Mapping residents' perceptions of neighborhood boundaries: a methodological note.

Neighborhood influences on children and youth are the subjects of increasing numbers of studies, but there is concern that these investigations may be biased, because they typically rely on census-based units as proxies for neighborhoods. This pilot study tested several methods of defining neighborhood units based on maps drawn by residents, and compared the results with census definitions of neighborhoods. When residents' maps were used to create neighborhood boundary definitions, the resulting units covered different space and produced different social indicator values than did census-defined units. Residents' agreement about their neighborhoods' boundaries differed among the neighborhoods studied. This pilot study suggests that discrepancies between researcher and resident-defined neighborhoods are a possible source of bias in studies of neighborhood effects.

Neighborhood views on the definition and etiology of child maltreatment.

OBJECTIVE: The purpose of this study, as part of a larger study on neighborhoods and child maltreatment, was to determine how parents residing in neighborhoods with differing profiles of risk for child maltreatment reports defined child abuse and neglect and viewed its etiology. METHOD: Parents (n = 400) were systematically selected from neighborhoods (n=20) with different profiles of risk for child maltreatment report rates. As part of a larger interview, parents were asked to generate lists of behaviors that they would define as child abuse and neglect and to rate 13 etiological factors on a 10 point scale as to their contribution to the occurrence of child maltreatment. RESULTS: While there were differences in definitional emphases, with African-American parents including behaviors of neglect and European-American parents including behaviors of physical abuse, there was marked congruence on the catalogue of behaviors that parents would define as child abuse and neglect. Four factors were identified that explained almost two-thirds of the variance in parents' etiological explanations: poverty and family disruption, substance abuse and stress; lack of moral and family values; and individual pathology. These factors were related to neighborhood conditions, individual perceptions of neighborhood and individual characteristics. CONCLUSIONS: Community-based programs aimed at preventing or ameliorating child maltreatment must have at their very core an understanding of how populations being served define child maltreatment and why they believe that it occurs.

Neighborhoods and child maltreatment: a multi-level study.

OBJECTIVE: To better understand how neighborhood and individual factors are related to child maltreatment. METHOD: Using an ecological framework, a multi-level model (Hierarchical Linear Modeling) was used to analyze neighborhood structural conditions and individual risk factors for child abuse and neglect. Parents (n = 400) of children under the age of 18 were systematically selected from 20 randomly selected census-defined block groups with different risk profiles for child maltreatment report rates. Parents were administered the Neighborhood Environment for Children Rating Scales, the Child Abuse Potential Inventory, the Zimet measure of social support, and the Conflict Tactics Scales as a measure of childhood experience with violence. RESULTS: Neighborhood factors of impoverishment and child care burden significantly affect child abuse potential after controlling for individual risk factors. However, neighborhood effects are weaker than they appear to be in aggregate studies of official child maltreatment reports. Variation in child abuse potential within neighborhoods is greater than between neighborhoods. However, adverse neighborhood conditions weakend the effects of known individual risk and protective factors, such as violence in the family of origin. CONCLUSIONS: If individual potential for child maltreatment is more evenly distributed across neighborhoods than reported maltreatment, then neighborhood and community play an important, if as yet unspecified, role in child maltreatment. Multi-level models are a promising research strategy for disentangling the complex interactions of individual and contextual factors in child maltreatment.

Impoverishment and child maltreatment in African American and European American neighborhoods.

Although it is well documented that child maltreatment exerts a deleterious impact on child adaptation, much less is known about the precise etiological pathways that eventuate in child abuse and neglect. This paper reports on a multimethod ecological study of the relationship between neighborhood structural factors and child maltreatment reports in African American and European American census tracts. The study had two major components. First, in an aggregate analysis, the effects of four measures of community structure (impoverishment, child care burden, instability, and geographic isolation) on child maltreatment report rates were examined separately for predominantly African American (n = 94) and predominantly European American (n = 189) census tracts. Impoverishment in particular had a significantly weaker effect on maltreatment rates in African American than in European American neighborhoods. Second, focused ethnographies were conducted in four selected census tracts with child maltreatment report rates in the highest and lowest quartiles. Ethnographic data point to the importance of the social fabric in accounting for differences in child maltreatment report rates by predominant neighborhood ethnicity.

Community level factors and child maltreatment rates.

