Responsibilities of directors of not-for-profit corporations faced with sharing control with other nonprofit organizations in health industry affiliations: a commentary on legal and practical realities.

This article concerns the legal responsibilities of not-for-profit corporation directors in merges and affiliations with other not-for-profits. The article considers three sets of legal duties board members have, ancillary contractual obligations, madatory statutes and procedural laws, and contextual legal duties.

The brave new world of health care compliance programs.

The need for corporate compliance programs in health care delivery systems is ever increasing. This article identifies the key items a good program should contain, and addresses issues raised by the existence of a program as well as its implementation.

Avoiding antitrust compliance difficulties in mergers and acquisitions.

Highly publicized court cases may lead hospital executives to believe that almost any merger or joint venture will provoke costly antitrust litigation. Executives need to realize that many types of workable and useful transactions may be accomplished without incurring legal action by antitrust law enforcement agencies.

Advance directives--medical record aspects of the Patient Self-Determination Act.

The next several years should bring forth a great deal of both law and lore on the implementation of the PSDA. Health information managers should be close to all of these developments and, state by state, in a position to contribute to the accomplishment of the public policy goals reflected in the enactment of the PSDA.

Health law: medical record implications of the Safe Medical Devices Act of 1990.

Health information management professionals have involuntarily been placed by Congress and the FDA not only in the important position of being able to assist their employers in complying with the SMDA, but also at the cutting edge in the development of new and more pervasive techniques of healthcare regulation. The implementation of the SMDA in the near term and over the next 48 months promises to have substantial implications for those charged with responsibility for medical record information.

Should not-for-profit organizations be exempt from antitrust laws?

The responsibilities and legal duties of not-for-profit healthcare organizations differ from those of for-profit organizations. Because of this difference, not-for-profit organizations often cannot be treated and regulated as for-profit institutions would be, especially when the legal question of antitrust arises. When Federal agencies responsible for enforcing antitrust laws begin to understand the difference, they will also begin to realize that strategies by not-for-profit organizations, such as mergers, acquisitions, and consolidations, are not opportunities to monopolize an industry, but means of survival.

Changing capital needs means changing capital solutions. Roundtable on capital financing.

For a full day, seven individuals representing varied backgrounds and viewpoints within the healthcare industry discussed the issues confronting capital financing for healthcare institutions--capital requirements and investment, tax reform, capital costs under PPS, and alternative methods of financing. This discussion, sponsored by the Healthcare Financial Management Association and Smith Barney, Harris Upham & Co., Inc., provided a public forum for discussion of upcoming capital financing issues and concerns. The article presented here, taken from that discussion, focuses on the upcoming capital needs of the industry. A "redeployment" of capital in the healthcare industry is going to occur because the industry is moving away from the acute care setting into long-term and ambulatory care. The mainstay of the healthcare industry--acute care--will be broken down into different components, requiring a significant redeployment of capital.

Teaching behaviorally handicapped preschool children to share.

We examined the effectiveness of Barton and Ascione 's (1979) package for training sharing in a classroom setting with six behaviorally handicapped preschool children, four of whom were also developmentally delayed. Individual responses in sharing and not sharing were examined. Training consisted of initial instructions, modeling, and behavioral rehearsal, followed by teacher prompts and praise regarding sharing directly in a classroom free play period. Introduction of training in a multiple-baseline design across three pairs of children resulted in substantial increases in sharing for five of the six children. Results for negative interactions were less clear but suggested that concomitant decreases occurred for the same five children. The response analysis indicated that (a) individual components of sharing (offers, requests, and acceptances ) all increased with training; (b) most children were more likely to initiate sharing through requests than through offers; (c) the proportion of sharing initiatives accepted by peers increased with training despite a much greater absolute number of initiatives; and (d) of the three negative behaviors (opposing play, taking without asking, and aggression) examined as incompatible with sharing, the most prevalent response was opposing other children's play. Individual differences in initial social repertoires and responsiveness to training were examined with respect to their implications for research and practice. Overall, the findings provide an encouraging indication of an intervention program for children with behavioral, social, and developmental handicaps.

Using water mist to reduce self-injurious and stereotypic behavior.

A mist of water sprayed in the face was used as a punisher for stereotypic and self-injurious behaviors by a boy diagnosed as severely mentally retarded with autistic-like behaviors. The boy had a long history of mouthing and hand-biting behaviors. The latter behavior was evinced by noticeable scar tissue on the backs of his hands. The study took place in a self-contained public school classroom for autistic children and other children with severe communication disorders and functional mental retardation. An ABAB withdrawal design with no treatment probes demonstrated the rapid and dramatic suppressive effects that the response-contingent water mist had on the target behaviors. This procedure was taught to classroom personnel who were able to maintain the suppression with minimal interruption of educational programming for the subject or his peers. No adverse physical effects were observed nor did the child attempt to escape or struggle against the procedure. The results are discussed in relation to ethical considerations and the use of response-contingent aversive stimulation.

Self-instructional training to increase independent work performance in preschoolers.

The generalized effects of self-instructional training on the classroom performance of three "impulsive" preschool children were investigated using a multiple-baseline design across subjects. Measures of child and teacher behavior in the classroom were obtained through direct observations during a daily independent work period. Self-instructional training followed Meichenbaum and Goodman's (1971) approach, except that training materials consisted of naturalistic task worksheets rather than psychometric test items and training sessions were of shorter duration. For all three children, self-instructional training resulted in increased levels of accuracy on worksheets in the classroom that were similar to those used in training. Results related to several supplementary measures were less clear; however, they suggested that rates of on-task behavior may also have improved, and that a mild classroom intervention further strengthened on-task rates and effect consistent work completion for all three children. The findings suggested that generalized increases in accuracy on classroom worksheets were related to the naturalistic format of the self-instructional training sessions. The level of teacher attention was controlled to rule out its effect on changes in child behavior.