Interpretation services for immigrants in federally qualified health centers: Barriers, best practices, and suggestions for the future

This paper examines the provision of interpretation services to immigrants with limited English proficiency in Federally Qualified Health Centers, through examination of barriers and best practices. The United States is a nation of immigrants; currently, more than 38 million, or 12.5 percent of the total population, is foreign-born. A substantial portion of this population does not have health insurance or speak English fluently: barriers that reduce the likelihood that they will access traditional health care organizations. This service void is filled by FQHCs, which are non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, and cultural barriers. By examining the importance and the implementation of medical interpretation services in FQHCs, suggestions for the future are presented.^

The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Targeting Special Populations for Family Preservation: The Influence of Worker Competence and Organizational Culture

Today there are approximately 581,000 children in the United States foster care system. Children of color, one special population group, are disproportionately represented in the foster care system. Family preservation, a program that aims to improve family functioning and thus decrease the need for foster care, has been examined closely. Some researchers believe that family preservation programs have failed partly due to practitioners' inability to target appropriate families (Feldman, 1990; Schuerman, Rzepnicki & Littell, 1994). Additionally, research confirms that children of color are not the target of family preservation services (Denby, Curtis, & Alford, 1998). Improvements in the effectiveness of family preservation will require many types of reform both internal and external to the program. Among the types of internal reform needed is accurate "targeting of services. " Given the overrepresentation of children of color in the foster care system, this group must be among those who are targeted for services. The results of a national survey of 254 family preservation workers reveal a "profile" of the worker who is likely to target special populations, including children of color, for family preservation services. A case is made for service improvements and training to facilitate the "profiled" workers' competencies.

Survey of living conditions of Arctic indigenous peoples

Major findings of the Survey of Living Conditions in the Arctic (SLiCA) are: (1) A combination of traditional activities and cash employment is the prevailing lifestyle of Arctic indigenous peoples; (2) family ties, social support of each other, and traditional activities have a lot to do with why indigenous people choose to remain in Arctic communities; (3) well-being is closely related to job opportunities, locally available fish and game, and a sense of local control. Well-being and depression (and related problems like suicide) are flip sides of the same coin. Improving well-being may reduce social problems; and, (4) health conditions vary widely in the Arctic: three-in-four Greenlandic Inuit self-rate their health as at least very good compared with one-in-two Canadian and Alaska Inuit and one-in-five Chukotka indigenous people. Findings are based on 7,200 interviews in a probability sample of Inupiat settlement regions of Alaska, the four Inuit settlement regions of Canada, all of Greenland, and the Anadyrskij, Anadyr, Shmidtovs, Beringovskij, Chukotskij, Iujl'tinskij, Bilibinskij, Chaunskij, Providenskij, Uel'Kal' districts of Chukotka. Indigenous people and researchers from Greenland, Russia, Canada, the United States, Denmark, Norway, Sweden, and Finland collaborated on all phases of the study.

The spatial and linguistic division of the city of Malaga

The city of Malaga underwent considerable growth in the 19th and 20th centuries. The territorial expansion paired with a massive influx of immigrants occurred in three waves and as a consequence the city of Malaga remains divided into three different parts up to today. The differences between these three neighbourhoods of the city lie in the type of houses, different cultural and industrial activities, socioeconomic level, and very interestingly, also in speech. Thus, the aim of this study is an examination of the interrelation between speech (phonetic features) and urban space in Malaga. A combination of quantitative and qualitative analysis was used, based on two types of data: 1) production data stemming from recordings of 120 speakers; 2) perception data (salience, estimated frequency of use, attitude, spatial and social perception, imitation) which was collected from several surveys with 120 participants each. Results show that the speech production data divides the city of Malaga clearly into three different parts. This tripartition is confirmed by the analysis of the perception data. Moreover, the habitants of these three areas are perceived as different social types, to whom a range of social features is attributed. That is, certain linguistic features, the different neighbourhoods of the city and the social characteristics associated with them are undergoing a process of indexicalization and iconization. As a result, the linguistic features in question function as identity markers on the intraurban level.

Speech features of the domain of the word in heterosexual twins during the second yeard of life

Speech is the major function, emergence and which development radically changes all course of formation of the identity of the child already in the early childhood. If language and speech development in solitary born children is investigated today quite well, at twin children this process practically is not studied. Our research was carried out for the purpose of studying of an originality of mastering by speech by heterosexual children of pair of twins within communicative and pragmatist approach (T.N. Ushakov,G. V. Chirkina). Application of this approach to the analysis of process of communication at twin children allowed us to allocate those peculiar receptions and means of communication which they functionally develop in a situation of pair of twins, as allows them to show the phenomena of the speech which are not meeting at solitary born contemporaries. In this work results of supervision and research of pair of heterosexual twins of the second year of the life, carried out by a technique developed by us under the scientific guide of G. V. Chirkina

"Our Father Isaac": Reading the Sahidic Testament of Isaac in an Egyptian Monastic Context

This dissertation argues that the textual community of fourth or fifth century monastic Egypt read Testament of Isaac as an ascetical regimen in order to transform themselves into children of Isaac. T. Isaac highlights three particular dimensions of Isaac's character from the remembered tradition of Isaac that would have resonated in the Egyptian monastic context of the textual community - Isaac as priestly authority, Isaac as sacrifice, and Isaac as blind ascetic - to create a model for the new self that the textual community aimed to achieve. Two important ascetic practices in T. Isaac that the textual community was to perform were copying and reading T. Isaac. These two practices functioned as technologies of the self that helped the members of the textual community to transform their present subjectivity into a new self modeled on Isaac in T. Isaac.

Post-Conflict Maternal Communication, Children's Understandings, and Child Functioning in Violent and Non-Violent Families

The last two decades have been marked by a growing public awareness of family violence. Research by social scientists has suggested that family violence is widespread (Gelles and Straus, 1988). It is estimated that every year 1.8 to 4 million women are physically abused by their partners (Novello, 1992). In fact, more women are abused by their husbands or boyfriends than are injured in car accidents, muggings, or rapes (Jaffe, Wolfe, and Wilson, 1990). A recent prevalence study by Fantuzzo, Boruch, Beriama, Atkins, and Marcus (1997) found that children were disproportionately present in households where there was a substantial incident of adult female assault. Experts estimate that 3.3 to 10 million children are exposed to marital violence each year (Carlson, 1984; Straus, 1991). Until recently, most researchers did not consider the impact of parental conflict on the children who witness this violence. The early literature in this field primarily focused on the incidence of violence against women and the inadequate response of community agencies (Jaffe et al, 1990). The needs of children were rarely considered. However, researchers have become increasingly aware that children exposed to marital violence are victims of a range of psychological maltreatment (e.g., terrorizing, isolation;Hart, Brassared & Karlson, 1996) and are at serious risk for the development of psychological problems (Fantuzzo, DePaola, Lambert, Martino, Anderson, and Sutton, 1991). Jouriles, Murphy and O'Leary (1989) found that children of battered women were four times more likely to exhibit psychopathology as were children living in non-violent homes. Further, researchers have found associations between childhood exposure to parental violence and the expression of violence in adulthood (Carlson, 1990). Existing research suggests that children who have witnessed marital violence manifest numerous emotional, social, and behavioral problems (Sternberg et al., 1993; Fantuzzo et al., 1991; Jaffe et al, 1990). Studies have found that children of battered women exhibit more internalizing and externalizing behavior problems than non-witnesschildren (Hughes and Fantuzzo, 1994; McCloskey, Figueredo, and Koss, 1995). In addition, children exposed to marital violence have been found to exhibit difficulties with social problem-solving, and have lower levels of social competence than nonwitnesses (Rosenberg, 1987; Moore, Pepler, Weinberg, Hammond, Waddell, & Weiser, 1990). Other reported difficulties include low self esteem (Hughes, 1988), poor school performance (Moore et al., 1990) and problems with aggression (Holden & Ritchie, 1991; Jaffe, Wolfe, Wilson, & Zak, 1986). Further, within the last decade, researchers have found that some children are traumatized by the witnessing experience, showing elevated levels of posttraumatic stress symptoms (Devoe & Graham-Bermann, 1997; Rossman, Bingham, & Emde, 1996; Kilpatrick, Litt, & Williams, 1997). These findings corroborate clinical reports that describe many exposed children as experiencing trauma reactions. It appears that the negative effects of witnessing marital violence are numerous and varied, ranging from mild emotional and behavioral problems to clinically significant levels of posttraumatic stress symptoms. These incidence figures and research findings indicate that children's exposure to violence is a significant problem in our nation today and has serious implications for the future.

