John H. Noble

The OHRP and SUPPORT - Another view

A group of physicians, bioethicists, and scholars in allied fields agrees with the Office for Human Research Protections about the informed-consent documents in SUPPORT.

Supported Employment in New York State: A Comparison of Benefits and Costs:

The rapid growth of supported employment programs in the last five years has been accompanied by the strong belief that through such programs many people with severe disabilities would be more satisfied with their lives and receive higher earnings than in sheltered workshops, work activity centers, and adult day care. This paper presents data collected in New York State that test these propositions and compare the benefits with the costs of operating the supported employment program.

Accumulating Evidence on the Benefits and Costs of Supported and Transitional Employment for Persons with Severe Disabilities

Evidence about the benefits and costs of supported and transitional employment for persons with severe disabilities is presented along with relevant caveats in the absence of controlled studies. Some of the major forms of supported and transitional employment services are compared with adult day care and traditional sheltered workshops, including work activity centers. Despite weaknesses in the data, sufficient information exists to argue that all forms of employment—supported, transitional, and sheltered—are more productive in terms of earnings and less costly to provide than adult day care. The lack of definitive data is seen as a major impediment to the expansion of supported and transitional employment options for people with severe disabilities; hence, stricter accountability is recommended. All service providers, regardless of the vintage of their programs, should be required to show benefits and costs within a uniform framework of measurement.

Case 24-1972

Presentation of Case A 48-year-old man was admitted to the hospital* because of dyspnea. He had been well until 10 months previously, when blurred vision developed; an ophthalmologist made a diagno...

NAMI Executive Summary

Reprinted from A Legacy of Failure: The Inability of the Federal-State Vocational Rehabilitation System to Serve People with Severe Mental Illnesses by J. H. Noble, Jr., R. S. Honberg, L. L. Hall, & L. M. Flynn, 1997, Arlington, VA: The National Alliance for the Mentally Ill. Copyright 1997 by The National Alliance for the Mentally Ill. Reprinted with permission. Employment: Avowed by all as the key to self-sufficiency and the backbone of a strong American society, it is seldom attained by citizens with severe mental illnesses (see Note). Despite the fact that people with these brain disorders want

A Closer Look at the Advanced-Standing Program in Social Work Education.

The abbrevtated advanced-standing program in social work education is evaluated in light of evidence that Bachelor of Social Work as compared to non-Bachelor of Social Work degree applicants are substantially less prepared to pursue graduate studies. Except for a few applicants from prestige colleges, discrepancies between the undergraduate grade potnt average and scores on the Graduate Record Examination and Test of Standard Written English reveal the existence of undergraduate grade inflation in most public and private institutions of higher education. A method for discounting the undergraduate grade point average is presented. Adopting an admissions policy that sets a higher graduate record examination or discounted undergraduate grade point average standard for acceptance into the advanced-standing program is recom mended by virtue of the unavoidable tradeoff between quantity and quality.

Faculty Productivity and Costs: A Multivariate Analysis.

There is increasing pressure on higher education to document results and to rationalize them within specific budgetary constraints. At margin, how much can universities influence the productivity of faculty through budgetary allocations? Are allocations for senior faculty more or less productive than for junior faculty, and in which sectors of performance — teaching, research, or services to the university and the community? A methodology is presented for analyzing faculty productivity and costs at the level of a department or school. Its application provides mixed support for the notion that university administrators can use annual budget decisions to influence faculty productivity and costs.

Isoniazid prophylaxis re-examined.

New developments in the chemotherapy of tuberculosis have thrown present policies and practices regarding isoniazid (INH) chemoprophylaxis into question. The eradication of tuberculosis by the syst...

Protecting People With Decisional Impairments and Legal Incapacity Against Biomedical Research Abuse

Ethical and legal principles are provided for reviewing the ethics of recent cases of biomedical research abuse involving persons with decisional impairments or legal incapacity who were unable to understand the risks and benefits of the research to which they were subjected. Research abuse continues to occur despite guidance from the Nuremburg Code, the Declaration of Helsinki, the U.S. Belmont Report, extensive federal regulations governing human participant research, and several professional and disciplinary codes of ethics with which, the authors believe, the majority of researchers comply. Contributing to research abuse are weaknesses in the institutional review board and research ethics board review process; conflicting opinions about applicable ethical principles; mounting evidence of pervasive conflicts of interest; and dubious conflated research and marketing practices involving researchers, pharmaceutical and medical device manufacturers, and government research sponsors and regulatory agencies. Several recommendations are made to correct identifiable weaknesses and failures in the governance of biomedical research.

Issues and Problems in the Treatment of Traumatic Brain Injury

Adequacy, equity, efficiency, legal rights, and dynamism in programs for people with traumatic brain injury are examined. Adequacy of services is compromised by costly care, restricted payments by third party carriers, restrictions on the use of available funds, and limited data for judging the types and amounts of services to provide. Compromised adequacy lowers efficiency, raises social costs, and causes horizontal and vertical inequity. Finding less costly and more effective treatment is impeded by a lack of information about the benefits and costs of services, the conservatism of service providers, and financial disincentives to change that are inherent to the existing disability service system. Rigorous research and development are needed to provide a factual basis for federal and state policy making. Greatly improved data are essential to the task of revising the current system of disability programs in the 1990s.