Medicine and Health Sciences Commons^™

We Are The Roots: The Culture Of Home Health Aides, Ruth Glasser, Jeremy Brecher

New England Journal of Public Policy

This article focuses on the contributions of its workers' culture to the success of Cooperative Home Care Associates (CHCA). It examines what the home healthaides bring to the culture of the company, how their contribution develops through their experience with the company, and how their heritage contributes to their CHCA work and to the company as an organization. This is one segment of a larger study that will deal with the background and history of CHCA, the vision of the founders and its implementation, the role of organizational policy, and the contribution of management philosophy to its accomplishment.

Distance Learning In Retrospect, Kathryn C. Cauble, Judith D. Burnett, S. Suzanne Roche

New England Journal of Public Policy

This article describes the design and implementation of a long-term education project, a joint effort of the Service Employees International Union, Bunker Hill Community College, and nine Massachusetts community hospitals. The object was to offer an associate degree in medical radiography to eleven participants. Details of the funding source, admission process, curriculum, student support services, quality assurance, and problems and solutions are outlined. The authors offer recommendations for future replication.

Performance And Accountability In Human Services: Ownership And Responsibility Of Professionals, Anna-Marie Madison

New England Journal of Public Policy

The recent frenzy of grant makers and government agencies in requiring impact evaluations of all grant recipients has created consternation among human service providers. To ensure their agencies' survival and worker job security, the leaders are faced with meeting the demands offunder-driven programming. Agencies seeking funding must comply with funder-defined needs and accountability criteria rather than their public missions. This article describes the use of mission-based performance evaluation rather than funder compliance to demonstrate accountability for mission accomplishment.

Improving Workforce Conditions In Private Human Service Agencies: A Partnership Between A Union And Human Service Providers, James Green

New England Journal of Public Policy

In 1995 the Service Employees International Union Local 509 and four Massachusetts human service providers signed an unusual agreement to forge a partnership in which employers would remain neutral while the union approached its workers with an offer to advocate in the state legislature for greater funding for private human service employees and to promote cooperative relations with their employers. This study examines the context of the agreement and the pressures on public employee unions and small human service providers whose workforce copes with low wages, high turnover, meager benefits, and poor public image as well as the give-and-take between …

From Welfare To What?: The Limitations Of Low-Income Work, Lande Ajose

New England Journal of Public Policy

The premise of the welfare law enacted by Congress is that people living in poverty could vastly improve their economic status if only they were employed. The author argues that economic security for welfare recipients will not be realized simply by increasing the labor-force attachment. Home health aides comprise an occupation that could absorb many of the large pool of workers expected to join the labor market because demand for their services is high and barriers to entry are low. However, as this survey shows, the home health field offers limited promise to welfare recipients because, significantly for women rolling …

Workplace Education At The Bottom Rungs, Andrés Torres

New England Journal of Public Policy

In the late 1980s, observers of the Massachusetts hospital industry were predicting a severe shortfall in skilled technical workers. The Worker Education Program (WEP) emerged as one of several responses to this projected labor shortage. It was premised on the idea of an internal solution to the need for workforce development, shifting the focus from external recruitment to upgrading of incumbents — nutrition, maintenance, clerical, and secretarial staff— and from traditional classroom training to workplace education. Other features of the WEP model made it an extremely interesting experiment: it was operated by labor-management partnership, it was located statewide in nine …

The Potential Impact Of Workforce Development Legislation On Cbos, Edwin Meléndez

New England Journal of Public Policy

The proposed congressional legislation revamping the employment and training system will result in budget cuts, program consolidation, and block grants for the states. These changes are potentially harmful to community-based organizations (CBOs) because (J ) they eliminate categorical funding that traditionally has required contracting with organizations which specialize in servicing the disadvantaged, and (2) they introduce stricter performance standards that may be unattainable for many small-scale operations. However, the adoption of best practices in serving non-English-speaking and poor populations, increasing connections to emerging government intermediaries in labor markets, and establishing greater linkages to postsecondary educational institutions may offer CBOs the …

Nursing: A New Day, A New Way, Lin Zhan, Jane Cloutterback

New England Journal of Public Policy

The U.S. health care environment is changing rapidly. Its structure, financing, and delivery are being reconfigured toward an integrated system based on managed care. Increasingly, national interest in health promotion and disease prevention is moving care away from a disease-oriented, institutionally based model to a population-focused, wellness-oriented, and community-based system. Health care consumers are diversifying in age, ethnicity, and socioeconomic status. The approach emerging from these changes and others requires nursing to rethink, redesign, and retool its workforce to meet new challenges. This article analyzes nursing education, practice, and operations. The authors discuss the dilemmas and complexity of developing an …

