Privatization

Part I

“The mythology of privatization in contracting for social services (Links to an external site.).”

Reflect: Approximately 1.2 million organizations are registered with the IRS as nonprofit organizations. It is estimated that millions more small formal and informal associations exist that do not register with the IRS because they have revenues of less than $5,000 per year. Nonprofit organizations in America have combined revenues of approximately $621.4 billion, which represents 6.2% of the nation’s economy (Luckert, n.d.). Congress developed the Top Tier Evidence standards for nonprofit organizations, defined as: Interventions shown in well-designed and implemented randomized controlled trials, preferably conducted in typical community settings, to produce sizable, sustained benefits to participants and/or society (“Top Tier”, n.d.).

In Oregon they have developed an intervention for parenting training for recently separated, single mothers with sons aged 6-10 years. It is administered by Implementation Sciences International, Inc. (ISII), a research-based, non-profit organization providing training for community practitioners in Parent Management Training – the Oregon Model (PMTO®). The cost per family to the organization is $1000 to $1500 dollars. The meetings teach five core parenting practices: appropriate, noncoercive discipline (e.g., setting limits, following through, reinforcing prosocial behavior); skill encouragement (e.g., breaking tasks such as homework into achievable steps); monitoring; problem solving; and positive involvement. They also teach skills tailored to divorcing women, including (i) emotional regulation (e.g., recognizing negative emotions, and practicing techniques to help regulate them); (ii) managing interparental conflict (e.g., through problem solving and negotiation); and (iii) addressing children’s divorce-related concerns (e.g., through active listening, problem solving, and recognizing and managing emotions). (“Parent Management Training”, n.d.).

Write: Imagine the Lovely People County Board of Eastern Kentucky are considering developing a program such as the ones rerferenced above for their county. The board is split, particularly around money and other resources, as to whether the county itself should implement the program or to take bids from other agents operating in the county. They have tapped you, as a county director of Temporary Assistance for Needy Families (TANF), to help them make the best choice. You are ready to give them a report based on your research. Utilizing the readings and your own sources, discuss what issues might be involved in your determination of your recommendation to the county board. Based on this analysis let us know what you would recommend. These are some helpful resources that may help guide you in your recommendation:

• “What’s the Matter With Eastern Kentucky?” (Links to an external site.)
• Super Pages: Lexington and Area (Telephone Directory) (Links to an external site.)

Use the following questions to help direct you in your response:

• Describe the advantages and challenges of the choice you are recommending over the other.
• Given your counties special needs what recommendations would you give for constructing this program in your county?
• Briefly, how would evaluate the success of the alternative you are recommending?

Guided Response: As a board member, what questions would you have given your fellow peer’s recommendation? What recommendations would you have regarding their decision. What suggestions can you give that would address concerns you might have given the constituites you represent? Your post should contain a minimum of 400 words.

Part II

“Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision.”

Reflect: Health Care Reform has, for a long time, been a hot topic. Costs of Medicare, loss of jobs, increased costs of doing business, are all part of the problem/need. Consider the two citations below:

We have invented more health care than we can afford to deliver….We already ration. The United States denies more health care to more people than any other developed country in the world. We did that by leaving 50 million people out of the system (before the Affordable Care Act).

[For example] I don’t believe you should give any extensive operations to anybody over 85. You should make sure that they’re clean, they’re loved, they’re comfortable, they’re pain-free, but we shouldn’t be doing high-technology medicine on people over 85. (Lamm, 2015)

A rising proportion of medical expenditure is now devoted to prolonging the lives of the very old and the terminally ill. The costs of this are potentially unlimited.

We should pause to ask ourselves the questions raised by the surgeon Atul Gawande in his book, Being Mortal. Perhaps the greatest challenges in modern healthcare are not those of meeting the spiraling cost of advanced medical technologies. They lie in accepting that we are all going to die, and learning to do so with dignity.

Efforts at cost containment and the rationing of medical services are impinging deeply on the elderly and placing physicians in roles that may interfere with the covenant of faithfulness that exists between physician and patient. Physicians must examine negative societal images that may influence the care of the elderly and hold firm to the commitment to respond to the needs, values, and best interests of the elderly in the face of changing health care policies and constraints of one kind or another. Further, a major ethical imperative for physicians relates to making themselves available for the treatment of the elderly in the context of an appreciation of these patients’ tasks in the final stage of development.

Write: As an assistant in arranging discharge planning with a social worker and a multi-disciplinary team, you are asked for your professional input as an elderly woman living alone is being discharged to a long term facility. A high risk procedure and expensive procedure is being suggested for this 87 year old woman. The issue of cost for such procedures for the elderly has surfaced among the team. The team is discussing the decision of the procedure and social services is consulted for a full consideration of the patient in her context.

Utilizing what you have learned in the program and including extra resources, address the following:

• Evaluate the value assumptions that influence your recommendation.
• Describe how you would respond to these values as you self-reflect.
• Describe how much cost of the procedure would influence your recommendation.
• Should you consider what your client wants? How does this weight against professional values and opinions?
• Explain your recommendations to the team.

Guided Response: In responding to your classmates, are you in agreement with the values they proposed? What input would you give to the treatment team based on their recommendations? Would you suggest a different perspective? If so, describe your perspective and why you would suggest this as a fellow team member. Your post should contain a minimum of 300 words.