Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold.     

Desistance from intimate partner violence: A critical review

Evidence suggests that a significant proportion of men who have been violent towards their partners desist from such violent behaviors; yet, research examining desistance from intimate partner violence (IPV) is limited. This omission is surprising given that an understanding of desistance processes is required to inform evidence-based IPV interventions. In this critical review of the empirical literature, eligible studies included 15 publications, identified through electronic databases and hand searches of bibliographies that directly investigated the cessation of physical violence against an intimate partner, by heterosexual men. No single theory was identified that explains desistance from IPV. However, empirical studies reveal that the severity and frequency of violence is associated with desistance, with those using moderate levels of violence being more likely to desist than those who engage in severe violence. Typology research suggests differences in individual characteristics (e.g., low psychopathology and impulsivity) can distinguish desisters from persisters. In addition, the nature of the dyad within which the violence occurs is also influential in desistance processes. It is concluded that much more research is needed to inform practice and in particular to examine the role of protective factors in mitigating risk and enabling individuals to desist from IPV.     

Youth Experiences of Family Violence and Teen Dating Violence Perpetration: Cognitive and Emotional Mediators

This article describes a conceptual model of cognitive and emotional processes proposed to mediate the relation between youth exposure to family violence and teen dating violence perpetration. Explicit beliefs about violence, internal knowledge structures, and executive functioning are hypothesized as cognitive mediators, and their potential influences upon one another are described. Theory and research on the role of emotions and emotional processes in the relation between youths’ exposure to family violence and teen dating violence perpetration are also reviewed. We present an integrated model that highlights how emotions and emotional processes work in tandem with hypothesized cognitive mediators to predict teen dating violence.     

First time gun carrying and the primary prevention of youth gun violence for African American youth living in extreme poverty

First time gun carrying is specified as a logical starting point for the primary prevention of youth gun violence, which is also consistent with the public health approach to the prevention of firearm injuries for at risk African American youth. However, it is difficult to disentangle youth gun violence from other aspects of violence that are concentrated in high poverty settings. Insights from developmental life-course criminology (DLC) are used to: (1) categorize first time gun carrying as a critical inflection point in the development of youth violence; and (2) categorize exposure to violence in the community as a developmental pathway for first time gun carrying for youth attempting to prevent and/or deter future violent victimization. The ecological-transactional model of community violence provides a more nuanced breakdown of the impact of exposure to violence in the community on first time gun carrying given the embeddedness of contexts that shape child and adolescent development in high poverty settings. Finally, several areas for future research are outlined that include a need to better integrate gun carrying into existing theories as well as future longitudinal studies of high risk African American youth.     

A Systematic Review of the Effects of Disclosing Carrier Results Generated Through Newborn Screening

Evidence on the effects of disclosing carrier results identified through newborn screening (NBS) is needed to develop effective strategies for managing these results, and to inform debate about contradictory policies governing genetic testing in minors in the context of NBS relative to clinical care. This is likely to be even more important as technological opportunities for carrier identification through NBS increase. We report the results of a systematic review of evidence related to the generation of carrier results through NBS to summarize what is known about: (1) the outcomes associated with these results; (2) the best strategies for providing information and follow-up care to parents; and (3) the impact they have on reproductive decision-making. Our study expands the existing body of knowledge and identifies gaps in the evidence base. As key players in the management of carrier results clinically, genetic counselors are well positioned to engage in formative research and policy development in this area.     

Ethnic Minority Women’s Experiences with Intimate Partner Violence: Using Community-Based Participatory Research to Ask the Right Questions

Current definitions, instruments, and processes for measuring intimate partner violence, including sexual assault, are insufficient to detect the nature and scope of violence against all women. To remedy this problem, we recommend the use of community-based participatory research (CBPR) principles to develop culturally informed quantitative instruments that measure ethnic minority women’s experiences of intimate partner violence (IPV). CBPR requires community members and researchers to work equitably together throughout the research process, sharing decision-making and ownership. This paper identifies problems with current measurement approaches and describes the strengths and challenges of the CBPR approach. We argue that this research orientation offers the potential for “flexible standardization” that can provide better estimates of the extent of IPV and sexual assault, and provide communities with the knowledge they need to address these problems in a culturally sensitive manner.     

Operationalizing the Assessment and Management of Violence Risk in the Short-term

Assessing risk of violence in the short term is crucial for managing and preventing violence, especially in institutions such as psychiatric units and prisons. Despite a lack of consensus on the definition of "short term", a number of recent tools and guidelines have been developed to aid short-term clinical decision-making. Whereas the supporting evidence for the new tools is impressive, limitations remain in terms of the focus on prediction, limited consideration of strengths, and poor integration with formulation and risk management. The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk. The START has the potential to operationalize the structured professional judgment (SPJ) approach in order to inform the evaluation of multiple risk domains relevant to everyday psychiatric clinical practice. However, explicit guidance on integrating risk assessment, formulation and management is limited in the START and this paper describes the SPJ approach, reviews recent developments in approaches to risk, and considers how the START can be used to inform SPJ approaches and link risk assessment, formulation, and management. Copyright ? 2012 John Wiley & Sons, Ltd.     

