Factors Affecting the LGBT Population When Choosing a Surrogate Decision Maker

ABSTRACT

For individuals in the marginalized population of lesbian, gay, bisexual, and trans- gender persons (LGBT), choosing a health care surrogate to make medical decisions is an emotionally challenging task. These decisions become more difficult when compounded by issues of discrimination, lack of legal and social support, varying levels of relationship commitment, and complications of disclosure to family and medical professionals. Limited research exists regarding the social, legal, medical, and familial environments that impact the choice of a surrogate decision maker for an LGBT individual. This systematic review examines 14 articles to identify factors influencing individual surrogate choice and existing gaps in the literature. To remedy current research limitations, future research recommendations address the areas of design, sampling, data collection, and data analysis within diverse subgroups of the LGBT population. This review further identifies related areas of service required by members of the LGBT population relative to diversity, demographics, and social, legal, medical, and familial environments influencing their choice of a surrogate decision maker.     

Key decisions in child protection services in cases of domestic violence: maintaining services and out‐of‐home placement

This paper looks at the response of the child protection services (CPS) system in cases where exposure to domestic violence occurs alone or together with abuse or neglect, focusing on the factors involved in decisions to maintain the case open for ongoing services or remove children from the home. The study is based on an analysis of clinical and administrative data from the files on children reported to a CPS agency in Montreal, Canada. A total of 1 071 substantiated reports were documented, including 337 cases of co‐occurrence (32%). Analysis of the data shows that domestic violence does not by itself constitute a factor liable to lead to more intrusive intervention. The CPS response appears to be influenced more by the existence of other forms of maltreatment and risk factors. Additionally, while domestic violence may be associated with more severe individual and family problems, it does not influence the decision to keep the case open because the child still need services. The lack of any connection between domestic violence and this decision is a cause for concern, as results indicate that such families need help. Knowing how to respond to their needs therefore remains a major challenge.     

Proactive Screening for Health Needs in United Way's 2-1-1 Information and Referral Service

ABSTRACT

Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n = 297), measuring their need for 6 cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1.     

Managing the science in the presence of financial conflict of interest

ABSTRACT

We consider the question of why (primarily) and how (secondarily) to perform scientific oversight of research performed by investigators with a financial conflict of interest (COI). One way to frame the trade-off of having investigators with financial COI participate in research is through a decision rule: “Our institution is willing for financially conflicted investigators to participate in research around their intellectual property if (a) the science is likely to be significantly better with their participation (or if other significant benefits accrue); and (b) the COI can be adequately managed”.

A key component of COI management is the demonstration that the underlying science is sufficiently rigorous and transparent, and in turn, a scientific oversight plan is a key element of that demonstration. Scientific oversight plans should be proactively generated, by individuals (i.e., scientific reviewers) who are independent and expert, and they should assess the rigor and transparency of the research, in a fashion which is fair and efficient.

Abbreviations: COI: conflict of interest; SOP: scientific oversight plan     

Paternal and Household Characteristics Associated With Child Neglect and Child Protective Services Involvement

ABSTRACT

This study examined the association of paternal and household characteristics with household-level measures of child neglect and Child Protective Services (CPS) involvement, measured when the index child was 5 years of age. Secondary analyses of the Fragile Families and Child Well-Being Study were conducted using a subsample of 1,089 residential, biological fathers. Logistic regression models indicated that paternal depression was associated with greater than doubled odds of child neglect and CPS involvement. Paternal alcohol use and parenting stress were associated with approximately 50% increased odds for child neglect, and a scale measuring 13 caregiving tasks to reflect positive father involvement with the child was also associated with less risk for child neglect. However, paternal alcohol use, parenting stress, and positive involvement with the child were not associated with CPS involvement. An implication of this study is that paternal psychosocial functioning is important to consider in conjunction with sociodemographic factors when examining maltreatment risk in two-parent families.     

Judging parental competence: A cross‐country analysis of judicial decision makers' written assessment of mothers' parenting capacities in newborn removal cases

This paper examines the discretionary reasoning of the judiciary in three jurisdictions, England, Germany and Norway, in cases deciding whether a newborn child is safe with her parents or intervention is necessary. Our analysis focuses on one specific dimension of decision makers' exercise of discretion, namely, if and how the strengths and weaknesses of the mother are considered. The data material consists of all decisions concerning care orders of newborns from one large city in Germany from 2015 to 2017 (n = 27) and 2016 in Norway (n = 76) and all publicly available newborn removal decisions in England for 2015–2017 (n = 14). The findings reveal a high number of risk factors in the cases and less focus on risk‐reducing factors. The situation of the newborn is considered to be harmful, as most cases result in a care order. Judicial discretion differs by how much information, and what types of factors, are included in the justification for the decision. A learning point for decision makers and policymakers would be to actively undertake a balancing act between risk‐increasing and risk‐reducing factors.     

