Policy Work Research Articles

Behavior Analysis at a Macro Level: The Case for Behavior Analysts in Public Policy Work

Behavior Analysis at a Macro Level: The Case for Behavior Analysts in Public Policy Work

Family, Parenting, and Motherhood: Myth and Reality in Media and Political Discourses and Implications for Social Work

The central focus of this article is how family, parenting, and motherhood are negotiated in media and political discourses. The premise is that these discourses influence social policy and social work practice. In this study 1574 newspaper articles and 251 parliamentary records are investigated by a discourse analysis. Results reveal controversial discourse strands: The »work–life balance issue« is significant in both politics and media, primarily discussed as an issue for mothers, rarely as a couple’s issue, and hardly as a topic concerning fathers. Mothers are expected to be integrated into the labor market due to economic interests but primarily remain mothers. At the same time idealised images of mother-hood persist, although the twofold stress of ideal motherhood alongside work is acknowledged. A stronger integration of fathers in family work is only minimally observed. Economically unattractive care work remains mostly unaddressed, and parenting is not socially situated within the structural con-text. Finally, media and politics strengthen the image of the bourgeois and private family. Parallels can be found in expert discourses on child protection.

Addressing diversity, equity, and inclusion: A response of professional nursing organizations to the future of nursing: 2020-2030 recommendations.

One way in which professional nursing organizations have chosen to address the social determinants of health (SDoH) is through policy work focused on diversity, health equity and anti-racism activities. The recent report, Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FON 2020-2030), calls on professional nursing organizations and/or nursing coalitions to focus on addressing the SDoH to mitigate health inequities, including a focus on addressing racism and promoting practices to ensure the diversity of the nursing workforce. While these recommendations highlight issues of high importance to nursing and the broader society, they assume that professional nursing organizations or coalitions have not been sufficiently engaged in this work to date. Our goal was to better understand the current and/or ongoing activities of professional nursing organizations around their anti-racism work of diversity, health equity, and inclusion (DEI) activities recommended in the FON 2020-2030 report. To address this goal, we conducted a needs assessment of professional nursing organizations to document their DEI activities and the timing of these activities relevant to the recommendations in the report. The 26 responding organizations indicated they had been engaged in work addressing DEI issues for periods ranging from 4months to 51years. Minimal funding was the major barrier to advancing this work. Creating a vigorous shared DEI agenda across the profession, as suggested in the FON 2020-2030 report, will require input from nurses across the profession, as well as identification of resources to support this critical endeavor.

Understanding the Determinants of ICC Involvement: Legal Mandate and Power Politics

Abstract What explains the initiation and escalation of International Criminal Court (ICC) involvement in a situation? In light of growing charges of bias against the court, understanding the determinants of ICC involvement is critically important. Building upon research on bounded discretion at international courts, we argue that two potentially competing forces influence the court. While prioritizing impartiality should lead the court to target perpetrators of the gravest violations of human rights in states with domestic impunity, prioritizing powerful states’ interests suggests that the court may avoid involvement in powerful states and those with close ties to powerful countries. We test these arguments using original data on ICC involvement and a novel estimator that accounts for the sequential nature of ICC activity. We find that the court acts more in accordance with the legal mandate when initiating preliminary examinations, but power politics play a more dominant role at the formal investigation stage. These findings have several implications for academic and policy work on both the ICC and international courts more generally.

Finding the humanity in policy work: A teacher educators’ response to the 2023 AMLE policy agenda

Finding the humanity in policy work: A teacher educators’ response to the 2023 AMLE policy agenda

Learning to Think Like an Economist without Becoming One: Ambivalent Reproduction and Policy Couplings in a Masters of Public Affairs Program

In recent years, sociologists have labored to understand how economists have gained influence over policymaking. We extend this research by shifting focus from the matter of influence to the matter of policy training. Granted that economists already have influence, how do future policy professionals learn economic rationales? How is this mindset transmitted to hesitant students? By asking these questions, we bring socialization back into institutional research on “new” professionals. Utilizing data from an ethnography of a Masters of Public Affairs program, we find that students learn economics through a process of “ambivalent reproduction”: they learn to “think like an economist without becoming one.” They remain skeptical and reject the notion that they are economists, and when they use economics in their future policy work they do so in limited ways. Nonetheless, ambivalent reproduction sustains the policy status-quo and allows economics to remain influential without true belief. Ambivalent reproduction provides a new means for understanding the loosely coupled influence of economics on policy, and it contributes to the sociology of economics, inhabited institutionalism, and professional socialization.

