of child age and account for the potential moderating role of maternal co-morbid health risk behaviors. Using prospective, self-report data collected yearly from 413 mother–child dyads (210 mother–son dyads and 203 mother–daughter dyads) between child ages 12–17, the results indicate that the effect of maternal depressive symptoms on daughters’ depressive symptoms steadily increases throughout adolescence whereas the effect of maternal depressive symptoms on sons’ depressive symptoms is relatively small, stable, and non-significant during mid-adolescence before increasing in effect in later adolescence. A positive interactive effect between maternal depressive symptoms and intimate partner violence is observed for sons and maternal depressive symptoms and substance use for daughters. A negative interactive effect of maternal depressive symptoms and substance use is observed among sons. Overall, this study identifies particular subgroups for whom intervention programming is most beneficial and suggests targeting health risk behaviors of mothers to lessen the impact of maternal depressive symptoms on offspring.     

Maternal Depressive Symptoms and Adolescent Health Risk Problems: The Role of School Engagement

Maternal depressive symptoms disrupt positive youth development, though the pervasiveness of this disruption is understudied. Additionally, it remains unknown whether prosocial factors such as adolescent school engagement may buffer against this risk factor. Using multigenerational, longitudinal data spanning ten years from an ethnically diverse sample of mother-child dyads (66% Black, 17% Hispanic, and 17% White), this study examines the effect of maternal depressive symptoms in late childhood (ages 8–13) on the development and progression of offspring depressive symptoms, substance use, and delinquent behavior during adolescence (ages 14–17). Further, the study examines whether school engagement moderates the ill effects of maternal depressive symptoms. Mother-son (n?=?212) and mother-daughter (n?=?215) dyads are compared to assess for similarities and differences between male and female offspring. The results indicate that offspring of mothers with greater maternal depressive symptoms are more likely to display higher levels of depressive symptoms, substance use, and delinquency throughout adolescence, although important nuances emerge across outcome and child sex. Additionally, while school engagement itself is associated with reduced depressive symptoms, substance use and delinquency among adolescents, it is not profound enough to offset the risk posed by maternal depressive symptoms. The findings of this study reinforce the pervasive, negative, intergenerational impact of maternal depressive symptoms and has implications for prevention and intervention efforts for adolescent health risk problems.

     

Nonmetric Cranial Trait Variation and Ancestry Estimation in Asian and Asian-Derived Groups

Traditionally, precontact Native Americans and Asian groups have been conflated for aspects of the biological profile due to their distantly shared genetic history, although this grouping remains largely unexplored. This study examines craniomorphic variability to ascertain whether Asian groups can be differentiated from each other and from Asian-derived groups using more fine-tuned models. Cranial and mandibular data for 35 nonmetric traits were recorded on precontact Native Americans (n = 150) and modern Japanese (n = 150) and Thai (n = 150) individuals. Chi-square analyses indicate that all groups exhibit statistically significant differences in most traits. Additionally, cross-validated binary logistic regression equations resulted in correct classification rates in the range of 65.0–93.3% and demonstrate that sex does not contribute to statistical models. Therefore, numerous traits provide discriminatory resolution that detects differences between the samples, thus highlighting the potential utility of nonmetric traits in identifying individuals beyond the traditional African, European, and Asian forensic ancestry groupings.     

Tipping the scales: The causes and consequences of administrative spending

The public administration literature once devoted great effort to identify the determinants of administrative intensity in organizations. While this literature has received some renewed attention, there remain questions about what aspects of organizational environments generate growth in administrative intensity, particularly as related to political oversight and external accountability mechanisms. This article aims to expand current theory on the determinants of administrative personnel and costs using data on four‐year public universities in the United States from 1998 to 2011, as this setting has received considerable criticism for perceived administrative bloat. Findings suggest that which political party is in control substantially influences both administrative costs and total personnel. These administrative levels, in turn, have a curvilinear relationship with student outcomes.