Taking Chances: Evaluating Risk as a Guide to Better Use of Best Practices

Recent attention to best practices has resulted in a complex array of terminology and a number of compendia of effective practices that may be daunting to public policy makers and administrators seeking solutions to important public problems. This study clarifies these distinctions and builds on them to create a decision tool that will help policy makers as they use best practice information in program adoption or development. Decision makers must know their goals in seeking out best practices. As they evaluate potential practices, they should consider not only the quality of available evidence of effectiveness but also the risk of harm to constituents and the cost per unit of benefit generated. The study applies the rubric to an emerging practice in support services for individuals with disabilities known as Cash and Counseling, demonstrating that the practice is low risk, cost neutral, and improves effectiveness and consumer satisfaction. The tool highlights the judgmental elements of concern in the decision process while providing a means to assess multiple decision dimensions in a coherent fashion.     

The place of stories in development: creating spaces for participation through narrative analysis

The stories that we hear as we conduct development research or implement development projects are often relegated to the margins of development studies. This article argues that these stories require our attention, for they are windows on to indigenous narratives of development and our placement in those narratives. Examining these stories as efforts to emplot experiences of development and encounters with development professionals within particular narratives enables us to better understand our own positionality in the communities in which we work, and therefore better understand the opportunities and challenges that our research/interventions present to the emergence of a truly participatory development.     

Health care financing reforms in Germany: the case for rethinking the evolutionary approach to reforms

Health care reform has been a perpetual issue in German politics since reunification. Reform initially focused on restructuring the health care system of the former East Germany. It has subsequently focused on questioning whether the financing of the German social health insurance (SHI) system is sustainable, in light of economic malaise that characterized the 1990s and heightened global competition. In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.     

Impossibility results in the axiomatic theory of intertemporal choice

Public Choice - We have shown formally that for infinite generation, transitive, intertemporal choice procedures the familiar conditions of Pareto optimality and independence together with the...     

A comparison of respondents in initial and recommitment hearings

Legislators and researchers have focused on one aspect of civil commitment: initial commitments. Many patients, however, remain in the hospital after their initial commitment expires and, thus, must be recommitted if they are to remain in involuntary treatment. Demographic, clinical, and treatment data were collected on 374 adults having initial or recommitment hearings during a 3-month period at a large state hospital in Virginia. Respondents in initial commitment hearings were younger and displayed acute symptoms; recommitment respondents were older with symptoms of chronic psychopathology, especially those associated with schizophrenia and organic brain syndrome. The subject of recommitment patients and hearings needs to be a focus of future research efforts to determine whether these differences are reflected in a greater relative gap between the letter and practice of the law in recommitment hearings.This research was supported by grant No. R03 MH44065-01 from the National Institute of Mental Health. The financial assistance of the Institute for Research Development of the Human Sciences Research Council is also acknowledged. This article was written while the first author was a postdoctoral fellow in Clinical Services Research, NIMH grant No. 5T32MH17184-06.     

A comparison of actuarial methods for identifying repetitively violent patients with mental Illnesses

This is a progress report on the development of practical methods for the actuarial prediction of violence. The literature indicates that actuarial prediction is more accurate than clinical prediction, but in practice actuarial methods seem to be used rarely. Here we address two obstacles to the clinical use of actuarial prediction methods. First, clinicians may be averse to actuarial methods that require calculations. To remedy this, we developed a regression tree screen that presents actuarial information about violence in a series of yes/no questions. Second, using actuarial methods to identify the small minority of violent patients in a general psychiatric population may be too costly. To remedy this, we developed a method to prescreen patients for intensive evaluation using an inexpensive assessment. We evaluated regression trees and two-stage screening by comparing their accuracies against conventional actuarial methods. The results showed that actuarial predictions based on regression trees and two-stage screens were as accurate as regression-based methods in identifying repetitively violent patients. These easier-to-use methods may therefore be useful techniques for actuarial predictions.