Definition, Management, and Training in Impacted Fetal Head at Cesarean Birth: A National Survey of Maternity Professionals

ABSTRACT Impacted fetal head (IFH) is a complication that occurs in 10% of cesarean deliveries (CDs). Disimpacting the fetal head can have significant maternal risks, including trauma to the uterus, vagina, cervix, and bladder, postpartum hemorrhage, as well as neonatal risks, including skull fracture, intracranial hemorrhage, head and face trauma, low oxygen levels, admission to the neonatal intensive care unit, and death. Perinatal head injury due to IFH has resulted in increased litigation, with IFH identified as a contributing factor in nearly 10% of the most expensive maternity claims in the United Kingdom in 2018. International consensus on the most effective and safe management of IFH is lacking. Moreover, recent surveys of maternity professionals in the United Kingdom have reported a scarcity of training, lack of confidence, and underused techniques for IFH. Understanding how maternity professionals view the management of IFH during CD is helpful to improve care, training, and research. The aim of this study was to assess the views, understanding and practices to manage IFH during CD. This was a survey of health care professionals who provide maternity care or work in policy, research, or other areas of maternity care, using a secure online collaborative platform called Thiscovery. Participants included Thiscovery subscribers and members of clinical practice societies, such as the Royal College of Midwives, Royal College of Obstetricians and Gynecologists, and Royal College of Anesthetists. The survey analyzed responses for open-ended questions, with free-text entries, and closed-ended questions. A total of 419 participants were included in the analysis, including 144 midwives, 216 obstetricians, and 59 other maternity professionals. A high level of agreement was found among 79% of obstetricians who preferred a definition of IFH at CD that included “additional maneuvers and/or tocolysis to disimpact and deliver the fetal head.” About a third of free-text responses from 17 respondents noted a need to incorporate the difficulty or inability to get a hand below the fetal head for delivery. Approximately 95% of participants agreed or strongly agreed that management of IFH at CD requires a multiprofessional approach. When asked about communicating an IFH emergency, 55% preferred using the declaration, “This is an impacted fetal head.” Free-text responses from 57 participants emphasized the importance of clear communication and awareness of the emergency across all team members before and during the management of IFH as well as with the woman and birth partner. More than 70% found that a change of operator, manual cephalic extraction, tocolysis, operating changing hand, reserve breech extraction, Fetal Pillow, head-down tilt, and vaginal disimpaction were safe and effective techniques and adjunctive measures for managing IFH at CD. However, free-text responses from 56 participants found mixed views on the use of tocolysis, noting the risk of complications such as postpartum hemorrhage. The use of Fetal Pillow was positively accepted by 71 participants. Comparing obstetricians with midwives, approximately three quarters of obstetricians considered vaginal disimpaction before CD acceptable (72% preincision and 76% postincision). Fewer midwives favored this technique (25% preincision and 52% postincision), with 88% reporting that knowing the position of the fetal head would be helpful to know before undertaking vaginal disimpaction. Training in vaginal disimpaction was considered essential by 85% of midwives and obstetricians. Yet only 81% of midwives and 57% of obstetricians had received such training. The preferred method of training was hands-on training in simulation (91%), followed by animated video illustrating disimpaction techniques (73%) and small-group teaching (55%). Free text responses form 159 participants demonstrated a need and appetite for more training. The most frequent suggestions to improve care for IFH at CD included holding briefings and debriefings before and after the emergency and having robust plans for escalation and calling for help. This study identified high agreement among United Kingdom maternity professionals to define IFH at CD. The study authors suggested a standard definition as “a cesarean birth where the obstetrician is unable to deliver the fetal head with their usual delivering hand, and additional maneuvers and/or tocolysis are required to disimpact and deliver the fetal head.” In addition, using unambiguous language in the emergency, such as declaring “This is an impacted fetal head,” facilitates teamwork and collaboration and improves care.

Using risk of crime detection to study change in mechanisms of decision making.

