MI Implementation in Juvenile Justice: A Case Report

Motivational interviewing (MI) is a communication style focused on enhancing clients’ own motivation towards change. In the justice system MI has evidence to support that it enhances communication and change behaviors in youth. As most MI training is designed for healthcare settings training and implementation of MI must be adapted to fit the juvenile justice model. This includes both rehabilitation and restorative justice. Here we describe the details that allowed one county small county in Pennsylvania to roll out MI training and initial skills review in less than 6 months. The case reviews the details of planning, trainings, and timing of activities. We then discuss what elements of those details fit into a greater implementation plan that may be applied elsewhere. Four key elements were instrumental to implementation: 1) appreciation of JPO time constraints, 2) cost containment 3) using blending to enhance JPO flexibility with MI use, and 4) policies that normalize use of MI. This outline may assist other courts in their own implementation efforts.     

Between morality and rationality: framing end-of-life care policy through narratives

This paper analyzes the nature of the debate generated prior to the implementation of the Act Respecting End-of-Life Care in 2015 in Québec (Canada). Including medical assistance in dying (MAID) along existing palliative care services, the act is an important policy change on a very sensitive issue. As such, MAID could be categorized as a morality policy issue, the latter being defined as a particular category of policy because of its specific features (issues of first principle, technical simplicity, high salience, public interest, and public participation). In line with Mucciaroni’s proposition, we rather analyze this issue by understanding morality policy as one of two framing strategies (moral and/or rational-instrumental frame). Our research reconstructs four public opinion framings as advanced and transmitted through the media between 2005 and 2015. It shows that although opponents to the bill unsurprisingly framed the debate in deontological terms, mostly referring to sanctity of life as one of the most important values in society, they also framed it on rational-instrumental grounds in a similar proportion, alleging the danger of a slippery slope and potential abuse. As well, if some of the proponents favored a moral framing centered on the argument that dignity and individual autonomy take precedence over all other values, others put forward a rational-instrumental one, where the slippery slope/abuse argument is used as a cautionary statement against the artificial prolongation of life. Our analysis reinforces Mucciaroni’s and Ferraiolo’s assertions that sensitive issues classified as morality policy cannot be apprehended solely through the unidimensional frame of morality.     

Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

A Nolan Committee for the German ethics infrastructure?

Abstract. An international trend towards establishing and conforming standards of ethical behaviour in the public sector has repeatedly been stated. Germany, however, remains surprisingly reluctant to adopt such recommendations. This article argues that the likelihood of German decision makers implementing new, and especially soft, ethics measures depends on the demand for such measures, on the one hand, and their supply, on the other. The analysis shows that contradictory forces have an impact on Germany. The demand for new ethics measures is relatively low as a high level of hard ethics measures incorporated in the longstanding formal legal system of rules and regulations make the implementation of new measures seem unnecessary. Also, the demand for soft ethics measures is less marked in Germany than in the United Kingdom. This comparatively weak pressure meets the natural inertia caused by cognitive and institutional path–dependency in institutional choices of political decision makers. On the other hand, external bodies (such as the Organisation for Economic Cooperation and Development – OECD) provide blueprints for soft ethics measures and encourage the implementation of uniform standards across countries. Which of these forces will prevail in the long run, however, cannot be deduced from the present situation.     

Horizontalité et gouvernance décentralisée: les conditions de collaboration dans le contexte de l'action communautaire

Sommaire: Cet article s'interroge sur les formes de gouvernance qui caractérisent le secteur communautaire en s'appuyant sur l'étude de deux cas de partenariats locaux initiés par l'organisme Québec en forme (QEF) dans les régions de l'Outaouais et de la Mauricie. La participation croissante des organismes communautaires à la prestation des services publics met en relief l'importance de la collaboration et du partenariat interorganisationnels dans le cadre d'une gouvernance plus horizontale. L'article présente certaines difficultés posées par la construction d'une telle gouvernance dans le secteur communautaire. Le poids des structures de pouvoir traditionnelles, de même que les innovations proposées dans la littérature sur la gouvernance et l'horizontalité (élargissement des partenariats, développement de nouveaux objectifs partagés, etc.), ont beaucoup de difficultéà prendre assise dans la pratique communautaire. Abstract: This article examines the forms of governance that characterize the community sector, referring to two case studies of local partnerships initiated by the group “Québec en forme” (QEF) in the Outaouais and Mauricie regions. The increasing participation of community organizations in the delivery of public services highlights the importance of cross‐jurisdictional cooperation and partnerships within the framework of a more horizontal governance. The article presents some of the challenges surrounding governance construction in the community sector. The weight of traditional power structures, as well as the innovations proposed in the literature on governance and the implementation of a horizontal approach (securing broader partnerships, developing new shared objectives, etc.), are not easily adopted in community practice.     

Detection of deception with fMRI: Are we there yet?

A decade of spectacular progress in functional magnetic resonance imaging (fMRI) technology and systems neuroscience research has so far yielded few changes in our daily lives. The dearth of clinical applications of this prolific and academically promising research tool began raising the eyebrows of the public and the research funding agencies. This may be one of the reasons for the enthusiasm and interest paid to the growing body of literature suggesting that blood oxygenation level‐dependent (BOLD) fMRI of the brain could be sensitive to the differences between lie and truth. The word ‘differences’ is critical here since it refers to the often‐ignored core concept of BOLD fMRI: it is only sensitive to differences between two brain states. Thus, available studies report using fMRI to discriminate between lie and truth or some other comparative state rather than to positively identify deception. This nuance is an example of the extent to which applied neuroscience research does not lend itself to the type of over‐simplification that has plagued the interpretation of fMRI‐based lie detection by the popular press and the increasingly vocal academic critics. As an early contributor to the modest stream of data on fMRI‐based lie detection, I was asked by Dr Aldert Vrij to write a piece in favour of fMRI‐based lie detection, to be contrasted with a piece by Dr Sean Spence presenting an opposite point of view ( Spence, 2008 ). This seemingly straightforward task presented two hurdles: having to respond to the popular as well as scientific view of what lie detection with fMRI is and present a wholly positive view of evolving experimental data.     

Do Competitive Examinations Promote Diversity in Civil Service?

The representative bureaucracy literature provides a growing body of empirical evidence that a representative public workforce enhances the efficacy and legitimacy of public services. However, little attention has been paid to the capacity of civil service competitive examinations to give equal opportunity of access to public jobs to equally competent citizens. To fill this gap, the authors use French databases to analyze whether competitive examinations comprising both written and oral tests ensure equality of treatment for all candidates regardless of gender, place of residence, or place of birth. The results challenge the capacity of these examinations to treat candidates equally, identifying inequalities in the written tests as well as evaluation biases in the oral tests. However, oral evaluation biases tend to offset inequalities in the written tests. Therefore, selection boards take a sort of affirmative action toward the sole successful members of groups suffering such inequalities.