Putting community risk in perspective: a look at correlations, causes and controls

Much research, but not all, appears to show that persons with severe mental illness are more dangerous and violent than others; but it is misleading and feeds the stigma cannon. This paper critically reviews reported correlations between severe mental illness and violence, examines their statistical confounds, highlights studies which seek causal mechanisms explaining the associations, points to what those causal mechanisms tell us about controlling risk in the community, and reviews legal attempts to control community risk in light of those causal mechanisms.     

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.     

An attempt to reduce guessing behavior in children's and adults' eyewitness identifications

The effects of age of witness, gender of witness, lineup presentation, and practice on eyewitness testimony were investigated. Ninety-six elementary-school children and 96 college students viewed a slide sequence of a crime, followed by target-present or target-absent photo identification in sequentially or simultaneously presented lineups. Prior to photo identification, half the subjects received a practice lineup. Children had a higher rate of choosing than adults, resulting in more foil identification errors in both target-present and target-absent lineups. Without prior practice, sequential presentation as compared to simultaneous presentation reduced errors in target-absent lineups for adult witnesses and showed a similar but nonsignificant reduction for child witnesses. With prior practice, sequential presentation lost the advantage over simultaneous presentation in target-absent error reduction. Practice reduced target-absent errors in simultaneous-presentation lineups for both age groups.     

Juvenile diversion and the constitution

The juvenile justice system has been a product of interaction between legal and socio-medical forces since its inauguration near the end of the last century. While the socio-medical forces have, for the most part, been dominant over the years, concern for minimum legal standards has been a conspicuous part of the picture since the years 1966 to 1967. The result is serious attention to due process and fundamental fairness in court processing, and low tolerance for abridgement of such rights in the interests of attaining the social goal of rehabilitation. The question arises as to how early in the procedural chain for juveniles various due process rights should enter. Some have argued that important due process rights should be components in the process leading to probation, and even police, diversion. The central argument of this article is that broad directives regarding due process in diversion are inappropriate. Indeed, analysis of actual and potential losses of freedom associated with diversion decisions leads to the general conclusion that very few diversion programs require usual procedural rights. Moreover, a survey of case law indicates that there is little reason to expect that the procedural protections enunciated by the U.S. Supreme Court so strongly in the 1960s will be extended by the courts to police (or probation) decisions on diversion in the 1980s.     

Factors affecting perceptions of medical errors

The purpose of the study was to assess how three factors affect subjects' perceptions of a medical error made in a hypothetical scenario. The factors were (i) type of compensation system, (ii) degree of procedural “voice” present in the physician-patient relationship, and (iii) magnitude of damage sustained by the patient. Perceptions were defined to include subjects' (i) emotional reactions to the incident, (ii) causal attributions about the incident, (iii) evaluations of the faimess of the compensation systems, and (iv) compensation demands. Results indicated that damage magnitude was the only factor that affected subjects' emotional reactions to the described incident and their compensation requests. When damage was severe, subjects reacted more negatively to the event and demanded greater compensation. Subjects rated the no-fault system and greater voice conditions as more fair. In general, subjects causally analyzed the error incident in a manner that was less blameworthy of the physician when procedural justice was high, especially if this was combined with a no-fault compensation system. Results were discussed in terms of Wexler and Winick's (1991) model of therapeutic jurisprudence.     

Corruption as a Self‐Fulfilling Prophecy: Evidence from a Survey Experiment in Costa Rica

An influential literature argues that corruption behaves as a self‐fulfilling prophecy. Its central claim is that the individual returns to corruption are a function of the perceived corruptibility of the other members of society. Empirically, this implies that if one were to exogenously increase beliefs about societal levels of corruption, willingness to engage in corruption should also increase. We evaluate this implication by utilizing an information experiment embedded in a large‐scale household survey recently conducted in the Gran Área Metropolitana of Costa Rica. Changes in beliefs about corruption were induced via the random assignment of an informational display depicting the increasing percentage of Costa Ricans who have personally witnessed an act of corruption. Consistent with the self‐fulfilling prophecy hypothesis, we find that internalizing the information from the display on average increased the probability that a respondent would be willing to bribe a police officer by approximately .05 to .10.     

The political management of managed care: explaining variations in state health maintenance organization regulations

In the 1990s, strong incentives for managed care organizations to control costs, once regarded as a fortuitous confluence of interests, came to be seen as antithetical to consumers' interests in quality of care. In response to this change in political climate, many states have greatly increased their regulatory control of managed care organizations since the mid-1990s. This activity is surprising in an era when public policy on health care issues is usually described as frozen, gridlocked, and/or stalemated as a result of intense activity on the part of organized interests. We take advantage of the variation in state regulations of health maintenance organizations (HMOs) to discover why some governments are able to address policy problems that are often perceived as intractable in a political if not in a true policy sense. From the history of HMOs, the backlash against managed care, and state responses to that backlash, we first extract a number of hypotheses about state regulatory activity. We then test these hypotheses with data on regulatory adoptions by states during the late 1990s and the early 2000s. Last, we discuss the findings with special attention to the role of politics in health care.     

The Evidentiary Significance of Automotive Paint from the Northeast: A Study of Red Paint

This population study was conducted to assess the frequency of physical, microscopical, and chemical properties of automotive paint chips. Population studies of trace evidence provide valuable analytical data for criminalists to assess evidentiary significance. Two‐hundred automotive paint chips were collected from auto body shops from the Northeastern United States. All samples were analyzed using stereomicroscopy, brightfield, and polarized light microscopy. Red paints were targeted for further analysis using a sequence of modern instrumental techniques commonly used by forensic paint examiners: Fourier‐transform infrared (FT‐IR), Raman, and ultraviolet–visible (UV–Vis) microspectroscopy. The discrimination potential of each analytical method was evaluated by inter‐comparing the paint samples. Results demonstrated that macroscopic and microscopic properties were able to differentiate 99.995% of the population (one undifferentiated pair out of 19,900). When combined with either FT‐IR or UV–Vis microspectroscopy, all paints were differentiated. The results of this research lead to the conclusion that one would not expect to encounter two indistinguishable paint chips originating from different sources during the investigation of a single event.