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This book shows how responsiveness in European welfare programs is institutionalized through nationally distinct legal foundations, professional traditions, and resource networks, while revealing how resource scarcities threaten to erode these capabilities

An ongoing challenge for the administrative state is balancing the programmatic values of responsiveness and accountability. Few studies have examined these policy issues cross‐nationally for social assistance, a needs‐based form of income support where these tensions are especially significant. Based on street‐level case studies, this article demonstrates persistent diversity among welfare states in how these programmatic tradeoffs are made, contrasting a U.S. approach that emphasizes programmatic control via a bureaucratic, flat‐grant system, with German and Swedish programs in which individualized assessments of need are a core organizational task. In each European case, legal frameworks, expertise, and work arrangements have evolved in nationally specific ways to contend with the challenges frontline discretion poses to program integrity.

Notice and comment provisions in agency rulemaking provide an important mechanism for the public to contribute to policy. Yet there is limited research on how interest groups participate in this process. California's passage of an ergonomics standard in 1997, the only current state statute in the country, provides a useful, high salience policy case for examining public commentary. Between an initially proposed comprehensive standard and the enactment of a much weaker regulation occurred the largest public response in California's state Occupational Safety and Health Administration history. Through a detailed content analysis of the notice and comment submissions we identify features of participation and claims -- making that differ between business and non-business submissions. Business groups were the large majority of participants and also presented a disproportionate amount of evidence, using an "abstract-technical" policy frame to assert the illegitimacy of the ergonomics standard. Labor, public health organizations and private citizens represented less than one-third of the participants and relied primarily on experiential information and a "concretized-moral" characterization of policy issues in support of the standard. The existence of these distinct "interpretive communities" that mobilize different resources raises questions about whether public commentary can fulfill its purported "democratic accountability" purpose as well as underline the limitations of appealing to scientific expertise for solving complex policy problems. Adapted from the source document.

The way frontline workers in human service organizations implement policy is greatly influenced by how their jobs are structured within particular organizational settings. Although scholars of street-level bureaucracy have provided important insights into this relationship in specific situations, they rarely move beyond case study findings toward a more general research approach. Through cross-case analysis of fieldwork from California welfare and welfare-to-work programs, the authors inductively developed a framework for investigating how organizational setting mediates between policy goals and frontline behavior. The authors illustrate the use of this framework for welfare programs and street-level studies more generally using illustrations from their prewelfare reform study as well as from more recent postreform/Temporary Aid to Needy Families studies.

Background Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles. Methods We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years, diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score, and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised; clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3-months. Secondary outcomes included asthma exacerbations requiring emergency health care and school absence. Registration: Pan African Clinical Trials Registry: PACTR201807211617031 Findings Between September 2018 to December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3-months: intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared to standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1-3.1, p<0.001). Fewer intervention children attended emergency health care (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001), compared to standard care children. Interpretation The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings.