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Children looked after by local authorities are considered to be some of the most vulnerable in society, often having experienced histories of abuse, neglect, conflict within their family of origin or other traumas. As a consequence, substitute care e.g. foster care or residential care is often used as a therapeutic intervention. The focus of this thesis is the role that professional caregivers play in supporting children in local authority care. Chapter I provides a critique of the research exploring the efficacy of therapeutic interventions designed to facilitate the attachment relationship between looked after children and their professional caregiver. Due to controversy surrounding the therapeutic application of attachment theory and a number of methodological limitations, a limited evidence-base was found. The clinical implications and directions for future research are discussed. Chapter II investigates Residential Children’s Workers experience of caring for looked after children, from a psychological perspective. Results revealed that their role and relationship with the children in their care, is affected by their emotional and psychological ability to cope with push and pull factors within a complex system. The clinical implications are discussed, and recommendations for future research made. Chapter III explores a reflective account of the author’s experience of both working clinically and carrying out research in this field. As many of the ideas were generated whilst conducting the doctoral research, the author applies the proposed model from the empirical paper to the reflections. Chapter III is written in a first person account.

<p> According to U.S. Census figures and the Michigan Department of Community Health (2011), there are approximately 5% - 6% of children in the State of Michigan who are uninsured and it is estimated 70% of these uninsured children may be eligible for State subsidized health insurance. While the percent of uninsured children in Michigan consistently rates well below the national average, it is concerning the rate of uninsured children in Michigan is relatively stable. There are strong financial and social incentives to design outreach efforts to reach all children in the State and make these efforts an "everyday event." </p><p> This research examines the question of whether or not a school-based outreach program is effective in reaching children who are eligible for State subsidized health insurance but are uninsured and will test the following two hypotheses: </p><p> Ho1: Incorporating health status outreach into routine school district operations does not identify a statistically significant number of uninsured children. </p><p> Ho2: There is no statistical difference in the number of applications received from a school-based outreach program during the pilot period. </p><p> The pilot program takes place in six of the eleven school districts that operate in Van Buren County, MI. School districts were provided two health insurance status collection forms. Form A is designed to be distributed with the Free and Reduced Lunch Application. Form B is designed to be distributed as part of the student registration packet and welcome material. The completed Form A and Form B are sent to a State of Michigan registered application assisting agency for SCHIP application assistance and enrollment. </p><p> As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Enrolling these children will help the State of Michigan to meet targeted enrollment gains and earn CHIPRA performance bonus payments. The additional funds from higher CHIPRA bonus payments could be used to provide the resources to fund the following specific recommendations: </p><p> 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. </p><p> 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. </p><p> 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes. (Abstract shortened by UMI.)</p>

<p> Human Immunodeficiency Virus (HIV) remains a serious public health issue, and many social factors are involved in virus transmission and treatment. The current conceptualization of how HIV status disclosure and perceived stigma of HIV diagnosis interact is undeveloped. This study was based on social cognitive theory and tested hypothesized positive relations between HIV serostatus disclosure, social support, and self-efficacy. In addition, self-rated HIV stigma was examined as a potential mediating variable. Participants were 109 HIV positive, mostly White gay men recruited via an online bulletin board. They completed the medical outcomes study social support survey, the general self-efficacy scale, the HIV stigma scale, a HIV serostatus disclosure questionnaire, and a demographic questionnaire. Linear regression revealed that social support significantly and positively predicted HIV serotatus disclosure. HIV stigma mediated this relation by lowering the perception of support. Sexual orientation disclosure significantly and positively predicted HIV serostatus disclosure and social support. It is recommended that future research examine the impact of HIV stigma in different groups (racial and sexual minorities, and women). Culturally-sensitive assessments may also be used to measure individual levels of perceived stigma, HIV status disclosure, and social support. Action for social change includes raising general public awareness regarding HIV misconceptions, such as transmission risk; lowering stigma and raising support through public education; and increasing sexual minority status self-identification via outreach in low self-disclosure communities.</p>

<p> The development of new medical treatments for patients is limited by the challenges of recruiting clinical-research participants. In the United States, the Food and Drug Administration regulates the multidimensional approval process for new drugs, biologics, and medical devices to ensure consumer safety. The regulatory approval processes includes complex clinical trials that necessitate either healthy volunteers or patients who are willing to participate. The low enrollment rates of volunteers and patients willing to participate in clinical trials are resulting in significant delays in bringing new treatments to the market and substantially increasing development costs, for which consumers ultimately pay. The available research indicates that young adults and adolescents represent two of the lowest participating groups in clinical trials. Even though they are the next generation of consumers and patients, little to no research has examined the adolescent and young adult populations and their knowledge and perceptions of clinical research or their willingness to participate in clinical trials. Understanding these populations' perspectives and knowledge of the drug-development process and providing education regarding on this issue may have a profound, positive trickle-down effect on medicine, their personal well-being, and the well-being of the general public. </p><p> This study used a simple experimental design consisting of an intervention group and a control group. The intervention was a 10-minute educational video on participation in clinical research. Adolescents and young adults (<i> n</i> = 527) were randomly distributed into the two groups. The knowledge, perceptions, and willingness to participate in clinical research were measured in both groups utilizing a 31-question survey instrument. The findings from this study may be used by educators, health care providers, patient advocacy groups, payers, and the pharmaceutical research and development industry to determine the best methods for educating adolescents and young adults on clinical research and trial participation. </p><p> The study concluded with a discussion of the importance of the role of leadership in social change and the process of igniting and sustaining such change. This process includes how, historically, public and private interests have come together to positively influence important public-health initiatives and, in turn, social change that holistically benefited all of society. Moving forward, leadership for social change could potentially deliver new and improved medical treatments in a timelier manner.</p>

