Therapeutic jurisprudence: A framework for evidence-informed health care policymaking

Translation of evidence-based practice (EBP) into health care policy is of growing importance, with discussions most often focused on how to fund and otherwise promote EBP through policy (i.e., at system level, beyond the bedside). Less attention has been focused on how to ensure that such policies - as enacted and implemented, and as distinguished from the practices underlying policies - do not themselves cause harm, or at least frustrate accomplishment of "therapeutic" goals of EBP. On a different front, principles of therapeutic jurisprudence (TJ) in law have been developed, most prominently in certain areas of law (e.g., mental health and family law), to support more collaborative, less traumatic advocacy and conflict resolution. This paper draws on current applications of TJ and translates such into a therapeutic approach to health care policymaking that moves beyond promotion of EBP in policy. Health care policy itself may be viewed as an intervention that impacts health, positively or not. The goal is to offer a framework for health care policymaking grounded in TJ principles that does not focus on which evidence is "right" for policy use, but rather how we can better understand how consequences of policy, intended or not, affect the well-being of populations. Such framework thus moves policymaking from an either/or debate to a data- and human-driven process. Utilizing TJ framing questions, policies can be developed and evaluated through open dialogue among diverse voices at the table, including - like interventions - the "patients" or, here, targets of such policies. Collectively, they clarify how ends sought - to enhance (or at least not impair) health - can best be achieved through policy when needed, recognizing that as an intervention, there are limits to and boundaries on the usefulness of policy.     

Informing Police Response to Intimate Partner Violence: Predictors of Perceived Usefulness of Risk Assessment Screening

Substantial research has demonstrated the value of using risk assessment tools for the prediction and management of violence risk, including for intimate partner violence (IPV) (Mills, Kroner, and Morgan 2011). Such tools have been advocated for use by police officers (Hilton, Grant, and Rice 2010), but little is known about police officers’ perceptions of using these tools to inform their decision-making. Using a sample of 159 Canadian police officers (73% male, M age =?41.8 years, SD?=?8.9), the current study examined police officer’s experiences with IPV risk tools, their attitudes about using such tools, and identified predictors of these attitudes using an online survey. Most of this sample had previously used an IPV risk tool, which was most commonly the Brief Spousal Assault Form for the Evaluation of Risk (64.1%). Most police officers rated use of risk tools as at least somewhat to extremely helpful (73.5%), and 67.4% indicated that they would use a risk tool with sufficient training on it. Regression analyses indicated that police officers’ perceived IPV risk tool usefulness was significantly predicted by older respondent age and greater perceived need for guidance in responding to IPV calls. In conclusion, most police officers view IPV risk screening as valuable for informing their responses to such calls for service and are likely to embrace such decision-aids with sufficient training on their potential impact for enhancing safety.     

Panel on the Economic and Political Consequences of Chernobyl'

This article summarizes a discussion by a panel of leading experts on Soviet energy analyzing the consequences of the accident at the Chernobyl' nuclear plant in the Ukraine on April 26, 1986.

The near-term economic costs associated with clean-up, relocation, and compensating for losses to electricity supplies are significant but manageable. The longer-term effects will focus on likely modifications in Soviet strategies for the nuclear industry, which may shift emphasis back towards conventional fuels and conservation.

The political consequences were managed fairly well by the leadership. Consistent with Secretary Gorbachev's policy of glasnost' (openness) more information has been available on this event than was the case in previous analogous situations. Journal of Economic Literature, Classification Numbers: 027, 124, 723.