Using census and administrative agency data for 177 urban census tracts, variation in rates of officially reported child maltreatment is found to be related to structural determinants of community social organization: economic and family resources, residential instability, household and age structure, and geographic proximity of neighborhoods to concentrated poverty. Furthermore, child maltreatment rates are found to be intercorrelated with other indicators of the breakdown of community social control and organization. These other indicators are similarly affected by the structural dimensions of neighborhood context. Children who live in neighborhoods that are characterized by poverty, excessive numbers of children per adult resident, populations turnover, and the concentration of female-headed families are at highest risk of maltreatment. This analysis suggests that child maltreatment is but one manifestation of community social organization and that its occurrence is related to some of the same underlying macro-social conditions that foster other urban problems.

Factors contributing to the early rehospitalization of elderly people.

The main determinants of rehospitalization of elderly people were studied with a longitudinal sample of 264 persons older than 60 years at a midwestern, urban, university-affiliated hospital. Path analysis was applied to survey data collected for this study. Seventeen percent of subjects were readmitted within 30 days of discharge. Controlling for health and socioeconomic factors, the main determinant of readmission was the discharge placement; those placed back into the community for care in the home were more likely to be rehospitalized than those discharged to institutions. Contrary to predictions in the literature and the authors' expectations, patient involvement in discharge planning had no discernible effect on placement decisions and subsequent hospitalization. The implications of these findings for discharge planning by social workers are discussed.

An assessment of the Health Assessment Questionnaire functional ability index among women with systemic lupus erythematosus.

The validity of the Health Assessment Questionnaire (HAQ) functional ability instrument was tested in 120 women with definite systemic lupus erythematosus (SLE) from rheumatology clinics at 2 local tertiary care institutions. Reliability and validity results for this population of women (mean age: 41 years +/- 13; age at diagnosis 33 years +/- 13) indicate that (1) the HAQ was internally reliable (standardized alpha = 0.9443) with no interitem correlation exceeding (r = 0.75); (2) confirmatory factor analysis identified 2 predominant factors among the HAQ components suggestive of large limb gross movements (e.g., walking, arising) and small limb fine movements (e.g., the ability to eat and firmly grip objects). Cumulatively, the 2 factors accounted for 64% of the variation in HAQ ability response. The HAQ response was also valid when compared to the overall disability index (r = 0.65 to 0.82) and other common disease variables that were reported by the patient and collected by the physician at the time of clinical examination. In addition, when stratified by active and inactive disease as defined by the Lupus Activity Criteria Count, inactive patients reported lower disability components (dress, arise, eat, walk, hygiene, reach, grip and activity) than active patients. These findings confirm the valid use of the HAQ as a measure of disability, when compared with other clinical measures of disease status and activity, in female patients with SLE.

Ethnicity, self-care, and use of medical care among the elderly with joint symptoms.

Elderly individuals with self-reported joint symptoms representing three ethnic groups (i.e., blacks [n = 105], Hispanics [n = 100], and whites of Eastern European origin [n = 112] answered questions about their use of self-care and medical care for these symptoms. Ethnic groups differed in both self-care practices and their use of medical care for joint symptoms. Multiple regression analyses demonstrated that arthritis-specific and general health status were better predictors than ethnicity of the tendency to rely on self-care and medical care. There was no evidence that self-care served as a substitute for medical care.

Research in patient and family decision making regarding life sustaining and long term care.

Involving patients in making decisions about their medical treatment and health care is a widely accepted goal. Yet there is considerable debate about what constitutes effective involvement, how much involvement is desirable, what are the benefits of involvement and how practitioners can help patients recognize and communicate their own preferences. Recent research on patient and family decision making processes provide some answers to these questions. These studies also point to key areas for future research on these issues.

Locus of control and decision making for posthospital care.

Discharge planning involves making choices about the type and amount of posthospital care a patient will receive within the reality of resource constraints. Elderly patients discharged from an acute-care hospital vary in their reactions to this decision-making process and the degree to which they exert final control over the decision. Perceived lack of control over the decision is associated with posthospital psychological distress for patients with high levels of internal locus of control, but not for those whose expectations for internal control are low.

An assessment of the Arthritis Impact Measurement Scales in 3 ethnic groups.

The Arthritis Impact Measure Scales (AIMS) have established validity and reliability in general adult populations with medically diagnosed rheumatoid arthritis. Our analysis extends this work to a community based sample of elderly individuals with self reported joint systems in 3 ethnic groups: Hispanics (N = 100), whites of Eastern European origin (N = 112) and blacks (N = 105). With the exception of the Social Activity and ADL scales, acceptable reliability and validity of the AIMs scales are found for all 3 groups. The assumption of factor invariance across ethnic groups is also supported.

