As the capacity of public leaders to bring about change is increasingly questioned, public agencies have come under pressure to transform and innovate. More research is needed to identify how leaders who promote innovation, creativity, and adaptability affect the performance of public organizations. Constant improvement of organizations and individuals encourages leaders to innovate, evaluate risks as opportunities, and tackle the status quo. This raises the significance of how transformational leadership contributes to organizational performance and reacts to public agencies‘ environment, and how it might reorganize them. The present study examines the relationship between transformational leadership behaviors and perceived leadership effectiveness in public organizations, particularly Federal Emergency Management Agency (FEMA). The study specifically focuses on FEMA as an independent agency and as an agency under the Department of Homeland Security. It also measures transformational leadership behaviors and explores how they relate to public employees‘ perceptions of leadership effectiveness as reported by the 2002, 2006, and 2008 Federal Human Capital Surveys (FHCS). Confirmatory factor analysis was conducted to validate the construct validity for the perceived leadership iv effectiveness measurement model. Structural equation modeling was conducted to examine the study hypotheses. This study has found that transformational leadership behaviors—idealized influence, intellectual stimulation, and inspirational motivation— all have a significant relationship with perceived leadership effectiveness. Each dimension of transformational leadership has a positive effect on employees‘ perceptions of leadership effectiveness, with intellectual stimulation having the highest effect. The standardized regression weights of exogenous variables are: .24 for idealized influence, .48 for intellectual stimulation, and .29 for inspirational motivation. Overall, these predictor variables accounted for 86% of the variance in perceived leadership effectiveness. Findings of the study reveals several organizational, managerial, and policy implications relating to increasing the effects of transformational leadership behaviors on employees‘ perceived leadership effectiveness and organizational performance. The study points out the significance of communication and information sharing, and providing sufficient opportunities to do a better job in public organizations. The findings also confirm that the leaders are required to obtain inspirational motivation behaviors and use them to give a feeling of personal empowerment to the employees

Currently, the drug court treatment outcome literature provides little guidance about examining clients that fail to complete drug court. Typically, only successful clients are tracked and measured for outcome success characteristics and not much is known about unsuccessful client outcomes. A large portion of individuals who begin drug court do not complete the program. With unsuccessful rates ranging from 34 to 73%, it seems reasonable to examine the outcome of these cases. Ignoring this phenomenon is problematic because various stakeholders remain uninformed about the drug court model’s full effectiveness. The focus on successful clients may fail to fully capture and understand positive residual effects of the drug court program. Questions in this research include: Do unsuccessful drug court clients experience positive program results? Has self-awareness increased about the extent of their substance abuse problem? Are unsuccessful clients more confident in their ability to effect positive change? Is there an increased motivation to change? If non-completers are more aware of the potential for harm, are there reductions in risky behaviors? This study is a qualitative investigation using a phenomenological design. The data source is a convenience sample of unsuccessful drug court clients that participated in a pre-trial intervention or postplea adult drug court program in East Central, Florida. The unit of analysis is the individual, and the total number of participants interviewed is N=30. A grounded theory approach, a harm reduction paradigm from the psychotherapy arena, and a variation of an Intention-to-Treat design from the medical field were used to frame the research. This study found some reductions in both criminality and substance use. Several participants also reported improved familial relations and continued connections to the recovery community. Many participants demonstrated an increased self-awareness of a destructive lifestyle, an increased motivation to change destructive behaviors, and an increased self-efficacy in their ability to make substantive life changes. Incarceration was also found to be a motivator for positive change. Therefore, the inclusion of unsuccessful client outcomes was found to be critical to fully understanding the impact of the therapeutic jurisprudence model. iv I wish to dedicate this dissertation to my family. In memory of my Great Aunt Pat and Uncle Charlie. To my mother, Lou Ray, who considered me her hero for which I never deserved. And to my sister, Toni, whom I truly love. I appreciate their understanding as I embarked on this sometimes onerous endeavor. To a few of my closest friends who were my champions throughout this process. To my dearest friend, Bill Van Poyck, for his continuous support and encouragement. Bill has helped me more than he will ever know. Thank you for acknowledging and understanding this difficult undertaking, and for always believing in me. To my dear friend, Kay McKee, who continually checked on me to make sure I was doing okay. Irrespective of her own life challenges, she put my struggles before her own. Kay has been such a wonderful friend and great supporter over the years. To my long-time, committed friend, JuJu, who shared one of my most stressful weekends working on this project. JuJu puts up with me when few people will. Most of all to my wonderful husband, Nick. He has been by my side through much angst and trepidation. He has helped me greatly with determining the best approach to take in several instances during this arduous endeavor. His unflagging patience, encouragement, and love I can never repay. Throughout my entire academic career, even though much time was taken away from him, he never once complained. He is the person I can always count on, and he often places my welfare ahead of his own. Finally, in memory of our boy, Willie McCool Francis. He brought so much joy into our lives. We know he can never be replaced. My dear friend told me, "we loved him and he loved us and that is a beautiful thing." We will never forget his unconditional and unwavering love for us. v AC