Introduction, James Jennings

Trotter Review

The Summer 1995 issue of the Trotter Review, "Public Health and Communities of Color: Challenges and Strategies," provides a range of essays and two personal commentaries on facets of public health, race, and ethnicity in urban America. The essays are written by scholars and activists familiar with public health and issues of race, access, and diversity. The first article is the Executive Summary of the Institute of Medicine's national report, Balancing the Scales of Opportunity: Ensuring Racial and Ethnic Diversity in Health Professions. This report focuses on the problem of underrepresentation of Blacks, Latinos, and Native Americans in the …

Executive Summary: Prepared By Institute Of Medicine, Marion Ein Lewin, Barbara Rice

Trotter Review

The underrepresentation of minorities in the health and other professions has long cast a shadow over our nation's efforts to develop a more representative and productive society. Many laudable and durable programs nave been developed over the past 20 years to enlarge the presence of minorities in health careers, but these efforts have been unable to develop the infrastructure and momentum to produce and sustain an adequate number of minority professionals among the ranks of America's clinicians, researchers, and teachers. While there has been an increase in the numbers of African Americans, Hispanics and Native Americans enrolled in professional schools …

The Multicultural Mental Health Research Center (Mmhrc), Castellano Turner

Trotter Review

African Americans, Asian Americans, Hispanic/Latino Americans, and Native Americans have had relatively less access to the resources of society compared to white Americans. These resources include such things as educational and employment opportunities, political and economic power, and the goods and services that a prosperous society can produce. Health care is an important resource to which access is not equal for all groups. African Americans and other ethnic minority groups are, by most indices of health care access and utilization, underserved. Mental health services, in particular, have been shown to be less available to ethnic minority populations. Jones and Korchin, …

Disparities In The Health Care Status Of Women: Implications For Research, Marcia I. Wells-Lawson

Trotter Review

Even a cursory review of data on the health status of women reveals striking differences by race. According to data from the National Center for Health Statistics, death rates among Black women from the three leading causes of death (cardiac disease, cancer and cerebrovascular disease) exceed those of white, Asian, Native American and Latina women for each age category from 45-84. With the exception of Black women, the death rates among white women from these diseases exceed those of other ethnic groups of women. Data on two of the risk factors for cardiac and cerebrovascular diseases (hypertension and obesity), show …

Can The Health Needs Of African American Men Be Met Through Public Health Empowerment Strategies?, Deborah Prothrow-Stith, Eric Whitaker

Trotter Review

Health promotion and disease prevention efforts, which use empowerment strategies and emphasize community control, are essential to overcoming the legacy of medical malfeasance and successfully improving the health status of black males. This discussion depicts the legacy of harm and presents the case for empowerment strategies; it also describes one Boston community-based program example of utilizing an empowerment strategy and concludes with a challenge to all health professionals to become enablers of empowerment rather than obstructions to it.

A National Minority Organ/Tissue Transplant Education Program: The First Step In The Evolution Of A National Minority Strategy And Minority Transplant Equity In The Usa, Clive O. Callender, Alvina S. Bey, Patrice V. Miles, Curtis L. Yeager

Trotter Review

In 1978, members of the Southeastern Organ Procurement Foundation approached us concerning the disparity between the large number of African American patients, 50% to 70% of all patients on dialysis (artificial kidney machines), and the small number of African American donors (3%), and asked us why and what could be done about it? From my perspective as an African American transplant surgeon at Howard University, these observations piqued my curiosity and I agreed to investigate them. Our investigation took us into three areas: 1. An evaluation of the data regarding transplantation in patients at the Howard University Hospital Transplant Center …

Programmatic Responses To The Aids Epidemic By Communities Of Color In Massachusetts, Ron E. Armstead

Trotter Review

The Centers for Disease Control found that minorities now account for more than half of all the HIV cases in the United States. For African Americans, the rate was more than 5 times as high as that for whites. Further, the disease has equally affected women and children in the African American community; 84% of the AIDS cases involving children age 12 and under can be found in the African American community. AIDS has now become the second leading cause of death for African American women. This essay describes a research project focusing on the factors involved in developing and …