Problems in access to benefits and services among persons with rheumatoid arthritis.

This exploratory survey of 100 patients with rheumatoid arthritis (RA) was conducted (1) to learn about the types and frequencies of disability law-related problems encountered as a result of having RA, and (2) to assess the respective relationships between the number of disability law-related problems reported and the patients' sociodemographic and RA disease characteristics. The underlying concern of health care and legal professionals was that the often protracted exclusionary RA diagnostic process and the episodic nature of RA could make it more difficult to establish a precise clinical diagnosis and level of disability. Therefore, patients with RA would encounter difficulties in accessing entitlements and benefits provided under disability laws. The findings from this survey were used to develop a legal manual to empower health care professionals and people with arthritis to take litigative, legislative, social action, and self-help measures to redress the disability-law related problems.

'Brain death' and organ retrieval. A cross-sectional survey of knowledge and concepts among health professionals.

A sample of 195 physicians and nurses likely to be involved in organ procurement for transplantation was interviewed about knowledge, personal concepts, and attitudes concerning "brain death" and organ donation. Only 68 respondents (35%) correctly identified the legal and medical criteria for determining death. Personal concepts of death varied widely. Most respondents (58%) did not use a coherent concept of death consistently; others (19%) had a concept of death that was logically consistent with changing the whole-brain standard to classify anencephalics and patients in a persistent vegetative state as dead. The findings demonstrate confusion about correct criteria for determining death and differences in concepts of death that might prove troublesome to the transplantation enterprise. We conclude that health professionals should do more to resolve the clinical and conceptual issues in the definition and determination of death before policies concerning organ retrieval are changed.

KIE: The authors surveyed 195 physicians and nurses likely to be involved in organ procurement for transplantation to determine knowledge, personal concepts, and attitudes concerning brain death and organ donation. Thirty-five percent of those surveyed correctly identified the legal and clinical criteria for determining death. There was a wide variation in personal concepts of death, with most respondents not using a coherent concept consistently. Others held a concept of death that was consistent with expanding the definition of brain death. Twenty-three percent of the respondents opposed required request laws. The authors conclude that their survey demonstrates confusion about determining death and differences in concepts of death that have implications for procurement of organs for transplantation. They recommend that health professionals do more to resolve the issues in the definition and determination of death.

Evaluating screening and early intervention: a puzzle with many pieces.

This article reviews some conceptual and methodological issues which arise in evaluating screening programs, screening protocols, lead time, sensitivity and specificity, and base rates among others. Benefits of screening need to be separated from those of early intervention. Replicable protocols are needed to strengthen studies of the benefits of preadmission screening. Preadmission discharge planning is an idea which warrants consideration.

Prospective payment requires increased attention to quality of post hospital care.

The quality of post hospital care is of growing importance as length of stay in hospitals declines and patients are discharged with greater dependency and instability in their conditions. Recovery and rehabilitation and, at times, even survival are contingent upon post hospital care being accessible and adequate. However, it is difficult to monitor and evaluate post hospital care and typically no one institution can be held responsible for its quality. Quality assurance in post hospital care requires interorganizational collaboration and social workers can take the lead in establishing these programs.

Assessment of the reliability and validity of the arthritis impact measurement scales for children with juvenile arthritis.

There are few multidimensional measures of functional status in children, and none have been developed for children with juvenile arthritis (JA). This report describes an attempt to apply selected components of the Arthritis Impact Measurement Scales (AIMS), which were developed and validated for adults, to a sample of children with active JA (n = 60) or inactive JA (n = 17). Our results suggest that the Pain scale and the Physical Activity scale are the most reliable measures for children with JA; the correlations of the Pain scale, Physical Activity scale, and Dexterity scale results with the clinical measures of JA diagnostic category and joint count support the convergent validity of these scales for the active JA group; and the AIMS revised Physical Disability dimension and the Pain dimension, used to predict the children's classification in the active or inactive JA group, evidence discriminant validity. Additional studies of children with a wider range of impairments are needed to further assess the usefulness of the AIMS for children with JA.

Implementing monitoring and evaluation systems in social work.

This article focuses on the steps for developing monitoring systems for quality assurance and suggests key criteria and sources of data for evaluating the quality of social work services on an ongoing basis, particularly discharge planning.