Perceptions of crime detection risk (e.g., risk of arrest) play an integral role in the criminal decision-making process. Yet, the sources of variation in those perceptions are not well understood. Do individuals respond to changes in legal policy or is perception of detection risk shaped like other perceptions-by experience, heuristics, and with biases? We applied a developmental perspective to study self-reported perception of detection risk. We test four hypotheses against data from the Dunedin Longitudinal Study (analytic sample of N = 985 New Zealanders), a study that spans 20 years of development (Ages 18-38, years 1990-2011). We reach four conclusions: (1) people form their perception of detection risk early in the life course; (2) perception of detection risk may be general rather than unique to each crime type; (3) population-level perceptions are stable between adolescence and adulthood; but (4) people update their perceptions when their life circumstances change. The importance of these findings for future theoretical and policy work is considered. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Access to Land, Building Materials & Finance for Rental Housing Production in Dodoma Capital City, Tanzania

This paper presents study findings concerning rental housing delivery systems in accommodating low-income urban residents in Tanzania. Generally, the study intended to establish operational and workable policy options for promoting affordable rental houses to narrow the urban housing shortage gap that has been increasing over time. The study involved 100 property developers, eighteen (18) key informants, six (6) brokers, and fifteen (15) tenants who were purposely selected for the study. Qualitative and quantitative data were collected through interviews with property developers, and focus group discussions with key informants and local leaders. Statistical Package for Social Science (SPSS) version 20 was employed in inferential and descriptive analysis. In line with this, a Chi-square technique was employed for describing the association between the variables while descriptive analysis was employed to describe the distribution of scores among the variables. The study has shown that 68% of property developers obtain land through an informal land market while the rest 32% obtain it from a formal market. Moreover, property developers have reported that savings are the dominant source of rental housing finance mechanisms in the study area which accounts for 65% of the housing finance mechanisms. Other sources are remittances (16%), pensions (8%), loans (7%), and borrowing from relatives (4%). The study has revealed that the Pearson chi-square value and significance value, confirm that, there is a significant association between affordability and the category of land market (= 65.696, P < 0.001). Furthermore, the study has evidenced that individual property developers are dominating the rental housing market in the absence of policies, regulations, standards, and plans that could take into consideration the access to rental housing for low-income urban residents. The study recommends to the central and local government that there should be an urgent strategy to establish an enabling housing policy to promote affordable rental housing as an option for low-income urban residents in Tanzania.

Understanding university technicians’ role in creating knowledge exchange routines and capabilities: a research agenda

AbstractKnowledge exchange (KE) is becoming a strategic imperative for universities globally. Research examining KE has tended to focus on a limited and select group of stakeholders. This paper builds on calls for a wider consideration of KE activities and other contributors to the KE agenda. The technical community is one such group that has received little attention or acknowledgement of their part in KE. We argue that the technical community makes a significant yet overlooked contribution to a broad array of KE activities. Technicians are problem solvers that often undertake work that their academic counterparts could not do—as users and managers of complex equipment to enable innovation. To date the literature provides limited understanding of the technician’s role and a lack of conceptualization of the contribution of technicians in KE. Adopting a micro-foundation approach, we present a conceptual framework which draws on the multi-level categories of individuals, processes and structures. We take a broader perspective of KE by including activities such as working with external businesses, enabling access to facilities and providing analysis, and contributing to public engagement and training. By synthesizing contemporary research with recent policy work we reveal the potential contribution of technician’s talent, know-how and boundary spanning activities. We conclude with a structured agenda and conceptual framework to help guide future research, showing how investigating the integration of individual, process and structural factors affecting technicians can help reveal new insights into KE capability development at the university level.

Examining the integrated model of the interpersonal-psychological theory of suicide and intersectionality theory among Black male adolescents.

Guided by Opara etal.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation. Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys. As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence. These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.

Policy implementation and outcome evaluation: establishing a framework and expanding capacity for advocacy organizations to assess the impact of their work in public policy

Advocacy organizations can play a crucial role in evaluating whether legislation or regulation has had its intended effect by supporting robust public policy implementation and outcome evaluation. The American Heart Association, working with expert advisors, has developed a framework for effective evaluation that can be used by advocacy organizations, in partnership with researchers, public health agencies, funders, and policy makers to assess the health and equity impact of legislation and regulation over time. Advocacy organizations can use parts of this framework to evaluate the impact of policies relevant to their own advocacy and public policy efforts and inform policy development and guide their organizational resource allocation. Ultimately, working in partnership, advocacy organizations can help bring capacity, commitment and funding to this important implementation and outcome evaluation work that informs impactful public policy for equitable population health and well-being.