The present study utilized a mixed-methods strategy to examine the effectiveness, diffusion, and institutionalization of the Memphis Crisis Intervention Team (CIT) model. To evaluate the effectiveness of the training component of the CIT model, a panel research design was employed in which a sample of 179 law enforcement officers and 100 correctional officers in nine Florida counties were surveyed on the first day of training (pretest), the last day of training (posttest), and one month following their completion of CIT training (follow-up). These surveys measured the extent to which CIT training achieved several officer-level objectives, including increased knowledge of mental illness and the mental health referral process, improved self-efficacy when responding to mental health crises, and enhanced perceptions of verbal deescalation skills, mental health services in the community, and the mental health referral process. The results of these surveys revealed officers experienced a statistically significant increase on every measure of training effectiveness between the pretest and posttest data collection points. However, a significant decline was found among the 117 officers that responded to the follow-up survey on the measures associated with self-efficacy and perceptions of verbal de-escalation, which points to a measurable decay in the effectiveness of the training in the intermediate timeframe with regard to these two measures. To examine the extent to which the diffusion of the CIT model resembles a social movement in the field of criminal justice and to explore the impact of CIT institutionalization on the organizational structure of criminal justice agencies, an online survey was distributed to 33 representatives of law enforcement and correctional agencies known to participate in the CIT program in the nine Florida counties in which officers were surveyed. The results of this survey indicate interagency communication and external pressure i from mental health providers and advocates largely contribute to the decision of criminal justice agencies to adopt the CIT model. In addition, the findings of this survey suggest criminal justice agencies modify their organizational structure in a number of different ways to internalize and institutionalize the CIT model. By coupling a training program evaluation with an assessment of diffusion and institutionalization, this study makes a unique contribution to organizational and evidence-based literature.

The prevalence of overweight and obese children has increased dramatically in the United States over the past 20 years and is a symptom of multiple systemic and cultural changes that have significantly influenced alterations in energy intake, energy expenditures, and the energy balance of children across the nation. School-based obesity prevention programs addressing nutrition and healthy eating behaviors within the school environment and cultural context provide a unique opportunity to educate and engage students in healthy food consumption practices. This study evaluated the effectiveness of a three-year elementary school nutrition education program for students in grades kindergarten through fifth using a longitudinal analysis of two separate data sets, a nutrition skills behavior assessment survey of self-reported eating behaviors, and body mass index (BMI) scores derived from height and weight measurements of program participants. Nutrition survey results indicated that students reported making healthier food choices from August 2001 to November 2004, with a significant decrease in reported consumption of fats/oils/sweets and significant increases in reported consumption of milk, meat, vegetables, fruit and grains. BMI results indicated a 7.8% decline in the percentage of students in the "overweight" and "at-risk for overweight" categories between August 2001 and October 2004. The combined results of both measures indicate that the nutrition education program appeared to positively affect eating behaviors and body mass index percentages. Implications of the study and strategies for further research are proposed.