Assessing Transfer-of-Learning Potential With Human Services Professionals

ABSTRACT

Transfer of learning (TOL) from training to the job was examined in two different populations of human services workers using the Transfer Potential Questionnaire (TPQ). A cross-validation study was conducted to explore commonalities and differences between public welfare (PW) professionals in California (n = 459) and Child Protective Services (CPS) social workers in Ohio (n = 598). The TPQ significantly correlated with perceived TOL for both training populations and added to the amount of TOL variance explained after controlling for participant satisfaction and perceived learning. Important TOL factors identified for both groups included perceived learning and application planning. Findings suggest TPQ is a valid predictor of TOL for both PW professionals and CPS social workers, supporting a shared construct relative to TOL across human services practice areas. Future research should explore additional TOL assessment methods and seek to further validate the TPQ with other populations of human services professionals.     

Today's Studies,Tomorrow's Meta-Analyses: Implications for Evidence Informed Decision–Making in Social Work

ABSTRACT

Meta-analyses play an important role in understanding aspects of human functioning and program effectiveness. Meta-analyses also inform practice and policy decision making in areas of interest to social work. This study examined the degree to which recent quantitative reports in top social work journals are eligible for inclusion in future meta-analytic studies based on method rigor. The results suggest a mixed picture. Articles in top social work journals typically present sufficient information on participant characteristics, p values, and Mean values, yet they often fail to present sufficient information on variance indicators or the precise numbers of participants, which limits the ability to calculate effect sizes. Furthermore, less than 10% of the reports utilized randomized experimental designs or tested for group equivalence. To enhance social work's ability to make evidence-based decisions by producing more meta-analyses, researchers should provide more detail in study reports and use stronger research designs.     

Resolving Beecher's Paradox: Getting beyond IRB reform

Protection of persons participating as research subjects is an essential element of ethical research conduct. There is growing concern that the existing system of institutional review boards (IRBs) and informed consent may not be adequate and is in need of reform. When science and medicine are “merged”; in clinical research, confusion of roles and conflicts of interests arise in relationships between patient‐subjects and physician‐investigators. IRBs have always had a primary role in protection of research participants. Their efforts to protect research subjects may make it more difficult for investigators to conduct research. This tension has lead to the development of an adversarial relationship between IRBs and investigators. Investigators and IRBs are also subject to external pressures that could impact efforts to protect research subjects. Efforts are underway to address these concerns. IRB reform, while needed, is not likely to be sufficient. Adoption of a new paradigm in which IRBs, investigators and research sponsors collectively accept protection of research subjects as their primary and shared responsibility may provide a more effective and efficient model that will be better able to deal with difficult ethical and social issues in clinical research.     

Informational Asymmetries and Observational Learning in Search

As economics modeling moves from super rational decision makers to considering boundedly rational agents, some economic problems deserve a second look. This paper studies the effects of learning on the efficiency of search. Once learning is taken into account, the structure of information flow becomes important. In particular, I highlight the truncated information structure in the search problem. Agents stop searching once a sufficiently attractive price is found. Therefore, they observe the performance of shorter searches, but do not directly observe the performance of longer searches. I design and conduct an experiment to test the hypothesis that this asymmetric flow of information leads agents to search too little. I find strong evidence in its favor. This suggests that in the presence of learning, the provision of a more symmetric information structure will make search more efficient.JEL Classification: C91, D83     

Positive confirmation bias in the acquisition of information

An experiment is reported which tests for positive confirmation bias in a setting in which individuals choose what information to buy, prior to making a decision. The design – an adaptation of Wason's selection task – reveals the use that subjects make of information after buying it. Strong evidence of positive confirmation bias, in both information acquisition and information use, is found; and this bias is found to be robust to experience. It is suggested that the bias results from a pattern of reasoning which, although producing sub-optimal decisions, is internally coherent and which is self-reinforcing.     

Collective Decision-Making: the Analytic Hierarchy Process

Analytic Hierarchy Process (AHP) is a method to improve decision making whose application here is to complex environments. “A.H.P.” involves structuring a decision into a hierarchy, determining relative priorities for the elements in the hierarchy, and combining the numbers into overall weights estimating each decision outcome. The need for decision aids such as AHP, is supported by the literature, which suggests that even experts can contend with only limited amounts of information and tend to arrive at decisions in a simple fashion. AHP allows for using more information to make decisions in more complex ways. This leads to more coherent decisions. In the case presented AHP helped a committee make resource allocation decisions in an urban renewal project in Israel. The example highlights the usefulness of AHP in group settings. Areas of disagreement were easily identified and discussed. This diffused much of the tension typical of these proceedings.     

