As in so many areas of life, there is no direct causative correlation between the amount of money spent and quality of services, progress, or positive outcomes for the individual. There are times when the right care is more expensive and there are times when the right care, the best care or intervention for the individual is less expensive. Simply throwing money at a problem is never a good idea. Sometimes as with some of the research cited below, it can actually produce worse outcomes. For example in the case of Medicare expenditures:
What's Enough, What's Too Much?
“Most important, the second of the two articles by Fisher and colleagues (2) demonstrates that patients in high-spending regions had no better survival (if anything, slightly worse) than those in lower-spending regions. Separate analyses of a sample of all Medicare beneficiaries further showed no gains in overall patient mortality, functional status, or patient satisfaction. “
http://www.annals.org/cgi/content/full/138/4/348
and
Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2438036
Using our best Critical Thinking skills we need to learn from the best research and provide what works, which is not always and quite often not, what is most expensive.
Learning from Evidence in a Complex World
John D. Sterman, PhD
The author is with the MIT Sloan School of Management, Cambridge, Mass.
Correspondence: Requests for reprints should be sent to John Sterman, MIT Sloan School of Management, 30 Wadsworth Street, Room E53-351, Cambridge Massachusetts 02142 (e-mail: jsterman@mit.edu ).
"Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended "side effects." Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies.
Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond".
http://www.ajph.org/cgi/content/abstract/96/3/505
There is a great deal of research about what works best for children with developmental disabilities and mental health concerns. Quite often we spend a great deal of money on substandard treatment which do not provide the best outcomes for the child. In some situations the key is to spend a little more money for the right treatment, which frequently provides better results at a lower financial cost over the life of the child.
According to Leonard Bickman of Vanderbilt University, More is Not Always Better.
http://books.google.com/books?hl=en&lr=&id=gLWnmVbKdLwC&oi=fnd&pg=PA395&dq=cost+and+quality+of+mental+health+care&ots=0WR4Frur43&sig=gw2MTOx_5AYDOAFMPg5JLcBJNwM
Thursday, April 23, 2009
Tuesday, April 14, 2009
It Takes a Family, Plus a Village
For thousands of years, people lived in extended families. In some cultures and in some parts of the world today you will still find many people living in an extended family system. When issues of hardship, disability or behavior outside of the norm, arise, the extended family is often involved. This extended family is often involved with raising all children within the family group and caring for the needy and elderly.
When you hear the phrase, “it takes a village” there is some truth and some inaccuracy because the village, often was the family.
In many parts of the world today, the extended family is not as close geographically or emotionally as it once was. The expectation and/or provision of support is significantly diminished. Grandparents, cousins, aunts and uncles often live in distant communities, regions, and sometimes even countries.
Raising children has often been challenging and the influence and assistance of both immediate and extended family crucial. Now with that assistance and influence less available in many societies and in many parts of the world, and unfortunately with more broken and sometimes even noxious families living in increased isolation, the challenge to raise healthy productive children is even greater. (Electronic communication through television, radio, the internet, texting and whatever else will be developed in the near future is not a poor substitute for real face to face dialogue; it is no substitute at all. While it may be an effective way to communicate information; it does not replace the more essential purposes of sitting down together, talking walks together, working together, being together, fishing, knitting, listening together and just talking.) Because it still takes a family plus a village, the composition of that village is an essential responsibility of the parents which if abdicated, will be decided by the children and society around them.
I grew up in a partial extended family situation with a grandmother either living with us or next door for most of my life and frequent contact with a couple of aunts and uncles and occasional contact with other aunts, uncles and cousins. These relationships provided me with an enriched childhood; however there was much more. I owe a great deal to scout and church leaders, close family friends, and others who were a part of my childhood. Though I am in my 50’s and have moved a number of times, I still have a close relationship with many of these individuals who are still living and their families. These people and new families are all a part of my village. My children did not live as close to extended family as I did but received the wonderful benefit of rich relationships though leaders, teachers and close friends with mostly high standards. With three of my four children out of the home, two of them especially continue to maintain strong relationships with both extended family and the villages that were a part of their childhood.
Here is my point, the family, the extended family and the village are the most important and constant influences in the life of a child. In almost all situations interventions that include those who have the most contact and influence are more powerful than interventions that only or even primarily include only the child and a therapist who will have a passing influence on and involvement with the child. Even if the intervention is intensive, if the parents and even other family members and perhaps even the village are not a part of the process and acting as co-therapist, then the long term positive impact will almost always be dramatically reduced, negligible, or possibly even non existent.
I know this from research and extended personal experience as a counselor/therapist. This does not necessarily mean that a family with a child needing intervention/treatment is dysfunctional, inept, or in any way inappropriate. Many excellent parents have children with difficulties and who require specialized intervention. Intervention that can be provided by those who have the most influence and contact with the child (family and other care providers) through consultation, collaboration and coaching, from an appropriately skillful therapist with occasional or intermittent direct intervention from the therapist has the most and sometimes only long term positive impact on the child.
When you hear the phrase, “it takes a village” there is some truth and some inaccuracy because the village, often was the family.
In many parts of the world today, the extended family is not as close geographically or emotionally as it once was. The expectation and/or provision of support is significantly diminished. Grandparents, cousins, aunts and uncles often live in distant communities, regions, and sometimes even countries.
Raising children has often been challenging and the influence and assistance of both immediate and extended family crucial. Now with that assistance and influence less available in many societies and in many parts of the world, and unfortunately with more broken and sometimes even noxious families living in increased isolation, the challenge to raise healthy productive children is even greater. (Electronic communication through television, radio, the internet, texting and whatever else will be developed in the near future is not a poor substitute for real face to face dialogue; it is no substitute at all. While it may be an effective way to communicate information; it does not replace the more essential purposes of sitting down together, talking walks together, working together, being together, fishing, knitting, listening together and just talking.) Because it still takes a family plus a village, the composition of that village is an essential responsibility of the parents which if abdicated, will be decided by the children and society around them.
I grew up in a partial extended family situation with a grandmother either living with us or next door for most of my life and frequent contact with a couple of aunts and uncles and occasional contact with other aunts, uncles and cousins. These relationships provided me with an enriched childhood; however there was much more. I owe a great deal to scout and church leaders, close family friends, and others who were a part of my childhood. Though I am in my 50’s and have moved a number of times, I still have a close relationship with many of these individuals who are still living and their families. These people and new families are all a part of my village. My children did not live as close to extended family as I did but received the wonderful benefit of rich relationships though leaders, teachers and close friends with mostly high standards. With three of my four children out of the home, two of them especially continue to maintain strong relationships with both extended family and the villages that were a part of their childhood.
Here is my point, the family, the extended family and the village are the most important and constant influences in the life of a child. In almost all situations interventions that include those who have the most contact and influence are more powerful than interventions that only or even primarily include only the child and a therapist who will have a passing influence on and involvement with the child. Even if the intervention is intensive, if the parents and even other family members and perhaps even the village are not a part of the process and acting as co-therapist, then the long term positive impact will almost always be dramatically reduced, negligible, or possibly even non existent.
I know this from research and extended personal experience as a counselor/therapist. This does not necessarily mean that a family with a child needing intervention/treatment is dysfunctional, inept, or in any way inappropriate. Many excellent parents have children with difficulties and who require specialized intervention. Intervention that can be provided by those who have the most influence and contact with the child (family and other care providers) through consultation, collaboration and coaching, from an appropriately skillful therapist with occasional or intermittent direct intervention from the therapist has the most and sometimes only long term positive impact on the child.
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