The United States currently provides a health care system that is neither efficient nor equitable. Despite outspending the world on health care, over three-fourths of developed countries produce better health outcomes (Auerbach et al., 2000). Simultaneously, the "Ecological School of Thought" has documented the large impact that social, economic, and environmental circumstances play in health outcomes. Unfortunately, these 'ecological" studies are frequently conducted without theoretical justification, and rely solely on a cross-sectional research design and a myriad of unrelated variables. This study represents an important step towards the development of a true theory of "ecology". More specifically, we argue that the adversity associated with socio-economic disadvantage, social disorganization, and a lack of health care resources, leads to adverse health outcomes, represented by sentinel health events. This research employs both a cross-sectional (2000) and longitudinal designs (1990 - 2000) to assess the antecedents of sentinel health events in 309 United States counties. Structural Equation Modeling was the statistical technique employed in the study. Findings revealed that socioeconomic disadvantage remains a primary contributor to sentinel health. Indeed the economic growth between 1990 and 2000 was associated with increased rates of sentinel health events. Social disorganization was identified as a primary contributor to sentinel health events at a specific time point (2000), but was not significant over time (1990 -2000). Conversely, the inadequacy of health care resources was non-significant in the cross-sectional model (2000), but significant in the longitudinal model (1990 -2000). In both models, racial characteristics were fundamentally linked to ecological predictors of health We found support for the notion that sentinel health events would be reduced through economic equity and the development of healthy environments where community ties are reinforced. Less support is found for saturating given geographical areas with health care resources in order to reduce sentinel health events. Future research should be directed by the theoretical advancements made by this study. More specifically, future studies should examine independent cross-level effects, that is, through the inclusion of behavior variables as mediating factors for ecological constructs.

Stafford and Warr (1993) reconceptualized general and specific deterrence into a single theory in which individuals' propensities to engage in criminal behavior are based on some combination of personal experiences with being punished and avoiding punishment and vicarious (or indirect) experiences with being punished and avoiding punishment. The researchers make a substantial contribution to the deterrence literature by accounting for the effect of punishment avoidance when assessing deterrence theory. Despite the theoretical appeal of this restatement, few studies have tested its empirical merit. The current study tests the applicability of Stafford and Warr's model but also addresses several key limitations that still exist in the deterrence literature. The present study was the first of its kind to directly test Stafford and Warr's (1993) model, blending specific and general deterrence, on an offending population. The majority of perceptual deterrence research examines largely pro-social groups. Evidence suggests that offenders may have unique decision-making processes and may be very different from those typically studied in deterrence research. Identifying the relevant deterrents among non-conventional or offending populations has significant policy implications. Additionally, in order to understand the decision-making process of criminals, this study incorporated alternative sanction forms from a rational choice perspective into the deterrence framework. This is a particularly salient point because non-legal costs may be more influential in criminal decision-making than formal sanctions. By examining the deterrent effects of several other factors (besides the traditional variables studied in deterrence models) among a non-conventional population, findings may suggest methods for designing more effective punishments. Therefore, the present study conducted survey research of high-criminality among an adult sample. This dissertation recruited 326 work release inmates from Orange County, Florida, and asked them to complete a written questionnaire. Results from the bivariate analyses revealed some support for the deterrence doctrine and the rational choice perspective. However, more rigorous tests of these predictions revealed no support for deterrence theory. Even though this study concluded that deterrence alone does not adequately predict future offending, the idea of choice was upheld. The results from this dissertation and from several other studies suggest the need for further analysis of the effect of extralegal sanctions on future criminal activity, especially among non-conventional populations. The current study offers suggestions for effective crime control policies and directions on how future research can clarify the inconsistencies between the theoretical predictions of deterrence theory and empirical reality.