Warning: Urban Living May Be Hazardous To Your Health: A Personal Perspective, Frederick G. Adams

Trotter Review

As a result of remarkable scientific and medical achievements of the 20th century, we now know that full and quality health is within reach for all Americans. Yet, despite these achievements, the burdens of inadequate health services too often falls more heavily on some population groups more so than on others. The fact that this "gap" in health status occurs more frequently among people with low income and people belonging to racial/ethnic minority groups, in particular African Americans, has been well documented nationally. Not only does the "gap" in the health status experienced by these groups include consistently higher excess …

Increasing The Number Of Black Health Professionals: A Case Of Commitment And Belief In Students, Harold Horton

Trotter Review

The infant mortality rate is as high as ever in the Black community; dental care is yet nil or almost non-existent for the vast majority of Black children; and hypertension continues to be a major problem in the Black community. Hence, even as we approach the 21st Century, healthcare in the Black community is yet, as the song stated in the movie, Casablanca, "it's still the same old story." There is seldom, if ever, a single solution to a catastrophic problem, but some kinds of solutions do stand out as logical and effective. Training Black physicians, who would be privileged …

Improving Health Care For Disadvantaged Local Communities: Proposing User Fees Based On Some International Experiences, Saskia Wilhelms

Trotter Review

The fact that national health care reform in the United States has been stalled is not reason for resign. More than ever, one has to design and implement creative options to achieve satisfactory health service at low costs. The political turnover in Congress shifts more responsibility to local governments. This means less funding and less willingness by the national government to be held accountable for health and social services. On the other hand, this situation may carry opportunity to impact social policies on a local level.

The living conditions in some of our communities equal those in so-called third world …

Coalition Building: Moving Toward Effective Coalitional Strategies Of Hiv/Aids Prevention In Communities Of Color, Lisa Roland

Trotter Review

Despite the overwhelming burden carried by blacks and Latinos in terms of AIDS, it has become evident that in keeping with the general and historical pattern of discrimination reflected in funding, allocation of resources, policies etc., communities of color have received insufficient support to effectively address the problem at hand. Further compounding this dilemma, communities of color have fought against each other to secure funding for particular community programs. While looking at our individual, immediate, and entirely valid needs, many of us have at times failed to see the impact of our individual actions and attitudes on a broader picture.

Ethnic Minorities And Mental Health: Ethical Concerns In Counseling Immigrants And Culturally-Diverse Groups, Gemima M. Remy

Trotter Review

Between 1980 and 1990 nearly 9 million foreign-born individuals migrated to the United States. In 1993, the Immigration and Naturalization Service recorded the entry of over 900,000 immigrants and refugees. This figure is believed to be higher given the estimated 1.5 to 2.5 million people who enter this country illegally each year. Currently, ethnic minority groups make up one-fourth of the United States population. It is estimated that by the year 2000, one-third of the U.S. population will be comprised of ethnic minorities. As the population of the United States becomes increasingly diverse, considerable attention is being directed to a …

Housing, Community Support, And Homelessness: Emerging Policy In Mental Health Systems, Paul J. Carling

New England Journal of Public Policy

This article summarizes the dramatic changes in public policy through which public mental health systems are attempting to meet the housing and community support needs of persons with severe and persistent mental illnesses, including those who are homeless. It traces the historical approach to meeting these needs through defining people principally as patients and providing some combination of psychotropic medications, outpatient therapy, and structured, supervised quasi-institutional settings such as group homes, shelters, and segregated single-room-occupancy, or board-and-care facilities. A transition phase in public policy has emphasized defining these individuals essentially as service recipients who need greater or lesser amounts of …

The Kindred Bonds Of Mentally Ill Homeless Persons, Richard C. Tessler, Gail M. Gamache, Peter H. Rossi, Anthony F. Lehman, Howard H. Goldman

New England Journal of Public Policy

While the unraveling of the kinship bond has long been suspected to play a role in the epidemiology of homelessness, the connection between kinship and homelessness has been little studied. Based on a normative analysis of the role of family structure in response to adversity, this article explores the impact of the amount and quality of kinship ties on episodes of homelessness experienced by discharged psychiatric patients in Ohio. Survey data derived from personal interviews with both former patients and their kin indicate more strain in relations with kin of the homeless than the nonhomeless. The strain in the kinship …