<p> The US Freedom of Information Act (FOIA) places citizens' rights to request and discover information in competition with the right of the government to conceal official secrets (Bathory &amp; McWilliams, 1977; Rourke 1957). Simply put, FOI in practice pits secrecy versus transparency, with administrative discretion in the middle. Though FOIA applies to all federal government departments and agencies in the United States, the tension becomes most acute when applied to the most secretive participants in the national security enterprise, the 16 member intelligence community. Secret-keeping can exert psychological and social pressure on organizations (Simmel, 1906; Weber, 1920/2009) that have the potential to impact individual decision making and shape collective norms (Freidman, Landes &amp; Posner, 1991; Keane, 2008; Sandfort, 2000). This effort examines how secrecy impacts transparency initiatives by researching how the US Intelligence Community FOIA programs perform compared to other federal agencies using multivariate analysis of FOIA annual report data in conjunction with an experimental methodology. The research results show that while intelligence agencies release similar information to control agencies, they differ significantly in the how and when that information is provided. In particular, intelligence agencies take longer to respond than peer agencies and offer less information with the response. These findings contribute to theory by leading to a refined model of transparency and contribute to practice by supporting recommendations for policy makers and FOIA program administrators.</p>

<p> How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.</p>

<p> The fast and easy global movement of capital throughout the financial system, from lenders to borrowers and through intermediaries and financial market participants, has been recognized as a source of instability associated with illiquidity and financial crises. The purpose of this research was to better understand how regulation either enables or constrains capital movement. The theoretical framework comprised 2 contrasting public policymaking models, Arrow's rational-comprehensive model and Kingdon's garbage can model, which were used to derive opposing hypotheses. The research question addressed the nature of the relationship between Credit Default Swaps (CDSs) regulations and the flow of capital into Collateralized Mortgage Obligations (CMOs) when lenders share their borrower-related loan risks through intermediaries with other market participants. This quantitative study was a quasiexperimental time series design incorporating an autoregressive integrated moving average (ARIMA) model using secondary data published by the U.S. government. The 2 independent variables were regulatory periods involving 2 CDSs regulations and the dependent variable was capital in the U.S. financial system that is deployed to CMOs. The Commodity Futures Modernization Act of 2000's ARIMA model (1,2,1) was significant at <i>p</i> &lt; .05 and was negatively correlated to the Emergency Economic Stabilization Act of 2008's ARIMA model (1,1,0), <i>r</i> = -.91, <i>n</i> = 18, <i>p</i> &lt; .001. These results suggest that regulations cannot be relaxed and then reinstated with predictable results. The potential for positive social change is from stable financial institutions that mutually benefit depositors and borrowers.</p>

The focus of the study was to examine the extent to which pharmacies in Indiana are currently selling cigarettes and alcohol, the current opinions of pharmacists, to compare findings with the previous 1996 Indiana study and to determine pharmacists' familiarity with available public health resources. A survey questionnaire was designed based on previous studies. It was reviewed by a jury of experts and subsequently administered to the randomly selected pharmacies in Indiana. Of those pharmacies that were included in the study, 74.4% were returned. Collected data were analyzed and compared to findings from 1996 using descriptivestatistical methods.Findings revealed that fewer pharmacies sold cigarettes in 2001 (58.1%) than in 1996 (63.7%). Alcohol sales continued at 206 (43.7%) of pharmacies currently selling alcoholic beverages, which is relatively the same level as in 1996, 202 (41.9%) of pharmacies. There is an increasing trend in pharmacists that believe pharmacies should be selling neither cigarettes (+7.2%) nor alcohol (+4.7). Most pharmacists' (64%) agree that they play asignificant role in health promotion/disease prevention to the public, yet only 42.6% involve themselves with publichealth promotion activities. The capability of pharmacists to refer people to outside resources for educational needsis limited. Over three-fourths of pharmacists are either completely unfamiliar with or have no opinion about thethree most well-funded public health programs in the state of Indiana. / Department of Physiology and Health Science

<p>Oregon&rsquo;s Statewide Planning Goals embody Smart Growth in their effort to revitalize urban areas, finance environmentally responsible transportation systems, provide housing options, and protect natural resources; yet the State defers to its municipalities to implement this planning framework. This research focuses on Goal 14 (Urbanization), linking most directly to Smart Growth Principle 7 (Strengthen and Direct Development toward Existing Communities). It assesses Eugene&rsquo;s, Keizer&rsquo;s, Salem&rsquo;s, and Springfield&rsquo;s growth management policies that specifically target infill development of single family homes against this Goal and Principle. Though these municipalities must demonstrate consistency with the same Goals (see Supplemental File 1 for this context), this research questions whether sufficiently different policy approaches to curtailing sprawl yield significantly different results. The primary analytical method is a logistic regression that uses parcel-level data to understand how administration affects development by isolating these policies&rsquo; direct effects on observed outcomes (see Supplemental File 2 for this theory). </p>