Managed mental health care and professional compensation

Managed care and organized systems of care are restructuring the delivery of care in the United States. As care is reorganized, physician practice styles, autonomy, and compensation are undergoing profound changes. To successfully integrate physicians into the new managed systems of care, their organizational relationship to and their compensation within these systems must be carefully considered. This paper first explores physician motivation as it is related to compensation. The paper then describes a variety of emerging organizational designs aimed at aligning the interests of physicians and hospitals. The author considers fully integrated, physician-hospital organizations with target income compensation arrangements to be most suitable to the collective success of professionals and organized systems of care. The paper concludes with a discussion of the many dilemmas and challenges posed by the intertwining of managed care, organized networks of care, and professional compensation.     

Human choice in concurrent ratio-interval schedules of reinforcement.

Seven undergraduates participated in a concurrent-choice experiment with monetary reinforcers. Response-independent analogues of variable-interval and variable-ratio schedules were used to assess whether subjects would maximize reinforcement rate. The optimal pattern of behavior, in terms of maximizing reinforcement rate, involved a large bias toward the ratio alternative, with only occasional sampling of the interval schedule. Most experiments with pigeons, however, demonstrate matching of response rates to reinforcement rates, with only slight biases for the ratio schedule. Although subjects in the present experiment allocated more time to the ratio alternative than required by matching, the magnitude of the bias did not approximate that predicted by a maximizing account. After exposure to clock stimuli correlated with the operation of each schedule, 1 subject's behavior did show a substantial level of bias, increasing the total number of reinforcers obtained, and lay at a point between the predictions of matching and maximizing. The other subjects, however, continued to respond less optimally. The present results can be accounted for by a view of matching that incorporates the effects of delayed reinforcement.     

Vasopressin, glucose homeostasis, and sucrose taste preferences

Previous research indicates that vasopressin-containing (LE) rats are capable of adapting to the stress of food restriction, whereas vasopressin-deficient (DI) rats cannot adapt to this stressor. It has been postulated that abnormalities in glucose metabolism may be one of the factors leading to the demise of food-restricted DI rats. The present study was conducted to determine if taste preferences are altered in DI animals and if the presentation of exogenous glucose, in the form of sucrose solutions, can ameliorate the effects of the stress of food restriction. Four different concentrations of sucrose solutions were presented to LE and DI rats under the food-restricted condition. In both strains, an 8% sucrose solution was preferred over 0%, 16%, and 32% concentrations, with DI rats consuming more of this concentration than LE rats. Thus, when DI rats had the opportunity of maintaining glucose homeostasis by exogenous supplements, they maintained body weight, displayed no stomach pathology, and survived.     

GLOBAL PROCESSING OF BIOLOGICAL MOTIONS

Abstract— The structure of the human form is quickly and unequivocably recognized from 10 to 13 points of light moving as if attached to the major joints and head of a person walking Recent psychophysical and computational models of this process suggest that these displays are organized by low-level processing constraints that delimit the pair-wise connections of the point lights In the current research, these low-level constraints were rendered uninformative by a masking paradigm The results from four experiments converged to show that the perception of structure in a point-light walker display does not require the prior detection of individual features or local relations     

College Students' Perceptions of the Relationship Between Fee and Counseling

Fee as a variable that could have an impact on college students' perceptions of counseling was explored because of the authentic concerns about college counseling centers needing to charge direct fees for their services. Participants (N = 350) represented a cross-section of potential consumers of psychological services, not just individuals currently receiving services. On an overt level, fees seemed to be less influential in counseling considerations, but were taken into account on a more covert level. This study supports the psychological literature, which suggests that fee is not the most important factor in clients' decisions to seek counseling. Implications for counselors, administrators, researchers, and program planners are discussed.     

Interpersonal Correlates of Narcissism in Adolescents

Researchers investigated the relationship between measures of interpersonal behavior and narcissism. Eight octant measures of interpersonal behavior were constructed, and validity and reliability estimates were obtained. High school and junior high school students (N = 333) completed five measures of narcissistic vulnerability, eight octant measures of interpersonal behavior, and a measure of social desirability. Canonical correlational analysis indicated a specific pattern of interpersonal behaviors for individuals with differing levels and types of narcissistic vulnerability. A multivariate analysis of variance (MANOVA) indicated that scores on several of the scales were found to differ significantly by sex and by treatment for emotional, behavioral, or educational difficulties. Implications for counseling are considered.     

Stress and family support as predictors of distress and rejection in people who care for a relative with schizophrenia

Relatives (N=121) of adult schizophrenia patients were interviewed to investigate predictors of their level of psychological distress and of rejecting attitudes toward the sufferer. The relatives' total stress, particularly that associated with poor communication skills in the sufferer, predicted several measures of their psychological distress, and the same variables plus turbulence of sufferer behavior (i.e., violence and disruptiveness) predicted rejection of the sufferer by the relative. In each case, adequacy of family support moderated the influence of the stressors, although this effect was more marked for distress outcomes than for rejection. The results have important implications for the sorts of professional and peer support which relatives may need to encourage their performance of this potentially burdensome role. In addition, the results fit a classic stress management model and provide a feasible alternative to the Expressed Emotion Model of the relationship between relatives' rejection and patients' illness severity.