Feminist foreign policy and global (health) care work migration: Addressing the invisibility of colonial gaps in feminist policy making

ABSTRACT The state-sponsored recruitment of migrant healthcare workers from the global South into the global North is a contemporary practice that requires critical engagement. Germany, like many other like-minded countries, has developed its own recruitment program Triple Win which aims to sustainably and ethically secure its national health care system through the use of foreign labor. Absent from Triple Win is an awareness of the ongoing colonial power relations that reproduce the program as a practice in neocolonial care extractivism. This lack of awareness is set against the country’s promotion of a feminist foreign and development policy, which seeks to transform international politics through a gender centred approach. Locating Triple Win within the context of feminist foreign policy we analyse how Germany’s feminist foreign and development policy makes visible, addresses and changes the colonial power relations that sustain care work migration programs. In doing so, we seek to build on existing studies of care work migration as a gendered and racial phenomenon. To do this we adopt a postcolonial feminist approach that is grounded in an ethics of care in order to remap the local and the global through a critical analysis of care work migration as a neocolonial development practice.

Keeping It Political and Powerful: Defining the Structural Determinants of Health.

Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work-implicitly and explicitly-to maintain their advantage by reinforcing or modifying these rules. This theoretically grounded definition of structural determinants can support a shared analysis of the root causes of health inequities and an embrace of public health's role in shifting power relations and engaging politically, especially in its policy work. Shifting the balance of power relations between socially constructed groups differentiates interventions in the structural determinants of health from those in the social determinants of health.

Lived experiences of genetic diagnosis for rare disease patients: a qualitative interview study

BackgroundGenetic diagnosis is often understood as a single event within the care pathway of rare disease patients. Legal, policy and ethical scholarship focusing on rare diseases and genetic information discusses questions of how to best deal with the process of genetic diagnosis and the communication of genetic information within a given health system. We co-created a research design with rare disease patients and their families in Austria to explore in-depth the experiences of genetic diagnosis for people affected by rare diseases. Our objective was to trace the whole pathway of genetic testing and understand how rare disease patients experience genetic diagnosis as part of their care pathway in the healthcare system.ResultsData was collected through in-depth semi-structured qualitative interviews with 14 patients with a suspected or diagnosed rare disease or their parents, focusing on their perception of the pathway of genetic diagnosis in Austria. This pathway included the initial triggering of genetic diagnosis, the process of testing and its immediate (communication of results, counselling) and long-term, wider aftermath. Patients missed a clear link to already established forms of care such as their primary care/treating physicians. They also advocate for an integrated and interdisciplinary care pathway.ConclusionsOur study underscores the importance of a continuous care and communication pathway spanning from the initial genetic diagnosis process to post-test phases. It further shows the importance of exploring patients’ perspectives through qualitative research methods to understand the intricate workings of public health policies and tools. Integrating genetic diagnosis into a broader care trajectory is crucial for a holistic approach to care for rare disease patients who often rely on regular interactions with the healthcare system. Achieving this holistic approach requires collaboration between experts in specific rare disease areas, primary care physicians, and support networks.

Proceedings from the Third Annual Conference of the Norwegian Network for Implementation Research (NIMP)

The third annual conference of the Norwegian Network for Implementation Research (NIMP) was held on November 28th, 2022, in Oslo, Norway. This event drew 98 participants from diverse sectors and disciplines such as health care, welfare, education, and government, with increased interest from non-research practitioners and policymakers (32% of attendees) compared to prior NIMP conferences. The conference featured a keynote presentation from Professor Per Nilsen, two plenary presentations, eleven parallel session presentations, and five poster presentations. The majority of presentations focused on applied implementation research (72%). However, 28% were from non-research implementation practice and policy work, indicating an increased awareness and use of implementation science outside of academia. The presentations were focused on implementation determinants and strategies, the use of theories, models, and frameworks, and research-to-practice partnerships. The conference saw limited rigorous evaluation of implementation, and more robust evaluation methods with strong measures of implementation outcomes may be needed to enhance implementation evidence in Norway. To sustain engagement in the conference, NIMP should continue integrating implementation research and practice, and consider interactive cross-professional sessions to foster knowledge exchange and collaboration. The conference’s increasing influence reflects the growing awareness and relevance of implementation science in Norway, and the conference may facilitate beneficial feedback loops between implementation research and practice to advance the science and practice of implementation in Norway.

Behaviour support provision in Australia: A cross‐sectional survey of practitioners developing behaviour intervention plans

AbstractThere is currently a limited understanding of the characteristics of the workforce of behaviour support practitioners in Australia. A better understanding will help future considerations of training requirements, professional credentialling and associated professional regulation. A cross‐sectional online survey captured the demographic and work‐related characteristics of those who develop behaviour intervention plans for people with disability in Australia. The sample (n = 423) was primarily female (78 per cent), aged 26–45 years (57 per cent) and held a graduate (39 per cent) or postgraduate (53 per cent) degree. The largest single professional group was psychologists (28 per cent). The most common duration of experience was 1 year. Approximately half of the respondents were allied health practitioners either registered with the Australian Health Practitioner Regulation Agency or a member of the National Alliance of Self‐Regulating Health Professionals. The majority of practitioners had registered with the National Disability Insurance Scheme to provide behaviour support services (85 per cent). Both clients and services were concentrated in metropolitan regions, raising concerns regarding equity of access to behaviour support in remote communities, and among Aboriginal and Torres Strait Islanders. Given the vulnerability of many people with disabilities in receipt of behaviour support, ongoing policy and procedure work is needed to ensure professional credentialling and regulation of the workforce.

Current hospital policies on breastfeeding: a survey from Italy

BackgroundThe availability of an appropriate newborn feeding policy is an essential component of the promotion of breastfeeding in health facilities. The Italian Society of Neonatology (SIN) and the Italian Society of Paediatrics (SIP) have run an online survey among Maternity Hospitals to explore the existing breastfeeding policies and their characteristics.MethodsBetween February and April 2023, an online survey was carried out among 110 Italian maternity hospitals with a Neonatal Intensive Care Unit (NICU).ResultsForty-nine Maternity Hospitals completed the online questionnaire. Twenty out of 49 (40.8%) reported to have a breastfeeding policy. When a policy is available, its quality appears to be suboptimal because of lack of inclusion of a family representative in the policy working group, limited options for translating breastfeeding policy into minority languages, lack of periodic assessment of their implementation.ConclusionCurrently, only a limited number of Italian Maternity Hospitals have developed a breastfeeding policy. Additional efforts are needed for their improvement as well as implementation.

Informality through the state: How overregulation and tolerance shape informal land development in metropolitan Brazil

The relationship between the state and informal land development in Global South metropolises has yet not received much attention in urban studies. Concerning that knowledge gap, this paper investigates how the state regulates and inspects irregular and clandestine land subdivisions in the Metropolitan Region of Belo Horizonte (MRBH). A mixed-methods approach, focused on the inner workings of the land development control policy led by the MRBH Agency between 2009 and 2018, provides new evidence of the relationships between inspectors, developers, and prosecutors, among other actors. By delving deep into the intricate nexus between a changing regulatory landscape and the bureaucratic, street-level, and everyday enforcement practices by officials, the paper reveals how land development control, directly and indirectly, shapes informal land development in the MRBH. Particularly, it sheds light on how land development control unrolls through a contradictory combination of overregulation on one side and tolerance on the other. In light of this, I argue that, as land development control evolves without effectively tackling the land question and the structural drivers of informality, the state becomes paradoxically entangled in the production of the same forms of informality it is expected to curb. Therefore, land development control is better understood as a fragile and ambivalent state compromise between the need to regulate urban expansion and market-driven informal urbanisation. By creating opportunities for rent extraction and capital accumulation which are explored by informal land developers, the state has been crucial for property-led informal urbanisation in metropolitan Brazil.

Labor lacuna: Disjunctures between local climate action and workforce development in advancing just transitions

ABSTRACT U.S. cities have launched expansive climate action initiatives, often touting these efforts’ economic development and job creation benefits. However, without creating the conditions for high-quality jobs and improved access and inclusion, climate mitigation initiatives may be shaped by neoliberal labor principles that sustain inequality. Drawing upon just transition, economic development, and workforce planning literature, we examine the role of workforce development in municipal climate mitigation efforts. Using Austin, Texas, as a critical case, and interviews with local public and non-profit organizations, we illustrate robust green job growth in a range of occupations can provide access to career-building, quality jobs for economically disenfranchised residents. Our case demonstrates that when state policies hamper just transition efforts, local government actions can still shape better outcomes. These case study insights can extend to numerous urban regions where state government policies work strongly against joining climate action and equitable economic development.