This research evaluates the relationships of time balance, social relations, role conflict, perception of work environment, and fourteen control variables to police officers' well-being in Turkish National Police. Well-being is identified in the management literature as having a strong relationship with performance. Therefore, by finding the factors affecting well-being, this research seeks to identify intervention strategies, which can promote a healthy workforce and police performance. Such interventions, in addition, may improve police performance through improved well-being. Individual police officers were analyzed to better understand the relationship between work environment on family life, social life, and the well-being of the police officers. A cross-sectional survey was conducted in the seven geographic regions of Turkey for all branches of Turkish National Police. Structural equation modeling (SEM) was used to validate the measurement of latent constructs and their relationships. A 45-item questionnaire collected demographic data and items associated with the latent constructs such as time balance, social relations, role conflict, perception of work environment, and the police officers' well-being. This 45-item questionnaire was based on two survey instruments that have been used by Eurofound in Europe for two decades. The response rate for the questionnaire in this dissertation was 47.14% with 495 respondents out of 1,050 subjects. The analysis revealed statistically significant relationships between following latent constructs: time balance and well-being (an indirect effect via role conflict), time balance and social relations, time balance and role conflict, social relations and role conflict, role conflict and well-being, and perception of work environment and well-being. In addition, six control variables (rank, department, optimism, isolation, income sufficiency, and working days per week) were statistically significantly related with well-being. No direct significant relationship was found between time balance and well-being, and social relations and well-being constructs. Eight control variables (gender, marital status, service time, extra work, confusion, region, work type, and working hours per day) had no significant relationship with well-being. These findings support some commonly expressed complaints of police officers. These findings also suggest that attention should be paid to the effects of time balance, income sufficiency, work environment, and workdays on the well-being of the officers.

It has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the educational backgrounds of the foreign-schooled physicians may contribute to an increase in medical board disciplining. Furthermore, graduates of medical schools where the instruction is not conducted in the English language may receive increased medical board disciplining when compared to the graduates of medical schools where English is the language of instruction. Finally, domestic medical schools that are ranked low according to The Gourman Report, 8th Edition may provide a substandard medical education, causing their graduates to have increased rates of discipline when compared to peers who have graduated from higher ranked medical schools. This study examines the effects of undergoing foreign medical training as opposed to domestic medical training and receiving medical school instruction in the English language or another language, on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (N = 39,559). Also examined are the effects of attending domestic medical schools that are ranked lower than other domestic medical schools on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (n = 25,479). Control variables used in this logistic regression analysis include whether the medical doctor is specialty board certified or not, the specialty practiced and the medical doctor's race and gender. Archival data from the Florida Department of Health were used for this study. This study found that the graduates of medical schools where the instruction is not in the English language are more likely to receive discipline and are more likely to receive more severe types of discipline than graduates of medical schools where the instruction is in the English language. It was also found that medical doctors who are ABMS certified, are practicing either a surgical specialty, obstetrics, gynecology, psychiatry, emergency medicine, family medicine or diagnostic radiology, or are male have increased odds of being disciplined by the Florida Board of Medicine.

This study was concerned with the following problem: What plan or procedures should the Lodi Elementary and Lodi Union High School Districts develop for civil defense and disaster preparedness in coordination with city, county, and state agencies? The specific purposes of this study were as follows: (1) To determine the need for a civil defense plan for the Lodi school districts.; (2) To determine the scope of civil defense plans for the Lodi school districts.; (3) To analyze various civil defense and disaster plans of other school districts.; (4) To investigate what civil defense and disaster plans have been formulated as the national and state levels.; (5) To develop a proposed plan for Lodi schools which will be in harmony with all other civil defense and disaster agencies, especially those within San Joaquin County.; and (6) To formulate a long range civil defense and disaster plan which can be adopted by the Lodi school districts.

The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitals' performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis Donabedian's structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT.