Preventing problems in prevention research

The design, conduct, and analysis of prevention research efforts present formidable challenges, but as the papers in this volume illustrate, the problems of prevention research are probably not altogether intractable; they simply require the best of our thinking and the firmest of our commitments. The papers included in this issue represent some of the best thinking likely to be available, and, in aggregate, they give reason for some optimism about prevention research. Which is fortunate, because it is by now abundantly clear that treatment of all the assorted personal and social maladies that afflict us individually and as a society, is impossibly intrusive and expensive, even if we were certain we knew what to do, and we are not. Treatment research is only a step or two ahead of prevention research in nearly any field.     

Probing the effects of individual components in multiple component prevention programs

Assessing the contributions of individual components in multi-component interventions poses complex challenges for prevention researchers. We review the strengths and weaknesses of designs and analyses that may be useful in answering three questions: (1) Is each of the individual components contributing to the outcome? (2) Is the program optimal? and (3), Through what processes are the components of the program achieving their effects? Factorial and fractional factorial designs in which a systematically selected portion of all possible treatment combinations is implemented are used to address question 1. Response surface designs in which each component is quantitatively scaled are explored in relation to question 2. Mediational analysis, a hybrid of experimental and correlational approaches, is considered in relation to question 3. Design enhancements are offered that may further strengthen some of these techniques. These techniques offer promise of enhancing both the basic science and applied science contributions of prevention research.     

Participating in social enquiry and action

This paper describes the collaborative endeavours of residents and a wide range of professional workers in a particular area of Nottingham, with reference to a community psychology approach to addressing sources of psychological distress. The activities include a survey of people's views about living in the area and the factors they identify as affecting their health; and initiatives in community participation and action. One hundred and twenty three people were interviewed by members of the Sneinton and Bakersfield Community Forum. Harmful influences upon health and causes of stress were revealed as litter, dog dirt, air and traffic pollution, feeling unsafe to go out at night and lifestyle-related issues such as smoking and diet. Public meetings, the local press and short written reports were used to publicize these results and encourage further involvement. Many local residents and professionals are now active in a network of groups which address social and environmental concerns.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Integrating systems of care in California for youth with severe emotional disturbance III: Answers that lead to questions about out-of-home placements and the AB377 evaluation project

This paper is the third in a series of reports on preliminary empirical findings from replications of an integrated system of care for youth suffering from serious emotional disturbance. The development of the innovative system of care was pioneered in Ventura County, California, and the replications in three other California counties were legislatively enabled through California legislation (Assembly Bill 377). This report presents results on the expenditure and utilization of foster homes, residential placements made through special education programs, and state hospitals. Evaluation results indicate that foster home and state hospital utilization and expenditures are lower for the counties replicating the innovative system of care than for the state of California as a whole. Expenditures for special education residential placements are either at the state rate or lower in one county. The cumulative evidence supports the conclusion that the replication counties are utilizing restrictive levels of care at lower rates than would be expected, given state-wide patterns. The results, in conjunction with prior findings, are discussed in the context of questions about the possible fates of youth who no longer live in publicly funded residential facilities.     

进化心理学的过去和现在

进化心理学这个术语是90年代出现的,它从社会生物学演化而来,声势逐渐壮大。但它的思想起源却可以向前追溯一个多世纪。进化心理学否定了标准社会科学模式,注重对平常问题的研究。解释取向的进化心理学是比较成功的,它作为一种思想方法,已经渗透进心理学之外的许多领域,成就突出的是经济学领域。对进化心理学的批评主要集中在它非经验主义的方法上,但它仍然有巨大潜力。     

A Recursive Frame Qualitative Analysis of MFT Progress Note Tipping Points

Medically oriented psychotherapists typically record progress notes by articulating client symptoms, diagnoses, functional status, progress, and adherence to treatment plans. This orientation can challenge marriage and family therapists working from discursive or post-modern perspectives. Although there are discursive therapy friendly treatment planning guides, no published research on such practice exists. To address this gap the researchers conducted a recursive frame qualitative analysis of 206 de-identified progress notes from 30 completed cases seen by MFT master’s students learning discursive approaches to therapy in a university-based training clinic. Researchers found students noted problem to solution-focused discourse tipping or turning points in 20 cases with positive outcomes and no comparable shifts in 10 cases with negative or unclear outcomes.     

One Mind or Two? How Psychiatrists and Psychologists Reconcile Faith and Science

Utilizing qualitative interviews, this study showed how, to what extent, and why psychiatrists and psychologists of Judeo-Christian religious orientations or nonaffiliated believers in Michigan were willing or reluctant to integrate religious paradigms in their mental health practices. Most of the study participants were found to believe that medical-scientific and religious paradigms are equally important and may coexist or even be integrated in psychotherapeutic practice. However, actual attempts to integrate them usually reflected the practitioners’ personal religious backgrounds and initiatives and/or were client driven. Yet these integration initiatives were found to face powerful institutional impediments such as politico-cultural norms of separation of religion from secular institutions and professional norms.     

进化心理学视角下的智力研究

进化心理学和差异心理学是心理学的两个分支。进化心理学认为智力是一种进化的适应。差异心理学中智力是个体差异变量。本文试图整合二者的观点。认为智力既是进化的适应,也是个体差异变量。这将启示进化心理学家去研究更广范围的心理特质,允许智力研究和差异心理学运用进化心理学的理论和概念。本文还介绍了与智力进化相关的热带草原法则和Kanazawa的Savanna—IQ互动假说。     

职业化院长与专业化院长比较研究

专家型院长和职业化院长,谁入主中国的医院管理,一直是倍受关注的焦点议题,尽管职业化院长具有诸多优点,却难以占据医院管理的主要市场。分析二类院长的特点及专业化普遍存在的原因,并阐述国内外现状和趋势,探讨职业化推进的诸多障碍及原因,最后提出推行职业化的建议。