Individual and couple decision behavior under risk: evidence on the dynamics of power balance

This article reports results of an experiment designed to analyze the link between risky decisions made by couples and risky decisions made separately by each spouse. We estimate both the spouses and the couples’ degrees of risk aversion, we assess how the risk preferences of the two spouses aggregate when they make risky decisions, and we shed light on the dynamics of the decision process that takes place when couples make risky decisions. We find that, far from being fixed, the balance of power within the household is malleable. In most couples, men have, initially, more decision-making power than women but women who ultimately implement the joint decisions gain more and more power over the course of decision making.     

Myopic risk-seeking: The impact of narrow decision bracketing on lottery play

In two experiments conducted with low-income participants, we find that individuals are more likely to buy state lottery tickets when they make several purchase decisions one-at-a-time, i.e. myopically, than when they make one decision about how many tickets to purchase. These results extend earlier findings showing that “broad bracketing” of decisions encourages behavior consistent with expected value maximization. Additionally, the results suggest that the combination of myopic decision making and the “peanuts effect”—greater risk seeking for low stakes than high stakes gambles—can help explain the popularity of state lotteries.

Individual and group decision making under risk: An experimental study of Bayesian updating and violations of first-order stochastic dominance

This paper reports the results of experiments designed to test whether individuals and groups abide by monotonicity with respect to first-order stochastic dominance and Bayesian updating when making decisions under risk. The results indicate a significant number of violations of both principles. The violation rate when groups make decisions is substantially lower, and decreasing with group size, suggesting that social interaction improves the decision-making process. Greater transparency of the decision task reduces the violation rate, suggesting that these violations are due to judgment errors rather than the preference structure. In one treatment, however, less complex decisions result in a higher error rates.

Implementing child mistreatment risk assessment systems: lessons from theory

Over the past ten years, public child protective services (CPS) agencies have adopted risk assessment systems in an effort to improve the quality of service delivery to children and their families. Various reviews of the impact of these models suggest that they have not lived up to their expectations and have had little or no impact on broad system indicators of service delivery. Foremost among the findings of existing studies is that these models have not been implemented and used as intended. The risk assessment field has not taken advantage of theoretical principles suggested by the organizational change literature. The researcher applies Lewin's Force Field Analysis to identify the forces for and against effective implementation of risk assessment systems in public agencies. The author suggests that lessons from theory could improve the effectiveness of the implementation of change in CPS agencies.     

Decision settings analysis – a tool for analysis and design of human activity systems

The paper describes a methodology to be used for analysis and design of human activity systems. The methodology is based on an analysis of the decision settings whereas most other decision analysis methodologies are analysing the process. The decision concept is analysed and discussed. A distinction between programmed and programmable as well as non-programmed and non-programmable decisions is proposed. A classification of different information types for decision making is presented. A methodology based on a systemic and systematic analysis of the information requirements of an organization is proposed. This methodology also indicates organizational discrepancies and information imbalances. The methodology focuses the settings of the decisions on all levels of organizations. The methodology can be regarded as a dynamic, learning system. The author proposes further research on the individuals decision making abilities.     

Parametric multi-attribute utility functions for optimal profit under risk constraints

We provide an economic interpretation of the practice consisting in incorporating risk measures as constraints in an expected prospect maximization problem. For what we call the infimum of expectations class of risk measures, we show that if the decision maker (DM) maximizes the expectation of a random prospect under constraint that the risk measure is bounded above, he then behaves as a “generalized expected utility maximizer” in the following sense. The DM exhibits ambiguity with respect to a family of utility functions defined on a larger set of decisions than the original one; he adopts pessimism and performs first a minimization of expected utility over this family, then performs a maximization over a new decisions set. This economic behaviour is called “maxmin under risk” and studied by Maccheroni (Econ Theory 19:823–831, 2002). As an application, we make the link between an expected prospect maximization problem, subject to conditional value-at-risk being less than a threshold value, and a non-expected utility economic formulation involving “loss aversion”-type utility functions.     

Advance Elder Care Decision Making

Abstract

Advances in modern technology have resulted in increasing health care options. Unfortunately, many adults do not think about health and end-of-life decisions until they are faced with a health crisis or long-term care issues. The lack of planning has left many families devastated and overwhelmed by the decisions they face on behalf of their loved ones. Social workers and other professionals are observing family members who are ill-prepared for the decisions they have to make and the roles that they undertake as a result of the failing health of an older relative. The Advance Elder Care Family Planning model (AECFP) is designed to empower families before they face these problems.