Valuing Our Communities: Ethical Considerations for Economic Evaluation of Community‐Based Prevention

Restricted public budgets and increasing efforts to link the impact of community interventions to public savings have increased the use of economic evaluation. While this type of evaluation can be important for program planning, it also raises important ethical issues about how we value the time of local stakeholders who support community interventions. In particular, researchers navigate issues of scientific accuracy, institutional inequality, and research utility in their pursuit of even basic cost estimates. We provide an example of how we confronted these issues when estimating the costs of a large‐scale community‐based intervention. Principles for valuing community members’ time and conducting economic evaluations of community programs are discussed.     

Promoting happiness: The malleability of individual and societal subjective wellbeing

Is it possible to enhance the subjective wellbeing of individuals and societies? If so, what are the mental health interventions and economic mechanisms by which subjective wellbeing could be enhanced? We address these questions in our review of the literature on subjective wellbeing. Research now shows that although subjective wellbeing is heritable and stable, it can change substantially over time. Long‐term changes can be affected by positive or negative life events; subjective wellbeing interventions have also proved to be effective for boosting wellbeing for as long as six months. At the societal level, economic factors matter for the subjective wellbeing of citizens. Economic wealth is shown to be a predictor of societal wellbeing across countries and over time. Also, high unemployment severely lowers the wellbeing of individuals and has spillover effects on other societal members, such as the employed. Given the weight of evidence, we are optimistic that subjective wellbeing can be enhanced. For practitioners, policy makers, and economists interested in the wellbeing of individuals, we propose that these findings have implications for mental health practice and economic policies. Future research and methodological issues are discussed.     

The Problem of Social Cost: Coase's economics versus ethics

ABSTRACT Coase's now famous paper, 'The Problem of Social Cost', argues that social harms caused by industry are best addressed through a policy which would be optimal in terms of market efficiency. I argue that this narrowly based policy represents a classic example of the failure of many welfare economists to consider adequately the ethical implications of their recommendations. I also indicate the manner in which Coase's recommendations conflict with intuitively well-established ethical principles. I conclude that only an approach that considers many more features than market efficiency can produce an optimal policy for dealing with the social costs of production.     

绝对的公平和相对的公平

效率和公平是经济伦理的两大原则 ,也是制定和衡量经济政策的价值依据 ,但大部分经济学家都认为 ,效率和公平存在着不可调和的矛盾 ,使得人们在指导经济行为和制定经济政策时处于两难境地。本文通过对自由主义、平等主义和功利主义公平观的批判 ,试图说明 ,从历史唯物主义的立场出发 ,抛弃绝对的公平观 ,主张相对的公平观 ,便能够解决这个难题。     

The role of teachers' commitment to implement in delivering evidence-based social-emotional learning programs

Although there are reasons to believe that teachers' commitment to learn and enact an evidence-based program (i.e., their commitment to implement) predicts their implementation fidelity, there is surprisingly little quantitative research testing this relationship. Using a national large-scale evaluation of three preschool social-emotional interventions, this study investigated how strongly teachers' commitment predicted implementation fidelity and whether commitment was a meaningful predictor of fidelity as compared to other individual factors (i.e., teacher stress at baseline) and contextual factors (i.e., collegial supports, classroom behavioral problems, and classroom quality at baseline). We surveyed 230 preschool teachers in their first year of implementing the interventions; data sources include surveys from teachers and 52 intervention coaches as well as classroom observational data. We found that teachers' baseline commitment consistently predicted implementation fidelity across time and that commitment predicted unique variation in fidelity after accounting for other individual and contextual factors. In addition, implementation fidelity had a moderate positive relationship with teachers' baseline classroom quality and a small negative association with baseline classroom behavior problems. Findings are discussed with respect to implementation science in education.     

Consider the Children

Summary

In this article, we consider interventions for children exposed to family violence in light of the research on children's problems associated with witnessing family violence. Next, we review risk and protective factors related to these children's adjustment with the view that all children are not similarly affected by exposure to family violence. Against this background, we then move to consider directions for interventions from a systemic perspective. We take into account not only the exposure to interactions between their mother and father, but also children's relationships with their mother, father, and siblings, as well as within broader systems such as the peer group, the school, and the community. We consider the critical challenges within each of these important systems for children exposed to family violence, and we propose some potential interventions to address the problems. Finally, we summarize an evaluation of an intervention that incorporates some of the elements identified by a systemic perspective. The evaluation revealed a significant improvement in children's self-reports of depression and anxiety over the course of the program. Mothers rated their children as significantly improved in emotional and hyperactive behaviour problems. There was no relation between mothers' involvement in counselling and children's improvement. Overall, the results suggest that the Peer Group Counselling Program effectively provided support to children exposed to family violence. Finally, we discuss the steps necessary to support children and families in moving toward violence-free lives.     

Interventions for Children With Autism Spectrum Disorders in Inclusive School Settings

Students with ASD present unique challenges to school systems. Despite these challenges, federal laws require that schools implement research-based practices in the least restrictive environment (LRE). The LRE is often deemed to be the general education classroom and the primary intervention agent is often the classroom teacher. Ensuring students with ASD receive effective intervention in these least restrictive and inclusive school settings will depend, in part, on the extent to which teachers and school personnel are prepared to implement research-based interventions. The purpose of this article is to provide a summary of research-based interventions for students with ASD. Our focus in this summary is on interventions that can be implemented in inclusive school settings by teachers and classroom support personnel. We first provide a general overview of interventions designed to reduce challenging behavior, teach communication skills, and improve social relationships. This is followed by a discussion of the obstacles to intervention implementation that may be present in school settings. Finally, we conclude by offering a list of intervention guidelines.     

Cost-effectiveness of online positive psychology: Randomized controlled trial

As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a randomized controlled trial of an online positive psychological intervention, a health-economic evaluation was conducted. Mild to moderately depressed adults seeking self-help and recruited in the general population were randomly assigned to the intervention group (n?=?143) and a waitlisted usual care group (n?=?141). Improved clinical outcomes were achieved in the intervention group (at least for depression) at higher costs. When outliers (the top 2.5%, n?=?5 in intervention group, n?=?2 in control group) were removed, cost-effectiveness was increased considerably. For positive psychology, economic evaluations may be a means to nudge policy decision-makers towards placing positive psychological interventions on the health agenda.     

The Legal and Ethical Fiction of “Pure” Confidentiality

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

Power Politics and the Balance of Risk: Hypotheses on Great Power Intervention in the Periphery

Great powers frequently initiate risky diplomatic and military interventions in the periphery—regions that do not directly threaten the security of a great power's homeland. Such risky interventions are driven by leaders' aversion to losses in their state's relative power, international status, or prestige. These leaders often persist in such courses of action even when they incur mounting political, economic, and military costs. More surprisingly, they undertake risky strategies toward other great powers in an effort to continue these failing interventions. Hypotheses concerning such interventions are derived from the prospect theory and defensive realist literatures.     

The genetic difference principle

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies--that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.     

Using Coaching to Support Teacher Implementation of Classroom-based Interventions

Despite the growing evidence base for the efficacy of preventive interventions, the level of implementation of these interventions in schools is often less than optimal. One promising approach to supporting teachers in implementation of interventions is the use of coaching. In this study, teachers were trained in a universal classroom management intervention and provided ongoing coaching. The association between the type and amount of coaching activities and teacher implementation of proactive classroom management over time were investigated. Results indicated that teachers who received more performance feedback had higher levels of implementation over time in comparison with teachers who received less feedback. In addition, a significant interaction between the amount of coaching a teacher received and his or her implementation of proactive classroom management was found. Increased implementation over time was observed for teachers with lower initial levels of implementation who received more coaching, whereas implementation decreased over time for teachers who received less coaching. The importance of coaching as a support system for enhancing implementation quality of classroom-based preventive interventions is discussed.     

Keeping the Spirit of Community Partnerships Alive in the Scale Up of HIV/AIDS Prevention: Critical Reflections on the Roll Out of DEBI (Diffusion of Effective Behavioral Interventions)

DEBI, or the Diffusion of Effective Behavioral Interventions is the largest centralized effort to diffuse evidence-based prevention science to fight HIV/AIDS in the United States. DEBI seeks to ensure that the most effective science-based prevention interventions are widely implemented across the country in community-based organizations. Thus, this is a particularly timely juncture in which to critically reflect on the extent to which known principles of community collaboration have guided key processes associated with the DEBI rollout. We review the available evidence on how the dissemination of packaged interventions is necessary but not sufficient for ensuring the success of technology transfer. We consider additional principles that are vital for successful technology transfer, which were not central considerations in the rollout of the DEBI initiative. These issues are: (1) community perceptions of a top-down mode of dissemination; (2) the extent to which local innovations are being embraced, bolstered, or eliminated; and (3) contextual and methodological considerations that shape community preparedness. Consideration of these additional factors is necessary in order to effectively document, manage, and advance the science of dissemination and technology transfer in centralized prevention efforts within and outside of HIV/AIDS.     

Implementation of the Consultative Approach in the Classroom in Support of Related Services

The consultative approach is described as a means for special services providers to facilitate incorporation of related service objectives and interventions for children with disabilities into their daily classroom routines. The approach involves collaboration between the special services consultant and classroom teacher in specifying the child's related service needs and then in designing, implementing, and evaluating classroom based related services interventions targeted to educational goals rather than medical/therapeutic criteria. Benefits to this kind of approach are discussed within the context of full inclusion of children with disabilities. Relatedly, barriers to implementation that are likely to be present when using the consultative approach are considered.     

Applying a Social Justice Lens to Youth Mentoring: A Review of the Literature and Recommendations for Practice

Youth mentoring interventions are often designed with the intention of promoting improved outcomes among marginalized youth. Despite their promise to reduce inequality through the provision of novel opportunities and increased social capital to marginalized youth, youth mentoring interventions hold the potential to reproduce rather than reduce inequality. In the current review, we explore literature on youth mentoring that has incorporated a social justice lens. We conclude that there is a need for greater attention to principles of social justice in the design, implementation, and evaluation of youth mentoring interventions. After reviewing the literature, we make recommendations for research and practice based on a social justice perspective and explore alternatives to traditional youth mentoring that may allow for better alignment with social justice principles.     

A Broader Perspective: Counseling Psychology’s Emphasis on Evidence

The process of identifying empirically supported treatments developed by the Division 12 of the American Psychological Association has been criticized from various perspectives. However, there are a number of alternative evidence-based models for using research findings to increase the efficacy of mental health services. In this article, the principles of empirically supported interventions developed and adopted by Division 17 (Society of Counseling Psychology) are presented. These principles (a) utilize a broad perspective of evidence, (b) consider a range of psychological interventions, (c) emphasize the quantitative aggregate of research evidence, (d) consider various levels of specificity, and (e) recognize philosophy of science issues that impinge on the types of conclusions that can be made.     

Improving session attendance in mental health and substance abuse settings: a review of controlled studies

Patient nonattendance to scheduled sessions results in excessive costs to mental health and substance abuse providers and compromises the care of clients. This paper presents a comprehensive review of interventions that have been shown to increase session attendance rates in these settings. Unique to other review papers, reliability estimates were performed in the selection and evaluation of obtained studies. Reliability of article selection and evaluation strategies was excellent (.80 to .88). Study results indicate several attendance improvement methods appear to be particularly promising, such as scheduling appointments promptly, reminder letters and telephone calls, soliciting patient commitment, and helping to resolve obstacles to attending the session. The specific manner in which these interventions are implemented appears to influence session attendance rates. Moreover, some attendance improvement interventions are clearly effective in some settings, but not others. Specific recommendations are provided in light of the study findings.     

Don't Tell Me What I Don't Want to Hear! Politicization and Ideological Conflict Explain Why Citizens Have Lower Trust in Climate Scientists and Economists Than in Other Natural Scientists

Studies suggest that citizens have higher trust in some groups of scientists than in others. However, we still know little about the causes of these trust gaps. The current study fills this knowledge gap by examining Norwegian citizens' trust in climate scientists, economists, and so-called “less politicized natural scientists.” I argue that trust in climate scientists and economists is lower than trust in less politicized natural scientists because the former fields are politicized, while the latter are not. Politicization strengthens ideological conflicts between citizens' ideology and research produced by climate scientists and economists, which leads to lower trust in these groups of scientists. I test this argument by running regression analyses on data from a representative survey of the Norwegian population. The results support the argument: Citizens have significantly higher trust in less politicized natural scientists than in both climate scientists and economists, and these differences can be explained by ideological biases in trust. Citizens with a proeconomic growth ideology have significantly lower trust in climate scientists than in less politicized natural scientists, and citizens with a left-wing economic ideology have significantly lower trust in economists than in less politicized natural scientists.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.