The role of moral knowledge in everyday immorality: What does it matter if I know what is right?

In contrast to other well-known cognitive models of moral decision-making, social cognitive theory posits that individuals can disengage from their own moral standards thereby allowing themselves to commit immoral acts. While previous research largely supports the general premise of moral disengagement, we suggest that direct tests of moral disengagement processes and the commensurate diminished role of moral knowledge are conspicuously absent. In five studies, we use multiple methods to capture both knowledge of the immorality of an act and theorized in situ processes of moral disengagement. Ultimately, we find no evidence of the proposed processes associated with moral disengagement. Furthermore, our data suggests that moral knowledge is a key driver of moral behavior in everyday situations and is not easily set aside. We conclude by discussing the implications of this research for theory and practice.     

Granny, (don't) get your gun: competency issues in gun ownership by older adults

This article explores the possible risks associated with gun ownership by older adults. We summarize existing regulations on who may own firearms, especially with respect to age. We then present data on older gun owners and violence committed by older adults in general, followed by a discussion of gun violence perpetrated by gun owners whose functional and cognitive abilities have declined, perhaps as a result of dementia. For comparison purposes, we review regulations on driving among older adults, drawing parallels to gun ownership. The paper concludes with recommendations for ensuring the safety of older gun owners and others, balanced against citizens' right to bear arms, and with some directions for research.     

The missing piece: a sociological autopsy of firearm suicide in the United States

Social, economic, violence, political, and gun access predictors of suicide and gun suicide were examined via sociological autopsy. The model predicting suicide rates overall had the best results, χ(2) (9, N=50)=5.279 (CMIN, the goodness of fit statistic that represents the minimum discrepancy between the unrestricted sample covariance matrix and the restricted covariance matrix) p=.809, [the goodness of fit statistic that represents the minimum discrepancy between the unrestricted sample covariance matrix and the restricted covariance matrix] indicating an excellent fit of the data and theoretical model. The model explained 76% of the variance in state suicide rates and was a significantly better predictor than one could expect by chance, F(6,43)=22.889, p<.001). All path coefficients were significant predictors of suicide with the exception of violence climate, which was not included. This study contributes to the theoretical knowledge by adding a comprehensive framework of analysis and model useful for prevention.     

Communicating evidence‐based mental health care to service users

There is a significant gap between evidence‐based mental health care and patients, their family members and carers. To inform preventative mental health care among existing and potential service users, this review identifies effective methods for communicating evidence. A systematic review located 14 publications that met search criteria. Several methods can effect behavioural and/or intermediary change among existing and/or potential service users: namely, mass media; health warning labels; policy change; community interventions; school‐based programs; parent programs; and psychoeducation. Robust evidence, however, is lacking. Although effective approaches are likely to be founded on several factors, the review concludes with a discussion of a research agenda, and appropriate methodologies that could strengthen the knowledge base that guides the communication of evidence‐based mental health care to service users. This agenda has important implications for practitioners, policymakers, and researchers, which are also discussed.     

Violent Movies and Severe Acts of Violence: Sensationalism Versus Science

Violent media has often been blamed for severe violent acts. Following recent findings that violence in movies has increased substantially over the last few decades, this research examined whether such increases were related to trends in severe acts of violence. Annual rates of movie violence and gun violence in movies were compared to homicide and aggravated assault rates between the years of 1960 and 2012. Time series analyses found that violent films were negatively, although nonsignificantly, related to homicides and aggravated assaults. These nonsignificant negative relations remained present even after controlling for various extraneous variables. Results suggest that caution is warranted when generalizing violent media research, conducted primarily in laboratories and via questionnaires, to societal trends in violent behavior.     

Selecting outcomes for intimate partner violence intervention trials: Overview and recommendations

Intimate partner violence (IPV) is endemic in societies around the world and detrimental to women's wellbeing. Abused women are frequent users of health services. Despite the recent World Health Organization guidelines on IPV and sexual violence, we need more evidence on effective responses to women in health care settings. Developing robust evidence with potential to inform policy and clinical practice requires greater clarity and consistency across studies in the selection and use of outcomes to evaluate interventions. Drawing on systematic reviews and individual trials aimed at reducing abuse and improving women's health, we discuss critical issues in respect of outcomes. We discuss primary, secondary, intermediate and proxy outcomes and measures used to evaluate interventions for women who experience IPV. We offer recommendations about which outcomes to assess and approaches to doing so within the context of trials in health care settings.     

Developing Guidelines for Domestic Violence Offender Programs

Summary

This article reviews research on domestic violence that can help inform the development of guidelines for programs for men who batter. It also illustrates some successes and problems in other fields that might be instructive for the domestic violence field. Firm conclusions about “best practice” guidelines for intervention seem to be premature because of flaws in evaluation studies. In addition, there is growing evidence of variability among men who batter on dimensions such as severity of violence, childhood traumas, generality of violence and personality traits. Programs also need to be able to respond to motivational and cultural difference among abusers. Existence of variability implies the need for multiple forms of interventions.     

Participatory Policy Making: Balancing between Divergence and Convergence

In participatory policy-making processes many different stakeholders have access to the policy-making arena. In order to benefit from the diversity of perspectives the stakeholders carry with them, interaction between these stakeholders should be facilitated. Three modes of facilitation are distinguished which differ in the balance they seek between divergence and convergence: inducement of better understanding, shared perspective, and policy learning. In particular it is examined how the technique of gaming simulation facilitates participatory policy making. From the application of this technique it is derived that a minimum common ground is necessary as a starting point for participatory policy making. Participatory policy making should start with a common challenge as well as agreement between stakeholders on some core concepts and rules of interaction. At any moment, stakeholders should be forced to put the common ground that is evolving up for discussion.     

Digital communities of practice: Investigation of actionable knowledge for local information networks

The article explores integration of knowledge-enabling digital technology into community functions through the development of local Digital Communities of Practice. This analysis includes both general considerations—in terms of domain, community, and practice dimensions—as well as results from an exploratory research project in Minnesota. The domain is described as integrated deployment of virtual services (education, human services, government) in local communities; the community is comprised of the local stakeholders and residents that would use or benefit from such services; and the practice is considered as a decision-making processes for designing and deploying these services. The paper concludes with research and policy considerations for providing an enduring source of knowledge about local virtual services, needs, and solutions. His research focuses on the evaluation of information technologies as they are planned and deployed in infrastructures, organizations and community systems. This research has been reported in Information Systems Frontiers, Communications of the ACM, Journal of Urban Technology, and Policy Studies Journal. Dr. Horan has also written two books, Digital Places (2000) and Digital Infrastructures (2004, co-edited with Rae Zimmerman). He has both his Masters and Doctorate degrees from the Claremont Graduate University and has held visiting scholar positions at MIT, Harvard, UCLA, and University of Minnesota. Kimberly Wells is an organizational psychologist currently working as an independent consultant. Since 1996 her research and work have converged upon issues involved with assessing the influence of technology in organizational and community settings. Ms. Wells is presently completing her doctorate at Claremont Graduate University, California. Her dissertation explores processes for improving the knowledge-creating capacity of virtual teams. Ms. Wells has a Masters degree in Organizational Behavior, Claremont Graduate University, and a Masters degree in Anthropology from the College of William and Mary, Virginia.     

Third_Person Perception of Television Violence: The Role of Self_Perceived Knowledge

This study investigated the proposition that self-perceived knowledge or self-expertise is a primary theoretical construct in understanding third-person perception of television violence effects. Consistent with most past research, the findings confirm people's third-person tendencies to attribute greater media effects of television violence on other people than on themselves. As hypothesized, self-perceived knowledge was a stronger predictor of third-person perception than sociodemographic variables (demographics, ideology, and media use). The study also found that self-perceived knowledge was more likely to moderate than mediate the relationship between sociodemographic variables and third-person perception. Whereas a moderator affects the strength of the relationship between an independent variable and a dependent variable, a mediator explains the relationship between the two variables. In sum, the findings indicate that respondents' judgments of their superior self-perceived knowledge of television violence might be of theoretical significance in third-person effect research.     

Professionalizing the Practice of Public Policy in the Prevention of Violence

The State of the Science Conference Statement on “Preventing Violence and Related Health-Risking Social Behaviors in Adolescents” accurately summarizes the state of knowledge regarding risk factors for violence and intervention efficacy. The Statement missed an opportunity, however, to move the field of prevention practice and policy forward by advocating for more systematic, central review of preventive interventions through a new federal regulatory body, such as an “FDA for Preventive Interventions.” This body would provide review of evidence-based programs and aid decision-making in funding. As a complement to this body, decision-makers also need guidelines in evidence-based practice in ambiguous circumstances, which characterize much of the reality of public policy. Therefore, this new regulatory body should be accompanied by guidelines for evidence-based practice in intervention and policy. Finally, in order to move forward both of these concepts, a National Academy of Sciences Panel should convene to deliberate how these concepts can be implemented.