The Effects of Father Absence Due to Divorce: A Systems Interpretation.

In American society, the incidence of divorce continues to rise. In 1974, the estimate was that 40% of all new marriages would end in divorce. When children are involved, the mother usually regains custody. Although the number of children of divorce living with their fathers is increasing, it is still a small percent. In addition, the rate of remarriages is lower when children are involved (Hetherington.et al.,1977). Consequently, a large number of children are being raised in father-absent homes, and indications are that the numbers are increasing. A recent Denver Post article predicted that 50% of all children now being born will spend some of their childhood in a single-parent home. In terms of frequency, the father-absent family is becoming quite common, even "normal," yet it often continues to be considered a "broken" home and, when compared to the two-parent family, an inadequate structure in which to raise healthy children. Since father-absent families are so common these days, this opinion is in need of review.This paper will present a review of the father absence research in three areas: sex role development, cognitive development and personality development. The role of moderator variables will be discussed. And, finally,an open systems model will be proposed as a vehicle to better understand the effects of father absence and as a guide for future research.

Associative Behaviours and Political Participation of EU migrants

Civic culture is structured on a network of interpersonal associations with different degrees of formalization. According to theories on civic and political action, certain agents, such as associations, play a key role in setting targets, socializing or coordinating sociopolitical actions, among other functions. Associations strengthen the political and civic system of societies. Likewise, they are a vehicle for individuals’ integration, which is particularly important in the case of immigrants. For these, associations are both a vehicle for integration and an instrument for political participation. This article explores the use and purpose of associations according to immigrants from Romania, Poland, the United Kingdom and Germany living in Spain.

Diary of Henry Flynt, 1723-1747

This diary, effectively a commonplace book, documents Flynt's daily activities and personal reflections from 1723 to 1747. Many entries concern his dealings with family members, business associates, acquaintances, ministers, and political officials. The diary includes a list of books Flynt loaned to others from 1723 to 1743 and detailed financial entries from 1724 to 1747. These entries provide information about the costs of goods and services, as well as Flynt's consumption habits; they detail where he traveled, what he ate and drank (including, apparently, many pounds of almonds), what he read, and many other aspects of daily life. The diary also contains entries related to Flynt's land holdings and other investments, as well as copies of meeting minutes from several sessions of the Harvard Board of Overseers.

Account book of the executors of the Henry Flynt estate, 1760-1767

The volume contains acknowledgements of the disbursements of Harvard Tutor Henry Flynt's estate written in the hands of the respective beneficiaries. The entries begin on February 27, 1760 following Flynt's death on February 13, 1760, and continue through May 9, 1767. Each receipt includes the date, name of the executors, description of the property, beneficiary's name, and signature. The beneficiaries include the wife of Sol. Davy, Dorothy Jackson, Edmund Quincy, J. Henry Quincy, Esther and Stephen Richard (received by attorney Nicholas Boylston), Dorothy Skinner (also received for her by her husband Richard Skinner), John Wendell, Edmund Wendell, Katherine Wendell, and Oliver Wendell, as well as Harvard College (received by Harvard Treasurer Thomas Hubbard), and the Deacons of the First Church of Cambridge. The volume also includes a loose document titled "Account from Messrs Edmund & Josiah Quincy Settled & Ballanced March 31, 1749."

Annual report of the Texas Child Migrant Program, ESEA, Title I.

Mode of access: Internet.

The vicar of Wakefield : a tale /

Illustrations are 12 mounted photographs.

Child care programs [microform] : hearings before the Military Personnel and Compensation Subcommittee of the Committee on Armed Services, House of Representatives, One Hundredth Congress, second session, hearings held June 16, August 2 and 9, 1988.

"H.A.S.C. no. 100-120."