Bringing life history theory into relationship science

In this article, I review three longitudinal studies that have investigated how exposure to more versus less predictable environments shunt individuals down different developmental pathways. After describing key principles of life history theory and how stress can shape social development over time, I discuss an interrelated set of findings from the Minnesota Longitudinal Study of Risk and Adaptation. Collectively, these studies reveal the pathways through which exposure to more unpredictable, chaotic early‐life environments prospectively forecast engaging in riskier behaviors and shorter‐term, more opportunistic, and less investing orientations to mating and parenting in one or both genders. I conclude by discussing the broader goals underlying this program of research.     

Trust in managed care organizations

Two basic criticisms of managed care are that it erodes patient trust in physicians and subjects physicians to incentives and pressures that compromise the physician's fiduciary obligation to the patient. In this article, I first distinguish between status trust and merit trust, and then argue (1) that the value of status trust in physicians is probably over-rated and certainly underdocumented; (2) that erosion of status trust may not be detrimental if accompanied by an increase in well-founded merit trust; and (3) that under conditions of managed care the physician's commitment to traditional medical ethics cannot serve as an adequate basis for merit trust. Next, drawing on an analogy between managed care organzations and politics, I argue that (4) the most appropriate basis for merit trust in managed care is a conception of organizational legitimacy that includes procedural justice, empowerment of constructive criticism within the organization, and organizational accommodation of the noninstrumental commitment to patient well-being that is distinctive of medical professionalism. I then explore the conditions necessary for robust competition for merit trust among managed care organizations and indicate the kinds of public policies needed to facilitate such competition. Finally, I show how the account of organization-based merit trust can accommodate the special fiduciary obligation of medical professionals, without indulging in the delusion that it is the physician's fiduciary obligation always to provide all care that is expected to be of any net benefit to the patient.     

Bringing science to bear: an empirical assessment of the Comprehensive Soldier Fitness program

This article outlines the U.S. Army's effort to empirically validate and assess the Comprehensive Soldier Fitness (CSF) program. The empirical assessment includes four major components. First, the CSF scientific staff is currently conducting a longitudinal study to determine if the Master Resilience Training program and the Comprehensive Resilience Modules lead to lasting resilience development in soldiers. Second, the CSF program has partnered with other researchers to conduct a series of longitudinal studies examining the link between physiological, neurobiological, and psychological resilience factors. Third, the CSF program is also incorporating institutional-level data to determine if its material influences health, behavioral, and career outcomes. Fourth, group randomized trials are being conducted to ensure that resilience training incorporated under the CSF program is effective with soldiers. A specific rationale and methodologies are discussed.     

Ethical issues in managed care: a Catholic Christian perspective.

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care.     

Considerations for ethical practice in managed care

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.     

Videodisc instruction in science and mathematics: Implications for media research and instructional design

This article summarizes research conducted over the last seven years on videodisc instruction in science and mathematics. Research findings, as well as the instructional design principles used to create programs, have direct implications for the general debate over media and its effects on learning. The array of studies conducted with the videodisc programs indicates that the medium is very cost effective. High quality instruction can be presented reliably and with much less human effort than traditional methods of instruction. By using videodiscs, developers are also able to exploit the strong graphic features of the medium, thus allowing carefully-designed visual images to play a key role in the instruction. Empirical support for non-text presentations along with examples of the graphics used in the science and mathematics programs are discussed.     

Evaluation of the Fort Bragg managed care experiment

Conclusion On the plus side, this study is a step forward. With a very specific population, it demonstrates that, with a moderate increase in communitybased services, fewer children need to be removed from their families and sent to residential treatment centers and psychiatric hospitals. On the other hand, it is only a step and, until we conduct more controlled, comparison studies in non-military communities and employ a more extensive array of innovative, community-based services, we run the risk of returning to a service delivery system that has proven to be so ineffectual in the past.     

Case vignette: the vicissitudes of managed care

Lee Wilson, age 26, was referred to Dr. Jackson for psychotherapy 5 weeks ago by a friend. Lee has been feeling increasingly depressed about longstanding family issues and the recent breakup of a 2-year relationship with a live-in companion. Over the course of the once-per-week sessions, Dr. Jackson notes persistent suicidal ideation, with vague plans to act if, as Lee puts it, "things get any worse." Just before the sixth session, Dr. Jackson is contacted by a reviewer for the managed care health insurance program covering Lee's therapy. The reviewer informs Dr. Jackson that the company will not authorize payment for further psychotherapeutic care. Dr. Jackson knows that Lee is in need of continued treatment and fears that terminating therapy at this time could result in increased suicide risk. Lee's income could cover only a small portion of Dr. Jackson's usual fee. Dr. Jackson does not wish to abandon Lee, but he already provides a significant amount of reduced-fee service to other clients. Is the health insurance carrier's stance ethical? Should Dr. Jackson be expected to treat Lee for the foreseeable future at a greatly reduced fee? How should Dr. Jackson handle this situation?     

Integrating brain science research with intelligence research

Understanding the possible causes of differences in intelligence is crucial if children are to achieve their full potential. Such understanding has been hampered until recently, however, because researchers who study intelligence have neglected recent findings in the brain sciences suggesting that the brain develops in response to environmental stimulation. These findings have seemed to contradict intelligence research that suggests that intellectual abilities are inherited. However, the findings from intelligence research and the brain sciences can be integrated if it is accepted that there are individual differences in the process by which the brain adapts to the environment, such that some people's brains are better at adapting than others'. The findings obtained from intelligence research are consistent with this integrated model. Such an integration has implications for better understanding the nature of intelligence.     

Conflict across organizational boundaries: managed care organizations versus health care providers

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.