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• 1. [Article] Two Delivery System Contexts for the Elderly:The "Institutional" Approach and the "Community" Approach.

  Theoretically every society has some institutional means which seeks to prevent and alleviate personal misfortune and illness "Institutions are standardized solutions to collective problems." The increasing ...

  Citation × Citation Citation Abstract Copy Title: Two Delivery System Contexts for the Elderly:The "Institutional" Approach and the "Community" Approach. Author: Freer, Mary Sarita Year: 1973 Theoretically every society has some institutional means which seeks to prevent and alleviate personal misfortune and illness "Institutions are standardized solutions to collective problems." The increasing population rate of older persons, many of whom suffer from chronic diseases and disabilities, does pose a collective problem for society. Formerly, the "institutional" approach developed to address the needs of chronic aging patients and society. Today the "community" approach, by which community service agencies whose goal is to help older adults remain independent of total institutional care by supplying supportive services, is achieving recognition . This thesis is an exploratory study to assess similarities and/or dissimilarities between two distinct groups of elderly persons -- those receiving services in a total institution and those living in the community but receiving supportive services via a community-based delivery system. This delivery system is concerned with supplying human services to those people assumed to be "at risk" of institutional care. It is assumed that the clients of such a system are similar to those persons within an institution. The major purpose of this study is to validate this assumption. If this assumption is proved true , it is thought that it could have important consequences on future policies concerning health-care systems for the aged. Title: Two Delivery System Contexts for the Elderly:The "Institutional" Approach and the "Community" Approach. Author: Freer, Mary Sarita Year: 1973 Theoretically every society has some institutional means which seeks to prevent and alleviate personal misfortune and illness "Institutions are standardized solutions to collective problems." The increasing population rate of older persons, many of whom suffer from chronic diseases and disabilities, does pose a collective problem for society. Formerly, the "institutional" approach developed to address the needs of chronic aging patients and society. Today the "community" approach, by which community service agencies whose goal is to help older adults remain independent of total institutional care by supplying supportive services, is achieving recognition . This thesis is an exploratory study to assess similarities and/or dissimilarities between two distinct groups of elderly persons -- those receiving services in a total institution and those living in the community but receiving supportive services via a community-based delivery system. This delivery system is concerned with supplying human services to those people assumed to be "at risk" of institutional care. It is assumed that the clients of such a system are similar to those persons within an institution. The major purpose of this study is to validate this assumption. If this assumption is proved true , it is thought that it could have important consequences on future policies concerning health-care systems for the aged. Close

• 2. [Article] Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO)

  While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical ...

