Family Preservation Services under Managed Care: Current Practices and Future Directions

Family preservation service agencies in the State of Kansas have undergone major changes since the implementation of a managed care model of service delivery in 1996. This qualitative study examines the successes and barriers experienced by agency directors in utilization of a managed care system. Outcome/ performance measures utilized by the State of Kansas are reviewed, and contributing factors to the successes and limitations of the program are discussed. Included in these reviews is an analysis and presentation of literature and research which has been used as support for the current program structure. Recommendations for further evolution of practice are proposed.

A multivariate frailty model for disease recurrences and survival

A multivariate frailty hazard model is developed for joint-modeling of three correlated time-to-event outcomes: (1) local recurrence, (2) distant recurrence, and (3) overall survival. The term frailty is introduced to model population heterogeneity. The dependence is modeled by conditioning on a shared frailty that is included in the three hazard functions. Independent variables can be included in the model as covariates. The Markov chain Monte Carlo methods are used to estimate the posterior distributions of model parameters. The algorithm used in present application is the hybrid Metropolis-Hastings algorithm, which simultaneously updates all parameters with evaluations of gradient of log posterior density. The performance of this approach is examined based on simulation studies using Exponential and Weibull distributions. We apply the proposed methods to a study of patients with soft tissue sarcoma, which motivated this research. Our results indicate that patients with chemotherapy had better overall survival with hazard ratio of 0.242 (95% CI: 0.094 - 0.564) and lower risk of distant recurrence with hazard ratio of 0.636 (95% CI: 0.487 - 0.860), but not significantly better in local recurrence with hazard ratio of 0.799 (95% CI: 0.575 - 1.054). The advantages and limitations of the proposed models, and future research directions are discussed. ^

Parent modeling and child food consumption

Obesity, among both children and adults, is a growing public health epidemic. One area of interest relates to how and why obesity is developing at such a rapid pace among children. Despite a broad consensus about how controlling feeding practices relate to child food consumption and obesity prevalence, much less is known about how non-controlling feeding practices, including modeling, relate to child food consumption. This study investigates how different forms of parent modeling (no modeling, simple modeling, and enthusiastic modeling) and parent adiposity relate to child food consumption, food preferences, and behaviors towards foods. Participants in this experimental study were 65 children (25 boys and 40 girls) aged 3-9 and their parents. Each parent was trained on how to perform their assigned modeling behavior towards a food identified as neutral (not liked, nor disliked) by their child during a pre-session food-rating task. Parents performed their assigned modeling behavior when cued during a ten-minute observation period with their child. Child food consumption (pieces eaten, grams eaten, and calories consumed) was measured and food behaviors (positive comments toward food and food requests) were recorded by event-based coding. After the session, parents self-reported on their height and weight, and children completed a post-session food-rating task. Results indicate that parent modeling (both simple and enthusiastic forms) did not significantly relate to child food consumption, food preferences, or food requests. However, enthusiastic modeling significantly increased the number of positive food comments made by children. Children's food consumption in response to parent modeling did not differ based on parent obesity status. The practical implications of this study are discussed, along with its strengths and limitations, and directions for future research.^