Program Design And Clinical Operation Of Two National Va Initiatives For Homeless Mentally Ill Veterans, Robert Rosenheck, Catherine A. Leda, Peggy Gallup

New England Journal of Public Policy

In 1987, in response to reports of large numbers of veterans among America's homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems …

Homelessness, Alcohol, And Other Drug Abuse: Research Traditions And Policy Responses, Gerald R. Garrett

New England Journal of Public Policy

Although homeless alcoholics and other drug abusers more often elicit public scorn than sympathy, ironically they enjoy a celebrity status as research subjects. This article provides an overview of research literature on the homeless and their alcohol and drug problems. The evolution of public policies concerning control, rehabilitation, and treatment of homeless substance abusers is also traced with special attention to the interaction between scientific literature and policy responses over the past century. Although homeless populations today are more diverse than their counterparts in earlier decades, the analysis suggests that the policies and programs developed in response to the crisis …

Homeless Children Having Children, Yvonne M. Vissing

New England Journal of Public Policy

Homeless teenagers who have babies pose a significant population of concern for those in health and human services. This article explores demographic, structural, and economic changes for homeless young and single-parent families. It proposes that their homelessness is due to these barriers and the problems that result. Case studies illustrate the process of troubled teens becoming homeless women with babies. Policy recommendations for assisting these youngsters are offered.

Aids And The Homeless Of Boston, James J. O'Connell, Joan Lebow

New England Journal of Public Policy

Homeless persons with AIDS and HIV infection face significant health hazards during the daily struggle for survival on the streets and in the crowded shelters of our cities. This article offers a historical perspective on the evolution of the AIDS epidemic within the homeless population of Boston and examines the demographics, risk behaviors, and survival statistics of that epidemic. The Boston Health Care for the Homeless Program is presented as a model of service delivery that offers quality health care to homeless persons with AIDS while addressing the special needs of those bound by the immediacy of the next meal …

Ending Homelessness Among Mentally Disabled People, Steven A. Hitov

New England Journal of Public Policy

This article examines some of the many shortcomings of the mental health system operated by the Massachusetts Department of Mental Health (DMH) and explores the impact of that system on single homeless individuals who suffer from some form of serious or long-term mental disability. To afford that discussion context, however, the article first briefly examines those forces which have, and have not, significantly contributed to the large number of mentally disabled homeless persons. It suggests certain changes, including a shift in departmental focus from hospitals to community services and the creation of a housing subsidy system exclusively for DMH clients, …

The Manufacture Of Dependency: Shelterization Revisited, Kostas Gounis

New England Journal of Public Policy

Emergency shelters have been the most comprehensive and enduring response to homelessness in the United States, with New York City leading the way since the early 1980s. Shelters have emerged as a hybrid between a degraded type of "public housing" and a new form of "institutionalization." The persistence of shelter dependency, or "shelterization," is an intractable problem that frustrates policymakers and service providers. Popular among certain circles of professional pathologists is the view that shelterization is a form of "adaptation" to the violent, anomic, and generally antisocial environment of the shelter. This explanation of shelter dependency is theoretically flawed and …

The New England Shelter For Homeless Veterans: A Unique Approach, Ken Smith, James M. Yates

New England Journal of Public Policy

It has been estimated that veterans comprise one third of the homeless population. To combat this national disgrace, many small veterans' groups have been formed nationwide to serve their homeless "brothers" in such settings as shelters, group homes, and outreach centers.

A Boston group, the Vietnam Veterans Workshop, based its New England Shelter for Homeless Veterans on the simple but powerful concept of veteran helping veteran. The shelter created a program to accomplish three important functions: providing the basic necessities of a bed, a meal, clothing, and a hot shower; rehabilitating the veterans by offering various activities to comfort and …

Aggressive Outreach To Homeless Mentally Ill People, Ellen Nasper, Melissa Curry, Elizabeth Omara-Otunnu

New England Journal of Public Policy

Historically, people with chronic mental illnesses have been particularly at risk for homelessness. In 1984, the Connecticut Department of Mental Health (DMH) articulated policy to insure housing for mentally ill persons. One facet of that policy is to increase mental health services to homeless people. The Greater Bridgeport Community Mental Health Center has addressed this need through the formation of the Homeless Outreach Team (HOT). This article describes the development, organization, clinical work, and future of HOT. The team is run jointly by the Mental Health Center (funded through DMH) and Family Service-Woodfield, a United Way-funded agency that provides case …