  Citation × Citation Citation Abstract Copy Title: Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO) Author: Nygren, Peggy Year: 2013 While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy Families Oregon (HS/HFO) home visitation program (treatment group) who completed a follow-up phone survey at the child’s 12 month birthday (n = 405). Families were offered HS/HFO services prenatally after meeting risk screening eligibility criteria on the New Baby Questionnaire (NBQ). Program mothers having received at least one home visit (n = 248) were included in the final analyses. Families had an average of 3.1 (SD = 1.2) NBQ risk factors at enrollment and 83% reported having trouble paying for basic needs. Families received an average of 16 home visits in the first 6 months of the program. Thirty-one percent of mothers were aged 19 or younger, 60% were White and Non-Hispanic, 31% were Hispanic, and 9% were another race/ethnicity. Hierarchical regression models with main effects (RFI, PFI, race) and an interaction term (RFI X PFI) were developed to predict eight outcomes. Interaction effects models were not significant. Five RFI main effects were significant: higher RFI scores were associated with greater likelihood of child welfare involvement, greater parenting stress, less favorable scores on child health and well-being, lower parent responsiveness and ii acceptance, and less supportive learning environments. One PFI main effect was significant: higher PFI scores predicted lower parenting stress. A trend level result showed higher PFI scores were associated with less child welfare involvement. Race was significant in two models: White/Non-Hispanic families were more likely to have a home visitor report child welfare involvement and had more frequent parent-child activities compared to other race/ethnicity families. Unpacking the results with separate single risk factor (12 items) and protective factor (10 items) regression models followed. Results showed parent’s prior family history of maltreatment and younger maternal age predicted child welfare involvement (home visitor report), while protection was seen for those with access to housing support. Social support and family functioning protectors were linked to lower parenting stress, while maternal depression showed the opposite finding. Better scores on a child health and well-being measure were seen with higher neighborhood cohesion and greater participation in HS/HFO; in contrast, neighborhood violence and frequent mobility were linked to worse scores. Developmentally supportive home environments were seen for families participating in additional parent support programs, in which the mother had greater knowledge of infant milestones and behavior, and if the family had access to housing supports. Unemployment proved to be associated with less enriched home environments. In summary, there was no support for the cumulative PFI in buffering risk for negative outcomes in this model. The RFI was also a more robust predictor of outcomes compared to the PFI in the main effects models. Overall, study findings provide some evidence for the utility of specific protective factors, as well as cumulative and specific single risk factors, for screening families for effectively targeting services and guiding the conceptual development of program and evaluation formats. Title: Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO) Author: Nygren, Peggy Year: 2013 While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy Families Oregon (HS/HFO) home visitation program (treatment group) who completed a follow-up phone survey at the child’s 12 month birthday (n = 405). Families were offered HS/HFO services prenatally after meeting risk screening eligibility criteria on the New Baby Questionnaire (NBQ). Program mothers having received at least one home visit (n = 248) were included in the final analyses. Families had an average of 3.1 (SD = 1.2) NBQ risk factors at enrollment and 83% reported having trouble paying for basic needs. Families received an average of 16 home visits in the first 6 months of the program. Thirty-one percent of mothers were aged 19 or younger, 60% were White and Non-Hispanic, 31% were Hispanic, and 9% were another race/ethnicity. Hierarchical regression models with main effects (RFI, PFI, race) and an interaction term (RFI X PFI) were developed to predict eight outcomes. Interaction effects models were not significant. Five RFI main effects were significant: higher RFI scores were associated with greater likelihood of child welfare involvement, greater parenting stress, less favorable scores on child health and well-being, lower parent responsiveness and ii acceptance, and less supportive learning environments. One PFI main effect was significant: higher PFI scores predicted lower parenting stress. A trend level result showed higher PFI scores were associated with less child welfare involvement. Race was significant in two models: White/Non-Hispanic families were more likely to have a home visitor report child welfare involvement and had more frequent parent-child activities compared to other race/ethnicity families. Unpacking the results with separate single risk factor (12 items) and protective factor (10 items) regression models followed. Results showed parent’s prior family history of maltreatment and younger maternal age predicted child welfare involvement (home visitor report), while protection was seen for those with access to housing support. Social support and family functioning protectors were linked to lower parenting stress, while maternal depression showed the opposite finding. Better scores on a child health and well-being measure were seen with higher neighborhood cohesion and greater participation in HS/HFO; in contrast, neighborhood violence and frequent mobility were linked to worse scores. Developmentally supportive home environments were seen for families participating in additional parent support programs, in which the mother had greater knowledge of infant milestones and behavior, and if the family had access to housing supports. Unemployment proved to be associated with less enriched home environments. In summary, there was no support for the cumulative PFI in buffering risk for negative outcomes in this model. The RFI was also a more robust predictor of outcomes compared to the PFI in the main effects models. Overall, study findings provide some evidence for the utility of specific protective factors, as well as cumulative and specific single risk factors, for screening families for effectively targeting services and guiding the conceptual development of program and evaluation formats. Close

• 3. [Article] Conceptualizing Risk and Effectiveness: A Qualitative Study of Women’s and Providers’ Perceptions of Nonsurgical Female Permanent Contraception

  Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability ...

  Citation × Citation Citation Abstract Copy Title: Conceptualizing Risk and Effectiveness: A Qualitative Study of Women’s and Providers’ Perceptions of Nonsurgical Female Permanent Contraception Author: Harrington, Elizabeth K., Gordon, Diane, Osgood-Roach, Isabel, Jensen, Jeffrey T., Aengst, Jennifer Year: 2015 Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women's and OB/GYN providers' perceptions of NSPC in Portland, OR. Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach. Results: The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5, and median number of children was one. Perspectives on NSPC were closely aligned with women's general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness, risk, and avoiding hormonal contraception. Many assumed NSPC would be less effective than surgery, however, and felt a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC's potential relative ease of administration could undermine the inherent seriousness of choosing PC. Conclusions: Women’s and providers’ perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted. Implications: This hypothesis-generating study elucidates women’s and provider’s perspectives on new methods of NSPC, and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC. Title: Conceptualizing Risk and Effectiveness: A Qualitative Study of Women’s and Providers’ Perceptions of Nonsurgical Female Permanent Contraception Author: Harrington, Elizabeth K., Gordon, Diane, Osgood-Roach, Isabel, Jensen, Jeffrey T., Aengst, Jennifer Year: 2015 Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women's and OB/GYN providers' perceptions of NSPC in Portland, OR. Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach. Results: The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5, and median number of children was one. Perspectives on NSPC were closely aligned with women's general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness, risk, and avoiding hormonal contraception. Many assumed NSPC would be less effective than surgery, however, and felt a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC's potential relative ease of administration could undermine the inherent seriousness of choosing PC. Conclusions: Women’s and providers’ perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted. Implications: This hypothesis-generating study elucidates women’s and provider’s perspectives on new methods of NSPC, and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC. Close