A latent profile analysis of child maltreatment among at-risk youth gang members: Associations with violent delinquency, non-violent delinquency, and gang organizational structures

BACKGROUND

The relationship between child maltreatment and later delinquency is an enduring concern worldwide. However, the maltreatment-delinquency relationship is relatively underexplored in youth gang populations. Consequently, to date, studies have not examined typologies of maltreatment and their associations with violent delinquency, non-violent delinquency, and gang organizational structures.

OBJECTIVE

First, to identify the characteristics of subgroups of youth gang members who varied in abuse type and severity within type. Second, to determine in what ways the profiles differed in terms of gang organizational structures, violent delinquency, and non-violent delinquency.

PARTICIPANTS AND SETTINGS

A sample of 161 youth gang members (mean age: 16.8; range: 12-24) were recruited and surveyed by outreach social workers in Hong Kong.

METHODS

Latent profile analysis was first used to examine heterogeneity in victimization experiences (physical abuse, sexual abuse, emotional abuse, and neglect). Thereafter, non-parametric tests and post-hoc analyses were conducted to examine associations between the yielded typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency.

RESULTS

Poly-victimization was prevalent in the sample, with 148 respondents (91.9 %) reporting at least two types of past abuses. Three profiles of maltreatment emerged, varying in abuse types and severity within types: 'Minimally maltreated', 'Moderately maltreated, except sexual abuse', and 'Severely maltreated'. In comparison to the 'Minimal' maltreatment profile, the 'Moderate' and 'Severe' profiles were associated with greater delinquent behaviors and being in gangs that encouraged congregate illegal behaviors.

CONCLUSIONS

There was a relationship between typologies of maltreatment and gang organizational structures, violent delinquency, and non-violent delinquency in the sample of youth gang members. Implications for practice and future research are discussed.

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

Background

A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign.

Methods

This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters.

Results

In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance.

Conclusions

Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08564-4.

Being bound and tied by the ropes of frugality: a case study on public management values and service integration

Purpose

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.

Design/methodology/approach

This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.

Findings

The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.

Originality/value

Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Private equity ownership and nursing home quality: an instrumental variables approach

Since the 2000s, private equity (PE) firms have been actively acquiring nursing homes (NH). This has sparked concerns that with stronger profit motive and aggressive use of debt financing, PE ownership may tradeoff quality for higher profits. To empirically address this policy concern, we construct a panel dataset of all for-profit NHs in Ohio from 2005 to 2010 and link it with detailed resident-level data. We compare the quality of care provided to long-stay residents at PE NHs and other for-profit (non-PE) NHs. To account for unobservable resident selection, we use differential distance to the nearest PE NH relative to the nearest non-PE NH in an instrumental variables approach with and without NH fixed effects. In contrast to concerns of the public regarding quality deterioration associated with PE ownership, we find that PE ownership does not lead to lower quality for long-stay NH residents, at least in the medium term.

Exploring the differential impact of individual and organizational factors on organizational commitment of physicians and nurses

BACKGROUND

Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups. Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee's affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians.

METHODS

Information about individual factors affecting organizational commitment was derived from self-administered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis.

RESULTS

Although organizational characteristics can explain differences in an employee's commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians' group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses' organizational commitment.

CONCLUSIONS

With the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee's commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians.

TRIAL REGISTRATION

German Clinical Trials Register ( DRKS00004589 , date of trial registration: 15.05.2013).

Organizing integrated care for older persons: strategies in Sweden during the past decade

PURPOSE

The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade.

DESIGN/METHODOLOGY/APPROACH

The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied.

FINDINGS

Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out.

RESEARCH LIMITATIONS/IMPLICATIONS

Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions.

PRACTICAL IMPLICATIONS

Guiding clinical practice to be aware of importance of setting follow-up goals.

SOCIAL IMPLICATIONS

Awareness of the risk that special funds may impede sustainable strategies development.

ORIGINALITY/VALUE

A theoretical framework of forms of integration was applied to several different strategies, which had been carried out mostly in practice. The study contributes to understanding of how different strategies have been developed and applied to organize integrated care, and highlights some relationships between integration theory and practice.